Ask An Expert: ICD-9
| 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: | Can a patient’s varicose veins or venous stasis be caused by their DM and coded as manifestations of ICD-9-CM code 250.7x, diabetes with peripheral circulatory manifestations? |
| A: |
No. The ICD-9-CM coding guidelines state that diabetic gangrene (785.4) and diabetic peripheral angiopathy/PVD (443.81/443.9) are the manifestations associated with ICD-9-CM code 250.7x, diabetes with peripheral circulatory manifestations. |
| 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: | 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: | What exactly is ICD-10? |
| A: |
ICD-10-CM (based on the International Classification of Diseases, 10th edition, Clinical Modification) is a standard set of codes used for conveying a patient’s clinical profile, if you will. Defined codes are used primarily to facilitate the gathering of data, its … 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 |
| Q: | One of our patients was treated for breast cancer in 2007, and the PCP has checked ICD-9-CM code 174.9 on the superbill. Is this correct? |
| A: |
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 |
| Q: | My PCP documented and coded breast cancer (ICD-9-CM code 174.9) for a patient who had a mastectomy in 2008 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-9-CM code is used. The scenario you presented isn’t quite so clear. Breast cancer has a treatment phase … Read Full Post |
| Q: | 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? |
| A: |
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 |