HCPro.com - Coding Educator

Hot Shot Pop Quiz

Mon, 16 Nov 2009 15:38:00 GMT

Do you know the answer to the question below? If so, submit your name and answer to Editor Lori Levans at llevans@hcpro.com. Each correct answer will be entered into a drawing with a chance to win a surprise. The winner will be announced in next month's issue.

What code describes gastronomy with suture repair of bleeding ulcer?

The winner from October was Ilona Waksmundzki, RHIT, coding specialist at Provena St. Joseph Hospital in Elgin, IL. Congratulations! Ilona won a FREE HCPro 2010 ICD-9-CM Coding Manual.The correct answer to the question "What code(s) describe the nausea you may have experienced due to turbulence on a flight to the AHIMA national convention" is code 994.6.

Class Act

Mon, 16 Nov 2009 15:28:00 GMT

NAME: Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CCDS

HOMETOWN: Richmond (Chesterfield), VA

INSTRUCTS: Certified Coder Boot Camp® - Original Version and Certified Coder Boot Camp® - Inpatient Version, Evaluation and Management Boot Camp – Professional Services Version

MOST CHALLENGING CODING AREA: I personally find that interventional Radiology is the most challenging area of coding. There are just so many rules to remember!!

FIRST CODING JOB: My first job was as an inpatient coder for a local hospital. I found out quickly that I talk WAY too much to be an inpatient coder full time!!

MOST EXCITING TRAVEL EXPERIENCE: The most exciting place I have taught a boot camp has to be Okinawa Japan back in 2004. As a very seasoned traveler, I am never worried about finding my way around (thank goodness for the GPS). But, it was quite intimidating to travel half way around the world by myself not speaking one word of Japanese (or better yet Okinawan) and not knowing a soul. Finding my way through the Nagoya airport to find my regional flight to Okinawa was quite an adventure considering there weren’t that many people who worked at the airport who spoke English. Luckily, there was a gentleman from England (who worked for a car distributor) helped me find my bus from the international terminal to the regional terminal. Arigato (thank you in Japanese) for reading this Coding Educator!

November is Diabetes Awareness Month

Mon, 16 Nov 2009 15:10:00 GMT

By Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CCDS

As children polish off the last bit of leftover Halloween candy, it comes to mind that sugar is not always every American’s friend. November is American Diabetes Month. There are approximately 18 million Americans who live with this disease. Diabetes is the body’s inability to produce or properly use insulin which is vital in converting sugar and starches into energy.

This disease has recently affected my mother and I have been so proud of her dedication to manage the condition with such a positive attitude. I have heard about her escapades of searching for the right glucose monitoring machine, finding the test strips, and effectively getting the blood sample into the monitoring machine – but that was only the beginning of her journey. She visited the dietician and was essentially told “no white stuff,” which included some of her favorite foods like potatoes and pasta.

There are a variety of underlying causes which lead to the development of diabetes. The causes can range from hereditary conditions, adverse effects of medications, pregnancy even preventable causes such as obesity.

There are a few major types of diabetes mellitus:

Type 1 – a condition where the body lacks the ability to produce insulin. Commonly referred to as “juvenile” diabetes because it is generally diagnosed in the adolescent years.
Type 2 – a condition where the body is unable to properly use insulin. Type 2 diabetes is the most common type and affects approximately 70% of those with diabetes.
Gestational – the condition develops during the anetpartum period and generally resolves postpartum. Only about 5-10% will be diagnosed as Type 2 diabetes.
Secondary – a condition due to an underlying cause such as a genetic condition, or other disease affecting the pancreas.

The common symptoms of diabetes are the “polys”: Polyuria (excessive urination), polyphagia (excessive hunger), polydipsia (excessive thirst). Other related symptoms can include unexplained weight loss, fatigue and blurry vision. Many patients are relatively asymptomatic therefore it is estimated that approximately 6 million people either have the disease or are suffering from the early signs of development of the disease known as “pre-diabetes”.

Routine testing for diabetes should be integral to a patient’s health care maintenance especially if there is a family history of the disease. Screenings can be performed via simple lab tests like Fasting Plasma Glucose Test or the Oral Glucose Tolerance Test.

Preventative measures, include things we should be doing routinely anyway; healthy diet, exercise, smoking cessation and reduction in alcohol consumption. Remember we only get one body, so we need to take care of it!

Complications and manifestations of diabetes should be a common concern for those with the disease. Diabetes mellitus is known to affect other organ systems such as the kidneys, eye, heart and vascular system.

Coding for diabetes depends on the type of diabetes and the absence or presence of complications and manifestations.

Type 1 – 250.x1 or 250.x3
Type 2 – 250.x0 or 250.x2
Gestational – 648.8x
Secondary – 249.xx

V58.67 can also be assigned for patient with long term (current) use of insulin.

There are many Americans who suffer from this often silent disease that is commonly overlooked or ignored. Please be aware of the warning signs and don’t hesitate to discuss your symptoms with your physician. The most common type of diabetes (Type 2) can be prevented with proper care.

I am sure many reading this have a loved one or even an acquaintance who suffers from a form of diabetes mellitus. Please join me in continuing to support people like my mother in dealing with this disease. We need to focus on taking care of ourselves and making the right decisions concerning diet and exercise so that we can hopefully avoid being in her shoes in 25 years. In fact, my best buddy (my dog, Damian) is looking at me now wanting to go on yet another walk… where are my tennis shoes??? Let’s go!

Beyond the Code

Mon, 16 Nov 2009 05:10:00 GMT

November 16, 1907.

Oklahoma becomes the 46th state.

Go Pink for Breast Cancer Awareness Month

Mon, 19 Oct 2009 05:00:00 GMT

By Jennifer Avery, CCS, CPC, CPC-H CPC-I

Breast cancer is a personal issue for me. There are several members of my family who have either had breast cancer or suffer from fibroids and I have to go for routine mammograms each year due to my own past personal history of Fibrocystic Breast Disease and strong family history. When I turned 18 I was promoted from screening to diagnostic mammograms on both breasts. And I used to have to follow those procedures with an ultrasound.

Therefore I feel breast cancer awareness is an extremely important topic, one I can’t stress enough. Breast cancer is the most common type of cancer among American women and is the second leading cause of death. The disease affects mostly women, but there is an increasing number of documented cases of male breast cancer.

Breast cancer is a malignant neoplasm (i.e., abnormal growth) that starts from cells from the breast. Most breast cancers begin in the ducts (i.e., ductal cancer), the tiny tubes that carry milk from the lobules to the nipple. Other women get lobular cancer, which forms in the cells that line lobules (i.e., the milk-producing glands). A smaller portion of breast cancer patients have tumors that form in other tissues. Breast cancer can metastasize (spread) to the other parts of the body. It is extremely important to identify if the cancer cells have spread to the lymph nodes, as this increases the chance that the cancer cells have reached the bloodstream and through it, other parts of the body. The more lymph nodes that have breast cancer, the more likely the cancer will be found in other organs as well.

There is some good news! Most breast lumps are not cancerous. However, patients with these benign neoplasms may need to have them sampled and viewed by a physician to verify they are not cancer. Most lumps turn out be fibrocystic (e.g., fibroids and cysts) changes. Other types of benign tumors such as fibroadenoma or interductal papilloma are abnormal growths, but they are not cancerous. Although these are all considered benign tumors, it is extremely important that women continue routine checks if they have them as they put women at a higher risk for developing breast cancer in the future.

Risk factors for breast cancer

Risk factors don’t tell us who will develop breast cancer and who won’t. There are many cases where a woman develops breast cancer but has no risk factors and there are others who have high risk factors and never develop the disease. Of course, monitoring personal behavior (e.g., not smoking or drinking excessively, watching your diet, limiting contact with cancer-causing agents) is recommended.

Some risk factors of breast cancer cannot be changed. For instance, gender (women are at a higher risk than men), age (women older than 55 are more likely to develop invasive breast cancer than those under the age of 45) and genetic risk factors (BRCA1 and BRCA2 gene mutation is the most common cause of hereditary breast cancer) all play a role. Family history of breast cancer also increases a person’s chance of developing breast cancer. Having one family member with the disease doubles your chances; having two relatives increases your chances five-fold. Ethnicity is another risk factor—Caucasian women are at a higher risk than other ethnicities. However, African-American women who develop the disease are more likely to die from breast cancer.

There are other risk factors such a dense breast tissue, which makes cancer more difficult to detect. Because of this, effective October 1, 2009 there is a new diagnosis code 793.82 to identify an inconclusive mammogram.

Finally, certain benign breast conditions can increase your risk for developing breast cancer. Physicians divide these benign conditions into three categories:

Nonproliferative (i.e., fibrocystic breast disease)
Proliferative (i.e., ductal hyperplasia)
Proliferative with atypia (i.e., atypical ductal hyperplasia or atypical lobular hyperplasia)

Proliferative can increase your chances of getting breast cancer by 150–200% whereas proliferative with atypia can increase your chances of developing breast cancer by 400-500%.

Detection and diagnosis

Detection or diagnosis of breast cancer generally involves self-breast examinations and screening mammograms. If you or your physician finds something during a screening test or if other signs and symptoms are present, there are several diagnostic options. Imaging tests such as diagnostic mammograms, digital mammograms, computer-aided detection and diagnosis (CAD), magnetic resonance imaging (MRI) of the breast, breast ultrasounds, ductograms, and newer imaging tests such as scintimammography and tomosynthesis are all available. Other diagnostic tests such as nipple discharge exam and ductal lavage and nipple aspiration. Physicians can also use biopsies such as fine-needle aspiration, core needle biopsy, vacuum-assisted biopsies, open surgical biopsy, lymph node dissection and sentinel lymph node biopsy to detect whether a lesion is benign or malignant, the type of cancer, and whether the cancer has spread to the lymph nodes.

Some of the common terms used to talk about breast cancer are adenocarcinoma, carcinoma in situ, and invasive/infiltrating carcinoma. Adenocarcinoma is cancer that begins in the glands such as the ducts and lobules of the breast. Carcinoma in situ is a term to describe cancer that is confined to the ducts or the lobules. These cancers have not grown into the deeper tissue of the breast or spread to other organs. Invasive or infiltrating carcinoma is a term to describe cancer that has spread beyond the layer of cells where it began. Most breast cancers are invasive or infiltrating.

A pathologist will also assign a grade to the cancer, which is based on how closely the biopsy sample resembles normal breast tissue. The grade is used to determine the woman’s prognosis. This is one time that a lower grade is better! The lower grade indicates a slower-growing cancer that is less likely to spread, while a higher number indicates a faster growing cancer that is more likely to spread. The tumor grade is one of the tools used to determine further treatment after surgery.

Treatments for breast cancer

Treating breast cancer is as individual as breast cancer itself. A physician will determine the course of treatment that is best for the type and grade of breast cancer. Surgical removal such as a lumpectomy or partial (segmental) mastectomy, known as breast conserving surgery, is an option for those with stage I or II breast cancer. However, for some women, mastectomy is more likely the course of treatment.

Radiation therapy using ionizing radiation is often given after surgical removal. It can be given one of two ways: through external beam radiation, which is the most common, or accelerated breast irradiation. Accelerated breast irradiation involves larger doses of radiation over a shorter period of time. Brachytherapy is another form of radiation a physician might recommend. It involves internal radiation using radioelements (seeds or pellets) placed into the breast tissue. Tumor size, location and other factors determine whether brachytherapy is an option. Chemotherapy is also common choice for treatment of breast cancer. It involves the use of oral or intravenous cancer-killing drugs generally given in cycles. Hormone therapy is another option, and it is often used as an adjuvant therapy to help reduce the risk of recurrence. It can also be used to treat a cancer that has come back or spread after treatment.

Breast cancer coding

For a patient admitted for the treatment of a malignant neoplasm of the breast by chemotherapy or radiation therapy, the first listed code is either V58.0, radiotherapy or V58.1x, chemotherapy. Use additional code(s) to identify the malignant neoplasm that is being treated. However, if the patient is admitted for surgical treatment of the malignant neoplasm and receives radiation/chemotherapy, the first listed code should be the malignant neoplasm.

Coding for hormone therapy such as Tamoxifen can be tricky as it is used treat breast cancer as well as prevent the recurrence, so it is extremely important for the physician’s documentation specify which scenario is the case. In 2008 a new code (V07.5x) was created to identify the use of prophylactic agents affecting estrogen receptors and receptor levels. (The fifth digit identifies the specific type of drug.) Code V07.5x is only for use as an additional diagnosis.

Coders should also use additional codes to identify whether the patient has a personal or family history of breast cancer. There seems to be some conflicting information between the coding guidelines in the ICD-9 Manual and Coding Clinic when Tamoxifen is involved. According to the Manual, coders should first report the applicable malignant neoplasm. However, per Coding Clinic 4th quarter 2008, coders should only report the malignant neoplasm when Tamoxifen is given prophylactically, but not when it is used for active treatment. Therefore, it would not be inappropriate to use this code with malignant neoplasm of the breast. However, keep in mind that a patient being treated with Tamoxifen may have a family history of breast cancer but never had the disease themselves.

Herceptin is another drug that is generally prescribed for five years post-surgery to treat HER2 positive breast cancer. This drug is administered intravenously on a weekly basis. According to Coding Clinic 3rd quarter 2009, coders should report code 174.9, malignant neoplasm of the breast, as the first listed diagnosis and V58.69 as an additional diagnosis for the Herceptin maintenance.

When it comes to coding for the malignant neoplasm keep in mind the general coding guidelines: First code the neoplasm being treated, which could be either a primary or secondary malignant neoplasm. For complications of malignant neoplasm, chemotherapy or radiation therapy that warrant an admission, code first the complication followed by the malignant neoplasm. When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, code personal history of breast cancer V10.3 to identify the former site of the malignancy.

Editor's note: Jennifer Avery, CCS, CPC, CPC-H CPC-I, is a regulatory specialist for HCPro, Inc. You can e-mail her at javery@hcpro.com.

Class Act

Mon, 19 Oct 2009 05:00:00 GMT

NAME: Jennifer Avery, CCS, CPC-H, CPC, CPC-I

HOMETOWN: Niles, MI

INSTRUCTS: Certified Coder Boot Camp® - Original Version and Certified Coder Boot Camp® - Inpatient Version

ICD-10: LOVE IT OR HATE IT: I’m looking forward to ICD-10 as I believe it will give us a lot more specificity.

IF YOU WEREN’T GOING TO TEACH CODING, WHAT WOULD YOU WANT TO BE: A party/bridal consultant

WEIRDEST TRAVEL EXPERIENCE: One time I went to Salt Lake City with a co-worker for a project. We arrived Saturday and we decided that because our meeting wasn’t until Monday we would drive to Vegas for the weekend. My co-worker drove the rental car and somehow got us turned in the wrong direction. We ended up in Reno, Nevada, which is a lot farther away. But we made the best of it, and it was definitely an adventure!

Hot Shot Pop Quiz

Mon, 19 Oct 2009 05:00:00 GMT

Do you know the answer to the question below? If so, submit your name and answer to Managing Editor Andrea Kraynak, CPC-A, at akraynak@hcpro.com. Each correct answer will be entered into a drawing with a chance to win a surprise. The winner will be announced in next month's issue.

What code(s) describe the nausea you may have experienced due to turbulence on a flight to the AHIMA national convention?

The winner from September was Sandra Dudley, CPC, CEMC, Coding & Reimbursement Supervisor for the Physician Practice Network in Harrisburg, PA. Congratulations! Sandra won a FREE 2010 Coding Manual. The correct answer to the question "What is the correct code to report a complete radiologic examination of left knee?" is code 73564-LT.

Beyond the Code

Mon, 19 Oct 2009 05:00:00 GMT

This day in history

October 19, 1781

British troops surrendered at Yorktown, VA and the American Revolution neared its end.

Prostate Health Month: Show your awareness

Mon, 21 Sep 2009 05:00:00 GMT

By Peggy S. Blue, MPH, CPC, CCS-P

Most people are aware of the very successful educational campaign of the pink ribbon signifying breast cancer awareness. But do you know what a light blue ribbon represents? A light blue ribbon is the symbol for prostate cancer. The American Foundation for Urologic Disease (AFUD) has designated September as Prostate Health Month.

The prostate is a gland that is part of the male reproductive system. It is located in front of the rectum and just below the bladder. The main function of the prostate is to produce fluid for semen, which transports sperm. Approximately the size of a walnut, the doughnut-shaped prostate wraps around the urethra, the tube through which urine exits the body.

Prostate problems are very common. Eight in 10 men will eventually develop an enlarged prostate and one in 10 men will develop prostate cancer. Prostate cancer is the second most common type of cancer among men in this country, following skin cancer. Approximately 37,000 American men die annually from prostate cancer—often because they were diagnosed too late. Despite the prevalence of prostate disease, many men lack awareness about prostate health and many are also reluctant to seek treatment.

Physicians can check for prostate cancer before any symptoms have occurred. During an office visit, the physician may perform a digital rectal exam (DRE) and/or draw a blood specimen, usually from the patient’s arm, to test for a prostate-specific antigen (PSA).

Coding Tip: Medicare requires coders to report prostate cancer screening DREs and screening PSA blood tests using screening diagnosis code V76.44 (special screening for malignant neoplasms, prostate).

Fear of the digital rectal exam is probably one of the biggest reasons that men avoid important screening services for prostate cancer. The bottom line (get it?) is that it only takes a few seconds. It may be somewhat uncomfortable, but it’s not very painful. The doctor inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall to check for hard or lumpy areas. (The AFUD also notes the irony of having the month of September declared as both Prostate Health Month and National Chicken Month.)

Coding Tip: The digital rectal exam for prostate cancer screening is represented by code G0102. Code G0102 is bundled into payment with a separately payable evaluation and management (E/M) service when the physician performs both on the same day. When the physician performs code G0102 by itself or with a noncovered preventative E/M, then it is separately payable by Medicare.

The physician may also order a blood test to check a patient’s PSA level. PSA levels above a certain level—usually 4 nanograms per mL—is considered abnormal.

Coding Tip: Report a screening PSA test with code G0103. A laboratory performs and bills the test. Report the physician’s collection of the specimen by venipuncture with code 36415.

The DRE and PSA test can detect a problem in the prostate. However, they can't show whether the problem is cancer or a less serious condition. When a patient has abnormal test results, the physician may suggest other tests to make a diagnosis. For example, the physician may include other tests (e.g., a urine test to check for blood or infection). Additionally, the physician may order other procedures (e.g., a transrectal ultrasound or ultrasound guidance with a biopsy).

When performing a transrectal ultrasound, physicians insert a probe into the rectum to check for abnormalities. The probe sends out sound waves, which bounce off the prostate. A computer uses the echoes to create a sonogram.

Coding Tip: Procedure code 76872 represents a transrectal ultrasound. Coders may break the procedure down by the professional component (with modifier -26) and technical component (with modifier -TC). Remember to report the appropriate modifier if you are not billing for the global service.

The physician may also perform a prostate biopsy with the aid of ultrasound guidance.

Coding Tip: CPT code 76942 (ultrasonic guidance for needle placement) describes an ultrasound used to localize a mass or region to be biopsied with a needle, and to guide the needle into the mass or region. Again, modifier -26 or -TC would apply when coders bill for only one component of the imaging service.

The purpose of the biopsy is to remove tissue to look for cancer cells. It's the only definitive way to diagnose prostate cancer. During the procedure, the physician inserts needles through the rectum into the prostate and removes small tissue samples from several areas. A pathologist then checks the tissue samples for cancer cells.

Coding Tip: The biopsy code will depend on how the physician performed the biopsy. Use code 55700 to describe a needle biopsy of the prostate.

Editor's note: Peggy S. Blue, MPH, CPC, CCS-P, is a regulatory specialist for HCPro, Inc. You can e-mail her at pblue@hcpro.com.

Class Act

Mon, 21 Sep 2009 05:00:00 GMT

NAME: Peggy S. Blue, MPH, CPC, CCS-P

HOMETOWN: Wrightsville, PA

INSTRUCTS: Certified Coder Boot Camp® - Original Version and Medicare Boot Camp® - Physician Services Version

ICD-10: LOVE IT OR HATE IT: Love it, I suppose. It’s about time we catch up with the rest of the world.

IF YOU WEREN’T GOING TO TEACH CODING, WHAT WOULD YOU WANT TO BE: Rich and retired.

WEIRDEST TRAVEL EXPERIENCE: On one of my recent flights, I was sitting next to a woman whom I had never met before, but we had so many things in common. She bought a parcel of land next to my house at a real estate auction, she went to school with some really good friends of mine, some really good friends of hers had recently been to my house, and on and on it went. Sometimes it’s such a small world.

Hot Shot Pop Quiz

Mon, 21 Sep 2009 05:00:00 GMT

What is the correct code to report a complete radiologic examination of left knee?

The winner from August was Deborah Herrera, CPC, from El Rio Health Center in Tucson, AZ! Congratulations! Deborah won a FREE 2009 ICD-9 Manual. The correct answer to the question "Which is the correct code to report for acute diastolic heart failure?" is code 428.31.

Beyond the Code

Mon, 21 Sep 2009 05:00:00 GMT

TODAY IN HISTORY:

September 21, 1981

Sandra Day O'Conner becomes the first female Supreme Court Justice.

August is Cataract Awareness Month: Keep your eyes safe this summer

Mon, 17 Aug 2009 05:00:00 GMT

By Joe Rivet, CPC, CCS-P, CEMC, CICA

Don't forget the importance of eye health as you enjoy your summer and the outdoor activities that go with it.

Unfortunately, if a person lives long enough, chances are very likely he or she will have some degree of cataract. But it is possible to delay or slow the disease. Wearing proper sunglasses and hats with a brim to block the sunlight is a good start.

The American Academy of Ophthalmology offers these tips to protect your eyes from the sun:

Don't focus on the color or darkness of sunglass lenses: Select sunglasses that block UV rays. Don’t be deceived by color or cost. The ability to block UV light is not dependent on the price tag.
Check for 100 percent UV protection: Make sure your sunglasses block 100 percent of UV rays and UV-B rays.
Choose wrap-around styles: Ideally, your sunglasses should wrap all the way around to your temples, so the sun's rays can't enter from the side.
Wear a hat: In addition to your sunglasses, wear a broad-brimmed hat to protect your eyes.
Don't rely on contact lenses: Even if you wear contact lenses with UV protection, remember your sunglasses.
Don't be fooled by clouds: The sun's rays can pass through haze and thin clouds. Sun damage to eyes can occur anytime during the year, not just in the summertime.
Protect your eyes during peak sun times: Sunglasses should be worn whenever you're outside. It's especially important to wear sunglasses in the early afternoon and at higher altitudes, where UV light is more intense.
Don't forget the kids: Everyone is at risk, including children. Protect their eyes with hats and sunglasses. In addition, try to keep children out of the sun between 10 a.m. and 2 p.m., when the sun's UV rays are the strongest.

Cataracts are very common in older people; they affect more than half of people 80 years age and older in the United States. Age-related cataracts occur when clumps of protein in the lens of they eye slowly change to a yellowish/brownish color, which affects vision.

Common cataract symptoms include:

Blurry vision
Colors that appear faded
Glare
Poor night vision
Double vision
Frequent prescription changes in your eye wear

Surgery is the typical treatment for cataracts. During the procedure a physician replaces the eye's clouded lens with a clear, artificial lens. The surgery typically takes less than an hour. If both eyes require surgery, the physician usually performs them separately, four to eight weeks apart.

There are three CPT codes that describe cataract surgery:

Code 66982: Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage
Code 66983: Intracapsular cataract extraction with insertion of intraocular lens prosthesis (one stage procedures)
Code 66984: Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification)

Code selection depends on the method of cataract extraction and complexity, Report codes 66982 or 66984 for extracapsular extraction or code 66983 for intracapsular extraction. For an extracapsular extraction, coders should the code based on whether it is complex (i.e., requiring devices or techniques not generally used in cataract surgery) using code 66982 or not complex, using code 66984.

In terms of diagnosis coding, coders will normally assign one code from the 366.XX series and one code from 367.XX series for refractive services.

Remember that it is common for a patient requiring cataract surgery on both eyes to undergo those surgeries a few weeks apart. Therefore, remember to append modifier -79 (unrelated procedure or service by the same physician during the postoperative period.) when coding for the procedure performed on the second eye. Check with your carrier regarding the necessity of reporting -LT and -RT modifiers as well.

Editor's note: Joe Rivet, CPC, CCS-P, CEMC, CICA, is a regulatory specialist for HCPro, Inc. You can e-mail him at jrivet@hcpro.com.

Class Act

Mon, 17 Aug 2009 05:00:00 GMT

NAME: Joe Rivet, CPC, CCS-P, CEMC, CICA

HOMETOWN: Detroit, MI

INSTRUCTS: Certified Coding Boot Camp – Original Version®, Evaluation & Management Boot Camp®

WEIRD TRAVEL EXPERIENCE: I was eating dinner in at a restaurant when I noticed a burning smell. I thought it might have been an entrée that was overcooked. But then the burning smell became stronger as time went on. After a certain point I could no longer handle the smell—not to mention smoke—so I left. As I walked to my car, the fire department showed up. It turned the problem was not a burned entrée, but that the building was on fire!

ICD-10: LOVE IT OR HATE IT: I think this is long overdue. We are one of the last industrialized nations to convert to ICD-10. Yes, the codes are going to be more specific, which some people grumbled about, however, many of the truncated codes will be simply one code. The hypertension table will no longer exist, and there will be many other modifications that will be big improvements. If you want to know more about my thoughts on ICD-10, you can visit the ICD-10 Watch blog at http://blogs.hcpro.com/icd-10/.

IF YOU WEREN’T GOING TO TEACH CODING, WHAT WOULD YOU WANT TO BE: A writer for a travel magazine. I’d love to travel the word and write about the locations and local restaurants.

Hot Shot Pop Quiz

Mon, 17 Aug 2009 05:00:00 GMT

Which is the correct code to report for acute diastolic heart failure?

The winner from June was Barbara Cronce-Roloson from Hills and Dales General Hospital in Cass City, MI! Congratulations! Barbara won a FREE 2009 ICD-9 Manual. The correct answer to the question "What code(s) describe anesthesia for third degree burn excision with skin grafting; 18% of body area?" is codes 01952 and 01953.

Beyond the Code

Mon, 17 Aug 2009 05:00:00 GMT

TODAY IN HISTORY:

August 17, 1978

The first successful trans-Atlantic balloon flight landed outside of Paris.

Enjoy the sun's rays but stay safe during Ultraviolet Safety Month

Mon, 20 Jul 2009 05:00:00 GMT

By: Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CCDS

Summer time is here! I don’t know about you but I could use a big dose of Vitamin D from the warm summer sun. Don’t we all feel like we look better and healthier with a slight summer glow?

I know how much I love being outdoors—whether I am working in my yard, sitting by the pool or relaxing at the beach. But it is important to remember that although the sun’s rays can be therapeutic, too much can be a health risk.

The sun’s rays are classified as UVA and UVB rays. While UVA rays take longer than UVB rays to damage the skin, they go deeper into the skin than UVB rays

Protecting ourselves from the sun’s rays is imperative during these hot summer months. Luckily, sunscreen SPF’s have gotten ridiculously high. I saw one on the shelf the other day that was SPF 100!

Protection is our best defense to prevent skin damage such as wrinkles, premature aging and skin cancer. The signs of skin cancer can be remembered easily by using the “ABCDE rule”.

Signs of skin cancer ABCDE rule:

Asymmetry: A mole that, when divided in half, doesn't look the same on both sides
Border: A mole with edges that are blurry or jagged
Color: Changes in the color of a mole, including darkening, spread of color, loss of color, or the appearance of multiple colors such as blue, red, white, pink, purple or gray
Diameter: A mole larger than 1/4 inch in diameter
Elevation: A mole that is raised above the skin and has an uneven surface

In addition to protecting your skin from the sun, don’t forget about protecting your eyes as well. Investing in a nice pair of sunglasses and a wide brimmed hat is a must. Eyes can also suffer ailments such as cataracts and age-related macular degeneration, which are directly associated with excessive exposure to UV rays. Although, we all may strive for the latest styles in hip sunglasses, make sure that the lenses block at least 99% of UVA and UVB rays. Wrap around sunglasses are best for keeping the rays from coming in on the sides of the lenses. This is especially important when you are on the water or pavement where reflective light is intensified.

When coding for skin cancer, report malignant melanoma, with ICD-9 category 172.x. Use category 173.x for other malignant neoplasm of skin.

Code for cataracts due to radiation with code 366.46. Use code E929.2 for exposure to radiation from visible and ultraviolet light sources.

It’s time for summer fun, so just remember to be safe and protect your skin and eyes from the dangers of UV exposure. And of course, consider other alternatives to obtain that healthy glow that are safer than sunlight. The best bet may be to invest in some self-tanning lotion or tanning sprays available through many tanning salons. It may feel odd to be “hosed down” with self-tanner, but it sure beats getting skin cancer or another disease associated with UV exposure.

Have a happy and healthy summer!

Editor's note: Shannon E. McCall, RHIA, CCS, CCS-P, CPC-I, CCDS is the director of coding and HIM for HCPro, Inc., in Chesterfield, VA. You can e-mail her at smccall@hcpro.com.

Class Act

Mon, 20 Jul 2009 05:00:00 GMT

NAME: Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CCDS

HOMETOWN: Richmond (Chesterfield), VA

INSTRUCTS: Certified Coder Boot Camp – Original Version and Certified Coder Boot Camp – Inpatient Version

FAVORITE CODE: CPT code 83893 (Molecular diagnostic dot/slot blot production). Try saying that 3 times fast!

ICD-10: LOVE IT OR HATE IT: Love it. I think it will be exciting to be in healthcare for the transition.

IF YOU WEREN’T GOING TO TEACH CODING, WHAT WOULD YOU WANT TO BE: I’d love to be a Today show host. I can envision it being “Where in the world is Shannon McCall?” (instead of Matt Lauer).

Hot Shot Pop Quiz

Mon, 20 Jul 2009 05:00:00 GMT

Take the quiz and win!

Do you know the answer to the question below? If so, submit your name and answer to Managing Editor Andrea Kraynak, CPC-A, at akraynak@hcpro.com. Each correct answer will be entered into a drawing with a chance to win a surprise. The winner will be announced in next month's issue.

What code(s) describe anesthesia for third degree burn excision with skin grafting; 18% of body area?

The winner from June was Jennifer Wolfe from Marshall Medical Center in Placerville, CA! Congratulations! Jennifer won a FREE 2009 ICD-9 Manual. The correct answer to the question "Which V code should you report for an encounter for breast reconstruction following mastectomy?" is code V51.0.

Beyond the Code

Mon, 20 Jul 2009 05:00:00 GMT

TODAY IN HISTORY:

July 20, 1969:
Astronaut Neil Armstrong was the first person to walk on the moon.