Archive for 'Coding Challenge'
Radiology Coding Challenge: Rate Your Reformatting Skills
Posted on 17. Jul, 2009 by .
Question: My radiology report documents axial CT slices from the orbits to the thoracic inlet and of the larynx. And there are sagittal and coronal computer reconstruction images. Which CPT codes should I report?
Answer: You’ll need only one CPT code for this report: 70491 (Computed tomography, soft tissue neck; with contrast material[s]).
You should not report reconstruction codes 76376- 76377 (3D rendering with interpretation and reporting of computed tomography …) because converting axial scans into the coronal and sagittal planes is 2D reformatting, which you should not report separately.
Codes 76376 and 76377, as the descriptors indicate, are specific to 3D reformatting.
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Oncology Coding Challenge: When Infusion Runs Long
Posted on 14. Jul, 2009 by .
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Question: The oncologist ordered a 90-minute chemotherapy infusion service, but the infusion lasted a few minutes longer than that. Is it OK to report the entire infusion time?
Answer: You may report the codes for the entire infusion time, but be sure the medical record notes why the infusion took longer than the prescribed time. You want to be able to prove medical necessity to an auditor because it is not appropriate to extend an infusion time just to increase reimbursement.
For example: If the patient has a chemotherapy infusion for one hour and 33 minutes, you would report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the first hour and +96415 (… each additional hour [List separately in addition to code for primary procedure]) for the additional 33 minutes beyond the first hour.
As your question suggests, if the patient receives a 90-minute infusion, you would report only an initial hour code (96413). A parenthetical note following +96415 indicates it is “for infusion intervals of greater than 30 minutes beyond 1-hour increments.” 90 minutes is only 30 minutes beyond one hour. It is not “greater than 30 minutes” beyond the hour.
Bottom line: While some infusions will last longer than the prescribed 90 minutes, slowing the infusion rate to ensure billing for an additional code would not be appropriate.
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Bundle of His Recording Coding Challenge
Posted on 13. Jul, 2009 by .
Question: How should I report right atrial pacing and recording when performed with bundle of His recording? May I report 93619 or should I append modifier 52?
Answer: When the cardiologist performs right atrial pacing and recording as well as bundle of His recording, but does not perform the other services described in 93619 (Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia), you should not report 93619.
You also should not report 93619-52 (Reduced services) because you have a more appropriate coding option:
• 93600 — Bundle of His recording
• 93602 — Intra-atrial recording
• 93610 — Intra-atrial pacing.
You should report these three individual codes because the cardiologist did not perform and document the other services listed in 93619’s descriptor.
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64450 or 64421: Which Code to Tap for TAP Block?
Posted on 10. Jul, 2009 by .
Question: What exactly is a “tap block,” and what code do I use?
Answer: A transverse abdominus plane (TAP) block is typically used for post-operative pain management following major abdominal surgery. Your provider may also use it as an adjunct to his anesthesia for abdominal laparoscopic procedures. If performed for postoperative pain management, report 64450 (Injection, anesthetic agent; other peripheral nerve or branch). Another option is 64421 (Injection, anesthetic agent; intercostal nerves,multiple, regional block).
Watch out: If the block is used as part of the anesthesia — not for post-operative pain management — do not report it separately from the anesthesia services code.A TAP block is particularly useful for patients where an epidural is contraindicated or refused. The TAP can be performed unilaterally (for example, for an appendectomy), or bilaterally when the incision crosses the midline (such as a Pfannenstiel incision). A single injection can be utilized, or a catheter may be inserted for several days of analgesic benefit.
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What’s the ICD-9 Code for TFCC?
Posted on 08. Jul, 2009 by .
Question: What Dx code should we use for TFCC (triangular fibrocartilage complex) of the wrist?
Answer: Is the injury acute? If not, you should report 718.03 (Articular cartilage disorder; forearm) rather than an acute code. If so, report 842.01 (Sprains and strains ofwrist and hand; wrist; carpal [joint]).
Note: TFCC occurs on the ulnar side of the wrist and is made of cartilage and ligaments. Sports injuries may also cause TFCC tears, typically by the patient landing on his outstretched arm or repetitive heavy lifting with the ulnar side of the wrist.
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CPT 45380 Challenge: Endoscopy with Biopsy
Posted on 01. Jul, 2009 by .
Question: My gastroenterologist performs mapping biopsies on patients who have inflammatory bowel disease. In this procedure, the doctor performs an endoscopy and takes a biopsy every 20 centimeters or so. How should I code this?
Answer: No matter how many biopsies your physician takes, code 45380 (Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple) once.
If the procedure is unusually extensive or time consuming, you could append modifier 22 (Increased procedural services). You would have to provide the payer with a well-documented and convincing argument — comparison of time with a normal biopsy procedure, number of biopsies and sites, substantial complications — as to why it should give your office additional reimbursement. Even then, you shouldn’t hold your breath in anticipation of extra money.
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Which Code Is Right for Fissure Cauterization?
Posted on 23. Jun, 2009 by .
Question: Our doctors cauterize fissures to stimulate granulation tissue for better healing. Would 46910 or 46940 be appropriate?
Answer: Call on 46940 (Curettage or cautery of anal fissure, including dilation of anal sphincter [separate procedure]; initial) to describe the procedure.
It sounds like your physician is actually creating a lesion — scar tissue — rather than destroying it.
An anal fissure (565.0) is an unnatural crack or tear in the anus skin. Code 46910 (Destruction of lesion[s], anus [e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle], simple; electrodesiccation) when your physician treats symptoms caused by viral infections: warts, herpes lesions, and so on.
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Correct Coding for H1N1 (Swine Flu) Screening in the ED
Posted on 18. Jun, 2009 by .
Question: A patient reports to the ED worried about a fever and chills; to rule out the H1N1 flu, the physician orders an immunoassay influenza screening. The patient does not have any type of flu. Should I report modifier 26 with 87804?
Answer: You should not report 87804 or modifier 26 (Professional component) on this claim. When the ED physician orders a lab test to check for flu, you should consider the work part of the overall E/M.
So if the notes indicate a level-two E/M, report 99282 (Emergency department visit for the evaluation and management of a patient …) for the service.
Remember to append 780.60 (Fever, unspecified) to the E/M to indicate the patient’s presenting symptoms, and V73.89 (Other specified viral diseases) to identify the type of screening.
Explanation: When the ED physician orders a lab test, the hospital charges for it. So the facility would report 87804 (Infectious agent antigen detection by immunoassay with direct optical observation; influenza) for this encounter. (more…)
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Coding Challenge: Foot Foreign Body Removal Vs. Soft-Tissue FBR
Posted on 16. Jun, 2009 by .
Question: Our physician performed a foreign-body removal (FBR) on a patient with a splinter in the subcutaneous tissues of his left foot. We reported 10120 and received a denial. Should I appeal, or did I code improperly?
Answer: : In this case, there is a more specific code for a foot FBR. Code 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) is in the “Integumentary” part of CPT’s “Surgery” section. It is for simple, subcutaneous incision and removal of foreign bodies when no more specific code exists.
For reporting subcutaneous FBRs from the foot, a more specific code does exist.
When your physician removes a foreign body from a patient’s foot, choose from:
• 28190 — Removal of foreign body, foot; subcutaneous
• 28192 — … deep
• 28193 — … complicated.
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Coder’s Anatomy Double-Take: What is NERD?
Posted on 11. Jun, 2009 by .
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Question: In the doctor’s notes, it states the patient has NERD. What does this mean? The patient was in for an EGD.
Answer: NERD stands for nonerosive reflux disease. Essentially, it’s gastroesophageal reflux disease (GERD), or heartburn, without damage to the mucous membrane.
The correct code is 530.81 (Other specified disorders of esophagus; esophageal reflux).
Don’t confuse it with another code commonly used for GERD, 530.11 (Esophagitis; reflux esophagitis), which indicates damage to the esophagus.
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