Coding IR Example-Aortogram and bilateral lower extremity angiogram

Procedures performed: Aortogram, Selective bilateral lower extremity angiography.

Indications for procedure: A 53-year-old patient with HTN, hyperlipidemia, DM II and leg pain that comes for arteriogram evaluation.

Procedure: After informed consent, the patient was brought, prepped and draped in the usual fashion. Under sterile conditions and local anesthesia percutaneous access was obtained using a 4F introducer in the left femoral artery using the modified Seldinger technique. A total of 80 ml of contrast was utilized during the procedure. Catheter was placed suprarenal, dye was injected and aortogram was obtained. And, the catheter was pulled back and kept at the aortic bifurcation, dye injected, bilateral pelvic angiograms were performed by power injector using a 4F pigtail catheter that was advanced with the help of 0.035 inch Terumo wire. Then, the catheter was advanced contra-lateral into the superficial femoral artery with the help of wire. Selective angiography of the lower extremity was performed. Finally, the catheter was pulled out and ipsilateral lower extremity angiography was performed through the artery introducer.

Abdominal aorta-iliac & pelvic arteriogram: The infra-renal abdominal aorta and the renal arteries are patent. The common, internal and external iliac arteries have minimal irregularities. The distal left common iliac artery has 75% stenosis. The left internal and external iliac arteries have minimal irregularities.

Left lower extremity arteriogram: The common & deep femoral and popliteal arteries have non-obstructive plaques. The proximal and distal superficial femoral artery has heavily calcified 75% to 85% lesions. The proximal anterior and posterior tibial arteries are occluded. The rest of the tibioperoneal arteries and branches are patent.

Right lower extremity arteriogram: The common & deep femoral and popliteal arteries have non-obstructive plaques. The mid SFA has a heavily calcified occlusion reconstitute by bridge collaterals. The proximal anterior tibial artery is occluded. The rest of the tibioperoneal arteries and branches are patent.

Impression: Obstructive peripheral arterial disease (PAD).

Codes:

ICD-9-CM: 440.20, 401.9, 272.4, 250.00

CPT: 36247, 75716 and 75774.

Hints: Ipsilateral pull back injections are not coded with 75774 as 75774 is a selective angiography code.

Coding Hip Hemiarthroplasty

Question: This 47-year-old female had a mechanical fall and sustained left femoral neck fracture and underwent a left hemiarthroplasty of the hip. Can we coded it with 27125?

Answer: No. Code it with 27236. Hemiarthroplasty done for the fractures is coded with 27236 and hemiarthroplasty done for conditions like osteoarthritis is coded with 27125.

CCS prep-Sample Medical Terminology Questions

1.       What is the meaning of metacarpophalangeal arthrodesis?

A.      Division of the metacarpophalangeal joint.

B.      Excision of the joint

C.      Fusion of the metacarpophalangeal joint.

D.      None.

2.       Patient had an abnormal clinical finding of steatorrhea. What is steatorrhea?

A.      Excessive fat in feces.

B.      Excessive fat accumulation in buttocks.

C.      A blood condition.

D.      Excessive sweating.

3.       What is steatopyegia?

A.      Excessive fat in feces.

B.      Excessive fat accumulation in buttocks.

C.      A blood condition.

D.      Excessive sweating.

4.       Which of the following is not a bone?

A.      Sacrum

B.      Humerus

C.      Ileum

D.      Phalanx

5.       Which of the following is a both exocrine and endocrine gland?

A.      Pancreas

B.      Liver

C.      Pituitary

D.      Thyroid

Answers:  1-C; 2-A; 3-B; 4-C; 5-A.

Interventional Radiology and Cardiovascular Certification-CIRCC

AAPC (Americal Academy of Professional Coders) is offering a speciality certification for interventional radiology and cardiovascular coders called CIRCC (Certified Interventional Radiology Cardiovascular coder). The first and only certification of its kind, the CIRCC signifies that an individual has achieved a high level of coding education and that his/her proficiency and accuracy in interventional radiology and cardiovascular coding and charging has been validated.

Although experience is not requirement to write the test, AAPC strongly recommends that the candidate at least have two years of experience in IR and cardiovascular coding.

CIRCC Exam covers the following :

1. Diagnostic angiography

2. Non-vascular interventions

3. Percutaneous vascular interventions

4. Diagnostic cardiac catheterization

5. Basic coronary arterial interventions

6. ICD-9

7. Anatomy

8. Terminology

Exam info:

This exam will have 150 multiple choice questions and you will have 5 hours 40 minutes to finish the exam.  If you fail, you will have one more chance to retake the exam. And, it is a open code book exam. You can take CPT and HCPCS level II code books and a set of anatomical charts.

Will post some sample IR reports next..

Resource: AAPC website.

Terms Which We Use Frequently In IR Coding

Antegrade- In the direction of flow.

Retrograde-In opposite direction to the flow.

Contralateral-Pertaining to the opposite side.

Ippisilateral-Pertaining to the same side.

Bifurcation-Place where division occurs.

First order-It is primary vascular branch of aorta or the vessel punctured during angiography.

Second order-Branch of first order.

Third order-Branch of second order.

Selective Cath-Catheterization of 1st, 2nd or 3rd or heigher vessel.

Nonselective Cath-Catheter placement in aorta, vena cava, or the vessel punctured.

Common Interventional Radiology procedures

• Angiography: imaging the blood vessels to look for abnormalities with the use of various contrast media, includingiodinated contrast, gadolinium based agents, and CO2 gas.

• Balloon angioplasty/stent: opening of narrow or blocked blood vessels using a balloon; may include placement of metallic stents as well (both self-expanding and balloon expandable).

• Chemoembolization: delivering cancer treatment directly to a tumour through its blood supply, then using clot-inducing substances to block the artery, ensuring that the delivered chemotherapy is not "washed out" by continued blood flow.

• Cholecystostomy: placement of a tube into the gallbladder to remove infected bile in patients with cholecystitis, an inflammation of the gallbladder, who are too frail or too sick to undergo surgery

• Drain insertions: placement of tubes into different parts of the body to drain fluids (e.g., abscess drains to remove pus, pleural drains)

• Embolization: blocking abnormal blood (artery) vessels (e.g., for the purpose of stopping bleeding) or organs (to stop the extra function e.g. embolization of the spleen for hypersplenism) including uterine artery embolization for percutaneous treatment of uterine fibroids. Various embolic agents are used, including alcohol, glue, metallic coils, poly-viny alcohol particles, Embospheres, encapsulated chemo-microsphere, and gelfoam.

• Thrombolysis: treatment aimed at dissolving blood clots (e.g., pulmonary emboli, leg vein thrombi, thrombosed hemodialysis accesses) with both pharmaceutical (TPA) and mechanical means

• Biopsy: taking of a tissue sample from the area of interest for pathological examination from a percutaneous or transjugular approach

• Radiofrequency ablation (RF/RFA): localized destruction of tissue (e.g., tumours) by heating

• Cryoablation - localized destruction of tissue by freezing

• Line insertion: Vascular access and management of specialized kinds of intravenous devices (IVs) (e.g. PIC lines, Hickman lines, subcutaneous ports including translumbar and transhepatic venous lines)

• IVC filters: - metallic filters placed in the inferior vena cavae to prevent propagation of deep venous thrombus, both temporary and permanent.

• Vertebroplasty: percutaneous injection of biocompatible bone cement inside fractured vertebrae

• Nephrostomy placement: Placing a catheter directly into the kidney to drain urine in situations where normal flow of urine is obstructed. NUS catheters are nephroureteral stents which are placed through the ureter and into the bladder.

• Radiologically Inserted Gastrostomy or RIG: Placement of a feeding tube percutaneously into the stomach and/or jejunum.

• Dialysis access and related intervention: Placement of tunneled hemodialysis catheters, peritoneal dialysis catheters, and revision/thrombolysis of poorly functioning surgically placed AV fistulas and grafts.

• TIPS : Placement of a Transjugular Intrahepatic Porto-systemic Shunt (TIPS) for management of select patients with critical end-stage liver disease and portal hypertension

• Biliary intervention - Placement of catheters in the biliary system to bypass biliary obstructions and decompress the biliary system. Also placement of permanent indwelling biliary stents.

• Endovenous laser ablation of varicose veins - Placement of thin laser fiber in varicose veins for non-surgical treatment of venous insufficiency.

Happy Coding!!

CPT Coding Revision of Pocket of Port-A-Cath

Coding Question.

Question: This 53-year-old female is having endometrial carcinoma and undergoing chemotherapy through Port-A-Cath. Her left anterior chest port was partially exposed; therefore preservation by revision was recommended. After infiltrating with Xylocaine, skin incision was done and the port was exposed completely. The capsule surrounding it was excised and a new pocket was developed and the port was secured to the chest wall in its new pocket. Can we code it to 36576?

Answer: No, code 17999. We cannot code 36576, because no repair is done to the catheter. He is doing only revision of the subcutaneous pocket of port. So, it comes under skin and integumentary section of the CPT and; since we do not have any code which describes subcutaneous pocket revision, code it with unlisted 17999. You might need to submit an additional report/information.

Opthalmology Abbreviations

Here is a list of opthalmology abbreviations which I came across while coding opthalmology records. Will update as and when get the new ones.

AMD: Age-related macular degeneration

CACD: Central areolar choroidal dystrophy

CHA: Compound hyperopia and astigmatism

CHAP: Compound hyperopia, astigmatism, and presbyopia

CHMP: Compound hyperopia, myopia, and presbyopia

CMA: Compound myopia, astigmatism

CMAP: Compound myopia, astigmatism and presbyopia.

CME: Compound myopia, esotropia.

COP: Capillary osmotic pressure

CR Scar: Chorioretinal scar

CRVO: Central retinal vein occlusion

CRVT: Central retinal vein thrombosis.

CSC: Central serous chorioretinopathy.

CSME: Cotton-spot macular edema or clinically significant macular edema

CVO: Central vein occlusion.

HVF: Humphrey visual field

IOL: Intraocular lens

IOP: Intraocular pressure

LASIK: Laser-assisted in situ keratomileusis

MHA: Myopia, hyperopia, and astigmatism

NPDR: Non-proliferative diabetic retinopathy.

NV: Near vision.

OD: Right eye

OS: Left eye

OU: Both eyes

PDR: Proliferative diabetic retinopathy

PERRL: Pupils equal, round and reactive to light.

PERRLA: Pupils equal, round, reactive to light and acoommodation

POAG: Primary open angle glaucoma

SH: Simple hyperopia

SHA: Simple hyperoptia and astigmatism

SM: Simple myopia

SMA: Simple myopia and astigmatism

VA: Visual acuity

VF: Visual field

Coding Glaucoma Screening

What is Glaucoma?

Glaucoma represents a family of disease commonly associated with the optic nerve damage and visual field changes. It is the second leading cause of the irreversible blindness in the US. Open angle glaucoma is the most common form of glaucoma.

Glaucoma occurs when increased fluid pressure in the eye presses against the optic nerve, causing damage. The damage to optic nerve fibers can cause blind spots to develop. These blind spots usually go undetected until the optic nerve is significantly damaged. If the entire optic nerve is destroyed, blindness results.

Why Glaucoma screening?

Since the glaucoma progresses with little or no warning signs or symptoms, and vision loss from glaucoma is irreversible, it is very important that people at high risk for the disease receive an annual screening. Studies have shown that early detection and treatment of glaucoma, before it causes major vision loss, is the best way to control the disease. The glaucoma screening covered by Medicare includes:

            A dilated eye examination with an intraocular pressure (IOP) measurement, and

            A direct opthalmoscopy examination or a slit-lamp biomicroscopic examination.

Who are eligible for glaucoma screening?

Anyone can develop glaucoma; however, some risk factors that may increase an individual’s chances of developing glaucoma include age, race, family history and medical history. Medicare provides an annual screening for beneficiaries in at least one of the following high risk groups:

                        Individuals with diabetes mellitus

                        Individuals with a family history of glaucoma

                        African-American ages 50 or over, and

                        Hispanic-Americans age 65 or over.

Coding:

Diagnosis is coded with V80.1 and HCPCS are coded with G0117 and G0118

For detailed information on Glaucoma screening refer to http://www.cms.gov/MLNProducts/35_PreventiveServices.asp

October 1st 2010 ICD-9-CM Code Updates-4

752.3-Subcategory 752.3, other anomalies of uterus, is expanded to 7 new codes.

                752.31-Agenesis of uterus

                752.32-Hypoplasia or uterus

                752.33-Unicornuate uterus

                752.34-Bicornuate uterus

                752.35-Septate uterus

                752.36-Acuate uterus

                752.39-Other anomalies of uterus

Coding Question:

Question: Is anomaly of uterus due to exposure to diethylstilbestol coded to 752.39, other anomalies of uterus?

Answer: No. It is coded to 760.76, as per excludes note under 752.39.

752.4- Anomalies of cervix, vagina, and external female genitalia. Four new codes were added to subcategory 752.4. And, the code 752.49, other anomalies of cervix, vagina, and external female genitalia is revised.

                752.43-Cervical agenesis

                752.44-Cervical duplication

                752.45-Vaginal agenesis

                752.46-Transverse vaginal septum

                752.47-Longitudinal vaginal septum

780.3-Convulsions. A new code 780.33, post traumatic seizures is added to the subcagetory 780.3.

Coding Question:

Question: How is post traumatic epilepsy is coded?

Answer: Post traumatic epilepsy is coded with a code from series 345.00 to 345.91, depending on type of epilepsy specified.

784.9-Other symptoms involving head and neck. A new code for Jaw pain 784.92 is added to the subcategory 784.9.


Refer also:
October 1st 2010 ICD-9-CM Code Updates-1
October 1st 2010 ICD-9-CM Code Updates-2
October 1st 2010 ICD-9-CM Code Updates-3
Official ICD-9-CM Coding Guideline Changes W.E.F Oct 1st 2010

Please find the complete list of new, deleted and revised codes here:
http://www.cms.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp#TopOfPage