ICD Q & A

Coding Q&A: Oct. 25, 2005

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Q: I have been told that hospitals must report the implanting of AICDs, other than by CPT to CMS as an implant. Anyone have info on the procedure for this?

A: The only thing I know for sure is the HCPCS codes are G0297, G0298, G0299 and G0300 for CMS.  I hope this helps. 

Jean Ryan-Niemackl, LPN, CPC
 



Q: When coding a Hysteroscopy with a fractional D&C, would the endocervical curettage be coded separately, 57505, in addition to the Hysteroscopy with D&C code, 58558? Or would the 58558 code cover the endocervical curettage already?

A: Referring to the code descriptions, CPT code 58558 describes a surgical hysteroscopy with sampling (biopsy) of endometrium and/or polypectomy, with or without D&C. CPT code 57505 describes an endocervical curretage (not done as part of dilation and curretage). CPT code 58558, by virtue of its description, includes a dilation and curretage. Accordingly, you are generally precluded from coding 58558 with 57505 because the CPT description of 57505 specifically states "not done as part of dilation and curretage." It may be conceivable but not very likely that an endocervical curretage (separate from a D&C) would be performed at the very same session as a surgical hysteroscopy with biopsy of endometrium and/or polypectomy since all the procedures described by code 58558 have a tendency to be performed together.

Glenn Krauss, RHIA, CCS, CCS-P
 



Q: How would you code this procedure, as a colonoscopy (reduced services) or flexible sigmoidscopy (unusual services)? The pediatric patient has had either a colon resection or bowel transplant and there is no splenic flexure. The scope is entered through the rectum and reaches the ileum, as stated there is either none or very little large bowel. Because this is a pediatric patient, it is very difficult with twists and turns even though the entire colon is not there.

A: I could not find an official source to answer your exact question.

The description you provide of the scope entering through the rectum and ending as reaching the ileum describes code 45378, Colonoscopy, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure).

Please look at the description of a colonoscopy under the Digestive System / Surgery subsection Endoscopy. As states "Colonoscopy is the examination of the entire colon, from the rectum to the cecum, and may include the examination of the terminal ileum". The basic service that this code describes was provided.

I do not believe that your description meets the definition of a reduced service just because the patient's anatomy has been altered. In order to append modifier 52, the service would not be completed due to extenuating circumstances, reduced or eliminated at the physician's discretion, time was not a factor in the code description, and the bilateral possibility does not apply to the colon (CPT Assistant, September 2003).

Kathy Myrick, RHIT, CCS
 



Q: Is it correct for a facility to bill for infusion pump in addition to ICU charges? I thought the pump should be part of the ICU charge.

A: A general rule of thumb is that Medicare does not reimburse directly for equipment associated with treating patients and this is applicable to infusion pumps used in the ICU. Capital related equipment is reimbursed indirectly through the Medicare cost reporting mechanism, which is filed yearly by inpatient short-term acute care hospitals. The facility's daily patient ICU charge should reflect the care provided to the patient as part of ICU stays including all the monitoring equipment employed in managing the critically ill patient.

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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