Coding Q&A

Coding Q&A: Nov. 21, 2006

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Q: When billing for 29580/una boot can an ace bandage also be billed?

A: Such supplies such as an Ace bandage are included in the E/M code assignment: a CPT code is not assigned for those, but one may charge for the supply.

Christina Benjamin, RHIA, CCS, CCS-P
 



Q: As part of my internship with a multi-physician family practice (my third day on the job will be tomorrow), I am doing diagnosis coding. Last week one of the docs listed Jones Fracture as the patient's diagnosis. I was able to find Jones Fracture in my medical dictionary, but not in my IDC-9. Is there another name for this? The dictionary says this is often confused with an avulsion fracture. Thank you for your assistance.

A: A Jones fracture is a fracture of the fifth metatarsal of the foot. The fifth metatarsal is at the base of the small toe where the Jones fracture occurs. A Jones fracture enters the intermetatarsal joint. This is not to be confused with a fracture entering the tarsometarsal joint; that would be an avulsion fracture.

The ICD-9-CM code for Jones Fracture is 825.25. In Volume 2 of the Index to Diseases, the main term would be Fracture, followed by subterm, metatarus, metatarsal (bone(s)), of one foot, (closed). After locating the ICD-9-CM code in Volume 2, confirm the diagnosis code in Volume 1.

Source: www.wikipedia.org/wiki/Jones fracture

             2006 ICD-9-CM, American Medical Association

Letitia Patterson, MPA, CPC, CCS-P


Q: What is the best code for RADS (reactive airway dysfunction syndrome)?

A: RADS is also known as irritant-induced asthma. This would be coded as 493.0, Extrinsic asthma.

Leah Grebner, MS, RHIA, CCS
 



Q: Can I bill a 58555 Diagnostic Hysteroscopy and a Fractional Dilation & Currettage (D&C) as two separate procedures?

A: I can't tell from the limited information provided if this is facility or physician. A surgical hysteroscopy always includes a diagnostic hysteroscopy. However, it appears from the brief sentence that a diagnostic hysteroscopy was performed, the hysteroscope was then pulled out and then a fractional D&C was performed. If that is the case, yes, you may code 58555 and 58120. However, if any other procedures were provided in addition to these two, it would change coding. If this is a physician office, you need to consider payer requirements, preauthorization requirements and global period inclusions.

REIMBURSEMENT ISSUES:

Diagnostic hysteroscopy (58555) is a separate procedure by definition. As a result, it is bundled into the surgical hysteroscopy codes (58558 - 58565) by the OCE edits.

Multiple surgical hysteroscopy codes can be coded together. For example, if a hysteroscopy with D&C and leiomyomata removal were both performed during the same operative session both procedures can be coded. The physician may elect to perform a diagnostic laparoscopy (49320) with a hysteroscopy to view the outside and the inside of the uterus to arrive at a diagnosis. If the hysteroscopy is performed in conjunction with a diagnostic laparoscopy, each procedure should be coded and billed. The laparoscopy is paid at 100 percent while the hysteroscopy payment is reduced by 50 percent.

Surgical hysteroscopies 58558, 58559 and 58562 are reimbursed under APC 190. CPT codes 58560 and 58561 are reimbursed under APC 387, and CPT code 58565 is reimbursed under APC 202. Diagnostic hysteroscopy (58555) is reimbursed under APC 190.

CODING AND COMPLIANCE ISSUES:

When a hysteroscopy is performed for biopsy with a dilation and curettage (D&C) (57800), the D&C should not be coded separately. CPT code 58558, Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D&C is the only code that should be reported.

Hysteroscopies are discussed in the March 2000 issue (p. 4) and the November 1999 issue (p. 27) of the CPT Assistant. Hysteroscopy with D&C is discussed in the Fall 1994 issue (p. 6).

Arlene F. Baril, MS, RHIA
 



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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