Improve Your Common ED Airway Procedure Accuracy

Seconds count with airway tube insertions, however take a few minutes to learn these significant tips.

A recurrent presenting problem in the emergency department is a patient having trouble breathing owing to pulmonary disease, injury, or swelling of the throat tissues. You would normally report these encounters as high level ED visits or critical care due to the nature of the presenting problem; however you may also be able to report a procedure code in case it is correctly documented. Read on for advice on correctly documenting to support your airway services procedure medical coding.

1. Define Reason for Airway

The most general airway related procedure in the ED setting is endotracheal intubation where the patient has a compromised airway that requires stabilization.

Sample scenario: You should look for documentation describing tube placement similar to the following medical coding example:

A 24 year old female is brought in by her boyfriend from a picnic in a neighbouring park. Her face depicts signs of increasing swelling and she complains of having trouble breathing as if her throat is closing. She then reports a history of reactions to bee stings that have intensified in severity since she was a child. She is unclear that she was actually stung, but the boyfriend reports that there were bees present in the area and that they were seated near a large flower garden.

The emergency physician then orders an epinephrine injection, and as the patient had established increasing respiratory distress, places a tube down her throat to maintain her airway. After obtaining that limited history due to her breathing issues, an examination shows no other indication for the allergic reaction and he finds a likely sting site on the back of her neck. The patient reacts well to the epinephrine and then the swelling starts to subside after 40 minutes once she is admitted to the hospital. The physician afterwards documents 32 minutes of critical care time outside of distinctly billable procedures and then gives a diagnosis of anaphylaxis because of the bee sting.

On the claim, you would report the following for error-free medical coding:

99291 {Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes}

31500 {Intubation, endotracheal, emergency) for the tube placement}

989.5 {Toxic effect of other substances, chiefly non-medicinal as to source, venom}

E905.3 {Venomous animals and plants as the cause of poisoning and toxic reactions, hornets, wasps, and bees}

Medical Coding Tip: Apply the modifier 25 to 99291 to demonstrate that the intubation is distinct from the critical care services.

2. Critical Care? Scan for Time Details

You must keep in mind that in case the patient was reported as critical care, you should back out the time spent providing other procedures, for instance intubation, from your entire patient care time. A lot of payers require a statement in the documentation to that effect. Fortunately, most emergency physicians can place a tube rather rapidly.

ICD-9 Coding: Welcome the New Year with a Reminder of Alcohol Related Diagnoses

Ensure that you choose the accurate diagnosis code when alcohol is a factor of an ED visit

The New Year is approaching and with it comes an upsurge in alcohol-related presentations to the ED. Even though a lot of presenting problems are injuries or illnesses to which alcohol was a reason, it may be worth reviewing the numerous alcohol-related diagnoses that are available and when are they applicable in the ED setting. Read this article to know what ICD-9 codes apply for stress-free medical coding.

Take a look at some common patient types:

1. Patients who are brought in as they are impaired

It is not unusual for a highly intoxicated person to be brought to the ED by concerned friends, parents, or law enforcement officers as the patient seems to be unresponsive or dangerously intoxicated.

First let’s consider the patient, for whom no other diagnosis is probable, has come under medical care owing to the maladaptive effect of a drug on which he is not reliant on, and that he has taken on his own initiative to the damage of his health or social functioning, for instance a New Year’s Eve or a Super Bowl party. In this case, the patient has no history of alcohol dependency, but seems to have considerably exceeded his limit on this occasion.

ICD-9 codes that might apply are as following:

1. 305.0 (Nondependent alcohol abuse)
2. 305.00 (Nondependent alcohol abuse, unspecified drinking behaviour)
3. 305.01 (Nondependent alcohol abuse, continuous drinking behaviour)
4. 305.02 (Nondependent alcohol abuse, episodic drinking behaviour)
5. 305.03 (Nondependent alcohol abuse, in remission)

2. Patients whose condition is caused by long time alcohol abuse

The other end of the range is the long time alcohol abuser whose medical problems are directly credited to that history. Probable presentations involve hallucinations, seizures or delirium tremens. These patients may or may not be impaired at the time of their visit.

Frequently seen ED presentations can be reported with the following diagnosis ICD-9 codes:

291 (Alcohol induced mental disorders)

291.0 (Alcohol withdrawl delirium)

291.1 (Alcohol induced persisting amnestic disorder)

291.2 (Alcohol-induced persisting dementia)

291.3 (Alcohol-induced psychotic disorder with hallucinations)

291.4 (Idiosyncratic alcohol intoxication)

291.5 (Alcoholic-induced psychotic disorder with delusions)

291.8 (Other specified alcohol-induced mental disorders)

291.81 (Alcohol withdrawl)

291.9 (Unspecified alcohol-induced mental disorders)

Is it time for an Intervention? Deliberate behavior change intervention ICD-9 codes

Occasionally the trip to the ED for an alcohol-related injury turns into a chance for a screening and intervention to occur. Consider the patient who fell down the stairs because they were intoxicated or when alcohol appears to have contributed to MVA related injuries. Even though a busy ED is not the best place for this service, check the chart documentation to find if there is support for reporting the following ICD-9 codes:

99408 {Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes (Do not report services of less than 15 minutes with 99408}

99409 {greater than 30}

For further details on this and for other medical coding updates, sign up  http://www.supercoder.com/.

Perfect Your Fibroid Claims By Knowing These Removal Methods

Reporting uterine fibroid removals can be hard if you do not know the way the ob-gyn used to take care of the growth. Read this article and learn about each method of fibroid treatment, so you will be ready for whatever your ob-gyn chooses to carry out.

Medical Coding Method 1: Count Hysterectomy As Most Common Procedure

Hysterectomy is when the ob-gyn does away with the uterus completely. Even though this is the most common approach, it is used only when the fibroids are producing problems, for nstance abdominal pain or heavy bleeding. In case the uterus is not removed, there are chances are that the fibroids will reappear. When you execute the CPT lookup, the code assignment will hinge on on the type and extent of the hysterectomy.

Coding example: As the patient is older than 50 years and has multiple fibroids, your ob-gyn carries out a total abdominal hysterectomy (58150, Total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]). You would not code the fibroid removal distinctly if the ob-gyn is eliminating the uterus.

Medical Coding Method 2: Hem in Your Hysteroscopy Choices

Fibroids can also be treated using the hysteroscopic procedure. Hysteroscopic submucous resection gets rid of a portion of the protruding fibroid and preserves fertility.

The procedure needs “the close monitoring of distention media, electrosurgical devices, along with a patient’s anatomy to circumvent perforating the uterus. Ob-gyns normally carry out this straightforward approach for intracavitary (submucosal) fibroids.

Medical Coding Method 3: Master These Myomectomy Codes

Myomectomy (58140-58146, 58545-58546) is one more choice for fibroid treatment. A myomectomy is the removal of uterine fibroids only, which preserves fertility.

Example 1: The ob-gyn sees a 32-year-old patient who has never given birth to a child but wishes to. She goes through heavy menses with anemia.

On examination, the physician finds a 15-cm uterus with manifold fibroids that distort the endometrium. As the patient wants to have children, she chooses to have a myomectomy, which the ob-gyn carries out by the means of an laparoscopic approach. The pathology report shows six intramural myomas.

For this case, when you execute the CPT lookup, you must report 58545 (Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 g or less and/or removal of surface myomas).

Medical Coding Method 4: Make Use of UAE Option

You may see additional uterine fibroid embolization or uterine artery embolization (UAE) procedures. UAE is a nonsurgical, minimally invasive procedure that will shrink the fibroids by cutting off the blood supply.

The ob-gyn inserts a catheter through an artery in the leg to the arteries in the uterus. The physician then inserts tiny particles of plastic or gelatin through the arteries to cease the blood flow inside the fibroids. Devoid of blood flow, the fibroids shrink or may even disappear over time.

In case this method is followed, once you do the CPT lookup, you’ll report using 37210 (Uterine fibroid embolization [UFE, embolization of the uterine arteries to treat uterine fibroids, leiomyomata], percutaneous approach inclusive of vascular access, vessel selection, embolization, and all radiological supervision and interpretation, intraprocedural roadmapping, and image guidance necessary to complete the procedure).

For further details on this and for other medical coding updates, sign up  http://www.supercoder.com/.

Hone Your Neuroendoscopy Coding Skills With These Easy Steps

You should ever use these codes for open surgery and endoscopy together.

In case your neurosurgeon carries out neuroendoscopy services during cranial procedures, you must never report the service with open procedures or else you might end up missing on reimbursement opportunities. Read this article to side-step errors in medical coding.

Codes to remember: While reporting the neuroendoscopy procedures, you will require choosing from the CPT codes 62161 (Neuroendoscopy, intracranial; with dissection of adhesions, fenestration of septum pellucidum or intraventricular cysts [including placement, replacement or removal of ventricular catheter]) – 62165 (Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or trans-sphenoidal approach) and the add-on code + 62160 (Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage [list separately in addition to code for primary procedure]).

1. Segregate Endoscopy from Open Codes

The surgeon may adopt either of the two choices to treat the problem, but he will never use both of them at the same time. He may either insert an endoscope to treat the underlying condition or may adopt an open approach for instance the affected area is surgically opened up to address the pathology. Neuroendoscopy CPT codes are definitive and independent. So, you cannot report neuroendoscopy codes with codes for parallel open procedures.

Example: In case your neurosurgeon undertakes an open approach to obliterate a supratentorial tumor which is not a meningioma, you would report 61510 (Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma). On the other hand if he adopts a neuroendoscopic procedure to accomplish the excision of the tumor, you would report 62164(Neuroendoscopy, intracranial; with excision of brain tumor, including placement of external ventricular catheter for drainage). This includes placement of a ventricular catheter for drainage.

Cautionary tip: You must be cautious to not report the codes for open and neuroendoscopic stand-alone procedures at the same time. Remember that you cannot report 61510 and 62164 together. The reason being that in one session, the surgeon can adopt either approach but not both to address the underlying pathology.

Exception: If your surgeon provides a detailed explanation of an accompanying procedure in the operative note, you can report 62160. CPT® allows this add-on code to be reported with primary procedure CPT codes like 62220, 62223, 62225 and 62230. CPT® made the neuroendoscopy codes to stand apart from open procedures, again, with the exception of 62160.

2. Beware the Bundles

You must never report a twist drill, cranial burr hole, or trephine along with the neuroendoscope code; NCCI bundles these access CPT codes with the endoscopy itself. The burr hole is assumed or included in the neuroendoscopy code(s), as you can’t do the neuroendoscopy excluding a burr hole, however you can do a burr hole excluding neuroendoscopy. In case twist drill, cranial burr, or trephine are carried out at the same time neuroendoscopy is, you would report only neuroendoscopy

CPT® 2012 Clarifications: Pediatric Hospital Rounds Will Be Stress-free to Code

Distinguish the common types of pediatric hospital visits and you'll be on the road to correct medical coding.

Though most pediatricians assess newborn inpatients as part of their fixed weekly work, some practices struggle with how to code such services. However once you break it down into the below listed most common categories of inpatient E/M rounds, you could be sending claims out the door sooner and more competently. Read this article for correct medical coding and know what CPT codes apply in this situation.

Check NICU Changes for CPT 2012

Two of the most severe types of infant hospital visits include time with intensive care or critical care. In both of such cases, the pediatrician has to go above and beyond what's needed when seeing a healthy newborn--and coding such visits can be a challenge.

The issue of level of care delivered is not specific to the site of service. Though, neonatal critical and intensive care services are normally provided in a NICU.

Intensive care: Assume that a baby is tachypneic with a fever as a newborn and is worked up and is getting treatment for sepsis. The pediatrician gives a neonatal intensive level of care, carrying out daily intensive care services. In these situations you'll report a code from the 99477-99480 series of CPT codes.

Critical care: After the pediatrician examines a patient for more austere issues—for instance organ system failure or serious respiratory distress--he might decide that the patient is in need of critical care, which you'll code using the 99468-99469 series of CPT codes. In a lot of cases, critical care would be administered by a neonatologist.

Changes for CPT 2012: Earlier, in case a patient was transferred from neonatal intensive to critical care--or vice versa--the coding rules were blurred. But, CPT 2012 clarifies that issue with parenthetical notes to guide you in making the correct CPT codes decision.

What CPT® now makes clear is that in case an infant recovers after the initial day and is transferred to a lower level of care, the transferring physician does not report a per-day intensive care service. In its place, the transferring doctor will report a code from the subsequent hospital care section (99231-99233) of CPT®. The receiving physician will report subsequent intensive care (99478-99480) or subsequent hospital care (99231-99233) as suitable based on the condition of the neonate or child.

In case the physician provides intensive care services but then the patient becomes critically ill and then is transferred to a dissimilar physician, the transferring physician reports either the critical hourly care service (99291-99292) or the daily intensive care service carried out , but not both.

Welcome Car Seat Testing Codes Effective Jan. 1

Plus: You'll find explanation on developmental testing codes 96110-96111.

Previous year, coders got a good dose of updates--and confusion--with the inclusion of numerous new vaccine administration codes. CPT 2012 goes lenient on pediatric practices with a few modifications to the code set which will generate the necessity for updates, but not overhauls. Read this article for stress-free and accurate medical coding.

At the top of the list this year, you'll find the following new CPT codes for car seat testing:

94780 – (Car seat/bed testing for airway integrity, neonate, with continual nursing observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with interpretation and report; 60 minutes)

+94781 – {...each additional full 30 minutes (List separately in addition to code for primary procedure)}

The car seat testing services will mainly be done in facility settings; however will be valued with facility and non-facility payment amounts. These tests are usually essential before premature or at-risk babies (with conditions such as heart disease or congenital malformations) are discharged home from NICU settings.

There are occasions where follow-up testing may be indicated. "This would normally be provided in a neonatal follow-up clinic, however could be carried out in the office setting, in case the setup is complete to offer all the necessities for the code. As more services shift to the medical home, this could happen more in the future. Having the CPT codes and the anticipated relative value payments should facilitate the process.

For More Information :- http://isupercoder.blogspot.in/2011/12/welcome-car-seat-testing-codes.html

Developmental 'Testing' Modifies to 'Screening'

New CPT codes are always great to find in CPT®, however occasionally you'll find changes that make significant explanations to present codes. Such is the case with existing developmental testing CPT codes 96110-96111. The new descriptors for these codes are listed below:

96110 – (Developmental screening, with interpretation and report, per standardized instrument form)

96111 – (Developmental testing, (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments), with interpretation and report)

Medical Coding Tip: Take Note of Vaccine Revisions

Last year, in pediatric medical coding, CPT® threw many practices for a loop with the adding of several new vaccine administration codes, which most payers finally began processing efficiently within the last few months. Luckily, such a main overhaul has not taken place this year. Instead, CPT® makes slight adjustments to how you'll report your vaccines for accurate medical coding.

For instance: CPT® will change meningococcal conjugate vaccine code 90644 to get rid of mention of "Hib-MenCY-TT." In its place, the new code descriptor reads "Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine (Hib-MenCY), 4-dose schedule, when administered to children 2-15 months of age, for intramuscular use.

CCI Edits 17.3: 32422, 71010 Bundle -- And More -- Enhance Your Pulmonary Coding Options

Immunotherapy code Q2043 is anot an area of concern for pulmonologists, and should be an oncology issue.

The most recent Correct Coding Initiative (CCI) edits bundle chest radiologic guidance along with numerous procedures on the lungs and pleura, and even though CCI edits 17.3 assemble immunotherapy code Q2043 with lots of ventilation and gas procedures, you must not worry -- here's why. Read this article for accurate medical coding.

Establish Chest X-ray Distinctness From Thoracentesis To Ignore Bundle

For the newest CCI edits version, you must keep an eye on bundled chest x-rays as well as chest tube procedures. Particularly, both 71010 (Radiologic examination, chest; single view, frontal) along with71020 (Radiologic examination, chest, 2 views, frontal and lateral) become parts of:

32422 – {Thoracentesis with insertion of tube, includes water seal (e.g., for pneumothorax), when performed (separate procedure)}

32550 – {Insertion of indwelling tunneled pleural catheter with cuff}

32551 – {Tube thoracostomy, includes water seal (e.g., for abscess, hemothorax, empyema), when performed (separate procedure)}

93503 – {Insertion and placement of flow directed catheter (e.g., Swan-Ganz) for monitoring purposes.}

CCI edits mention the motive for the bundle as wrongly using column two code with column one code. These CCI edits have a modifier indicator of "1", consequently you may overrule the edits with a modifier (i.e., modifier 59, Distinct procedural service) on the column 2 code when the services are different.

Example: A patient with COPD (490-496) gets admitted with shortness of breath (786.05) along with chest pain (786.5), deteriorating with inspiration. A chest x-ray (71010) prove pneumothorax (512.x) and the patient must go through thoracentesis with insertion of tube (32422) to get rid of the excess air and let the lung re-expansion. In this sceanrio, you would report 32422, 71010-59 to point out that the chest x-ray was different from the thoracentesis.

For More Info :- http://www.supercoder.com/coding-newsletters/my-pulmonology-coding-alert/cci-edits-173-32422-71010-bundle-and-more-improve-your-pulmonary-coding-options-this-quarter-108569-article

Take note: Pulmonary specific guidelines preside over the abovementioned Column 1 codes. For example when coding 32422, you must consider a dissimilar radiologic guidance code for catheter placement/confirmation (e.g., 76942, 77002, 77012), which more precisely reflects the service description, method as well as service time linked with the procedural guidance provided.

The similar guidelines are applicable to 32550-32551. In other words, you must consider code 75989 (Radiological guidance [i.e., fluoroscopy, ultrasound, or computed tomography], for percutaneous drainage [e.g., abscess, specimen collection], with placement of catheter, radiological supervision and interpretation) to signify radiologic guidance for catheter placement/confirmation.

Medical Coding Tip: Remember that you must use 71010 and 71020 simply for radiologic examination of the chest, and not to assist or substantiate needle placement.