2013MCT CPC PA WB Instructor-no-crops - Enos Medical …

Chapter

20

Medicine

Case 1

1. A 10-year-old established patient presents today for well child check with mother with 2. complaints of frequent urination during the day.

The patient has two sisters and sees dad sporadically. Lives in a smoke free environment. 1 dog, 1 rabbit.

Denies dysuria, abdominal pain, or rashes; all other systems are reviewed and negative.

Patient going into fourth grade with good grades. No parental concerns. Patient cooperates but does tend to back talk. Doing well on Concerta.

Exam General: Normal

Head: Normal

Eyes: Normal

Ears: Normal

Nose: Normal

Mouth/throat: Normal

Neck: Normal

Abdomen: Normal

Rectal: Not examined

Genitals: Normal

Skin: 3 mm papule on dorsal R hand without disruption of creases

Urinalysis: Ketones, nitrite, leukocytes normal; trace blood, low specific gravity.

Counseled patient on the use of seat belts, bicycle/skate helmets, gun safety, water/sun safety.

Assessment: Well Child Check, ADHD, Wart, Frequent Urination

3.

Refill Concerta 18 mg PO q AM

Wart cleansed with alcohol. Histofreeze x 25 seconds was performed to destroy the wart. 4.

Varicella Vaccine #2 administered without any complications.

5.

1. The patient is established

2. Patient presents for a preventive exam.

3. Preventive exam and problems treated.

4. Wart is destroyed.

5. Vaccination is administered.

CPT ? copyright 2012 American Medical Association. All rights reserved.

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Medicine

Chapter 20

What are the CPT? and ICD-9-CM codes reported?

CPT? Codes: 99393-25, 17110, 90471, 90716, 81002

ICD-9-CM Codes: V20.2, 078.10, 314.01, 788.41

RATIONALE: CPT? Codes: The patient presents for a well child check which is a preventive exam. The code is selected based on whether the patient is new or established and the age of the patient. The patient is established and 10-years-old which is reported with 99393. Modifier 25 is appended to report a separate and significant E/M is reported in addition to other procedures (wart destruction and vaccination). Next select the code for the wart destruction. In the CPT? Index, look up Destruction/warts/flat. You are referred to 17110?17111. The correct code is selected based on the number of warts destroyed. In this case it is one which is reported with 17110. A varicella vaccination is administered via an injection. Two codes are required, one for the administration and one for the vaccine. In the CPT? Index, look up Administration/immunization/one vaccine/toxoid. There is no indication that counseling for the vaccination was performed which makes 90471 the correct code. Next select the code for the vaccine which is located under Vaccines/varicella. You are referred to 90716. A urinalysis is also performed. Look in the CPT? Index for Urinalysis/without microscopy and you are referred to code 81002.

ICD-9-CM Codes: The patient presents for a well child check. From the Index to Diseases, look up Examination/health of/child. You are referred to V20.2. According to the Official Coding Guidelines, when additional conditions are treated during a screening exam, report the additional diagnoses. The patient is diagnosed with ADHD for which a prescription is renewed and a wart. From the Index to Diseases look up Wart. You are referred to 078.10. From the Index to Diseases, look up Disorder/attention deficient/with hyperactivity. You are referred to 314.01. Look up Urination/frequent. You are referred to 788.41. Verify all codes in the Tabular List for accuracy.

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2013 Medical Coding Training: CPC Practical Application Workbook--Instructor

CPT ? copyright 2012 American Medical Association. All rights reserved.

Chapter 20

Medicine

Case 2

Pre-procedure diagnosis: Asthma

Post-procedure diagnosis: Asthma

1.

Procedure: Psychophysiological Therapy Biofeedback

The patient returned to clinic with daily diary documenting home peak flow readings

and asthma symptoms. Diary was assessed and discussed with patient. Patient reports

reduced dosing with inhaled steroids and fewer asthmatic episodes. Lungs and respiratory

resistance assessed. Lungs clear, no wheezes or rhonchi noted.

2.

HRV biofeedback was performed using a physiograph. ECG data were collected from the 3. left arm and right leg, and were digitized at 510 Hz. EEG biofeedback equipment attached and baroreflex gain was assessed with beat-to-beat BP recordings and digitized at a rate of 252 samples per second. The sensor was placed on the participant's right middle finger, and the hand was elevated on a table to approximately the level of the heart.

Respiratory system impedance (Zrs) [between 2 and 32 Hz with 2-Hz increments] was measured using a pseudorandom noise forced oscillation system. It was presented in 40, 2-second bursts spaced equally throughout.

In order to minimize the effects of possible partial glottal closure during exhalation, each burst was triggered by the beginning of an inhalation.

Post procedure, inspirometer readings were recorded. Asthma symptoms were scored

with the patient. Biofeedback procedure lasted approximately 28 minutes.

4.

The patient is to return to clinic in two weeks with daily diary. It is expected the patient will continue with reduced regiment and asthmatic episodes.

What are the CPT? and ICD-9-CM codes reported?

CPT? code: 90875

ICD-9-CM code: 493.90

RATIONALE: CPT? code: Biofeedback is found in the index under Training/biofeedback. Code selection is between 90901?90911. Under the heading for Biofeedback, there is a parenthetical instruction for psychophysiological therapy incorporating biofeedback, see 90875, 90876. The code selection is based on minutes. 28 minutes is coded with 90875. 90901 is not reported separately. 90875 also includes the psychotherapy for behavior modification.

ICD-9-CM code: The patient has asthma. Look in the Index to Diseases for asthma and you are directed to 493.9x. The asthma is not stated as having status asthmaticus or acute exacerbation, so the fifth digit is 0.

1. Post procedural diagnosis used for coding.

2. Psychophysiological training.

3. Biofeedback documentation.

4. Biofeedback time.

CPT ? copyright 2012 American Medical Association. All rights reserved.

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Medicine

Chapter 20

Case 3

Performed in the office

Pre-procedure diagnosis: Gastroesophageal reflux disease (GERD), Heartburn

1. Post procedure diagnosis used 1. Post-procedure diagnosis: GERD

for coding.

2. Procedure: Esophageal pH monitoring with Bravo pH Capsule

2. Acid reflux testing.

3. Placement of electrode placement.

Pt was placed in supine position on examining bed, IV moderate sedation was administered. Visualization of esophagus with anatomic markers located during endoscopy. Endoscopy was removed and the Bravo pH Capsule delivery system was passed into the esophagus using the oral passage until the attachment site was obtained at approximately 5 cm proximal to the upper margin of the LES. The external vacuum pump was activated pulling the adjacent esophageal mucosa into the fastening well. Vacuum guage at 600 mm Hg and held for 10 seconds.

The plastic safety guard on handle was then removed and the activation button was 3. depressed and turned attaching the pH capsule to the esophageal wall. The activation

button on handle was then twisted 90 degrees and re-extended, releasing the pH capsule. Esophagoscopy was repeated to verify capsule attachment.

Prior to procedure, the Bravo pH capsule was activated and calibrated by submersion in pH buffer solutions.

The patient tolerated the procedure well and was transferred into the recovery room.

The patient returned to the office two days later for download of the recording. The information was analyzed and interpreted.

What are the CPT? and ICD-9-CM codes reported?

CPT? code: 91035

ICD-9-CM code: 530.81

RATIONALE: CPT? code: Esophageal pH monitoring with Bravo pH Capsule is a test performed for acid reflux. In the CPT? Index, look for Esophagus/Acid Reflux Test and you are directed to code range 91034?91038. The test is performed for by attaching a telemetry electrode to the esophageal mucus making 91035 the correct code. The rest of the codes are performed by nasal catheter.

ICD-9-CM code: GERD is found in the Index to Diseases by looking under Disease/ Gastroesophageal Reflux (530.81). Verification in the Tabular List confirms code selection.

20.4

2013 Medical Coding Training: CPC Practical Application Workbook--Instructor

CPT ? copyright 2012 American Medical Association. All rights reserved.

Chapter 20

Medicine

Case 4

Pre-procedure diagnosis: Sleep Apnea

Post-procedure diagnosis: Obstructive sleep apnea

Procedure: Overnight Sleep Study

The 35-year-old patient in a Hospital Sleep Lab for attended, overnight polysomnogram. 1. Patient oriented to room and changed into overnight clothing brought into lab by patient.

Latency to sleep onset slightly prolonged at 32.3 minutes. During the first 82 minutes of sleep, 80 obstructive apneas were manifested. The lowest SpO2 during the non-supplemented sleep period was 73%. CPAP was then applied at 5 cm H2, and sequentially titrated to a final pressure of 18 cm H2O. The Apnea-hypopnea index (AHI) changed from 60 events/hr to 4 events/hr. SpO2 increased to 90%.

The sleep study with and without CPAP shows severe obstructive sleep apnea with improvement with CPAP settings at 18 cm H20. Based on the improved SpO2 levels with CPAP, it is recommended this patient use a BIPAP machine during sleep hours due to obstructive sleep apnea events.

What are the CPT? and ICD-9-CM codes reported?

CPT? code: 95808

ICD-9-CM code: 327.23

RATIONALE: CPT? code: In the index, look for polysomnography and you are directed code range 95808?95811. The codes are based on sleep staging parameters. The code selection is based on parameters of sleep as defined in the sleep testing guidelines. For this case, there are less than four additional parameters performed. The additional parameters are the following: Oxyhemoglobin saturation (SpO ) and sleep latency.

2

ICD-9-CM code: The patient is diagnosed as having obstructive sleep apnea. In the Index to Diseases, look at Apnea/sleep/obstructive 327.23. Verification of the code in the Tabular List confirms code selection.

1. Polysomnogram performed.

CPT ? copyright 2012 American Medical Association. All rights reserved.

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