Below is a complete listing of all Ask the Expert articles that have appeared in JustCoding News.
July 5, 2011
QUESTION: When a patient has pneumonia due to H1N1, should we report ICD-9-CM code 488.1x (Influenza due to identified novel H1N1 influenza virus) and an additional code for the pneumonia? Viral pneumonia with influenza codes to 487.0 (influenza with pneumonia) and 480.9 (viral pneumonia, unspecified).
June 28, 2011
QUESTION: A patient who is undergoing chemotherapy for cancer treatment comes to the office to make sure that he or she is healthy enough for it. The patient has no new symptoms and is not showing any signs of toxicity. Would you code this as a low medical decision-making or moderate?
June 14, 2011
QUESTION: A patient in the hospital receives observation services with the diagnosis of orthostatic hypotension. The patient also has a history of hypertension being treated with Propranolol. Do we code only the orthostatic hypotension (code 458.0) or do we report both codes 458.0 and 401.9 (unspecified essential hypertension)?
June 7, 2011
QUESTION: How should I report patellofemoral chondrosis?
May 27, 2011
QUESTION: While processing bills from providers, I frequently need to deny arthrogram CPT® codes when the provider authorizes an "MRI arthrogram”. Can you please explain arthrogram coding and documentation vs. MRI arthrogram?
May 23, 2011
QUESTION: A consultant has advised us to code only diagnoses listed on the discharge summary. If the diagnosis is not on the discharge summary, the consultant instructed us to query the physician. How do other facilities handle these scenarios?
May 17, 2011
QUESTION: A provider debrides a wound and applies a multilayer venous wound compression dressing below knee to the same wound. When we report CPT® codes 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq. cm or less) and 29581 (Application of multilayer venous wound compression system, below knee) we hit an edit stating 29581 is considered a component of the debridement code.
Should we credit the compression dressing charge or submit the charge without a CPT code attached?
May 10, 2011
QUESTION: A physician documents community-acquired pneumonia for a patient who is HIV-positive. In the tabular index of the ICD-9-CM Manual, “HIV” appears next to the pneumonia code 486 (pneumonia, organism unspecified), indicating that the condition is considered a major HIV-related condition. Because the symbol is next to pneumonia, is pneumonia always an HIV-related condition? When the physician specified that it is community-acquired, isn't he or she indicating that it is unrelated to the HIV?
May 3, 2011
QUESTION: We are having a conflict billing drug-eluting and non-drug-eluting stents together for Medicare patients. When coding G0290 (transcatheter placement of a drug-eluting intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) and 92981 (transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; each additional vessel), even with modifiers, the billing scrubber is hitting an edit that says we cannot bill code 92981 without code 92980 (transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel). But when we add 92980, it hits an edit stating that we cannot bill codes G0290 and 92980 together.
Should we code G0290 and G0291 (transcatheter placement of a drug-eluting intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; each additional vessel), since the drug-eluting stent is most extensive of the two procedures coded? Please help.
April 26, 2011
QUESTION: We have a patient who has sick sinus syndrome, and the physician ultimately needed to insert a pacer. Physician documentation stated that the patient also had a “15–20 second episode of asystole that resolved.” Other notes in the record refer to this as a 15–20 second pause and also cardiac arrest.
According to Uniform Hospital Discharge Data Set guidelines, you may code asystole even when the provider does not perform CPR. One of our cardiologists said that if they don't have to resuscitate the patient, it's not truly asystole but rather a sinus pause (for which we would report a different code). After explaining the guidelines to the cardiologist, I asked, “If the physicians document asystole or cardiac arrest, do you agree that it should be coded?” He said yes, but reiterated that unless the physician performs CPR, he doesn't feel it's truly asystole. We’re wondering how to handle these kinds of scenarios.