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Meet the Panelists | Submit Your Question
Q: My question pertains to the definition of a concurrent IV infusion. It is clear that if two therapeutic substances (in separate bags) are administered at the same time through the same IV site, the add-on code 96368 should be used to report the second substance. What if two drugs are infused at the same time through different IV sites? Is this considered a concurrent infusion, or a subsequent infusion for CPT coding purposes?
A: Per CMS 100-04 Medicare claim process manual, Chapter 4, section 230, one initial drug administration service is to be reported per vascular access site per encounter. If two drugs are infused at the same time through different IV sites, two units of initial infusion code can be reported.
June Wang, MS, RHIT, CCS, CCS-P
Q: I have a patient who had a Nissen Fundoplication performed a few months ago after being diagnosed with gastroesophageal reflux disease. The Nissen has slipped now and I'm trying to code this diagnosis for the re-do surgery. Diagnosis: Slipped Nissen. I can't find any ICD-9 code that fits this. Please help! Thanks!
A: Slippage of Nissen fundoplication:
This is coded as 997.4 (Digestive system complications). Coding Clinic 2nd quarter, 2001, pages 4-6, addresses the problem of Nissen wrap slippage, and lists the codes for both the diagnosis and the procedure. Code 44.66 (other procedures for creation of esophagogastric sphincteric competence) is the proper procedure code.
Per the Coding Clinic, code also any problems, such as reflux, dysphagia, heartburn, etc. that resulted from the Nissen slippage.
Rebecca Campbell, MBA, RHIA
Q: We have a debate raging in our office. Half the coders maintain that "dyspnea" and "shortness of breath" are used interchangably. Others state that because there are two different codes in the ICD-9, they are separate things. Could you clarify this issue for us? Some of the LCDs will only pay for one or the other, so this affects reimbursement.
A: The term dyspnea and shortness of breath have two different definitions and code assignments. Per Tabers's Cyclopedic Medical Dictionary dyspnea is air hunger resulting in labored or difficult breathing sometimes accompanied by pain. This is due to insufficient oxygenation of the blood. Symptoms include: audible labored breathing, distressed anxious expression, dilated nostrils, protrusion of abdomen and expanded chest, gasping and/or marked cyanosis. Shortness is the inability to adequately inspirate the lungs of breath and is not to be used interchangeably with dyspnea. Both have two different codes. You can always query your physicians when it is unclear as to which diagnosis the patient has.
Mary Mills, RHIT, CCS
Q: I code for psychiatry and there is a psychologist who just got back his external audit results and the auditor is telling him that for his individual psychotherapy visits he must indicate the time of the visit in his documentation. I cannot find anything anywhere that specifies time has to be documented for individual psychotherapy. Can you verify for me if time needs to be documented and if so, where I can find it in writing?
A: CMS does require that mental health providers document in the medical record the time spent with the patient. Please see the statement from MLN Matters Number SE0816 below:
MLN Matters Number: SE0816
Medicare Payments for Part B Mental Health Services
"The OIG's report found that the majority of miscoded individual psychotherapy claims lacked documentation to justify the time billed. Individual psychotherapy can be billed as one of three time periods: 20 to 30 minutes, 45 to 50 minutes, or 75 to 80 minutes. Because reimbursement of psychotherapy services is based on face-to-face time spent with the patient, practitioners are required to document in the medical record the time spent with the patient. Providers must note that Section 1833(e) of the Act requires that providers furnish "such information as may be necessary to determine the amounts due" to receive Medicare payment." One of the principal causes of miscoded services occurs because no time is documented. When this happens, the services should be billed at the lowest possible time period.
Amy Hodges, CPC, CPC-I
The consultants, their companies and ADVANCE do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information.
Coding Clinic is published quarterly by the American Hospital Association
CPT is a registered trademark of the American Medical Association.
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