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Q: Can anyone give me information on the codes for G0328 or 82274, does Medicare want the code G0328 instead of 82274 to be billed?
A: The question is very vague, but here are my suggestions:
1. Review code descriptions as there are differences between them, against actual procedure performed to ensure correct coding/billing
G0328: Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous
82274: Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations. Coders Desk Reference: Fecal sample is dispersed in a diluent with antibodies for hemoglobin antigen to form a complex of antibody and antigen. A complex of antibody and antigen is separated from the specimen and exposed to a second antibody for the hemoglobin antigen. A sample from the first complex is bound to a solid carrier, and a sample from the second antibody exposure is labeled with a detection agent to determine the presence of hemoglobin antigen in the original fecal specimen. This code requires one to three consecutive stool samples, which must be obtained from separate bowel movements, and each sample must be placed in a sterile, leakproof container with a screw-cap lid for transport to the laboratory.
2. Check with your local FI/MAC to determine what code is acceptable.
- Tasha Cameron, RHIA, CCS, CDIP
Q: How would you code a "Surveillance Colonoscopy"? Doesn't one need more information to code this? There is no other indication on the report.
A: Surveillance colonoscopy: CPT 45378 Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)
Medicare: G0105 - Colon cancer screening; colonoscopy on individual at high risk.
Click here to view a CMS reference, MedLearn Matters, on the subject
NOTE: There are criteria for screening vs. surveillance. If the patient meets the surveillance criteria (has had a history of a qualifying condition), as indicated here, these are the applicable codes. Be sure to check for payer guidelines and reimbursement policies.
- Dwan Thomas Flowers, MBA, RHIA, CCS
Q: I was reviewing a note to validate a diagnosis for acute exacerbations of chronic bronchitis, and the claim had 491.9 with which I did not agree. What would be the proper diagnosis? Some coders suggest that it should be two codes 466.0 and 491.8?
A: Acute bronchitis is an acute exacerbation of chronic bronchitis. I would code both acute and chronic bronchitis since there are no excludes notes under either code. Use the index in the coding book for appropriate code assignment. Acute bronchitis codes to 466.0 and chronic bronchitis, unspecified codes to 491.9. See AHA Coding Clinic for ICD-9-CM, 1Q, 2009, pg.8 for an example of how an exacerbation of a condition is coded to acute on chronic.
- Mary Mills, RHIT, CCS
Q: If a doctor treats a condition while in the hospital and documents it in a pn but forgets to put it in the discharge summary, do we still code the condition he treated? I work for a psychiatric hospital and a lot of the times the attending psychiatrist forgets to add dx that the general medical doctors do, or they say see general medicine results on the H&P.
A: Yes, it is appropriate to code the diagnosis that is documented by the physician in the progress note as long as there is no conflicting documentation from another physician. AHA Coding Clinic, First Quarter 2004 states that "code assignment may be based on other physician (i.e., consultants, residents, anesthesiologist, etc.) documentation as long as there is no conflicting information from the attending physician. Medical record documentation from any physician involved in the care and treatment of the patient, including documentation by consulting physicians, is appropriate for the basis of code assignment. A physician query is not necessary if a physician involved in the care and treatment of the patient, including consulting physicians, has documented a diagnosis and there is no conflicting documentation from another physician. If documentation from different physicians conflicts, seek clarification from the attending physician, as he or she is ultimately responsible for the final diagnosis."
- June Wang, MS, RHIT, CCS, CCS-P