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Ask the Experts: Feb. 21, 2012

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Q: I have some doubts regarding coding of pregnancy cases for which I need some clarification. If normal delivery of the baby occurs but conditions like smoking, asthma or any other condition or disease also exist and are documented in the medical record as risk factors or problems identified, does it mean these conditions affect the current pregnancy and is it a complication of pregnancy? Or do we just code the conditions that are under active treatment (using medicines) as a complication of pregnancy?

A: The official coding guidelines state that, "Obstetric cases require codes from chapter 11, codes in the range 630-679, Complications of Pregnancy, Childbirth, and the Puerperium. Chapter 11 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with chapter 11 codes to further specify conditions. Should the provider document that the pregnancy is incidental to the encounter, then code V22.2 should be used in place of any chapter 11 codes. It is the provider's responsibility to state that the condition being treated is not affecting the pregnancy."  If the physician documents a mother's medical condition as a risk factor, the condition should be assigned using a code form Chapter 11.
-June Wang, MS, RHIT, CCS, CCS-P

Q: How should decompressive laminectomy be coded? Is it 0SB-Root Operation Excision, 00N- Root Operation Release or both? Lynn Kuehn author of ICD-10-PCS Applied Approach (p. 632) uses the rationale that a nerve root is released by the removal of some of the intervertebral disc. However from another resource, ICD-10-CM and ICD-10-PCS Coding Handbook 2012 with answers, by Nelly Leon-Chisen, RHIA (p. 303) uses OSB for excision. Please clarify the correct root operation for this procedure.

A: My recommended code for decompressive laminectomy is OON with root operation release because the actual action done is to free the nerve root and that meets the definition of the root operation release. 
-Christina Benjamin, MA, RHIA, CCS, CCS-P

Q: Please clarify the CPT coding assignment for the post breast reconstruction/revision by using autologous fat injection: Recently, CPT Assistant (December 2011, Vol. 21, Issue 12, page 14, question 2) says to use 19366 (or 19380?) for this procedure. However, AHA Coding Clinic for HCPCS (Vol. 10, No. 4, 4th Quarter 2010, Ask the Editor, question 7) says to report 20926 for this procedure. Which one should we be following for coding post breast reconstruction/revision by using autologous fat injection? Also, what CPT code should be selected in 2012 for revision of reconstruction breast with placement of AlloDerm dermal matrix?

A: 19366 should be assigned for this procedure because of its specificity. 20926 is a genetic code, which does not fully describe the procedure performed. Here is the description of code 19366:

 The physician excises skin, fat, and/or muscle from another site on the patient for use in the reconstruction of the breast following a modified radical or radical mastectomy. The tissue is excised and the operative wound is sutured in a layered repair. In preparation for the graft, any mastectomy scar is excised. The tissue is transferred to the mastectomy site. The physician adjusts the flap for the most aesthetic appearance and secures it with sutures to the chest wall, adjacent muscles, and skin. An operating microscope may be employed. If the tissue does not have sufficient bulk, a breast implant may be required. The chest incision is repaired with sutures.
- Bella Logvinov MBA, CCS, CPC

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