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Coding Q&A: Jan. 4, 2005

Q: Is it true that Medicare will pay for a preventive office visit w/pap starting 2005? What is the correct way to bill this?

A: CMS Transmittal 417, published on Dec. 22, 2004, provides for an Initial Preventative Physical Examination (IPPE) for new Medicare beneficiaries effective Jan. 1, 2005. The transmittal states that, "Medicare will pay for ONE IPPE per beneficiary per lifetime." Code G0344, Initial preventative physical examination; face-to-face visit, services limited to new beneficiary during the first 6 months of Medicare enrollment, has been developed for reporting this service. Coverage for screening pap smears is defined in section 1861 of 42CFR410.16(a).

CMS Transmittal 128, published on Dec. 10, 2004, outlines Medicare's preventative benefits and services on an annual basis. The information in this transmittal is also effective Jan. 1, 2005. This transmittal states, "Medicare helps pay for screening Pap tests every 24 months. For more information about Pap tests, call 1-800-633-4227."  I would suggest checking out this transmittal at as it provides contact information based on your state.

Leah Grebner, RHIA, CCS

Q: The hospital I work for has recently started transferring some patients to Swing Bed status. I cannot find any information as to how to code these Swing Bed visits. Do we use the same diagnosis codes as on the inpatient chart or is the principal diagnosis a V-code along with the inpatient diagnoses?

A: Keep in mind that swing beds are authorized in critical access hospitals located in rural areas as well as noncritical access hospitals. Swing beds provide both hospital and SNF services. As with any inpatient case, the documentation in the medical record and the circumstances of admission govern the assignment of the principal diagnosis. If the patient's acute condition such as MI or infarct is continuing to be managed in the swing bed, then the acute condition is assigned as principal diagnosis. If the sequele of the acute condition is being managed in the swing bed, such as late effects of the cerebral infarction, then this would be considered the principal diagnosis.

Glenn Krauss, RHIA, CCS, CCS-P

Q: CPT code 58661, Laparoscopy surgical; with removal of adenexal structures(partial or total oophorectomy and/or salpingectomy) is not designated as a unilateral or bilateral procedure. There was a CPT Assistant, January 2002 p. 11, stating CPT code 58661 describes a unilateral procedure. Therefore, append CPT code 58661 with modifier -50, to indicate bilateral procedure. I am a little confused. In the Laparoscopy section CPT code range 58660-58679. ( Codes 58673 and 58679 are used to report unilateral procedures. For bilateral procedure, use modifier 50). It does not indicate that CPT code 58661 is a unilateral procedure. My question is, is it necessary to append the modifier -50 for bilateral removal, when it is not listed as a unilateral procedure, whereas, codes 58673 and 58679 are designated as a unilateral procedure?

A: From looking at the codes in the CPT book and the information provided by the CPT Assistant, I would follow the CPT Assistant advice on using the modifier 50 for CPT code 58661 to show it was a bilateral procedure. I looked at the notation in the CPT book under code 58673, and it states that codes 58672 and 58673 are used to report unilateral procedures and modifier 50 should be used if a bilateral procedure was done. It does not comment on the remaining code range as to whether they are unilateral or bilateral procedures in the CPT book like it does under code 58673. The code 58661 has a CPT Assistant quote pertaining to that code that specifically states to use a modifier for bilateral procedures when reporting that code. When reading the description of all the other codes, 58662 - 58671, they use terms that are pleural such as occlusion of oviducts meaning bilateral would be included in this code and no modifier would be necessary. Only code 58661 gives instruction to use a bilateral modifier through the CPT Assistant. You would not use a modifier on code 58679 because it is an unlisted procedure. I hope this helps.

Mary Mills, RHIT, CCS

Q: Should the code for Congestive Heart Failure (428.0) always be added as a secondary code, for an inpatient with the history of the disease, but not currently on any medication for it; and, the admission is not associated with the CHF, but for orthopedic surgery?

A: I am responding to your recent coding question pertaining to the applicability of assigning a code for CHF as a secondary condition. A cardinal rule of coding is that chronic conditions must meet the UHDDS definition of other diagnoses to justify assignment as a secondary condition. According to the Official Guidelines for Coding & Reporting, for reporting purposes the definition for "Other Diagnoses" is interpreted as additional conditions that affect patient care in terms of requiring :

1) Clinical evaluation; or

2) Therapeutic treatment; or

3) Diagnostic Procedures; or

4) Extended length of stay; or

5) Increased nursing care and/or monitoring.

In the case you describe where the patient is admitted for scheduled orthopedic surgery and the H&P notes a "history" of CHF, it is not justified in assigning an additional code for the CHF. Because the patient is not under any active management for the CHF, the condition in and of itself does not meet the definition of "other diagnoses" and thus should not be reported. Now, if the patient goes into CHF anytime during the hospital stay necessitating specific clinical management such as institution of a diuretic, then the reporting of the condition is warranted and justifiable.

Glenn Krauss, RHIA, CCS, CCS-P

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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