CMS Coverage of Obesity Screening
by Bonnie Schreck, CCS, CPC, CPC-H, CCS-P, COBGC - December 21, 2011
On November 29, 2011, a final coverage decision memorandum was passed by the Center for Medicare and Medicaid Services (CMS) for intensive behavioral therapy for obesity. These services have been deemed reasonable and necessary for the prevention or early detection of illness and/or disability and are appropriate for individuals entitled to benefits under Part A or enrolled under Part B.
CMS specified in the decision memo that it will cover:
- One face-to-face visit every week for the first month in the primary care setting;
- One face-to-face visit every other week for months 2-6;
- One face-to-face visit every month for months 7-12, if the Medicare beneficiary meets the 3kg (6.7 lbs) weight loss requirement.
Tip of the Week: V Codes
by Lori Becks, RHIA - December 21, 2011
The V codes in category V85 for body mass index can only be reported as secondary diagnoses; however, the assignment of BMI can be based on documentation from a clinician involved in the patient’s care, such as a dietician, and need not necessarily come from the patient’s physician. The associated main diagnosis, whether overweight, obesity, or morbid obesity must be established by the patient’s physician or other legally qualified healthcare practitioner.
ICD-10 Corner: Overweight and Obesity Codes
by Lauri Gray, CPC, RHIT - December 21, 2011
In ICD-10-CM, overweight and obesity codes are listed in category E66. Overweight is reported with code E66.3. Obesity may be due to excess calories (E66.0-), drug-induced (E66.1), with alveolar hypoventilation (E66.2), due to other specified causes (E66.8) or unspecified (E66.9). Obesity due to excess calories is further differentiated as severe/morbid (E66.01) or other (E66.09). For drug-induced obesity, the drug is coded first from categories T36-T50. If the body mass index (BMI) is known, it is reported with an additional code from category Z68.
Coding for Screening Laboratory Tests
by Roxanne Thames CPC, CEMC - December 14, 2011
Often we have patients who identify to us that they have coverage for “screening blood work.” This can pose a dilemma for coders and billers due to the coding rules related to reporting screening diagnosis codes. Here are a few things to consider when choosing the code to be used to bill for labs being drawn for a well adult visit.
Has this patient been previously diagnosed with a medical condition that would require you to perform this lab test? If your answer is yes, then this does not qualify as screening blood work. Use the code associated with the diagnosis (e.g., hyperlipidemia or diabetes or benign essential hypertension) and not a screening code as the primary diagnosis code for the lab tests.
Tip of the Week: Diagnosis Code V70.0
by Lauri Gray, CPC, RHIT - December 14, 2011
In ICD-9-CM, diagnosis code V70.0 is used for routine medical examinations. If the patient does not have any diseases or other conditions that are addressed, only diagnosis code V70.0 is reported. If the patient has other conditions that are addressed during the routine medical examination, diagnosis codes for those conditions are also reported. It may also be appropriate to report both a comprehensive preventive medicine examination (99381-99397) and a separate office/outpatient evaluation and management service (99201-99215) for the medical services related to any diseases or other medical conditions addressed during the encounter.
ICD-10 Corner: Adult Medical Examination
by Lauri Gray, CPC, RHIT - December 14, 2011
In ICD-10-CM there are two codes for reporting an encounter for a general adult medical examination. For an examination without abnormal findings code Z00.00 is used. For an examination with abnormal findings code Z00.01 is used and additional codes are reported to identify the abnormal findings.
Root Operations Excision and Resection
by Lori Becks, RHIA - December 7, 2011
Coding procedures correctly in ICD-10-PCS depends on a solid understanding of the root operations within each section. All of the root operations in the medical and surgical section are grouped together into nine groups based upon similar attributes, such as root operations that take out some or all of a body part, root operations that involve cutting or separation only, and root operations that always involve a device. This article will focus on two of the most common root operations in the medical and surgical section that take out some or all of a body part, namely excision and resection.
Tip of the Week: Dilation of Esophagus
by Lori Becks, RHIA - December 7, 2011
Dilation of esophagus by unguided sound or bougie is used for an optical dilation in which the dilator is inserted without the use of a guidewire. A scope may be used to locate the stricture first and then withdrawn; however, the dilator is placed directly in procedure code 43450.
ICD-10 Corner: Excision and Resection
by Lauri Gray, CPC, RHIT - December 7, 2011
In ICD-10-PCS, coding the root operation as an excision or resection depends on whether a portion of the body part is cut out or off (excision) or whether the entire body part is cut out or off (resection). Remember that the body part is the fourth character and body part values may be available for a portion of an organ. For example, body part values for the liver include liver (0), right lobe liver (1), and left lobe liver (2). If the entire right lobe of the liver is cut out or off, the procedure would be coded as a resection of the right lobe of the liver. If a wedge excision was done on a portion of the right lobe of the liver, the procedure would be coded as an excision.
November Hot Topics Contest
by Elena Wellard - December 5, 2011
Contexo Media extends our congratulations to Geneva M. Santos, our October Hot Topics Contest winner. She will receive a Coding Diva t-shirt. We had a wonderful time with this contest and want to thank all the participants.
Would you like to win a Coding Diva t-shirt?
To enter to win, simply leave a comment listing the Hot Topic from each of our three November issues. The first person to submit the correct response will win the t-shirt. Please don’t forget to add your e-mail address so we can notify you if you are the winner.
Hint: The Hot Topic appears each week in the header of Coder’s Voice.
Good Luck!
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