Most Missed Medical Coding Concepts Ambulatory Surgical

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Most Missed Medical Coding Concepts Ambulatory Surgical with practice questions

Pay attention to Activity Codes

• Activity codes and place of occurrence codes are used in ICD-10-CM for injuries

• Activity codes describe the cause of the injury, such as playing tennis

• Place of occurrence codes describe where the injury occurred, such as a tennis court

• The 7th character "a" represents initial encounters in injury coding

• Examples of initial care include emergency department treatment, evaluation and management, and surgical treatment

• The 7th character "d" is for subsequent encounters, such as cast change or removal, adjustments, and follow-up visits

• The 7th character "s" is for sequela, which are complications or conditions that arise as a direct result of an injury

Open Burst Fracture

• Peripheral nerve or blood vessel injuries should be coded separately from the primary injury

• Fractures should be coded based on site, laterality, and type of fracture

• Open fractures are classified using the Gustillo classification, with higher numbers indicating worse damage

• Limb salvage for traumatic fractures uses the appropriate 7th character extender for initial encounter

Principal Diagnosis Code

• Burn codes are used for thermal burns, burns from electricity or radiation, and corrosions

• The code for the burn of the highest degree is sequenced first when treating external burns

• The circumstances of admission govern the selection of the principal diagnosis for burn injuries and related conditions

• Codes from category T31 are used for burns classified by extent of body surface involved

• Codes from category T32 are used for corrosions classified by extent of body surface involved

The Adverse Effect

• Adverse effects occur when a substance is taken correctly but a reaction occurs

• Adverse effects are coded using the appropriate code for the adverse effect and additional codes for manifestations

• Poisonings occur when the wrong substance is taken or given, or when there is an error in administration

• Poisonings are coded using codes from categories T36-T50

• Underdosing refers to taking less of a medication than prescribed and is coded using codes from categories T36-T50

• Toxic effects occur when a harmful substance is ingested or comes in contact with a person and are coded using codes from categories T51-T65

• Most Missed Medical Coding Concepts Ambulatory Surgical

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External Cause codes

• Codes from categories T74 and T76 are used for adult and child abuse, neglect, or other maltreatment

• Mental health or injury codes may accompany abuse or neglect codes

• Complications of transplanted organs and tissues are coded using codes from category T86

• Code T86.1 is used for complications of kidney transplants, such as failure or rejection

• The code should not be used for post-kidney transplant patients with CKD unless

Extracapsular Cataract Removal Procedures

• 66982 is for an extracapsular cataract removal that requires complex treatment

• Involves removal of the entire natural lens while leaving the lens capsule intact

• Lens is replaced with an intraocular lens prosthesis

• Endoscopic cyclophotocoagulation treats the ciliary body of the eye with a laser

Different Types of Cataract Removal Procedures

• 66984 is an extracapsular cataract removal procedure that is often considered routine

• Does not require any special devices or techniques

• Removes the diseased lens and replaces it with a prosthesis

• Intracapsular cataract extraction removes the lens and the surrounding capsule in one piece

• Requires a larger incision and exerts pressure on the vitreous body

• Relatively high rate of complications, rarely performed in the US

Codes for Secondary IOL Placement and IOL Exchange

• 66985 is used when the patient does not have a natural lens or current cataract and a secondary IOL is being placed

• No current cataract removal involved

• Piggybacking can improve the lens power of the existing IOL

• 66986 is the removal of a previously placed IOL and insertion of a new IOL

• No current cataract removal involved

• Exchange of an IOL may be for incorrect positioning, wrong power, or other complications

Treatment for Nosebleeds

• Different codes for different types of nosebleeds and treatments

• 30901 is for a nosebleed in the front of the nasal cavity with limited cautery or packing

• 30903 is for difficult to control hemorrhages or multiple bleed areas with extensive anterior cautery or packing

• 30905 is for a nosebleed in the rear of the nasal cavity, controlled by packing through the back of the throat

• 30906 is for subsequent treatment if the bleeding reoccurs

Use of Modifiers 53 and 74

• Modifier 53 is for a discontinued procedure due to extenuating circumstances or patient's well-being (physician billing)

• Modifier 74 is for a discontinued procedure in outpatient hospitals or ASCs

• Modifier 70 can only be used with modifier 74 if anesthesia has been administered

Repair of Blepharoptosis and Blepharoplasty

• Blepharoptosis is a drooping of the upper eyelid

• Repair involves resection or advancement of the levator muscle

• 67903 is for an internal approach to repair blepharoptosis

• 67904 is for an external approach to repair blepharoptosis

• Blepharoplasty is for excess skin causing drooping of the eyelid, while blepharoptosis is caused by muscle weakness

Cornea Laceration Repair

• Codes based on whether the laceration is perforating and involves uveal tissue

• 65275 is for nonperforating laceration without uveal tissue involvement

• 65280 is for perforating laceration involving cornea and/or sclera without uveal tissue repositioning or resection

• 65285 is for perforating laceration involving cornea and/or sclera with uveal tissue repositioning or resection

Treatment for Hallux Valgus (Bunion)

• Different techniques used for different levels of complexity

• 28292 is for excision of the base of the phalanx to realign the joint to normal anatomical position

• Does not include osteotomy or fusion procedures

Bunionectomy Codes

• Code 28295: Removal of the base of the metatarsal to realign the joint

• Code 28296: Excision of a portion of the distal metatarsal next to the metatarsophalangeal joint to remove the medial eminence

• Code 28297: Fusion of the 1st metatarsal and the medial cuneiform

Skin Graft Codes

• Code range 15271-15278: Application of a skin substitute graft

• Codes 15271-15272: Trunk, arms, and legs

• Codes 15273-15274: Legs with a wound surface area of 100 square centimeters or more

• Codes 15275-15276: Hands with a wound surface area of less than 100 square centimeters

• Codes 15277-15278: Hands with a wound surface area of 100 square centimeters or more

Arthrography and Arthrocentesis Codes

• Arthrography: Examination of the joint under image guidance

• Arthrocentesis: Accessing the joint to aspirate or inject fluid or medication

• Codes 27093-27095: Hip arthrography with or without anesthesia

• Codes 20610-20611: Arthrocentesis into major joints with or without ultrasound guidance

Rhinoplasty Codes

• Primary rhinoplasty: Codes in range 30400-30420

• Secondary rhinoplasty: Codes in range 30430-30450

• Code 30400: Addressing lower parts of the external nose, often performed for cosmetic purposes

• Code 30410: Complete rhinoplasty including the bony pyramid

• Code 30420: Soft tissue and bony work with major septal repair

Cystourethroscopy Codes

• Code 52000: Cystourethroscopy to view the inside of the bladder and urethra

• Separate procedure designation for code 52000

Supporting Details

• Bunionectomy codes involve the removal or fusion of bones in the foot to correct bunions.

• Skin graft codes are used to report the application of a skin substitute graft to different areas of the body.

• Arthrography codes are used to report the examination of joints using imaging techniques.

• Arthrocentesis codes are used to report accessing joints for fluid aspiration or injection.

• Rhinoplasty codes are used to report surgery to change the shape of the nose.

• Cystourethroscopy is a procedure to view the inside of the bladder and urethra using a scope.

Scope issues

• Cystourethroscopy can be used to treat conditions such as post-operative bleeding, pelvic fractures, and kidney stones trapped in the ureter.

• The procedure involves using an endoscopy sheath inserted into the bladder to evacuate clots.

Supporting details:

• Clots obstructing the urinary tract can be removed from the bladder or urethra using cystourethroscopy.

• A large diameter endoscopy sheath is inserted into the bladder.

• Clots are evacuated through the sheath using an ELLIC or piston syringe evacuator.

Procedure Details

• Ureteral catheterization or ureteral pyelography is performed during the procedure.

• Urethral catheterization may or may not be performed, and a flush or installation of fluid into the bladder may be done.

• Saline solution may be instilled to improve visibility during the procedure.

• Contrast medium is used for radiological study of ureteric and renal pelvic structures.

Supporting details:

• Ureteral catheterization or ureteral pyelography is done through the stethoscope.

• Urethral catheterization may involve flushing or installing fluid into the bladder.

• Saline solution is instilled to enhance the view of structures.

• Contrast medium is used to facilitate visualization in radiological studies.

Coding Information

• Code 52001 includes a diagnostic cystourethroscopy.

• Code 5200 should not be reported with 52001.

• Code 52007 is similar to code 52005 but requires a brush biopsy of the ureter and/or the renal pelvis if ureteral pyelography is performed.

• Modifier 50 should be appended if the procedure is performed bilaterally.

Supporting details:

• Code 52001 covers a diagnostic cystourethroscopy.

• Code 5200 should not be reported together with code 52001.

• Code 52007 is similar to code 52005 but includes a brush biopsy of the ureter and/or renal pelvis if ureteral pyelography is performed.

• Modifier 50 is used to indicate bilateral performance of the procedure.

 Now try these questions written by Medical Coding by Jen Most Missed Medical Coding Concepts Ambulatory Surgical

What are burn codes used for in ICD-10-CM?

1 poisonings

2 complications of transplanted organs and tissues

3 thermal burns, burns from electricity or radiation, and corrosions

4 adverse effects

 Answer:

3 thermal burns, burns from electricity or radiation, and corrosions

How should fractures be coded in ICD-10-CM?

1 based on the extent of body surface involved

2 based on site, laterality, and type of fracture

3 based on the cause of the injury

4 based on the Gustillo classification

 Answer:

2 based on site, laterality, and type of fracture

How are open fractures classified in ICD-10-CM?

1 based on site, laterality, and type of fracture

2 based on the cause of the injury

3 based on the extent of body surface involved

4 using the Gustillo classification

 Answer:

4 using the Gustillo classification

What does the 7th character "a" represent in injury coding?

1 subsequent encounters

2 complications or conditions

3 initial encounters

4 limb salvage

Answer:

3 initial encounters

What does the 7th character "d" represent in injury coding?

1 subsequent encounters

2 initial encounters

3 limb salvage

4 complications or conditions

 Answer:

1 subsequent encounters

What may accompany abuse or neglect codes in ICD-10-CM?

1 poisonings

2 adverse effects

3 mental health or injury codes

4 complications of transplanted organs and tissues

 Answer:

3 mental health or injury codes

Where are toxic effects coded in ICD-10-CM?

1 using codes from categories T74 and T76

2 using codes from categories T36-T50

3 using codes from category T86

4 using codes from categories T51-T65

 Answer:

4 using codes from categories T51-T65

How are poisonings coded in ICD-10-CM?

1 using codes from categories T36-T50

2 using the appropriate 7th character extender for initial encounter

3 using codes from categories T74 and T76

4 using codes from category T86

 Answer:

1 using codes from categories T36-T50

What are activity codes used for in ICD-10-CM for injuries?

1 indicating the extent of body surface involved

2 classifying the type of fracture

3 coding adverse effects

4 describing the cause of the injury

 Answer:

4 describing the cause of the injury

What do place of occurrence codes describe in ICD-10-CM for injuries?

1 the cause of the injury

2 the extent of body surface involved

3 the type of fracture

4 where the injury occurred

 Answer:

4 where the injury occurred

What is correct for limb salvage for traumatic fractures use in ICD-10-CM?

1 codes from categories T74 and T76

2 the appropriate code for the adverse effect and additional codes for manifestations

3 codes from category T86

4 the appropriate 7th character extender for initial encounter

 Answer:

4 the appropriate 7th character extender for initial encounter

What does the 7th character "s" represent in injury coding?

1 subsequent encounters

2 limb salvage

3 sequela, which are complications or conditions that arise as a direct result of an injury

4 initial encounters

 Answer:

3 sequela, which are complications or conditions that arise as a direct result of an injury

What are codes from categories T74 and T76 used for in ICD-10-CM?

1 adult and child abuse, neglect, or other maltreatment

2 mental health or injury codes

3 burn injuries and related conditions

4 complications of transplanted organs and tissues

Answer:  

1 adult and child abuse, neglect, or other maltreatment

When are adverse effects coded in ICD-10-CM?

1 when a harmful substance is ingested or comes in contact with a person

2 when the wrong substance is taken or given, or when there is an error in administration

3 when there is underdosing of a medication

4 when a substance is taken correctly but a reaction occurs

 Answer:

4 when a substance is taken correctly but a reaction occurs

How are complications of transplanted organs and tissues coded in ICD-10-CM?

1 using codes from category T86

2 using codes from categories T74 and T76

3 using codes from categories T36-T50

4 using codes from categories T51-T65

 Answer:

1 using codes from category T86

What are examples of initial care in injury coding?

1 emergency department treatment, evaluation and management, and surgical treatment

2 complications of transplanted organs and tissues

3 cast change or removal, adjustments, and follow-up visits

4 mental health or injury codes

 Answer:

1 emergency department treatment, evaluation and management, and surgical treatment

What governs the selection of the principal diagnosis for burn injuries and related conditions in ICD-10-CM?

1 the cause of the injury

2 the circumstances of admission

3 the type of fracture

4 the extent of body surface involved

 Answer:

2 the circumstances of admission (This question was the most missed. Remember reason for todays visit and treatment is always principal diagnosis.)

Which code is used for complications of kidney transplants in ICD-10-CM?

1 T86.1

2 T36-T50

3 T31

 Answer:

1 T86.1

Which code is sequenced first when treating external burns in ICD-10-CM?

1 codes from category T86

2 the code for the burn of the highest degree

3 codes from categories T31

4 the appropriate code for the adverse effect and additional codes for manifestations

 Answer:

2 the code for the burn of the highest degree

What does underdosing refer to in ICD-10-CM?

1 taking the wrong medication

2 taking less of a medication than prescribed

3 taking the medication correctly but experiencing a reaction

4 taking more of a medication than prescribed

 Answer:

2 taking less of a medication than prescribed

 I hope this helps, Jen Most Missed Medical Coding Concepts Ambulatory Surgical

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