Coding for Gastrointestinal Endoscopy

[Pages:55]Coding for Gastrointestinal Endoscopy

Audio Seminar/Webinar

May 10, 2007 Practical Tools for Seminar Learning

? Copyright 2007 American Health Information Management Association. All rights reserved.

Disclaimer

The American Health Information Management Association makes no representation or guarantee with respect to the contents herein and specifically disclaims any implied guarantee of suitability for any specific purpose. AHIMA has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this audio seminar, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this program. AHIMA makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service.

CPT? five digit codes, nomenclature, and other data are copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein.

As a provider of continuing education the American Health Information Management Association (AHIMA) must assure balance, independence, objectivity and scientific rigor in all of its endeavors. AHIMA is solely responsible for control of program objectives and content and the selection of presenters. All speakers and planning committee members are expected to disclose to the audience: (1) any significant financial interest or other relationships with the manufacturer(s) or provider(s) of any commercial product(s) or services(s) discussed in an educational presentation; (2) any significant financial interest or other relationship with any companies providing commercial support for the activity; and (3) if the presentation will include discussion of investigational or unlabeled uses of a product. The intent of this requirement is not to prevent a speaker with commercial affiliations from presenting, but rather to provide the participants with information from which they may make their own judgments.

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Faculty

Margi Brown, RHIA, CCS, CCS-P, CPC

Margi has over twenty years of experience in Health Information Management (HIM) field covering hospital outpatient, inpatient, surgical centers, physician office, clinic, law firms, consulting, and third-party carrier areas. Ms. Brown earned her Bachelor of Science degree in Health Information Management from the University of Central Florida. Areas of expertise include coding, education, audits, compliance, ensuring optimal reimbursement, operational assessments, billing office process flows, reviewing tools, revising forms, implementation of policies and procedures and assisting in making the process more efficient and "doable". Margi has extensive hands-on experience working with physicians in the hospital setting and in the office/clinic environment. She brings the hospital outpatient and physician component together.

A knowledgeable and versatile speaker, Ms. Brown had done numerous presentations for a wide-ranging audience including national and state associations such as the American Health Information Management Association-AHIMA, Florida Health Information Association-FHIMA, Tennessee Health Information Management Association-THIMA as well as serving as a guest speaker for several groups. Ms. Brown was a consultant and seminar instructor through the Southern Medical Association (SMA) and presented basic, advanced and specialty-coding classes for physicians, instructed a medical billing course for the University of South Alabama, and was the Eastern Division Coding Consultant for the Medical Group Management Association-MGMA in 2000. She instructs on how accurate coding and complete documentation connects to optimal reimbursement, following guidelines and meeting compliance regulations in real world settings.

Prior to joining DCBA, Margi has been a consultant working with a variety of facilities. She has worked with APC implementation, assessment, CDM revision, auditing, and education in the hospital arena. Additionally, she has worked with coding, medical necessity, denial management, compliance, and documentation improvement for both the hospital and the physician areas. She has held previous positions in the physician world such as Director of areas of Coding and Compliance for Phycor in Nashville, TN; Coding, Compliance, and Reimbursement for the Infirmary Health System in Mobile, AL; and Matthews Clinic in Orlando, FL. Previous hospital positions include Manager of Prospective Payment, Assistant Director of Health Information Management, DRG coordinator, and Supervisor in a large size level 1 trauma teaching facility over coding, as well as other areas.

Robert S. Gold, MD

Dr. Gold is known nationally for his educational presentations regarding the clinical orientation of coding in AHIMA audio conferences and at the 2002 National Conference for the Society for Clinical Coding. His contributions of Clinically Speaking articles in Briefings on Coding Compliance Strategies have been valuable to coding professionals and his A Minute for the Medical Staff articles in Medical Record Briefings have demonstrated value to the documentation practices of medical staff members.

Dr. Gold is a co-founder of DCBA, Inc, a consulting company that evaluates physician documentation to support the compliant assignment of ICD-9-CM and CPT-4 codes. They specialize in physician led education of HIM personnel, physicians and Documentation Specialists on the clinical aspects of diseases and procedures and how accurate and specific codes support professional and financial profiling for the hospital and for the medical staff.

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Table of Contents

Disclaimer ..................................................................................................................... i

Faculty .........................................................................................................................ii

Objectives ................................................................................................................... 1

GI Tract ................................................................................................................... 2 Embryology .......................................................................................................... 3 Anatomy .............................................................................................................. 3 Abdominal Quadrants RUQ ............................................................................................................ 4 LUQ ............................................................................................................ 5 RLQ............................................................................................................. 5 LLQ ............................................................................................................. 6

Why Scope ................................................................................................................... 6 Abdominal Pain ..................................................................................................... 7 Gastrointestinal Bleed ............................................................................................ 7 Prophylactic vs. Screening...................................................................................... 8 How to Get Into the GI Tract ................................................................................. 8

Vascular Supply to the GI Tract ....................................................................................... 9 Veins of GI Tract................................................................................................... 9 Portosystemic Shunts ...........................................................................................10 GI Bleeding Issues ...............................................................................................10 Cause .........................................................................................................11 Vascular Malformations.........................................................................................12 Vascular Insufficiency ...........................................................................................13

Endoscopy Types of GI Scopes ..............................................................................................14 Reasons to Scope.................................................................................................15 Coding Endoscopic Procedures ..............................................................................15 Esophagoscopy ....................................................................................................16 Dilation of Esophagus ..................................................................................16 EGD ..................................................................................................................18 Scenario .....................................................................................................19 Control of Bleeding...............................................................................................20 Insertion of PEG/PEJ Tube ....................................................................................21 PEG Codes...........................................................................................................21

Biliary System Anatomy .................................................................................................22 ERCP ..................................................................................................................22

Endoscopy Definitions....................................................................................................23 Colonoscopy vs. Sigmoidoscopy.............................................................................24 Colonoscopy Scenario ...........................................................................................25 Colorectal Endoscopy............................................................................................26 Endoscopic Biopsies..............................................................................................26 Scenario .....................................................................................................28 Polypectomy ........................................................................................................29 Virtual Colonoscopy ..............................................................................................31

Case Study ..................................................................................................................32

Modifiers Discontinued Procedures.......................................................................................36 Reduced or Discontinued Services .........................................................................36 Discontinued Procedures with Anesthesia ...............................................................37 Modifier -52 Reduced Service ................................................................................37 Incomplete Colonoscopy .......................................................................................38

AHIMA 2007 Audio Seminar Series

Table of Contents

Modifier -59 Distinct Procedure..............................................................................39 Example Multiple Lesion Removal ..........................................................................40 Outpatient Coding Guideline...........................................................................................40 Incidental Findings ...............................................................................................41 Diagnostic Exam ..................................................................................................41 Screening Exams..................................................................................................42 Colon Screening Example......................................................................................43 Colorectal Cancer Screening ? HCPCS Code ............................................................44 Colonoscopy Type?...............................................................................................44 Follow-up Exam ...................................................................................................45 References ..................................................................................................................46 Audience Questions Appendix ..................................................................................................................49 CE Certificate Instructions .....................................................................................25

AHIMA 2007 Audio Seminar Series

Coding for Gastrointestinal Endoscopy

Notes/Comments/Questions

Objectives

At the end of this session you should

? Improve your coding knowledge with a review of the most current ICD-9-CM and CPT coding guidelines related to GI endoscopy.

? Understand coding and modifier usage for screening endoscopy, multiple endoscopy, snare vs. ablation vs. biopsy procedures....

1

GI Topics of Discussions

? The gastrointestinal tract anatomy ? Everything you wanted to know about

endoscopes and tools ? Diagnostic considerations of endoscopy ? Procedural considerations of endoscopy

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AHIMA 2007 Audio Seminar Series

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CPT? Codes Copyright 2006 by AMA. All Rights Reserved

Coding for Gastrointestinal Endoscopy

Notes/Comments/Questions

The GI Tract

Pertinent thought processes for coding

Review embryologic development Review anatomy of the gastro-intestinal

tract and its circulation Disease of the organs

? Esophagus ? Stomach ? Duodenum ? Small intestine ? Large intestine ? Liver ? Pancreas

3

The GI Tract

Pertinent thought processes for coding

Disease of the vessels

? AVM (angiodysplasia) ? Aneurysm ? Varices

Gastrointestinal bleeding and sequencing

Endoscopic Procedures Rules and regs regarding coding

and sequencing 4

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CPT? Codes Copyright 2006 by AMA. All Rights Reserved

Coding for Gastrointestinal Endoscopy

Notes/Comments/Questions

Embryology of the GI Tract

Straight tube

? Foregut ? Midgut ? Hindgut

Open to yolk sac Herniates into

umbilical cord Returns to

abdomen 270o rotation

based on superior mesenteric artery Fastens to back 5

Anatomy of the GI Tract

Esophagus

E-G junction

Stomach

Duodenum

Jejunum/Ileum

Colon

? Right/appendix

? Transverse

? Left

? Sigmoid

Rectum

Anus

6

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CPT? Codes Copyright 2006 by AMA. All Rights Reserved

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