Coding Q&A

Ask the Experts: September 1, 2014

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Question: Patient is transferred from another facility with an endotracheal tube. Patient has mono with severe epiglottis swelling. Should the principal diagnosis be acute respiratory failure or obstruction due to swelling of the epiglottis?

Answer: If the patient was also transferred for acute respiratory failure, it could be principal diagnosis.  See AHA Coding Clinic for ICD-9-CM 1Q 2005 pages 3-8 for sequencing respiratory failure as PDX guidelines. When two or more conditions meet the definition of the PDX and are equally treated, either diagnosis can be the PDX. Which diagnosis occasioned the admission to the hospital?
- Mary Mills, RHIT, CCS

Question: My question is about when to use Aftercare versus Follow Up codes? For example, if a patient gets a CT scan of the skull and the reason for the exam is listed as s/p ventricular shunt check. This patient is also status post craniotomy. Would this be aftercare V5872 or follow up V6709 since I cannot use the status code for the ventricular shunt (V452) as first listed? I'm confused b/c nothing is being done to the shunt, it is only being checked on. My understanding is that status codes were only used with aftercare codes, whereas follow up codes only go with history codes and are for when the patient is completely finished with treatment and the disease/problem is eradicated. Since the shunt is still present-wouldn't this be aftercare? If this is aftercare would I use V6709 or V5301? Can a follow up code be used with a status code?

Answer: I would recommend using V67.09 because the purpose of the encounter is surveillance of the device specifically and this code appears to most closely represent that type of care. The includes notes under code category V67 states "surveillance only following completed treatment." And the treatment has been completed and there is no need to remove or adjust a specific device (which is when you would use the V53 codes) and so V67.09 along with a code to specify the presence of the device (V45.2) should be adequate. Codes that specify the presence of a device can be assigned with other codes most of the time unless the code already specifies the device in the description.  If this were a case of needing to adjust or remove the shunt just because it was no longer needed and there was no other complication or problem, then the V53.01 code would be assigned alone because the device involved is specified in the code description.  Hence, V45.2 would not be required. I rarely recommend the use of the V58.7 code category because this category of V codes is nonspecific.
- Christina Benjamin, MA, RHIA, CCS, CCS-P

Question: Is it appropriate for the hospital to code 95972, analysis and reprograming of spinal neurostimulator, at the time it's initially surgically placed and it takes less than 30 minutes.

Answer: Per the CPT Professional Edition instructional notes, this code may be assigned if less than 31 minutes of treatment are provided along with modifier -52 to indicate the reduced services.
- Christina Benjamin, MA, RHIA, CCS, CCS-P

Question: How should the following ancillary visit for Rt hand xray be coded? DJD of joints or disorder of bones What are the codes for the final diagnosis? (not concerned with CKD or DM) outpatient facility coding EXAMINATION: Right hand. (XR, 3 view) CLINICAL HISTORY: ARTH WRIST HAND, CKD,DM FINDINGS: Three views of the right hand including AP, oblique and lateral projections were obtained. There is no evidence of acute fracture or dislocation identified. Mild degenerative changes are seen in the first metacarpal phalangeal joint and first interphalangeal joint. Minimal degenerative changes are seen in the remaining interphalangeal joints. IMPRESSION: No evidence of fracture or dislocation.

Answer: I would assign 715.04 Generalized osteoarthrosis, hand since more than one site of hand joints was mentioned.
- June Wang, MS, RHIT, CCS, CCS-P

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