CODING FOR PEDIATRICS. Agenda

Transcription

1 CODING FOR PEDIATRICS Code Set 4 in the Series Answers to the Assignment PMG, Inc. 700 School Street Pawtucket, RI P: F: E: PMGConsulting@gopmg.com Coding for Pediatrics - Examples Next Steps Agenda 1

2 Speaker: Ray Jorgensen, MS, CPC, CHBME Raymond T. Jorgensen is a Co-Founder & Partner at PMG, Inc. (PMG). Ray is responsible for oversight of consulting operations as well as coding, reimbursement, and payer related issues for the out-sourced billing component of PMG s services (more than 1.2 million annual encounters). He has personally trained thousands of providers from over 35 states on coding, billing, and reimbursement in addition to authoring several books and dozens of articles. Ray s health care experience and education is unique in that he was schooled by the payers. Having worked for Blue Cross and Blue Shield as well as United HealthCare Corporation, primarily in professional relations and contracting, Ray has an understanding and perspective on the payer s objectives and process unlike other medical business consultants groomed from the provider side. He continues to travel nationally working with clients and strategic partners to enhance opportunities for the success of CHCs around coding, billing, and reimbursement. BA from The College of the Holy Cross (Worcester, MA) MS from Northeaster University (Boston, MA( CPC from the American Academy of Professional Coders (Salt Lake City, UT) CHBME from the Healthcare Billing & Management Association (Laguna Cliffs, CA) Disclaimer 1. The coding guidelines, interpretations, and recommendations set forth as part of this training session are presented as a guide only. Attendees understand and recognize that actual coding decisions are the sole liability and responsibility of the provider(s) and respective billing staff. PMG, Inc. does not accept any liability or responsibility in this regard. 2. The presentation today may include discussion about a particular commercial product/service and the presenter has significant financial interest/relationship with the organization that provides this product/service. 2

3 f g h a These codes are for patients who do not show any sign or symptom of a disease but are suspected to have been exposed to it by close personal contact with an infected individual or are in an area where a disease is epidemic indicate that a patient is either a carrier of a disease or has the sequelae or residual of a past disease or condition testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease explains a patient s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring A B C D Personal history Counseling Aftercare Follow-up e for use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease. E Family history c d b cover situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase to explain continuing surveillance following completed treatment of a disease, condition, or injury used when a patient or family member receives assistance in the aftermath of an illness or injury, or when support is required in coping with family or social problems F G H Contact/exposure Status codes Screening 1.Contact Dermatitis of the Eye H

4 2.Infected ingrown toenail, right great toe L Bronchial asthma, allergic, due to house dust (1 of 2) 4

5 3.Bronchial asthma, allergic, due to house dust (2 of 2) J Mild intermittent asthma with status asthmaticus J

6 5.Pneumonia, bacterial, left upper lobe (1 of 2) 5.Pneumonia, bacterial, left upper lobe (2 of 2) J15.9 6

7 6.Perforation of tympanic membrane due to chronic suppurative otitis media, right ear (1 of 3) Answer, Part 1: H Perforation of tympanic membrane due to chronic suppurative otitis media, right ear (2 of 3) 7

8 6.Perforation of tympanic membrane due to chronic suppurative otitis media, right ear (3 of 3) Answer, Part 2: H66.3X1 Final H66.3X1, H Acute suppurative otitis media, with spontaneous rupture of ear drum, right ear H

9 8. Swimming-pool conjunctivitis B Intractable epilepsy, grand mal type, status Epilepticus (1 of 2) 9

10 9.Intractable epilepsy, grand mal type, status Epilepticus (2 of 2) G Type 1 diabetes with ketoacidosis E

11 11.Type 1 diabetes with diabetic nephrosis 11. Type 1 diabetes with diabetic nephrosis E

12 12.Visit to change surgical dressing Z Dysuria R

13 14. Syncope, cause undetermined R55 15.Well baby exam, baby is 3 months old, without abnormal findings Z

14 16.Down Syndrome Q Feeding problems in a 10 day old infant P

15 18.Immunization for MMR Z23 19.Colic R

16 20. Cardiac Murmur, in infant R Nursemaid s elbow, left elbow, initial encounter S53.032A 16

17 22. Anaphylactic reaction due to eating peanuts initial encounter (1 of 2) 22. Anaphylactic reaction due to eating peanuts, initial encounter (2 of 2) T78.01XA 17

18 23.Superficial burns of face and chest due from a tanning bed (1 of 2) 23. Superficial burns of face and chest from a tanning bed (2 of 2) Answer, Part 1: L56.8 Answer, Part 2: W89.1XXA, D or S- Ask doc for more info. 18

19 24. Headache due to lumbar puncture G Examination for eye and vision without abnormal findings Z

20 Next Steps Complete Homework Assignment on next page Fill in complete first and last name as you wish it to appear on your CEU certificate Scan completed homework and to: 1.5 CEUs will be ed to the address provided on completed homework 20

21 Full First and Last Name: Organization Name address Ecourse 4/Set 4 ICD 10 Coding for Pediatrics Submit Homework to: PMGConsulting@gopmg.com MIPCA 1. Match the following These codes are for patients who do not show any sign or symptom of a disease but are suspected to have been exposed to it by close personal contact with an infected individual or are in an area where a disease is epidemic indicate that a patient is either a carrier of a disease or has the sequelae or residual of a past disease or condition testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease explains a patient s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring for use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease. cover situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase to explain continuing surveillance following completed treatment of a disease, condition, or injury used when a patient or family member receives assistance in the aftermath of an illness or injury, or when support is required in coping with family or social problems A B C D E F G H Personal history Counseling Aftercare Follow-up Family history Contact/exposure Status codes Screening Page 1 of 3

22 Full First and Last Name: Organization Name address Ecourse 4/Set 4 ICD 10 Coding for Pediatrics Submit Homework to: PMGConsulting@gopmg.com MIPCA 2. Contact dermatitis of the eyelid 3. Infected ingrown toenail, right great toe 4. Bronchial asthma, allergic, due to house dust 5. Mild intermittent asthma with status asthmaticus 6. Pneumonia, bacterial, left upper lobe 7. Perforation of tympanic membrane due to chronic suppurative otitis media, right ear 8. Acute suppurative otitis media, with spontaneous ear of ear drum, right ear 9. Swimming-pool conjunctivitis 10. Intractable epilepsy, grand mal type, status epilepticus 11. Type 1 Diabetes with ketoacidosis 12. Type 1 diabetes with diabetic nephrosis 13. Visit to change surgical dressing 14. Dysuria Page 2 of 3

23 Full First and Last Name: Organization Name address Ecourse 4/Set 4 ICD 10 Coding for Pediatrics Submit Homework to: PMGConsulting@gopmg.com MIPCA 15. Syncope, cause undetermined 16. Well baby exam, baby is 3 months old, without abnormal findings 17. Down Syndrome 18. Feeding problems in a 10 day old infant 19. Immunization for MMR 20. Colic 21. Cardiac Murmur, in infant. 22. Nursemaid s elbow, left elbow, initial encounter 23. Anaphylactic reaction due to eating peanuts, initial encounter 24. Superficial burns of face and chest due from a tanning bed. 25. Headache due to lumbar puncture 26. Examination for eye and vision without abnormal findings Page 3 of 3