Q: A patient presents with lower back pain and the physician documents findings of stenosis, degenerative “changes,” and mild facet arthropathy. Which diagnosis codes should we report? I would code 724.02 (stenosis, lumbar region, without neurogenic claudication) and 721.3 (lumbosacral spondylosis without myelopathy) for the facet degeneration. Another coder has stated that I cannot code 724.02, as the 721.3 diagnosis code will exclude the use of 724.02. Can you help with this scenario?
Skin and dermatology coding includes unique challenges with its extensive terminology and the need to calculate wound and lesion sizes. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , discusses common documentation problems and how coders can improve their efficiency and proficiency.
Q: When we send in a claim for CPT ® code 29898 (arthroscopy, ankle, surgical; debridement, extensive) to Aetna with modifier –AS (non-physician assisting at surgery) for our physician’s assistant, Aetna will deny the claim saying “assistant not covered.” However, that procedure code says it is covered for an assistant surgeon. I have sent appeal after appeal and printouts from the American College of Surgeon’s (ACOS) Coding Today website showing this procedure code is payable to Aetna, and Aetna still denies the claim. Medicare pays on this claim, why wouldn’t Aetna?
Hydration services, located on the bottom of the drug administration hierarchy, present challenges for coders due they are used with other injections and infusions. Jugna Shah, MPH, and Valerie A. Rinkle, MPA, review how to code hydration, along with other special considerations for drug administration.
With the added specificity available in ICD-10-CM, coders have many more options for reporting malignancies of the skin. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I , compares ICD-9-CM codes with their ICD-10-CM counterparts and notes where more documentation may be needed to select the proper code.
Documentation for vertebral augmentation procedures (VAPs) must adhere to Local Coverage Determination (LCD) policies in order to be paid by Medicare. CMS recently provided guidance for these claims in the Medicare Quarterly Provider Compliance Newsletter .
More than 330 codes have been added, deleted, or revised in the 2014 CPT ® Manual . Almost one quarter of those changes appear in the digestive system. Joanne Schade-Boyce, BSDH, MS, CPC, ACS , notes important code and guideline changes to be aware of for 2014.
Codes for OB/GYN haven’t changed much recently, but some diagnoses still confuse coders. Glade B. Curtis, MD, MPH, FACOG, CPC, CPPM, CPC-I, COBGC , and Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, review some top areas of concern and walk through case studies to explain those problems.
Jugna Shah, MPH, and Valerie A. Rinkle, MPA, look at drug administration coding, beginning with documentation, in order to highlight the information coders need to ensure accuracy. They also review the hierarchy coders must follow when coding for injections and infusions.
Q: How does CPT ® define "final examination" for code 99238 (hospital discharge day management; 30 minutes or less)? Does the dictation have to include an actual detailed examination of the patient? We have been coding 99238 for discharges that include final diagnosis, history of present illness, and hospital course along with discharge labs, medicines, and home instructions. Very few contain an actual exam of the patient. Have we been miscoding all this time?
In order to report accurate evaluation and management codes, coders need accurate, complete documentation. Coders can play a critical role in ensuring proper documentation. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, looks at methods coders can use to promote better documentation.
In its 2014 OPPS Final Rule , CMS finalized its proposal to replace existing evaluation and management CPT ® clinic visit codes with a single HCPCS G-code.
Coding for acute and chronic pain will not change greatly in ICD-10-CM, though coders will have some new options at their disposal. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I , discusses some common pain diagnoses and how they will translate from ICD-9-CM.
Q: When a procedure is performed by laparoscopy, but only a code for the open approach is listed, do you use the unlisted procedure code? For example, the physician documented: laparoscopic pyloromyotomy, hypertrophic pyloric stenosis. We used CPT ® code 43520-22 (pyloromyotomy, cutting of pyloric muscle, Fredet-Ramstedt type operation, with the increased procedural services modifier) but the coding department corrected with 43659 (unlisted laparoscopy procedure, stomach). We are a pediatric surgical practice. I feel because the procedures are very common and performed often, our revenue will drop by using unidentified procedure codes, but I want to code them correctly.
ICD-10-CM codes may look unfamiliar, but many concepts are the same as those in ICD-9-CM, with a few notable changes. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC , look at some of the new conventions and guidelines for ICD-10-CM.
CMS recently released five online resources to aid providers in their ICD-10 implementation efforts. Although CMS designed some of these resources with providers in mind, much of the information is applicable to hospitals, payers, and vendors as well.
ICD-10-CM codes may look completely different, but many of the coding steps remain the same. Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD; Julia Palmer, MBA, RHIA, CCS ; and Melanie Endicott, MBA/HCM, RHIA, CCS, CCS-P, FAHIMA, CDIP, AHIMA-approved ICD-10-CM/PCS trainer explain how to code for neoplasms in ICD-10 and which changes to note.
Coding for podiatry services requires an extensive understanding of complex anatomy and regulations. Lynn M. Anderanin, CPC, CPC-I, COSC , AAPC Certified ICD-10-CM instructor, AHIMA Approved ICD-10-CM trainer, reviews what steps coders can make to ensure complete documentation for podiatry services that are facing increasing audits.
The 2014 IPPS Final Rule was supposed to be implemented with enforcement beginning October 1, but one of its most controversial aspects has seen another delay in enforcement, with major healthcare trade groups seeking more.
Q: We recently had a situation where a patient had come in to have his port re-assessed. He had been complaining of the port being difficult to access. Preliminary x-ray showed the port accessed, with great blood return. Patient has an allergy to IV contrast, so we just flushed the port, and did not give the contrast. The port remained accessed. How do we code this? Do we use 36598 (contrast injection[s] for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report) with a modifier -52 (reduced services)? The other option is a modifier -73 (discontinued outpatient procedure prior to anesthesia administration) or -74 (discontinued outpatient procedure after anesthesia administration). However we have no documentation regarding anesthesia, and I'm not sure the patient would even get anesthesia for a procedure such as this.
