Cracking the Code

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06.04.2020

New Telehealth Therapy Reimbursements

Telehealth services allow a physician or other approved licensed care provider with the ability to provide services and effectively communicate with their patients via secure telecommunication devices. As of April 30, 2020, CMS has expanded the list of approved telehealth services to include physical therapy (PT), occupational therapy (OT), and speech therapy (ST). Please be sure to check with individual third-party payers about their policies in order to receive full reimbursement.

A 50-year-old Medicare patient consents to a remote evaluation service with their Physical Therapist. The patient has questions about whether they are performing the recommended exercises correctly. The patient records themselves and sends it off to the Physical Therapist for review via email. After reviewing the video, the Physical Therapist calls the patient on the telephone to provide further instruction on how to properly perform the exercise.

G2010 (remote evaluation of recorded video and/or images submitted by an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment). GP modifier is added to indicate this is a physical therapy service.

https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

Featured

05.28.2020

Coding CHF with Pleural Effusion

Pleural effusion is a typical disorder that is seen in patients who have congestive heart failure. It is an abnormal accumulation of fluid within the pleural space. If the physician completes therapeutic intervention or diagnostic testing for the pleural effusion, then it is acceptable to report it as a secondary diagnosis. If the physician does NOT specifically evaluate or treat the pleural effusion separately from the congestive heart failure, then it should NOT be reported as a secondary diagnosis.

A patient is admitted into the inpatient setting with congestive heart failure and pleural effusion. The congestive heart failure is monitored with chest x-rays, and the physician also completes an additional lateral decubitus x-ray to assess the volume of pleural effusion. The patient's final diagnosis is congestive heart failure with pleural effusion.

150.9, heart failure, unspecified J91.8, pleural effusion in other conditions classified elsewhere (acceptable secondary diagnosis because of the additional x-ray to assess the volume)

AHA Coding Handbook Ch. 18: Diseases of the Respiratory System—Pleural Effusion Coding Clinic 2114 Quarter 2015, pg. 16: Heart failure with pleural effusion

ALL CRACKING THE CODE QUESTIONS

Coding Tips: Sequencing Multiple Injuries

May 21, 2020

When a patient presents to the hospital for treatment of multiple injuries, it is appropriate to code all of the injuries for accurate reporting purposes. All of the injuries should be reported separately unless there is a combination diagnosis code provided for those conditions. The injury that is sequenced first is the injury that is determined by the physician and focus of treatment to be the most serious.

A 45-year-old patient presents to the ED with complaints of left shoulder, leg and ankle pain after falling off a ladder while painting her home. The physician places orders for x-rays. The imaging results reveal a pilon fracture of the left tibia and a sprain of the left AC joint of the shoulder. The patient is discharged home with a splint applied to the left foot.

S82.872A, Displaced pilon fracture of left tibia, initial encounter for closed fracture - primary diagnosis S43.52XA, Sprain of left acromioclavicular joint, initial encounter - secondary diagnosis

ICD-10-CM Official Guidelines for Coding and Reporting FY 2020 Ch. 19 Section b.

What’s the latest code for Vaping-related disorders?

May 14, 2020

Starting April 1, 2020, the World Health Organization (WHO) implemented a brand new ICD-10-CM diagnosis code: U07.0, vaping-related disorder. This is being implemented now due to the recent occurrences of vaping related disorders. For all discharge dates on or after April 1, U07.0 will be sequenced as the primary diagnosis IF the physician’s documentation states that the vaping caused the patient’s current condition. It is then followed by that condition as a secondary diagnosis code.

A patient presents to the emergency department with shortness of breath. The patient admits to the physician that they use electronic cigarettes on a regular basis. After a full work-up was completed, the patient was admitted into the hospital. Upon discharge, the physician provides a final diagnosis of acute respiratory distress syndrome due to the electronic cigarette usage.

U07.0, vaping-related disorder J80, acute respiratory distress syndrome Reference: 1st Quarter Coding Clinic 2020 pgs. 3-4: Vaping-related disorder

1st Quarter Coding Clinic 2020 pgs. 3-4: Vaping-related disorder

Coding Changing Severity of Pressure Ulcers

May 7, 2020

If a patient is admitted to a hospital with a pressure ulcer that progresses during the patient’s stay to another severity, then it’s appropriate to report two separate diagnosis codes. The first code is for the site and severity of the ulcer that was present on admission, and the second one is for the severity level that was reported during the stay.

If a patient is admitted to a hospital with a pressure ulcer that progresses during the patient's stay to another severity, then it's appropriate to report two separate diagnosis codes. The first code is for the site and severity of the ulcer that was present on admission, and the second one is for the severity level that was reported during the stay.

L89.314 (pressure ulcer of right buttock, stage 4) L89.313 (pressure ulcer of right buttock, stage 3)

ICD -10-CM Official Coding Guidelines Ch. 12 Section B.3. Coding Clinic 4th Quarter 2016 pg. 124

What modifiers eliminate COVID-19 deductibles?

April 30, 2020

On April 7, 2020, CMS proposed a new Families First Coronavirus Response Act. This act waives co-insurance and deductibles for additional COVID-19 related services. Under this act, CMS requires modifier CS applied to applicable institutional and non-institutional claim lines to identify that the service is subject to the cost-sharing waiver for COVID-19 testing-related services. This ensures that Medicare members are NOT charged any co-insurance or deductibles for those services as well.

A 30-year-old male presents to the hospital emergency department with a fever, cough, and shortness of breath. The physician orders a CDC COVID-19 lab test, and the results are positive.

L89.314 (pressure ulcer of right buttock, stage 4) L89.313 (pressure ulcer of right buttock, stage 3)

Primary diagnosis: U07.1, COVID-19 CPT for COVID-19 lab test: U0001-CS CMS

When is COVID-19 NOT the primary diagnosis?

April 23, 2020

When COVID-19 meets the definition for principal diagnosis, it should be sequenced first followed by all other appropriate secondary diagnoses. There is an exception for sepsis, obstetric, and newborn patients. However, if sepsis does NOT meet the guidelines for principal diagnosis, it should be sequenced as a secondary diagnosis. Please see the example below:

A 52 year old woman was admitted to the hospital with pneumonia due to COVID-19 virus. During the patient's stay, she developed viral sepsis. What's the correct primary diagnosis?

tJ07.1, COVID-19

References: ICD-IO-CM Official Coding Guidelines section 1_CLd_ Chapter-specific Guidelines: Sepsis, Severe Sepsis, and Septic Shock COVID-19 Guidelines