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Coding Q&A

HCPro Coder Connection, June 2, 2004

Read the following coding questions and pick the appropriate codes. How well do you know your codes?

 

Questions:

 

1. What is the appropriate code for the magnetic resonance imaging (MRI) of the brain with and without contrast, and an MRI of the internal auditory canals?

 

2. What observation code is appropriate for patients directly admitted to the facility from a physician's office, skilled nursing facility, or assisted living facility who do not meet the criteria for payable observation, code G0244?

 

3. How should you code the removal of two colon polyps from the sigmoid colon, one by snare technique and the other by hot biopsy technique?

 

Answers:

 

1. Code 70533, "MRI, Brain; without contrast material, followed by contrast material and further sequences," according to CPT Assistant, July 2001. The imaging of the brain includes the internal auditory canals and therefore reflects the appropriate code.

 

2. Use code G0264. When patients are directly admitted to the facility from a physician's office, skilled nursing facility, or assisted living facility, there is no clinic or emergency department (ED) code to generate the aforementioned patient. That is why CMS created this code.

 

This code tells the FI that the patient did not arrive at the facility through a standard point-of-care entry route (i.e., ED or clinic) and that because the patient does not meet qualifications for payable observation, the facility will essentially receive no payment for any E/M services that the facility provided on the technical side. Never code G0264 with an ED or clinic E/M code.

 

3. Report code 45385, "Colonoscopy with removal of tumor(s), polyp(s), or other lesion(s) by snare technique" and code 45384, "Colonscopy with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery."

 

According to CPT coding guidelines, you look at the number of techniques used to remove the polyps, not the number of polyps removed when determining which codes to use. Therefore these two codes can be reported together for the same encounter because two separate lesions were removed by two separate techniques.

 

This week's HCProCoder Connection was adapted from the May 2004 APC Answer Letter. Go to http://www.hcmarketplace.com/Prod.cfm?id=579 for more information or to order or call our Customer Service Department at 800/650-6867.

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