ICD-9 Coding for Rotator Cuff Pain: 727.61 or 840.4?

Posted on 22. Jul, 2009 by in Coding Challenge, Hot Coding Topics.


Question: In treating pain stemming from an injury to the rotator cuff, how do you determine which code to use: 727.61 or 840.4?

Answer: Miscoding either one of these scenarios is a fairly common mistake. Typically, 840.4 (Sprains and strains of shoulder and upper arm, rotator cuff [capsule]) should be used for an acute injury, while 727.61 (Complete rupture of rotator cuff) is used to report a chronic condition. The difference is traumatic versus nontraumatic. Sometimes you may find clues based on the patient’s age and whether it was accident- or sportsrelated.

You should look for supporting documentation to determine if the rotator cuff has suffered a traumatic (840.4) versus non-traumatic (727.61) tear, sprain, strain, or rupture. You’ll see the non-traumatic diagnosis more frequently in older patients.

If you can’t find a definitive diagnosis in the documentation – for example, if the documentation states “rotator cuff syndrome”– use 726.10 (Disorders of

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3 Pulmonary Diagnosis Coding Tips

Posted on 20. Jul, 2009 by in Hot Coding Topics.


Remember to focus on acute conditions & exacerbations.

Correctly reporting asthma, bronchitis, and chronic obstructive pulmonary disease (COPD) depends on the internist’s documentation and the patient’s medical record. Making sure the documentation supports the patient’s diagnosis and that you code for any associated acute conditions will ensure that you’re correctly reporting pulmonary diagnoses.

1. Look to 493 for Asthma With COPD

One condition that can be associated with asthma is COPD. You can find all of the asthma codes in the 493 category of the ICD-9 codes. When your physician diagnoses both COPD and asthma together, you’ll refer to his documentation in the medical record to settle on a code. The three asthma codes you’ll choose from are:

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PRC Coding: Put Your Finger on Proximal Row Bones

Posted on 20. Jul, 2009 by in Coding Challenge, Hot Coding Topics.


Question: Our surgeon performed a proximal row carpectomy (PRC) and circled code 25215. That code refers to all the bones in the proximal row, though, and he only dictated working on four bones. Aren’t there five bones in the proximal row?

Answer: Your physician circled the correct code if he addressed the scaphoid, lunate, triquetrum, and pisiform bones. These four bones make up the proximal row of the patient’s hand.

If the physician documented carpectomies of these bones, you should report 25215 (Carpectomy; all bones of proximal row). If he did not refer to all four of these, you may want to consider reporting 25210 (… one bone) instead. You can report additional units of 25210 if he documented carpectomies of more than one bone.

Note: The surgeon may remove just part of the scaphoid rather than the entire bone, but this should not change your code choice….

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Decision Chart: Modifier 78, 58, or 79?

Posted on 20. Jul, 2009 by in Toolkit.


Simplify your post operative service claims with this nifty tool.

If you have trouble targeting just when modifiers 78 (Unplanned return to the operating room for a related procedure during the postoperative period), 58 (Staged or related procedure or service by the same physician  during thepostoperative period), and 79 (Unrelated procedure or service by the same physician during the postoperative period) apply to your claims, check out this handy flow chart which can lead you to the correct modifier decisions every time.

AUDIO: Surgical vs. Non-Surgical Modifiers Guide. Avoid mayhem and denials.

Please click ‘read more’ to get decision chart.

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Audit-Proof Your Modifier 25 Claims

Posted on 17. Jul, 2009 by in Hot Coding Topics.


Getting ready to append a modifier 25 to that E/M code?

Before you do that, let’s spend a few moments in an auditor’s shoes and learn how to think like the auditors who will potentially review our modifier 25 claims.

“I audit, and I highlight everything that pertains to the procedure” when I’m looking at modifier 25 claims, reports Catherine Gray, who spoke at the recent Family Practice & Internal Medicine Specialty Coding Conference in Orlando. The rest is simple. If there’s not enough left un-hilighted in the note that supports the level of E/M service reported, the modifier 25 is inappropriate.

Tip: Document the procedure and the E/M as separate notes, or as separate parts of the same note, advises Jill Young, who taught a great modifiers class at the conference. A different diagnosis code is not…

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Ahhhhh: Relief for Your Migraine ICD-9 Coding Headaches

Posted on 17. Jul, 2009 by in Hot Coding Topics.


Don’t let migraines’ five subcategories and 30 codes suck you into opting for the lower paying generic headache code. To stop relying on 784.0 (Headache) and assign more specific migraine codes, identify the correct subcategory. Then, focus on two words to pin down the final fifth digit. Here’s how.

Step 1: ID Your Migraine Family

Use Symptoms to Code Migraine With Aura

You’ll be in the 346.0x (Migraine with aura) family if you find these details that indicate a migraine with aura or “classic migraine.” An aura is a warning symptom that precedes a migraine attack. Auras are characterized by visual symptoms, such as blind spots, flashes of light, and other visual distortions. Often, they also include motor weakness, paresthesia, or aphasia.

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Radiology Coding Challenge: Rate Your Reformatting Skills

Posted on 17. Jul, 2009 by in Coding Challenge, Hot Coding Topics.


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.

AUDIO: Stark law for radiology. The impact of the final rule. With health care attorney Wayne Miller.

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Proposed 2010 Physician Fee Schedule: A Closer Look

Posted on 15. Jul, 2009 by in Provider News.


21.5 percent cut looms for your services

Last week, Coding News outlined highlights of the proposed Medicare Physician Fee Schedule, printed in the July 13 Federal Register. Today, we’ll look more closely at some of the black holes–such as the reimbursement hit practices will take when they must charge E/M visits instead of consults. But we won’t ignore shining little lights such as a payment boost for the ‘Welcome to Medicare’ exam.

CMS is projecting a record 21.5 percent rate cut, and proposes halting payment for consult codes in 2010. Instead of reporting consult codes, you’d report new or established patient office visit or hospital care (E/M) codes for these services, and CMS would increase payments for the existing E/M codes.

To determine the impact of this change, you’d have to compare the reimbursement from the new fee schedule office visit…

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Coding Ovarian Cyst Removal: Are You Making These 4 Mistakes?

Posted on 15. Jul, 2009 by in Hot Coding Topics.


Here’s how you could potentially add $184 to your bottom line.

Coding for the removal/excision, aspiration, or drainage of an ovarian cyst doesn’t have to be rocket science, especially if you know the truth when it comes to 4 ovarian cyst coding myths.

When you’re preparing to code for ovarian cyst removal, you should pay particular attention to the approach, whether it is vaginal, abdominal (open), or laparoscopic, says Celia Hernandez, CPC, certified coder at South Haven Community Hospital in Mich.

You can’t know approach unless you know the lay of the land. Learn more about ovary anatomy here.

For Laparoscopic Cysts, Look to Extent of Procedure

Myth #1: If your ob-gyn documents that he removed an ovarian cyst via a laparoscope, then you have all you need to choose what code to report.

Reality: For a laparoscopic removal of an ovarian cyst, you’ve got to dig deeper into your ob-gyn’s documentation…

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Oncology Coding Challenge: When Infusion Runs Long

Posted on 14. Jul, 2009 by in Coding Challenge, Hot Coding Topics.


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…

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