Archive for 'Coding Challenge'
Posted on 23. Jan, 2013 by rpandit.
Question: What’s the diagnosis code for “atypical” chest pain?
Answer: The ICD-9 index points to 786.59 (Other chest pain) for atypical chest pain. This code applies for any sort of discomfort, pressure, or tightness in the chest if there’s no more specific code for the condition.
Posted on 08. Jan, 2013 by rpandit.
Question: How should I file a claim on a patient who has new coverage but has not received an insurance identification card yet?
Posted on 24. Dec, 2012 by rpandit.
Question: How do we report the following?
- Decompressive Laminectomies Total L3, partial L2-L4
- Bilateral Forminotomy L2-3 and Redo L3-4
- Only Dural Graft with PAM
Is it correct to report 63047 (Laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [e.g., spinal or lateral recess stenosis], single vertebral segment; lumbar)? How do we capture the bilateral foraminotomy?
Posted on 11. Dec, 2012 by rpandit.
Question: My doctor saw a new patient in the office (99205) and then decided to admit her to the ICU. When he saw the patient later that same day, he documented and billed 99291. How do we bill both procedures, so they are both paid?
New Jersey Subscriber
Answer: There are certain circumstances during which you can bill an E/M service and the critical care services together. The first and foremost thing is that your doctor should have completed two separate services, the standard E/M service prior to the critical care services provided.
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Posted on 29. Nov, 2012 by rpandit.
Question: I’ve been expecting to see more information about CMS’s place of service (POS) rule with an October 1 implementation date. Have there been any updates?
North Carolina Subscriber
Answer: CMS has delayed implementation for the POS rule you reference. The new effective/implementation date is April 1, 2013. CMS also added some revisions and clarifications to the rule regarding global diagnostic services, determining payment locality, and inpatient and outpatient services.
Posted on 12. Nov, 2012 by rpandit.
Question: When my pediatrician writes “Neck is supple,” should I count the phrase as part of the musculoskeletal exam or the lymph system when tallying the E/M level?
Answer: Supple means “able to bend.” So you can always give the physician credit for the phrase “Neck is supple,” as range of motion under the musculoskeletal section.
Some pediatricians may use the phrase to refer to the lymph system. The term “Neck is supple” has also come to mean the physician checked the patient’s node and found no swelling, meaning the patient doesn’t have enlarged lymph nodes. Not all physicians like using the term this way.
Regardless of which way your practice feels, be careful that you don’t double-count the phrase. You can use the note under either the musculoskeletal system or the lymph system, but you shouldn’t count it under both exams at the same time.
Exception: You can consider the term part of both systems if the note states, “The neck is supple without adenopathy.” That means the neck is bendable and the nodes aren’t swollen.
Communication is key: Discuss this as a practice. Ask the practitioners what they are looking for and what they specifically mean when they refer to the neck as supple.
Posted on 23. Oct, 2012 by rpandit.
Question: Our surgeon excised mass in the finger. The procedure is as follows:
“Excision of multiple soft tissues masses was done. These appeared to be benign tumors encapsulated from the right fifth finger and the dorsum of the DIP base of the distal phalanx and also extended palmar radially. These appeared to originate possibly from the radial edge of the extensor tendon insertion. The second lobule was on the ulnar side of the extensor insertion and it was hard to say if this came from underneath the extensor tendon or across the top of the original radial lobules. There was a separate palmar nodule on the radial side accessible from the mid axial incision with this being deep to the neurovascular bundle and that was resected as well.”
What is the most appropriate code we can use to report this procedure?
Answer: If all the masses excised are through different incisions, report 26160 (Excision of lesion of tendon sheath or joint capsule [e.g., cyst, mucous cyst, or ganglion], hand or finger). You report multiple units of 26160 for the number of incision with modifier 59 (Distinct procedural service….). If it is through one incision only, report 26160 once only.
However, in the most ideal case, you should review the surgical pathology report to determine the nature of the nodules. The final code selection will depend on what the nodules are and/or where these nodules originated from.
Posted on 10. Oct, 2012 by rpandit.
Question: Some of our Medicare patients want to drop by and have blood drawn so that when they come for their next visit we’ll have the test results. We code 36415 to track the lab work, but the payers deny our claims. Does Medicare view this as part of either the prior visit, or the next when the doctor discusses lab results?
Answer: No, Medicare should pay for the service if the patient hasn’t had a recent blood draw elsewhere for the same diagnosis. Continue to report 36415 (Collection of venous blood by venipuncture). Include a supporting diagnosis that relates to the lab test for which the blood is being drawn, such as hypertension (401-405, Hypertensive disease) or high cholesterol (such as 272.0, Disorders of lipoid metabolism; pure hypercholesterolemia). Include the patient’s usual physician as the referring doctor.
Posted on 26. Sep, 2012 by rpandit.
Question: Patient had hysteroscopy with lysis of adhesions and a dilation and curettage (D&C). Diagnoses are infertility and Asherman’s syndrome. Path report for curettage shows “Placental site nodule,” “is
lands of intermediate trophoblast,” and “HCG and inhibin are weakly positive.” I queried the MD if he considered this to be a hydatidiform mole or something else pertaining to products of conception.
The ob-gyn discussed with pathologist who believes it is a remnant of placental tissue after the last delivery, which was two years ago. Placenta had been manually removed. Would 667.14 and 677 be appropriate as diagnosis codes in this case, even if delivery was two years ago?
Posted on 14. Sep, 2012 by rpandit.
Question: I had a question regarding the ICD-9 code 651.3X and ultrasound (US) coding. For example, the patient has a multiple pregnancy, and one of the fetuses shows no cardiac activity on US. What would be the primary code, and would 632 fit in anywhere here? The reason I ask this is because while it is a loss, the fetus in not expelled and may remain in utero until delivery of the live fetus/es.
Answer: The ICD-9 coding staff weighed in on this one and said that fetal loss is fetal loss even if retained. So you should use 651.3 (Twin pregnancy with fetal loss and retention of one fetus [0,1,3]). But they did admit, however, that it was not a perfect solution, but that it would probably not be appropriate to code both 632 (Missed abortion) and 651.xx.
Also, keep in mind that in this case, per the American Congress of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM), a twin pregnancy is still a twin pregnancy even when one dies and is retained.
ICD-10: This coding issue will be addressed in ICD-10 where you will have a code for “Continuing pregnancy after intrauterine death of one fetus or more.” Specifically, these codes are:
- O31.20 – Continuing pregnancy after intrauterine death of one fetus or more, unspecified trimester
- O31.21 – … first trimester
- O31.22 – … second trimester
- O31.23 – … third trimester
You will also have codes for continuing pregnancy after one or more abortions, and a code when one or more is reduced. They are O31.1 (Continuing pregnancy after spontaneous abortion of one fetus or more) and O31.3 (Continuing pregnancy after elective fetal reduction of one fetus or more).