Ask An Expert: MRA
| 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 patient has PVD, atherosclerosis of the lower extremities, and an AAA, which are all in HCC 105. 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 of my time reporting all three conditions? |
| A: |
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, they must all be documented and reported. From a purely payment … 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: | 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-9-CM code is 440.0. However, it’s important to distinguish the difference between atherosclerosis of the vessel (which is a risk adjusted diagnosis) and a valve (ICD-9-CM code … 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 |