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REFLUX DIAGNOSIS

Laura Posted Fri 11th of May, 2012 12:46:29 PM

Our doctors are doing a bilateral deep venous duplex exam and the diagnosis is bilateral reflux... I am not sure which diag to use

SuperCoder Answered Fri 11th of May, 2012 13:51:40 PM

Depending upon the documentation. For gastroesophageal reflux, code should be 530.81.
Vesicoureteral with bilateral reflux neuropathy: 593.72

Laura Posted Fri 11th of May, 2012 19:24:12 PM

So.. if they are doing a 93971/93970 and there is reflux in the greater saphenous vein you would recommend 530.81 or 593.72? I am confused

SuperCoder Answered Fri 11th of May, 2012 19:44:44 PM

Venous insufficiency is a very common condition resulting from decreased blood flow from the leg veins up to the heart, with pooling of blood in the veins. Normally, one-way valves in the veins keep blood flowing toward the heart, against the force of gravity. When the valves become weak and don't close properly, they allow blood to flow backward, a condition called reflux. Veins that have lost their valve effectiveness, become elongated, rope-like, bulged, and thickened. These enlarged, swollen vessels are known as varicose veins and are a direct result of increased pressure from reflux. A common cause of varicose veins in the legs is reflux in a thigh vein called the great saphenous, which leads to pooling in the visible varicose vein below.

The Dx should be 454.8 as per the scenario.

SuperCoder Answered Sat 12th of May, 2012 03:36:31 AM

Laura, I understood that question is from circulatory system. I have given you codes that are all from digestive and genitourinary. I am not recommending 530.81/593.72 for CPT 93971/93970. As there is no direct reflux code for DUPLEX VEIN, I just told you that these are the codes that exists for gastro reflux and vesicoureteral with bilateral reflux neuropathy what I saw only in ICD-9 manual. On the other hand, ICD 454.8 says (Varicose veins of lower extremities with other complications) such as pain, swelling etc. Question is here bilateral reflux (backward flow). I don't think 454.8 is appropriate here. Need some time to research on this for exact ICD-9 code from circulatory system that will best fit for bilateral reflux.

SuperCoder Answered Sat 12th of May, 2012 03:49:56 AM

However, this link says 454.8 is the appropriate code for varicose veins with reflux based on this clinical example. Still If you are billing for ICD-9 454.8 for CPTs 93971/93970, ICD-9 454.8 would not be a valid dx and you may get denial. Still need some time on this for researching.

http://www.optumcoding.com/codethis/?id=281

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