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
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