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Coding Q&A: Ask the Experts

ADVANCE for Health Information Professionals has assembled a panel of experts to provide health information management (HIM) professionals with a free forum where they can ask a variety of coding questions and get more information about coding a specific condition.

Q: I work in an outpatient surgery center and I'm having trouble coding one of the orthopedic surgeries that was done here. The surgery was a resection of the terminal branch of the interosseous nerve in the wrist. The patient had chronic wrist pain. Please help me pick the correct coding for billing purposes.

A: CPT code range 64732-64772 defines the Transection or Avulsion of a Nerve. There is no CPT code specific to the Transection of the Interosseous Nerve in the wrist. In this case, CPT 64999 is applicable. Please refer to CPT Assistant, April 2001, p. 3 for information on the usage of Unlisted CPT codes. Submit supporting documentation (i.e., operative report, office notes) along with the UB-92. Any additional procedures performed independent from the above procedure should be coded separately as well.
Michelle Duffy, RT(R), CPC, CPC-H

Q: In coding emergency room visits on the professional side with the usage of the 1995 E/M documentation guidelines is it possible to establish a cheat sheet or E/M guidance tool so I won't have to do so much counting to determine the appropriate E/M level?

A: When coding emergency room visits it is common to use a template for documentation as with any specialty. You may determine to use the E/M 1995 or 1997 guidelines when creating this. There are several companies in the market that sell "E/M guidance tools" for correcting coding and documentation. I recommend you set up your template as a SOAP note with all elements to reach the highest levels of service with guidance for the practitioner as to how to reach the level for each section (i.e., history, exam and medical decision making).
Deborah Grider, CMA, CPC, CPC-H, CCS-P, CCP

Q: If a patient is admitted to the hospital due to respiratory failure and aspiration pneumonia, what is the principal diagnosis? The physician never linked the two conditions, and both were equally treated.

A: The question states that both the respiratory failure and aspiration pneumonia were the reasons for admission to acute care and were equally treated. Also, it is stated that the physician did not indicate an associated relationship between the two respiratory conditions.

In selecting the principal diagnosis, consider the UHDDS guideline for selection based on two or more diagnoses that equally meet the definition of principal diagnosis (CC 4Q 2002, p. 175). When a case meets the criteria, any one of the diagnoses may be sequenced first.
Kathy Myrick, RHIT, CCS

Q: If a pregnant patient present with a urinary tract infection (UTI), is this coded separately or will this be with the complications code?

A: Assign code 646.6x, Infections of the genitourinary tract in pregnancy (assign the appropriate 5th digit) plus code 599.0, Urinary tract infection site not specified. Refer to AHA's Coding Clinic 4th quarter 1995 for Obstetric coding guidelines.
Cay Moriarity, RHIT, CCS

Q: What are the coding rules when coding CPTs designated as separate procedures?

A:  The CPT book defines "separate procedure" as a service that is "carried out independently or considered to be unrelated or distinct from other procedures/services provided at that time."

What that means is you can only code separate procedures when the procedure is performed alone. If the procedure is performed in conjunction with a related procedure you are not able to bill for both procedures. 

The separate procedure could be coded if it is performed independently and not in conjunction with the larger or major procedure. In those cases a modifier like modifier -59 (distinct services) should be added to show special circumstances where the separate procedure was not performed integral to the major procedure.

Use as an example 58720. This code would be appropriate to use if the situation were that only a salpingo-oopherectomy was performed. If the salpingo-oopherectomy was done as part of a larger procedure (58150 or 58180), the addition of code 58720 is inappropriate and would be considered unbundling of services.
Jean Ryan-Niemackl, LPN, CPC

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.

Coding Q&A: Ask the Experts:
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Our provider is doing an I&D Simple (10060) then injecting the lesion with kenalog (11900). Can we bill for both procedures?

Marissa Bielecki,  Mid-Michigan DermatologyMarch 26, 2015
Lansing, MI

Question? Mammosite radiation therapy is a twice a day therapy. Therefore, codes 77786 are billed twice with modifiers 26 on the first line item, the second with 26 and 76 modifiers. I'm getting a denial that these are being bundled with 77427 which is also done on the same date of service. Can modifier 76 be changed to 59? Is it appropriate to apply 59 to both cpt codes 77786(since they are done at separate times) or just one?

Trish March 12, 2015

I am trying to figure out a word on a chart note. It sounds like "adevitus" and is used in this sentence. "There is a large, well-demarcated, shiny, red, ___________, tender rash covering most of the lateral aspect of the right leg with peripheral tenderness." I have tried everything I can. Please let me know if you have any ideas on what this word may be.
Thank You!!

Crissy February 20, 2015

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