493.2x: Your Physician's Notes are Your Best Bet Here

You should have the right information ready prior to referring to your ICD-9 coding manual to save yourself from trouble.

It always helps to have the right documentation in place. When a patient comes to the pulmonologist with asthma or bronchitis, and symptoms of chronic obstructive pulmonary disease, your physician's notes may be your best choice.

You should have the right information ready prior to referring to your ICD-9 coding manual to save yourself from trouble. Ensure the documentation supports the physician's diagnosis. After this, be on the lookout for any associated acute conditions. When you face the situation, ask these three important questions that can help you breathe easily through your lung diagnosis coding.

Check whether the patient has status asthmaticus or acute exacerbation before using 493.20

If a pulmonologist diagnosed a patient with both asthma and chronic obstructive pulmonary disease, go to the v493.x section of ICD-9 and choose from the three options: 493.20, 493.21, and 493.22. For some payers, 493.20 is default code. It is always better to check with your pulmonologist first to see if the patient has status asthmaticus or acute exacerbation before settling with 493.20.

Note of caution: A diagnosis of 'status asthmaticus' is the most acute presentation and takes precedence over any type of COPD; as such you should primarily list the most acute diagnosis addressed if the physician documents both findings. On the claim, you should report 493.21, and not 493.22 (an acute exacerbation). If status asthmaticus is documented by the provider with any type of COPD or with acute bronchitis, the status asthmaticus should be sequenced first. It supersedes any type of COPD including that with acute exacerbation or acute bronchitis.

Don't report 466.0 for obstructive chronic bronchitis

When your pulmonologist documents chronic obstructive bronchitis with an episode of acute bronchitis, you should code 491.22. You should not report 466.0 (Acute bronchitis) for the obstructive chronic bronchitis since this code fails to capture the patient complexity of an acute-on-chronic illness, as in 491.22.

Get thorough documentation from your pulmonologist

If you are coding COPD, full details are very important. The documentation should include a listing of signs, symptoms, and conditions. A mere entry of “shortness of breath and cough" may not just be enough. Since cardiopulmonary diseases manifest themselves in this fashion, these symptoms can represent a progression of chronic illness or other acute issues, either related or not related to the patient's chronic disease. As such, clinical evaluation, based on a detailed history, is of prime importance. In order to determine a new illness or a progressing/exacerbating chronic illness, the physician may order blood studies, along with radiographical and physiological evaluations. Just listing COPD as the diagnosis does not reflect the patient's present status. Including the signs, symptoms, or the exacerbation will aid in justifying the medical necessity of the studies ordered. The payer will better understand that these aren't routine surveillance studies.

ICD-9 Coding: 700 Basics: Simplify Corn and Callus Coding

Learn what to do when these lesser-known terms show up in your doctor's documentation?

For dermatologists who are treating the skin of a patient's foot, one of the most generally coded diagnoses is corns (and calluses). This particular condition has a slew of puzzling names that may be difficult to find -- or may not be present in your ICD-9 coding book -- and could quickly overturn your claims.

Decoding all of the corn and callus terminology can be particularly complex in case you work for numerous physicians and each one has his own particular way of naming the same thing, or in case you've lately started working at another practice. But you no longer have to be ignorant as far as a callus-related term is concerned.

Watch out: "Tylosis" could lead you down the erroneous coding path if you're not cautious. The ICD-9 index present in the front of the coding book presents numerous options, for instance 757.39 (Other specified amomalies of skin; other; includes accessory skin tags, congenital; congenital scar; epidermolysis bullosa; keratoderma [congenital]), and this is the incorrect path for a basic corn or callus. The best way you encounter this particular term present in the documentation is to ask the dermatologist to explain the condition.

ICD-10: Once ICD-9 changes to ICD-10 in October, 2013, code 700 become invalid. In its place, you would report ICD-10 code L84 (Corns and callosities).

Ace the Definitions

In case you're still uncertain about your dermatologist's everyday explanation of these general conditions, learning the definitions of "corn" and "callus" will help. Remember, a corn is a small, horny area of the skin produced by local pressure (e.g., a shoe or hosiery) irritating the tissue over a bony prominence.

Corns normally takes place on a toe, where they form "hard corns." (Between the toes, pressure can form a soft corn of macerated skin, which often yellows.)

Moreover, a callus is localized thickening and enlargement of the horny layer of the skin because of pressure or friction. Normally, calluses as well as corns can result in pain, and soft-tissue inflammation may take place around the base of the lesion.

Knowing these definitions is also supportive in case you plan to ask the dermatologist for explanation.

For instance: You're struggling with how you should code a patient diagnosis that defines a "keratosis" of the bottom of the great toe and the heel. You've learned the synonyms for corns/calluses and recall that this is one more name for a callus, however you notice that a different nearby code has the identical word in its descriptor: 701.1 (Keratoderma, acquired; Keratosis [blennorrhagica]).

For an error-free ICD-9 coding , you request the dermatologist for more particulars about the patient's condition so you can code it correctly, and he defines a basic thickening of the skin owing to bad shoes. After studying the definitions, now you know that it's just a callus and you can further code it as 700.

For More Information :- http://www.supercoder.com/coding-newsletters/my-dermatology-coding-alert/icd-9-coding-700-basics-take-the-rough-edge-off-corn-and-callus-coding-108680-article

ICD-9 2012 Choices for Thalassemia Coding

The ICD-9 2012 codes went into effect on October 1 this year; here are some ICD-9 tips to ramp up your oncology coding.

This time ICD-9 2012 has added six new codes for thalassemia: 282.40, 282.43, 282.44, 282.45, 282.46, and 282.47.

ICD-9-CM codes: Under the previous ICD-9, there was a one ICD-9-CM code to capture all non-sickle cell related thalassemias. This one ICD-9 code covers the entire range from asymptomatic patients (silent carrier or thalassemia trait) to patients with severe disease (thalassemia major)

A big portion of thalassemia patients are asymptomatic. Those who suffer from the most severe forms need life-long monthly blood transfusions, iron overload monitoring, chelation therapy and they're candidates for hematopoietic stem cell transplant.

Important: You should review the inclusion list for all of the 282.4x codes. For instance, the list with 282.46 clarifies the code is proper if documentation points to 'silent carrier' or thalassemia trait."

In addition, changes to the inclusion notes for 282.49 show a change for how you code microdrepanocytosis. In place of coding the condition to 282.49 (as you did in the previous one), the recent inclusion note revisions guide you to code the condition to 282.41.

For Pancytopenia, you should mark 284.1 as Invalid. Yet another important change is that now 284.1 is no longer a valid code.

Now you'll need to add a fifth digit: 284.11, 284.12, and 284.19.

Under 2011 ICD-9, coders were confused about how to report drug-induced pancytopenia. The Diagnosis Agenda points to 284.89 as the 2011 code. However since pancytopenia related to drugs wouldn't necessarily be related to aplastic anemia, ICD-9 added the more specific 284.1x codes.

You should split 793.1 to get new SPN code

Make it a point to highlight this change in your coding references, too. Under ICD-9 2012 , 793.1 is no longer a valid code. This time it adds required fifth digit choices for 793.1x.

The changes allow for more specific reporting of a solitary pulmonary nodule (SPN). A patient may have more than one SPN present and each may be in a distinct anatomic area. Doctors may find out SPNs using X-ray, CT, or PET, and biopsy can later recognize the nature of the disease or condition the SPN is related to.

ICD-9 Coding: Boost Your Upper Body ICD-9 Choices

Read on for 2012 ICD-9 updates for chest and shoulder conditions and more.

ICD-9 2012 changes went into effect on October 1 this year. If you're still not up to speed on these code changes, here's an opportunity to do so.

When it comes to Pneumothorax coding, you'll have to shift to 512.89. Even if you normally find yourself reporting the code for 'not otherwise specified' (NOS) pneumothorax, you will see a change as to how you should code.

Previously, under ICD 9 codes 2011, you used to report an acute, chronic, or NOS pneumothorax with 512.8, however ICD-9 2012 revises 512.8 and turns into a range of codes. To put it in other words, there's a new range of five-digit 512.8x codes; as such 512.8 is no longer valid.

These codes 512.81-512.82 specify 'spontaneous' and differ based on primary and secondary.

This time ICD-9 splits and provides you a new SPN code. See to it that you highlight this change in your coding references also: Under ICD-9 2012, 793.1 is not a valid code anymore. The new code set adds required fifth digits to 793.1 for two new codes: 793.11 (Solitary pulmonary nodule) and 793.19 (Other nonspecific abnormal finding of lung field).

This change brings forth more specific reporting of a solitary pulmonary nodule (SPN). A patient may have more than one SPN present and each may be in a distinct anatomic area.

Notice this difference: ICD-9 Codes 2011 covered an index entry for "Nodule(s), nodular; lung, solitary, which pointed to 518.89; however the new ICD 9 code set revises the index.

Apart from pulmonary revisions, you also need to take note of 726.13. As per the diagnosis Agenda, a partial tear refers to rotator cuff tendon damage in which the tear does not go completely through the tendons. Instead if documentation shows a complete tear, you should go for 727.61.

ICD-9 Coding 2012 has two new Codes for Common Hair-Follicle Cysts

The 2012 ICD-9 codes just went into effect on October 1 this year; if your lab bills transfusion medicine services, pathology exams for certain cysts or for that matter blood tests for hemorrhagic disorders, you have some ICD-9 changes to adapt to.

For one, ICD-9 coding creates two new codes for common hair-follicle cysts - 704.41 and 704.42. Despite having distinct characteristics, Pilar cysts are often confused with sebaceous cysts.

And if you bill transfusion medicine codes, you must not miss ICD-9 revisions that'll change how you code serum reactions. Codes 999.4 and 999.5 will become invalid and these codes will be replaced by 999.41, 999.42, 999.49, 999.51, 999.52, and 999.59.

Code 999.4 is not transfusion specific. The new codes - 999.41 and 999.42 - will help distinguish anaphylaxis due to transfusion or vaccination; say for instance ICD-9 2012 provides similar distinctions in new codes 999.5x.

The just-in codes will boost the precision of recording transfusion associated adverse reactions and boost the ability to conduct active surveillance of transfusion safety.

ICD-9 2012 also brings new Lupos code. ICD-9 2012 expands four-digit code 286.5 into a new range of five-digit codes: 286.52, 286.53, and 286.59. This'll allow for more specific identification and will help track trials on the cause, self-correction, and pharmaceutical treatment of these disease types of hemophilia.

You will quite often see 286.53 used to report the hemorrhagic disorder with an antibody known as lupus anticoagulant or systemic lupus erythematosus. Those labs that test for this antibody may report the test as 85598.

ICD-9 Coding Tips for Your Pediatric Practice

The ICD-9 2012 code changes have just gone into effect on October 1, which means you'll soon need to be well-versed with the latest changes. This time there are not much diagnosis code changes as far as your pediatric practice is concerned. But there are still quite a few that could lead you to denied claims if you're not aware about it.

Here are some pediatric coding scenarios to help your ICD-9 coding:

For instance when a 12-year-old patient presents with influenza due to identified novel influenza A virus with pneumonia you should go for new code 488.81. Prior to this, you'd most likely have used 487.0; however that code did not specify the nature of influenza A.

The ICD-9 Committee has revised the influenza codes several years, which might make coding these conditions confusing; however the most important fact to remember when reporting these illnesses is to check the documentation for confirmation of the type of influenza that the patient suffers from. When you're in doubt, you should check any lab reports or ask the physician to clarify.

What's more, you'll find revised diagnosis code descriptors for the H1N1 codes for these codes: 488.11, 488.12, and 488.19.

And what if a patient comes for a tuberculosis skin test and the results come back showing that the patient experienced a reaction to the test but doesn't have active tuberculosis. Well, from October 1, the ICD-9 code listing has deleted code 795.5 and replaced it with a couple of more specific codes, one of which is the right answer to this question, 795.51.

ICD-9 has also come up with code 795.52 to separate out the former 795.5 category.

And what if a six year old patient presents with a rare anaphylactic reaction owing to a vaccination that your pediatrician administered earlier in the day? Well, in 2012, you'll have a wide range of anaphylactic reaction codes, including 999.42 which describes this situation more specifically than other codes.

Now you will not be able to report previous codes 999.4 and 999.5 as these codes have been axed. Many other anaphylaxis codes have been revised too.

And in a situation where a ten year old patient presents with a migraine headache with aura, but without status migrainosus, you should go for 346.01 now post ICD-9 2012 code changes.

ICD-9 Coding: Changes for Hemophilia, LEMS, and Anaphylaxis & More

With less than a month to go for the proposed changes for ICD-9 2012 to go into effect, here's a rundown on the codes that'll have a say on your oncology and hematology claims.

This time, the list of proposed ICD-9 codes is fairly short; but even then quite a few of them apply to your oncology and hematology claims. Here's what you need to watch out for:

Bansal and Squamous Cell

The proposed changes to ICD-9 medical codes 2012 include an expansion of 173.x. Each code in that series will get fifth digit choices, which will provide further details of the skin neoplasm type. The revisions in the 173.xx skin cancer codes follow a pattern where:

The fifth digit "0" refers to an unspecified malignant neoplasm

"1" denotes basal cell cancer (BCC)

"2" refers to squamous cell carcinoma (SCC)

"9" describes "other" specified malignant neoplasm.

Better documentation need of the hour: You will need to improve documentation as it'll allow you to code these conditions more specifically starting October 2011. In fact, this will also stand you in good stead when you switch to ICD-10.

Own code for hemophilia

You should also plan for the soon-to-go-into-effect ICD-9 codes to expand current four-digit code 286.5 into a new range of five-digit codes: 286.52, Acquired hemophilia, 286.53, Antiphospholipid antibody with hemorrhagic disorder, 286.59, Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors.

These changes will allow for more specific identification. It'll also help track trials on the cause, self-correction, and pharmaceutical treatment of these disease types of hemophilia.

Three new codes related to LEMS

ICD-9 2012 is likely to add three new codes pertaining to Lambert-Eaton myasthenic syndrome (LEMS): 358.30, Lambert-Eaton syndrome, unspecified, 358.31, Lambert-Eaton syndrome in neoplastic disease, 358.39, Lambert-Eaton syndrome in other diseases classified elsewhere.

Right now, LEMs falls under 358.1. The code has an instruction to code first underlying disease. Say for instance, you may select the proper malignant neoplasm code from 140.0-208.9.

ICD-9 Coding: Each Code in 173.X Series Will Get Fifth Digit Options

Although there are fewer changes to ICD-9 codes this year, oncology and hematology coders will have their hands full.

Here are the main proposals you need to keep an eye on when they go into effect on October 1, 2011. This time you can see an expansion of 173.x (Other malignant neoplasm of skin) as each code in that series will get fifth digit choices, which will provide further details of the skin neoplasm type.

The changes in skin cancer codes (173.xx) follow a pattern where the fifth digit of '0' refers to an unspecified malignant neoplasm, '1' denotes basal cell cancer (BCC), 2 refers to squamous cell carcinoma (SCC) while "9" describes "other" specified malignant neoplasm. The two most common types of skin cancer are basal cell cancer and specified malignant neoplasm.

Why the expansion? The code series was expanded following a request from the New York Cancer Registry to help distinguish reportable skin cancers from non-reportable skin cancers – say for instance BCC and SCC. These common neoplasms behave differently – so it would be more useful to separate them.

Right now, you use ICD code 173.0 for any non-melanoma malignant lip neoplasm; however using the proposed codes, you'll choose from: 173.00, 173.01, 173.02 and 173.09.
Four-digit 173.x codes will no longer be valid with effect from October 1, 2011

This is because each code in the range will need a fifth digit to be complete.

Better documentation habits: Preparing for the just-in and revised ICD-9 code changes, you need better documentation habits. You should encourage practitioners to document the type, specific location and nature of the disease process. You'll have a two-pronged advantage as improving documentation will not only allow you to code these conditions more specifically starting October this year but will also help you gear up for ICD-10's general increase in documentation requirements after it goes into effect on October 1, 2013.

What's more, you should also plan for ICD-9 2012 to expand the present four-digit code 286.5 into these five-digit codes: 286.52 (Acquired hemophilia ), 286.53 (Antiphospholipid antibody with hemorrhagic disorder), 286.59 (Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors).

The changes will help track trials on the cause, self-correction and pharmaceutical treatment of these disease types of hemophilia.

ICD-9 Coding: Generalized Complaints for Blurry Vision Can Lead to Confusion

Having trouble getting to the proper ICD 9 diagnosis code for blurred vision? That should not be a problem if you know the reason behind the blurred vision.

A person complains of blurred vision and visits an eye-care specialist. But when a patient comes with hazy, generalized complaints, say for instance blurry vision, dry eyes, and the like – coders find it difficult to report these. ICD-9 codes that describe blurred vision specifically and similar diagnoses that relate to refractive error sometimes are not covered. So how do you go about this situation? Many coders use 368.8 (Visual disturbances; other specified visual disturbances).

The ICD-9 manual covers the note “blurred vision not otherwise specified" (NOS). This points to the fact that this is a good option for blurred vision. But then some carriers do not agree using the logic that there must be something leading to the blurriness and insisting you report the cause and not the symptom.

Rule for coders: You need to use the final diagnoses if a patient has a medical problem; however if the patient has only blurred vision, you should go for 368.8. Here’s an instance: A patient reports with a blurry vision and the ophthalmologist finds a cataract. Here you need to report cataract (366.xx) as the primary diagnosis and blurred vision (368.8) as the secondary diagnosis. This gets more confusing when the patient does not specifically complain of blurred vision and asks for a regular eye exam instead. Experts say that how you code depends on the insurance. If the patient visits for a routine vision exam and you know you are going to bill a vision insurance, report with a routine diagnostic code for refractive error [367.x]. But if the patient does not have a vision plan, then you may choose 368.8 to report it.

According to some coders, while billing with a symptom code like 368.8, their carrier also needs the use of V80.2. And in case you are have some confusion, ask the carrier for its written policy.

Dry-Eye Syndrome

The most common ICD-9 diagnosis code related to dry eye is 375.15. One more code would be 370.33. A word of caution though: Many believe they can report 375.15 and 370.21 interchangeably; however this is not true.

Diagnosis Coding Quiz: Are Your DX Coding Skills Up to Snuff? Take This Quick Quiz to Find Out

Hint: Coders shouldn't be interpreting test results to get quick diagnosis codes.

As your practice continues to prepare for the ICD-10 transition, it's important to still remain up-to-date on the ICD-9 coding rules, which remain in effect until Oct. 1, 2013. Read the following diagnosis coding questions submitted by our readers and check out our expert answers below.

Leave Diagnosing Patients to the Doctor

Question 1: If the physician hasn't indicated ECG results in his final diagnosis, should I code the findings? The doctor wrote a complete interpretation on the strip. He says "yes," because usually he has another diagnosis to justify the ECG.

Answer 1: The bottom line is if the test is positive, you should report the findings from the electrocardiogram (ECG) as the final diagnosis. If the test is negative, you should report the indications. For you to report positive findings from the ECG, the physician must document the findings as a final diagnosis. Choosing a diagnosis based on the patient's test results -- even when that diagnosis seems obvious-- is inappropriate and possibly fraudulent coding. CMS describes its guidelines for this issue in Transmittal AB-01-144 (Sept. 26, 2001) in which the agency states that a physician must confirm a diagnosis based on the test results.

This CMS transmittal goes on to say that if the test results are normal or nondiagnostic, you should code the signs or symptoms that prompted the test -- in other words, the indications. Similarly, the ICD-9 coding guidelines for diagnostic testing instruct you not to "interpret" what a study says, but rather to rely on the physician's stated diagnosis. If the ECG findings seem like an important component of the case -- and may play a role in substantiating the medical necessity for the visit-- you should query the physician regarding the diagnosis.

Heads up: Choose the CPT ECG code based on how much of the ECG service the physician's office provided. If the physician's office provided the entire service (both technical and professional components), assign 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report).

Code the technical component only as 93005 ( tracing only, withoutinterpretation and report). If the physician provided only the professional component, use 93010 ( interpretation and report only).

Don't Let Diabetes Dx Trip Up Your Claims

Question 2: Our physician treated a patient with diabetes, but he was actually seeing the patient to treat a complication of the diabetes, diabetic neuropathy. During his evaluation, the physician also noted that the patient had joint inflammation. Should we report the neuropathy complication only, or several of the ICD-9 codes?

Source URL :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/diagnosis-coding-quiz-are-your-dx-coding-skills-up-to-snuff-take-this-quick-quiz-to-find-out-107415-article

2012 ICD- 9-CM Codes: Get Four Options for Non-Melanoma Malignant Neoplasm of the Lip

Plus, new codes will make cancer classification easier.

The proposed changes to 2012 ICD-9 codes is out; approved by the ICD-9-CM Coordination and Maintenance Committee, the new, revised and invalid codes were published in the Federal Register on May 5, 2011. After the new codes go into effect on October 1 this year, CMS will add ICD-9 codes on an emergency basis as it gears up to switch over the diagnosis coding system to ICD-10.

Expanded ICD-9 diagnosis code sets: As per the changes, from October 1 this year, dermatology coders will be able to report the location of carcinomas and other neoplasms of the skin more accurately. This time they include an expansion of the 173.x (Other malignant neoplasm of skin) series. Each code in that series will get a list of fifth digits that'll provide specifications on whether the malignant neoplasm is basal cell, squamous cell, or unspecified.

Source Code :- http://www.supercoder.com/icd9-codes/

ICD 9 codes 2011: Right now dermatology coders use 173.0 for any non-melanoma malignant neoplasm of the lip. This will become an invalid code once ICD-9 2012 codes go into effect.

ICD-9 codes 2012: When the ICD-9 2012 goes into effect, coders can choose from four options - 173.00, 173.01, 173.02 and 173.09.

New codes will make cancer classification easier: Normally, majority of skin cancers are either basal or squamous cell, neither of which are reportable conditions to central cancer registries. Due to the difficulty in distinguishing reportable skin cancers from non-reportable skin cancers, the facilities are transmitting skin cancers to central registries. This puts an additional burden on central registries and also ends up in the transmission of confidential patient information on patients whose information shouldn't be reported. The expansion of the category of 173 codes will allow for the differentiation of reportable and non-reportable skin cancer.

ICD-10 codes: We're not sure whether there'll be expanded skin neoplasm codes when coders update their diagnosis codes in 2013 with the new code set. Presently, ICD-10 is likely to include C44.0-C44.9, a code series that does not have the specificity as the soon-to-go-into-effect ICD-9 2012 codes.

Diagnosis Coding: Follow These 4 Steps to Master 940-949 Burn Diagnoses

Proper ICD-9 coding for burn patients can require several codes.

Dermatology coders who cannot choose the proper diagnosis codes for each burn treatment patient could end up costing their practices time and money.

How? Let's say your dermatologist provides local burn treatment for a patient (16000, Initial treatment, first degree burn, when no more than local treatment is required). If the claim contains an inaccurate burn diagnosis code, or no diagnosis code at all, the insurer could deny claims for burn treatment based on lack of medical necessity. Snuff out potential denials by following these four quick steps to picking the perfect burn diagnosis codes for each burn treatment encounter.

Step 1: Check Notes for Location of Burn

When choosing a burn diagnosis code, you first need to check the anatomic location of the burn, confirms Kevin Arnold, CPC, director of compliance for LYNX Medical Systems, based Washington. If you have notes indicating the anatomy of the burn, you'll first choose a burn diagnosis code from the 940.x (Burn confined to eye and adnexa …) to 947.x (Burn of internal organs …) code set.

The first three digits of the 940.x-947.x codes “refer to the general anatomic location of the burn. The fourth digit refers to the degree of the burn, with the fifth digit being the most specific anatomic location of the group," says Arnold. Not all of the codes in this diagnosis set have fifth-digit requirements, but you must code to the fifth digit if the code specifies it.

Example: The dermatologist treats a patient with first degree burns on his left foot. On the claim, you would report 945.12 (Burn of lower limb[s]; erythema [first degree]; foot) to represent the patient's condition.

If you have no evidence of burn location in the notes, choose a code from the 949.x code set instead, explains Jeffrey Linzer Sr., MD, FAAP, FACEP, Associate Medical Director for Compliance, Emergency Pediatric Group, Children's Healthcare of Atlanta at Egleston.

For example, operative notes indicate that a patient suffered second-degree burns, but there is no indication as to the anatomical location of the burn. For this claim, you would choose 949.2 (Burn, unspecified; blisters, epidermal loss [second degree]) as a diagnosis code.

Step 2: Ensure You've Coded for All Burns

You'll also need to make sure that you are coding for each burn the patient suffered. How many codes you include to represent the patient's injuries depends on encounter specifics.

Article Source :- http://www.supercoder.com/coding-newsletters/my-emergency-medicine-coding-alert/diagnosis-coding-follow-these-4-steps-to-master-940-949-burn-diagnoses-article

Spot on Coding Does not Require An Overly-Detailed Coding Policy

Spot on coding does not require an overly-detailed coding policy. ICD-9 Coding policy can certainly help keep your claims.

An ICD-9 coding policy can certainly help keep your claims flowing smoothly, but then you cannot just set it up and sit back. Read on and know how to establish a policy that'll remain current and help you duck the the auditors when they come calling.

The first element of a well-designed coding policy is to point out that you adhere to the ICD-9-CM Official Guidelines for Coding and Reporting. If you do not stay tuned to these standard rules you may land in trouble.

Secondly, establish your coding process, including who does the coding and how you make corrections.

Third, describe how your coding staff will stay tuned and maintain their coding competencies. Keeping pace with the changes can be especially important, whether to the official guidelines, payer requirements or the ensuing transition to ICD-10.

Document your auditing process, including the percentage of charts you will audit for accuracy and how often you will conduct those audits. Internal auditing can help ensure your dermatology coding is accurate before your mistakes are found in a costly audit from a ZPIC, RAC, or one of the other auditing entities.

Gauge your dermatology coders' accuracy. Paired with auditing, establishing an accuracy rate for your medical coders can help set the bar for your commitment to accurate coding. If you need your coders to maintain a 95 percent accuracy rate with their coding, include this information in your policy.

Keep policies up to date. Do not let your coding policy sit on the shelf and grow dusty. Try to check your policy periodically to ensure it's current.

For more on this and other diagnosis coding tips, sign up for a medical coding guide like

http://www.supercoder.com/

Steps to Pave the Way to Audit-Hardy Coding

ICD-9 coding: 6 steps to pave the way to audit-hardy coding. But remember what not to do.

An ICD-9 coding policy can keep your claims flowing smoothly; however you cannot just set it up and forget about it. Here's how to establish a policy that'll remain current and help you avoid headaches when auditors come calling.

Step 1: The first building block of a well-designed coding policy is to indicate that you adhere to the ICD-9-CM official guidelines for coding and reporting. If you don't stay up to date with these standard rules, you could be in for trouble.

For details: The official guidelines are updated each year and are normally available shortly after the annual ICD-9 updates go public.

If you keep up on the rules in the official guidelines, you will not have to worry about being blindsided by any across-the-board ICD-9 coding changes.

Step 2: Establish your coding process, including who does the coding and how you make corrections.

Step 3: Describe how your coding staff will stay up to date and keep up their coding competencies. Staying on top of changes can be especially vital, whether to the official guidelines, payer requirements or the transition to ICD-10.

Important issue: Right sequencing is always a concern for medical coders. Selecting the most proper diagnosis helps ensure not only that your practice gets its proper payments but that your coding will stand up under scrutiny from auditors. The assessing clinician and the expert coder must work together to ensure the ICD 9 codes are listed as per the seriousness of the patient's condition.

Step 4: Documenting your auditing process – including the percentage of charts you will audit for accuracy and how often you will conduct those audits. Internal auditing can help ensure your dermatology coding is spot on before your mistakes are traced in a costly audit from a ZPIC, RAC, or one of the other auditing entities.

Step 5: Weigh the accuracy of your dermatology coders. Paired with auditing, establishing an accuracy rate for your coders can help set the bar for your commitment for precise coding. If you want your coders to maintain a 95 percent accuracy rate with their coding, include this information in your policy.

Step 6: Keep polices up to date. Do not let your coding policy sit on the shelf and grow dusty. Ensure the effort to check your policy periodically to make sure it's up to date.

Mistake: Do not write policies that attempt to address how you are going to code each particular diagnosis. General policies that address the methods you use to keep your coding spot on are more useful and workable.

Source URL :- http://www.supercoder.com/coding-newsletters/my-ophthalmology-coding-alert/diagnosis-coding-6-steps-pave-the-way-to-audit-hardy-coding-104080-article

Follow up: If you get downcoded in an audit related to your diagnosis codes, gear up to ask for a redetermination. If your coding is supported by clear clinical documentation and you have followed the proper guidance, be prepared to write an appeal stating why the coding is right and quote official guidance in that appeal.

Auditors are not necessarily coders and may not be aware of the rules that govern the practice of coding. Quoting specific sections of the official coding guidelines helps to show that you are knowledgeable and have coded right.

FAQ to Boost Your Pain Management ICD-9 Coding

FAQ to boost your pain management ICD-9 coding

If you do not know how many diagnosis codes you can report, you could find yourself assigning the wrong code. Here's a question followed by the answer that'll help you get quick tips to help your pain management ICD-9 coding:

How many diagnosis codes are 'too many'?

Question: Our pain management specialist treated a patient with diabetes, however he was actually seeing the patient to treat a complication of the diabetic polyneuropathy. During his evaluation, the doctor also noted that the patient has shoulder joint inflammation. Should we use the neuropathy complication only or several ICD-9 codes to represent various conditions of the patient?

Answer: Normally, the primary diagnosis code that you list on your claim should represent the main reason for the encounter, or the condition with the highest risk of morbidity/mortality that the physician tends to during the visit. However, when you deal with a condition like diabetes, the situation changes.

Section 1.A.6 of the ICD-9-CM official

Guidelines for coding and reporting certain conditions have both an underlying etiology and multiple body system manifestations owing to the underlying etiology. For conditions such as this, the ICD-9-CM(http://www.supercoder.com/icd9-codes/) has a coding convention that requires that the underlying condition be sequenced first after the manifestation.

If a patient has more than one manifestation of diabetes, more than one code from category 250 may be used with as many manifestation codes as are needed to describe the patient's diabetic condition fully.

As such, you should first use 250.6x (Diabetes with neurological manifestations). Remember to add a fifth digit to reflect the patient's type of diabetes and status of control. Your secondary code should represent the specific pain manifestation being treated. In this case, you should report 357.2 (Polyneuropathy in diabetes) as the secondary diagnosis. As because your pain practitioner documented joint inflammation, you should also report the right code describing that condition (716.91, Arthropathy, unspecified; shoulder region).

Why so many codes: Even though many payers will link only the first, main diagnosis code that you list to support the provided service's medical necessity, reporting all the diagnoses that follow the HIPAA-mandated guidelines is compliant coding. As of July 2007, Medicare must accept up to eight diagnoses for each electronic claim reported. The additional diagnoses might indicate more complex presenting problems and can provide the help you might need for a higher-level E/M service.

Make Perfect your ICD-9 Coding Skills

OB-Gyn - ensure you have coded high-risk or complicated obstetrical care correctly - and that means perfecting your ICD-9 coding skills.

You can get increased payments when your ob-gyn provides additional visits outside of the normal global ob package; however you'll have to ensure you have coded high-risk or complicated obstetrical care correctly – and that means perfecting your ICD-9 coding (http://www.supercoder.com/icd9-codes/) skills.

Be firm on perfect ICD-9s

To demonstrate the reason for the additional service, you have to link the ICD-9 code on the CMS-1500 claim form (boxes 21 and 24E) to an E/M code. You can add this to the claim that includes the global service or you can submit it as an additional claim.

Here's an example: A 33-year-old patient, gravida 3, para 2 (both normal spontaneous vaginal delivery [NSVD] full term), is tended to 19 times due to developing pre-eclampsia. Post delivery, you review the case and find that the patient required six additional visits (beyond the usual 13) for this care. The documentation for three of these visits supports reporting 99212 while three of the visits have more extensive documentation that supports reporting 99213.

To add to it, post delivery, the patient experiences prolonged pain and irritation owing to a hemorrhoid. The ob-gyn tends to her for a thrombosed hemorrhoid, which he incises in the office two weeks post-delivery. In the end, the ob-gyn rechecks the patient at her six weeks postpartum visit.

Break it down: When coding for this patient, remember the claim form must note both the CPT codes describing the additional services as well as the diagnoses that depict why the patient required the additional services.

Heads up: Observe the fifth digits of these ICD-9-codes. The digit ‘3' that takes place in most of these codes has become a ‘4' in the last ICD-9 code to indicate a postpartum condition rather than an antepartum one. In other words, the patient has been discharged from the hospital after giving birth. Using ‘3' indicates she did not deliver during the hospital stay.

To add to it, after delivery, the patient experiences prolonged pain and irritation owing to a hemorrhoid. The ob-gyn sees her for a thrombosed hemorrhoid, which he incises in the office two weeks post delivery. In the end, the ob-gyn rechecks the patient at her six weeks postpartum visit.