Below is a complete listing of all Ask the Expert articles that have appeared in JustCoding News.
May 21, 2013
Q: Can you explain how the recent updates to the three-day payment window pertain to self-administered drugs?
May 14, 2013
Q: A patient suffered a nontraumatic intracerebral hemorrhage six months ago and is now being seen for long-standing aphasia as a result of the stroke. How would we code this in ICD-10-CM?
May 7, 2013
Q: A surgeon’s dictated report for a right hip hemiarthroplasty states the following:
Of note, while drilling one of our transosseous suture holes with a 2.0 mm drill bit, the end of the drill bit broke off inside of the trochanter. It seemed to be quite deep into the bone and was not retrievable. As such, it was left in place.
Should we report 998.4 (foreign body accidentally left during a procedure) for this case?
April 21, 2013
Q: Is it appropriate to introduce new information in a multiple choice-formatted query?
April 16, 2013
Q: A physician's office collects a pap specimen and sends the specimen to the hospital lab for processing. The physician's office lists ICD-9-CM code V72.31 (general gynecological examination with or without Papanicolaou cervical smear) as the diagnosis for this service. What is the proper diagnosis code for the hospital to use for billing when only processing the specimen?
April 9, 2013
Q: Using the ICD-10-CM guidelines for the seventh character extensions for fracture codes, how should I identify each of the following?
- Avascular necrosis following fracture
- Cast change or removal
- Emergency treatment
- Evaluation and management by a new physician
- Follow-up visits following fracture treatment
- Infection on open fracture site
- Malunion of fracture
- Nonunion of fracture
- Medication adjustment
- Patient delayed seeking treatment for the fracture or nonunion
- Removal of external of internal fixation device
- Surgical treatment
April 2, 2013
Q: We received an outpatient radiology report (exam performed 7/11/12) where the radiologist states:
CLINICAL INDICATION: LUMBOSACRAL NEURITIS
EXAM: LUM SPINE AP/LAT
CLINICAL STATEMENT: LUMBOSACRAL NEURITIS
COMPARISON: MAY 23, 2012
FINDINGS: There is posterior spinal fusion L-3-L-5 with solid posterolateral bridging bone graft. Pedicle screws and rods are stable in position. There are bilateral laminectomy defects at L3-L-4. The vertebral body and disc space heights are preserved. The spinal alignment is maintained without evidence of spondylolisthesis. No acute fracture is identified. No lytic or blastic lesions are seen. The sacroiliac joints are unremarkable.
IMPRESSION: Stable postsurgical changes with solid posterolateral fusion graft.
Would you use the following ICD-9 codes: V67.09, 724.4. or 724.4, V45.4? Our coders disagree.
March 26, 2013
Q: Can you clarify the requirements surrounding the use of E codes? We have been working on documentation concerns related to patient safety indicator (PSI) 15 and wonder if E codes are required. Can a facility simply decide not to use them?
March 19, 2013
Q: A patient received Toradol 30 mg IV and Zofran 4 mg IV at 14:38. He also had normal saline wide open with documented start of 14:30 and stop of 15:40.
Is the hydration chargeable as 96361 (intravenous infusion, hydration; each additional hour) even though the initial service is not 90 minutes?
Is the hydration a concurrent service?
March 12, 2013
Q: A patient with undiagnosed syncope is admitted to observation. Later that evening, the patient is diagnosed with syncope and develops complications that warrant an inpatient admission. Should the patient be considered an inpatient from the time inpatient criteria are met or from the time the inpatient order is written?