Archive for 'Coding Challenge'
Posted on 06. Oct, 2009 by .
Answer: Auto- vs. allo- doesn’t change harvest coding. You should report 38230 (Bone marrow harvesting for transplantation) for bone marrow harvesting whether the transplant will be autologous or allogenic.
The autologous vs. allogenic distinction, however, will be important when you code the transplant. You should choose 38241 (Bone marrow or blood-derived peripheral stem cell transplantation; autologous) for an autologous transplant, in which the physician takes stem cells from the patient before chemotherapy or radiation treatment. Following treatment, the patient receives those cells back. You may see this called a “rescue” transplant or “AuSCT.”
If the donor and patient are two separate individuals, you instead should report 38240 (… allogenic) for the transplant.
Hint: “Auto” means “self” and “allo” means “other.” This will help you remember which code describing the harvested tissue’s origin is appropriate.
Posted on 04. Oct, 2009 by .
Question: We are a fertility practice, and we’re seeing a patient who may have had Clomid treatments or other medication cycles with her ob-gyn prior to coming to us. Our physicians want to evaluate her status by performing a saline sonogram and some other gauging lab work. What diagnosis should I use as the primary if the patient is not in a medical cycle or being monitored for medical cycle? Should I report 628.x? The patient already had treatment from her prior ob-gyn for a fertility issue. Should I instead use V26.21 as the primary (or secondary diagnosis to 628.x)?
Answer: If your physician is evaluating the patient to find the cause of her infertility, you are in the testing or counseling phase, and you should use V26.21 (Fertility testing) or V26.49 (Other procreative management counseling and advice).
You should report 628.x (Infertility, female) only when the ob-gyn has confirmed the patient is infertile and knows the cause. If your ob-gyn knows the patient is infertile and does not know the cause, you could use 628.9 (… of unspecified origin).
Before settling on the above options, consider doing some more hunting. Check for the diagnosis used by the previous ob-gyn who did the treatment. Was a definitive diagnosis given at the time of treatment? If the other physician diagnosed polycystic ovarian syndrome (PCOS), for instance, you would use that code (256.4, Polycystic ovaries) until your ob-gyn establishes some other cause.
Posted on 01. Oct, 2009 by .
Question: Our surgeon biopsied a lesion from the skull, but did not perform a craniectomy or create a burr hole for the procedure; he made an incision over the lesion and obtained the biopsy. How should I code this?
Answer: Your best option is 61500 (Craniectomy; with excision of tumor or other bone lesion of skull) though some coders might lean toward 61563 (Excision, intra and extracranial, benign tumor of cranial bone [e.g., fibrous dysplasia]; without optic nerve decompression). 61563 isn’t your best choice because there is no description of an intracranial component.
Posted on 29. Sep, 2009 by .
Question: Our podiatrist treats many nursing home patients. One has foot pain and all her nails are mycotic, but her nails are not painful. How can we report our physician’s services for this patient when she doesn’t have nail pain or any systemic disease to give class findings?
Answer: Check your local carrier’s guidelines because some (such as WPS Medicare) state that “In the absence of a systemic condition, treatment of mycotic nails may be covered.” The patient might experience pain but it isn’t always a requirement for coverage, especially if the patient has secondary infection or other complications. If you do report the treatment, submit 11721 (Debridement of nail[s] by any method[s]; 6 or more).
One idea: Some physicians might treat the patient once without billing the care if the patient has no qualifications. Then they let the nursing home staff know they will only treat the patient in the future if the nursing home covers the service (unless the patient’s condition changes and insurance will reimburse the physician). Coders who go this route say the nursing home often agrees to pay for the service.
Posted on 26. Sep, 2009 by .
Answer: You don’t see a code, because no specific code exists for a biopsy of the tonsils.
You should instead report the code based on whether the otolaryngologist used a scope. If he didn’t, you should assign 42800 (Biopsy; oropharynx).
If the physician used an endoscope, you should report 31535 (Laryngoscopy, direct, operative, with biopsy) or 31536 (… with operating microscope).
Note: CPT classifies “indirect” laryngoscopy as an endoscopy, even though the procedure requires a mirror, not an endoscope.
Posted on 24. Sep, 2009 by .
Question: A 30-year-old female presents to a rural ED with several injuries after the all-terrain vehicle she was driving overturned. During a level-five ED E/M service, the physician diagnoses a fractured metacarpal shaft in her left hand and a fractured left femur. The ED physician provides closed manipulative treatment for each fracture. How should I code this scenario?
Answer: Report the most severe fracture first, and make sure that you append a surgical modifier to the treatment codes. To make things easier, we’ll list the appropriate CPT codes first, then the ICD-9 codes.
CPT coding: On the claim, report the following:
• 27502 (Closed treatment of femoral shaft fracture, with manipulation, with or without skin or skeletal traction) for the femur treatment
• 26605 (Closed treatment of metacarpal fracture, single; without manipulation, each bone) for the metacarpal treatment
• modifier 54 (Surgical care only) appended to 27502 and 26600 to show that you are coding only for the fracture treatment (If the ED physician is, for some reason, providing all the follow-up care for the patient, then you can leave modifier 54 off the claim). (more…)
Posted on 22. Sep, 2009 by .
Answer: CPT does not include a code for hallux arthroplasty with implant, so it’s time to turn to unlisted codes.
Your best option is to report 28899 (Unlisted procedure, foot or toes). When you determine a comparison code for the most accurate reimbursement, compare the unlisted code 28899 to 28289 (Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint) or 28293 (Correction, hallux valgus [bunion], with or without sesamoidectomy; resection of joint with implant) when submitting your claim.
Good news! Podiatry Coding Alert is back. Download your 2 FREE sample issues here.
Posted on 20. Sep, 2009 by .
Answer: Report the lab test as 87475 (Infectious agent detection by nucleic acid [DNA or RNA]; Borrelia burgdorferi, direct probe technique), because Borrelia burgdorferi is the causative organism that you’d test for in a case of suspected Lyme disease.
The diagnosis coding is a little less straightforward. You should not list the diagnosis for Lyme disease (088.81, Lyme disease). The physician ordered the test for a suspected condition, so you should not code the disease as though it is confirmed.
Instead, list the diagnosis based on signs and symptoms that the ordering physician identifies. For instance, you could use a V code to show exposure: V01.89 (Contact with or exposure to other communicable diseases). You could also add E906.4 (Other injury caused by animals; bite of nonvenomous arthropod) to further define the condition that led to the need for the test.
Bottom line: Avoid the ‘rule-out Lyme Disease’ diagnosis coding trap. If the ordering physician provides an ICD-9 code, you should list that as the ordering diagnosis. If the physician provides only a narrative, such as “tick bite, rule-out Lyme disease,” you’ll need to assign the most specific diagnosis known at the time of testing.
Posted on 17. Sep, 2009 by .
Question: A new patient reports to the gastroenterologist with complaints of frequent belching and heartburn. After performing a level-two E/M service, the gastroenterologist performs a diagnostic EGD.
During the EGD, she also inserts a Bravo capsule and performs a reflux test. Tests came back negative for both cancer and gastroesophageal reflux disease (GERD). How should I code this scenario?
Answer: You should be able to report the EGD and the Bravo insertion separately along with an E/M service. On the claim, report the following:
• 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic,with or without collection of specimen[s] by brushing or washing [separate procedure]) for the EGD (more…)
Posted on 15. Sep, 2009 by .
Question: The cardiologist documented testing pacemaker leads using fluoroscopy (71090) in the hospital. Which code is appropriate for the testing?
Answer: You mention 71090 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation), which is specific to radiological supervision and interpretation at the time of device insertion. So presumably the cardiologist was testing the leads at the time the patient first received the pacemaker.
You can’t report lead evaluation separately at the time of pacemaker insertion (such as 33206-33208).
Verify device: Doctors sometimes document “pacer” when referring to a pacing automatic internal cardioverter defibrillator (AICD), so confirm which device the cardiologist is referring to. You may report one of the following two codes for evaluating leads at the time of an AICD insertion:
• 93640-26 — Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; Professional component.
• 93641-26 — … with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator.
Code 93640 is appropriate when your cardiologist performs the EP AICD lead evaluation before he connects them to the pulse generator. This is rare.
In contrast, 93641 is much more common and represents the cardiologist testing the entire system once he connects the pulse generator. It requires induction of ventricular tachycardia/fibrillation to assess the system’s defibrillation capabilities. So you would not report 93641 for just testing the lead for pacing thresholds and sensitivity.