Meet the Panelists | Submit Your Question
Q: How do you code a follow-up colonoscopy after attempted diagnostic exam of lower bowel with endoscope coded 45330 other patient code v12.72?
A: I am not sure I understand the question, but if a patient is coming in for a colonoscopy after having a sigmoidoscopy, the appropriate diagnosis codes to assign would be the symptoms or patient history that would merit the colonoscopy. If there are no symptoms, but a past history of polyps, then V67.09 and V12.72 could be assigned alone if there were no findings on this second exam.
-Christina Benjamin, MA, RHIA, CCS, CCS-P
Q: According to the Coding Clinic, Third Quarter, 1997, pages 11-12, rehabilitation admission for debility , when debility documented in a medical record with multiple chronic medical problems and the reason for the debility is also multifactorial, we can add a code for debility for rehabilitation admission since the admission was for physiotherapy for debility. My doubt is whether we can add a code for debility when it's documented with multiple chronic or severe conditions such as pneumonia, COPD, sepsis etc., or we can only consider this as a codable condition for the above mentioned type of visits only?
A: In the Coding Clinic (CC) referenced in the question, the key point is that the physician did not specify the condition most contributing to the debilitation, therefore, that is why the code for the debility is recommended as a secondary code along with the chronic conditions.
When a patient is admitted to an inpatient rehabilitation unit there is always an underlying condition that prompted the admission. This may need to be queried if there are multiple factors involved in the patient's admission. If it is a chronic condition that exacerbated, i.e., acute exacerbation of COPD, and caused admission to the inpatient unit and then the patient became debilitated because of that condition, when they are transferred to the rehab unit they should no longer be in exacerbation and the condition that is coded is chronic COPD not debility (since the underlying cause of the debility in known). If a patient is transferred for debility due to pneumonia and the patient is still being treated for pneumonia, i.e., antibiotics, etc, then the condition to be coded is pneumonia not debility. It would be the same scenario for sepsis (CC, 3rd Q, 2006, pg. 3). If the patient is no longer being treated for the an acute condition, such as pneumonia or sepsis, and the patient is being transferred for the debility, then it is appropriate for the debility code to be assigned as it is inappropriate to code the acute condition since it is no longer being treated. (CC, 3rd Q, 1997, pg. 12).
-Tasha Cameron, RHIA, CCS
Q: The physician treated a biopsy-proven superficial basal cell skin cancer by electrocautery only; no other procedure was done. What or how would that be coded?
A: The codes would be 17260-17266 (17260, 17261, 17262, 17263, 17264, 17266)
The physician destroys a malignant lesion of the trunk, arms and legs. Destruction may be accomplished by using a laser or electrocautery to burn the lesion, cryotherapy to freeze the lesion, chemicals to destroy the lesion, or surgical curettement to remove the lesion. Report 17260 for a lesion diameter 0.5 cm or less; 17261 for 0.6 cm to 1 cm; 17262 for 1.1 cm to 2 cm; 17263 for 2.1 cm to 3 cm; 17264 for 3.1 cm to 4 cm; and 17266 if the lesion diameter is greater than 4 cm.
-Bella Logvinov, MBA, CCS, CPC