Ask An Expert: Billing & Coding
| I am confused about HIV coding. When do I use Z21 and B20? | |
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Good question and one where we find a few errors! The ICD-10-CM code Z21, Asymptomatic human immunodeficiency virus, is used when there is no documentation of symptoms, or if the patient is described as HIV positive, having known HIV, or … Read Full Post |
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| Our patient has SSS & a pacemaker. How do I code the pt’s condition correctly? | |
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Sick Sinus Syndrome (SSS) is a condition in which the patient’s heart rhythm is disrupted; depending on the patient’s symptoms, he or she may receive a permanent pacemaker (PPM) to regulate the heart’s rhythm. In the past, SSS (I49.5) was … Read Full Post |
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| How do I correctly code HTN, DM2 & CKD4 on a visit? | |
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Coding guidelines have long reflected a causal relationship between HTN and CKD, and coders are accustomed (and permitted) to linking these conditions and coding I12.- and the appropriate stage of CKD (in this case, N18.4). But when the PCP links … Read Full Post |
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| My patient has PVD, atherosclerosis of the lower extremities, and an AAA, which are all in HCC 108. I was told we need to document all three conditions even though there is only one payment for each HCC. Do I really need to waste my time reporting all three conditions? | |
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Yes, you do. The medical record is a legal document that must reflect all the conditions the patient has and their management. If the patient has all three conditions, and they are properly assessed and documented, they must all be … Read Full Post |
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| When an MRA patient has several diabetic manifestations, do I need to report all the diabetic codes even though there is a hierarchy? | |
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Yes, and the creation of combo codes in ICD-10-CM makes coding multiple diabetic manifestations much easier. (Check out our blog on Combination Codes) There are a few reasons why you should code them all, assuming they were all assessed at … Read Full Post |
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| My physician documents diabetes as follows: DMII/CKD III/Peripheral neuropathy. What is the correct way to code this? | |
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Assuming your provider is the last hold-out from an EMR conversion, and based on the way you wrote your question, the correct ICD-10-CM codes are: E11.22 N18.3 E11.40 Remember that you cannot infer a causal relationship between the diabetes and … Read Full Post |
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| How does risk adjusted payment work with regard to hierarchies? I’ve heard that some ICD-10-CM codes ‘trump’ others. | |
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Risk adjusted diagnoses are classified into hierarchical condition categories (HCCs). Some HCCs are in a hierarchy. Imagine the HCCs on a ladder, if you will. As you climb up the HCC ladder, the HCCs on the lower rungs are ‘replaced’ … Read Full Post Tagged:
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| We attended an MRA training workshop and we were told that once a patient with an AAA has had surgery, we cannot code the aneurysm. We’re very confused! Is this correct? | |
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It depends. (Don’t you just hate those answers?!) When an AAA is resected, the bulging section of the vessel is removed. After surgery, if the patient were to undergo an abdominal ultrasound, there will be no evidence of the aneurysm. … Read Full Post |
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| The doctor documented that a patient has DM with glaucoma. How do I code this for MRA purposes? | |
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Glaucoma can be a manifestation of a patient’s diabetes and the situation you describe would be coded as E11.39 and H42. (Remember that absent a specified diabetes type, the default is Type 2.) Although a lot of diabetics also have … Read Full Post |
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| One of our patients was treated for breast cancer in 2007, and the PCP is reporting ICD-10-CM code C50.912. Is this correct? | |
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In all likelihood, no. The coding guidelines for cancer state that “When the primary malignancy has been excised, no further treatment is directed to the site & there is no evidence of an existing malignancy,” the clinician must document ‘history … Read Full Post Tagged:
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