National Conference Orlando Teach the Teacher Top Missed Coding Concepts on CPC ® Certification...

National Conference Orlando Teach the TeacherNational Conference Orlando Teach the Teacher

Top Missed Coding Concepts on CPC® Certification Exam


CPT® Disclaimer

CPT copyright 2012 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association.


• Review top missed coding concepts • Test tips to review with students

Objectives

33


• Read, understand and know how to apply all coding guidelines (ICD-9-CM, CPT ® and HCPCS Level II).

• Read, understand and know how to apply all CPT ® parenthetical notes.

• Pay attention to the details in the question/scenario.

• Use the index if the code description does not accurately describe the diagnosis.

Tips for Success

44


• Instruct students to add notes to the CPT ®

E/M coding guidelines to define:– Brief versus extended HPI– Problem pertinent, extended and complete ROS– Pertinent and complete PFSH– Number of body areas/organ systems for

different levels of the exam component– Include details for the MDM table on page 10

E/M

55


• Review the number of key components needed for each E/M category. – When three of the three key components are

required, select the code with the lowest level component documented. • New patient: expanded problem focused Hx,

detailed exam and moderate MDM

E/M

66


• Review the number of key components needed for each E/M category. – When three of the three key components are

required, select the code with the lowest level component documented. • New patient: expanded problem focused Hx,

detailed exam and moderate MDM99202

E/M

77


• When two of the three key components are required, select code based on the highest of the two key components. MDM does not need to be one of the two key components to select the E/M level. It can be supported with history and exam for certification exam purposes. For day to day coding, review the requirement for the MAC in your area. – Established patient: detailed history, comprehensive exam,

low MDM

E/M

88


• When two of the three key components are required, select code based on the highest of the two key components. MDM does not need to be one of the two key components to select the E/M level. It can be supported with history and exam for certification exam purposes. For day to day coding, review the requirement for the MAC in your area. – Established patient: detailed history, comprehensive exam,

low MDM99214

E/M

99


The service performed and documented for an established patient includes six elements of HPI, five elements of ROS, and a complete past, family, social history (PFSH). Also supported by the documentation is a complete examination of ten organ systems, one established stable diagnosis, prescriptions reviewed and renewed, and the physician orders blood tests and a chest X-ray. The physician documents a low complexity MDM.

E/M Example

1010


The service performed and documented for an established patient includes six elements of HPI, five elements of ROS, and a complete past, family, social history (PFSH). Also supported by the documentation is a complete examination of ten organ systems, one established stable diagnosis, prescriptions reviewed and renewed, and the physician orders blood tests and a chest X-ray. The physician documents a low complexity MDM. 99214

E/M Example

1111


• Do not report 99211 when the reason for the patient encounter is for vaccine administration(s) only.

• Do not report 99211 when the patient is being seen for venipuncture only.

E/M Nurse Visits

1212


• Start and stop times– Start time: anesthesia provider begins to

prepare the patient for induction.– Stop time: anesthesia provider is no longer in

attendance.

Anesthesia

1313


PREOPERATIVE DIAGNOSIS: Symptomatic internal and external hemorrhoids, bleeding and prolapsed.POSTOPERATIVE DIAGNOSIS: Symptomatic internal and external hemorrhoids with bleeding and prolapse.PROCEDURE PERFORMED: Hemorrhoidectomy, two quadrants.

The anesthesiologist begins to prepare this patient for surgery at 1:00 PM. The surgery begins at 1:15 PM and ends at 1:40 PM. The anesthesiologist releases the patient to the recovery nurses at 1:45 PM.Anesthesia time:

Anesthesia Example

1414


PREOPERATIVE DIAGNOSIS: Symptomatic internal and external hemorrhoids, bleeding and prolapsed.POSTOPERATIVE DIAGNOSIS: Symptomatic internal and external hemorrhoids with bleeding and prolapse.PROCEDURE PERFORMED: Hemorrhoidectomy, two quadrants.

The anesthesiologist begins to prepare this patient for surgery at 1:00 PM. The surgery begins at 1:15 PM and ends at 1:40 PM. The anesthesiologist releases the patient to the recovery nurses at 1:45 PM.Anesthesia time: 45 minutes

Anesthesia Example

1515


• Surgical approach will determine the use of one code versus another.

• The surgeon performs the removal of an electrode from a dual lead pacing cardioverter-defibrillator via transthoracic approach. General anesthesia is required.

Anesthesia

1616


00534 Anesthesia for transvenous insertion or replacement of pacing

cardioverter- defibrillator (For transthoracic approach, use 00560)

00560 Anesthesia for procedures on heart, pericardial sac, and great vessels

of chest; without pump oxygenator

Anesthesia Example

1717


00534 Anesthesia for transvenous insertion or replacement of pacing

cardioverter- defibrillator (For transthoracic approach, use 00560)

00560 Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator

Anesthesia Example

1818


• Unlisted codes are reported when an existing code does not describe the procedure or service. Follow instructions in parenthetical notes when directed to report an unlisted code. – Example: Nonsurgical alcohol septal ablation

(For nonsurgical septal reduction therapy [eg, alcohol ablation], use 93799)

Unlisted Codes

1919


• Pay attention to code descriptions– Anatomic site of hernia: inguinal, lumbar,

ventral, etc– Approach: open or laparoscopic– Age of the patient– Incarcerated or strangulated, reducible– Initial or recurrent– Mesh: for hernias, only report with 49560-49566

Hernia Repairs

2020


PREOPERATIVE DIAGNOSIS: Bilateral inguinal herniaPOSTOPERATIVE DIAGNOSIS: Bilateral inguinal herniaTYPE OF PROCEDURE: Laparoscopic repair of bilateral inguinal herniaANESTHESIA: General

Hernia Repair Example

2121


PREOPERATIVE DIAGNOSIS: Bilateral inguinal herniaPOSTOPERATIVE DIAGNOSIS: Bilateral inguinal herniaTYPE OF PROCEDURE: Laparoscopic repair of bilateral inguinal herniaANESTHESIA: General


2222


DESCRIPTION OF PROCEDURE: With the patient on the operating table in the dorsal supine position under satisfactory general endotracheal anesthesia, the abdomen was prepped with Betadine and draped with sterile towels and sheets in a standard manner. A subumbilical 2-cm midline incision was made. The right anterior rectus sheath was exposed and incised.


2323


The muscle was retracted laterally, and the dissecting balloon trocar slid easily down to the pubis. It was insufflated to 750 cc, deflated, and removed. The self-retaining trocar was then placed, and the preperitoneal space thus created was insufflated to 12 mmHg pressure. The laparoscopic telescope with attached video camera was introduced. Under direct vision, two 5-mm trocars were placed in the lower midline-one suprapubically and one halfway between the umbilicus and the pubis. The instruments were introduced. The right iliopectineal area was dissected completely.


2424


The muscle was retracted laterally, and the dissecting balloon trocar slid easily down to the pubis. It was insufflated to 750 cc, deflated, and removed. The self-retaining trocar was then placed, and the preperitoneal space thus created was insufflated to 12 mmHg pressure. The laparoscopic telescope with attached video camera was introduced. Under direct vision, two 5-mm trocars were placed in the lower midline-one suprapubically and one halfway between the umbilicus and the pubis. The instruments were introduced. The right iliopectineal area was dissected completely.


2525


Good coverage was obtained. Attention was then turned to the left iliopectineal area. Similar dissection was carried out. A 4 x 6 portion of Atrium mesh was brought to lie over this area and tacked across anteriorly and medially to the pubis and the Cooper's ligament. No lateral or inferior tacks were applied. Good coverage was obtained. Pneumo-insufflation was resolved, and the instruments and trocars were removed. All trocar sites were injected with 0.5% Marcaine with epinephrine.


2626


Good coverage was obtained. Attention was then turned to the left iliopectineal area. Similar dissection was carried out. A 4 x 6 portion of Atrium mesh was brought to lie over this area and tacked across anteriorly and medially to the pubis and the Cooper's ligament. No lateral or inferior tacks were applied. Good coverage was obtained. Pneumo-insufflation was resolved, and the instruments and trocars were removed. All trocar sites were injected with 0.5% Marcaine with epinephrine.


2727


The rectus incision was closed with a figure-of-eight suture of 0 Vicryl. The skin edges were approximated with clips. Sterile dressings were applied. The patient tolerated the procedure well and returned to the recovery room in satisfactory condition.

Correct codes:


2828


The rectus incision was closed with a figure-of-eight suture of 0 Vicryl. The skin edges were approximated with clips. Sterile dressings were applied. The patient tolerated the procedure well and returned to the recovery room in satisfactory condition.

Correct codes: 49650-50 Laparoscopy, surgical; repair initial inguinal hernia

550.92 Inguinal hernia without mention of obstruction or gangrene, bilateral, (not specified as recurrent)


2929


• Code determined based on the approach– 54640 Orchiopexy, inguinal approach, with or

without hernia repair – 54650 Orchiopexy, abdominal approach, for

intra-abdominal testis (eg, Fowler-Stephens) – 54692 Laparoscopy, surgical; orchiopexy for

intra-abdominal testis

Orchiopexy

3030


• Pay close attention when imaging guidance is included. – Is imaging guidance reported separately?– If imaging guidance is included-what is the type

of imaging? • Review the coding guidelines and parenthetical

notes• Append modifier 26 if the service is performed by

the provider in the facility setting

Imaging Guidance

3131


Using ultrasound guidance, an anesthesiologist injects an analgesic and a steroid mixture into the L2-L3 paravertebral facet joint on the right side.

Imaging Guidance Example

3232


Using ultrasound guidance, an anesthesiologist injects an analgesic and a steroid mixture into the L2-L3 paravertebral facet joint on the right side.

Correct codes: 0216T-RT Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level

Imaging Guidance Example

3333


(Image guidance [fluoroscopy or CT] and any injection of contrast are inclusive components of 64490-64495.Imaging guidance and localization are required for theperformance of paravertebral facet joint injectionsdescribed by codes 64490-64495. If imaging is not used, report 20552-20553. If ultrasound guidance is used, report 0213T-0218T)

Imaging Guidance

3434


• Cervical X-rays selected on the number of views:– Anterior/Posterior (AP)– Lateral– Flexion and extension– Oblique– Odontoid– Pillar– Prevertebral soft tissue and stress

Radiology

3535


72040 Radiologic examination, spine, cervical; 3 views or less

72050 …4 or 5 views

72052 …6 or more views

Radiology

3636


• Proper use of surgical modifiers– Modifier 58: staged or related– Modifier 59: distinct service– Modifier 78: unplanned return to the OR for

related procedure– Modifier 79: unrelated procedure

Modifiers

3737


38-year-old male had a hernia repair and then about six days later, he started to have swelling of the pocket and redness. The patient was brought to the operating room. A skin incision was made through the midline in which there was an infection of large amount of purulent material that escaped under high pressure. Multiple cultures were taken. A 3-L of ortho irrigation was used to Pulsavac out the wound, any remaining sutures were removed. The wound was packed with iodoform gauze and dressing applied. Correct code and modifier:

Modifier Example

3838


38-year-old male had a hernia repair and then about six days later, he started to have swelling of the pocket and redness. The patient was brought to the operating room. A skin incision was made through the midline in which there was an infection of large amount of purulent material that escaped under high pressure. Multiple cultures were taken. A 3-L of ortho irrigation was used to Pulsavac out the wound, any remaining sutures were removed. The wound was packed with iodoform gauze and dressing applied. Correct code and modifier: 10180-78

Modifier Example

3939


• Complications of pregnancy, childbirth and the puerperium– Codes in Chapter 11 have sequencing priority– Example: One week postpartum, the patient is

diagnosed with rubella.

ICD-9-CM

4040


Example: One week postpartum, the patient is diagnosed with rubella.

Correct code(s): 647.54 Maternal rubella complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication 056.9 Rubella without mention of complication

ICD-9-CM

4141


• Drug and alcohol use, abuse or dependence– Determined based on the diagnosis documented– Fifth digit: unspecified, continuous, episodic or in

remission– Report all diagnoses treated and documented.

• Example: Patient treated for cocaine dependence and anxiety caused by cocaine use.

Correct code(s):

ICD-9-CM

4242


Example: Patient treated for cocaine dependence and anxiety caused by cocaine use.

Correct code(s): 292.89 Other specified drug-induced mental disorder 304.20 Cocaine dependence, unspecified

Use additional code for any associated drug dependence

ICD-9-CM

4343


• Code sets required under HIPAA• Covered entities• Privacy Rule• Security Rule

HIPAA

4444


Questions?

National Conference Orlando Teach the Teacher Top Missed Coding Concepts on CPC ® Certification...

Documents

Transcript of National Conference Orlando Teach the Teacher Top Missed Coding Concepts on CPC ® Certification...