Below is a complete listing of all Ask the Expert articles that have appeared in JustCoding News.
January 10, 2012
QUESTION: The 2012 CPT® Manual includes the typical time physicians spend at the bedside and on the patient’s hospital floor or unit for initial observation care codes 99218, 99219, and 99220. Do these codes only apply when the counseling and/or coordination of care support the respective 30/50/70 minutes of time? Do you know if CMS has published any new guidelines related to these times?
January 3, 2012
QUESTION: A patient had an aneurysm at arteriovenous (AV) fistula, and the physician excluded the aneurysm between two clamps, ends oversewn, and excised the aneurysm. The physician used a tunneler to tunnel an 8 mm Flixine graft from the arterial to the venous side, and two end-to-side anastomoses were then performed at the vein and arterial end.
Should we report code 39.42 (revision of AV shunt for renal dialysis) with code 38.63 (other excision of vessel), or code 38.43 (resection of vessel with replacement), or another code(s)?
December 17, 2011
QUESTION: A patient is diagnosed with severe nonproliferative diabetic retinopathy with macular edema due to insulin-dependent type 1 diabetes mellitus. Which ICD-10-CM code(s) should you assign?
December 13, 2011
QUESTION: We have some questions about coding for observation services. Should we still report HCPCS code G0378 (hospital observation services, per hour)? When should we bill the per-day observation charges instead of the per-hour charges? Is the per-day based on 24 hours or a calendar day?
December 6, 2011
QUESTION: A physician admitted a patient with pneumonia, which was the first diagnosis. The second diagnosis was malnutrition secondary to feeding difficulties of the elderly. Two days later, the physician inserted a percutaneous gastrostomy tube. A day or two later, the physician documented only that the patient had aspirated. Our clinical documentation analyst then queried the physician for aspiration pneumonia. I'm an inpatient coder, and we had a different viewpoint on this, and I wanted to get someone else's insight on this topic.
November 29, 2011
QUESTION: In the past, we reported CPT® code 25620 for open reduction of distal radius and ulna fracture with or without internal fixation. The AMA replaced that code with three other CPT codes, all of which include internal fixation:
We had a case where the physician performed a limited open reduction of a distal radius and ulna fracture without internal fixation after unsuccessful closed reduction in the ED. Which CPT code would you suggest we assign for this procedure?
November 15, 2011
QUESTION: How will coding for diabetes change in ICD-10-CM?
November 8, 2011
QUESTION: A preoperative history and physical (H&P) dated February 1 includes documentation of systolic congestive heart failure (CHF). The patient is admitted February 10 for surgery, and then discharged February 13 with a diagnosis of chronic CHF, treated with Lasix®.
Can we assign a code for chronic systolic CHF based on the preoperative H&P even though it is dated outside of the inpatient admission?
November 1, 2011
QUESTION: Our surgeon aspirates bone marrow from the patient’s iliac crest and combines it with a substance like Osteocel® Plus. Since an allograft doesn’t contain living cells, what CPT® code should I use for the graft?
Is aspiration of the bone marrow separately reportable during that episode of surgery? Sometimes harvesting is bundled . . . but I’m not sure if that applies to bone or bone marrow, etc.
by Ben Amirault | October 25, 2011
QUESTION: What code(s) should I report for an inguinal hernia with incarcerated omentum, meaning the bowel was constricted and confined of blood flow? The physician noted in the record that the omentum was hemorrhagic and necrotic via microscopy.