Abdominal Pain Dx: Location Is Everything When You Report Abdominal Pain   (July 2010)

Follow these 3 tips for successful coding now – and later.
The term “abdominal pain” includes a myriad of diagnosis possibilities, so don’t just skim the surface and accept 789.00 (Abdominal pain; unspecified site). An “unspecified” diagnosis could equal no pay, so follow these tips for using more specific – and more successfully paid – diagnoses.
1. Establish the Exact Location
For ease of coding, the abdomen is divided into four areas, or quadrants, so it’s easier to pinpoint areas. Imagine [...]

Diagnosis Coding News: CMS Quashes Rumors About ICD-10 Implementation Delay   (July 2010)

Plus: CMS has proposed freezing the ICD-9 code set after next year.
If you were hoping that the Oct. 1, 2013 ICD-10 implementation date wasn’t set in stone, you are out of luck. That’s the word from CMS during a June 15 CMS Open Door Forum entitled “ICD-10 Implementation in a 5010 Environment.”
“There will be no delays on this implementation period, and no grace period,” said Pat Brooks, RHIA, with CMS’s Hospital and Ambulatory Policy Group, [...]

Reader Questions: Evaluate Services For Gun Shot Wound   (July 2010)

Question: I am trying to code a chest exploration following a gun shot wound. Would I use an unlisted procedure code for this?
Florida Subscriber
Answer: No, although circumstances would vary depending on the specific case and documentation. The code set 20100-20103 is available to describe surgical exploration and enlargement of the wound, extension of dissection (to determine penetration), debridement, removal of foreign body(s), ligation or coagulation of minor subcutaneous and/or muscular blood vessel(s), of the subcutaneous [...]

Reader Questions: Choose Between 917.8, 917.9 for Toe Tourniquet   (July 2010)

Question: The physician removed a “hair tourniquet” of human hair wound tightly around a patient’s third and fourth toes. There was no injury, but the toes were very red and swollen. What diagnosis should we code?
Connecticut Subscriber
Answer: Your best choice is 917.8 (Other and unspecified superficial injury of foot and toes without mention of infection). If the tourniquet led to infection, change to 917.9 (Other an unspecified superficial injury of foot and toes, infected).
The [...]

Reader Questions: Be Confident in Coding for Teaching Physicians   (July 2010)

Question: A resident in the ED sees a new patient complaining of heartburn. The resident conducts an expanded problem-focused history and exam and prescribes some antacids. All of this is documented in the resident’s progress note. The ED physician, who is working as a “teaching physician,” also evaluates the patient, and writes a brief note stating that he examined the patient and was involved in the key or critical aspects of the patient’s care. How [...]

Reader Questions: Keep Same HTN Code for Uncontrolled/Controlled   (July 2010)

Question:Does ICD-9 distinguish controlled and uncontrolled hypertension (HTN)?
Missouri Subscriber
Answer: No. Section I.C.7.a of the ICD-9 official guidelines indicates that you should assign a code from 401.x-405.x (Hypertensive disease) for both controlled and uncontrolled hypertension (guidelines available at www.cdc.gov/nchs/data/icd9/icdguide09.pdf).
Controlled hypertension “usually refers to an existing state of hypertension under control by therapy,” the guidelines state. “Uncontrolled hypertension may refer to untreated hypertension or hypertension not responding to current therapeutic regimen.”
Caution: Don’t confuse “uncontrolled” with “malignant” hypertension, [...]

Reader Questions: Anemia or Underlying Disease? You Decide   (July 2010)

Question: A patient with mild (stage II) chronic kidney disease presented for increased lethargy, which the physician diagnosed as anemia. Which condition should I list first: anemia or CKD?
Kansas Subscriber
Answer: The correct diagnoses sequence would be: 285.21 ��” Anemia in chronic kidney disease, first, and585.2 ��” Chronic kidney disease, Stage II (mild).
Use the anemia codes as the principal/first listed code if the reason for the encounter is to treat the anemia, states the ICD-9-CM Official [...]

Reader Questions: Check If Exceptions Exist in Fracture Modifiers   (July 2010)

Question: A parent brings her 14-year-old son to the ED with an injured right finger he suffered during a skiing accident. The physician diagnoses a closed metacarpal fracture, which he resets using manipulation and places in a plaster cast. He tells the parent to follow up with an orthopedist for continuing care. Notes indicate a level-three pre-procedure E/M service. What modifier should I append to the E/M code?
North Carolina Subscriber
Answer: Many private payers (and Medicare) [...]

You Be the Coder: Make 948 Your Burn Coding Constant   (July 2010)

Question: Do I need to include a code from category 948 on every claim for burn victims?Michigan Subscriber
Answer: Yes. Once you locate code(s) to represent the patient’s burn(s), find the appropriate code from category 948 (Burns classified according to extent of body surface involved) as a secondary diagnosis. The 948.xx codes can also serve as primary diagnoses when the documentation doesn’t specify the burn site, according to ICD-9 2010.
Reason: This code helps paint a better [...]

Break Fact, Fiction Apart on Your Fracture Care Claims   (July 2010)

The break of a bone does not always mean a fracture code.
A patient presents to the ED with a broken bone. The physician confirms the fracture, treats the patient and sends him home. This is automatically a fracture care claim … right?
Wrong: Eliminate misconceptions about your ED physician’s fracture care treatment with the following fact or fiction challenge.
Fact or Fiction? Fractured Bone = Fracture Care
Fiction. Patients with broken bones don’t always receive reportable fracture treatment [...]