|
Meet the Panelists | Submit Your Question
Q: What code would you assign for a transplant patient with a diagnosis of CMV mismatch on an inpatient record? Or, do you think it is necessary to even assign a code? Typically, these patients are treated with an antiviral, such as Valcyte, prophylactically and they are not exhibiting any current signs or symptoms of a CMV infection.
A: It is common for a transplanted organ to be infected with this virus. I would only use the V-code for the transplant organ status since the patient is asymptomatic.
Mary Mills, RHIT, CCS
Q: How would COPD/ROADs be coded in the final impression, since 496, 492 and 491 are interrelated and Asthma in category 493 is not and is excluded from 491 category? Roads includes bronchitis, asthma and emphysema.
A: I would code to 493.20 - chronic obstructive asthma, nos.
Rebecca Campbell, MBA, RHIA
Q: What codes would be reported for exploratory surgery of the lymph nodes?
A: When an exploration is done, it may require an incision depending on what is being explored. On inpatient cases look at the index in the procedural section of the coding book under "exploration," "lymphatic structure," code 40.0 is assigned. If the lymph nodes are biopsied or excised, then a different code would be assigned, depending on what procedure was performed. I hope this helps.
Mary Mills, RHIT, CCS
Q: V15.29 was a new code added Oct. 1, 2008 for FY 2009. This is a very vague code and there are no official instructions on how to appropriately assign this code. There are several scenarios in which this code will increase the SOI significantly. We are reimbursed via APR DRGs so it is important we get this right! An outside group of Physician auditors are suggesting we utilize this code in the following examples:
1. Patient has history of excision of liver cysts (V15.29)
2. Patient is s/p VP shunt (V45.2) - Physician auditor suggests also coding V15.29 for 'history of surgery on the brain'. Seems redundant to assign both codes - obviously you had surgery on the brain if you are s/p a VP shunt.
3. Patient is s/p abdominal surgery with bowel resection - Physician auditor suggests coding V45.72 (acquired absence of intestine) and V15.29 (history of surgery to organ which is intestine). Again, seems redundant to assign both codes.
4. Patient is s/p CABG - Physician auditor suggests coding V45.81 (aortocoronary bypass status) and V15.1 (history of surgery to heart and great vessels). Seems redundant to assign both codes.
Bottom line: we would not be having this conversation or dilemma if codes V15.29 and V15.1 did not increase the SOI and impact reimbursement. However, for ALL of the above scenarios, the SOI DOES increase by adding either of these codes. It just seems redundant to code both V15.2X and V45.XX for the same episode of care. I know that the coding guidelines for 'Status' codes V45 state that 'status' codes are distinct from 'history' codes and that is all I can locate regarding the subject. Your thoughts please? Since this does impact reimbursement, in some cases significantly, we want to get it right and not be inappropriately 'reaching' beyond that defensible zone. Thanks again for your time and assistance with this matter! Your opinion is greatly revered.
A: I am confused by this coding situation. Just by looking in the ICD-9-CM coding book, V15 is under the heading of "Persons with Potential Health Hazards Related to Personal and Family History (V10-V19)", and under category "Other personal history presenting hazards to health." My question is can the physician specify that the patient still has a potential health hazard or was the health hazard relieved by the prior surgery? It appears to me that there must be a potential for further health problems related to the specific surgery, exposure, or history.
Codes V15.21 and V15.22 under subcategory V15.2 are for personal histories of surgeries in utero while pregnant.
Then to use V15.29 for surgeries to other organs just does not seem to fix with the above.
I also agree with you that coding V15.29 and V15.1 does look redundant when coded with the status codes, but I do not find any exclusion notes to prevent these two codes from being used with the status V codes from the examples you have supplies.
Can your physician adviser supply further written information regarding the use of these codes from a coding perspective and not a reimbursement perspective?
Since neither you nor I have found information preventing the coder from using the V codes as suggested by the physician adviser, coding as per the physician adviser's recommendation is strictly up to you and your hospital's upper management.
I have copied this e-mail to two expert coders to get their opinion. In the mean time, I would love for you to submit this to Coding Clinic and get the "official" opinion.
Rebecca Campbell, MBA, RHIA
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.
|