Below is a complete listing of all Ask the Expert articles that have appeared in JustCoding News.
May 23, 2011
QUESTION: A consultant has advised us to code only diagnoses listed on the discharge summary. If the diagnosis is not on the discharge summary, the consultant instructed us to query the physician. How do other facilities handle these scenarios?
May 17, 2011
QUESTION: A provider debrides a wound and applies a multilayer venous wound compression dressing below knee to the same wound. When we report CPT® codes 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq. cm or less) and 29581 (Application of multilayer venous wound compression system, below knee) we hit an edit stating 29581 is considered a component of the debridement code.
Should we credit the compression dressing charge or submit the charge without a CPT code attached?
May 10, 2011
QUESTION: A physician documents community-acquired pneumonia for a patient who is HIV-positive. In the tabular index of the ICD-9-CM Manual, “HIV” appears next to the pneumonia code 486 (pneumonia, organism unspecified), indicating that the condition is considered a major HIV-related condition. Because the symbol is next to pneumonia, is pneumonia always an HIV-related condition? When the physician specified that it is community-acquired, isn't he or she indicating that it is unrelated to the HIV?
May 3, 2011
QUESTION: We are having a conflict billing drug-eluting and non-drug-eluting stents together for Medicare patients. When coding G0290 (transcatheter placement of a drug-eluting intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) and 92981 (transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; each additional vessel), even with modifiers, the billing scrubber is hitting an edit that says we cannot bill code 92981 without code 92980 (transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel). But when we add 92980, it hits an edit stating that we cannot bill codes G0290 and 92980 together.
Should we code G0290 and G0291 (transcatheter placement of a drug-eluting intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; each additional vessel), since the drug-eluting stent is most extensive of the two procedures coded? Please help.
April 26, 2011
QUESTION: We have a patient who has sick sinus syndrome, and the physician ultimately needed to insert a pacer. Physician documentation stated that the patient also had a “15–20 second episode of asystole that resolved.” Other notes in the record refer to this as a 15–20 second pause and also cardiac arrest.
According to Uniform Hospital Discharge Data Set guidelines, you may code asystole even when the provider does not perform CPR. One of our cardiologists said that if they don't have to resuscitate the patient, it's not truly asystole but rather a sinus pause (for which we would report a different code). After explaining the guidelines to the cardiologist, I asked, “If the physicians document asystole or cardiac arrest, do you agree that it should be coded?” He said yes, but reiterated that unless the physician performs CPR, he doesn't feel it's truly asystole. We’re wondering how to handle these kinds of scenarios.
April 19, 2011
QUESTION: Colonoscopy coding can be a nightmare at times because hospital coding and the physician office coding do not match.
Here's an example. The patient had a colonoscopy five years ago with history of polyps found. The hospital coding will be code V76.51 (Special screening for malignant neoplasms of the colon [screening colonoscopy not otherwise specified]) as primary because it has been five years and code V12.72 (Colonic polyps) secondary.
We would use the screening G code G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) for low risk since the provider did not classify the polyps as adenomatous. The physician's office is coding V12.72 as the primary diagnosis along with the diagnostic CPT® code 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression). Please provide any assistance and references.
April 12, 2011
QUESTION: A provider administers CPR to a patient, and the patient develops a pneumothorax as a result of the CPR. Should we report code 512.1 (iatrogenic pneumothorax)?
March 29, 2011
QUESTION: Is systemic inflammatory response syndrome (SIRS) a real medical condition? Is it an inherent part of an infection? For example, when a patient comes in with pneumonia, should coders or clinical documentation improvement specialists query physicians for SIRS when clinical indicators are present?
March 22, 2011
QUESTION: A basic metabolic panel (BMP) (CPT® code 80048) and comprehensive metabolic panel (CMP) (code 80053) can't be performed on the same date of service because of national correct coding initiative (NCCI edits). Do you credit the BMP or do you submit the charge without a CPT code attached?
March 15, 2011
QUESTION: I have been trying to determine whether a skin graft includes debridement. Based on what I have read in coding guidelines and Coding Clinic, I believe that I should report two separate codes. Otherwise, the graft code would have an includes note indicating the debridement is inherent in the code. I work in an acute care center with a burn unit and have been striving for accuracy and consistency.