tag:blogger.com,1999:blog-31201241257614040522024-03-19T02:13:22.693-06:00Lori-Lynne's Coding Coach BlogThis is a blog dedicated to Medical Coding professionals,to find help with coding, billing, payment, revenue, medical records issues and other ancillary concerns for those "worker bees" that perform the difficult job of "coding".Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.comBlogger216125tag:blogger.com,1999:blog-3120124125761404052.post-59438815004821532722019-10-22T23:58:00.000-06:002019-10-23T12:33:06.296-06:00UPDATE TO THE 2020 ICD-10 coding Guidelines E-Cig/Vaping <br />
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ICD-10-CM Official Coding Guidelines - Supplement<br />
<br />Coding encounters related to E-cigarette, or Vaping, Product Use<br />Post Date: October 17, 2019<br />
<br /><strong>Introduction</strong><br />The purpose of this document is to provide official diagnosis coding guidance for healthcare encounters related to the 2019 health care encounters and deaths related to e-cigarette, or vaping, product use associated lung injury (EVALI). This guidance is consistent with current clinical knowledge about e-cigarette, or vaping, related disorders.<br />As necessary, this guidance will be updated as new clinical information becomes available. The clinical scenarios described below are not exhaustive and may not represent all possible reasons for health care encounters that may be related to e-cigarette, or vaping, product use. Proposals for new codes that are intended to address additional detail regarding use of e-cigarette, or vaping, products will be presented at the March 2020 ICD-10 Coordination and Maintenance Committee Meeting.<br />This guidance is intended to be used in conjunction with current ICD-10-CM classification and the ICD-10-CM Official Guidelines for Coding and Reporting (effective October 1, 2019). <a href="https://www.cdc.gov/nchs/data/icd/10cmguidelines-FY2020_final.pdf">https://www.cdc.gov/nchs/data/icd/10cmguidelines-FY2020_final.pdf</a>. The ICD-10-CM codes provided in the clinical scenarios below are intended to provide e-cigarette, or vaping, product use coding guidance only. Other codes for conditions unrelated to e-cigarette, or vaping products may be required to fully code these scenarios in accordance with the ICD-10-CM Official Guidelines for Coding and Reporting. A hyphen is used at the end of a code to indicate that additional characters are required.<br />General Guidance<br />Lung-related complications<br />For patients documented with electronic cigarette (e-cigarette), or vaping, product use associated lung injury (EVALI), assign the code for the specific condition, such as:<br />• J68.0, Bronchitis and pneumonitis due to chemicals, gases, fumes and vapors; includes chemical pneumonitis<br />• J69.1, Pneumonitis due to inhalation of oils and essences; includes lipoid pneumonia<br />• J80, Acute respiratory distress syndrome<br />• J82, Pulmonary eosinophilia, not elsewhere classified<br />• J84.114, Acute interstitial pneumonitis<br />• J84.89, Other specified interstitial pulmonary disease<br />For patients with acute lung injury but without further documentation identifying a specific condition (pneumonitis, bronchitis), assign code:<br />• J68.9, Unspecified respiratory condition due to chemicals, gases, fumes, and vapors<br />
<strong>ICD-10-CM Coding Guidance</strong><br />Vaping related disorders (October 17, 2019)<br />2<br />Poisoning and toxicity<br />Acute nicotine exposure can be toxic. Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their skin or eyes. For these patients assign code:<br />• T65.291-, Toxic effect of other nicotine and tobacco, accidental (unintentional); includes Toxic effect of other tobacco and nicotine NOS.<br />For a patient with acute tetrahydrocannabinol (THC) toxicity, assign code:<br />• T40.7X1- Poisoning by cannabis (derivatives), accidental (unintentional).<br />Substance use, abuse, and dependence<br />For patients with documented substance use/abuse/dependence, additional codes identifying the substance(s) used should be assigned.<br />When the provider documentation refers to use, abuse and dependence of the same substance (e.g. nicotine, cannabis, etc.), only one code should be assigned to identify the pattern of use based on the following hierarchy:<br />• If both use and abuse are documented, assign only the code for abuse<br />• If both abuse and dependence are documented, assign only the code for dependence<br />• If use, abuse and dependence are all documented, assign only the code for dependence<br />• If both use and dependence are documented, assign only the code for dependence.<br />Assign as many codes, as appropriate. Examples:<br />Cannabis related disorders: F12.---<br />Nicotine related disorders: F17.----<br />Specifically, for vaping of nicotine, assign code:<br /> F17.29-, Nicotine dependence, other tobacco products. Electronic nicotine delivery systems (ENDS) are non-combustible tobacco products.<br />Signs and symptoms<br />For patients presenting with any signs/symptoms (such as fever, etc.) and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as:<br />• M79.10 Myalgia, unspecified site<br />• R06.00 Dyspnea, unspecified<br />• R06.02 Shortness of breath<br />• R06.2 Wheezing<br />• R06.82 Tachypnea, not elsewhere classified<br />• R07.9 Chest pain, unspecified<br />ICD-10-CM Coding Guidance<br />Vaping related disorders (October 17, 2019)<br />3<br />• R09.02 Hypoxemia<br />• R09.89 Other specified symptoms and signs involving the circulatory and respiratory systems (includes chest congestion)<br />• R10.84 Generalized abdominal pain<br />• R10.9 Unspecified abdominal pain<br />• R11.10 Vomiting, unspecified<br />• R11.11 Vomiting without nausea<br />• R11.2 Nausea with vomiting, unspecified<br />• R19.7 Diarrhea, unspecified<br />• R50.- Fever of other and unknown origin<br />• R53.83 Other fatigue<br />• R61 Generalized hyperhidrosis (night sweats)<br />• R63.4 Abnormal weight loss<br />• R68.83 Chills (without fever)<br />
This coding guidance has been approved by the four organizations that make up the Cooperating Parties: the National Center for Health Statistics, the American Health Information Management Association, the American Hospital Association, and the Centers for Medicare & Medicaid Services.<br />
References:<br />Ghinai I, Pray IW, Navon L, et al. E-cigarette Product Use, or Vaping, Among Persons with Associated Lung Injury — Illinois and Wisconsin, April–September 2019. MMWR Morb Mortal Wkly Rep 2019;68:865–869. DOI: <a href="http://dx.doi.org/10.15585/mmwr.mm6839e2">http://dx.doi.org/10.15585/mmwr.mm6839e2</a><br />National Academies of Sciences, Engineering, and Medicine. 2018. Public Health Consequences of E-Cigarettes. Washington, DC: The National Academies Press. <a href="https://doi.org/10.17226/24952">https://doi.org/10.17226/24952</a>.<br />Perrine CG, Pickens CM, Boehmer TK, et al. Characteristics of a Multistate Outbreak of Lung Injury Associated with E-cigarette Use, or Vaping — United States, 2019. MMWR Morb Mortal Wkly Rep 2019;68:860–864. DOI: <a href="http://dx.doi.org/10.15585/mmwr.mm6839e1">http://dx.doi.org/10.15585/mmwr.mm6839e1</a><br />Schier JG, Meiman JG, Layden J, et al. Severe Pulmonary Disease Associated with Electronic-Cigarette–Product Use — Interim Guidance. MMWR Morb Mortal Wkly Rep 2019;68:787–790. DOI: <a href="http://dx.doi.org/10.15585/mmwr.mm6836e2">http://dx.doi.org/10.15585/mmwr.mm6836e2</a><br />Siegel DA, Jatlaoui TC, Koumans EH, et al. Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury — United States, October 2019. MMWR Morb Mortal Wkly Rep. ePub: 11 October 2019. DOI: <a href="http://dx.doi.org/10.15585/mmwr.mm6841e3">http://dx.doi.org/10.15585/mmwr.mm6841e3</a>Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-85607934659330815462018-10-13T00:00:00.000-06:002018-10-13T00:00:08.024-06:002019 Coding Updates Virtual Boot Camp<table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; width: 100%px;"><tbody>
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<tr><td align="center" style="padding: 10px 0px;"><strong><span style="color: #00599c; font-family: Verdana; font-size: small;"><a href="https://www.audioeducator.com/virtualbootcamp/coding-updates/ob-gyn-codes-updates?utm_source=AE-SERVER-VRT&utm_medium=email&utm_campaign=EOCAN1A7-%3CDATE%3E" style="color: #00599c; text-decoration-line: none;">Register Now</a></span></strong></td></tr>
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<tr><td style="padding: 0px 10px 10px;"><ul>
<li><span style="color: black; font-family: Verdana; font-size: small;">ICD-10-CM/PCS and CPT<sup>®</sup>/HCPCS Updates in OB-GYN <strong></strong></span></li>
<li><span style="color: black; font-family: Verdana; font-size: small;">Auditing for OB-GYN</span></li>
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<tr><td style="padding: 0px 10px 10px;"><strong><span style="color: black; font-family: Verdana; font-size: small;">Session Agenda</span></strong></td></tr>
<tr><td style="padding: 0px;"><ul>
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<li><span style="color: black; font-family: Verdana; font-size: small;">How to rectify documentation issues</span></li>
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Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-34306856705564681892018-08-24T11:34:00.002-06:002018-08-24T11:34:36.462-06:00New Webinars from me! Come listen in... HELLO!!! I have a couple of new webinar's coming out in September and October in conjunction with AudioEducator.com. I will be doing one on the ICD-10cm & PCS Updates targeted for OB/GYN or areas of interest for those of us currently working in OB/GYN, URO. then in October I will do a special Webinar on how to use the NCCI edits correctly to ensure that your claims go thru and to lessen denials.<br />
<br />
Please join me! and if you would like a "discount code". Hit me up on Facebook or e-mail and I'll be happy to send you my discount codes....<br />
<br />
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<br />Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-44249951542272482392018-07-26T23:50:00.000-06:002018-07-26T23:50:01.031-06:00Stress Urinary Incontinence – Surgical Intervention Coding for Urinary Sling<br />
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial Narrow","sans-serif";">Stress Urinary Incontinence –
Surgical Intervention Coding for Urinary Sling<o:p></o:p></span></u></b></div>
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial Narrow","sans-serif";">March 2018 </span></u></b></div>
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<br /></div>
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<span style="font-family: "Arial Narrow","sans-serif";">Urinary
incontinence is the <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">unintentional</i></b> loss of urine.<span style="mso-spacerun: yes;">
</span>Stress Urinary Incontinence (SUI) is what occurs when there is stress or
movement/ activity put upon your bladder.<span style="mso-spacerun: yes;">
</span>This activity can be something as minor as laughing, coughing, sneezing,
running or lifting.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>SUI is not a condition related to “stress” in
a psychological way, such as a person who is suffering from a mental anxiety or
issue,<span style="mso-spacerun: yes;"> </span>SUI is purely related to a
movement/activity that is related to a physical stress upon the body. .<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "Arial Narrow","sans-serif"; font-size: 11.0pt; mso-bidi-font-family: Arial;">There are four main types of urinary
incontinence <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: normal; margin-bottom: 1.2pt; margin-left: 19.2pt; mso-list: l1 level1 lfo1; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: black; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-themecolor: text1;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><a href="https://en.wikipedia.org/wiki/Urge_incontinence" title="Urge incontinence"><span style="color: black; font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Arial; mso-themecolor: text1; text-decoration: none; text-underline: none;">Urge
incontinence</span></a><span style="color: black; font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Arial; mso-themecolor: text1;"> <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: black; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-themecolor: text1;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><a href="https://en.wikipedia.org/wiki/Stress_incontinence" title="Stress incontinence"><span style="color: black; font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Arial; mso-themecolor: text1; text-decoration: none; text-underline: none;">Stress incontinence</span></a><span style="color: black; font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Arial; mso-themecolor: text1;"> (SUI) <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: black; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-themecolor: text1;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><a href="https://en.wikipedia.org/wiki/Overflow_incontinence" title="Overflow incontinence"><span style="color: black; font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Arial; mso-themecolor: text1; text-decoration: none; text-underline: none;">Overflow incontinence</span></a><span style="color: black; font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Arial; mso-themecolor: text1;"> <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: black; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-themecolor: text1;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><a href="https://en.wikipedia.org/wiki/Functional_incontinence" title="Functional incontinence"><span style="color: black; font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Arial; mso-themecolor: text1; text-decoration: none; text-underline: none;">Functional incontinence</span></a><span style="color: black; font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Arial; mso-themecolor: text1;"> </span><span style="color: black; font-family: "Arial Narrow","sans-serif"; mso-themecolor: text1;"><o:p></o:p></span></div>
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<span style="font-family: "Arial Narrow","sans-serif";">Stress urinary incontinence is defined as the
unintentional loss of urine caused by the bladder muscle contracting, involuntarily
with physical movement.<span style="mso-spacerun: yes;"> </span>Some patients
also experience a sense of urgency. <span style="mso-spacerun: yes;"> </span>SUI
is much more common in women than men, however, the most common cause of </span><span style="background: white; color: black; font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-themecolor: text1;">SUI is a <span style="mso-bidi-font-style: italic; mso-bidi-font-weight: bold;">pelvic floor disorder, damage to,<span style="mso-spacerun: yes;">
</span>or weakening of the soft tissue that normally supports the urinary
organs</span>. <o:p></o:p></span></div>
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<span style="font-family: "Arial Narrow","sans-serif";">SUI is a direct result of the urinary </span><span style="background: white; color: black; font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-themecolor: text1;">sphincter muscle that controls the urethra becomes weakened, in addition
to the weakening of the soft tissues.<span style="mso-spacerun: yes;">
</span>When both the muscle and the soft tissue supports become weak, this
allows the release of urine to happen during a “stressful, physical event” such
as laughing, coughing, sneezing, etc. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial Narrow","sans-serif";">Coding interventions<o:p></o:p></span></u></b></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial Narrow","sans-serif";">SUI
surgery is not exclusive just to the Urology specialty, many gynecologists also
perform surgical intervention for SUI in women.<span style="mso-spacerun: yes;">
</span>CPT has given us many code choices for surgical intervention of
SUI.<span style="mso-spacerun: yes;"> </span>Currently the most commonly used for
treatment in both men and women are the surgical procedures for a urinary “sling”.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial Narrow","sans-serif";">When
a sling procedure is performed, the surgeon uses the patient's own tissue (or
other type of supply)<span style="mso-spacerun: yes;"> </span>to essentially
“sling up” or “pex up” the uretha by inserting a strip of additional material/tissue
to create an additional support system for the urethra.<span style="mso-spacerun: yes;"> </span>This support is sewn into the pelvic area to
help keep the urethra in the proper physical location.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial Narrow","sans-serif";">Slings
can be used for both men and women with SUI.<span style="mso-spacerun: yes;">
</span><o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial Narrow","sans-serif";">Urinary
Sling procedures can be performed as an open procedure or as a laparoscopic
procedure.<span style="mso-spacerun: yes;"> </span>The two most common types of
bladder slings are the TOT sling (transobturator tape sling) and the TVT sling
(tension-free vaginal tape sling).<span style="mso-spacerun: yes;"> </span>The TOT
sling and the TVT sling are normally performed as a quick 30 minute, outpatient
procedures with a high success rate of nearly 90%. The incisions are small
(less than one centimeter) and recovery times are quick.<span style="mso-spacerun: yes;"> </span>However, these procedures can be done in
coordination with other surgical procedures. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial Narrow","sans-serif";">The
CPT codes below are those that are specifically related to SUI.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">57288 Sling
operation for stress incontinence (eg, fascia or synthetic) -<span style="mso-spacerun: yes;"> </span>Open Approach<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">57287 Removal or
revision of sling for stress incontinence (eg, fascia or synthetic) – Open or
laparoscopic Approach <br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">53440 Sling
Operation for correction of male urinary incontinence (eg, fascia or synthetic)
– Open Approach<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">53442 Removal or
revision of sling for male urinary incontinence (eg, fascia or synthetic) –
Open Approach <br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">51990 <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Laparoscopy</i></b>,
surgical; urethral suspension for stress incontinence <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">51992 <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Laparoscopy</i></b>,
surgical; sling operation for stress incontinence (eg, fascia or synthetic)<br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">10120 Incision
and removal of foreign body, subcutaneous tissue – simple <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">10121 Incision
and removal of foreign body, subcutaneous tissue - complicated<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial Narrow","sans-serif";">When
coding for these procedures, the coder need to carefully review the operative
report to double check if the procedure is being performed laparoscopically or
as an open procedure.<span style="mso-spacerun: yes;"> </span>The codes for the
open approach include the 57287, 57288, 53440 and 53442.<span style="mso-spacerun: yes;"> </span>The physician/surgeon may state this is a
“mini-laparotomy” however, this still means the surgical approach is
“open”.<span style="mso-spacerun: yes;"> </span>If the physician documents the
procedure was performed with a laparoscope, the codes 51990 and 51992 would be
the correct codes to choose.<span style="mso-spacerun: yes;"> </span>If the
sling is removed laparoscopically, the 57287 is the correct code to use
regardless if the procedure was performed as an open procedure or a
laparoscopic procedure. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial Narrow","sans-serif";">Codes
53440, 53442, 51990, 51992, 57287 and 57288 all have a 90 day global period.
Should a sling revision be surgically necessary during the global period, you
will need to add modifier -78,<span style="mso-spacerun: yes;"> </span>to your
code, as this is an unplanned return to the OR for a related procedure.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial Narrow","sans-serif";">In
addition, revision of an SUI sling procedure code(s)<span style="mso-spacerun: yes;"> </span>57287 or 53442 both of these codes<span style="mso-spacerun: yes;"> </span>include replacement procedure of a sling
(codes 57288 or code 53442) when performed on the same date of service.<span style="mso-spacerun: yes;"> </span>These codes are bundled in the CCI bundling
edits from CMS, and do not allow a modifier to over-ride the bundling
edit.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial Narrow","sans-serif";">The
usage of code 10120 and 10121 have become common when physicians have “removed”
portions of a mesh erosion that has eroded into the subcutaneous tissues around
the abdomen and groin areas.<span style="mso-spacerun: yes;"> </span>These
integumentary codes are very specific if the mesh is only being removed from
the subcutaneous tissue, and not a full excision or revision of the sling
itself.<span style="mso-spacerun: yes;"> </span>When reporting<span style="mso-spacerun: yes;"> </span>CPT code 10120 or 101210 you will need to add
either a modifier -58 or modifier -78 if the mesh erosion is treated in the
office/procedure room.<span style="mso-spacerun: yes;"> </span>The verbiage of
codes 10120/10121 strictly denotes in the definition as a removal of foreign
body<b style="mso-bidi-font-weight: normal;">“subcutaneous”</b> tissue.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial Narrow","sans-serif";">Unfortunately,
CPT does not give clear guidance as to what constitutes “simple” versus
“complicated” when it comes to codes 10120 and 10121.<span style="mso-spacerun: yes;"> </span>So if you choose to use CPT Code 10121
(incision and removal of foreign body, subcutaneous tissues; complicated) when
an incision is necessary to remove the foreign body you will need to educate
the physician to document in the operative note that the removal was
“complicated”.<span style="mso-spacerun: yes;"> </span>In addition, the
physician should also document “why” the removal was complicated, with the
usage of additional terms such as; embedded, deep, size, location,
abnormality.<span style="mso-spacerun: yes;"> </span>It may necessitate having
the physician document the amount of time spent in the removal to<span style="mso-spacerun: yes;"> </span>support the usage of the “complicated” code
10121, rather than the “simple” code 10120. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial Narrow","sans-serif";">Operative Report SPARC
suburethal Sling <o:p></o:p></span></u></b></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<span style="font-family: "Arial Narrow","sans-serif";">PROCEDURE:<span style="mso-spacerun: yes;"> </span>SPARC suburethral sling <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<span style="font-family: "Arial Narrow","sans-serif";">PREOPERATIVE
DX: Stress urinary incontinence;<span style="mso-spacerun: yes;">
</span>hypermobility of urethra<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<span style="font-family: "Arial Narrow","sans-serif";">POSTOPERATIVE
DX: Stress urinary incontinence;<span style="mso-spacerun: yes;">
</span>hypermobility of urethra.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<span style="font-family: "Arial Narrow","sans-serif";">OPERATIVE
PROCEDURE: SPARC suburethral sling.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<span style="font-family: "Arial Narrow","sans-serif";">FINDINGS
& INDICATIONS: Outpatient evaluation was consistent with urethral
hypermobility, stress urinary incontinence. Intraoperatively, the bladder
appeared normal with the exception of some minor trabeculations. The ureteral
orifices were normal bilaterally.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<span style="font-family: "Arial Narrow","sans-serif";">DESCRIPTION
OF OPERATIVE PROCEDURE: This patient was brought to the operating room, a
general anesthetic was administered. She was placed in dorsal lithotomy position.
Her vulva, vagina, and perineum were prepped with Betadine scrubbed in
solution. She was draped in usual sterile fashion. A Sims retractor was placed
into the vagina and Foley catheter was inserted into the bladder. Two Allis
clamps were placed over the mid urethra. This area was injected with 0.50%
lidocaine containing 1:200,000 epinephrine solution. Two areas suprapubically
on either side of midline were injected with the same anesthetic solution. The
stab wound incisions were made in these locations and a sagittal incision was
made over the mid urethra. Metzenbaum scissors were used to dissect bilaterally
to the level of the ischial pubic ramus. The SPARC needles were then placed
through the suprapubic incisions and then directed through the vaginal incision
bilaterally. The Foley catheter was removed. A cystoscopy was performed using a
70-degree cystoscope. There was noted to be no violation of the bladder. The
SPARC mesh was then snapped onto the needles, which were withdrawn through the
stab wound incisions. The mesh was snugged up against a Mayo scissor held under
the mid urethra. The overlying plastic sheaths were removed. The mesh was cut
below the surface of the skin. The skin was closed with 4-0 Plain suture. The
vaginal vault was closed with a running 2-0 Vicryl stitch. The blood loss was
minimal. The patient was awoken and she was brought to recovery in stable
condition.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<span style="font-family: "Arial Narrow","sans-serif";">Cpt
Code:<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; text-indent: .5in;">
<span style="font-family: "Arial Narrow","sans-serif";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">57288 Sling
operation for stress incontinence (eg, fascia or synthetic) -<span style="mso-spacerun: yes;"> </span>Open Approach<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; text-indent: .5in;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<span style="font-family: "Arial Narrow","sans-serif";">ICD-10CM
: <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<span style="font-family: "Arial Narrow","sans-serif";"><span style="mso-tab-count: 1;"> </span>N39.3 Stress incontinence
(female) (male)<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<span style="font-family: "Arial Narrow","sans-serif";"><span style="mso-tab-count: 1;"> </span>N36.41 Hypermobility of urethra<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial Narrow","sans-serif";">Operative Report Male Sling<o:p></o:p></span></u></b></div>
<div style="background: white; margin-left: .5in;">
<span style="color: black; font-family: "Arial Narrow","sans-serif"; font-size: 11.0pt;">General anesthesia
administered and patient positioned in the dorsal lithotomy position. A 16F
Foley catheter placed to drain the bladder. Peri-operative antibiotics are
administered.<span style="mso-spacerun: yes;"> </span>A vertical incision is
made to the perineum approximately 1-2 cm inferior to the penoscrotal junction
and carried 1 cm anterior to the rectum. Dissection is continued through
Colles' fascia and the underlying bulbocavernous muscle. Sharp dissection is
continued until the spongiosal bulb has been freely dissected. The perineal
body is identified and dissection is continued proximally approximately 4 cm.<o:p></o:p></span></div>
<div style="background: white; margin-left: .5in;">
<span style="color: black; font-family: "Arial Narrow","sans-serif"; font-size: 11.0pt;">Attention is then focused
on identification and marking of the anatomical and landmarks for placement of
the surgical passers. The adductor longus tendon is identified and marked, each
of the two trochar insertion sites are then marked, and insertion is performed
just lateral to the inferior pubic ramus. The skin sites are incised and
surgical passer placement is performed.<span style="mso-spacerun: yes;">
</span>A surgical finger is placed inside the perineal dissection and to
identify the inferior pubic ramus where the passer will exit. Under manual
guidance, the passer is advanced through the medial aspect of the obturator
foramen, exiting at the level of the perineal body lateral to the spongiosal
bulb.<span style="mso-spacerun: yes;"> </span>Care is taken to maintain a 45º
angle during passage, therefore completing the trochar rotation. The passer is
then hooked to the respective sling arm, which is then pulled though the
obturator foramen to exit via the skin incision bringing the mesh into place.
The mesh is then checked to ensure that twisting has not occurred.
Subsequently, the opposite passer is placed in an identical fashion and the
sling is pulled into place.<o:p></o:p></span></div>
<div style="background: white; margin-left: .5in;">
<span style="color: black; font-family: "Arial Narrow","sans-serif"; font-size: 11.0pt;">The central mesh anchor is
sutured into place, with the posterior aspect fixed to the spongiosal tissue at
the most proximal aspect of the bulbar dissection. The distal anchor is then
sutured to the spongiosal tissue, each performed with 3-0 vicryl suture.<span style="mso-spacerun: yes;"> </span>Tensioning of the sling is now performed, by
pulling the mesh arms so the bulb of the corpus spongiosum is brought cephalad
by the sling. Sling tensioning is<span style="mso-spacerun: yes;">
</span>increased until 3-4 cm of proximal urethral movement is obtained. Bulbar
suspension is confirmed by measuring proximal movement from the initial point
of fixation to the perineal body.<span style="mso-spacerun: yes;"> </span>A
cystourethroscopy is then performed to rule out any urethral or bladder injury.
The arms of the mesh are cut below skin level and skin incisions closed with
Dermabond.<span style="mso-spacerun: yes;"> </span>The perineal dissection is
then closed with a standard 3-layer closure with absorbable suture.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<span style="font-family: "Arial Narrow","sans-serif";">Cpt
Code:<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoListParagraph" style="text-indent: .5in;">
<span style="font-family: "Arial Narrow","sans-serif";">5</span><span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">3440 Sling
Operation for correction of male urinary incontinence (eg, fascia or synthetic)
– Open Approach<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; text-indent: .5in;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<span style="font-family: "Arial Narrow","sans-serif";">ICD-10CM
: <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; text-indent: .5in;">
<span style="font-family: "Arial Narrow","sans-serif";">N39.3 Stress incontinence
(female) (male)<span style="color: black;"><o:p></o:p></span></span></div>
<div style="background: white;">
<br /></div>
<div style="background: white;">
<b style="mso-bidi-font-weight: normal;"><u><span style="color: black; font-family: "Arial Narrow","sans-serif"; font-size: 11.0pt;">Operative
Report – Laparoscopic removal <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></u></b></div>
<div style="background: white; margin-left: .5in;">
<span style="background: white; color: black; font-family: "Arial Narrow","sans-serif"; font-size: 11.0pt;">A
laparoscopic approach was utilized to remove the polypropylene mesh sling from
the retropubic space and , bladder, We entered the peritoneal cavity through
the umbilicus and then placed 3 ancillary ports under direct vision <strong><span style="font-family: "Arial Narrow","sans-serif";">.<span style="mso-spacerun: yes;"> </span></span></strong>A 10-mm port is placed in the
left paramedian region for suturing, and 5-mm ports are placed suprapubically
and in the right paramedian region. After the pneumoperitoneum was created, and
adhesiolyis was performed, and taken down, the bladder is filled in a
retrograde manner with 200 mL to 300 mL of saline, allowing for identification
of the superior border of the bladder edge. Entrance into the space of Retzius
was accomplished with a transperitoneal approach using a Harmonic scalpel.<span style="mso-spacerun: yes;"> </span>The incision was made approximately 3 cm
above the bladder reflection, beginning along the medial border of the right
obliterated umbilical ligament. After entering the space of Retzius the pubic
ramus was visualized; the bladder drained to prevent injury during dissection.
Separation of the loose areolar and fatty layers using blunt dissection
develops the retropubic space, and dissection is continued until the retropubic
anatomy is clearly visualized. Identification of the sling mesh was made where
it touches the pubic rami, <span style="mso-spacerun: yes;"> </span>approximately
3 cm lateral from midline.<span style="mso-spacerun: yes;"> </span>Once
identified, the mesh was grasped and excised from the anterior abdominal wall
and then peeled free of the pubic rami periosteum. Dissection was then
continued down along the mesh toward the bladder and pubocervical fascia.
Extensive scarring was encountered, and the mesh was cut out with the scarred
tissue.<span style="mso-spacerun: yes;"> </span>In addition, the mesh was eroded
into the bladder, and the dissection was continued down to where the mesh appeared
to be eroded into the bladder.<span style="mso-spacerun: yes;"> </span>The mesh was
removed<span style="mso-spacerun: yes;"> </span>but erosion was not found to be
in the bladder. Dissection was continued down to and through the pubocervical
fascia on both sides. An incision was then made suburethrally, and the remaining
mesh below the urethra identified, cut in the midline, and freed up allowing
removal of the entire portion of the mesh sling.<span style="mso-spacerun: yes;"> </span>All laparoscopic surgical devices were
removed and accurate sponge and surgical devices accounted for.<span style="mso-spacerun: yes;"> </span>Patient then taken to the recovery area, and
will be discharged when stable. <o:p></o:p></span></div>
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<span style="font-family: "Arial Narrow","sans-serif";">Cpt
Code:<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="font-family: "Arial Narrow","sans-serif";"><span style="mso-tab-count: 1;"> </span>57287 </span><span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Removal or revision of sling for stress
incontinence (eg, fascia or synthetic) – Open or laparoscopic Approach</span><span style="font-family: "Arial Narrow","sans-serif";"><o:p></o:p></span></div>
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<span style="font-family: "Arial Narrow","sans-serif";">ICD-10CM
: <o:p></o:p></span></div>
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<span style="font-family: "Arial Narrow","sans-serif";">T83.711D<span style="background: white; color: black;"> Erosion of implanted vaginal mesh to surrounding
organ or tissue</span>; <span style="background: white; color: black;">subsequent
encounter<o:p></o:p></span></span></div>
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial Narrow","sans-serif";">Wrap up<o:p></o:p></span></u></b></div>
<div style="background: white;">
<span style="font-family: "Arial Narrow","sans-serif"; font-size: 11.0pt; mso-bidi-font-family: Arial;">The biggest challenge of coding for SUI is ensuring
that the correct codes were chosen for either open or laparoscopic
approach.<span style="mso-spacerun: yes;"> </span>In addition to ensuring that
your codes for CPT are correct, but double check your ICD-10cm diagnoses for
accuracy.<span style="mso-spacerun: yes;"> </span>And with all claims, follow
them to ensure that they were submitted in a timely manner, but were also
reimbursed correctly.<span style="mso-spacerun: yes;"> </span>If not, then file
an appeal for readjudication or peer review as necessary. <o:p></o:p></span></div>
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<i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Arial Unicode MS";">Lori-Lynne
A. Webb, CPC, CCS-P, CCP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an
E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA
Privacy specialist, with over 20 years of experience.<span style="mso-spacerun: yes;"> </span>Lori-Lynne’s coding specialty is OB/GYN
office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology,
Urology, and general surgical coding.<span style="mso-spacerun: yes;">
</span>She can be reached via e-mail at </span></i><a href="mailto:webbservices.lori@gmail.com"><i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Arial Unicode MS";">webbservices.lori@gmail.com</span></i></a><i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Arial Unicode MS";"> or you can also find current coding information
on her blog site: </span></i><a href="http://lori-lynnescodingcoachblog.blogspot.com/"><i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Arial Unicode MS";">http://lori-lynnescodingcoachblog.blogspot.com/</span></i></a><i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Arial Unicode MS";">.<span style="mso-spacerun: yes;"> </span></span></i><span style="mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<br />Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-51487035447889264462018-07-26T23:45:00.000-06:002018-07-26T23:45:11.586-06:00Modifier 22 - A new perspective on a misunderstood modifier<div class="MsoNoSpacing">
<b>Modifier 22 - A new perspective on a misunderstood modifier
<o:p></o:p></b></div>
<div class="MsoNoSpacing">
<b>01/28/2018 - Lori-Lynne A. Webb <o:p></o:p></b></div>
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<span style="background: white; font-family: Arial, sans-serif;">Modifier 22 Increased Procedural
Services modifier, as explained in <b>CPT</b>® Appendix A: <o:p></o:p></span></div>
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<span style="background: white; font-family: Arial, sans-serif;">“ When the work required to
provide a service is substantially greater than typically required, it may be
identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial
additional work and the reason for the additional work (ie, increased intensity,
time, technical difficulty of procedure, severity of patient’s condition,
physical and mental effort required).” <o:p></o:p></span></div>
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<span style="background: white; font-family: Arial, sans-serif;">Neither CPT, the Centers for Medicare & Medicaid Services (CMS), or
even AMA guidelines precisely define the term “substantially greater” than typically
required. Nor does CPT address the issue
that </span><span style="background: white; font-family: Helvetica, sans-serif; font-size: 10.5pt;">modifier 22 allows a
physician to receive a larger reimbursement (usually an extra 20-25%) for an
especially difficult or time-consuming procedure. Unfortunately, 3<sup>rd</sup> party payers
won’t automatically increase reimbursement for a modifier 22 claim. It is common for physicians to increase their fee by 20-25%
when submitting a claim with the modifier 22 attached to compensate the
provider for the “over and above” work that was performed on the case. CPT does not specify “financial compensation”
in the modifier definition. <o:p></o:p></span></div>
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<span style="background: white; font-family: Helvetica, sans-serif; font-size: 10.5pt;">However, in getting modifier
22 claims <b><i><u>paid</u></i></b> ; overall the case will require more than just
extra work in the operating room; it also means clear and concise clinical documentation
to support the “additional work performed” to be noted by the provider. As the coder, you have a responsibility to
ensure the claim submission went through correctly; and you have followed the
claim through to ensure it was paid by the carrier with the additional revenue. If your claim was not paid correctly, it will
be up to you to formulate an appeal back to the carrier for the additional
reimbursement you have asked for . </span><span style="background: white;"><o:p></o:p></span></div>
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<b><u>When to use Modifier 22<o:p></o:p></u></b></div>
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Modifier
22 <i>Increased Procedural Services</i>; is to be used only for
services/procedures which are greater
than usual and which requires increased physician work above and beyond
normal. When it comes to a “normal”
procedure, the definition of “above and beyond” normal is very vague and can be
interpreted in a multitude of ways by the 3<sup>rd</sup> party payers. <o:p></o:p></div>
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Specific
circumstances that may support modifier 22 include: <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Excessive/unexpected
blood loss or hemorrhage relative to the procedure <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Presence
of an excessively large surgical specimen(especially in abdominal surgery) <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Trauma
that is <i>extensive enough</i> to
complicate the particular procedure. (and that cannot be billed with additional
procedure codes or with an unlisted procedure code) <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Abnormal
and/or other pathology, tumors, malformations that interfere directly with the
surgery <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Procedures
that are significantly more complex than described in CPT 9and cannot be billed
with additional procedure codes and/or an unlisted procedure code) <o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Morbid
obesity and <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Altered
anatomy such as severe scarring or adhesions from previous trauma.<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Patient
complications during complex surgery such as converting a laparoscopic procedure
to an open approach; patient hemorrhage during surgery; or unexpected operative
complications during surgery. <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]-->Complex
delivery/birth (eg twins, excessive
hemorrhage, fetal or maternal distress)<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="background: white; font-size: 12pt;">Modifier 22 usage with global maternity
care, or maternal services may be appropriate if:</span><span style="font-size: 12pt;"><o:p></o:p></span></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="background: white; line-height: normal; margin-bottom: 0.0001pt; margin-right: 12pt;"><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">Management
of pregnancy related complications (pre-eclampsia, preterm labor,
bleeding, etc…) has required greater than 15 antepartum visits.<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; line-height: normal; margin-bottom: 0.0001pt; margin-right: 12pt;"><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">For
cesarean delivery of multiple gestations.<o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; line-height: normal; margin-bottom: 0.0001pt; margin-right: 12pt;"><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">The
cesarean delivery requires substantial additional work.</span><o:p></o:p></li>
</ul>
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<span style="font-size: 12pt;">However,
with usage in obstetric services, the 3<sup>rd</sup> party payers may have
restrictions or specified criteria to be followed when submitting obstetric
service claims with a modifier 22.
CMS/Medicare/Medicaid have not specifically addressed usage of this
modifier with claims. American Congress
of Obstetricians and Gynecologists have noted that modifier 22 can be used for
3<sup>rd</sup> and 4<sup>th</sup> degree lacerations that occur at the time of
delivery. </span><o:p></o:p></div>
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<div class="MsoNormal" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 6.0pt; margin-right: 12.0pt; margin-top: 0in;">
In Appendix A of the CPT book, the
definition also includes a “note” that informs
us that modifier -22 should not be appended to an E/M service. This information implies that modifier 22
should only be used along with valid procedure/surgery CPT codes. According to
the Medicare Physician Fee Schedule Database, modifier 22 can be appended to
procedures having a global surgery indicator of 000, 010, or 090 post operative
days. Modifier -22 is not valid for
“XXX” global period indicators, which includes E/M, radiology, laboratory,
pathology, and most medicine codes. With
some 3<sup>rd</sup> party payers, procedure codes with global day indicator of
ZZZ, or MMM in addition of modifier 22 upon those claims may be considered upon
review.<o:p></o:p></div>
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<b><u>Clinical
Documentation<o:p></o:p></u></b></div>
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The clinical documentation provided in the patients’
operative record is crucial to substantiate usage of modifier 22. A clear and concise description of the
unusual circumstance(s) that outline <b><i>why</i></b> this particular encounter
required greater effort, than the normal services, should be well documented by
the provider. <o:p></o:p></div>
<div class="MsoNormal" style="background: white; line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="color: #333333; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">When
documenting in the operative/procedural record avoid using a generalized
statement. Comments like "patient was obese" or "surgery took
longer than usual" or "multiple adhesions" lack specificity to
truly detail why the procedure was beyond the normal or routine type difficulties
that are encountered with the procedure on a day to day basis. The surgeon should explain and identify any
additional acute or chronic illnesses, and/or preexisting conditions, or
complications that were encountered within the surgery that contributed to
warrant extra time effort and the usage of modifier 22. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="color: #333333; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">Communicate
with the provider to use “comparative” verbiage to show how this procedure was
significantly different from the typical and or average procedure. For example, a statement such as “The patient
lost 850 cc’s of blood during the delivery with extensive clotting, hemorrhage
and uterine atony. Normal blood loss is approximately 200 cc’s”. The provider should also denote any and all
additional procedures that were performed to control the hemorrhage during the
delivery. ( eg. postpartum curettage, application of a Bakri-Balloon or
hemabate) If the original clinical documentation does
not support the usage of the modifier 22 prior to the claim being submitted,
ask the provider to amend or re-document the surgery to accurately reflect the
complexity of the surgery that necessitates the usage of the modifier 22. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="color: #333333; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">When
using <b><i>time</i></b> as a modifier 22 criteria, comparative verbiage is also
helpful, such as stating “I spent 2 hours of abdominal adhesiolysis due to the
patient’s morbid obesity before gaining access to the operative field. Normal time for adhesiolysis for this surgery
is usually 20-30 minutes. Other good clinical examples are “Due to the altered
anatomical issues and scarring from previous
abdominal surgeries; upon entrance to
the abdominal cavity, we had to delicately lyse colonic adhesions from the
abdominal and peritoneal area for over an hour to obtain access into the
surgical field, whereas, this normally takes 5-10 minutes.” Or “We had to make four attempts to place the
guide wire due to extensive plaque buildup prior to the start of the catheterization.”
<o:p></o:p></span></div>
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<b><u><span style="color: #333333; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">Claims Submission<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="background: white; line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="color: #333333; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman";">Unfortunately,
many 3<sup>rd</sup> party payers automatically reject or refuse any claims that
have a modifier 22 appended to them upon initial electronic claim
submission. Once this rejection has been
received back to the provider, you will need to submit the procedure/operative
report documents to support your claim for payment of additional revenue for modifier
22claims. In addition, be prepared to
submit the operative notes and a separate statement or letter indicating how
the procedure was significantly more difficult that the normal surgical
procedure. You may also want to consider
adding a notation within the separate statement asking for the additional
20-25% more reimbursement for the additional work performed. Last but not least, if the 3<sup>rd</sup>
party payer refuses to consider your claim upon the submission of the
additional information, appeal to the highest level possible, up to and
including a peer to peer physician review with physicians that practice within
the same specialty. <o:p></o:p></span></div>
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<i><span style="font-family: "Tahoma","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Arial Unicode MS"; mso-fareast-language: EN-US;">Lori-Lynne
A. Webb, CPC, CCS-P, CCP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an
E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA
Privacy specialist, with over 20 years of experience. Lori-Lynne’s coding specialty is OB/GYN
office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology,
Urology, and general surgical coding.
She can be reached via e-mail at </span></i><span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><a href="mailto:webbservices.lori@gmail.com"><i><span style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";">webbservices.lori@gmail.com</span></i></a></span><i><span style="font-family: "Tahoma","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Arial Unicode MS"; mso-fareast-language: EN-US;"> or
you can also find current coding information on her blog site: </span></i><span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><i><span style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";"><a href="http://lori-lynnescodingcoachblog.blogspot.com/">http://lori-lynnescodingcoachblog.blogspot.com/</a></span></i></span><br />
<span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"></span>Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-26319386934421504702018-07-26T23:30:00.000-06:002018-07-26T23:30:01.622-06:00Understanding Coding of Hypertension in Pregnancy<br />
<br />
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Understanding
Coding of Hypertension in Pregnancy <o:p></o:p></span></u></b></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Saturday, June 23,
2018<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Hypertension
in pregnancy still remains as one of the most misunderstood complications of
pregnancy, in addition to the incorrect usage of the ICD-10 diagnosis codes
that go with it.<span style="mso-spacerun: yes;"> </span>ICD-10cm has a specific
block of codes allocated to Pregnancy and hypertension, that should be used
with all pregnancy coding.<span style="mso-spacerun: yes;"> </span>These codes
denote a pre-existing hypertention and then the gestational or
pregnancy-induced hypertension. <br style="mso-special-character: line-break;" />
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<!--[endif]--><o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">ICD-10cm Code block Group <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">O10<span style="mso-spacerun: yes;"> </span>Pre-existing hypertension complicating
pregnancy, childbirth and the puerperium<o:p></o:p></span></div>
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</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">O11<span style="mso-spacerun: yes;"> </span>Pre-existing hypertension with pre-eclampsia<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">O12<span style="mso-spacerun: yes;"> </span>Gestational [pregnancy-induced] edema and
proteinuria without hypertension<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .75in; mso-list: l2 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">O13<span style="mso-spacerun: yes;"> </span>Gestational [pregnancy-induced] hypertension
without significant proteinuria<o:p></o:p></span></div>
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</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">O14<span style="mso-spacerun: yes;"> </span>Pre-eclampsia<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">O15<span style="mso-spacerun: yes;"> </span>Eclampsia<o:p></o:p></span></div>
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</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">O16<span style="mso-spacerun: yes;">
</span>Unspecified maternal hypertension<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">As
you can see from the list above, there are numerous codes to choose from.<span style="mso-spacerun: yes;"> </span>As coders, we rely on our physicians to give
us good clinical documentation within the pregnancy record, so we can code and
bill appropriately for their services.<span style="mso-spacerun: yes;">
</span>As in the case of a pregnancy that the OB is supervising, the added
diagnosis of Hypertension in pregnancy brings added risk factors to that pregnancy
oversight.<span style="mso-spacerun: yes;"> </span>We also need to add ICD-10cm
code for a high risk pregnancy due to hypertension.<span style="mso-spacerun: yes;"> </span>The pregnancy supervision code for high risk
pregnancy will be coded as the primary code based upon the ICD-10cm
guidelines.<span style="mso-spacerun: yes;"> </span>ICD-10cm coding guidelines
for high-risk pregnancy changed in 2017. The current rule from the 2018
ICD-10-CM Official Guidelines for Coding and Reporting (effective Oct 1, 2017 –
Sept 30, 2018) is below:<o:p></o:p></span></div>
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<b><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial Narrow","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Supervision of High-Risk Pregnancy </span></i></b><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial Narrow","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">(ICD-10-CM
Official Guidelines for Coding and Reporting <span style="mso-bidi-font-weight: bold;">FY 2018<b> </b></span>Page 58 of 117) Codes from category O09,
Supervision of high-risk pregnancy, are intended for use only during the
prenatal period. For complications during the labor or delivery episode as a result
of a high-risk pregnancy, assign the applicable complication codes from Chapter
15. If there are no complications during the labor or delivery episode, assign
code O80, Encounter for full-term uncomplicated delivery. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></i></div>
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<i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial Narrow","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">For routine prenatal outpatient visits for patients
with high-risk pregnancies, a code from category O09, Supervision of high-risk
pregnancy, should be used as the first-listed diagnosis.. <span style="mso-spacerun: yes;"> </span></span></i><span style="font-family: "Arial Narrow","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
high risk supervision codes noted below, do not have a category specifically
for oversight of hypertension in pregnancy, however this is something that we
need to have coded for our diagnoses.<span style="mso-spacerun: yes;"> </span>If
we are going to add a high risk pregnancy diagnosis to our record, the code
choice of O09.89 would the best choice, as the hypertension in pregnancy is in
the “other high risk” category and our provided has specified it as such.<span style="mso-spacerun: yes;"> </span><br />
<br />
</span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span><a href="https://www.blogger.com/null" name="O09"><span style="color: blue; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">O09</span></a><span style="mso-bookmark: O09;"></span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> Supervision of
high risk pregnancy<o:p></o:p></span></div>
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</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.0"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.0"><span style="mso-bookmark: "O09\.0";"><span style="text-decoration: none; text-underline: none;">O09.0</span></span><span style="mso-bookmark: "O09\.0";"></span></a><span style="mso-bookmark: "O09\.0";"></span> Supervision of pregnancy with
history of infertility<o:p></o:p></span></div>
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</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.1"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.1"><span style="mso-bookmark: "O09\.1";"><span style="text-decoration: none; text-underline: none;">O09.1</span></span><span style="mso-bookmark: "O09\.1";"></span></a><span style="mso-bookmark: "O09\.1";"></span> Supervision of pregnancy with
history of ectopic pregnancy<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: black; font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.A"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.A"><span style="mso-bookmark: "O09\.A";"><span style="text-decoration: none; text-underline: none;">O09.A</span></span><span style="mso-bookmark: "O09\.A";"></span></a><span style="mso-bookmark: "O09\.A";"></span> Supervision of pregnancy with
history of molar pregnancy<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: black; font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.2"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.2"><span style="mso-bookmark: "O09\.2";"><span style="text-decoration: none; text-underline: none;">O09.2</span></span><span style="mso-bookmark: "O09\.2";"></span></a><span style="mso-bookmark: "O09\.2";"></span> Supervision of pregnancy with other
poor reproductive or obstetric history<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: black; font-family: "Courier New"; font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.21"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.21"><span style="mso-bookmark: "O09\.21";"><span style="text-decoration: none; text-underline: none;">O09.21</span></span><span style="mso-bookmark: "O09\.21";"></span></a><span style="mso-bookmark: "O09\.21";"></span> Supervision of pregnancy with
history of pre-term labor<o:p></o:p></span></div>
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<a href="https://www.blogger.com/null" name="O09.29"><!--[if !supportLists]--><span style="color: black; font-family: "Courier New"; font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.29"><span style="mso-bookmark: "O09\.29";"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; text-decoration: none; text-underline: none;">O09.29</span></span></a><span style="mso-bookmark: "O09\.29";"></span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> Supervision of pregnancy with other poor
reproductive or obstetric history <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: black; font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.3"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.3"><span style="mso-bookmark: "O09\.3";"><span style="text-decoration: none; text-underline: none;">O09.3</span></span><span style="mso-bookmark: "O09\.3";"></span></a><span style="mso-bookmark: "O09\.3";"></span> Supervision of pregnancy with
insufficient antenatal care<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: black; font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.4"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.4"><span style="mso-bookmark: "O09\.4";"><span style="text-decoration: none; text-underline: none;">O09.4</span></span><span style="mso-bookmark: "O09\.4";"></span></a><span style="mso-bookmark: "O09\.4";"></span> Supervision of pregnancy with grand
multiparity <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: black; font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.5"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.5"><span style="mso-bookmark: "O09\.5";"><span style="text-decoration: none; text-underline: none;">O09.5</span></span><span style="mso-bookmark: "O09\.5";"></span></a><span style="mso-bookmark: "O09\.5";"></span> Supervision of elderly primigravida
and multigravida<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: black; font-family: "Courier New"; font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.51"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.51"><span style="mso-bookmark: "O09\.51";"><span style="text-decoration: none; text-underline: none;">O09.51</span></span><span style="mso-bookmark: "O09\.51";"></span></a><span style="mso-bookmark: "O09\.51";"></span> Supervision of elderly
primigravida <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: black; font-family: "Courier New"; font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.52"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.52"><span style="mso-bookmark: "O09\.52";"><span style="text-decoration: none; text-underline: none;">O09.52</span></span><span style="mso-bookmark: "O09\.52";"></span></a><span style="mso-bookmark: "O09\.52";"></span> Supervision of elderly
multigravida <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: black; font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.6"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.6"><span style="mso-bookmark: "O09\.6";"><span style="text-decoration: none; text-underline: none;">O09.6</span></span><span style="mso-bookmark: "O09\.6";"></span></a><span style="mso-bookmark: "O09\.6";"></span> Supervision of young primigravida
and multigravida<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l1 level2 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: black; font-family: "Courier New"; font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.61"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.61"><span style="mso-bookmark: "O09\.61";"><span style="text-decoration: none; text-underline: none;">O09.61</span></span><span style="mso-bookmark: "O09\.61";"></span></a><span style="mso-bookmark: "O09\.61";"></span> Supervision of young primigravida<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l1 level2 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: black; font-family: "Courier New"; font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.62"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.62"><span style="mso-bookmark: "O09\.62";"><span style="text-decoration: none; text-underline: none;">O09.62</span></span><span style="mso-bookmark: "O09\.62";"></span></a><span style="mso-bookmark: "O09\.62";"></span> Supervision of young multigravida<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: black; font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.7"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.7"><span style="mso-bookmark: "O09\.7";"><span style="text-decoration: none; text-underline: none;">O09.7</span></span><span style="mso-bookmark: "O09\.7";"></span></a><span style="mso-bookmark: "O09\.7";"></span> Supervision of high risk pregnancy
due to social problems<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: black; font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.8"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.8"><span style="mso-bookmark: "O09\.8";"><span style="text-decoration: none; text-underline: none;">O09.8</span></span><span style="mso-bookmark: "O09\.8";"></span></a><span style="mso-bookmark: "O09\.8";"></span> Supervision of other high risk
pregnancies<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l1 level2 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: black; font-family: "Courier New"; font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.81"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.81"><span style="mso-bookmark: "O09\.81";"><span style="text-decoration: none; text-underline: none;">O09.81</span></span><span style="mso-bookmark: "O09\.81";"></span></a><span style="mso-bookmark: "O09\.81";"></span> Supervision of pregnancy resulting
from assisted reproductive technology<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l1 level2 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: black; font-family: "Courier New"; font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.82"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.82"><span style="mso-bookmark: "O09\.82";"><span style="text-decoration: none; text-underline: none;">O09.82</span></span><span style="mso-bookmark: "O09\.82";"></span></a><span style="mso-bookmark: "O09\.82";"></span> Supervision of pregnancy with
history of in utero procedure during previous pregnancy<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l1 level2 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: black; font-family: "Courier New"; font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.89"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.89"><span style="mso-bookmark: "O09\.89";"><span style="text-decoration: none; text-underline: none;">O09.89</span></span><span style="mso-bookmark: "O09\.89";"></span></a><span style="mso-bookmark: "O09\.89";"></span> Supervision of other high risk
pregnancies<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: black; font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <a href="https://www.blogger.com/null" name="O09.9"></a><a href="https://www.icd10data.com/ICD10CM/Codes/O00-O9A/O09-O09/O09-/O09.9"><span style="mso-bookmark: "O09\.9";"><span style="text-decoration: none; text-underline: none;">O09.9</span></span><span style="mso-bookmark: "O09\.9";"></span></a><span style="mso-bookmark: "O09\.9";"></span> Supervision of high risk pregnancy,
unspecified<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">In
some cases, the high blood pressure diagnosis is present prior to the
pregnancy, <span style="mso-spacerun: yes;"> </span>however, the patient can
develop high blood pressure during pregnancy, which would then be noted as gestational
hypertension.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in; mso-list: l0 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Chronic hypertension is
high blood pressure that was present <i style="mso-bidi-font-style: normal;">before
pregnancy</i> or t<i style="mso-bidi-font-style: normal;">hat occurs before 20
weeks of pregnancy.</i> But because high blood pressure usually doesn't have
symptoms, the provider may be reluctant to state this as a chronic condition,
as this may or may not have been noted as a diagnosis for the patient by a
previous provider or prior to the pregnancy. <br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in; mso-list: l0 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Chronic hypertension
with superimposed preeclampsia is condition that can also occur in women with
chronic hypertension before pregnancy who develop worsening high blood pressure
and protein in the urine or other blood pressure related complications during
pregnancy.<br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in; mso-list: l0 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Gestational
hypertension is the patient noted in the record to have high blood pressure
that develops <i style="mso-bidi-font-style: normal;">after</i> 20 weeks of
pregnancy. Normally there is no excess protein noted in the urine or other
signs of organ damage however, some women with gestational hypertension may develop
preeclampsia.<br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in; mso-list: l0 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Preeclampsia occurs
when hypertension develops <i style="mso-bidi-font-style: normal;">after </i>20
weeks of pregnancy, and is associated with signs of damage to other organ
systems, including the kidneys, liver, blood and/or brain. Untreated
preeclampsia can lead to serious complications for mother and baby, including
development of seizures which then the diagnosis becomes eclampsia.<br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l0 level2 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Previously,
preeclampsia was clinically diagnosed only if a pregnant woman had high blood
pressure <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">and </i></b>protein in her urine. However, it has been noted that it's
possible for the patient to have preeclampsia without having protein in the
urine.<br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in; mso-list: l0 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Eclampsia is the
onset of seizures (convulsions) in a woman with pre-eclampsia.<span style="mso-spacerun: yes;"> </span>The onset may be before, during, or after
delivery, but it can be diagnosed and treated<span style="mso-spacerun: yes;">
</span>during the second trimester in the<span style="mso-spacerun: yes;">
</span>pregnancy.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l0 level2 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The seizures are
usually the<span style="mso-spacerun: yes;"> </span>tonic–clonic type and
typically last between 30 and 60 seconds.<span style="mso-spacerun: yes;">
</span>Complications of eclampsia include aspiration pneumonia, cerebral
hemorrhage, kidney failure, and cardiac arrest<br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="background: white; margin-bottom: 6.0pt; margin-left: 1.0in; margin-right: 0in; margin-top: 6.0pt; mso-list: l0 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #222222; font-family: Wingdings; font-size: 12.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">HELLP Syndrome </span><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">is another variant of pre-eclampsia
and/or eclampsia <span style="mso-spacerun: yes;"> </span>as a known pregnancy
complication. HELLP syndrome is characterized as hemolysis, elevated liver
enzymes, and<span style="mso-spacerun: yes;"> </span>low platelet count.<span style="mso-spacerun: yes;"> </span>HELLP syndrome can be fatal to both the
mother and the fetus.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in;">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
clinical documentation of consistent pregnancy blood pressure is an important
part of the patients’ prenatal care. The list below designates the levels at
which the blood pressures should be noted.<span style="mso-spacerun: yes;">
</span>As a coder, if you are not seeing these designations, you will want to
query the provider and ensure if the patient has a true “hypertension” or
simply an elevated blood pressure.<span style="mso-spacerun: yes;"> </span>This
will make a difference in your code choice.<span style="mso-spacerun: yes;">
</span>This will also determine if the ob visit should be considered part of
the prenatal care/OB package, or if it should be billed as a separately
identifiable visit outside of the prenatal care/OB package. <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l3 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Elevated blood
pressure</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">:<span style="mso-spacerun: yes;"> </span>Elevated blood pressure is a systolic
pressure ranging from 120 to 129 millimeters of mercury (mm Hg) and a diastolic
pressure below 80 mm Hg. Elevated blood pressure tends to get worse over time
unless steps are taken to control blood pressure.<br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l3 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Stage 1 hypertension:</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"> Stage 1 hypertension
is a systolic pressure ranging from 130 to 139 mm Hg or a diastolic pressure
ranging from 80 to 89 mm Hg.<br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l3 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Stage 2 hypertension:</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"> More severe
hypertension, stage 2 hypertension is a systolic pressure of 140 mm Hg or
higher or a diastolic pressure of 90 mm Hg or higher.<br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">NOTE:<span style="mso-spacerun: yes;"> </span>After 20 weeks of pregnancy</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">, blood pressures
that exceeds 140/90 mm HG — documented on two or more occasions within the
prenatal record, that are at least four hours apart, without any other organ
damage — is considered to be gestational hypertension.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<br /></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="Default">
<span style="font-family: "Arial","sans-serif";">As we look to
the ICD-10cm coding guidelines, the pre-existing condition (such as
hypertension) should be considered carefully.<span style="mso-spacerun: yes;">
</span><o:p></o:p></span></div>
<div class="Default">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<b><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial Narrow","sans-serif"; font-size: 12.0pt; mso-bidi-font-family: Arial;">Pre-existing conditions versus conditions due to
the pregnancy </span></i></b><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial Narrow","sans-serif"; font-size: 12.0pt; mso-bidi-font-family: Arial;">(ICD-10-CM Official Guidelines for Coding and Reporting FY 2018 Page 59
of 117) <o:p></o:p></span></i></div>
<div class="Default" style="margin-left: .5in;">
<br /></div>
<div class="Default" style="margin-left: .5in;">
<i style="mso-bidi-font-style: normal;"><span style="color: windowtext; font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: Arial;">Certain categories in Chapter 15 distinguish between
conditions of the mother that existed prior to pregnancy (pre-existing) and
those that are a direct result of pregnancy. When assigning codes from Chapter
15, it is important to assess if a condition was pre-existing prior to
pregnancy or developed during or due to the pregnancy in order to assign the
correct code. <o:p></o:p></span></i></div>
<div class="Default" style="margin-left: .5in;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial Narrow","sans-serif"; font-size: 12.0pt; mso-bidi-font-family: Arial;">Categories that do not distinguish between
pre-existing and pregnancy-related conditions may be used for either. It is
acceptable to use codes specifically for the puerperium with codes complicating
pregnancy and childbirth if a condition arises postpartum during the delivery
encounter.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></i></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">The
ICD-10cm guidelines also go on to say that the “O” codes that have been set
forth for hypertension in pregnancy also include the codes for hypertensive
chronic kidney disease.<span style="mso-spacerun: yes;"> </span>If this is the
case we are then to assign not only the appropriate O10 code, but also add an
additional code from the appropriate hypertension category from ICD_10cm
Chapter 9: Diseases of the Circulatory System (I00-I99) and specify the type of
heart failure or CKD. <o:p></o:p></span></div>
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<b><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial Narrow","sans-serif"; font-size: 12.0pt; mso-bidi-font-family: Arial;">Pre-existing hypertension in pregnancy </span></i></b><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial Narrow","sans-serif"; font-size: 12.0pt; mso-bidi-font-family: Arial;">(ICD-10-CM Official
Guidelines for Coding and Reporting FY 2018 Page 60 of 117)<b><br style="mso-special-character: line-break;" />
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<!--[endif]--></b><o:p></o:p></span></i></div>
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<i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial Narrow","sans-serif"; font-size: 12.0pt; mso-bidi-font-family: Arial;">Category O10, Pre-existing hypertension complicating
pregnancy, childbirth and the puerperium, includes codes for hypertensive heart
and hypertensive chronic kidney disease. When assigning one of the O10 codes
that includes hypertensive heart disease or hypertensive chronic kidney
disease, it is necessary to add a secondary code from the appropriate
hypertension category to specify the type of heart failure or chronic kidney
disease. See Section I.C.9. Hypertension <o:p></o:p></span></i></div>
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<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><u>Office Coding
Scenario – Admission to L&D: <o:p></o:p></u></b></div>
<div class="MsoNormal">
Patient is a 32 year old who has come in at the request of
our Triage RN status post patient call 1 hr ago. Pt is G2 and P1 at 35 and 3/7
weeks with gestational hypertension stable on labeletol. Pt arrived 20 minutes
ago and is now complaining of a severe headache, leg swelling, blurred vision,
abdominal pains, and a BP of 170/102.<span style="mso-spacerun: yes;">
</span>She notes baby is moving well, but is having contractions.<span style="mso-spacerun: yes;"> </span>Her husband is present with her and is very
supportive, but concerned.<span style="mso-spacerun: yes;"> </span>Sarah has a
history of mild pre-eclampsia with her first child who delivered vaginally 2
years ago. She is allergic to PCN with a bad rash noted 4 years ago. Her Blood
pressure in the clinic 2 days ago was 140/85.. She was not started on any new
medications, nor any changes to her current Labeletal dose,<span style="mso-spacerun: yes;"> </span>but was put on bedrest.<span style="mso-spacerun: yes;"> </span>She continues to complain of a severe
headache.<span style="mso-spacerun: yes;"> </span>She is oriented x3, but
somewhat sleepy. She has pitting edema bilaterally at a 3+<span style="mso-spacerun: yes;"> </span>She has also complained of some mild nausea
with no vomiting at this point. No complaints of shortness of breath. Lungs are
still clear. She continues to complain of upper abdominal pain. Her urine dip
indicated some mild 2+ proteinuria.<span style="mso-spacerun: yes;"> </span>Her
most recent vital signs are BP158/98, P98 R14, T98.6 .<span style="mso-spacerun: yes;"> </span>She has current symptoms of severe
pre-eclampsia, with pre-term labor and trending toward eclampsia.<span style="mso-spacerun: yes;"> </span>At this time, I will send orders for direct
admission to L&D Observation for continued surveillance of severe
pre-eclampsia.<span style="mso-spacerun: yes;"> </span>Patient directed to
L&D.<span style="mso-spacerun: yes;"> </span>I will follow with patient at
evening rounds. <o:p></o:p></div>
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<span style="font-family: "Arial","sans-serif";">Coding
Considerations: <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "Arial","sans-serif";">ICD-10
cm Diagnosis: <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in;">
<span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">O09.89 Supervision of other high risk pregnancies<o:p></o:p></span></div>
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<span style="background: white; color: black; font-family: "Arial","sans-serif";">O14.13 Severe pre-eclampsia third trimester<br />
O60.03 Preterm labor without delivery<br />
Z3A.37 </span><span style="background: white; color: black; font-family: "Verdana","sans-serif"; font-size: 10.0pt; line-height: 115%;">37 weeks gestation of pregnancy<o:p></o:p></span></div>
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<span style="background: white; color: black; font-family: "Verdana","sans-serif"; font-size: 10.0pt; line-height: 115%;">According to the CPT
Maternity Care and Delivery guidelines that are noted at the beginning of the
maternity care section within the CPT book it clearly states <o:p></o:p></span></div>
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<span style="background: white; color: black; font-family: "Verdana","sans-serif"; font-size: 10.0pt; line-height: 115%;">“Medical complications of pregnancy; (eg cardiac problems, neurological
problems, diabetes, hypertension, toxemia, hyperemesis, preterm labor,
premature rupture of membranes,trauma) and medical problems complicating labor
and delivery management may require additional resources and may be reported
separately.”<span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial","sans-serif";">Billing/Reimbursement Issues<o:p></o:p></span></u></b></div>
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<span style="font-family: "Arial","sans-serif";">Some 3<sup>rd</sup>
party payers may consider the above scenario of care as part of the OB package
of care, and not reimburse for the admission to observation as a separately
identifiable service outside of the OB package.<span style="mso-spacerun: yes;">
</span>If that is the case, CPT does allow for this and you should code, bill
and subsequently appeal for your appropriate payment of such.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Arial Unicode MS";">Lori-Lynne
A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC and ICD10 cm/pcs Ambassador/trainer
is an E&M, and Procedure based Coding, Compliance, Data Charge entry and
HIPAA Privacy specialist, with over 20 years of experience.<span style="mso-spacerun: yes;"> </span>Lori-Lynne’s coding specialty is OB/GYN
office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology,
Urology, and general surgical coding.<span style="mso-spacerun: yes;">
</span>She can be reached via e-mail at </span></i><a href="mailto:webbservices.lori@gmail.com"><i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Arial Unicode MS";">webbservices.lori@gmail.com</span></i></a><i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Arial Unicode MS";"> or you can also find current coding information
on her blog site: </span></i><a href="http://lori-lynnescodingcoachblog.blogspot.com/"><i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Arial Unicode MS";">http://lori-lynnescodingcoachblog.blogspot.com/</span></i></a><i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Arial Unicode MS";">.<span style="mso-spacerun: yes;"> </span></span></i><b style="mso-bidi-font-weight: normal;"><span style="mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></b></div>
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<br />Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-52028652842243873342018-07-26T23:00:00.000-06:002018-07-26T23:00:03.463-06:00<br />
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial","sans-serif";">Pelvic Congestion Syndrome: Pelvic
Varices <o:p></o:p></span></u></b></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif";">5/13/2018<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif";">Pelvic
congestion syndrome is denoted as chronic pelvic pain in women who have
varicose veins in or near their ovaries within the pelvic cavity.<span style="mso-spacerun: yes;"> </span>Pelvic congestion syndrome is a common cause
of chronic pelvic pain, but many times is overlooked as a cause for the pelvic
pain.<span style="mso-spacerun: yes;"> </span>In women that have pelvic varicose
veins and venous insufficiency pelvic pain is a complaint, however, may not
have any symptoms at all.<span style="mso-spacerun: yes;"> </span>It remains a
medical mystery as to why some women develop pain and other symptoms, yet
others have no complaint at all.<span style="mso-spacerun: yes;"> </span>The
majority of women diagnosed with pelvic congestion syndrome normally fall within
the 20-45 year age demographic and have had multiple pregnancies.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif";">Physician
have noted that chronic and acute pelvic pain from these enlarged veins,<span style="mso-spacerun: yes;"> </span>primarily develops after pregnancy, and the
pain level from this trends upward and seems to worsen with each subsequent
pregnancy.<span style="mso-spacerun: yes;"> </span>Typically, this type of
pelvic pain is a dull ache, however, it may be reported by the patient as an
acute, sharp, stabbing, or throbbing type of pain. <span style="mso-spacerun: yes;"> </span>Some patients have stated that it seems to worsen
at the end of the day, or after sitting/ standing for long periods of time.<span style="mso-spacerun: yes;"> </span>Pelvic pain from pelvic varices can also
occur during or after sexual intercourse, and may be accompanied by low back
pain, aches in the legs, and abnormal menstrual bleeding.<span style="mso-spacerun: yes;"> </span>In addition, some women may also have
varicose veins in the vulva, vagina, perineal area, buttocks, thighs, and lower
legs.<span style="mso-spacerun: yes;"> </span>And as if these symptoms weren’t
enough, some women experience a clear or watery discharge from the vagina, fatigue,
mood swings, headaches, abdominal bloating, painful ovaries and cervical pain
with motion tenderness.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial","sans-serif";">Diagnosing Pelvic Congestion Syndrome<o:p></o:p></span></u></b></div>
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<div style="margin-top: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">In
the clinical diagnosis and documentation of pelvic congestion syndrome, a
diagnosis can be made using non-invasive ultrasound testing, or by a diagnostic
pelvic laparoscopy.<span style="mso-spacerun: yes;"> </span>Ultrasound is the
diagnostic tool most commonly used and many OB physicians perform both an
abdominal and a transvaginal duplex ultrasound in the office as the first-line
testing .<span style="mso-spacerun: yes;"> </span>These ultrasounds may be
enough to enable the provider to see if there is a pelvic varicosity within the
pelvic area, and if venous enlargement and/or venous reflux is causing the patients’
pelvic pain.<span style="mso-spacerun: yes;"> </span>Unfortunately ultrasound
may not show pelvic varices, or pelvic veins well, especially when the patient
is lying down, or is obese.<span style="mso-spacerun: yes;"> </span>Ultrasound
does not produce good images in patients that are obese as the sound waves do
not travel through adipose tissue as well as they do in non-obese patients.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div style="margin-top: 0in;">
<span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">If
ultrasound does not diagnose or confirm the pelvic congestion syndrome, additional
testing such as venography, CT, MRI, magnetic resonance venography may be necessary
to confirm the pelvic varicosities diagnosis.<span style="mso-spacerun: yes;">
</span>If venography is performed, contrast dye tests may be utilized for
better imaging and real time viewing. <span style="mso-spacerun: yes;"> </span>If
non-invasive procedures do not give the provider a good confirmed diagnosis of
pelvic congestion syndrome, then the option of a diagnostic surgical pelvic
laparoscopy may be the next choice for diagnosis confirmation.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif";">When
Pelvic Congestion Syndrome occurs pelvic pain is one of the first symptoms,
however, clinically, <span style="mso-spacerun: yes;"> </span>the same effect
happen to the pelvic veins , similar to development of varicose veins that develop
in other areas of the body, such as in the perineal, vulvar and groin area, and
the upper and/or lower extremities.<span style="mso-spacerun: yes;"> </span>The
physiology behind this, is the vein valves in the veins no longer function
normally, causing blood to back up within the vein, therefore becoming
enlarged, <span style="mso-spacerun: yes;"> </span>engorged or “congested”.<span style="mso-spacerun: yes;"> </span>This “congestion” is what causes the pain. <o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial","sans-serif";">Treatment for pelvic congestion
syndrome<o:p></o:p></span></u></b></div>
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<span style="font-family: "Arial","sans-serif";">OB
providers may treat pelvic congestion syndrome with oral drug therapy, such as
NSAIDS (nonsteroidal anti-inflammatory drugs) which can reduce pain, decrease
fever, prevent blood clots and, reduce inflammation.<span style="mso-spacerun: yes;"> </span>At this time, aspirin, ibuprofen, and naproxen
sodium, can be purchased over the counter, but many NSAIDs, such as ketorolac
tromethamine, celecoxib, meloxicam and many others still requires a
prescription from the provider.<span style="mso-spacerun: yes;"> </span>Usually<span style="mso-spacerun: yes;"> </span>the first line treatment is nonsteroidal
anti-inflammatory drugs, as nonsteroidal anti-inflammatory drugs (NSAIDs)
usually relieve the pain.<span style="mso-spacerun: yes;"> </span>If NSAIDs are
ineffective, the provider may prescribe a suppression of ovarian function and
prescribe oral or injected hormone therapy.<span style="mso-spacerun: yes;">
</span>It is also becoming more and more common for providers to refer patients
out for non-traditional medical therapies for pain relief such as acupuncture
therapy, physical therapy, bio-feedback training, and yoga meditative therapy
in addition to traditional medical therapy.<span style="mso-spacerun: yes;">
</span><o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif";"><span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div style="background: white; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 6.0pt;">
<span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 11.0pt;">If the above treatments fail, the next option is a minimally
invasive surgical option which involves stopping blood flow to the varicose
veins using a procedure called known as venous embolization. The
procedure requires an overnight stay in hospital, and is done using a
local anesthetic or conscious sedation, and has a fairly high success rate. </span><span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif";">Currently
there are two procedures are available:<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l5 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Embolization
of a vein: After using an anesthetic to numb a small area of the thigh, doctors
make a small incision there. Then, they insert a thin, flexible tube (catheter)
through the incision into a vein and thread it to the varicose veins. They
insert tiny coils, sponges, or glue-like liquids through the catheter into the
veins to block them.<br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l5 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Sclerotherapy:
Similar to embolization, a catheter is inserted into the vein, and the provider
injects a sclerosing solution through it and into the varicose veins. The
solution blocks the vein(s).<span style="mso-spacerun: yes;"> </span>It is
assumed that when blood can no longer flow into the varicose vein(s) in the
pelvis, the pain usually lessens.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial","sans-serif";">Coding Considerations:<o:p></o:p></span></u></b></div>
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<span style="font-family: "Arial","sans-serif";">Scenario 1
- For pelvic congestion syndrome<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif";">A
diagnostic venogram is obtained from a right common femoral venous puncture,
with selective catheterization and diagnostic venography of the left renal
vein, left ovarian vein, bilateral hypogastric veins, and bilateral external
iliac veins. A large, varicose left ovarian vein is shown with reflux into
enlarged uterine veins. The left ovarian vein is embolized with coils and
sotradecyl.<o:p></o:p></span></div>
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<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif";">CPT Codes:
<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l4 level1 lfo5; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">37241:
Venous embolization<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l4 level1 lfo5; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">36012X3:
Selection of left renal/ovarian, left hypogastric, left external iliac veins<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l4 level1 lfo5; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">36011:
Selection of right hypogastric vein<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l4 level1 lfo5; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">75822-59:
Bilateral extremity venogram<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l4 level1 lfo5; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">75831-59:
Left renal/ovarian venogram<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif";">ICD-10cm Codes
<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">N94.89
Other specified conditions associated with female genital organs and menstrual
cycle<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">I86.2
Pelvic varices<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">R10.2
Pelvic and perineal pain<o:p></o:p></span></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif";">Scenario 2 - Pelvic congestion
syndrome, persistent unimproved pelvic pain despite bilateral gonadal vein
embolizations<o:p></o:p></span></b></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif";">Moderate
sedation was employed using Versed and Fentanyl titrated for patient comfort by
a trained independent observer. Continuous physiologic monitoring vital signs
was performed for approximately 105 minutes. <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif";">Lidocaine
was administered locally. A small dermatotomy was made and a micropuncture
needle was placed into the right internal jugular vein. Ultrasound guidance was
used. A hardcopy image was saved. An 0.018" wire was easily passed. A
micropuncture sheath assembly was advanced and a Benson guidewire was then
advanced into the IVC.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif";">A 6 French
sidearm sheath was then placed into the IVC. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif";">Using AP
venous catheter, the right internal iliac vein was catheterized contrast was
injected to confirm position. The catheter was then advanced over a wire into the
main trunk draining pelvic varicosities. A 1 cc Foley catheter was then
advanced over an exchange length Bentson guidewire and the balloon was
insufflated proximally 0.3 cc of dilute contrast to include flow. Approximately
5 cc of contrast was then gently injected to fill numerous large pelvic
varicosities. Access was then gained into the left internal iliac vein and
contrast was injected. A 1 cc Fogarty catheter was then placed into the left
internal iliac vein and contrast was injected following insufflation of the
balloon. Access was regained into the right internal iliac vein varicosity. The
portable gland was insufflated to occlude flow and 3 cc of 3% Sotradecol was
then administered as a sclerosing agent. This was allowed to dwell for 5
minutes. Repeat venogram was performed which demonstrated decreased size of
varicosities. <span style="mso-spacerun: yes;"> </span>The catheter was removed
and manual compression was used to achieve hemostasis.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif";">FINDINGS:<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l2 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Initial
right internal iliac vein venogram demonstrates numerous large varicosities in
the pelvis. The majority of these are present inferiorly. Treatment was
performed only of the more inferior varicosities. Post sclerotherapy venogram
demonstrates significant decrease in size of varicosities. <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l2 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Left
internal iliac vein venogram demonstrates several mildly enlarged pelvic veins.
These are much less impressive than noted on the right.<o:p></o:p></span></div>
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<span style="background: #FAFAFA; color: #333333; font-family: "Arial","sans-serif";">CPT Codes:<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #333333; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="background: #FAFAFA; color: #333333; font-family: "Arial","sans-serif";">36470 </span><span style="font-family: "Arial","sans-serif";">Injection
of sclerosing solution; single vein <span style="background: #FAFAFA; color: #333333;"><o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #333333; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="background: #FAFAFA; color: #333333; font-family: "Arial","sans-serif";">75822 </span><span style="font-family: "Arial","sans-serif";">Venography,
extremity, bilateral, radiological supervision and interpretation<span style="background: #FAFAFA; color: #333333;"><o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #333333; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="background: #FAFAFA; color: #333333; font-family: "Arial","sans-serif";">36012 (rt int iliac) </span><span style="font-family: "Arial","sans-serif";">Selective catheter placement, venous
system; second order, or more selective, branch (e.g., left adrenal vein,
petrosal sinus)<span style="background: #FAFAFA; color: #333333;"><o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="background: #FAFAFA; color: #333333; font-family: "Arial","sans-serif";">36012 (lt int iliac) </span><span style="font-family: "Arial","sans-serif";">Selective catheter placement, venous
system; second order, or more selective, branch (e.g., left adrenal vein,
petrosal sinus)<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif";">ICD-10cm
Codes <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l3 level1 lfo6; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">N94.89
Other specified conditions associated with female genital organs and menstrual
cycle<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l3 level1 lfo6; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">I86.2
Pelvic varices<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l3 level1 lfo6; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">R10.2
Pelvic and perineal pain<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial","sans-serif";">Billing/Reimbursement Issues<o:p></o:p></span></u></b></div>
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<span style="font-family: "Arial","sans-serif";">Some 3<sup>rd</sup>
party payers may consider venous embolization or pelvic venous sclerotherapy of
the ovarian or internal iliac veins as experimental, unproven or not medically
necessary.<span style="mso-spacerun: yes;"> </span>If the provider and patient
wish to have this procedure performed, a pre-authorization and
patient/insurance policy review should be performed before the procedure is
scheduled.<span style="mso-spacerun: yes;"> </span>If the insurance carrier
does not consider these procedures as medically valid, or necessary be sure to
have the patient sign an advanced beneficiary notice and collect payment as
appropriate for your practice. <o:p></o:p></span></div>
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<i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Arial Unicode MS";">Lori-Lynne
A. Webb, CPC, CCS-P, CCP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an
E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA
Privacy specialist, with over 20 years of experience.<span style="mso-spacerun: yes;"> </span>Lori-Lynne’s coding specialty is OB/GYN
office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology,
Urology, and general surgical coding.<span style="mso-spacerun: yes;">
</span>She can be reached via e-mail at </span></i><a href="mailto:webbservices.lori@gmail.com"><i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Arial Unicode MS";">webbservices.lori@gmail.com</span></i></a><i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Arial Unicode MS";"> or you can also find current coding information
on her blog site: </span></i><a href="http://lori-lynnescodingcoachblog.blogspot.com/"><i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Arial Unicode MS";">http://lori-lynnescodingcoachblog.blogspot.com/</span></i></a><i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Arial Unicode MS";">.<span style="mso-spacerun: yes;"> </span></span></i><b style="mso-bidi-font-weight: normal;"><span style="mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></b></div>
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<br /></div>
<br />Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-30774411414895073052018-07-26T22:30:00.000-06:002018-07-26T22:30:02.756-06:00<br />
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial","sans-serif";">Usage of Time Based Billing for
CPT<span style="mso-spacerun: yes;"> </span>Evaluation and Management<o:p></o:p></span></u></b></div>
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<div align="right" class="MsoNoSpacing" style="text-align: right;">
<span style="font-family: "Arial","sans-serif";">Lori-Lynne A. Webb<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif";">07.21. 2018<o:p></o:p></span></div>
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<span style="color: #666666; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Within the guidelines of the CPT code book, CPT<span style="mso-spacerun: yes;"> </span>has stated; <span style="mso-spacerun: yes;"> </span>“When counseling and/or coordination of care
dominates (more than 50%) the physician/patient and/or family encounter
(face-to-face time in the office or other outpatient setting or floor/unit time
in the hospital or nursing facility), then time may be considered the key or
controlling factor to qualify for a particular level of E/M services.<span style="mso-spacerun: yes;"> </span>This includes time spent spent with parties
who have assumed responsibility for the care of the patient or decision making
whether or not they are family members (eg, foster parents, person in loco
parentis, legal guardian).<span style="mso-spacerun: yes;"> </span>The extent of
counseling and/or coordination of care must be documented in the medical
record.” <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 15.0pt; margin-bottom: 11.25pt; margin-left: 0in; margin-right: 0in; margin-top: 3.75pt;">
<span style="color: #666666; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">What this means to our physicians and providers, is that time
alone can be used to select a level of care, and bill for our services
regardless of the clinical documentation of history, exam and medical decision
making that is noted or documented in the in the medical record for the current
encounter or visit.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">The lack of complete documentation from busy
providers is an area of concern that many coders see and take note of when
performing coding audits in their role as a coder/clinical documentation
specialist. Physicians are not consistently documenting the “nuts and bolts” of
the core CPT criteria needed in regard to meet the CPT’s criteria especially
when admitting their patients to the hospital.<span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<br /></div>
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<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">The CPT codes 99221 – 99223 are set aside for
inpatient admission, and the lowest level admission code, 99221(level 1
admit)<span style="mso-spacerun: yes;"> </span>requires <i>a detailed or comprehensive
history; a detailed or comprehensive examination; and medical decision making
of straightforward or low complexity;<span style="mso-spacerun: yes;">
</span>the 99222 (level II admit)<span style="mso-spacerun: yes;">
</span>requires </i>a comprehensive history; a comprehensive examination; and
medical decision making of moderate complexity, the 99223 (level III
admit)<span style="mso-spacerun: yes;"> </span>requires a comprehensive history;
a comprehensive examination; and medical decision making of high
complexity.<span style="mso-spacerun: yes;"> </span>Also within meeting these
criteria, all three key components are to be met.<span style="mso-spacerun: yes;"> </span>The only difference between a 99222 and a
99223 code is the medical decision making of moderate complexity vs/ high
complexity. <b style="mso-bidi-font-weight: normal;"><i><o:p></o:p></i></b></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">As a case in point, In order to bill a 99222 <span style="mso-spacerun: yes;"> </span>“level II” admission, CPT guidelines require a
comprehensive exam to be noted in the clinical documentation of the medical
record.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">It is common to see the clinical documentation
noted in the record denoting a<span style="mso-spacerun: yes;">
</span>comprehensive history, and moderate to high level medical decision making,
but the “exam” portion can be very<span style="mso-spacerun: yes;"> </span>skimpy.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<br /></div>
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<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">As per the 1995 exam guidelines to code/bill a
99222 or a 99223 admission, the clinical documentation must state that <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">greater
than 8 body systems or body areas</i></b> were </span><b style="mso-bidi-font-weight: normal;"><span style="color: red; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">examined</span></b><span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"> to meet the
comprehensive exam requirement (on a multisystem exam). <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<br /></div>
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<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">As per the 1997 exam guidelines the clinical
documentation must state that for the Comprehensive Examination (single
specialty)<span style="mso-spacerun: yes;"> </span>– should include performance
of all elements identified by a bullet (•), whether in a shaded or unshaded
box. Documentation of every element in each box with a shaded border and at
least one element in a box with an unshaded border is expected.<o:p></o:p></span></div>
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<br /></div>
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<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Unfortunately, the reality is that these
examinations are more than likely being performed by the providers, however, coders
are finding that clinicians are doing a <span style="mso-spacerun: yes;"> </span>poor job of documenting that these exams were
performed, even with the many EMR documentation tools at their disposal.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<br /></div>
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<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>However, if these physicians and providers utilize
the option of documentation of “Time” in the clinical notes, <span style="mso-spacerun: yes;"> </span>they still have to document the care given,
but it can be noted that they spent “XX amount of time”<span style="mso-spacerun: yes;"> </span>at the bedside and/or on the unit in care of
the patient and of that 50% of this time was spent in counseling, and
coordination of care of “XXX diagnosis, testing, etc” <o:p></o:p></span></div>
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<br /></div>
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<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">From a revenue and denial standpoint, it is
frustrating to have an auditor or insurance carrier review the clinical chart
and downcode the admission from a<span style="mso-spacerun: yes;">
</span>99222/223 to a low level admission 99221 due to skimpy history, <span style="mso-spacerun: yes;"> </span>exam, or medical decision notations.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<br /></div>
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<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">So the “pearl” of wisdom is to be cognizant of
the clinical documentation habits, for the physician providers, which can include
macro’s, shortcuts and additional EMR/EHR data based tools.<span style="mso-spacerun: yes;"> </span>As coders/billers/managers, <span style="mso-spacerun: yes;"> </span>we need to be diligent and educate providers
on the usage of time based billing for admissions and other pertinent E&M
services.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Not all CPT E&M services have a time based
component that can be utilized to represent the care provided.<span style="mso-spacerun: yes;"> </span>Within the CPT codes outlined for usage in an
Emergency Department, “Time” is NOT a descriptive component, and all three key
components for each CPT code 99281 - 99285 must be denoted within the emergency
department patient visit.<span style="mso-spacerun: yes;"> </span>The
rationale that CPT gives us for this caveat is that emergency services that are
typically provided can be hugely variable due to acuity and presenting
diagnosis factors.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">The usage of time should not be a totally
foreign concept to most providers, as this has been in place in one form or
another since1992.<span style="mso-spacerun: yes;"> </span>The usage of time as
a billing/coding component for providers to use, can get overlooked, or
forgotten when in the heat of the moment, or in the day to day busy patient
load or high complexity patient demand on the provider.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Time based clinical documentation does need to
be very specific,<span style="mso-spacerun: yes;"> </span>The face-to-face time
spent in an outpatient or office type setting <span style="mso-spacerun: yes;"> </span>includes not only the time the provider spent
counseling and coordination of the patients care but has to be rendered face to
face with the patient.<span style="mso-spacerun: yes;"> </span>Any pre or post
time spent ( when patient and provider are not face to face) cannot be included
in the time component described in the CPT E&M codes.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">If the provider is providing care for a
patient that is on a hospital unit or floor, the intraservice time for these
codes is noted or defined as “unit/floor time”<span style="mso-spacerun: yes;">
</span>which includes the time present on the patient’s hospital unit and at
the patient’s bedside providing services for that patient.<span style="mso-spacerun: yes;"> </span>In this setting, this includes time to
establish and review the patient’s chart, examine the patient, write clinical
notes, documentations,<span style="mso-spacerun: yes;"> </span>orders and to
communicate with other providers and the patient’s family.<span style="mso-spacerun: yes;"> </span>In this hospital setting the pre and post
time including time spent off that patient’s floor are NOT to be included in
the time component noted in the CPT code descriptors.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">In the descriptors below it outlines the
criteria for the 99221, 99222 and 99223 hospital admission codes and how the
dime designations are presented.<span style="mso-spacerun: yes;"> </span>These
times noted in the CPT descriptions are considered a “typical” amount of time
spent, however, actual time may vary. <o:p></o:p></span></div>
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<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">CPT® 99221 is defined by the AMA as:<o:p></o:p></span></div>
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<i><span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Initial hospital care,
per day, for the evaluation and management of a patient, which requires these
three key components: a detailed or comprehensive history; a detailed or
comprehensive examination; and medical decision making of straightforward or
low complexity. Counseling and/or coordination of care with other providers or
agencies are provided consistent with the nature of the problem(s) and the
patient's and/or family's needs. Usually, the problem(s) requiring admission
are of low severity. Physicians typically <b style="mso-bidi-font-weight: normal;"><u>spend
30 minutes</u></b> at the bedside and on the patient's hospital floor or unit. <o:p></o:p></span></i></div>
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<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">CPT® 99222 is defined by the AMA as:<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Initial hospital care,
per day, for the evaluation and management of a patient, which requires these
three key components: a comprehensive history; a comprehensive examination; and
medical decision making of moderate complexity. Counseling and/or coordination
of care with other providers or agencies are provided consistent with the
nature of the problem(s) and the patient's and/or family's needs. Usually, the
problem(s) requiring admission are of moderate severity. Physicians typically <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">spend
50 minutes</i></b> at the bedside and on the patient's hospital floor or unit.<o:p></o:p></span></div>
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<br /></div>
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<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">CPT® 99222 is defined
by the AMA as <o:p></o:p></span></div>
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<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Initial hospital care,
per day, for the evaluation and management of a patient, which requires these
three key components: a comprehensive history; a comprehensive examination; and
medical decision making of high complexity. Counseling and/or coordination of
care with other providers or agencies are provided consistent with the nature
of the problem(s) and the patient's and/or family's needs. Usually, the
problem(s) requiring admission are of high severity. Physicians typically <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">spend
70 minutes</i></b> at the bedside and on the patient's hospital floor or unit.<o:p></o:p></span></div>
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<br /></div>
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<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Clinical documentation of time can be denoted as a cumulative
amount, or as a time in/time out notation within the record.<span style="mso-spacerun: yes;"> </span>In a best practice, the provider would
document both. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 5.0pt;">
<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Appropriate time statement examples <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: 5.0pt; margin-left: 39.0pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #222222; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Time in was 1400,<span style="mso-spacerun: yes;"> </span>time out at 1506, I spent 40 minutes of the
66 minutes in the encounter counseling the patient on<span style="mso-spacerun: yes;"> </span>their diagnosis<span style="mso-spacerun: yes;"> </span>of<span style="mso-spacerun: yes;">
</span>“xxxxx” and the remainder of the time was spent obtaining the HPI and
examination of the patient. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 5.0pt; margin-left: 39.0pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #222222; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">I spent greater than
50% of my 30 minute visit with the patient discussing the options of surgery
versus watchful waiting regarding their diagnosis of “xxxxxx” <o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">Inappropriate Time Statement Examples: <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: #222222; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">I
had a lengthy discussion with the patient. </span><span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 5.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #222222; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">I
spent 20 minutes in supportive counseling.</span><span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 5.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #222222; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">I
spent 15 minutes talking about the treatment options.</span><span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: 5.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #222222; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">I
spent 30 minutes with the patient</span><span style="color: #222222; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";">Lori-Lynne
A. Webb, CPC, CCS-P, CCP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an
E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA
Privacy specialist, with over 20 years of experience.<span style="mso-spacerun: yes;"> </span>Lori-Lynne’s coding specialty is OB/GYN
office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology,
Urology, and general surgical coding.<span style="mso-spacerun: yes;">
</span>She can be reached via e-mail at </span></i><a href="mailto:webbservices.lori@gmail.com"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";">webbservices.lori@gmail.com</span></i></a><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";"> or you can also find current
coding information on her blog site: </span></i><a href="http://lori-lynnescodingcoachblog.blogspot.com/"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";">http://lori-lynnescodingcoachblog.blogspot.com/</span></i></a><i style="mso-bidi-font-style: normal;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";">.<span style="mso-spacerun: yes;">
</span></span></i><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></b></div>
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<br />Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-57164344334589568692017-10-18T09:24:00.002-06:002017-10-18T09:24:03.752-06:002018 OB-GYN Coding Bootcamp!!! Join me!!! (and save some $'s) <table bgcolor="#ffffff" border="0" cellpadding="0" cellspacing="0" class="removeborder" style="width: 100%px;"><tbody>
<tr><td align="center" bgcolor="#e1313b" style="padding: 10px 10px 5px;"><strong><span style="background-color: #e1313b; color: white; font-family: Verdana; font-size: large;">2018 Coding Updates Virtual Bootcamp </span></strong> </td></tr>
<tr><td align="center" bgcolor="#e1313b" style="padding: 0px 10px 10px;"><span style="color: white; font-family: Verdana; font-size: large;"><span style="background-color: #e1313b;">Preparing Coders for a Successful <strong>2018</strong></span></span></td></tr>
<tr><td align="center" bgcolor="#201e1f" style="padding: 10px 10px 0px;"><span style="color: white; font-family: Verdana; font-size: small;"><strong><span style="background-color: #201e1f;">Attend the Year’s Biggest Virtual<span style="color: #f7941d;"> Ob-Gyn </span></span><span style="background-color: #201e1f;">Coding Event</span></strong></span></td></tr>
<tr><td align="center" bgcolor="#201e1f" style="padding: 10px;"><span style="background-color: #201e1f; color: white; font-family: Verdana; font-size: small;"><strong>Dec. 07 & Dec. 08, 2017</strong></span> </td></tr>
<tr><td><table align="center" style="width: 55%px;"><tbody>
<tr><td align="center" bgcolor="#231f20" style="padding: 0px 10px 10px;"><span style="background-color: #231f20; color: white; font-family: Verdana; font-size: small;">Presented by: Lori-Lynne A. Webb</span></td></tr>
</tbody></table>
</td></tr>
<tr><td style="padding: 10px;"><table align="center" style="border-image: none; border: 1px solid rgb(35, 31, 32); width: 98%px;"><tbody>
<tr><td style="padding: 10px;"><span style="color: black; font-family: Verdana; font-size: small;">You’ll start 2018 off right if you’ve got a clear understanding of the codè adjustments you’ll need to make for your ob-gyn claims. Having someone clear out the clutter and focus on what’s most important is like feng shui for the brain, and we have an expert to do this for you. <br /><br /><strong>Lori-Lynne A. Webb</strong> will update you on the CPT<sup>©</sup>, ICD-10, and Medìcare changes you need to know and will advise you on how to accurately report your E/M services in the coming year. Listen as she unravels the mysteries of the Ob global package and hear what auditors will be looking for in the coming year so you can prepare. Join us! </span></td></tr>
<tr><td style="padding: 10px;"><table align="center" bgcolor="#ffffff"><tbody>
<tr><td align="center" height="30" style="background-color: white; border-image: none; border: 1px solid rgb(64, 64, 64); padding: 0px 10px;"><span style="color: #231f20; font-family: Verdana; font-size: small;"><strong>Get 6 AAPC-APPROVED CEUs</strong></span></td></tr>
</tbody></table>
</td></tr>
<tr><td style="padding: 10px;"><span style="color: #231f20; font-family: Verdana; font-size: small;"><strong>Sessions</strong></span></td></tr>
<tr><td style="padding: 0px 10px;"><ul>
<li><span style="color: black; font-family: Verdana; font-size: small;">2018 CPT, ICD-10 & HCPCS updates for Ob-Gyn</span></li>
<li><span style="color: black; font-family: Verdana; font-size: small;">Coding in the Ob ‘global package’ and coding for the Gyn ‘surgical package’</span></li>
<li><span style="color: black; font-family: Verdana; font-size: small;">Clinical and coding audits for 2018: What’s on the radar for the OIG, CMS and pay for performance</span></li>
<li><span style="color: black; font-family: Verdana; font-size: small;">How-to for auditing: A hands-on review of clinical documentation, queries, audits, appeals and reimbursement</span></li>
</ul>
</td></tr>
<tr><td style="padding: 10px;"><span style="color: #231f20; font-family: Verdana; font-size: small;"><strong>Training Highlights</strong></span></td></tr>
<tr><td style="padding: 0px 10px;"><ul>
<li><span style="color: black; font-family: Verdana; font-size: small;">In-depth strategies and the most up-to-date concepts for global and unbundled OB services billed in the physìcian office</span></li>
<li><span style="color: black; font-family: Verdana; font-size: small;">What’s on the radar screens of the big players and government payers, and how it will affect Ob-Gyn physìcians in particular, as well as the hospitals, and public health services that they and their patients currently accèss, including outside labs, health departments and others </span></li>
<li><span style="color: black; font-family: Verdana; font-size: small;">Strategies for parsing the OIG’s plans for Ob-Gyn services in 2018</span></li>
<li><span style="color: black; font-family: Verdana; font-size: small;">A solid understanding of the federal programs and services that will be effecting change in the healthcare fìeld next year and beyond</span></li>
<li><span style="color: black; font-family: Verdana; font-size: small;">In-depth strategies and timely concepts for how to conduct audits within your practice for clinical documentation</span></li>
<li><span style="color: black; font-family: Verdana; font-size: small;">How to query and write appeals for denìed claims </span></li>
<li><span style="color: black; font-family: Verdana; font-size: small;">How to deal effectively with reimbursement issues </span></li>
</ul>
</td></tr>
<tr><td><table cellpadding="0" cellspacing="0" style="margin: 15px;"><tbody>
<tr><td align="center" style="border-bottom-color: rgb(35, 31, 32); border-bottom-style: solid; border-bottom-width: 1px; border-top-color: rgb(35, 31, 32); border-top-style: solid; border-top-width: 1px; padding: 10px;"><em><strong><span style="color: black; font-family: Verdana; font-size: x-small;"><em>Get the knowledge and skills to combat common problems and find answers to complex ob-gyn coding questions in these comprehensive training sessions. Prepare for a successful 2018!</em></span></strong></em></td></tr>
</tbody></table>
</td></tr>
<tr><td style="padding: 10px;"><table align="center" bgcolor="#231f20"><tbody>
<tr><td align="center" height="30"> <span style="color: white; font-family: Verdana; font-size: small;"><a href="https://www.audioeducator.com/virtualbootcamp/coding-updates/ob-gyn-codes-updates?utm_medium=Email&utm_campaign=S99NVTEM" style="color: white; display: block; text-decoration: none;"> CLICK HERE TO REGISTER </a></span> </td></tr>
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<tr><td align="center" bgcolor="#201e1f" style="padding: 10px;"><span style="color: white; font-family: Verdana; font-size: small;"><span style="background-color: #201e1f;">✆ Call now at <strong>1-866-251-3060</strong></span><span style="background-color: #201e1f;"> and mention S99NVTEM</span></span> </td></tr>
<tr><td align="center" bgcolor="#e1313b" style="padding: 10px;"><span style="color: white; font-family: Arial, Helvetica, sans-serif; font-size: large;"><u><span style="background-color: #e1313b;">Get $50 Off On</span></u><a href="https://www.audioeducator.com/virtualbootcamp/coding-updates/ob-gyn-codes-updates?utm_medium=Email&utm_campaign=S99NVTEM" style="color: white; text-decoration: none;"><span style="background-color: #e1313b;"> Registering NOW!</span></a></span><br /><span style="background-color: #e1313b; color: white; font-family: Arial, Helvetica, sans-serif; font-size: small;"><u><strong>(Use Codé "Webb50" at Checkóut )</strong></u></span></td></tr>
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Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-90415832464965185292017-08-01T13:58:00.001-06:002017-08-01T13:58:04.691-06:00IdHIMA Coding Roundtable - On-line Access For those of you that need a quick/easy and inexpensive way to get your CEU's (for AHIMA or AAPC) ... the IdHIMA Coding Roundtable is now live and easily accessible from our IdHIMA website! Check it out! <br />
<br />
We have Great pricing for amazing education... and you don't have to be a member, we allow both members and non-members access! <br />
<br />
<a href="https://www.idhima.org/physician-based-obgyn-edventure-online-education/">https://www.idhima.org/physician-based-obgyn-edventure-online-education/</a>Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-91053021159016861192017-07-20T08:40:00.000-06:002017-07-20T08:40:20.116-06:00Communication - The bridge between providers and coders
<br />
This originally published in March of 2014... yet still has some GREAT information for all to use<br />
<br />
******************************************************************************<br />
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Communication - The bridge between
providers and coders</span></u></b></div>
<div class="MsoNormalCxSpFirst" style="margin: 1em 0px;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";"></span></u></b><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">March 11, 2014 (Revised and Updated 07 20 2017)<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: "Calibri","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";">We have all heard the adage “if it wasn’t documented, it
wasn’t done”.<span style="mso-spacerun: yes;"> </span>However, in the role of
the medical provider, the fast pace of the job can get in the way of the
accuracy of documentation.<span style="mso-spacerun: yes;">
</span>Unfortunately, in our current healthcare state, our practices <span style="mso-spacerun: yes;"> </span>have to be fiscally solvent.<span style="mso-spacerun: yes;"> </span>This is accomplished by accurate coding/billing,
AND providing good patient care.<span style="mso-spacerun: yes;">
</span>Clinical Documentation is a fundamental piece of our total job function
coupled with the challenge of providing good communication to our coders for
accurate coding a billing. <o:p></o:p></span></div>
<span style="font-family: "Calibri","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";"><o:p> </o:p></span><br />
<br />
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<span style="font-family: "Calibri","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";">The importance of good clinical documentation cannot be
underestimated.<span style="mso-spacerun: yes;"> </span>Medical documentation is
essential to ensure high quality medical care for your patient throughout the
continuum of care.<span style="mso-spacerun: yes;"> </span>Good clinical documentation
both to and from all medical providers (physicians, nurses, PT/OT, etc) benefit
not only the patient, but also your revenue stream.<span style="mso-spacerun: yes;"> </span>If your coder/biller is able to quickly
decipher and bill the claim it means the reimbursement will be back to your practice
that much faster.<span style="mso-spacerun: yes;"> </span>Good documentation
supports medical necessity for payment and clarification of services provided
to your patients, especially if they have an emergent visit, or unexpected
clinical finding upon testing. <o:p></o:p></span></div>
<span style="font-family: "Calibri","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";"><o:p> </o:p></span><br />
<br />
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<span style="font-family: "Calibri","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";">Documentation will always be a “necessary evil” in the role
of healthcare and reimbursement.<span style="mso-spacerun: yes;"> </span>The
conversion to ICD-10 cm <em><span style="background-color: cyan;"> (Took place on 10.01.2015)</span></em> will take place October 1, 2014, and providers will be
tasked with providing better documentation with this new diagnostic/diagnosis
system.<span style="mso-spacerun: yes;"> </span>Your willingness to improve your
clinical documentation now, will only make it easier for you to adapt and
continue to provide excellent patient care in the future. <o:p></o:p></span></div>
<br />
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<span style="color: black; font-family: "Calibri","sans-serif"; mso-bidi-font-family: Tahoma;">Communication is the bridge between
the provider of care, and the coder/biller.<span style="mso-spacerun: yes;">
</span>According to the Merriam-Webster dictionary a “wordsmith” is one who is
an expert in the use of words; a person who works with words, or is an
especially skillful writer.<span style="mso-spacerun: yes;"> </span>As a
providers and coders, think about this….. both fall into this category of
expertise!<span style="mso-spacerun: yes;"> </span>The primary function of a
coder is to apply that which is written by the provider, into a <i style="mso-bidi-font-style: normal;">numeric</i> format; such as ICD-9cm <em><span style="background-color: cyan;">(ICD-10cm).</span></em><span style="mso-spacerun: yes;"> </span>However, once ICD-10cm is implemented, coders
will need an excellent understanding of not only medical terminology, but
anatomy, physiology, disease process, the numeric codes, and a little bit of
“wordsmithing” to correctly apply the written diagnoses per the documentation
into the new alpha-numeric ICD-10cm format.<span style="mso-spacerun: yes;">
</span><o:p></o:p></span></div>
<span style="color: black; font-family: "Calibri","sans-serif"; mso-bidi-font-family: Tahoma;">ICD-10 includes many new terms, and
certain codes will now require documentation to be more precise and complete to
give coders the best “picture” of the care received by the patient via a
numeric format.<span style="mso-spacerun: yes;"> </span>Our challenge as good
providers is to document and<span style="mso-spacerun: yes;"> </span>communicate
this new criteria more effectively so we can all share the same understanding
of the words needed to continue being fiscally solvent, but to also document
the clinical course of care provided.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span><br />
<br />
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px;">
<span style="color: black; font-family: "Calibri","sans-serif"; mso-bidi-font-family: Tahoma;">Unfortunately, most physician and
clinical providers don’t have the "inside track" as to what criteria
or “words” are needed to clearly document in ICD-9, much less for ICD-10.<span style="mso-spacerun: yes;"> </span>Both the coder and the providers are
challenged even more by the specificity needed in ICD-10.<span style="mso-spacerun: yes;"> </span>A coder and the clinical documentation
specialist are going to be looked up to as the expert.<span style="mso-spacerun: yes;"> </span>The ‘experts’ <span style="mso-spacerun: yes;"> </span>will now be looked to help educate and inform
providers how to document more clearly and to get to the desired goal of clear,
concise, correct documentation, which can be interpreted correctly, and most
closely to ICD-10cm definitions.<span style="mso-spacerun: yes;"> </span>If we
succeed in this endeavor, everyone benefits.<span style="mso-spacerun: yes;">
</span><o:p></o:p></span></div>
<span style="color: black; font-family: "Calibri","sans-serif";">The coding query process can help.<span style="mso-spacerun: yes;">
</span>The query process is a very useful tool, but real 1-1, face to face
communication, combined with good ICD-10cm training for the coder, clinical
staff, physicians and mid-level providers will be a critical point for ICD-10cm
and pcs coding success.<span style="mso-spacerun: yes;"> </span>Currently none
of us are “good” or “expert” at ICD-10, so we all are struggling to become
proficient at what we need.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span><br />
<br />
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px;">
<span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">As
the transition to ICD-10 marches forward, the documentation and support for
‘medical necessity’ remains.<span style="mso-spacerun: yes;"> </span>The
clinical documentation is always the first thing requested for a payment audit
or review.<span style="mso-spacerun: yes;"> </span>Not only as providers are we
having to make the leap to ICD-10, but the healthcare payers are also
challenged to be proficient at this new documentation system also.<span style="mso-spacerun: yes;"> </span>We have substantial challenges for payment at
this point in time.<span style="mso-spacerun: yes;"> </span>Concern is are the
payers going to be ready also, and how will they respond, if there is a
question regarding documentation, payment for your services.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Outlined
below are a few quick clinical documentation tips and hints to help clarify
your clinical record documentation.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span><br />
<br />
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px;">
<span style="font-family: "Calibri","sans-serif"; font-size: 10pt; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";"><o:p> </o:p></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">A)<span style="mso-spacerun: yes;">
</span>The medical record should be complete and legible</span></b></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px; text-indent: 0.5in;">
<span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Documentation for each encounter should include:</span></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Reason
for the encounter and relevant history, physical exam findings and prior
diagnostic test results;</span></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Assessment,
clinical impression or diagnosis</span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 0.65in; mso-add-space: auto; mso-list: l0 level1 lfo1; tab-stops: list .65in; text-indent: -0.15in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Plan
of care</span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 0.65in; mso-add-space: auto; mso-list: l0 level1 lfo1; tab-stops: list .65in; text-indent: -0.15in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Time
spent (eg face to face/counseling-coordination of care)</span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 1.5in; mso-add-space: auto; mso-list: l0 level2 lfo1; tab-stops: list 1.5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Documented
time in</span></div>
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<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Documented
time out</span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 1.5in; mso-add-space: auto; mso-list: l0 level2 lfo1; tab-stops: list 1.5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Documented
total time spent (eg at bedside, on monitor(s), etc)</span></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Date
and Signature</span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 0.65in; mso-add-space: auto; mso-list: l0 level1 lfo1; tab-stops: list .65in; text-indent: -0.15in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">The
rationale for ordering diagnostic and other ancillary services</span></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Past
and present diagnoses (If pertinent to the encounter) </span></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Appropriate
health risk factors should be identified (if pertinent to the encounter)</span></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Patient’s
progress, response to and changes in treatment and/or revision of diagnosis </span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">B)<span style="mso-spacerun: yes;">
</span>Avoid Ambiguous Language</span></b></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 0.5in; mso-add-space: auto;">
<span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Eg.. “Non-contributory” : The term
“non-contributory” is<span style="mso-spacerun: yes;"> </span>good example of
ambiguous documentation.<span style="mso-spacerun: yes;"> </span>In some instances,
a provider intends the term to mean the body system was not relevant, therefore
was not reviewed... while another provider may intend that verbiage to mean
that the body system was reviewed, but had no pertinent findings to be
reported.<span style="mso-spacerun: yes;"> </span>Be clear, concise and
relevant by avoiding using the term “non-contributory”. <o:p></o:p></span></div>
<br />
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 0.5in; mso-add-space: auto;">
<span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Another term that can be misconstrued
is “abnormal” be sure to clarify, qualify, or quantify<span style="mso-spacerun: yes;"> </span>what is “abnormal”.</span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">C)<span style="mso-spacerun: yes;">
</span>Clarify your diagnosis</span></b></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 0.5in; mso-add-space: auto;">
<span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">“For a presenting problem <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><u>with
an established diagnosis</u></i></b><span style="mso-spacerun: yes;"> </span>the
documentation should reflect whether the problem is:</span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 1.25in; mso-add-space: auto; mso-list: l3 level1 lfo2; tab-stops: list 1.25in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri;"><span style="mso-list: Ignore;">a)<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">improved, well controlled, resolving
or resolved;<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 1.25in; mso-add-space: auto; mso-list: l3 level1 lfo2; tab-stops: list 1.25in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri;"><span style="mso-list: Ignore;">b)<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";"><span style="mso-spacerun: yes;"> </span>inadequately controlled, worsening, or failing
to respond/or change as expected<br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--></span><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">“For a presenting problem <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><u>without an established
diagnosis</u></i></b>, the assessment or clinical impression can be </span><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">stated </span><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">a) as a “possible”,
“probable”, or “rule out” (R/O) diagnosis,(such as rule out kidney stone)<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 1.25in; mso-add-space: auto; mso-list: l3 level1 lfo2; tab-stops: list 1.25in; text-indent: -0.25in;">
<span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";"><span style="mso-spacerun: yes;"></span></span><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">c) <b style="mso-bidi-font-weight: normal;">and </b>should also denote any signs and/or
associated symptoms in your findings (such as pelvic pain, sinus pressure etc)<br />
<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<br />
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">D) Ordering of Tests and Procedures </span></b></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 0.45in; mso-add-space: auto;">
<span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Clinical documentation guidelines
state that the rationale for tests/procedures should be ‘easily inferred’, but
suggest clearly documenting the reason(s) for any testing or procedures<o:p></o:p></span></div>
<br />
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 0.95in; mso-add-space: auto; mso-list: l1 level1 lfo3; tab-stops: list .95in; text-indent: -0.15in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">document
‘what’ test/procedure is being ordered.<span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Calibri","sans-serif"; font-size: 10pt; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">(i.e. Fetal NST,
fetal fibronectin)</span><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">
</span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 0.95in; mso-add-space: auto; mso-list: l1 level1 lfo3; tab-stops: list .95in; text-indent: -0.15in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">document
‘why’ the test/procedure is being ordered </span><span style="font-family: "Calibri","sans-serif"; font-size: 10pt; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">(i.e. decreased fetal movement) </span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">E)<span style="mso-spacerun: yes;">
</span>Omitted Information </span></b></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px; text-indent: 0.5in;">
<span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">In the event information is inadvertently forgotten,
delayed, or omitted from the medical record, it is acceptable to amend the
record. “Late entries” are also acceptable however, should be used
infrequently.</span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px; text-indent: 0.5in;">
<span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Acceptable methods for recording “amendments”, “addendum”
and “late entries” follow: <o:p></o:p></span></div>
<br />
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 1in; mso-add-space: auto;">
<span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">•Create a new entry for the additional
information</span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 1in; mso-add-space: auto;">
<span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">•Do not annotate in the margins to add
information </span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 1in; mso-add-space: auto;">
<span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">•Keep all entries chronological and in
record sequence</span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 1in; mso-add-space: auto;">
<span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">•Title or head the entry or note as
“Addendum”, “Amendment” or “Late Entry” </span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 1in; mso-add-space: auto;">
<span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">•Use the actual date of the addendum,
amendment or late entry </span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 1in; mso-add-space: auto;">
<span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">•Reference the original entry or
document by indicating the date of the service </span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px 1em 1in; mso-add-space: auto;">
<span style="font-family: "Calibri","sans-serif"; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">•Always sign the additional entry or
document <o:p></o:p></span></div>
<span style="color: black; font-family: "Calibri","sans-serif";">The need for good communication and documentation brings us back
to the term “wordsmith”.<span style="mso-spacerun: yes;"> </span>Again, both the
coder and the physician/provider will need to add this to their job
proficiencies. Getting the conversation started is the first step.<span style="mso-spacerun: yes;"> </span>A quick way to begin is to conduct a mini review
of the current physician/provider documentation.<span style="mso-spacerun: yes;"> </span>The coder can develop, or may have a feel, as
to how best to ascertain the top 5 or top 10 commonly mis-coded or difficult to
code diagnoses in the practice.<span style="mso-spacerun: yes;"> </span>If the
coders’ are currently struggling with appending these “difficult” diagnoses now
utilizing ICD-9, this challenge now is amplified by dual coding/cross coding
with ICD-10cm codes which will be mandatory in October of 2014.<span style="mso-spacerun: yes;"> </span>Have the coder document and analyze what
they've found. <span style="mso-spacerun: yes;"> </span>This quick analysis will
help define where better communication and documentation is needed for both the
coder and provider.<span style="mso-spacerun: yes;"> </span></span><br />
<br />
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px;">
<span style="color: black; font-family: "Calibri","sans-serif";">Here's a quick process to help enhance communication processes for
both the coder and the physician/provider of care.
<!--[endif]--><o:p></o:p></span></div>
<br />
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormalCxSpMiddle" style="color: black; mso-list: l2 level1 lfo4; tab-stops: list .5in;"><span style="font-family: "Calibri","sans-serif";">Ask
the coder(s) and provider(s) for the top 5 mis-coded or difficult to code
diagnoses <o:p></o:p></span></li>
<li class="MsoNormalCxSpMiddle" style="color: black; mso-list: l2 level1 lfo4; tab-stops: list .5in;"><span style="font-family: "Calibri","sans-serif";">Pull
the operative/procedure notes that were associated with these diagnoses <o:p></o:p></span></li>
<li class="MsoNormalCxSpMiddle" style="color: black; mso-list: l2 level1 lfo4; tab-stops: list .5in;"><span style="font-family: "Calibri","sans-serif";">Cross-code
the documentation with both ICD-9 and ICD-10 codes <o:p></o:p></span></li>
<li class="MsoNormalCxSpMiddle" style="color: black; mso-list: l2 level1 lfo4; tab-stops: list .5in;"><span style="font-family: "Calibri","sans-serif";">Identify
areas that need to be clarified for the coder with the physician or
provider<o:p></o:p></span></li>
<li class="MsoNormalCxSpMiddle" style="color: black; mso-list: l2 level1 lfo4; tab-stops: list .5in;"><span style="font-family: "Calibri","sans-serif";">Schedule
a meeting (face to face)<span style="mso-spacerun: yes;"> </span>with the
coder and the provider and include<o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormalCxSpMiddle" style="color: black; mso-list: l2 level2 lfo4; tab-stops: list 1.0in;"><span style="font-family: "Calibri","sans-serif";">The
actual provider notes<o:p></o:p></span></li>
<li class="MsoNormalCxSpMiddle" style="color: black; mso-list: l2 level2 lfo4; tab-stops: list 1.0in;"><span style="font-family: "Calibri","sans-serif";">The
ICD-9 codes (using the code -book) <o:p></o:p></span></li>
<li class="MsoNormalCxSpMiddle" style="color: black; mso-list: l2 level2 lfo4; tab-stops: list 1.0in;"><span style="font-family: "Calibri","sans-serif";">The
ICD-10 codes (using the code-book)<o:p></o:p></span></li>
</ol>
</ol>
<br />
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px;">
<span style="color: black; font-family: "Calibri","sans-serif";">Then, once this is all in place, you then have a terrific
“learning opportunity” to share and commit to learning from each other how best
to document or “wordsmith” so all get what they need.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle" style="margin: 1em 0px;">
<span style="color: black; font-family: "Calibri","sans-serif";">Amazingly, the communication process is not only an informative
session, but the opportunity to get to know and understand what each area needs
for a successful transition and implementation to ICD-10. </span></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Calibri","sans-serif"; font-size: 9pt; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">Lori-Lynne A. Webb,
CPC, CCS-P, CCP, CHDA, COBGC and ICD10 CM/PCS Ambassador/trainer is an E&M,
and Procedure based Coding, Compliance, Data Charge entry and HIPAA Privacy
specialist, with over 20 years of experience.<span style="mso-spacerun: yes;">
</span>Lori-Lynne’s coding specialty is OB/GYN office & Hospitalist
Services, Maternal Fetal Medicine, OB/GYN Oncology, Urology, and general
surgical coding.<span style="mso-spacerun: yes;"> </span>She can be reached via
e-mail at </span></i><a href="mailto:webbservices.lori@gmail.com"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Calibri","sans-serif"; font-size: 9pt; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";"><span style="color: blue;">webbservices.lori@gmail.com</span></span></i></a><i style="mso-bidi-font-style: normal;"><span style="font-family: "Calibri","sans-serif"; font-size: 9pt; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";"> or you can also find current coding information on her
blog site: </span></i><a href="http://lori-lynnescodingcoachblog.blogspot.com/"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Calibri","sans-serif"; font-size: 9pt; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";"><span style="color: blue;">http://lori-lynnescodingcoachblog.blogspot.com/</span></span></i></a><i style="mso-bidi-font-style: normal;"><span style="font-family: "Calibri","sans-serif"; font-size: 11pt; mso-bidi-font-family: "Arial Unicode MS"; mso-fareast-font-family: "Arial Unicode MS";">.</span></i><span style="font-family: "Calibri","sans-serif";"><o:p></o:p></span></div>
Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-82151578109873739312017-07-14T15:06:00.001-06:002017-07-14T15:06:44.334-06:00Medical Necessity Toolkit! Available NOW!!!+<span style="font-size: x-large;">Guess what??? My <a href="http://hcmarketplace.com/complete-guide-to-medical-necessity?code=EB337890&utm_source=mktg&utm_medium=eml&utm_content=CMNTP&utm_campaign=eml_HIM_EB337890_071417&spMailingID=11470432&spUserID=MTY3NzQ2ODA2Mzg4S0&spJobID=1201200514&spReportId=MTIwMTIwMDUxNAS2">Medical Necessity Toolkit</a> that I developed for HC-Pro is available now... so please take advantage of some GREAT info at an extremely good price!!! .... Just click on the link above! ... and again. HAPPY CODING! </span><br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: x-large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZVnM46Phiq2G0CBSBFsApTNQUtmSU6dE_I2nQ_3WpqeRXuEzZRfaUJxZTLWOrQVoGq8NmYL0HCP1TNYe-ROUlssuMK_krl8FT9-8mtjAurOq9KGMkFEaTZX8OFx7ajlXMqshRmEWXDWS3/s1600/15727002_10209613470470890_4433085388268339450_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="399" data-original-width="399" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZVnM46Phiq2G0CBSBFsApTNQUtmSU6dE_I2nQ_3WpqeRXuEzZRfaUJxZTLWOrQVoGq8NmYL0HCP1TNYe-ROUlssuMK_krl8FT9-8mtjAurOq9KGMkFEaTZX8OFx7ajlXMqshRmEWXDWS3/s320/15727002_10209613470470890_4433085388268339450_n.jpg" width="320" /></a></span></div>
<br />
<span style="font-size: x-large;"><br /></span>Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-31236053533056272242017-07-14T10:47:00.000-06:002017-07-14T10:47:11.252-06:00Are you needing an Ed'Venture??? <div style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; margin-bottom: 6px;">
<span style="font-size: x-large;">Hey - did you know??? Idaho State University is a CAHIIM accredited school in the State of Idaho?? AND you can get your education 100% on-line??? </span></div>
<div style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; margin-bottom: 6px;">
<span style="font-size: x-large;">See the info below and get your ED'Venture started.... You get the opportunity to be taught by some of the most amazing faculty - These folks are GREAT!!!</span></div>
<div style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; margin-bottom: 6px;">
<span style="font-size: 14px;"><br /></span></div>
<div style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; margin-bottom: 6px;">
<span style="font-size: x-large;"></span><span style="font-size: 14px;">******************************************************************************************************************</span></div>
<div style="background-color: white; margin-bottom: 6px; margin-top: 6px;">
<span style="color: #741b47; font-family: Trebuchet MS, sans-serif; font-size: large;">Greetings Fellow HIM Professionals:</span></div>
<div style="background-color: white; margin-bottom: 6px; margin-top: 6px;">
<span style="color: #741b47; font-family: Trebuchet MS, sans-serif; font-size: large;"><br /></span></div>
<div style="background-color: white; margin-bottom: 6px; margin-top: 6px;">
<span style="color: #741b47; font-family: Trebuchet MS, sans-serif; font-size: large;">The Idaho State University, College of Technology, Health Information Techn<span class="text_exposed_show" style="display: inline;">ology (HIT) program is pleased to announce that we are expanding our program to continue to meet your businesses needs and the entire health care industry’s needs. </span></span></div>
<div style="background-color: white; margin-bottom: 6px; margin-top: 6px;">
<span style="color: #741b47; font-family: Trebuchet MS, sans-serif; font-size: large;"><span class="text_exposed_show" style="display: inline;">Our statistics show that the demand for Health Information Technicians and Medical Coders is vastly increasing each year. To compensate for this high demand, we have recently expanded our class sizes to train even more students for these health care positions. The HIT program offers both traditional seated and wholly online options, with the exception of the final hands on practicum, that prepares students to pass the Registered Health Information Technician exam once graduated.</span></span></div>
<div class="text_exposed_show" style="background-color: white; display: inline;">
<div style="margin-bottom: 6px;">
<span style="color: #741b47; font-family: Trebuchet MS, sans-serif; font-size: large;">Graduates that you hire will still have the same superior educational skills and training. The only difference in the HIT program is that it can now enroll and accept a larger number of students, and a Medical Coding Certificate option is available. Our program has proudly prepared highly qualified health information technicians and/or medical coders who have been hired by companies all over the world. We know this expansion will be a benefit to multiple health care trades including your own. </span></div>
<div style="margin-bottom: 6px;">
<span style="color: #741b47; font-family: Trebuchet MS, sans-serif; font-size: large;">We encourage you to take advantage of this exciting opportunity and reach out to colleagues, associates, family members, and friends who may be interested in pursuing a rewarding, profitable career in health information technology and/or medical coding. The program is particularly well suited to individuals who are already working in HIM and wish to pursue their RHIT credential. </span></div>
<div style="margin-bottom: 6px;">
<span style="color: #741b47; font-family: Trebuchet MS, sans-serif; font-size: large;">The program can also work with individuals who wish to retrain into the HIM field. Full and part-time student status is available. We are always available to meet with future students and help them start their successful careers!</span></div>
<div style="margin-bottom: 6px; margin-top: 6px;">
<span style="color: #741b47; font-family: Trebuchet MS, sans-serif; font-size: large;">The HIT program is now enrolling for the Fall 2017 semester, beginning in August!</span></div>
<div style="margin-bottom: 6px; margin-top: 6px;">
<span style="color: #741b47; font-family: Trebuchet MS, sans-serif; font-size: large;">For more information on the Health Information Technology program, please contact any of the following faculty:</span></div>
<div style="margin-bottom: 6px; margin-top: 6px;">
<span style="color: #3d85c6; font-family: Verdana, sans-serif;"><b><i>Glenna Young, RHIA, CCS at younglen@isu.edu or 208-282-4524<br />Wade Lowry, RHIT at lowrwade@isu.edu or 208-282-3738<br />Rhonda Ward, RHIT at wardrhon@isu.edu or 208-282-2388</i></b></span></div>
<div style="margin-bottom: 6px; margin-top: 6px;">
<span style="color: #3d85c6; font-family: Verdana, sans-serif;"><b><i>We are also pleased to announce the addition of full-time faculty in the Boise area, housed at the ISU Meridian Center! The faculty member can be reached at:</i></b></span></div>
<div style="margin-bottom: 6px; margin-top: 6px;">
<span style="color: #3d85c6; font-family: Verdana, sans-serif;"><b><i>Mona Doan, RHIT, CCS-P at doanmona@isu.edu or 208-242-8119</i></b></span></div>
</div>
Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-56203808016854478762017-06-15T23:30:00.000-06:002017-06-15T23:30:22.173-06:00A new Webinar for me - July 2017 <div style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px;">
I will be doing another AudioEducator Webinar in July. I will be doing a webinar regarding Ultrasound Services in the physician office. We'll be discussing both Obstetric Ultrasound and Gyncologic Ultrasound. If you'd like to join me - Here's a $20.00 off "coupon code" ... and as always... I'll be Packing in a LOT of info in a short amount of time!!! You always get your $'s worth of info!</div>
<div style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
Ultrasound Services In The OB/Gyn Office<br />Presented By: Lori-Lynne A. Webb<br />Live Webinar | Date: Thu, Jul 20, 2017 | Duration: 60 minutes<br />Time: 1 pm ET | 12 pm CT | 11 am MT | 10 am PT<br /><a href="https://www.audioeducator.com/ob-gyn/ultrasound-billing-in-physician-practices.html?utm_medium=Email&utm_source=Webb_%3cdate%3e&utm_campaign=SOCAHT01" rel="nofollow noopener" style="color: #365899; cursor: pointer; font-family: inherit; text-decoration-line: none;" target="_blank">https://www.audioeducator.com/…/ultrasound-billing-in-physi…</a></div>
<div style="background-color: white; color: #1d2129; display: inline; font-family: Helvetica, Arial, sans-serif; font-size: 14px; margin-top: 6px;">
Become Competent in Billing Ultrasound Services in OB/Gyn Physician Offices<br />Get $20 Off On Registering NOW!<br />(Use Codé "Webb20" at Checkóut )</div>
Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-5569698836127804152017-04-27T17:30:00.000-06:002017-06-15T20:53:30.488-06:00The Medical Necessity Hot Button<br />
<em><strong><u>Clearing up the confusion surrounding Medical Necessity!</u></strong></em><br />
<br />
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: normal; margin: 0in 0in 0pt; mso-outline-level: 3; vertical-align: baseline;">
<i><span style="border: 1pt; color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt; padding: 0in;">by Lori-Lynne A. Webb, CPC, CCS-P, CCP, COBGC, CHDA (originally printed through HCPro March 2017) </span></i></div>
<br />
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">Understanding and
determining medical necessity can be very complex for physicians, clinicians,
coders, and billers.</span><span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">A physician or
clinical provider of care may have a completely different understanding,
interpretation, and definition of medical necessity than the patient or a
patient’s family member. A third-party insurance payer may also have another
completely different understanding and application of the term.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 0pt; vertical-align: baseline;">
<b><span style="border: 1pt; color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt; padding: 0in;">Defining medical necessity</span></b><span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;"><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">So what is medical
necessity? Coders or billers struggle to understand and sort out as the term,
which leads to misinterpretation and misunderstanding of what needs to be communicated
in a variety of areas.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">CMS provides a
specific definition under the Social Security Act:<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 0pt 30pt; vertical-align: baseline;">
<i><span style="border: 1pt; color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt; padding: 0in;">… no Medicare payment shall be
made for items or services that are not reasonable and necessary for the
diagnosis or treatment of illness or injury or to improve the functioning of a
malformed body member.</span></i><span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;"><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">In essence, the
diagnosis drives medical necessity. Coders need to understand the diagnosis
itself, as well as what services or treatment options are available to the
provider.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 0pt; vertical-align: baseline;">
<b><span style="border: 1pt; color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt; padding: 0in;">Third-party payers add more confusion</span></b><span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;"><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">Medical necessity can
also be confusing when it comes to who is going to pay for the procedure or
services. Many third-party payers have specific coverage rules regarding what
they consider medically necessary or have riders and exclusions for specific
procedures. Third-party payers may have a specific exclusion for procedures
that they consider experimental, unproven for a specific diagnosis, or
cosmetic.<o:p></o:p></span></div>
<br />
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<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">One example is a
surgeon using a daVinci robotic surgical device to perform a laparoscopic
surgery. Upon pre-authorization for the surgery, the insurance payer states it
will not pay for the surgery if the daVinci is used. The insurer’s policy
includes a rider that deems the daVinci as an experimental surgical device.
However, if the physician uses a traditional laparoscopic or open procedure,
the third-party payer would reimburse. In this case, the insurance carrier is
not stating that the surgery is not medically necessary, just that it will not
reimburse for this surgery if the robotic device is used.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">Even if a particular
procedure or service is considered medically necessary, some payers impose limits
on how many times a provider may render a specific service within a specified
time frame. For Medicare and Medicaid, these limitations are known as National
Coverage Determinations (NCD) and Local Coverage Determination (LCD). Private
payers may simply refer to this type of limitation as a policy guideline or
policy exclusion or rider.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">Within these
guidelines, payers may define where or when they will cover a specific service,
but may limit coverage to a specific diagnosis. For example, insurance policies
may have a wellness or preventive care benefit, but may only cover one such
visit per year. Some payers may only reimburse for a single Prostate-Specific
Antigen (PSA) test per year. The payer may require a documented screening
diagnosis in coordination with the test.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">If the patient
underwent a PSA test January 1, 2012, for screening, his insurance may not pay
for another test until 365 days (or one calendar year) have elapsed. However,
if the patient undergoes a PSA blood test for screening and the test results
are abnormal, the clinician may decide another PSA test is needed. The coder
must submit that claim as a PSA blood test with the appropriate diagnosis for a
sign, symptom, or abnormality, not as a screening.</span></div>
<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;"></span><br />
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;"><br />
<b><span style="border: 1pt windowtext; mso-border-alt: none windowtext 0in; padding: 0in;">Documenting medical necessity</span></b></span></div>
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;"><b><span style="border: 1pt windowtext; mso-border-alt: none windowtext 0in; padding: 0in;"></span></b></span><span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">Medical necessity
continues to be open for interpretation by all parties involved. Many
third-party payers have created lists of criteria they use to interpret medical
necessity. These lists do not necessarily reflect all options, but payers
include this reference in their policy guidelines.<o:p></o:p></span></div>
<br />
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<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">Most providers have
not developed a comprehensive listing of medically necessary qualifiers, so
coders and clinicians must focus on good documentation and coding accuracy to
communicate the medical necessity of services accurately to payers. If
third-party payers deny reimbursement for medical services, physicians,
clinicians, and coders need to rely on the formal appeal process.<o:p></o:p></span></div>
<br />
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<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">Medical necessity
documentation from a physician or provider should include the following:<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 18pt; margin: 0in 0.25in 6.75pt; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #424242; font-family: "wingdings"; font-size: 10pt;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #424242; font-family: "arial" , "sans-serif"; font-size: 9pt;">Severity of the “signs and symptoms” or direct
diagnosis exhibited by the patient. This is our diagnosis driver, and multiple
diagnoses may be involved.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 18pt; margin: 0in 0.25in 6.75pt; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #424242; font-family: "wingdings"; font-size: 10pt;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #424242; font-family: "arial" , "sans-serif"; font-size: 9pt;">Probability of an adverse or a positive
outcome for the patient, and how that risk equates to the diagnosis currently
being evaluated. This is the medical risk vs. gain.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 18pt; margin: 0in 0.25in 6.75pt; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #424242; font-family: "wingdings"; font-size: 10pt;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #424242; font-family: "arial" , "sans-serif"; font-size: 9pt;">Need and/or availability of diagnostic studies
and/or therapeutic intervention(s) to evaluate and investigate the patient’s
presenting problem or current acute or chronic medical condition. In other
words, does the facility, office, or hospital have what the provider or
clinician needs to render care?<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">These bullet points
reflect the basics of evaluation and management (E/M) guidelines that are
currently in place from CPT<sup>®</sup>: the history, exam, and medical
decision making processes. Coders will have an easier time evaluating medical
necessity from this aspect. Of course, a good understanding of this integration
of medical necessity within the E/M guidelines makes communicating this same
principle to the providers much easier. Coders should encourage providers to
continually enhance their documentation to improve overall coordination between
the medical record, coding accuracy, and third-party payer reimbursement.<o:p></o:p></span></div>
<br />
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<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">The third-party payers
employ a wide spectrum of policies defining medical necessity is and should
encompass. Physicians, clinical providers, and coders should review what these
payers have established within their guidelines. Someone within the physician
office, hospital, or medical facility should thoroughly scrutinize these
guidelines before establishing a contractual relationship with a particular
third party payer. This up-front communication will help avoid claim denials in
the future.<o:p></o:p></span></div>
<br />
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<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">Here are some examples
of what some third party payers are currently including in their medically
necessary verbiage:<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 18pt; margin: 0in 0.25in 6.75pt; mso-list: l1 level1 lfo2; tab-stops: list .5in; text-indent: -0.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #424242; font-family: "wingdings"; font-size: 10pt;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #424242; font-family: "arial" , "sans-serif"; font-size: 9pt;">Treatment is consistent with the symptoms or
diagnosis of the illness, injury, or symptoms under review by the provider of
care.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 18pt; margin: 0in 0.25in 6.75pt; mso-list: l1 level1 lfo2; tab-stops: list .5in; text-indent: -0.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #424242; font-family: "wingdings"; font-size: 10pt;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #424242; font-family: "arial" , "sans-serif"; font-size: 9pt;">Treatment is necessary and consistent with
generally accepted professional medical standards (i.e., not experimental or
investigational).<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 18pt; margin: 0in 0.25in 6.75pt; mso-list: l1 level1 lfo2; tab-stops: list .5in; text-indent: -0.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #424242; font-family: "wingdings"; font-size: 10pt;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #424242; font-family: "arial" , "sans-serif"; font-size: 9pt;">Treatment is not furnished primarily for the
convenience of the patient, the attending physician, or another physician or
supplier.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 18pt; margin: 0in 0.25in 6.75pt; mso-list: l1 level1 lfo2; tab-stops: list .5in; text-indent: -0.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #424242; font-family: "wingdings"; font-size: 10pt;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #424242; font-family: "arial" , "sans-serif"; font-size: 9pt;">Treatment is furnished at the most appropriate
level that can be provided safely and effectively to the patient, and is
neither more or less than what the patient is requiring at that specific point
in time.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 18pt; margin: 0in 0.25in 6.75pt; mso-list: l1 level1 lfo2; tab-stops: list .5in; text-indent: -0.25in; vertical-align: baseline;">
<!--[if !supportLists]--><span style="color: #424242; font-family: "wingdings"; font-size: 10pt;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #424242; font-family: "arial" , "sans-serif"; font-size: 9pt;">The disbursement of medical care and/or
treatment must not be related to the patient’s or the third party payer’s
monetary status or benefit.<o:p></o:p></span></div>
<br />
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<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">Documentation of all
medical care should accurately reflect the need for and outcome of the
treatment.<br />
Treatment or medical services deemed to be medically necessary by the provider
of those services,(e.g., physician, therapist, clinician, etc.) does not imply
or infer that the service(s) provided will be covered by or deemed a medically
necessary service payable by a third-party insurance payer.</span></div>
<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;"></span><br />
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "museoslab-900" , "serif"; font-size: 12pt;"><span style="color: black;">Medical Necessity Q&A</span></span></b></span></div>
<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;">
</div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "museoslab-900" , "serif"; font-size: 12pt;"><span style="color: black;">Q:<span style="mso-spacerun: yes;">
</span></span><span style="color: black;">Could you give me some guidance on how I can instruct my MD's on
avoiding vague and/or subjective clinical documentation?</span></span></b></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;">
</div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;">
<span style="color: black; font-family: "gillsans-light" , "sans-serif"; font-size: 12pt;">A:.<span style="mso-spacerun: yes;"> </span>Ask your providers to adequately
describe his/her <i style="mso-bidi-font-style: normal;">skilled care provided</i>
and give a clear picture of the treatment and/or “next steps” to be taken.</span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;">
</div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;">
<span style="color: black; font-family: "gillsans-light" , "sans-serif"; font-size: 12pt;">Do not use vague or subjective descriptions like "tolerated
treatment well," "improving," "caregiver instructed on med
management," or "continue with plan of care." <span style="mso-spacerun: yes;"> </span>"patient is here for follow up" </span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;">
<span style="color: black; font-family: "gillsans-light" , "sans-serif"; font-size: 12pt;">examples of more complete and compliant statements:<o:p></o:p></span></div>
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<span style="color: black; font-family: "times new roman"; font-size: small;">
</span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0in 0in 0pt 1in; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><i><span style="color: black; font-family: "gillsans-lightitalic" , "sans-serif"; font-size: 12pt;"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span></i><!--[endif]--><i><span style="color: black; font-family: "gillsans-lightitalic" , "sans-serif"; font-size: 12pt;">Patient tolerated ROM
exercises with a pain level of 6/10.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: black; font-family: "times new roman"; font-size: small;">
</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0in 0in 0pt 1in; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><i><span style="color: black; font-family: "gillsans-lightitalic" , "sans-serif"; font-size: 12pt;"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span></i><!--[endif]--><i><span style="color: black; font-family: "gillsans-lightitalic" , "sans-serif"; font-size: 12pt;">Patient was able to
verbalize understanding and importance of checking their blood sugars prior to
administering insulin.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: black; font-family: "times new roman"; font-size: small;">
</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0in 0in 0pt 1in; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><i><span style="color: black; font-family: "gillsans-lightitalic" , "sans-serif"; font-size: 12pt;"><span style="mso-list: Ignore;">3.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span></i><!--[endif]--><i><span style="color: black; font-family: "gillsans-lightitalic" , "sans-serif"; font-size: 12pt;">Plan for next visit: to
continue education on importance of daily inspection of feet for diabetic
patient, provide wound care, etc.</span></i></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;">
</div>
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: black; font-family: "times new roman"; font-size: small;">
</span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;">
<b style="mso-bidi-font-weight: normal;"><i><span style="color: black; font-family: "gillsans-lightitalic" , "sans-serif"; font-size: 12pt;">Q<span style="mso-spacerun: yes;"> </span></span></i></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "cambria" , "serif"; font-size: 12pt;"><span style="color: black;">I work in dermatology and need to know </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "cambria" , "serif"; font-size: 12pt;"><span style="color: black;">what documentation is required for excisions?<span style="mso-spacerun: yes;"> </span></span><span style="color: black;">We are struggling with getting paid </span></span></b><span style="color: #2079ff; font-family: "museoslab-900" , "serif"; font-size: 12pt;"><o:p> </o:p></span></div>
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: black; font-family: "times new roman"; font-size: small;">
</span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;">
<span style="color: black; font-family: "gillsans-light" , "sans-serif"; font-size: 12pt;">A:<span style="mso-spacerun: yes;"> </span>The provider should
include the actual "size" of the lesion/mass they are going to
excise.<span style="mso-spacerun: yes;"> </span>Then they should document the
area of the excision which needs to include the lesion + any margins.<span style="mso-spacerun: yes;"> </span>(Height, Width, Depth) and if
circular/elliptical etc… and denote the "why" it was performed that
way.<span style="mso-spacerun: yes;"> </span>If you have to appeal, the
problem with using strictly the sizes from a pathology report, is</span><span style="color: black; font-family: "gillsans-light" , "sans-serif"; mso-bidi-font-family: GillSans-Light;"><span style="font-size: small;"> that tissue "shrinks" once it is excised, and the would
"enlarges" once the tissue is excised. </span></span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;">
</div>
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: black; font-family: "times new roman"; font-size: small;">
</span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;">
<span style="color: black; font-family: "gillsans-light" , "sans-serif"; mso-bidi-font-family: GillSans-Light;"><strong><span style="font-size: small;">Q.<span style="mso-spacerun: yes;"> </span></span><span style="font-size: small;">What is the BEST way to document our time
spent… the CPT codes state a vague "time" amount but the doctors
struggle with this..</span></strong><span style="font-size: small;"><span style="mso-spacerun: yes;"> </span></span></span></div>
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: black; font-family: "times new roman"; font-size: small;">
</span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;">
<span style="color: black; font-family: "gillsans-light" , "sans-serif"; mso-bidi-font-family: GillSans-Light;"><span style="font-size: small;">A.<span style="mso-spacerun: yes;"> </span></span><span style="font-size: small;">Notation of Time in/Time out is always very
helpful…</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">it is also helpful if the
provider "explains"</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">the
time.</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">Eg -</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">spent 20 minutes of our 30 minute visit
discussing how to properly use their new asthma inhaler.</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">Or</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">I
was requested by Dr. Doe for "standby" for a possible cesarean section
during vaginal delivery.</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">I entered the
delivery room at 0800 and departed at 0915 status post a successful vaginal
delivery. <o:p></o:p></span></span></div>
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<span style="color: black; font-family: "times new roman"; font-size: small;">
</span></div>
</span><br />
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
</div>
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
</div>
<br />
<div class="MsoNormal" style="background: rgb(251, 250, 246); line-height: 18pt; margin: 0in 0in 19.7pt; vertical-align: baseline;">
<span style="color: #453125; font-family: "arial" , "sans-serif"; font-size: 9pt;">Coders must understand
the complex relationships between the physician, the patient, the medical
record documentation, the coder, the biller, the insurance payer, and the
communication between all of these entities to successfully guide the
interpretation of medical necessity.</span></div>
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Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-4883154840493850882017-03-31T23:44:00.000-06:002017-03-31T23:44:29.843-06:00I have a webinar for HCPRO coming up!Are you struggling with Medical Necessity - I have a webinar coming up on Coding and Medical Necessity... HCPRO!!! https://hcmarketplace.com/coding-reporting-medical-necessity<div>
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<div>
I have a LOT of great info that I'll be presenting. I would love to have you join me! :) </div>
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Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-7858812654494826762017-03-16T12:03:00.000-06:002017-03-16T12:03:02.191-06:00Webinar on 04.11.2017 Free CEU's <br />
Good Morning!!! Below is info for a Webinar from our friends at Navicure... <br />
<span style="color: #666766; font-size: 20.5pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><strong></strong></span><br />
<span style="color: #666766; font-size: 20.5pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><strong>Live Webinar:</strong></span><span style="color: #666766; font-family: "Times New Roman","serif"; font-size: 20.5pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"> Patient Payments
Check-Up™: Survey of Patient & Provider Attitudes & Behaviors</span><br />
<span style="color: #666766; font-family: "Times New Roman","serif"; font-size: 20.5pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="color: white; font-family: "Times New Roman","serif"; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><strong><span style="color: red;"><em><u>Tuesday,
April 11 | 1 pm EDT / 10 am PDT</u></em></span></strong></span></span><br />
<span style="color: #666766; font-family: "Times New Roman","serif"; font-size: 20.5pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="color: white; font-family: "Times New Roman","serif"; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><strong><em><u><span style="color: red;"></span></u></em></strong></span></span><br />
<span style="color: #666766; font-family: "Times New Roman","serif"; font-size: 20.5pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Good for 1.0 CEU (and it's free) </span><br />
<span style="color: #666766; font-family: "Times New Roman","serif"; font-size: 20.5pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"></span><br />
<span style="color: #666766; font-family: "Times New Roman","serif"; font-size: 20.5pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Click link below to get registered. - </span><br />
<br />
<a href="https://www.navicure.com/events.html">https://www.navicure.com/events.html</a><br />
Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-58287623013864562032017-02-20T01:00:00.000-07:002017-02-20T01:00:23.536-07:00<div class="MsoNoSpacing">
<b><u>New Code
2017: 58674- Laparoscopic ablation of
Uterine Fibroid Tumors <o:p></o:p></u></b></div>
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February 4, 2017<o:p></o:p></div>
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CPT has granted coders a new code for the laparoscopic
ablation of uterine fibroid tumors. As
of January 1, 2017 the code is officially denoted as <i>58674 </i><i><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Laparoscopy, surgical, ablation of uterine fibroid(s), including
intraoperative ultrasound guidance and monitoring, radiofrequency</span></i><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">.<b> </b>The addition of this new code by CPT
marks another successful transition of a code from the Category III code 0336T <i>Laparoscopy, surgical, ablation of uterine
fibroid(s), including intraoperative ultrasound guidance and monitoring, radiofrequency</i>.<b> </b> Category III codes are the temporary codes
set forth by CPT for emerging technology, services and procedures. The usage of this code as a Category III
code, allowed for the collection of specific data and its usage of code O336T code
for ablation of fibroid tumors has allowed for CPT to create a permanent CPT
code for this new technology. <o:p></o:p></span></div>
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<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">The usage and transition of a Category III code to a permanent CPT code
is a very good thing. This allows for a
solid RVU value allocation to the code, and insurance payers will also put this
into their payment code base for standardized payment. However, some insurance payers may still
consider this to be an “experimental” code, so it is advisable to call the
carrier prior to the procedure being performed to inquire about payment of this
procedure with the new CPT code. <o:p></o:p></span></div>
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<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">The new CPT code 58674 is primarily targeted for usage with the procedure
known as Laparoscopic Radiofrequency Volumetric Thermal Ablation (RFVTA). RFVTA is used to destroy uterine fibroids,
yet preserve the uterus. This is
revolutionary for some women who still may want to pursue pregnancy, or simply
to avoid major surgery such as hysterectomy, to definitively remove fibroid
tumors from the uterus. <o:p></o:p></span></div>
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<b><u><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Clinical indications
and documentation<o:p></o:p></span></u></b></div>
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<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Uterine fibroids are benign, muscular tumors in a woman's uterus that can
cause heavy bleeding, painful periods, pressure, and abdominal pressure, pain
and distention. According to the
National Institute of Health (NIH) at least 70% of women in the US will develop
fibroid tumors. Fibroids are a significant women’s health issue, and symptoms
can be very mild, to very extreme. The American
Congress of Obstetricians and Gynecologists (ACOG) has stated that 39% of all
hysterectomies are due to fibroid tumors and the issues related to those tumors. Hysterectomy has been one of the more
“traditional” methods for relief of fibroid uterine tumors. The usage of a less invasive procedure that
is performed laparoscopically is becoming more popular with surgeons and
patients alike. <o:p></o:p></span></div>
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<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">In women who have symptoms, the most common symptoms of uterine fibroids
include:<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: #333333; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Heavy menstrual bleeding.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: #333333; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Menstrual periods lasting more than a week.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: #333333; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Pelvic pressure or pain.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: #333333; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Frequent urination.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: #333333; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Difficulty emptying the bladder.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: #333333; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Constipation.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: #333333; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Backache or leg pains<o:p></o:p></span></div>
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<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">The ablation of these fibroid tumors via a laparoscopically delivered
system of direct ablation to the uterine fibroid allows the patient to
alleviate the tumor, and preserve the uterus, thereby avoiding the effects of a
hysterectomy or major surgery for elimination of these tumors. <o:p></o:p></span></div>
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<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Clinically, this procedure is considered “minimally invasive” and is
performed as an outpatient procedure, and the patient can return to a normal
lifestyle within 2-3 days post procedure.
<o:p></o:p></span></div>
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<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">The procedure allows the surgeon to ablate targeted fibroids within the
uterine cavity. The surgeon the utilizes
the laparoscopic tools to specifically targe and deliver thermal radiofrequency
energy to the specific fibroid tumor with precise tip inserted into the fibroid itself. With this needle/tip the surgeon can then
control the amount of thermal energy need to destroy the fibroid tumor. Ultrasound
guidance allows the surgeon to visualize each tumor and the precise location of
where the needle/tip of the tools are to be placed for successful ablation of
the tumors. <o:p></o:p></span></div>
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<b><u><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">RVU’s and Payment
Considerations<o:p></o:p></span></u></b></div>
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<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">With any new CPT code, pricing and payment is something to be considered
if the physician has decided to include this into their practice. Below is the table from CMS that outlines the
National RVU’s allocated to code 58674.
This information can be accessed through the CMS link <o:p></o:p></span></div>
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<a href="https://www.cms.gov/apps/physician-fee-schedule/search/search-results.aspx?Y=0&T=0&HT=0&CT=0&H1=58674&M=1"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">https://www.cms.gov/apps/physician-fee-schedule/search/search-results.aspx?Y=0&T=0&HT=0&CT=0&H1=58674&M=1</span></a><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">. <o:p></o:p></span></div>
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZiTxkS8m4sYsC_nTMPBoD6367xRkwZ67qtlI4qjF7OzpOAKo1btrY6F_hYp6wAQqThyCxF2qD7lw_dO6DkocB2kkDS0OPeiXEe4jASxDTrEKmIauGoejCEERuJACIbaOI9WZV5HwWUUgR/s1600/fee+schedule.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="326" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZiTxkS8m4sYsC_nTMPBoD6367xRkwZ67qtlI4qjF7OzpOAKo1btrY6F_hYp6wAQqThyCxF2qD7lw_dO6DkocB2kkDS0OPeiXEe4jASxDTrEKmIauGoejCEERuJACIbaOI9WZV5HwWUUgR/s640/fee+schedule.png" width="640" /></a></div>
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<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">As you can see from the above table this represents the National Payment
indicators from CMS, and therefore may not represent what is the actual RVU
values for your particular CMS locality.
CMS does allow for payment of this procedure, however many private
insurers may still consider this an “experimental” procedure and now allow for
payment of this procedure under their specific policies and contracts. <o:p></o:p></span></div>
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<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">If the patient and physician have decided to pursue this method of
surgical intervention, it is advisable to do a thorough pre-authorization with
the patients’ insurance carrier to determine if they will pay for this new
technology. If the patient’s carries
does not pay for this procedure, then you should collect up-front and/or make
payment arrangements with the patient.
However, this does not preclude you, as the coder/biller from requesting
a pre-authorization request for consideration of payment for this code based
upon the patients’ medical necessity and the adoption of this procedure by CPT
as a permanent code into the codeset, and CMS’s adoption of RVU’s. In addition, a coder/biller can still file a
claim with the patients’ insurance post procedure and submitting the operative
notes and a formal request for payment. <o:p></o:p></span></div>
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<b><u><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Case Example<o:p></o:p></span></u></b></div>
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<b><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">History</span></b><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">: L.W. is a 44-year-old woman (G2P2) with a
2-year history of menorrhagia and severe dysmenorrhea but no intermenstrual
spotting or bleeding. We reviewed the failure of controlling her symptoms using
hormonal methods, without success. <br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><b><o:p></o:p></b></span></div>
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<b><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Examination</span></b><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">: Palpation reveals
that patient has an irregular, nontender uterus 8 weeks in size. Ultrasound
reports for the Transvaginal
ultrasonography shows two deep, prominent, intramural fibroids. The first is 2
cm by 3 cm in size in the left lateral uterus, adjacent to the endometrial
stripe. The second fibroid is 3 cm by 4 cm in the fundal region.
Sonohysterography reveals no intracavitary fibroids, although the left lateral
myoma has distorted the endometrial cavity.<o:p></o:p></span></div>
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<b><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Medical Decision
Making</span></b><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">: The patient is seeking removal of her fibroids but would like to
preserve her uterus, if at all possible.
We have decided to pursue uterine-sparing fibroid treatment, performed
laparoscopically instead of a hysterectomy.
Patient has signed all appropriate consents and we will contact her
insurance carrier for pre-authorization and confirmation. <o:p></o:p></span></div>
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<b><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Operative
Session/report: <o:p></o:p></span></b></div>
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<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Utilizing the RFVTA technique we begin with a standard 5-mm laparoscopic
infraumbilical port for the camera and video laparoscope. Placee a 12-mm port in the midline,
suprapubically at the level of the uterus, and inserted the laparoscopic
ultrasound probe. With the laparoscope in place I began the mapping of the
uterus and outlined plan with the surgical team with the approach to destroy
the fibroids.<o:p></o:p></span></div>
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<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">I then inserted the handpiece containing the radiofrequency needle
through the abdominal wall under laparoscopic visualization and placed the
needle into the targeted fibroid using both laparoscopic and ultrasound
guidance. I then accessed the first fibroid, in the left lateral uterus and
deployed the needle array to the maximum diameter necessary to begin the destruction.
I then engaged the radiofrequency generator and set it for optimal destruction
of the 2 x 3 cm fibroid, The fibroid was then ablated and destroyed without
damage to the surrounding healthy myometrium. I then performed this same
procedure upon the second fibroid in the fundal region. This fibroid measured 3 x 4 cm with optimal
destruction. Treatment is complete, and
confirmed I retracted the needle array.
I then coagulated the needle track during withdrawal of the probe, and
confirmed hemostasis of all surgical areas within the uterine cavity. All sponge and instruments counts were
correct and accounted for. The patient
was then taken to recovery area in good condition. Patient to be discharged the same day. I will see the patient back in-office on day 3
for a postoperative check. <o:p></o:p></span></div>
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<b><u><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Wrapping it up<o:p></o:p></span></u></b></div>
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<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">As a coder, remember to code what you know, and do not assume. If in doubt, or the documentation does not
appear to be clear or is confusing, query the provider. Good patient care requires the provider to
accurately reflect the patient care via their documentation in the medical
record. Our job, as a coder, is to correlate
the coding and billing to reflect the medical that was documented and provided
by the physician. If you are unsure
about the coding guidelines utilize your resources such as CPT, ICD-10cm,
ICD-10pcs and HCPCS. <o:p></o:p></span></div>
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<i><span style="font-size: 10pt; line-height: 115%;">Lori-Lynne A. Webb, CPC,
CCS-P, CCP, CDIP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an
E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA
Privacy specialist, with over 20 years of experience. Lori-Lynne’s coding
specialty is OB/GYN office & Hospitalist Services, Maternal Fetal Medicine,
OB/GYN Oncology, Urology, and general surgical coding. She can be reached via
e-mail at webbservices.lori@gmail.com or you can also find current coding
information on her blog site: http://lori-lynnescodingcoachblog.blogspot.com/.<o:p></o:p></span></i></div>
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Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-46987749059258839882017-02-20T00:30:00.000-07:002017-02-20T00:30:12.692-07:00Overview: Coding and Billing in an OB Hospitalist Practice<div class="MsoNormal">
<b><span style="font-family: "Tahoma","sans-serif";">Coding and Billing in an OB
Hospitalist Practice<o:p></o:p></span></b></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "Tahoma","sans-serif";">In an OB
Hospitalist practice, currently there are many different medical and billing scenarios
each and every day that bring challenges.
Coding and billing for these scenario’s, and how they are documented,
submitted to 3<sup>rd</sup> party payers, and the reimbursement back to the
practice is integral to keeping an OB hospitalist practice solvent and
thriving. </span></div>
<div class="MsoNormal">
<br /></div>
<span style="font-family: "Tahoma","sans-serif";">At this time in the OB
hospitalist specialty there are many different practice and billing models to
choose from, and determining which one is right for your business can be
confusing. In addition, OB hospitalists encounter
patients who don’t have access to, or
have not chosen to see a traditional OB or health care provider to oversee
their care. Many patients also rely on
the OB hospitalists to respond to their emergencies and care for them around
the clock. </span><br />
<span style="font-family: "Tahoma","sans-serif";"><br /></span>
<span style="font-family: "Tahoma","sans-serif";">In many instances, we are now
the go-to for traditional OB/GYN providers to augment and provide specialty
hospital based services for high risk and trauma ob and GYN patients. The OB hospitalist program concept is fairly
new to the American hospital system, and coding and billing for this
subspecialty poses a bigger challenge for the providers, as well as the
hospital and coding/billing staff. OB
hospitalists are bearing the weight of maintaining above standard specialty patient
care, in addition to being fiscally solvent. <o:p></o:p></span><br />
<span style="font-family: "Tahoma","sans-serif";"><br /></span>
<span style="font-family: "Tahoma","sans-serif";"><br /></span>
<span style="font-family: "Tahoma","sans-serif";">The OB-GYN hospitalist
program has a positive impact on at-risk OB patients’ health care because these
programs <strong>enable the patients
to have emergent care for any type of OB or GYN emergency when their own
physician is unavailable on a 24/7/365 basis</strong>. </span><br />
<span style="font-family: "Tahoma","sans-serif";"><br /></span>
<span style="font-family: "Tahoma","sans-serif";">Of course, we provide many other functions
such as, supporting local obstetricians as back-up for deliveries and emergency
C-sections; providing ancillary testing services for walk-in or emergent trauma
situations, and also step in as an assistant surgeon for many operative
procedures at a moment’s notice. (that
may or may not be OB related) <o:p></o:p></span><br />
<span style="font-family: "Tahoma","sans-serif";"><br /></span>
<span style="font-family: "Tahoma","sans-serif";"><br /></span>
<span style="font-family: "Tahoma","sans-serif";">The fiscal mainstay for the
OB Hospitalist practice is evaluation and management (E/M) services, which
include all areas of inpatient hospital, outpatient hospital, emergency
department, critical care, complex care management, and office-quick/urgent
care coding. In addition to the
evaluation and management codes, procedure based CPT codes provide an enormous
source of revenue, which can include surgery, interventional, diagnostic and
therapeutic medicine, radiology/ultrasound services. Not only does and OB hospitalist team provide
these services, but are instrumental in also providing “down-stream” services
that can impact a facility in a positive way, such as laboratory, radiology,
NICU, pharmacy, nutritional services, social work services, and other areas
within the facility that would not have had these financial opportunities had
the OB hospitalist team not been in place. <o:p></o:p></span><br />
<span style="font-family: "Tahoma","sans-serif";"><br /></span>
<span style="font-family: "Tahoma","sans-serif";"><br /></span>
<span style="font-family: "Tahoma","sans-serif";">Each OB hospitalist program
functions under many different licenses within the hospital setting. Some practices are embedded with the
Emergency Room, some are an integral part of the Labor & Delivery floor,
while others operate as a “emergent outpatient” area of the hospital similar to
a “quick-care, urgent-care” walk in clinic.
The most common is the OB hospitalist physician team is a “stand alone”
practice comprised of OB hospitalist (specialty) physicians that function as a
separately identifiable group practice that bills as a physician based practice
team utilizing and coding and billing with their own practice management
software and/or coding/billing team. <o:p></o:p></span><br />
<span style="font-family: "Tahoma","sans-serif";"><br /></span>
<span style="font-family: "Tahoma","sans-serif";"><br /></span>
<span style="font-family: "Tahoma","sans-serif";">Coding and billing in an OB
hospitalist practice is a specialty concept within itself. The OB hospitalists practice specialty has to
provide superior care not only for the pregnant patient, but for the fetus
too. During routine coding and billing
audits, many times the “hish risk” factor is overlooked or undervalued during
the “scoring” when determining the
evaluation, plan of care, clinical documentation, risk factors, proposed
procedures and ancillary services options when coding and billing is performed.
<o:p></o:p></span><br />
<span style="font-family: "Tahoma","sans-serif";"><br /></span>
<span style="font-family: "Tahoma","sans-serif";"><br /></span>
<span style="font-family: "Tahoma","sans-serif";">The nuts and bolts of
traditional CPT evaluation/management and procedure codes are utilized in
addition to the current ICD-10cm diagnosis codeset. Clinical documentation by
the OB hospitalist is integral to success when the coder/biller has to combine
all these pieces together for the evaluation and management code, the
procedures performed, diagnosis, ancillary circumstances (eg pt fell, etcc) are
relevant to report for reimbursement for services provided. </span><br />
<span style="font-family: "Tahoma","sans-serif";"><br /></span>
<br />
<span style="font-family: "Tahoma","sans-serif";">The coding and billing for
the OB hospitalist team should be one of your primary areas of concern as this
will be the key to a successful practice.
Education in coding, billing and clinical documentation for the entire OB hospitalist practice should
be one of the important areas to review and consider, as you implement a new
practice, or work to renew or revitalize a practice that is struggling with a
financial issue. <o:p></o:p></span><br />
<br />
<span style="font-family: "Tahoma","sans-serif";">Commonly coded/billed CPT
Procedures <o:p></o:p></span><br />
<div class="MsoNormal">
<st1:place w:st="on"><b><u><span style="font-family: "Tahoma","sans-serif";">Ob</span></u></b></st1:place><b><u><span style="font-family: "Tahoma","sans-serif";">
Hospitalist Procedures</span></u></b><span style="font-family: "Tahoma","sans-serif";">:<o:p></o:p></span></div>
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<div style="margin-left: .75in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">59050/51 Fetal monitoring (IUPC) <o:p></o:p></span></div>
<div style="margin-left: .75in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">59150/51 Laparoscopic treatment of ectopic
pregnancy<o:p></o:p></span></div>
<div style="margin-left: .75in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">59120/21 Surgical treatment of ectopic
pregnancy<o:p></o:p></span></div>
<div style="margin-left: .75in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">58605 Ligation or transection of
fallopian tube(s), during same
hospitalization<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">58611 Tubal Ligation (Add on
w/c-section) <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">59025-26 Fetal
NST interpretation<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">59160 Curettage - Post Partum <o:p></o:p></span></div>
<div style="margin-left: .75in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">59200 Insertion
of cervical dilator<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">59300 Episiotomy or vaginal repair, by
other than attending physician<o:p></o:p></span></div>
<div style="margin-left: .75in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">59320 Cerclage of cervix<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">59409 Vag Deli Only <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">59412 External cephalic version, with
or without tocolysis<o:p></o:p></span></div>
<div style="margin-left: .75in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">59414 Placenta only delivery <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">59514-80 Assist
to a surgeon for cesarean delivery<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">59514 Cesarean delivery only;<o:p></o:p></span></div>
<div style="margin-left: .75in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">59525 Hysterectomy (post cesarean
delivery)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">59612 V-back delivery <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">59618 Cesarean post failed attempted
vback delivery <o:p></o:p></span></div>
<div style="margin-left: .75in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">59899 CPT “unlisted” services such as
Bakri Balloon hemorrhage care
<o:p></o:p></span></div>
<div style="margin-left: .75in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">76815
Bedside quick-peek
Ultrasound <o:p></o:p></span></div>
<div style="margin-left: .75in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">76818/19 Fetal Bio-physical profile(s)<o:p></o:p></span></div>
<div style="margin-left: .75in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Tahoma","sans-serif";">76998 Intraoperative ultrasound <o:p></o:p></span></div>
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<div class="MsoNormal">
<i><span style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";">Lori-Lynne
A. Webb, CPC, CCS-P, CCP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an
E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA
Privacy specialist, with over 20 years of experience. Lori-Lynne’s coding specialty is OB/GYN
office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology,
Urology, and general surgical coding.
She can be reached via e-mail at </span></i><a href="mailto:webbservices.lori@gmail.com"><i><span style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";">webbservices.lori@gmail.com</span></i></a><i><span style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";"> or you can also find current
coding information on her blog site: </span></i><a href="http://lori-lynnescodingcoachblog.blogspot.com/"><i><span style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";">http://lori-lynnescodingcoachblog.blogspot.com/</span></i></a><i><span style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";">. </span></i><span style="font-family: "Tahoma","sans-serif";"><o:p></o:p></span></div>
Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-63537925803216595542017-01-02T14:45:00.000-07:002017-01-02T14:45:13.039-07:00Connecting the dots: Diagnosis, Procedures, Documentation<div class="MsoNoSpacing">
<b><u>Connecting the
dots: Diagnosis, Procedures, Documentation <o:p></o:p></u></b></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing" style="text-align: right;">
<o:p>Originally published on 07.30.2016</o:p></div>
<div class="MsoNoSpacing" style="text-align: right;">
<o:p>Lori-Lynne A. Webb </o:p></div>
<div class="MsoNoSpacing" style="text-align: right;">
<o:p><br /></o:p></div>
<div class="MsoNoSpacing" style="text-align: right;">
<o:p><br /></o:p></div>
<div class="MsoNoSpacing">
In the outpatient setting, we have a different set of
“rules” to follow in regard to the official guidelines for coding and reporting
in ICD-10cm than those that follow the guidelines for “inpatient” care. The ICD-10cm guidelines for outpatient coding
are followed and are used by hospitals/providers for coding and reporting
hospital-based outpatient services, and provider-based office visits. In addition, the terms “encounter” and
“visit” can be used interchangeably. As
a reminder, the guidelines for outpatient coding are different from inpatient
coding in the fact that the term “principle diagnosis” is only applicable to
inpatient services; as are the coding of probable, suspected, rule outs and
inconclusive. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
For those who code outpatient or office based services; instead
of reporting a “principle” diagnosis, you would code the first-listed diagnosis,
as well as signs and symptoms that are documented by the provider of care. In some cases, it may take more than one
visit or encounter to arrive at and/or confirm a specific “diagnosis”. ICD-10cm guidelines allow us to continue to
report signs and symptoms over the course of the outpatient workup. The majority of the signs and symptom codes
are found in Chapter 18 of the ICD-10cm diagnosis codes, however, other signs
and symptom codes can be found in many of the other sections and chapters of
ICD-10cm. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
When assigning an ICD-10cm diagnosis code for an
outpatient surgery, or same-day surgery, it is appropriate to code the “reason”
for the surgery as the first listed diagnosis (eg reason for the
encounter). When coding for an outpatient hospital observation
stay, it is appropriate to code the current medical condition as the first-listed
diagnosis. (eg. pregnant patient with decreased fetal
movement) , In addition it is appropriate to code for all additionally documented
conditions. If the patient has chronic
diseases noted, the chronic disease or chronic disease status may be coded in
addition to the primary “reason” the patient is seeking treatment, but only if
the physician documents the chronic condition is impacting the current care or
medical decision making of the presenting problem or illness. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Diagnosis codes are to be used and reported at their
highest number of characters available and specificity. However, sometimes all we have to go by is
the documentation of the “signs and symptoms” that the provider of care has
documented. If the provider has not
referenced a clinical significance to complaints or ill-defined symptoms, we
have to code it as a “sign or symptom” from the ICD-10cm codeset. It is the providers responsibility to clearly
document the patients’ diagnosis. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Coders are not allowed to “infer” or code directly from
an impression on diagnostic reports such as an x-ray, ultrasound, or pathology
report. In the outpatient setting, the provider of
care must confirm the diagnosis in the body of the patients’ visit note,
procedure /operative note, or progress note.
An example of this is; In the provider notes, the documentation states
the patient has an “elevated blood pressure” of 160/90. As a coder, this does not mean the provider
has diagnosed the patient with hypertension, it simply means that today, the
patients’ blood pressure is elevated.
However, if the provider notes
that the patient has an “elevated blood pressure of 160/90 today, and will
begin treating for hypertension; the coder can code the specific “hypertension”
diagnosis rather than the ‘signs and symptom” code of elevated blood
pressure. If the coder does not have
more specific information than “hypertension” written in the record; a query to
the provider is in order to get the most specificity for coding clarity, and
good clinical documentation for the overall quality of medical care. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
When assigning codes for an outpatient or ambulatory
surgery case, code the diagnosis for which the surgery was performed. However…. If the post-operative diagnosis <i>is different</i> than the pre-operative
diagnosis listed by the surgeon, then code what is reported as the
post-operative diagnosis. In reviewing
or auditing an operative record, the surgeon should give both diagnoses. The rule of thumb, is the coder will defer to
coding the diagnosis based on the post-operative notation, or most definitive
clinical documentation recorded in the patients’ medical chart. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
When coding a diagnosis for and ambulatory or same-day surgery,
the urge to rely on the absolute information from a pathology report can be
hard to resist. As coders, we have been
trained to hold or delay submitting the insurance claim pending more
information from a pathology report. Pathology
reports contain great information as to sizes, weights, measures, cell types,
malignancies, infections, and even more extensive clinical information than is
normally reported in an operative/procedure record. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
However, within the guidelines of coding, coders should
not assign codes based on the pathology report, unless the physician has <i>confirmed the diagnosis</i> within their
operative, procedure, or progress notes.
For example, if the physician notes within the documentation the removal
of a “breast lesion/mass” and the pathology record documentation states “breast carcinoma”, the coder should
not code a “breast carcinoma” until the surgeon clarifies or adds this
additional information from the pathology report to the operative and/or
progress note. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Pathology reports certainly help us paint the picture to
good coding standards, but sometimes do not “help” as much as they can “hinder”
the true picture. When coding for a
lesion removal with CPT codes, understanding how lesions are measured, is vital
to good documentation of the procedure.
According to the CPT manual guidelines the measurements of the lesion
need to include the size of the lesion itself, and include the margins needed
for medical necessity <i>prior to excision. <o:p></o:p></i></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
As part of good clinical documentation, the provider
should document and include an accurate measurement of the lesion itself, and
the margins to be included. If the coder
relies on only the pathology report, it
may not be an accurate sizing.
Unfortunately when excising specimens, it is common to have the procured
tissue “shrink” or the specimen may be “fragmented” upon receipt to the
pathology department. Measurement of the
defect size post excision may also be incorrect, as the excision site may
“expand” once the tissue has been incised or excised. Either way, this leads to incorrect
documentation and incorrect coding. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
The documentation bottom line is this:<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
• Measurement of the lesion plus
the margins should be made prior to the excision<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
• Pathology reports should not
be used in lieu of physician documentation<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
• Query the physician regarding
the size of the lesion as well as the margins excised if not clearly noted in
the operative/procedure note. <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<br /></div>
<div class="MsoNoSpacing">
Below is a copy of a very generic type of lesion excision
query form you can use to communicate to your provider the information you need
to accurately code the encounter: <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
********************************************************************************<o:p></o:p></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<b><u><span style="font-family: "tahoma" , sans-serif; font-size: 10pt;">EXCISION OF LESION(S) CLARIFICATION<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
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<span style="font-family: "tahoma" , sans-serif; font-size: 10pt;">Patient Name: ________________________ : DOB:________________<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<span style="font-family: "tahoma" , sans-serif; font-size: 10pt;">DOS: _____________ MR #:_________________<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
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<span style="font-family: "tahoma" , sans-serif; font-size: 10pt;">Query Date:________
Requested by: _____________<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
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<span style="font-family: "tahoma" , sans-serif; font-size: 10pt;">Documentation clarification is required
to meet medical record documentation compliance, medical necessity, and
accuracy of diagnosis and procedure coding. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
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<span style="font-family: "tahoma" , sans-serif; font-size: 10pt;">In the medical record/operative
procedure note, the following information is needed to assign the correct ICD-10cm
and CPT code(s). Please provide the following:<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l1 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "wingdings"; font-size: 10pt;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="color: #0730c3; font-family: "tahoma" , "sans-serif"; font-size: 10.0pt;">SIZE </span><span style="font-family: "tahoma" , sans-serif; font-size: 10pt;">of the
greatest clinical diameter in centimeters plus margins for each lesion excised<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l1 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "wingdings"; font-size: 10pt;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="color: #0730c3; font-family: "tahoma" , "sans-serif"; font-size: 10.0pt;">DEPTH </span><span style="font-family: "tahoma" , sans-serif; font-size: 10pt;">of the
tissue involved for each lesion (e.g., skin, fascia, muscle or bone)<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l1 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "wingdings"; font-size: 10pt;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="color: #0730c3; font-family: "tahoma" , "sans-serif"; font-size: 10.0pt;">Type of CLOSURE </span><span style="font-family: "tahoma" , sans-serif; font-size: 10pt;">for
each lesion (e.g., simple, intermediate or complex)<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "tahoma" , sans-serif; font-size: 10pt;">Please document and/or addend the
patients’ operative/procedure record to include the requested information above. This information can be noted in the
electronic medical record, or noted on this form as noted by you in the area
below. If you are using this form,
please sign and date the attestation/addendum. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<span style="font-family: "tahoma" , sans-serif; font-size: 10pt;">*******************************************************************************<o:p></o:p></span></div>
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<br /></div>
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The relationship between the documentation and the coding
is a very intricate and oftentimes confusing process. Every chart note, or clinical documentation
the record must stand on its own merit.
If the record is audited, the coding should accurately reflect what was
noted by the provider. As a coder, the documentation should always clearly
reflect this set of criteria listed below: <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]-->Clinical Evaluation and work-up to include any
pertinent history<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]-->Diagnostic and/or Therapeutic Treatment(s)
carried out or ordered (such as lab tests, x-rays etc.) <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]-->Continued plan of care or follow up plans<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]-->Clinical diagnosis of disease, signs and/or
symptoms. <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]-->Documentation of patient education provided in
regard to the above <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
The usage of an electronic medical record for outpatient
care and office based services has also been instrumental in giving the coder a
clearer picture of the overall care and services provided to the patient. Many electronic medical records allow the
physician to choose the ICD-10cm diagnosis code and include the additional supplies
or procedures performed during the visit.
If the provider documents the diagnosis for any performed procedures via
an electronic record, the coder now has the additional role of auditing the patient
record and the actual diagnosis codes chosen by the provider prior to billing
the 3<sup>rd</sup> party insurance payers.
<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
If upon review by the coder, that the physician or
provider has not chosen the “most specific” of codes, the coder/auditor now has
the unique opportunity to easily review, clarify and/or correct any errors
quickly and easily prior to a claim being sent out. In addition, some payers have the capability
to accept electronic copies of the patients’ clinical documentation for their
review or pre-authorization to expedite payment of services rendered. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Outpatient and office based services are not always about
illness. Wellness services, preventive
care, pre and post operative care, and specialty specific diagnosis care are
all a part of outpatient and office based services. ICD-10cm has accounted for these types of
encounters. If these encounters are well
documented, they also need to be coded, billed and incorporated into the claim. Many 3<sup>rd</sup> party payers are now
providing coverage for payment of screening services.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
The ICD-10cm coding guidelines give clear instruction for
how these type of services are to be reported.
Again, it is the physicians role to clearly state within the clinical
documentation that the patient has presented for a wellness exam, or has
presented for screening testing for specific illnesses or diagnoses (such as a
pap test for cervical cancer, a colonoscopy to screen for colon cancer, lab
tests for elevated blood sugar/diabetes) .
In these cases the coding should reflect a clear diagnosis of screening. The screening diagnosis may be the only
diagnosis assigned, as it may truly be the only “reason” for the patient visit. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
It is becoming more common that the physician will be
following and providing care for both an established chronic problem, and also “screen”
for other issues during the same encounter.
If this is the case, the coder needs to audit and review the notes
carefully to ensure that the record clearly denotes what has been performed in
regard to “follow up” and what has been performed as “screening” (for either
wellness, or a suspected illness) If
the record does not clearly show these as separately identifiable services, a
physician query and/or addendum is in order. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Last but not least, always “code what the record shows”. If you are in doubt, query. Many coders rely on the old adage of “if it
wasn’t documented, it wasn’t done”. This type of coding should no longer be the
rule of thumb or status quo. As a good
coder, if it appears in the clinical documentation, a service or procedure was performed,(but
poorly documented) it is well worth the time to investigate, confirm, have the
record amended, then coded with accuracy. <o:p></o:p></div>
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<br />
<div class="MsoNormal">
<i>Lori-Lynne
A. Webb, CPC, CCS-P, CCP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an
E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA
Privacy specialist, with over 20 years of experience. Lori-Lynne’s coding specialty is OB/GYN
office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology,
Urology, and general surgical coding.
She can be reached via e-mail at </i><a href="mailto:webbservices.lori@gmail.com"><i>webbservices.lori@gmail.com</i></a><i> or you can also find current coding information
on her blog site: </i><a href="http://lori-lynnescodingcoachblog.blogspot.com/"><i>http://lori-lynnescodingcoachblog.blogspot.com/</i></a><i>. </i><b><o:p></o:p></b></div>
Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-61293754308342919812017-01-02T14:40:00.000-07:002017-01-02T14:40:04.814-07:00HPV: Diagnostics, Coding and Insurance Coverage<div class="MsoNoSpacing">
<b>HPV: Diagnostics, Coding and Insurance Coverage <o:p></o:p></b></div>
<div align="right" class="MsoNoSpacing" style="text-align: right;">
October 8,
2016<o:p></o:p></div>
<div align="right" class="MsoNoSpacing" style="text-align: right;">
<i>Lori-Lynne
A. Webb <o:p></o:p></i></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Human
Papilloma Virus also known as HPV is the most common sexually transmitted
infection in the United States. HPV is a virus, and is so common that nearly
all sexually active men and women get it at some point in their lives. There
are more than 150 different types and strains of HPV, and some of the types can
cause health problems including genital warts and cancers. HPV is so common
that nearly all sexually active men and women get it at some point in their
lives.<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<span style="background: white; font-family: Arial, sans-serif; font-size: 10pt;">HPV is named for the warts (papillomas) some HPV
types can cause. There are some strains of HPV that can lead to cancer. Most commonly these HPV strains have been
linked to cervical cancer in women.
Unfortunately, there are more than 40 HPV types that can infect the
genital areas of both men and women. However,
research has created vaccines that can prevent infection with some of the most
common types of HPV. <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Human
Papillomavirus (HPV), low-risk types are associated with strain(s) 6, 11, 42, 43, 44. High risk strains have been identified as
strain(s) 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">According
to the Advisory Committee on Immunization Practices (ACIP) during its February
2015 meeting, it has been recommended that the
9-valent (9 different strains HPV vaccine; also known as 9vHPV) as one
of three HPV targeted vaccines that can be used for routine vaccination. The HPV vaccine is recommended for routine
vaccination at age 11 or 12 years and they also recommend vaccination for
females aged 13 through 26 years and males aged 13 through 21 years not
vaccinated previously. <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Previously,
the quadravalent (4-strain) HPV vaccine was only effective against HPV
strain(s) 6, 11, 16 and 18. The 9-valent
vaccine is effective against HPV strains 6, 11, 16, 18, 31, 33, 45, 52, and
58. <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Prevention
of cervical cancer due to HPV can be initiated with regular screening performed
at the same time as the Papanicolaou screening test, also known as a Pap Smear,
for cervical cancer. The PAP looks for
abnormal cells on the cervix that could turn into cancer over time. Screening
does not eliminate the problem, it allows for these types of diagnoses to be found
and treated before they turn into cancer. <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ACOG
has recommended that women should start getting regular Pap tests
at age 21. For women ages 30 and older, the HPV test can be used
along with the Pap test. Cervical cancer often does not cause symptoms until it
is advanced. The Pap Smear and the HPV tests look
for different things: The Pap test is a screening to check the cervix
for abnormal cells that could turn into cervical cancer. The HPV test is
performed to check the cervix for the <b><i>virus</i></b> (HPV) that can cause abnormal
cells and cervical cancer.<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<b><u><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">CMS Policy:<o:p></o:p></span></u></b></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">In
July of 2015, the Centers for Medicare & Medicaid Services (CMS) came out
with the implementation of payment for screening for cervical cancer with HPV
testing under National Coverage Determination policy 210.2.1. Up until this change was implemented,
Medicare was covering a screening pap and pelvic exam for its female
beneficiaries every 12 or 24 month interval, based upon whether the patient was
considered low or high risk.
Unfortunately, at that time HPV screening and testing was not paid for
by CMS. However, CMS has since
determined that HPV screening/testing <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">In
conjunction with the Pap and Pelvic exam is of value, and will allow a
screening test once per every 5 years, for beneficiaries aged 30 to 65 years<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">For
Medicare beneficiaries (and some private payers too) HCPCS has implemented code
G0476. HCPCS 2017 Code : G0476;
Infectious Agent Detection By Nucleic Acid (Dna Or Rna); Human Papillomavirus
(Hpv), High-Risk Types (Eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68)
For Cervical Cancer Screening, Must Be Performed In Addition To Pap Test . <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The
ICD-10cm codes used in conjunction with G0476 are: <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l3 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;">1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ICD-10
Z11.51 Encounter for screening for human papillomavirus (HPV) and Z01.411 Encounter
for gynecological examination (general)(routine) with abnormal findings <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">OR<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l3 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;">2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Z01.419
Encounter for gynecological examination (general)(routine) without abnormal
findings<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="Default">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Once
the claim is submitted to your CMS carrier (Such as Medicare, True Blue, etc) <o:p></o:p></span></div>
<div class="Default" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;">a)<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Medicare/Medicaid
will not apply beneficiary coinsurance and deductibles to claims with the HCPCS
code G0476, HPV screening<br />
<o:p></o:p></span></div>
<div class="Default" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;">b)<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Part
B claims can only be accepted with a Place of Service Code equal to ‘81’,
Independent Lab or ‘11’, Office; <br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div class="Default" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;">c)<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">This
is only effective for claims with dates of service <b><i>on or after July 9, 2015</i></b>. <br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div class="Default" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;">d)<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">If
your clams contain HCPCS G0476, HPV screening, more than once in a 5-year
period [at least 4 years and 11 months (59 months total) must elapse from the
date of the last screening] they will be denied.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div class="Default" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;">e)<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">CMS
will deny line-items on claims containing HCPCS G0476, HPV screening, If the
beneficiary is less than 30 years of age or older than 65 years of age. <br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div class="Default" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;">f)<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> If you know that the patient is not eligible
for payment, then be sure to have the ABN signed, on file and submit the claim
with the GA modifier. <o:p></o:p></span></div>
<div class="Default">
<br /></div>
<div class="Default">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Some
provider offices were having problems getting the code G0476 paid, with
diagnosis code Z12.4 Encounter for screening for malignant neoplasm of
cervix. The issue with this ICD-10 code
is that <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: normal; margin-bottom: 12.0pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;">a)<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">CMS policies are only
for those FEDERAL programs such as Medicare/Medicaid/Tricare. and they
don't necessarily pertain to private insurance payers (such as Blue Cross/Blue
Shield/Aetna/etc... )<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: normal; margin-bottom: 12.0pt; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;">b)<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">The HCPCS code G0476
is actually the HCPCS code for the <b><i>"lab test
itself" </i></b> therefore that is why only those
particular ICD-10 codes would be applicable.
<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: normal; margin-left: .5in; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;">c)<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">The ICD-10cm code </span><i><span style="font-family: Arial, sans-serif; font-size: 10pt;">Z12.4 Encounter for screening for malignant neoplasm of
cervix</span></i><span style="font-family: Arial, sans-serif; font-size: 10pt;"> </span><span style="color: #222222; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">is exactly that - it is for the<i>"Encounter" </i> the
Office/Visit aka E&M code. It not
appropriate to append a ICD-10 “encounter for” code to a "lab
test" code such as the G00476.<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">In
January of 2015, CPT has revised the HPV test codes by deleting laboratory
codes 87620-87622 and adding three new
codes 87623-87625 Human Papilloma Virus (HPV).
These new codes have been added to differentiate between <b><i>high
and low risk</i></b> HPV types. Low-risk
types would be reported with code 87623 and high-risk types with code 87624.
Again, these are laboratory codes, not the codes you would normally use in the
providers office. <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<b><u><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">HPV Vaccinations and
Cervical Cancer<o:p></o:p></span></u></b></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Cervical
Cancer has been one of the most common causes of cancer death for American
women prior to Pap test.<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Since
the Pap test, cervical cancer mortality has declined by almost 70%. Most cervical cancers occur in unscreened or<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">inadequately
screened women. According to the American Cancer society, most cases of
cervical cancer are diagnosed in women younger than 50, and more than 20% are
diagnosed in women over the age of 65. In
the U.S., Hispanic women have been shown to be the most likely demographic to
get cervical cancer, followed by African-Americans, Asians, Pacific Islanders,
and Whites. In women over the age of 30 HPV
infections are more likely to be persistent and/or high-grade.
Most HPV-related lesions progress slowly into a cervical cancer. This slow rate of growth is somewhere between
3 – 7 years on average for a severe dysplasia to progress to invasive cancer. <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The
HPV strain 16 accounts for nearly 55 – 60%, and the HPV 18 strain accounts for
approximately 10 – 15% of those that develop cervical cancer. The ACS notes that about 10 other HPV strains
cause remaining 25 – 35% of cervical cancers.
<span style="background: white; color: #252525;">HPV vaccines are used to
prevent HPV infection and therefore cervical cancer. ACOG and the World Health Organization (WHO)
have recommended for women who are 9 to 25 years old, and who have not been
exposed to HPV receive the vaccination for HPV virus. Since the vaccine only covers the partial
listing of HPV strains, routine PAP smears should still be a part of cervical
cancer screening. Normally, the vaccines
require two or three doses depending on how old the patient is. Vaccinating
girls around the ages of nine to thirteen is typically recommended. The
vaccines provide protection for at least eight years. It has also been recommended that young and
adolescent men ages 9–26 receive the HPV vaccine for the prevention of genital
warts and anal cancer. <o:p></o:p></span></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="background: white; color: #252525; font-family: "Arial","sans-serif"; font-size: 10.0pt;">The first FDA approved HPV vaccination came out
in 2006 and were targeted to the four most common strains of HPV. However, improvements and more research has
continued to develop better vaccines which now target up to nine of the most
common strains of HPV that can potentially cause cervical cancer. <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<b><u><span style="background: white; color: #252525; font-family: "Arial","sans-serif"; font-size: 10.0pt;">Coding, Clinical Documentation and Reimbursement <o:p></o:p></span></u></b></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">When
coding the vaccinations for the HPV vaccine (such as GARDASIL<sup>®</sup>9 Human
Papillomavirus 9-valent Vaccine, Recombinant) Below represents what would
normally be coded from the physician/provider office. Modifier -51 should not
be reported for vaccines when performed
with the administration procedure code .<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; margin-left: 37.5pt; mso-border-bottom-alt: solid #DBDBDB 1.5pt; mso-border-left-alt: solid #DBDBDB 1.5pt; mso-border-top-alt: solid #DBDBDB 1.5pt; mso-padding-alt: 0in 0in 0in 0in; mso-yfti-tbllook: 1184; width: 588px;">
<tbody>
<tr>
<td style="border-bottom: none; border: solid #DBDBDB 1.5pt; padding: 1.5pt 1.5pt 1.5pt 1.5pt; width: 13.2%;" valign="top" width="13%">
<div class="MsoNormal" style="line-height: normal; margin-bottom: 22.5pt;">
<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">90649<br />
CPT<o:p></o:p></span></div>
</td>
<td style="border-bottom: none; border-left: none; border-right: solid #DBDBDB 1.5pt; border-top: solid #DBDBDB 1.5pt; padding: 1.5pt 1.5pt 1.5pt 1.5pt; width: 86.8%;" valign="top" width="86%">
<div class="MsoNormal" style="line-height: normal; margin-bottom: 22.5pt;">
<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Human Papillomavirus vaccine, types 6, 11,
16, 18, quadrivalent (4vHPV), 3 dose schedule, for intramuscular use<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-bottom: none; border: solid #DBDBDB 1.5pt; padding: 1.5pt 1.5pt 1.5pt 1.5pt; width: 13.2%;" valign="top" width="13%">
<div class="MsoNormal" style="line-height: normal; margin-bottom: 22.5pt;">
<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">90650<br />
CPT<o:p></o:p></span></div>
</td>
<td style="border-bottom: none; border-left: none; border-right: solid #DBDBDB 1.5pt; border-top: solid #DBDBDB 1.5pt; padding: 1.5pt 1.5pt 1.5pt 1.5pt; width: 86.8%;" valign="top" width="86%">
<div class="MsoNormal" style="line-height: normal; margin-bottom: 22.5pt;">
<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Human Papillomavirus vaccine, types 16, 18,
bivalent (2vHPV), 3 dose schedule, for intramuscular use<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: solid #DBDBDB 1.5pt; padding: 1.5pt 1.5pt 1.5pt 1.5pt; width: 13.2%;" valign="top" width="13%">
<div class="MsoNormal" style="line-height: normal; margin-bottom: 22.5pt;">
<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">90651<br />
CPT<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid #DBDBDB 1.5pt; padding: 1.5pt 1.5pt 1.5pt 1.5pt; width: 86.8%;" valign="top" width="86%">
<div class="MsoNormal" style="line-height: normal; margin-bottom: 22.5pt;">
<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Human Papillomavirus vaccine types 6, 11,
16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 3 dose schedule, for
intramuscular use <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-bottom: none; border-left: solid #DBDBDB 1.5pt; border-right: solid #DBDBDB 1.5pt; border-top: none; mso-border-top-alt: solid #DBDBDB 1.5pt; padding: 1.5pt 1.5pt 1.5pt 1.5pt; width: 13.2%;" valign="top" width="13%">
<div class="MsoNormal" style="line-height: normal; margin-bottom: 22.5pt;">
<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">90471<br />
CPT<o:p></o:p></span></div>
</td>
<td style="border-right: solid #DBDBDB 1.5pt; border: none; mso-border-top-alt: solid #DBDBDB 1.5pt; padding: 1.5pt 1.5pt 1.5pt 1.5pt; width: 86.8%;" valign="top" width="86%">
<div class="MsoNormal" style="margin-bottom: 22.5pt;">
<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%;">Immunization
administration (includes percutaneous, intradermal, subcutaneous, or
intramuscular injections); one vaccine (single or combination vaccine/toxoid)</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%;"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: solid #DBDBDB 1.5pt; padding: 1.5pt 1.5pt 1.5pt 1.5pt; width: 13.2%;" valign="top" width="13%">
<div class="MsoNormal" style="line-height: normal; margin-bottom: 22.5pt;">
<span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Z23<br />
</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ICD-10-CM</span><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid #DBDBDB 1.5pt; padding: 1.5pt 1.5pt 1.5pt 1.5pt; width: 86.8%;" valign="top" width="86%">
<div class="MsoNormal" style="line-height: normal; margin-bottom: 22.5pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Encounter for Immunization
</span><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<br /></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The
clinical documentation for injections and infusions that are “vaccination”
based need to clearly reflect this is a “vaccine” as a prophylactic measure and
not a diagnostic or therapeutic service.
In addition be sure to inform the provider that these items should be
clearly reflected in the record: <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The
site of the injection/infusion<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The
route of the administration (eg.
Intramuscular, subcutaneous, subdermal, intradermal) <o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The
substance administered (eg Gardasil-9) <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The
number of units administered <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The
medical necessity (eg diagnosis) <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">As,
HPV vaccines are fairly new on the market not all insurance payers will
reimburse for this service.
CMS/Medicaid eligible or those that have no insurance, may qualify for
the Vaccines for Children (VFC) program or have these vaccines proved at a
local Health Departments. Private
insurance payers such as Blue Cross, Blue Shield, Aetna, UHC, etc.. will varies
based upon how the patient’s insurance plan is written and whether they have
immunization coverage as a benefit<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">As
a provider office, it is important that you check with the patients’ plan ahead
of time to determine if they will pay for the cost of the vaccine. If the private insurance payer does not cover
the vaccine, the patient would be responsible for the cost. In this instance it would be advisable to
have the patient also sign an Advance Notice of potential non-payment and
collect the cost of the service in advance.
<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The
“average” cost per single dose of an HPV vaccine can ranges between $175 –
250.00 per vial of vaccine serum, plus
an administration fee for the administration of the serum. Three doses of the vaccine, spaced one month
apart are required to complete the
series. It is imperative that the patient
understands the financial cost and the requirement of 3 visits to the provider
to obtain the complete series for protection against HPV. <o:p></o:p></span></div>
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<i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%; mso-fareast-font-family: "Arial Unicode MS";">Lori-Lynne A. Webb, CPC, CCS-P,
CCP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an E&M, and
Procedure based Coding, Compliance, Data Charge entry and HIPAA Privacy
specialist, with over 25 years of experience.
Lori-Lynne’s coding specialty is OB/GYN office & Hospitalist
Services, Maternal Fetal Medicine, OB/GYN Oncology, Urology, and general
surgical coding. She can be reached via
e-mail at </span></i><a href="mailto:webbservices.lori@gmail.com"><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%; mso-fareast-font-family: "Arial Unicode MS";">webbservices.lori@gmail.com</span></i></a><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%; mso-fareast-font-family: "Arial Unicode MS";">
or you can also find current coding information on her blog site: </span></i><a href="http://lori-lynnescodingcoachblog.blogspot.com/"><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%; mso-fareast-font-family: "Arial Unicode MS";">http://lori-lynnescodingcoachblog.blogspot.com/</span></i></a><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%; mso-fareast-font-family: "Arial Unicode MS";">. </span></i><b><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%;"><o:p></o:p></span></i></b></div>
Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-73642543768997421332017-01-02T14:35:00.000-07:002017-01-02T14:35:01.314-07:00ICD-10cm – 2017 Urinary Diagnosis Codes and Male Genito-urinary Code Update! (Part 2)<div class="MsoNoSpacing">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">ICD-10cm
– 2017 Urinary Diagnosis Codes and Male Genito-urinary Code Update! (Part 2) <o:p></o:p></span></div>
<div align="right" class="MsoNoSpacing" style="text-align: right;">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">November 2, 2016<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">As
we discussed in part one, the ICD-10CM code set used within the United States
is maintained by the ICD Coordination and Maintenance Committee. It is this organization that is responsible
for putting for the additions, deletions, and updates to ICD-10-cm code set on
a yearly basis. This committee includes
representatives from the National Center for Health Statistics (NCHS) and the
Centers for Medicare and Medicaid Services (CMS). <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">The
ICD-10cm guidelines, as well as the actual numeric code set, should be reviewed
frequently and used as a vital companion reference when coding for diagnosis in
physician based and clinical diagnosis services. As a coding procedure, it is necessary to
review all sections of the guidelines to fully understand all of the rules,
procedural and instructional processes needed to code clinical documentation
presented in the medical records properly.
<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">The
complete ICD-10cm guidelines can be found at the beginning of your ICD-10cm
2017 book and/or e-files. The new
updates for the ICD-10 code set for 2017 actually went into effect on
10/01/2017. If you haven’t downloaded
the new codes, or purchased your books yet, you really need to! Access to the new updates and revisions is an
essential tool for coders and clinical providers. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">As
we look at some of the codes that affect Urology (genitourinary) there are a couple of areas that include <i>both</i> male and female gender codes. Even though we think of the “N” codes as
primarily genito-urinary, some of the breast codes are also within the “N”
code-set and affect both male and female gender. Be aware that some carriers have edits in
place, that some carriers use edits and tag certain diagnoses as “female” only
codes, when in fact they should be for both genders. If you are getting an edit or denial for an
inappropriate gender, be sure to appeal, or contact the carrier/payer so the
edit can be corrected. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Most
of the changes in the Urologic code-set is for the codes involving renal
tubule-intersitial diseases within the codes of N10 – N16. Of these the N10 is truly a three-character
code, and the revision has been made to make it easier to understand. <o:p></o:p></span></div>
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<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 147.0pt; margin-right: 0in; margin-top: 10.0pt; mso-layout-grid-align: none; text-autospace: none; text-indent: -75.0pt;">
<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Revise
from </span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">N10 Acute tubulo-interstitial nephritis</span><span style="font-family: "arial" , sans-serif; font-size: 10pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 147.0pt; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none; text-indent: -75.0pt;">
<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Revise to </span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">N10 Acute pyelonephritis</span><span style="font-family: "arial" , sans-serif; font-size: 10pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 183.0pt; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none; text-indent: -75.0pt;">
<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Revise from </span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Acute pyelonephritis<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in;">
<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Revise to </span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Acute tubulo-interstitial nephritis</span><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">To
completely understand this code revision, be aware that an </span><span lang="EN" style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Acute interstitial nephritis can be the cause of acute renal failure
complicated by medications, infection, and/or other causes. However, with this verbiage change, the
physician or provider will only need to provide documentation for "Acute Pyelonephiritis" then if more documentation is found, the
acute tubulo-interstitial nephritis will fall under this code set. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">The
next change is for the codeset of N13.
Within this code set there was an addition of the code N13.0 to denote
hydronephrosis with a UPJ obstruction. ICD-10cm
also includes guideline direction for an excludes 2 note for the N13.0. In addition, it includes the revision for
verbiage in the N13.6 pyonephrosis code and expanded out that code set. <o:p></o:p></span></div>
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<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Add </span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">N13.0
Hydronephrosis with ureteropelvic junction obstruction</span><span style="font-family: "arial" , sans-serif; font-size: 10pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 176.0pt; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none; text-indent: -68.0pt;">
<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Add </span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Hydronephrosis due to acquired
occlusion of ureteropelvic junction <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 231.0pt; margin-right: 0in; margin-top: 10.0pt; mso-layout-grid-align: none; text-autospace: none; text-indent: -159.0pt;">
<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Add </span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Excludes2:
</span><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Hydronephrosis with ureteropelvic junction obstruction due to
calculus (N13.2) <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 176.0pt; margin-right: 0in; margin-top: 10.0pt; mso-layout-grid-align: none; text-autospace: none; text-indent: -104.0pt;">
<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">No
Change </span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">N13.6 Pyonephrosis</span><span style="font-family: "arial" , sans-serif; font-size: 10pt;"><o:p></o:p></span></div>
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<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Revise
from </span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Conditions in N13.1-N13.5
with infection<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 2.0in;">
<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Revise to </span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Conditions in </span><span style="color: red; font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N13.0-N13.5
</span><span style="font-family: "arial" , sans-serif; font-size: 10pt;">with infection</span><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">As
we look at the codes within the code set of N30 – N39 <i>Other diseases of the urinary system</i>, there were minimal changes, however, the
N36.0 Urethral Fistula code had a small revision change, as the excludes 1
notes, show an expanded out code from N50.8
to N50.89 which is now a five-character code from a four-character code.
<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">In
the codes for other specified disorders of the urethra code N36.8; ICD-10cm now denotes an "Excludes
1" notation <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 176.0pt; margin-right: 0in; margin-top: 10.0pt; mso-layout-grid-align: none; text-autospace: none; text-indent: -104.0pt;">
<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">No
Change </span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">N36.8 Other specified disorders of urethra </span><span style="font-family: "arial" , sans-serif; font-size: 10pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 231.0pt; margin-right: 0in; margin-top: 10.0pt; mso-layout-grid-align: none; text-autospace: none; text-indent: -159.0pt;">
<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Add </span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Excludes1:
</span><span style="font-family: "arial" , sans-serif; font-size: 10pt;">congenital urethrocele (Q64.7)<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 231.0pt; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none; text-indent: -123.0pt;">
<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;"> Add
</span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">female urethrocele (N81.0) <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">A
small verbiage change was made for the code N39.42 as they added the diagnosis
of insensible (urinary) incontinence under the code N39.42 <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 211.0pt; margin-right: 0in; margin-top: 10.0pt; mso-layout-grid-align: none; text-autospace: none; text-indent: -139.0pt;">
<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">No
Change </span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">N39.42 Incontinence without sensory awareness</span><span style="font-family: "arial" , sans-serif; font-size: 10pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 211.0pt; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none; text-indent: -103.0pt;">
<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;"> Add </span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Insensible
(urinary) incontinence <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">The
code set for N39.49 Other specified urinary incontinence actually added two new
codes for 2017. These additions are very
important as the previous code set we had to choose a much more vague
diagnosis, where these new codes give us much better specificity. <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in;">
<i>Add </i>N39.491 Coital
incontinence <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in;">
<i>Add </i>N39.492 Postural
(urinary) incontinence <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in;">
<br /></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">The
next area of revision is within the codes specific to the male genital organs,
and specifically regarding the prostate.
The N40 code set simply added some verbiage revisions however, the N42.3 code set for dysplasia of
prostate includes deletions within verbiage.
Below outlines the added new codes, which encompass the deletion
verbiage within the previous "excludes" notes. <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">No
Change </span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N42.3 Dysplasia of prostate<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Delete
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Prostatic
intraepithelial neoplasia I (PIN I)<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Delete
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Prostatic
intraepithelial neoplasia II (PIN II)<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Delete
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Excludes1: </span><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">prostatic intraepithelial neoplasia III (PIN
III) (D07.5)<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N42.30 Unspecified dysplasia of prostate<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
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<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N42.31 Prostatic intraepithelial neoplasia<o:p></o:p></span></div>
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<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">PIN<o:p></o:p></span></div>
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<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add </span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Prostatic intraepithelial neoplasia I (PIN I)<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none; text-indent: .5in;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add </span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Prostatic intraepithelial neoplasia II (PIN
II)<o:p></o:p></span></div>
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<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add </span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Excludes1: </span><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">prostatic
intraepithelial neoplasia III (PIN III) (D07.5)<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N42.32 Atypical small acinar proliferation of
prostate<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add </span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N42.39 Other
dysplasia of prostate</span><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">The N50 Other and unspecified disorders of male
genital organs code set includes codes for much better specificity for genital
pain. ICD-10cm 2017 deleted many
diagnoses that were previously housed within the code set to now having a
specific diagnosis added for better specificity. This is a huge boon to coders that previously
used the non-specified codes for testicular pain and scrotal pain. As you can see below, there is also added
specificity for laterality on the testes. <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">No
Change </span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N50.8 Other specified disorders of male genital
organs<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 2.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Delete
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Atrophy
of scrotum, seminal vesicle, spermatic cord, tunica vaginalis and vas deferens<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 2.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Delete
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Edema
of scrotum, seminal vesicle, spermatic cord, testis, tunica vaginalis and vas
deferens<o:p></o:p></span></div>
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<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Delete
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Hypertrophy
of scrotum, seminal vesicle, spermatic cord, testis, tunica vaginalis and vas
deferens<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 2.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Delete
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Ulcer
of scrotum, seminal vesicle, spermatic cord, testis, tunica vaginalis and vas
deferens<o:p></o:p></span></div>
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<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Delete
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Chylocele,
tunica vaginalis (nonfilarial) NOS<o:p></o:p></span></div>
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<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Delete
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Urethroscrotal
fistula<o:p></o:p></span></div>
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<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Delete
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Stricture
of spermatic cord, tunica vaginalis, and vas deferens<o:p></o:p></span></div>
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<br /></div>
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<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N50.81 Testicular pain<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 2.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N50.811 Right testicular pain<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 2.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N50.812 Left testicular pain<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 2.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N50.819 Testicular pain, unspecified<o:p></o:p></span></div>
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<br /></div>
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<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N50.82 Scrotal pain<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 2.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N50.89 Other specified disorders of the male genital
organs<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 2.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Atrophy
of scrotum, seminal vesicle, spermatic cord, tunica vaginalis and vas deferens<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 2.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Chylocele,
tunica vaginalis (nonfilarial) NOS<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 2.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Edema
of scrotum, seminal vesicle, spermatic cord, tunica vaginalis and vas deferens<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 2.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Hypertrophy
of scrotum, seminal vesicle, spermatic cord, tunica vaginalis and vas<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 2.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">deferens<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 2.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Stricture
of spermatic cord, tunica vaginalis, and vas deferens<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 2.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Ulcer
of scrotum, seminal vesicle, spermatic cord, testis, tunica vaginalis and vas
deferens<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 2.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Urethroscrotal
fistula<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">ICD-10cm
2017 also addressed the erectile dysrunction codes and revised the verbiage, in
addition to adding new codes for specificity.
The subtle verbiage change of "post surgical" to "post procedural" is a huge
change in interpretation for coding and payer compensation. In addition to verbiage changes, the addition
of four new codes will really enhance the coding specificity for urologic
surgical procedures in relation to erectile dysfunction. The breakout below
shows these revisions and additions. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<span style="color: red; font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Revise from </span><span style="color: red; font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N52.3 Post-surgical </span><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">erectile dysfunction<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="background: yellow; font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Revise to </span></i><i><span style="background: yellow; font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N52.3
Postprocedural </span></i><i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">erectile dysfunction<o:p></o:p></span></i></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
</span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N52.35 Erectile dysfunction following radiation
therapy<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.5in;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt; line-height: 115%;">Add </span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt; line-height: 115%;">N52.36 Erectile dysfunction following interstitial
seed therapy<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 247.0pt; margin-right: 0in; margin-top: 10.0pt; mso-layout-grid-align: none; text-autospace: none; text-indent: -139.0pt;">
<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Add</span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">N52.37 Erectile dysfunction following prostate
ablative therapy</span><span style="font-family: "arial" , sans-serif; font-size: 10pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 283.0pt; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none; text-indent: -139.0pt;">
<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Add </span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Erectile
dysfunction following cryotherapy<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 283.0pt; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none; text-indent: -139.0pt;">
<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Add </span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Erectile
dysfunction following other prostate ablative therapies<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 283.0pt; margin-right: 0in; margin-top: 0in; mso-layout-grid-align: none; text-autospace: none; text-indent: -139.0pt;">
<i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Add </span></i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Erectile
dysfunction following ultrasound ablative therapies <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 211.0pt; margin-right: 0in; margin-top: 10.0pt; mso-layout-grid-align: none; text-autospace: none; text-indent: -139.0pt;">
<i><span style="color: red; font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Revise from
</span></i><span style="color: red; font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N52.39 Other post-surgical </span><span style="font-family: "arial" , sans-serif; font-size: 10pt;">erectile dysfunction</span><span style="font-family: "arial" , sans-serif; font-size: 10pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<i><span style="background: yellow; font-family: "arial" , sans-serif; font-size: 10pt; line-height: 115%;">Revise to </span></i><i><span style="background: yellow; font-family: "arial" , sans-serif; font-size: 10pt; line-height: 115%;">N52.39 Other and unspecified postprocedural</span></i><i><span style="font-family: "arial" , sans-serif; font-size: 10pt; line-height: 115%;">
erectile dysfunction<o:p></o:p></span></i></div>
<div class="MsoNoSpacing">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">In
part 1 of this article series we also addressed the mastitis codes below. Again,
these codes are not necessarily "gender specific" and mastitis can
develop in both male and female breasts.
We included these in both part 1
and part 2 of this series, as these codes truly cross the gender male/female
anatomy boundaries. <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt; line-height: 115%;">ICD-10cm 2017
added <o:p></o:p></span></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 176.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -104.0pt;">
<i><span style="font-size: 10.0pt;">Add </span></i><span style="font-size: 10.0pt; mso-bidi-font-weight: bold;">N61.0 Mastitis without abscess</span><span style="font-size: 10.0pt;"><o:p></o:p></span></div>
<div class="Default" style="margin-left: 212.0pt; text-indent: -104.0pt;">
<i><span style="font-size: 10.0pt;">Add </span></i><span style="font-size: 10.0pt;">Infective
mastitis (acute) (nonpuerperal) (subacute)<o:p></o:p></span></div>
<div class="Default" style="margin-left: 212.0pt; text-indent: -104.0pt;">
<i><span style="font-size: 10.0pt;">Add </span></i><span style="font-size: 10.0pt;">Mastitis
(acute) (nonpuerperal) (subacute) NOS<o:p></o:p></span></div>
<div class="Default" style="margin-left: 212.0pt; text-indent: -104.0pt;">
<i><span style="font-size: 10.0pt;">Add </span></i><span style="font-size: 10.0pt;">Cellulitis
(acute) (nonpuerperal) (subacute) of breast NOS<o:p></o:p></span></div>
<div class="Default" style="margin-left: 212.0pt; text-indent: -104.0pt;">
<i><span style="font-size: 10.0pt;">Add </span></i><span style="font-size: 10.0pt;">Cellulitis
(acute) (nonpuerperal) (subacute) of nipple NOS <o:p></o:p></span></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 176.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -104.0pt;">
<i><span style="font-size: 10.0pt;">Add </span></i><span style="font-size: 10.0pt; mso-bidi-font-weight: bold;">N61.1 Abscess of the breast and nipple</span><span style="font-size: 10.0pt;"><o:p></o:p></span></div>
<div class="Default" style="margin-left: 212.0pt; text-indent: -104.0pt;">
<i><span style="font-size: 10.0pt;">Add </span></i><span style="font-size: 10.0pt;">Abscess
(acute) (chronic) (nonpuerperal) of areola<o:p></o:p></span></div>
<div class="Default" style="margin-left: 212.0pt; text-indent: -104.0pt;">
<i><span style="font-size: 10.0pt;">Add </span></i><span style="font-size: 10.0pt;">Abscess
(acute) (chronic) (nonpuerperal) of breast<o:p></o:p></span></div>
<div class="Default" style="margin-left: 212.0pt; text-indent: -104.0pt;">
<i><span style="font-size: 10.0pt;">Add </span></i><span style="font-size: 10.0pt;">Carbuncle
of breast<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.5in;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt; line-height: 115%;">Add </span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt; line-height: 115%;">Mastitis
with abscess</span><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt; line-height: 115%;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt; line-height: 115%;">The N64
category only had a minor change in the revision from a 5-character code to a
6-character code. <o:p></o:p></span></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 140.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -104.0pt;">
<i><span style="font-size: 10.0pt;">No Change </span></i><span style="font-size: 10.0pt; mso-bidi-font-weight: bold;">N64.1 Fat necrosis of breast <br />
</span><i><span style="font-size: 10.0pt;">No Change </span></i><span style="font-size: 10.0pt; mso-bidi-font-weight: bold;">Code first </span><span style="font-size: 10.0pt;"><o:p></o:p></span></div>
<div class="Default" style="margin-left: 297.0pt; text-indent: -153.0pt;">
<i><span style="font-size: 10.0pt;"> Revise
from: </span></i><span style="font-size: 10.0pt;">breast necrosis due to breast graft (T85.89)<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 2.0in;">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt; line-height: 115%;"> Revise to: </span></i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt; line-height: 115%;">breast necrosis due
to breast graft (T85.898)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt; line-height: 115%;">This is also a
"repeat" of information from part 1, in this 2 part series. As we have previously reviewed for ICD-10cm
2017 pertaining to <i>both</i> urologic and gynecologic
surgery, The following codes were revised and added to separate out terms that
were previously combined. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt; line-height: 115%;">In N99.92 it
states “Postprocedural hemorrhage and hematoma” and this was revised to simply
be “post procedural” hemorrhage. ICD-10
then included expansion for a 6<sup>th</sup> character for added specificity. The verbiage removal of “hematoma” was then
added to seroma and added to the code set N99.84, with the expansion of the 6<sup>th</sup>
character for increased specificity. <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in; mso-list: l1 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10.0pt;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Revise from:<i> </i></span><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N99.82 Postprocedural
hemorrhage and hematoma of a genitourinary system organ or structure following
a procedure<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in; mso-list: l1 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10.0pt;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Revise to: </span></i><i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N99.82 Postprocedural
hemorrhage of a genitourinary system organ or structure following a procedure<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--></span></i><i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;"><o:p></o:p></span></i></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l1 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; font-size: 10.0pt;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="color: red; font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Revise from </span><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N99.820
Postprocedural hemorrhage and hematoma of a genitourinary system organ or
structure following a genitourinary system procedure<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l1 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; font-size: 10.0pt;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Revise to
N99.820 Postprocedural hemorrhage of a genitourinary system organ or structure
following a genitourinary system procedure<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></i></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l1 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; font-size: 10.0pt;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="color: red; font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Revise from </span><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N99.821
Postprocedural hemorrhage and hematoma of a genitourinary system organ or
structure following other procedure<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l1 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; font-size: 10.0pt;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Revise to </span></i><i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">N99.821
Postprocedural hemorrhage of a genitourinary system organ or structure
following other procedure</span></i><i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;"><o:p></o:p></span></i></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 1.25in; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 10.0pt;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add
N99.84 Postprocedural hematoma and seroma of a genitourinary system organ or
structure following a procedure<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.75in; mso-list: l0 level2 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; font-size: 10.0pt;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add N99.840
Postprocedural hematoma of a genitourinary system organ or structure following
a genitourinary system procedure<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.75in; mso-list: l0 level2 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; font-size: 10.0pt;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add N99.841
Postprocedural hematoma of a genitourinary system organ or structure following
other procedure<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.75in; mso-list: l0 level2 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; font-size: 10.0pt;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add N99.842
Postprocedural seroma of a genitourinary system organ or structure following a
genitourinary system procedure<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.75in; mso-list: l0 level2 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; font-size: 10.0pt;">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Add N99.843
Postprocedural seroma of a genitourinary system organ or structure following
other procedure<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .75in;">
<br /></div>
<div class="MsoNoSpacing">
<span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">As
ICD-10cm continues to be improved, we should also remember the goal of working
hand in hand with the clinical providers of care to ensure that the clinical
documentation of the patient record is clearly reflected by the procedure and
diagnosis codes chosen and billed to the insurance payers. The patients’ medical record documentation is
essential for determining the most appropriate codes and reimbursement. Failing to provide clear, concise and
accurate documentation can lead to incorrect and/or inaccurate medical care and
diagnosis; inappropriate or incorrect claims for services; claim denials or the
worst case scenario of allegation of fraud/abuse. The verbiage revisions, added codes and expanded code set characters
within ICD-10cm in 2017 is a welcome addition to making our job as coders that
much better. <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<br />
<div class="MsoNormal">
<i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt; line-height: 115%;">Lori-Lynne A. Webb, CPC, CCS-P,
CCP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an E&M, and
Procedure based Coding, Compliance, Data Charge entry and HIPAA Privacy
specialist, with over 20 years of experience.
Lori-Lynne’s coding specialty is OB/GYN office & Hospitalist
Services, Maternal Fetal Medicine, OB/GYN Oncology, Urology, and general
surgical coding. She can be reached via
e-mail at </span></i><a href="mailto:webbservices.lori@gmail.com"><i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt; line-height: 115%;">webbservices.lori@gmail.com</span></i></a><i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt; line-height: 115%;">
or you can also find current coding information on her blog site: </span></i><a href="http://lori-lynnescodingcoachblog.blogspot.com/"><i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt; line-height: 115%;">http://lori-lynnescodingcoachblog.blogspot.com/</span></i></a><i><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt; line-height: 115%;">. <o:p></o:p></span></i></div>
Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-39065319967715742552017-01-02T14:30:00.000-07:002017-01-02T14:30:29.916-07:00ICD-10cm – 2017 Genitourinary and Gynecology Diagnosis Update! (Part 1)<div class="MsoNoSpacing">
ICD-10cm – 2017 Genitourinary and Gynecology Diagnosis Update! (Part 1) <o:p></o:p></div>
<div align="right" class="MsoNoSpacing" style="text-align: right;">
October
22, 2016<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
As you may be aware, the ICD-10CM code set used within the United
States is maintained by the ICD Coordination and Maintenance Committee. It is this organization that is responsible
for putting for the additions, deletions, and updates to ICD-10-cm code set on
a yearly basis. This committee includes
representatives from the National Center for Health Statistics (NCHS) and the
Centers for Medicare and Medicaid Services (CMS). <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
The ICD-10cm guidelines, as
well as the actual numeric code set, should be reviewed frequently and used as
a vital companion reference when coding for diagnosis in physician based and
clinical diagnosis services. As a coding
procedure, it is necessary to review all sections of the guidelines to fully
understand all of the rules, procedural
and instructional processes needed to code clinical documentation
presented in the medical records properly.
<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
The complete ICD-10cm guidelines can be found at the beginning of
your ICD-10cm 2017 book and/or e-files.
The new updates for the ICD-10 code set for 2017 actually went into
effect on 10/01/2017. If you haven’t
downloaded the new codes, or purchased your books yet, you really need to! Access to the new updates and revisions is an
essential tool for coders and clinical providers. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
As we look at some of the codes that affect Gynecology coding, the
sepsis “A” codes had verbiage revision, and also, had some additions and
deletions that are important to review. <o:p></o:p></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.75in; margin-right: 0in; margin-top: 10.0pt; text-indent: -.75in;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">No
Change </span></i><b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Other
bacterial diseases (A30-A49) </span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 147.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -75.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">No
Change </span></i><b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">A40
Streptococcal sepsis </span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 10.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">No Change </span></i><b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Code first </span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="Default" style="margin-left: 232.0pt; text-indent: -124.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Revise
from </span></i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">postprocedural
streptococcal sepsis (T81.4)<o:p></o:p></span></div>
<div class="Default" style="margin-left: 232.0pt; text-indent: -124.0pt;">
<b><i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Revise to </span></i></b><b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">postprocedural streptococcal sepsis (T81.4-) <o:p></o:p></span></b></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 147.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -75.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">No
Change </span></i><b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">A41
Other sepsis </span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 10.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">No Change </span></i><b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Code first </span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="Default" style="margin-left: 232.0pt; text-indent: -124.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Revise
from </span></i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">postprocedural
sepsis (T81.4)<o:p></o:p></span></div>
<div class="Default" style="margin-left: 232.0pt; text-indent: -124.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Revise
to </span></i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">postprocedural
sepsis (T81.4-) <br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in;">
<b><i><span style="color: red; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Delete </span></i></b><b><span style="color: red; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Excludes1:
</span></b><b><span style="color: red; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">sepsis NOS (A41.9)<o:p></o:p></span></b></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
The Zika virus that made news this year was also revised to make
it easier to code out for the actual virus itself, not for “screening of” for Zika Virus. <o:p></o:p></div>
<div class="Default">
<br /></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 147.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -75.0pt;">
<span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"> <i>No Change </i><b>A92 Other mosquito-borne
viral fevers </b><o:p></o:p></span></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 176.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -104.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Add
</span></i><b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">A92.5 Zika virus disease</span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="Default" style="margin-left: 212.0pt; text-indent: -104.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Add
</span></i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Zika virus fever<o:p></o:p></span></div>
<div class="Default" style="margin-left: 212.0pt; text-indent: -104.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Add
</span></i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Zika virus infection<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in;">
<i>Add </i>Zika NOS<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></div>
<div class="MsoNoSpacing">
If the patient has had an <b><i>exposure to</i></b> the Zika Virus you
would want to code that diagnosis with Z20.828 - Contact with and (suspected)
exposure to other viral communicable diseases.
As a coder, be sure that the
documentation is clearly reflecting the difference of an “exposure to” the Zika
virus or if the patient currently “has” the Zika virus infection. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
In the Neoplasms codeset, ICD-10cm made a minor change within the
D27 code set – Benign Neoplasm of Ovary.
Even though there was not any major
changes, the “excludes 2” notes have verbiage revision within them and that you
should review carefully when appending
this diagnosis to a claim. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<i>No Change</i>D27 Benign
neoplasm of ovary <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .5in;">
<i>No Change </i><b><span style="color: red; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Excludes 2 note</span></b>: <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in;">
<i>Revise from </i>corpus
albicans cyst (N83.2)<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in;">
<b><i>Revise
to </i></b><b>corpus
albicans cyst (N83.2-)<br />
<o:p></o:p></b></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in;">
<i>Revise from </i>corpus
luteum cyst (N83.1) <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in;">
<b><i>Revise
to </i></b><b>corpus
luteum cyst (N83.1-) <br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></b></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in;">
<i>Revise from </i>follicular
(atretic) cyst (N83.0) <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in;">
<b><i>Revise
to </i></b><b>follicular
(atretic) cyst (N83.0-) <br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></b></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in;">
<i>Revise from </i>graafian
follicle cyst (N83.0) <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in;">
<b><i>Revise
to </i></b><b>graafian
follicle cyst (N83.0-) <br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></b></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in;">
<i>Revise from </i>ovarian
cyst NEC (N83.2) <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in;">
<b><i>Revise
to </i></b><b>ovarian
cyst NEC (N83.2-) <br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></b></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in;">
Revise from
ovarian
retention cyst (N83.2) <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in;">
<b><i>Revise
to </i></b><b><i>ovarian
retention cyst (N83.2-)<o:p></o:p></i></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNoSpacing">
As we move forward through these updates, the “N” codes associated
with the genito-urinary systems include both male and female gender codes. The male gender codes will be addressed in
part 2. Even though we think of the “N”
codes as primarily genito-urinary, some of the breast codes are also within the
“N” code-set and affect both male and female gender. Be aware that some carriers have edits in
place, that some of these codes were tagged as only “female” codes, when in fact
they should be for both gender. If you
are getting denials for an inappropriate gender, be sure to appeal, or contact
the carrier/payer so the edit can be corrected.
<o:p></o:p></div>
<div class="MsoNormal">
The codes in N61
and N64 had some minor changes. ICD-10cm
2017 added <o:p></o:p></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 176.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -104.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Add
</span></i><b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">N61.0 Mastitis without abscess</span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="Default" style="margin-left: 212.0pt; text-indent: -104.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Add
</span></i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Infective mastitis (acute) (nonpuerperal) (subacute)<o:p></o:p></span></div>
<div class="Default" style="margin-left: 212.0pt; text-indent: -104.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Add
</span></i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Mastitis (acute) (nonpuerperal) (subacute) NOS<o:p></o:p></span></div>
<div class="Default" style="margin-left: 212.0pt; text-indent: -104.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Add
</span></i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Cellulitis (acute) (nonpuerperal) (subacute) of breast NOS<o:p></o:p></span></div>
<div class="Default" style="margin-left: 212.0pt; text-indent: -104.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Add
</span></i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Cellulitis (acute) (nonpuerperal) (subacute) of nipple NOS <o:p></o:p></span></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 176.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -104.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Add
</span></i><b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">N61.1 Abscess of the breast and nipple</span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="Default" style="margin-left: 212.0pt; text-indent: -104.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Add
</span></i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Abscess (acute) (chronic) (nonpuerperal) of areola<o:p></o:p></span></div>
<div class="Default" style="margin-left: 212.0pt; text-indent: -104.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Add
</span></i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Abscess (acute) (chronic) (nonpuerperal) of breast<o:p></o:p></span></div>
<div class="Default" style="margin-left: 212.0pt; text-indent: -104.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Add
</span></i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Carbuncle of breast<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.5in;">
<i>Add </i>Mastitis with abscess<o:p></o:p></div>
<div class="MsoNormal">
These codes were expanded
from the N61 category of inflammatory disorders of the breast. However, take note that the mastitis code set N61 denotes
“nonpuerperal” within it. If it is a
puerperal mastitis, those diagnoses are found in the “O” codes under the code
set of O91 - Infections of breast associated with pregnancy, the puerperium and
lactation. <o:p></o:p></div>
<div class="MsoNormal">
The N64 category
only had a minor change in the revision from a 5-character code to a
6-character code. <o:p></o:p></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 140.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -104.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">No
Change </span></i><b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">N64.1 Fat necrosis of breast <br />
</span></b><i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">No Change </span></i><b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">Code first </span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="Default" style="margin-left: 297.0pt; text-indent: -153.0pt;">
<i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"> Revise from:
</span></i><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">breast necrosis due to breast graft (T85.89)<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 2.0in;">
<i>
Revise to: </i>breast necrosis due to breast graft (T85.898)<o:p></o:p></div>
<div class="MsoNormal">
The N83 code set included a number of changes, in that the code
set was expanded to include codes for an unspecified side, left and right side
laterality codes throughout the N83 code set.
The laterality notation for the N83 code set includes the ovary,
fallopian tube and broad ligament. These
changes are: <o:p></o:p></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 176.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -104.0pt;">
<b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">N83.0
Follicular cyst of ovary </span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l9 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.00 Follicular cyst of ovary,
unspecified side <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l9 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.01 Follicular cyst of right ovary
<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l9 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.02 Follicular cyst of left ovary <o:p></o:p></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 176.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -104.0pt;">
<b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">N83.1
Corpus luteum cyst </span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l6 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 12.0pt;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.10 Corpus luteum cyst of ovary,
unspecified side<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l6 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 12.0pt;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.11 Corpus luteum cyst of right
ovary <span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l6 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.12 Corpus luteum cyst of left
ovary<o:p></o:p></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 211.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -139.0pt;">
<b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">N83.20
Unspecified ovarian cysts </span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l10 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.201 Unspecified ovarian cyst,
right side <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l10 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.202 Unspecified ovarian cyst,
left side <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l10 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.209 Unspecified ovarian cyst,
unspecified side<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 2.0in; mso-list: l10 level2 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><i>Add
</i>Ovarian cyst, NOS <o:p></o:p></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 211.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -139.0pt;">
<b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">N83.29
Other ovarian cysts </span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l0 level1 lfo5; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.291 Other ovarian cyst, right
side <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l0 level1 lfo5; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.292 Other ovarian cyst, left side
<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l0 level1 lfo5; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.299 Other ovarian cyst,
unspecified side <o:p></o:p></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 211.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -139.0pt;">
<b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">N83.31
Acquired atrophy of ovary </span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l8 level1 lfo6; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.311 Acquired atrophy of right
ovary <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l8 level1 lfo6; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.312 Acquired atrophy of left
ovary <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l8 level1 lfo6; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.319 Acquired atrophy of ovary,
unspecified side<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 2.0in; mso-list: l8 level2 lfo6; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><i>Add
</i>Acquired atrophy of ovary, NOS <o:p></o:p></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 211.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -139.0pt;">
<b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">N83.32
Acquired atrophy of fallopian tube </span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l7 level1 lfo7; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.321 Acquired atrophy of right
fallopian tube <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l7 level1 lfo7; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.322 Acquired atrophy of left
fallopian tube <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l7 level1 lfo7; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Ad </i>N83.329 Acquired atrophy of fallopian
tube, unspecified side<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 2.0in; mso-list: l7 level2 lfo7; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><i>Add
</i>Acquired atrophy of fallopian tube, NOS <o:p></o:p></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 211.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -139.0pt;">
<b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">N83.33
Acquired atrophy of ovary and fallopian tube </span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l3 level1 lfo8; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.331 Acquired atrophy of right
ovary and fallopian tube <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l3 level1 lfo8; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.332 Acquired atrophy of left ovary
and fallopian tube <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l3 level1 lfo8; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.339 Acquired atrophy of ovary and
fallopian tube, unspecified side<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 2.0in; mso-list: l3 level2 lfo8; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><i>Add
</i>Acquired atrophy of ovary and fallopian tube, NOS <o:p></o:p></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 176.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -104.0pt;">
<b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">N83.4
Prolapse and hernia of ovary and fallopian tube </span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l13 level1 lfo9; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.40 Prolapse and hernia of ovary
and fallopian tube, unspecified side<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 2.0in; mso-list: l13 level2 lfo9; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><i>Add
</i>Prolapse and hernia of ovary and fallopian tube, NOS <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l13 level1 lfo9; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.41 Prolapse and hernia of right
ovary and fallopian tube <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 2.0in; mso-list: l13 level2 lfo9; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><i>Add
</i>N83.42 Prolapse and hernia of left ovary and fallopian tube <o:p></o:p></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 211.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -139.0pt;">
<b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">N83.51
Torsion of ovary and ovarian pedicle </span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l4 level1 lfo10; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.511 Torsion of right ovary and
ovarian pedicle <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l4 level1 lfo10; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.512 Torsion of left ovary and
ovarian pedicle<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l4 level1 lfo10; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.519 Torsion of ovary and ovarian
pedicle, unspecified side <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 2.0in; mso-list: l4 level2 lfo10; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><i>Add
</i>Torsion of ovary and ovarian pedicle, NOS <o:p></o:p></div>
<div class="Default" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 211.0pt; margin-right: 0in; margin-top: 10.0pt; text-indent: -139.0pt;">
<b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;">N83.52
Torsion of fallopian tube </span></b><span style="font-family: "calibri" , "sans-serif"; font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l2 level1 lfo11; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.521 Torsion of right fallopian
tube <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l2 level1 lfo11; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.522 Torsion of left fallopian
tube <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l2 level1 lfo11; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N83.529 Torsion of fallopian tube,
unspecified side <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 2.0in; mso-list: l2 level2 lfo11; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><i>Add
</i>Torsion of fallopian tube, NOS<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 2.0in;">
<br /></div>
<div class="MsoNormal">
In the next
series of code set changes that present some terrific updates for gynecologic
coding is the updates for the hypertrophy of vulva in code set N90.6. The addition/expansion of these codes was a
nice surprise to see added for 2017. In
the past the hypertrophy vulva/labia was very generic in the code set. In 2017 these codes have been added and now
have given us three much more diagnostically driven diagnoses. We still have an “unspecified” code, but we
now have the option to code as CALME (Childhood Asymmetric Labium Majus
Enlargement) or utilize the newly added “other specified” hypertrophy. <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l5 level1 lfo12; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N90.60 Unspecified hypertrophy of
vulva <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 2.0in; mso-list: l5 level2 lfo12; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><i>Add
</i>Unspecified hypertrophy of labia <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l5 level1 lfo12; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N90.61 Childhood asymmetric labium
majus enlargement <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 2.0in; mso-list: l5 level2 lfo12; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><i>Add
</i>CALME <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l5 level1 lfo12; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N90.69 Other specified hypertrophy of
vulva <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 2.0in; mso-list: l5 level2 lfo12; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><i>Add
</i>Other specified hypertrophy of labia<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNormal">
ICD-10cm has also
given the gynecology codes an expansion for the diagnosis of dyspareunia. For patients who have been a diagnosed with
dyspareunia, payers oftentimes been view or tag in the edits as an inconsequential,
or not medically relevant diagnosis to many surgical cases performed in
gynecology. The definition of
dyspareunia is painful sexual intercourse due to medical or psychological
causes. Patients describe the pain
location as primarily be on the external surface of the genitalia, or deeper in
the pelvis upon deep pressure against the cervix. It has also been noted to affect a small
portion of the vulva or vagina. There
have also been notations that it is felt all over the genital areas both inside
and out. As a coder, it is our responsibility
to ensure that we communicate to the providers to give us better clinical
documentation for the diagnosis of dyspareunia.
If it is clinically documented more clearly, it will help ensure clearer
medical necessity for our insurance claims. <o:p></o:p></div>
<div class="MsoNormal">
The code set for
the diagnosis of dyspareunia has now been taken from a simple code of N94.1 to
the expanded code set seen below. <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 2.0in; mso-list: l1 level1 lfo13; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N94.10
Unspecified dyspareunia <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 2.0in; mso-list: l1 level1 lfo13; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N94.11
Superficial (introital) dyspareunia <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 2.0in; mso-list: l1 level1 lfo13; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N94.12
Deep dyspareunia <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 2.0in; mso-list: l1 level1 lfo13; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><i>Add </i>N94.19
Other specified dyspareunia<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in;">
<br /></div>
<div class="MsoNormal">
The
last area of review for ICD-10 pertaining to gynecology, is the verbiage
revision(s) to the N99.82X and an addition of N99.84X code sets based upon the
verbiage revision. These codes were
revised and added to separate out terms that were previously combined. In N99.92 it states “Postprocedural
hemorrhage and hematoma” and this was revised to simply be “post procedural”
hemorrhage. ICD-10 then included
expansion for a 6<sup>th</sup> character for added specificity. The verbiage removal of “hematoma” was then
added to seroma and added to the code set N99.84, with the expansion of the 6<sup>th</sup>
character for increased specificity. <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in; mso-list: l12 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><b>Revise from</b>:<i> </i>N99.82
Postprocedural hemorrhage and hematoma of a genitourinary system organ or structure
following a procedure<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.0in; mso-list: l12 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><b><i>Revise to: </i></b><b><i>N99.82
Postprocedural hemorrhage of a genitourinary system organ or structure
following a procedure</i></b><b><i><o:p></o:p></i></b></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l12 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b>Revise from</b> N99.820
Post procedural hemorrhage and hematoma of a genitourinary system organ or
structure following a genitourinary system procedure<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l12 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><i>Revise to N99.820 Postprocedural hemorrhage of
a genitourinary system organ or structure following a genitourinary system
procedure<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></i></b></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l12 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b>Revise from</b> N99.821
Postprocedural hemorrhage and hematoma of a genitourinary system organ or
structure following other procedure<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.5in; mso-list: l12 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><i>Revise to </i></b><b><i>N99.821
Postprocedural hemorrhage of a genitourinary system organ or structure
following other procedure</i></b><b><i><o:p></o:p></i></b></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 1.25in; mso-list: l11 level1 lfo14; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><b>Add
N99.84 Postprocedural hematoma and seroma of a genitourinary system organ or
structure following a procedure<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></b></div>
<div class="MsoNoSpacing" style="margin-left: 1.75in; mso-list: l11 level2 lfo14; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Add
N99.840 Postprocedural hematoma of a genitourinary system organ or structure following
a genitourinary system procedure<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.75in; mso-list: l11 level2 lfo14; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Add
N99.841 Postprocedural hematoma of a genitourinary system organ or structure following
other procedure<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.75in; mso-list: l11 level2 lfo14; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Add
N99.842 Postprocedural seroma of a genitourinary system organ or structure following
a genitourinary system procedure<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 1.75in; mso-list: l11 level2 lfo14; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Add
N99.843 Postprocedural seroma of a genitourinary system organ or structure following
other procedure<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: .75in;">
<br /></div>
<div class="MsoNoSpacing">
As ICD-10cm continues to be improved, we should also
remember the goal of working hand in hand with the clinical providers of care
to ensure that the clinical documentation of the patient record is clearly reflected
by the procedure and diagnosis codes chosen and billed to the insurance
payers. The patients’ medical record
documentation is essential for determining the most appropriate codes and
reimbursement. Failing to provide clear,
concise and accurate documentation can lead to incorrect and/or inaccurate
medical care and diagnosis; inappropriate or incorrect claims for services;
claim denials or the worst case scenario of allegation of fraud/abuse. The verbiage revisions, added codes and expanded code set characters
within ICD-10cm in 2017 is a welcome addition to making our job as coders that
much better. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<br />
<div class="MsoNormal">
<i>Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA,
COBGC and ICD10 cm/pcs Ambassador/trainer is an E&M, and Procedure based
Coding, Compliance, Data Charge entry and HIPAA Privacy specialist, with over
20 years of experience. Lori-Lynne’s
coding specialty is OB/GYN office & Hospitalist Services, Maternal Fetal Medicine,
OB/GYN Oncology, Urology, and general surgical coding. She can be reached via e-mail at </i><a href="mailto:webbservices.lori@gmail.com"><i>webbservices.lori@gmail.com</i></a><i> or you can also
find current coding information on her blog site: </i><a href="http://lori-lynnescodingcoachblog.blogspot.com/"><i>http://lori-lynnescodingcoachblog.blogspot.com/</i></a><i>. </i><b><i><o:p></o:p></i></b></div>
Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-76753146520231724002017-01-02T10:05:00.000-07:002017-01-02T10:05:01.058-07:00Complex Chronic Care Management Services 99487 +99489 (part 2 of 2) <div class="MsoNoSpacing">
<b><u><span style="font-family: Arial, sans-serif; font-size: 12pt;">Complex Chronic Care Management Services 99487 +99489<o:p></o:p></span></u></b></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">(Part 2 of 2) <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">December 21, 2016 <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">As we discussed in the article for chronic
care management services (code 99490) these patients that utilize these
services are those that are generally chronically ill who have continuous and/or
ongoing episodic "chronic medical diagnoses. The majority of these patients are receiving
these services within an assisted living facility, some still reside at home, and
others are in a full-service nursing care center. <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">Complex Chronic Care Management is not reported
by location, but are provided in coordination with other care providers and at
times, performed by clinical staff that is not necessarily an MD or DO. It is not uncommon to see the clinical staff document,
develop, implement, and revise care plans for these complex chronically ill
patients. However, this takes place under
the direction of the physician and/or other qualified health care professionals
such as a Physician Assistant, or Nurse Practitioner. <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">CPT in 2017 denotes the codes 99487 with
add-on code 99489 for the reporting of Complex Chronic Care Management codes. (note: Code 99488 has been deleted) The acronym "CCCC" which stands for
complex chronic care coordination – is often noted in the clinical
documentation to report these services. Patients
needing complex care coordination often have many providers involved with their
care, which can include physical therapy, psychiatric and behavioral services,
social and home care services, in addition to on-going internal medicine,
specialty services for cardiology, orthopedics, neurology, urology, etc. <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">The 99487 and the add on code 99489 that we
utilize from CPT is coded similar to those codes such as critical care services
and is a time-based service in addition to other qualifiers that must be
met. <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">CPT created these codes to assist physicians in
billing for time spent coordinating the many different services and medical
specialties needed to effectively provide are for these complex patients' and
their medical condition(s), psychosocial needs and normal every-day
activities. <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">When billing for complex chronic care
management services CPT has outlined very specific guidelines. These guidelines within CPT state that
complex chronic care management services are provided during a "calendar
month" timeframe and include criteria to be met<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: Arial, sans-serif; font-size: 12pt;">Establishment OR substantial revision of a
comprehensive care plan that includes: <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt;">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: Arial, sans-serif; font-size: 12pt;">Medical, Functional and/or Psychosocial
problems requiring medical decision making of moderate or high complexity; <o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: Arial, sans-serif; font-size: 12pt;">Includes clinical staff care management
services for at least 60 minutes under the direction of the physician<br />
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</span></span><!--[endif]--><span style="font-family: Arial, sans-serif; font-size: 12pt;">CPT also states that these patients are
treated with three or more prescription medications, and receiving other types
of therapeutic interventions such as PT or OT.
<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">The usage of these codes may NOT be reported
if the care plan is "unchanged" or requires only a
"minimal" change (such as a medication change or an adjustment to a
treatment modality is ordered). <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">In addition the patients that require complex
chronic care management services have multiple illnesses, multiple medication
use, and the inability to perform activities of daily living, requirements for
a care-giver and/or repeat admissions to an inpatient facility or emergency
department. Normally they will have two
or more chronic continuous or episodic health conditions that are expected to
last at least 12 months OR until the death of the patient, and the patient is
at risk of death, acute exacerbation/decompensation or functional decline. These patients are truly at risk for
mortality/morbidity issues. <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">CPT has given us a handy table to code from
for this time based service: <o:p></o:p></span></div>
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<b><i><span style="font-family: Arial, sans-serif; font-size: 12pt;">Total Duration of
Staff Care Management Services<o:p></o:p></span></i></b></div>
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<b><i><span style="font-family: Arial, sans-serif; font-size: 12pt;">Complex Chronic Care
Management <o:p></o:p></span></i></b></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">Less than 60 minutes<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">Not reported separately (Use standard
E&M)<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">60 to 89 minutes<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">(1 hour – 1 hour 29 minutes)<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">99487<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">90 – 119 minutes<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">(1 hour 30 minutes – 1 hour 59 minutes<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">99487 and 99489 x 1<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">120 minutes or more<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">(2 hours or more)<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">99487 and 99489 x 2 and 99489 for each
additional 30 minutes <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">Since CPT deleted code 99488 if the physician
has a face to face visit with the patient during this same timeframe within the
month, the coder should bill with the appropriate E/M code. The physician or provider also needs to
include a "separately identifiable' way for the coder to see the
documentation of this care management so this time-based service can be
accurately coded and viewed to ensure that the clinical reporting is valid and
meets all criteria in addition to the notation of time. CPT has also included the caveat "<i>if the physician personally performs the
clinical staff activities, his/her time may be counted toward the required
clinical staff time to meet the elements of the code". </i><o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">CMS is proposing for 2017 the following RVU
allocation on these two codes as shown in the table below. With CMS including RVU's on these codes, it
is much more incentivizing for physicians to perform, document and bill for the
complex chronic care management services. <o:p></o:p></span></div>
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<b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">CMS Proposed Work Values for fy2017 </span></b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">HCPCS</span></b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Descriptor</span></b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Current work RVU</span></b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">RUC work RVU</span></b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">CMS work RVU</span></b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">99487 <o:p></o:p></span></div>
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<span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Complex chronic care
management services, with the following required elements: multiple (two or
more) chronic conditions expected to last at least 12 months, or until the
death of the patient, chronic conditions place the patient at significant
risk of death, acute exacerbation/decompensation, or functional decline,
establishment or substantial revision of a comprehensive care plan, moderate
or high complexity medical decision making; 60 minutes of clinical staff time
directed by a physician or other qualified health care professional, per
calendar month.; <o:p></o:p></span></div>
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<span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">0.00 <o:p></o:p></span></div>
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<span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">- <o:p></o:p></span></div>
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<span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">1.00 <o:p></o:p></span></div>
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<b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">HCPCS</span></b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Descriptor</span></b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Current work RVU</span></b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">RUC work RVU</span></b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">CMS work RVU</span></b><span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">99489 <o:p></o:p></span></div>
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<span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Complex chronic care
management services, with the following required elements: multiple (two or
more) chronic conditions expected to last at least 12 months, or until the
death of the patient, chronic conditions place the patient at significant
risk of death, acute exacerbation/decompensation, or functional decline,
establishment or substantial revision of a comprehensive care plan, moderate
or high complexity medical decision making; 60 minutes of clinical staff time
directed by a physician or other qualified health care professional, per
calendar month.; each additional 30 minutes of clinical staff time directed
by a physician or other qualified health care professional, per calendar
month <o:p></o:p></span></div>
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<span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">0.00 <o:p></o:p></span></div>
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<span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">- <o:p></o:p></span></div>
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<span style="color: #4f4f4f; font-family: "Lucida Sans Unicode","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">0.50 <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">As billers and coders, it is our job to code
and bill appropriately for the care being provided. Code 99487 and the add on code 99489 were
implemented to incentivize providers to manage and communicate more thoroughly
between the multiple providers for patients with extensive and complicated
chronic conditions. Unfortunately, as a
biller/coder, it may be hard to “find” this care documentation within the
chart. In addition to charting the
“time” the diagnosis for the two (or more) chronic conditions must be
documented and clearly connected as medically necessary for this oversight
care. The medical necessity will be
borne out with clear documentation of the provider and the morbidity/mortality
of the complex diagnoses being managed. <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">If there is a question regarding the time
spent, or problems being cared for communication with the provider is
vital. You can always help your provider
get you the appropriate documentation by creating a "clinical
documentation checklist" that includes the pertinent information that you
need, or have this information readily available in the electronic medical
records or health care record. The most
helpful clinical documentation includes: <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: Arial, sans-serif; font-size: 12pt;">A clear description of the condition
(diagnosis)<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: Arial, sans-serif; font-size: 12pt;">New pertinent clinical findings or outcomes<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: Arial, sans-serif; font-size: 12pt;">New or substantially changed diagnostic
and/or therapeutic procedures and services <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: Arial, sans-serif; font-size: 12pt;">New or substantially changed
medications/medication listing <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: Arial, sans-serif; font-size: 12pt;">Changes in severity of patient condition<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: Arial, sans-serif; font-size: 12pt;">Clear documentation for the "Month"
being code for, and a clear documented record of time spent performing the
above. <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt;">As the coder/biller, it is your help and
expertise, coordinated with the physician and clinical providers, to pull in
all the "pieces" which will ensure the utilization of the Complex
Chronic Care Management codes of 99487 and 99489 make a difference in the physician
practice revenue stream and enhance the patients' overall care. <o:p></o:p></span></div>
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<i><span style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";">Lori-Lynne
A. Webb, CPC, CCS-P, CCP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an
E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA
Privacy specialist, with over 20 years of experience. Lori-Lynne’s coding specialty is OB/GYN
office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology,
Urology, and general surgical coding.
She can be reached via e-mail at </span></i><a href="mailto:webbservices.lori@gmail.com"><i><span style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";">webbservices.lori@gmail.com</span></i></a><i><span style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";"> or you can also find current
coding information on her blog site: </span></i><a href="http://lori-lynnescodingcoachblog.blogspot.com/"><i><span style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";">http://lori-lynnescodingcoachblog.blogspot.com/</span></i></a><i><span style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Arial Unicode MS";">. </span></i><span style="font-family: "Tahoma","sans-serif";"><o:p></o:p></span></div>
Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0tag:blogger.com,1999:blog-3120124125761404052.post-45015643739299452712017-01-02T10:00:00.000-07:002017-01-02T10:00:30.074-07:00Chronic Care Management codes – post implementation… Are you missing out?Chronic Care Management codes – post implementation… Are you missing out?<br />
<br />
December 4, 2016<br />
<br />
In January of 2015 CMS developed codes for chronic care management. This was based on the premise that more careful oversight would result in better care and reduced spending in regard to patients with chronic conditions. The (CPT) code 99490, for non-face-to-face care coordination services was developed for this reason. <br />
<br />
As a time-based code there are some criteria that need to be met, but the amazing part of this code implementation is it does not require face to face time with the patient. This is all done as “non” face to face time. CPT and CMS both require these specifics to be met :<br />
<br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>At least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient<br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>Chronic conditions must place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline<br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>A comprehensive care plan is to be established, implemented, revised, or monitored.<br />
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<br />
Some practitioners were concerned with the comprehensive care plan, but this list below from CMS helps with the clinical documentation of establishing and implementing this care plan.<br />
<br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>Problem List<br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>Expected Outcome and Prognosis<br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>Measurable Treatment Goals<br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>Symptom Management<br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>Planned Interventions and Identification of those services/individuals responsible/needed for each intervention<br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>Medication management<br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>Community/Social Services Ordered<br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>A description of how the services/agencies outside of the practice will be coordinated<br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>A Schedule for periodic review and revision of the care plan<br />
<br />
However, there are some down-side items that have been discovered over the last 18 months. One of the findings is that CPT code 99490 cannot be billed during the same service period as CPT codes 99495–99496 transitional care management; HCPCS codes G0181/G0182 home health care supervision/hospice care supervision; or CPT codes 90951–90970 End-Stage Renal Disease services. If you are unsure if a code can/cannot be billed with the 99490 CCM code, always run a CCI edit scrub or review the CCI bundling edits to ensure that you can bill the CPT code 99490 with a specific code. This will also confirm if the codes are truly bundled, or if they can be over-ridden with a modifier added to the claim. <br />
<br />
Another issue of concern from coders is what place of service (POS) should be reported on the physician claim. Physicians/Practitioners must report the POS for the billing location as the same place where a face-to-face office visit with the patient would take place. (eg POSs 11-office etc.) Again, if the care is furnished in the hospital outpatient setting, (eg provider-based locations) then they should be reported as the appropriate place of service for a hospital outpatient setting. In addition, Medicare and CPT allow billing of E/M visits during the same service period as CPT 99490. If an E/M visit or other E/M service is furnished on the same day as a CCM service, the clinical documentation needs to clearly define the allocation of total time between the CCM CPT 99490 code and the E/M code(s). <br />
<br />
Medicare guidelines state that only one E/M service can be billed per day unless the criteria is met for the usage of modifier -25, and the designation of “time” cannot be counted twice, regardless if the time denoted from the provider is face-to-face or non-face-to-face time. <br />
<br />
Face-to-face time that can be/or is used to calculate the E/M service that was provided by the physician cannot be counted towards CPT 99490. However, the time spent by clinical staff providing non-face-to-face services within the scope of the CCM service can be counted towards CPT 99490. If both an E/M and the CCM code are billed on the same day, modifier -25 has to be reported, and appended on the CCM claim. <br />
<br />
The other issue of concern from coders is if the provider spends greater than 20 minutes of non-face to face time, that there is not a code or an “add on” code to designate the additional non-face to face time spent. The CPT code criteria and verbiage are very specific in regard to code 99490. The CPT criteria state “Code 99490 is reported when, during the calendar month, at least 20 minutes of clinical staff time is spent in care management activities.” This means that even if a practitioner spends more than 20 minutes, there is no additional reimbursement or coding option for more “units” or the addition of an “add on” code for additional time based reimbursement. <br />
<br />
Another concern from medical billers and coders, is repayment for the physician providers within their practice, if another physician practice or specialty practice have billed for this code within the same month. Medicare will only pay for this code once per calendar month. If more than one provider/specialty submits a claim on the patient, the first claim to be received by the insurance carrier will be paid. Any other claims for code 99490 will be denied reimbursement. The code 99490 can be billed by any provider of care; however, again only 1 provider will be paid for the claim. This can be problematic if the patient is being cared for by multiple providers and specialties. Communication between the providers is necessary to provider not only good care, but to ensure that each provider is coding and billing appropriately.<br />
<br />
As billers and coders, it is our job to code and bill appropriately for the care being provided. Code 99490 was implemented to incentivize providers to manage and communicate more thoroughly between the multiple providers for patients with extensive and complicated chronic conditions. Unfortunately, as a biller/coder, it may be hard to “find” this care documentation within the chart. In addition to charting the “time” the diagnosis for the two (or more) chronic conditions must be documented and clearly connected as medically necessary for this oversight care. <br />
<br />
In the last 18 months, since code 99490 has been implemented in the CPT code set, one of the biggest issues that has come to the forefront is physician reluctance to document and bill for the 99490 CCM code. Many providers have implemented the basic criteria into their electronic health records, yet are not utilizing this method to document and bill for cod 99490. The EHR is the most effective way to meet and guarantee that the fulfillment of all criteria for billing of this code is met. However, the usage of a basic “table” format into a hard-copy chart or file can be just as effective and easy to use. With either system, it still allows the biller/coder to easily audit and bill for this code. (see end of article for a template for hard copy documentation)<br />
<br />
Another “bonus” of this code, is if the practice utilizes mid-level providers of care (as listed below) those providers can provide this care management without a huge amount of impact to the physician providers of care. <br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>Physician Assistants<br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>Nurse Practitioners<br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>Certified Nurse Midwives<br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>Clinical Nurse Specialists<br />
<br />
For those physician providers that have been billing for this code, for 20 minutes of work time, the national Medicare payment amount on this code for fiscal year is $40.82, and the proposed payment for 2017 is $42.21. According to CMS, in the fiscal year of 2015, only 275,000 Medicare beneficiaries received (and CMS paid for) this service under code 99490. Considering how many Medicare beneficiaries are enrolled and receiving Medicare services (approx. 54 million) 275,000 services provided with code 99490 is a very small percentage of total Medicare beneficiaries that could have received these services. At first glance, it seems that $40.82 as the reimbursement for this service is small, however, this can add up quickly if you have a large Medicare population. Code 99490 can easily be provided, documented and billed for to increase the revenue stream into the practice. <br />
<br />
It remains, however, the area of continued concern from providers is they must also allow the patient to “Opt in” and consent to have oversight for this care. This can be problematic, as this is a non-face to face coordination of care, and patients may view this as a “charge” for a service not rendered appropriately, as they did not physically “see” the provider. Patients have complained to their providers for having to pay for this “invisible” service. Again, it is imperative that the physician provider communicate clearly to the patient regarding this service and allow the “opt in” or “opt out”. Physicians also stated concern, if they would be able to ensure or maintain a 24-hour-a-day, 7-day-a-week (24/7) access to care management services as required by the CMS guidelines.<br />
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As a coder, billing code 99490 is one way to help your physician actually get paid for time spent performing this care management service. This service can include telephone calls, coordination of continuing services, and collaboration with specialty physicians which are services that are not normally paid for, or bundled in traditional E&M services. In addition to providing good patient care, the billing/coding of CCM code 99490 that can also help the practice revenue stream and enhance the patients overall care. It is your expertise of you, the coder/biller that can pull this all together with your providers.<br />
<br />
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA Privacy specialist, with over 20 years of experience. Lori-Lynne’s coding specialty is OB/GYN office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology, Urology, and general surgical coding. She can be reached via e-mail at webbservices.lori@gmail.com or you can also find current coding information on her blog site: http://lori-lynnescodingcoachblog.blogspot.com/. <br />
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<br />Lori-Lynne Amos Webb, COBGC, CHDA, CPC, CCS-P, CCP, CDIPhttp://www.blogger.com/profile/07245607641230053707noreply@blogger.com0