Below is a complete listing of all Ask the Expert articles that have appeared in JustCoding News.
February 21, 2012
QUESTION: We have a question in regards to hydration that we are trying to figure out. Does the physician specifically have to state in his or her documentation that the IV is for hydration purposes or can a coder figure it out through critical thinking and using the process of hierarchal injection/infusion coding when reading the record?
For example, X IV fluids are being used for an antibiotic and after the antibiotic, the IV fluids continue at 125/hr for hydration.
Does the physician need to document "for hydration"? Our physicians do not want to write that. Do you have any good advice on this?
February 7, 2012
QUESTION: We are a nondialysis facility, so when a patient is in observation for some other reason and must undergo hemodialysis, we report code G0257 (unscheduled or emergency dialysis treatments for an ESRD [end stage renal disease] patient in a hospital outpatient department that is not certified as an ESRD facility). But how should we code peritoneal dialysis when a patient is in observation or inpatient for other problems? I have received three different codes from different coders. I cannot really find any information on this anywhere.
January 31, 2012
QUESTION: A physician admits a 30-year-old male with lower abdominal pain. A CT scan showed consistency with perforated appendicitis. However, the patient had an appendectomy 10 months prior. The physician documents "appendiceal stump syndrome." How should I code this case?
January 24, 2012
Q: How will coding for depression change in ICD-10-CM?
January 17, 2012
QUESTION: I have a question regarding the coding of a computer-assisted fluoroscopy.
Consider the following documentation:
Use and interpretation of intraoperative fluoroscopy. After positioning the patient, the posterior lumbar area was prepped and draped in the standard sterile fashion. The prior incision was marked with a marking pen. C-arm fluoroscopy was used to map an incision extending from the tip of the spinous process of L2 to that of L5.
After performing a time-out, this incision was infiltrated with local anesthetic and incised with a 10-blade scalpel. Dissection proceeded through the subcutaneous fat using Bovie monopolar cautery. Self-retaining retractors were applied. Dissection then proceeded in the midline through the avascular plane through the lumbodorsal fascia and musculature using the Bovie. Self-retaining retractors were deepened.
Would you assign a procedure code for the fluoroscopy for this inpatient procedure or would it just be inclusive in the procedure? There seems to be confusion when comparing this procedure in an inpatient setting vs. an outpatient setting.
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.