Q: We have a patient who is diagnosed as having acute renal insufficiency due to dehydration with decreased urinary output and was admitted for IV hydration. What diagnosis codes should we assign?
Q: In what instance would septic shock not be coded as a principal diagnosis (PDX)? I’ve been under the impression that septic shock should always be reported as a PDX.
Q: When is it appropriate to bill CPT code 77470 (special treatment procedure [e.g. total body irradiation, hemibody radiation, per oral or endocavitary irradiation]) for a special treatment procedure?
Q: Our coding team is currently debating how to report acute tubular necrosis (ATN) in ICD-10-CM for a patient after a renal transplant. Can you provide any guidance?
Q: In ICD-10-CM, how would you report a patient who is receiving hemodialysis and has chronic kidney disease (CKD) when a failed kidney transplant is also documented?
Q: A physician performs wound debridement on a patient’s right foot, then applies bilateral, multilayer compression dressings to each leg. How should this be reported?
Q: Could you shed some light on reporting ICD-10-CM codes K66.1 (hemoperitoneum), an MCC, and R58 (hemorrhage, not elsewhere classified), which is not considered a CC or an MCC?
Q: A patient presents to the emergency department with chest pain. The physician orders multiple services along with a subsequent infusion without a stop time. What CPT codes would be used to report these services?
Q: If a patient is immobile or comatose for an extended period of time in the hospital and develops a stage 3 or 4 pressure ulcer of the left upper back, would this be considered a hospital-acquired condition (HAC)?
Q: If a patient comes into an outpatient facility for a surgical procedure and the physician evaluates the patient before performing the procedure, can you append modifier -25 to the E/M service?
Q: A patient receives treatment for two ulcers, one on his foot and one on his hip. The physician performs a subcutaneous debridement to treat the foot ulcer and a muscle debridement to treat the hip ulcer. How would this be reported?
Q: If a patient is seen for a pressure ulcer on the foot related to diabetes, would you report a diabetes diagnosis code? If surgical debridement is performed and the patient receives treatment for their diabetes, can you charge for both an office visit and debridement?
Q: We have gotten conflicting advice regarding ICD-10-CM code categories B95-B97 (Bacterial and viral infectious agents) regarding CCs, MCCs, and severity of illness/risk of mortality. Could you clarify the impact of reporting causative organisms?
Q: We are having trouble determining what qualifies a patient as having an acute myocardial infarction (MI) and what documentation would support the diagnosis. Can you help our coding team clarify?
Q: When querying a physician to confirm the stage of a pressure ulcer, is it appropriate to ask questions that require the physician to mark “yes” or “no” responses to the query?
Q: If a patient is admitted with a high blood alcohol level and the provider documents the blood alcohol level in his or her note, does the provider also need to specifically write “patient with intoxication?”
Q: According to the ICD-10-CM Official Guidelines for Coding and Reporting, uncertain diagnoses should be documented at the time of discharge. If a consultant documents an uncertain diagnosis in the final or last progress note and not in the discharge summary, can we code that uncertain diagnosis?
Q: Our facility has attempted to use the -X{EPSU} modifiers on 2017 and 2018 claims but our Fiscal Intermediary Standard System (FISS) did not process the claims. I reverted to using modifier -59 (distinct procedural service). Do you have any knowledge of when these modifiers might go into use?
Q: We keep receiving denials for our use of ICD-10-CM code G94 (other disorders of brain in diseases classified elsewhere). Is there any coding guidance out there that can help our coding team decipher when we can use this code?
Q: What should we report if you have a compression dressing that was applied to the thigh, in addition to the lower leg, since CPT code 29582 (multi-level compression bandage application, thigh to foot) was deleted for 2018?
Q: If the attending physician documented, “likely mixed cardiogenic and septic shock,” can I assign ICD-10-CM codes R57.0 (cardiogenic shock) and R65.21 (severe sepsis with septic shock)?
Q: Could you discuss or explain evaluating encounter billing vs. monthly billing for recurring outpatient services such as chemotherapy infusions or radiation oncology?
Q: I have a question regarding unilateral weakness from a previous stroke. The patient has ongoing weakness in both right arm and leg post cerebrovascular accident (CVA) and associated ataxia post CVA in 2013. What is the accurate code assignment?
Q: What would be the ideal way to code a case where a patient has ongoing encephalopathy after a subdural hematoma multiple years ago? I keep seeing documentation as a brain injury with ongoing encephalopathy, but is there a way to improve on this?
Q: Our coding department has been reviewing the AHIMA Standards of Ethical Coding but were interested in learning more about standard seven. I didn’t realize that continuing education credits help with ethical coding.
Q: Can acute respiratory failure be used as the principal diagnosis rather than ICD-10-CM code I46.9 (cardiac arrest, cause unspecified) when both are present on admission?
Q: If only a central vein is treated when performing treatment for an arteriovenous fistula, is it correct to report CPT code 36901 since 36907 is an add-on code?
Q: If you have an acute exacerbation of chronic right heart failure (CHF) with a preserved ejection fraction (EF) above 55%, can you code it as heart failure (HF) with preserved EF? All the clinical symptoms exemplify right-sided heart failure (e.g., ascites, pronounced neck vein distension, swelling of ankles and feet).
