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Coding Q&A: Feb. 15, 2005

Q: Is 90862 the correct code to use for medication management in a 1 hour group setting? Or is there another more appropriate code?

A: This answer would be dependent upon what else occurred in the group session. If psychotherapy were provided, it would be more appropriate to assign 90853 or 90857. It seems unlikely that a 1 hour session with a group would only provide medication management. It also seems unlikely that medication management would occur in a group setting.

Leah Grebner, RHIA, CCS

Q: What is the correct ICD-9 code to use when the physician's diagnosis is: Abnormal CT of Chest?

A: First of all you need more information as to what part of the chest was scanned. If it was of the intrathoracic organs, you would use code 793.2. If it was of the lung, you would code 793.1. If it is of the soft tissues or other, you would code the 793.9 for other radiological findings. Additional documentation will assist in accurate coding. Abnormal CT scans code to abnormal radiological findings. I hope this helps.

Mary Mills, RHIT, CCS

Q: What is the ICD-9 code for abdominal sepsis? What is the ICD-9 code for pseudomonas? What is the ICD-9 code for C Difficile Colitis?

A: There were three parts to your question so I will answer each separately. The first question pertained to coding of abdominal sepsis or intraabdominal sepsis.

Intraabdominal sepsis most frequently follows penetrating or blunt abdominal trauma or perforated appendicitis or diverticulitis. The resulting initial leakage of gastrointestinal microflora into the peritoneal cavity results in peritonitis and secondary sepsis. Primary treatment of abdominal sepsis focuses upon immediate surgical intervention to alleviate the source or contributing factor to intraabdominal sepsis.

The ICD-9 code for "abdominal sepsis" would come from the 038 series, depending upon if the organism was identified and documented by the physician. You would also need to assign an additional code for the abdominal condition that led to the sepsis.

The second question pertains to coding of pseudomonas. Pseudomonas is a type of organism, specifically, motile gram negative bacteria rods that are clinically relevant in that they are resistant to most antibiotics and they are able to survive in conditions that few other organisms may tolerate. Pseudomonas infections are possible at numerous sites leading to UTIs, sepsis, pneumonia and pharyngitis to name a few. To properly code a pseudomonas infection, you would need the type of infection such as UTI, (599.0 and 041.7) or pseudomonas pneumonia (482.1).

C. Difficile Colitis is coded as 008.45, found in ICD-9 by first looking up Enteritis, then Clostridium and then difficile.

Glenn Krauss, RHIA, CCS, CCS-P

Q: Any idea on an ICD-9 code for Pseudomonas Xeroginosa and Line (or Linc) Sepsis?

A: I found no exact definition for the variety of Pseudomonas described as Xeroginosa. Xero is a prefix that means dry (Gr.). In any case, by ICD-9-CM classification, the genus of gram-negative bacilli known as Pseudomonas is classified to 041.7, Infection, pseudomonas, NEC or 038.43, Septicemia, pseudomonas.

For your next question regarding line sepsis, I will assume that you are asking about an infection due to a vascular access device. The latest clarification to date on this coding issue can be found in Coding Clinic, 2Q 2004, p. 16. The code assignment sequence is 996.62, Infection and inflammatory reaction due to other vascular catheter, followed by one of the appropriate codes from 038 septicemia category, and finally a code from the SIRS subcategory 995.9.

Kathy Myrick, RHIT, CCS

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.

ICD Q & A Archives


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