Archive | Coding Corner RSS feed for this section

E/M Could Be Best When Second Physician Removes Nasal Packing

20. November 2013

0 Comments

Question: One of our ED physicians removed nasal packs that another doctor at our hospital placed for the patient. The two physicians belong to the same ED group. Is there a code for the nasal pack removal? It’s not a foreign…

Continue reading...

Hip Replacement With Anemia Complication

16. October 2013

0 Comments

Question: An inpatient underwent hip replacement. The diagnosis on the discharge summary was anemia due to surgery. In addition, the provider stated on the discharge summary that, “There was no evidence of further blood loss; therefore it seemed to be…

Continue reading...

CPT® coding is compliant with definitive guidance straight from the AMA offered in Code Connect

16. October 2013

0 Comments

This year there were innumerable coding and billing changes and every practice is trying hard to ensure a smooth transition and report the correct CPT codes . From resourcing the transition, depth of training required, maintaining two coding systems, policies…

Continue reading...

Focus on Initial Reason for Admission When Listing Diagnoses

17. September 2013

0 Comments

Question: A patient was admitted for a total hip replacement because of arthritis of the hip. Just prior to the surgery, he developed a fever so the physician ordered tests. His chest X-ray showed pneumonia. The patient was discharged and…

Continue reading...

Bypass the Confusion of Coding Pericardiectomy

21. August 2013

0 Comments

Question: An inpatient underwent a complete pericardiectomy without cardiopulmonary bypass. What is the correct CPT® code for reporting this procedure? Also, what would be the correct code for reporting subtotal pericardiectomy with a cardiopulmonary bypass? Pennsylvania Subscriber

Continue reading...

Severity Of Injury Determines E/M Coding In The Emergency Department

25. July 2013

0 Comments

Question: A patient presented to the ED with an uncomplicated laceration to the hand. The physician repaired the laceration and discharged the patient. Typically, we code this evaluation and management (E/M) service as “low,” but could this be a moderate-risk…

Continue reading...

Start With DRG 313, Then Move to More Specific Choice

12. June 2013

0 Comments

Question: A patient was admitted for observation of suspected cardiovascular disease. What is the correct DRG assignment? Colorado Subscriber   Answer:  Be careful using the word observation in these types of cases.  Physicians do use this terminology, but there…

Continue reading...

Don’t Change Inpatient POS for Radiology

15. May 2013

0 Comments

Question: One of my coworkers heard that some Medicare rules have changed regarding whether face-to-face time can change a patient’s inpatient/outpatient status when a radiologist is involved. What is she talking about?  Answer: Your coworker probably is referring to the…

Continue reading...

EMR Templates Need Specific Critical Care Times

15. April 2013

0 Comments

Question: Would a template listing a range of time spent rather than a specific time statement providing critical care time be acceptable for documenting the duration of service? Answer: Although the templated time range concept may sound attractive, proceed with caution. The…

Continue reading...

Quality Measures Get Added to Contract Equations

11. March 2013

0 Comments

Question: I’ve heard that quality issues will become a bigger part of contract negotiations in the near future. Is that right?   Answer: Yes, quality measures likely will become a more important focus when hospitals negotiate with insurers on care measures. Some payers…

Continue reading...