Ask An Expert: coding
| Q: | The doctor documented that a patient has DM with glaucoma. How do I code this for MRA purposes? |
| A: |
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 |
| Q: | My PCP documented and coded breast cancer (ICD-10-CM code C50.-) for a patient who had a mastectomy three years ago and is receiving Tamoxifen. He was told that if the patient was receiving treatment, he could code active cancer. Is this correct from an MRA standpoint? |
| A: |
Yes and no. When a patient has an active cancer, regardless of whether he or she is receiving treatment, the primary cancer ICD-10-CM code is used. The scenario you presented isn’t quite so clear. Breast cancer has a treatment phase … Read Full Post |
| Q: | The PCP documented “aortic atherosclerosis.” How do I code this for MRA purposes? |
| A: |
Atherosclerosis of the aorta is a common condition in the elderly and the ICD-10-CM code is I70.0. However, it’s important to distinguish between atherosclerosis of the vessel (which is a risk adjusted diagnosis) and a valve (ICD-10-CM code I35.8, which … Read Full Post |
| Q: | Two years ago, I saw Mrs. Jones as a new patient. I took a detailed history and developed a treatment plan for her HTN, CAD and other health issues. My office has attempted to schedule additional appointments and Mrs. Jones is either a no-show or cancels the appointment at the last minute. Mrs. Jones had a recent hospital stay where CHF and valvular heart disease were diagnosed. I haven’t seen her in two years and she has come to my office to continue outpatient treatment. I basically have to start from scratch due to her long absence and new health problems. Can’t I bill her visit as a new patient? |
| A: |
The answer is no. Mrs. Jones may be a noncompliant patient, but she is an established, noncompliant patient. CMS guidelines specifically define a new patient as someone who has not received services from this physician or another physician in the … Read Full Post |
| Q: | Our office has a patient with a compression fracture of the vertebra that was diagnosed in 2009. Our PCP continues to check off the ICD-9-CM code 733.13. Is this correct? How is a vertebral fracture different from an arm fracture? |
| A: |
It’s not different. Fractures are coded when they occur and for the time the patient is receiving treatment or medication. The ICD-9-CM code of 733.13 is also used when the PCP documents “chronic fracture” or “pathologic fracture.” These fractures are … Read Full Post |
| Q: | The doctor documented that a patient has DM with glaucoma. How do I code this for MRA purposes? |
| A: |
This answer was updated for ICD-10-CM and with new coding information. Read here. Glaucoma can be a manifestation of a patient’s diabetes and the situation you describe would be coded as 250.5x and 365.44. Although a lot of diabetics also … Read Full Post |
| Q: | When an MRA patient has several diabetic manifestations, do I need to report all the diabetic codes even though there is a hierarchy? |
| A: |
Yes. The correct way to code the manifestation is with its associated diabetic ‘category.’ So, if the patient has CKD III, retinopathy and PVD, all secondary to diabetes, the correct ICD-9-CM codes to report are: 250.4x, 585.3, 250.5x, 362.01, 250.7x, … Read Full Post |
| Q: | I attended a workshop where I was told that we need more than one lab value to diagnose a condition. Is this correct? |
| A: |
It depends on the value and as always, the physician’s clinical judgment and documentation as well as the condition guidelines. Most of the time, laboratory tests are repeated after a few months to ensure the value was not an aberration … Read Full Post |
| Q: | My PCP has a habit of documenting a lot of conditions as “history of.” I was told that for a condition like CHF, I can code ICD-9-CM 428.0 when she documents “history of CHF.” Is this correct? |
| A: |
No. The term ‘history’ is actually used in two manners by clinicians. In one case, it means the patient had this condition in the past. It can also mean the patient has actually had the condition for some time and … Read Full Post |
| Q: | My physician documents diabetes as follows: DMII/CKD III/Peripheral neuropathy. What is the correct way to code this? |
| A: |
Based on the way you wrote your question, the correct ICD-9-CM codes are: 250.00 585.3 356.9 Remember that you cannot infer a causal relationship between the diabetes and the other two conditions unless the clinician specifically documents it by using … Read Full Post |