Q: If a patient is admitted as an inpatient and receives hemodialysis several times during the hospital stay, should the dialysis procedure code be coded each day they receive dialysis?
A: Several hospitals that I know of only code the hemodialysis once during an inpatient admission. There is nothing in coding clinic to direct a coder to code hemodialysis more than once during an inpatient admission. It is up to the hospitals internal policy as to how many times a coder should code the same non-operative procedure performed during the same admission for reporting. I hope this helps.
Mary Mills, RHIT, CCS
Q: During lysis of extensive adhesions, the surgeon creates a colonic serosal tear with subsequent repair of a 2 by 6mm flap, which was tacked down and repaired with a running 3-0 silk. Would you code this as an accidental laceration? The physician believes that this tear is insignificant and not code worthy. My coders disagree.
A: This is a touchy answer. Technically speaking this is part of the "risks" the physician discusses with the patient. When these situations occur we can technically code for them. However PR-wise this isn't something I would probably code for. This is just my opinion, BUT to be absolutely clear, if the physician documented the repair it may be coded.
Jean Ryan-Niemackl, LPN, CPC
Q: A patient presents to the ED with partially amputated digits. Some coders at our facility are struggling with the correct procedure codes for a partial amputation of the 3rd and 4th distal phalanges of the left hand. Plastic Surgery ronguered the bone back, flapped the skin and applied sutures. Could you give us the correct ICD-9 procedures and CPT codes? The above information is all we had to work with as far as procedural description is concerned.
A: The term "partial" is not mentioned in either code set and that may be a source of confusion. There is little advice on this subject; however the CPT code description for codes 26951-26952 in the 2005 Coder's Desk Reference by Ingenix, is helpful in that it explains in part that the primary amputation service follows injury or infection. The ICD-9-CM classifies amputations of upper limb to codes 84.00-84.09 and there is a series of helpful terms listed describing further the types of amputation including revision of current traumatic amputation.
Based on the information you provide, the surgeon is completing the amputation of the partially traumatic amputated distal 3rd and 4th phalanges of the left hand for repair. Assign ICD-9-CM code 84.01, Amputation and disarticulation of finger. Assign for each finger repaired CPT code 26952, Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with local advancement flaps (V-Y, hood). HCPCS Level II finger modifiers can be appended per FI/Carrier specifications.
Kathy Myrick, RHIT, CCS
Q: What are the new Medicare changes for PET scans and how do you bill for them?
A: Beginning April 4, 2005, the following codes will no longer be valid for the Centers for Medicare and Medicaid Services (CMS):
G0296 and G0336
A new HCPCS code G0235 was added but is not covered currently.
The codes that must be used beginning April 4th for CMS are:
78459-Myocardial imaging, positron emission tomography (PET), metabolic evaluation
78491-Myocardial imaging, positron emission tomography (PET), perfusion; single study at rest or stress
78492-Myocardial imaging, positron emission tomography (PET), perfusion; multiple studies at rest and/or stress
78608-Brain imaging, positron emission tomography (PET); metabolic evaluation
78609-Brain imaging, positron emission tomography (PET); perfusion evaluation
78811-Tumor imaging, positron emission tomography (PET); limited area (e.g., chest, head/neck)
78812-Tumor imaging, positron emission tomography (PET); skull base to mid-thigh
78813-Tumor imaging, positron emission tomography (PET); whole body
78814-Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; limited area (e.g., chest, head/neck)
78815-Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; skull base to mid-thigh
78816-Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; whole body
The codes indicate the type of procedures performed, but do not give specific indications as the G codes did.
According to CMS the changes are retroactive to Jan. 30, 2005, and you must notify CMS to get the claims adjusted and paid, it will not be automatic.
Two G codes are still effective:
G0219-PET imaging whole body; melanoma for non-covered indications and
G0252-PET imaging, full and partial-ring PET scanners only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (e.g. initial staging of axillary lymph nodes)
For further information regarding the PET CPT codes and the new codes added, a good reference is the AMA publication "CPT Changes, An Insiders view 2005.
Deborah Grider, CPC, CPC-H, CCS-P, CCP
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Coding Clinic is published quarterly by the American Hospital Association
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