Coding Tip: CPT code 93452 and 93453
by Lori Becks, RHIA - February 1, 2012
CPT code 93452 and 93453 for diagnostic left heart catheterization and combined left and right heart catheterization include left ventricular and left atrial angiography done during the procedure, the necessary injection, and radiological imaging and supervision. Procedures that may be coded in addition are 93462 when left heart catheterization is done by septal or apical puncture; 93463 when pharma agents are given to take hemodynamic measurements; and 93464 for exercise with assessment of hemodynamic measurements.
ICD-10 Corner: Aspirated foreign body in the respiratory tract
by Lauri Gray, CPC, RHIT - February 1, 2012
An aspirated foreign body in the respiratory tract is classified by site, such as pharynx, larynx, trachea, or bronchus, then by type of foreign body such as gastric contacts, food, other specified foreign body, or unspecified, then by the type of injury, such as asphyxiation or other injury, and finally by episode of care, such as initial encounter, subsequent encounter, or sequela. So an initial ED encounter for aspirated peanut lodged in the trachea causing partial obstruction and asphyxiation would be reported with T17.420A, Food in trachea causing asphyxiation, initial encounter.
ICD-10-PCS Says Extirpation – What Does the Physician’s Documentation Say?
by Lauri Gray, CPC, RHIT - February 1, 2012
If you have not glanced at the Operations Table in ICD-10-PCS and reviewed the 31 root operations listed there for the Medical and Surgical section of ICD-10-PCS, you might wonder what the word “extirpation” has to do with coding. The word extirpation is not one that most of us see in documentation of surgical procedures. Searching Google for the word extirpation brought up a definition on the Wikipedia website of “local extinction of a species or other taxon, the condition where a species ceases to exist in a geographic area in which it had previously existed but continues to exist elsewhere.” Another definition found in Merriam-Webster online was “complete excision or surgical destruction of a body part.” That definition brings us a little closer to the ICD-10-PCS definition, but it is still not the exact definition used for coding purposes.
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ICD-10 Corner
by Lauri Gray, CPC, RHIT - January 24, 2012
There are a growing number of pathogenic microorganisms that are resistant to some or all of the drugs previously used to treat the resulting infections. Infections caused by drug resistant microorganisms must be captured using either a combination code for the infectious organism and the drug resistance or if no combination code is available, a code identifying the microorganism followed by a second code identifying the drug resistance. The combination codes in ICD-10-CM are new for 2012, and include Methicillin resistant Staphylococcus aureus (MRSA) sepsis (A41.02) and MRSA pneumonia (J15.212). MRSA infections in diseases classified elsewhere are identified with code B95.62 which is reported as a secondary code. Other drug resistant microorganisms are captured using a code from category Z16, Resistance to antimicrobial drugs. This code category was expanded in the 2012 ICD-10-CM Draft and codes now identify the specific type or class of antimicrobial drug.
Tip of the Week: ERCP
by Lori Becks, RHIA - January 24, 2012
ERCP, endoscopic retrograde cholangiopancreatography is an examination of the hepatobiliary system done by inserting a special, side-viewing endoscope through the mouth and passing it down into the duodenum to the point where the ducts empty into the duodenum at the papilla, cannulating the duodenal papilla, and injecting contrast agent. The diagnostic examination 43260 includes viewing the Ampulla of Vater (duodenal papilla), pancreatic ducts, common bile duct, hepatic ducts, and the gallbladder. Fluoroscopy is included.
Root Operations Drainage and Fragmentation
by Lori Becks, RHIA - January 24, 2012
The next group of root operations that we will be discussing in our articles has the objective of taking out solids, fluids, or gases from a body part. This group contains three specific root operations: drainage, extirpation, and fragmentation. Since extirpation is a new concept in procedural coding for many coders, it will be presented in a separate article next week. This article discusses the ICD-10-PCS root operations of drainage and fragmentation.
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Tip of the Week: Code 29898
by Lori Becks, RHIA - January 18, 2012
Code 29898 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, extensive includes services that may be documented as debridement of an osteochondritis dissecans lesion, resection or removal of osteophytes, articular shaving, limited synovial resection for visualization, limited chondroplasty, joint manipulation, and insertion of synthetic bone substitutes or osteoconductive or inductive agents such as methylmethacrylate, calcium phospates, demineralized bone matrix, etc. None of these may be reported in addition to 29898. Services that are not included and may be reported in addition to code 29898 are arthroscopic synovectomy (29895) and arthroscopic removal of foreign bodies through a a separate incision (29894).
Understanding ICD-10-CM Episode of Care 7th Character Extensions
by Lauri Gray, CPC, RHIT - January 18, 2012
To begin with let’s look at similarities and differences between ICD-9-CM and ICD-10-CM format and structure.
|
ICD-9-CM |
ICD-10-CM |
| 3 digit categories | 3 character categories |
| 4 digit subcategories | 4 or 5 character subcategories |
| 5 digit subclassifications | No subclassifications |
| 3, 4, or 5 digit codes | 3, 4, 5, 6, or 7 character codes |
One significant difference between ICD-9-CM and ICD-10-CM is the need to assign a 7th character, also called a 7th character extension, to codes in certain ICD-10-CM categories. These 7th character extensions are found predominantly in two chapters, Chapter 19 – Injury, Poisoning and Certain Other Consequences of External Causes, and Chapter 15 – Pregnancy, Childbirth and the Puerperium. The details captured with the 7th characters are not details found in ICD-9-CM. For injuries, poisonings and other external causes, the 7th character provides information about the episode of care. For pregnancy, childbirth, and the puerperium, the 7th character provides information about the fetus. More specifically, the two types of 7th character extensions provide information as follows:
ICD-10 Corner: Disorders Affecting the Eyelids
by Lauri Gray, CPC, RHIT - January 18, 2012
In ICD-10-CM, disorders affecting the eyelids require documentation of laterality (right, left) and whether the upper or lower eyelid is affected. For example, codes for senile entropion of the eyelid include H02.031 (right upper eyelid) H02.032 (right lower eyelid), H02.033 (right eye, unspecified lid), H02.034 (left upper eyelid), H02.035, (left lower eyelid), H02.036 (left eye, unspecified lid), H02.039 (unspecified eye, unspecified lid).
Testing New Payment Processes in 2012: CMS Targets Error-Prone Providers
by Kim Charland, BA, RHIT, CCS - January 11, 2012
In January, the Centers for Medicare and Medicaid Services (CMS) will launch several demonstration projects aimed at curbing improper Medicare and Medicaid payments. Each project affects the billing and reimbursement process in some way. It’s no surprise that CMS designed the demonstrations to target the areas listed below, which have a high incidence of error, fraud, and abuse.
RAC Prepayment Review
Under this demonstration, recovery audit contractors (RACs) will review, prior to payment, certain types of claims that have shown high rates of improper payments. The prepayment review demonstration will test an alternative to the traditional “pay-and- chase” method of tracking down improper claims after Medicare pays them.
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