What’s the Code for ‘Fir Tree in Lung’?

Posted on 24. Apr, 2009 by in Provider News.


The mainstream press has been buzzing about the live fir tree that Russian doctors removed from a man’s lung. Some say the story just has to be an urban myth. But here at Coding News, we have other fish to fry (or firs to code). How would you code it? Here’s the ‘op note,’ if you will.

Twenty-eight-year-old Artyom Sidorkin presented complaining of chest pain and coughing up blood. An x-ray revealed what doctors thought was a malignant lung tumor, so they took him into surgery. Instead, physicians found a 3-inch live fir tree growing in his lung tissue. One Russian surgeon thinks the young man swallowed a seed, which then grew. Please click here for full story and photos from an English-language Russian news site.

So what would be the correct coding if this case occurred in the US? How about …

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Boost HIT Security with This HIPAA Checklist

Posted on 24. Apr, 2009 by in Toolkit.


The scenario: A patient in your financial planner’s office gets too good a look at the planner’s computer screen, which includes other patients’ information. How do you prevent future leaks like this?

The resolution: Use this checklist to help you catch HIPAA violations and track problem areas in your medical office. For each item listed, check whether you observed the activity, the number of occurrences, and any pertinent comments.

• Staff discusses confidential information in public areas.

• Conversations with patient or family regarding confidential information are held in public areas.

Did you know that the stimulus bill just gave HIPAA much sharper teeth? Find out your new HIPAA compliance obligations here.

• Overhead and intercom announcements include confidential information.

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The Latest on the New Epley Maneuver CPT Code

Posted on 24. Apr, 2009 by in Hot Coding Topics.


Medicare slaps ‘bundled’ status on 95992, denies reimbursement for new code.

In January, you finally got a code to describe the Epley maneuver, a simple but time-consuming treatment for a type of dizziness. But now you’re having even more trouble getting paid for the work.

The Epley maneuver treats a form of vertigo (386.11, Benign paroxysmal positional vertigo) that is caused by small calcium carbonate stones that have moved from the vestibule of the inner ear into the semicircular canals, where your sense of balance rests. The stones stimulate nerves and cause a spinning sensation, nausea, and unsteadiness.

Otolaryngology Specialty Coding Conference, plus a special audiology coding workshop: Orlando, July 9-11.

In the Epley, the patient’s head is maneuvered so the calcium crystals roll out of the sensing tube and into another inner chamber of the ear, from which the body can absorb them.

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A Press Release Is Not a Legal Ruling, PECOS Pundits Point Out

Posted on 23. Apr, 2009 by in Provider News.


Keep an eye on the Federal Register as you use Medicare’s Internet-based Provider Enrollment, Chain and Ownership System (PECOS), analysts who have reviewed the process tell Part B Insider.

Background: CMS issued a press release on April 1 from Valerie Haugen, a director with CMS, announcing that the person filling out the PECOS form need not be the physician or non-physician practitioner, but “may be an employee of the provider or supplier organization, or an employee of a separate organization.”

The update: During an April 7 CMS Open Door forum, CMS reiterated its position that the physician doesn’t need to personally fill out the PECOS form. However, CMS press releases and phone conferences don’t make the rule legal, says Robert Burleigh, CHBME, president of Brandywine Healthcare Consulting in West Chester, Pa.

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7 Steps to the Correct Anesthesia Code

Posted on 23. Apr, 2009 by in Toolkit.


When it comes to correct anesthesia coding, think ‘LUCKY 7.

Check information in these seven places to ensure you report the right procedure code.

1. Anesthesia cover sheet (or charge sheet)

2. Complete anesthesia record

3. Operative (or surgical) report

4. Related consultation notes (history and physical, etc.)

5. Pathology report

6. Hospital medical record and codes

7. Nurses’ notes

© Anesthesia & Pain Management Coding Alert

AUDIO: Self-Auditing Secrets for Your Anesthesia Department

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Orthopedic Coding Clinic: Complete the ICD-9 Picture with These Tips

Posted on 23. Apr, 2009 by in Hot Coding Topics.


Code the condition your ortho treats first, followed by co-morbidity.

If you think you can bill only one diagnosis code per claim, you could be unintentionally sending your claim to limbo land. Find out how your ICD-9 codes can complete your patient’s story and even boost your claim’s success.

Use All the Appropriate ICD-9 Codes

Don’t believe the myth that you can bill only one diagnosis code.

Fact: Based on physician documentation, you should bill as many diagnosis codes as you need to establish medical necessity for the services you’re billing, says Kerry Sheskier, billing manager CPBS at Orthopaedic Dept./Physical Therapy of Winthrop Hospital in Bethany, N.Y. Medicare will process up to eight diagnosis codes.

AUDIO: Up Your Diagnostic-Related Pay with This Orthopedic Note Makeover.

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Quickly Find the Correct V Code

Posted on 22. Apr, 2009 by in Toolkit.


Don’t end your search with ‘Aftercare.’

Hunting for V codes in the alphabetic index of your ICD-9 manual can be frustrating. They’re tucked away under a wide variety of terms.

But using the correct V code can get your claims paid fast. To help shorten your search, Charlotte Lefert, RHIA, suggests keeping this handy list of main reference terms nearby.

To get the V code navigation tool, please click here.

Will ICD-10 have V codes? Find out here.

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Coder’s Mixology: -ST Modifier and EMR

Posted on 22. Apr, 2009 by in Hot Coding Topics.


Certain things go very well together. Chocolate and peanut butter? Yes. Vodka and vermouth? Yes. A modifier that’s correctly appended to a parent code? Yes.

The ST modifier and your EMR system? No. If your payers accept the ST modifier, you can really boost your reimbursement for a trauma patient’s care, Suzan Berman-Hvizdash told AAPC National Conference attendees last week.

But even if your payers accept it, don’t put the ST modifier in your computer system, Suzan warns. If you put it in the system, chances are it will stay there and flag the patient’s subsequent visits to the hospital as ‘trauma,’ even years down the road.

AUDIO: How to document POA in the ED, with Linda Martien.

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Cross the Bridge From ICD-9 to ICD-10

Posted on 22. Apr, 2009 by in Provider News.


The transition to ICD-10-CM might be a little less painful, thanks to new tools from CMS that help you crosswalk from the current diagnosis code set (ICD-9-CM) to the new one.

CMS’s general equivalence mappings offer a backward and forward tool to help you convert diagnosis codes between the two systems.

Keep in mind: In some cases,you won’t find a direct one-to-one match between the code sets. Instead, one ICD-9 code may lead you to several options on the ICD-10 code set.

You can review the general equivalency mapping at the CMS web site here.

WEBINAR: Don’t buy that ICD-10 conversion package until you run this make-or-break test. Jeanne Yoder explains.

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Look for More Info Before Marking UTI, HTN ICD-9 Codes

Posted on 22. Apr, 2009 by in Hot Coding Topics.


Perceiving ‘due to,’ ‘benign’ could land you with incorrect Dx.

Be careful that your septicemia and hypertension savvy don’t leak into your diagnostic code choice, or you could end up with an unsupported code. See if you’re inferring too much with this quick quiz.

Internal Medicine Specialty Coding Conference: July 9-11 in Orlando.

‘Urosepsis’ Is Synonymous With UTI

Question 1: A physician is treating a patient in the hospital and billing initial and subsequent care with documentation that contains only the term “urosepsis.” Should you code 038.9?

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