Diagnosis Coding: G Codes Are Your Key To Coding Correct High Risk Colonoscopy

Posted on 07. Mar, 2011 by dchandhok.

Get your hemorrhoid report right and stress-free in a snap. We’ll tell you the difference between internal and external hemorrhoids, but you can learn more from this sample physician’s report:

PREPROCEDURE DIAGNOSIS: History of colon polyps and partial colon resection, right colon.

POSTPROCEDURE DIAGNOSES:

1. Normal operative site.
2. Mild diverticulosis of the sigmoid colon.
3. Internal hemorrhoids.

PROCEDURE: Total colonoscopy.

PROCEDURE IN DETAIL: The 60-year-old patient presents to the office to be evaluated for the preprocedure diagnosis. The patient also apparently had an x-ray done at the hospital and it showed a dark spot, and because of this, a colonoscopy was felt to be needed. She was prepped the night before and on the morning of the test with oral Fleet’s, brought to the second floor and sedated with a total of 50 mg of Demerol and 3.75 mg of Versed IV push. Digital rectal exam was done, unremarkable. At that point, the Pentax video colonoscope was inserted. The rectal vault appeared normal. The sigmoid showed diverticula throughout, mild to moderate in nature. The scope was then passed through the descending and transverse colon over to the hepatic flexure area and then the anastomosis site was visualized. The scope was passed a short distance up the ileum, which appeared normal. The scope was then withdrawn through the transverse, descending, sigmoid, and rectal vault area. The scope was then retroflexed, and anal verge visualized showed some internal hemorrhoids.

RECOMMENDATIONS: Repeat colonoscopy in three years.

Let Location Guide You

You can easily identify external hemorrhoids (455.3-455.5) because of its place of appearance. This type of hemorrhoid

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Know the Types of Graft

Posted on 02. Mar, 2011 by dchandhok.

Question: What’s the difference between a spinal allograft and an autograft?

Answer: If the surgeon harvests bone from the patient’s own body, you’ll code for an autograft with one of the following codes:

+20936 — Autograft for spine surgery only (includes harvesting the graft); local (e.g., ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure)

+20937 — … morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure)

+20938 — … structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure).

Example: The surgeon removes a portion of bone from the patient’s rib through

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Ensure Compliance With ICD-10 With These 3 Tips

Posted on 01. Mar, 2011 by dchandhok.

When ICD-9 becomes ICD-10 in 2013, you will not always have a simple crosswalk relationship between old codes and the new ones. Often, you’ll have more options that may require tweaking the way you document services and a coder reports it. Check out the following examples of how ICD-10 will change your coding options when the calendar turns to Oct. 1, 2013.

Celebrate Sinusitis Codes’ One-to-One Relationship for ICD-10

When your physician treats a patient for sinusitis, you should report the appropriate sinusitis code for sinus membrane lining inflammation. Use 461.x for acute sinusitis. For chronic sinusitis — frequent or persistent infections lasting more than three months — assign 473.x.

For both acute and chronic conditions, you’ll choose

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4 Tips Help You Ensure Inhaler Service Success

Posted on 01. Mar, 2011 by dchandhok.

Often a nurse or medical assistant helps a patient with an inhaler demo or evaluation, but whenever coding it, you must keep these three areas in mind: the type of device used, documentation requirements, and qualifying modifiers. Follow these four tips from our experts to understand why some payers might deny payment for the service — and what you can do to win deserved dollars.

1. Categorize the Diskus Correctly

Many physician offices use the Advair Diskus for their patients, which is an aerosol generator. “An aerosol generator is a device that produces airborne suspensions of small particles for inhalation therapy,” explains Peter Koukounas, owner of Hippocratic Solutions medical billing service in Fairfield, N.J. If the nurse or medical assistant taught someone to use an Advair Diskus — or any other diskus — you should report 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).

The physician starts a patient with asthma (493.00, Extrinsic asthma; unspecified or 493.20, Chronic obstructive asthma; unspecified) on Advair. A nurse then teaches the patient how to use the Diskus. According to CPT guidelines, you should report

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Code Correct Closure Level With These Tips

Posted on 28. Feb, 2011 by dchandhok.

All closures aren’t created equal; one of the nuances of coding these procedures is knowing how to distinguish one type from another. Read on for our experts’ advice on how to assess the three closure levels and assign the best codes.

A simple repair involves primarily the dermis and epidermis. It might involve subcutaneous tissues, but not deep layers.

How do you know when a closure might involve subcutaneous layers but is still considered a simple repair? Your provider’s documentation is the key. The difference is whether the wound is closed in layers or just a single layer, experts note. The provider might decide to include the subcutaneous layer in the closure but does so by

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ICD-10: Here’s How To Report Hiatal Hernia In 2013

Posted on 27. Feb, 2011 by dchandhok.

When ICD-9 becomes ICD-10 in 2013, you’ll need to get familiar with different sections in the new diagnosis code system, even if the condition you’re reporting has a simple one-to-one crosswalk.

When your surgeon performs a hiatal hernia repair, you might need to report a diaphragm hernia or a specific congenital hiatal hernia, depending on the physician’s documentation. Look to these code choices for ICD-9 and the one-toone crosswalk for ICD-10:

Whether ICD-9 or ICD-10, you’ll need to use the

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One Medicare Contractor OK’s RNs and LPNs to Furnish Annual Wellness Visit

Posted on 23. Feb, 2011 by dchandhok.

CMS staffers confirmed this week that MACs can determine whether they’ll allow licensed practical nurses (LPNs) and registered nurses (RNs) to perform annual wellness visits (AWVs) and collect from Medicare for those services. That’s the word from a Feb. 22 CMS Open Door Forum, where providers called in with several questions affecting Part B providers.

One caller phoned into the forum to ask about a Q&A posted on the Web site of WPS Medicare, a Part B payer in four states, which asks whether an RN or LPN can perform “the entire annual wellness visit (AWV, G0438-G0439).” WPS responds on the site, “Yes, an RN or LPN can perform the visit. They need to be under the direct supervision of a physician and the state license needs to allow for them to do all the ocmpoennts of the service.” (http://www.wpsmedicare.com/part_b/education/awv-faq.shtml). The caller asked whether this is a general CMS policy or if it only applies to WPS Medicare.

“Remember, the LPN’s not billing,” said CMS’s William Rogers, MD, reminding the caller that the visit would be

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Switch to 43327, 43328 for Esophagogastric Fundoplasty

Posted on 22. Feb, 2011 by dchandhok.

Open or laparoscopic, through chest or abdominal wall, with or without hiatal hernia repair, with or without mesh … these are the various ways your surgeon might perform an esophagogastric fundoplasty. And these are the factors you’ll need to take into account when you try to pick the proper code(s) from among nine new choices in CPT 2011.

Let our experts show the way with four how-to tips for paraesophageal hiatalhernia repair and fundoplication coding for 2011.

Tip 1: Understand Pathophysiology

“When a patient is described as having a hiatal hernia, it usually means that part of the stomach has herniated through the opening in the diaphragm [esophageal hiatus] into the chest and is usually associated with esophageal reflux disease,” according to Gary W. Barone, MD, a physician and associate professor at the University of Arkansas for Medical Sciences in Little Rock.

The hernia repair typically involves the surgeon reducing the stomach

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37228-+37235 Cover Your Tibial/Peroneal Service Codes

Posted on 21. Feb, 2011 by dchandhok.

Facing denials on your tibial/peroneal codes? No worries, help is at hand.

The new tibial/peroneal service codes are below. Note that all of the codes include angioplasty in the same vessel when that service is performed.

The first four codes apply to the initial tibial or peroneal vessel treated in a single leg:

• Angioplasty: 37228 — Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty
• Atherectomy (and angioplasty): 37229 — … with atherectomy, includes angioplasty within the same vessel, when performed

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Pain Management: Is Headache Coding Giving You Headaches?

Posted on 19. Feb, 2011 by dchandhok.

If your neurologist or pain specialist administers greater occipital nerve blocks, don’t let coding turn into a headache. Verify specifics about the patient’s headache and the service your provider offered to pinpoint the correct diagnosis and procedure codes every time. Our 4 questions will point you to the best diagnosis and injection codes.

Where Is the Occipital Nerve?

The greater occipital nerve (GON) originates from the posterior medial branch of the C2 spinal nerve and provides sensory innervations to the posterior area of the scalp extending to the top of the head. Physicians typically inject the GON at the level of the superior nuchal line just above the base of the skull for occipital headaches or neck pain.

Some physician practices include a small illustration in the chart that the physician can mark with various injection sites. Including this type of tool helps your physician clearly document the

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