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A: No, a lab test confirmation is not needed.only a definite and certain diagnosis from the physician is adequate. This is per the updated guidelines effective Oct. 1, 2009, which state: "Code only confirmed cases of avian influenza (code 488.0, Influenza due to identified avian influenza virus) or novel H1N1 influenza virus (H1N1 or swine flu, code 488.1). This is an exception to the hospital inpatient guideline Section II, H. (Uncertain Diagnosis).

In this context, "confirmation" does not require documentation of positive laboratory testing specific for avian or novel H1N1influenza. However, coding should be based on the provider's diagnostic statement that the patient has avian or novel H1N1 (H1N1 or swine flu) influenza.

If the provider records "suspected or possible or probable avian or novel H1N1 influenza (H1N1 or swine flu)," the appropriate influenza code from category 487 should be assigned. A code from category 488, Influenza due to certain identified influenza viruses, should not be assigned."

Christina Benjamin, MA, RHIA, CCS, CCS-P

Q: What is the correct way to code bilateral inguinal hernias when just one side is recurrent? Should both 550.90 and 550.91 be used to show that one side is recurrent and the other side is not, or should one just use 550.93? In my study guides, I have seen this situation coded both ways. Obviously, one of my books has incorrectly coded this scenario.

A: As per Coding Clinic, November-December 1985, p. 12: "The fifth digit "3" is used to identify bilateral hernia when one or both of the hernias are diagnosed as recurrent." The correct code assignment would be 550.93.

Arlene Baril, MS, RHIA

Q: Does this documentation support CPT 14000 flap closure?

Surgical scar 4-5 cm. Path states melanoma re-excision of 9.1 x 1.6 x 0.9 cm PROCEDURE: wide excision of the right flank primary tumor site A 2 cm radial margin was measured around the primary excision site. An elliptical incision was placed excising the entire incision of the previous tumor excision. Incision was placed with the scalpel in an elliptical fashion encompassing the entire previous incision with at least 2 cm radial margins, which were measured. Dissection was carried through the subcutaneous tissues with the use of the Bovie electrocautery down to the muscle fascia of the abdominal wall. The specimen was excised off of the abdominal wall with the use of the Bovie electrocautery and sent as specimen. The specimen was marked with a short silk suture superior and a long silk suture posterior. Flaps were then raised inferiorly and superiorly after injecting more local anesthetic in the plane between the subcutaneous tissues and the muscle fascia on each side. The flaps were raised retracting with small rakes and incising in the plane with the use of the Bovie electrocautery. This was accomplished both inferiorly and superiorly for approximately 4 to 5 cm in each direction. This allows primary closure of the excision site with a layer of interrupted 3-0 Vicryl sutures in the subcutaneous tissue and a 4-0 Vicryl sutures in a running subcuticular fashion in the skin.

A: It should be 14001 (between 10.1 to 30.0 sq cm).

June Wang, MS, RHIT, CCS, CCS-P

Q: Would a G0121 screening colonoscopy be changed to a 45378 or other diagnostic colonoscopy CPT if diverticulosis or internal hemorrhoids were found but nothing was done to either?

A: No, continue to use the G0121 code for the screening colonoscopy. The diverticulitis and/or hemorrhoids were incidental findings. You might want to review the Coding Clinics and CPT Assistant articles regarding screenings.

Rebecca Campbell, MBA, RHIA

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