Dermal fillers in HIV related Facial Lipodystrophy Syndrome (LDS)

Patients who are suffering from HIV may loss fat in face as a complication of the disease or due to long-term use of anti-retrovital drugs.  This loss of fat in face some times can causes abnormalities like severely sunken cheeks. Due to the appearance of their face, patients become depressed and sometimes will discontinue taking the anti-retroviral drugs in an attempto to resolve that condition. To restore the appearance of their face, reconstructive procedure like injecting the dermal fillers into subcutaneous tissuewill be done. This is a covered service.

W.E.F March 23^rd, 2010, Medicare covers the injection of face with dermal fillers which are approved by Food & Drug Administration in patients who are depressed due to facial LDS.

Sculptra and Radiesse are the FDA approved dermal fillers for the treatment of LDS.

Coding (for date of service after March 23^rd 2010):

ICD-9-CM Dx: 272.6 and 042. We can also assign 311 for depression, but not mandatory.

HCPCS: Q2026, Q2027 and G0429

 

 

Reference: http://www.cms.gov/Transmittals/downloads/R1978CP.pdf

Replagal infusion and Fabry's disease

Indication:  It is indicated for long term enzyme replacement therapy with confirmed cases of Fabry disease.

Fabry disease: Fabry disease is rare inherited disease caused by recessive X-link due to mutation of GLA (alfa-galactosidase gene). It means the people who are suffering from Fabry disease does not have enough GLA which breaks down the fatty substance called globotriaosylceramide (Gb3). If GLA is not present, Gb3 will not break down and build up in cells, such as kidney cells and can cause renal insufficiency and renal failure. If these fatty cells deposit in heart cells, it increases the risk of heart disease, which manifest in form of cardiomyopathy and HTN.  Angiokeratomas are dermatological manifestations of Fabry disease. And, keratopathy is the ocular manifestations of Fabry disease.

Treatment: Replagal is infused every two weeks over 40 minutes at a dose of 0.2 mg/kg body weight.

Coding: Fabry disease is classified ICD-9-CM in Endocrine, Nutritional and Metabolic Diseases, and Immunity under category 272, Disorders or lipid metabolism and it is coded to 272.7, Lipidosis. Infusion of Replagal for 40 minutes is coded to CPT code 96365.

Test Yourself Medical Terminology-4

1. Chymo-

A. to pour
B. half
C. drug
D. bone marrow

2. Chromo-

A. drug
B. color
C. time
D. lip

3. Chemo-

A. drug
B. time
C. lip
D. color

4. Cheilo-

A. time
B. drug
C. color
D. lip

5. Celio-

A. lip
B. drug
C. belly
D. color







Answers: 1-A; 2-B; 3-C; 4-D; 5-C.

October 1st 2010 ICD-9-CM Code Updates-3

ICD-9-CM 2010 updates-3

From october 1^st 2010, the subcategory 787.6, incontinence of feces, is expanded into 4 new codes.

                787.60: Full incontinence of feces.

                787.61: Incomplete defecation

                787.62: Fecal smearing

                787.63: Fecal urgency

Coding Question

Question: What is the code for fecal impaction?

Answer: Fecal impaction is coded to 560.32, which is a new codew.e.f. october 1^st 2010. Previously, it was coded to 560.39 which is a other conditions in the subgcategory 560.3, impaction of intestine.

Fecal Incontinence

Lumbar spinal stenosis with neurogenic claudication

                One new code 724.03, lumbar spinal stenosis with neurogenic claudication is added to the subcategory 724.0, spinal stenosis other than cervical. And the code 724.02 is revised as lumbar spinal stenosis, without neurogenic claducation.

Try to code this Coding Scenario:

Preoparative diagnosis:  Lumbar spinal stenosis, L5-S1 disc herniation, bilateral lower extremity radiculitis and neurogenic claudication.

Postopearative diagnosis: Lumbar spinal stenosis with neurogenic claudication, L5-S1 disc herniation, and bilateral lower extremity radiculitis.

Procedure:  Bilateral L5-S1 microdiskectomy with partial medial facetectomy and foraminotyr for decompression.

Codes would be:

Dx: 722.10, 724.03

ICD Procedure: 80.51

CPT: 63030-50
Refer also:
October 1st 2010 ICD-9-CM Code Updates-2
October 1st 2010 ICD-9-CM Code Updates-1

Happy Coding!!

October 1st 2010 ICD-9-CM Code Updates-2

287.4-Secondary thrombocytopenia.

Subcategory 287.4 is expanded into two codes. 287.41 for post transfusion purpura and 287.49 for other secondary thrombocytopenia.

315.3-Developmental speech or languate disorder.

Added 315.35, childhood onset fluency disorder to the subcagetory 315.3 for stuttering, which is childhood onset. Before we had only one default code for stuttering for both adult and childhood as 307.0, stuttering, and is being revised to adult onset fluency disorder.

447-Other disorders of arteries and arterioles.

                A new subcategory is being added to category 447 as 447.7-Aortic ectasia and it is expanded into four new codes.

                                447.70: Aortic ectasia, unspecified site.

                                447.71: Throacic aortic ectasia

                                447.72: Abdominal aortic ectasia.

                                447.73: Thoracoabdominal aortic ectasia.

Aortic Aneurysms

488.0-Influenza due to identified avian influenza virus.

                This subcategory 488.0 is expanded into 3 new codes.

                        488.01: Influenza due to identified avian influenza virus with pneumonia

488.02: Influenza due to identified avian influenza virus with other respiratory manifestations.

488.09: Influenza due to identified avian influenza virus with other manifestations.

488.1-Influenza due to identified novel HINI influenza virus.

                This subcategory 488.1 is expanded into 3 new codes.

                        488.11: Influenza due to identified novel H1N1 influenza virus with pneumonia

488.12: Influenza due to identified nove H1N1 influenza virus with other respiratory manifestations.

488.19: Influenza due to identified nove H1N1 influenza virus with other manifestations.

Coding Question:

Question: Inpatient encounter: Patient is discharged with rule out H1N1 (swine flu) with respiratory manifestations, can we code 488.12?

Answer: No. We cannot code suspected H1N1. H1N1 is exception from coding rule “rule out conditions at the time of discharge need tobe coded as if existed”. We need to code a code from category 487, instead of 488.1.

Refer also: http://happymedicalcoders.blogspot.com/2010/10/october-1st-2010-icd-9-cm-code-updates.html

Happy Coding!!

Coding Questions and Answers-1

Coding Questions:

Question: Patient is diagnosed with hemochromatosis due to blood transfusion. Is it coded to 275.02 or 275.03, since repeat is not documented?

Answer: Code 275.02. Even though word repeat is not documented, hemochromatosis due to blood transfusion is coded to 275.02. Also assign E934.7, Drugs, medicinal, and biological substances causing adverse effects in theuraputic use, natural blood and blood products to show the external cause.

Question: This 37-year-old morbidly obese female is diagnosed with obesity hypoventilation syndrome. Her body mass index is 58. How is this be coded.

Answer: Code 278.03, 278.01 and V85.53. Morbid obesity code 278.01 is coded, if documented along with 278.03, since obesity hypertentilation syndrome can be found in patients who are not morbidly obese also.

Reference: Coding Clinic 4q 2010.

Happy Coding!!

October 1st 2010 ICD-9-CM Code Updates-1

237.7 Neurofibromatosis :

Two new codes are added to the subcategory 237.7, neurofibromatosis. 237.73 for swannomatosis and 237.79 for unspecified neurofibromatosis.

275.0 Disorders of iron metabolism (Iron Overload):

                Subcategory 275.0 is expanded into we have 4 new codes in this subcagetory.

                                275.01:  Hereditary hemochromatosis.

                                275.02: Hemochromatosis due to repeated red blood cell transfusion.

                                275.03: Other hemochromotosis.

                                275.09: Other disorders or iron metabolism

278.0 Overweight and obesity.

               

                One new code is added 278.03, Obesity hypoventilation syndrome in sub category 278.0.

Happy Coding!!

Medical Coding Practice Cases

For those who are studying medical coding and for those who are preparing for CCS or any other medical coding certification exams, you have lot of practice cases available at the following links.  There are around 65 ambulatory surgery records, 65 physician office records, 56 ed records and 45 IP records available for practice.

http://web.alfredstate.edu/him/records/asucases/asucase001.pdf
http://web.alfredstate.edu/him/records/pocases/pocase001.pdf
http://web.alfredstate.edu/him/records/edcases/edcase001.pdf
http://web.alfredstate.edu/him/records/ipcases/ipcase001.pdf

To go to the next record, change the number from 001 to 002 and so on.

These cases are intended for acadamic purpose only. As per the website, you have permission to reuse this material for academic purposes, including printing and duplication, copying to media (e.g., CD-ROM), and/or saving on your school’s server for student access. You do not have permission to republish the records and/or answer keys for the purposes of profit.

Happy coding

Official ICD-9-CM Coding Guideline Changes W.E.F Oct 1st 2010

Coding Convention Change:

The word "with" should be interpreted to mean "associated with" or "due to"  when it appears in a code title, the Alphabetic Index, or an instructionsl note in the Tabular List.

Coding Guideline Change:

Hypertensive Chronic Kidney Disease

Assign codes from cagetory 403, Hypertensive chronic kidney disease, when conditions classified to category 585 or code 587 (renal sclerosis) are present with hypertension.

Renal sclerosis code 587 is added in this guideline along with category 585.

Please find the complete list of ICD-9-CM guidelines effective October 1st, 2010 at the below link.

Referrence: http://www.cdc.gov/nchs/data/icd9/icdguide10.pdf

Spell Alike Medical Words

ilium: It is a part of pelvic bone.

iIleum: it is a part of small intestine.

Urethra: It is a tube leading from urinary bladder.

Ureter: It is one of two tubes each leading from a single kidney and inserting into the urinary bladder.

Spinal column: It is a back bone or vertebrae. It is a bony tissue.

Spinal cord: Nerves surrounded by the spinal column. It is a nervous tissue.

Coccus:  It is berry shaped bacterium grows in twisted chains.

Cocci:  It is also berry shaped  bacteria grows in small clusters.

Dysphagia:  difficulty in swallowing.

Dysphasia:  partial or complete impairment of the ability to use or understand speech; caused by disease of, or injury to the brain (such as in a stroke).

Test Yourself Medical Terminology-3

1. -eal

A. process
B. formation
C. pertaining to
D. full of

2. -iac

A. process
B. pertaining to
C. formation
D. full of

3. -ior

A. pertaining to
B. process
C. formation
D. full of

4. -ose

A. formation
B. pertaining to
C. full of
D. both B & C

5. -ical

A. formation
B. process
C. full of
D. pertaning to






Answers: 1-C; 2-B; 3-A; 4-D; 5-D

Test Yourself Medical Terminology-2

1. -sis

A. to cut
B. condition
C. state of
D. both B and C

2. -cis

A. to cut
B. condition
C. state of
D. both A and C

3. -osis

A. to cut
B. condition
C. state of
D. both A and B

4. -y

A. to cut
B. condition
C. state of
D. none

5. -al

A. to cut
B. condition
C. state of
D. pertating to






Answers: 1-C; 2-A; 3-B; 4-B; 5-D.

Test Yourself Medical Terminology-1

1. -ectomy

A. to cut into
B. excision of
C. both A & B.
D. none

2. -ic

A. pertaining to
B. process
C. produced by
D. produced in

3. epi-

A. around
B. below
C.above
D.within

4. endo-

A. below
B. out
C. within
D. towards

5. trans

A. above
B. below
C. upon
D. across






Answers: 1-B; 2-A; 3-C; 4-C; 5-D.