Beth W. Rackow, MD Columbia University Medical Center New York, NY. Participants will:

Transcription

1 Beth W. Rackow, MD Columbia University Medical Center New York, NY Participants will: Review appropriate use of ICD10 diagnostic codes. Understand appropriate procedural coding and specific codes for common PAG procedures. Compare different ways to code for certain procedures and determine the most effective codes to utilize. 1

2 Codes condense a lot of information Medical procedures, diagnoses, and supplies are identified by codes Cycle from treatment to payment is streamlined 2

3 Compliance issues: Physician is responsible for the information on every claim that leaves the office. Codes and coding rules change every year To enable fair, timely reimbursement Only the physician knows what occurred during the patient encounter. To have direct input into the process of creating and valuing codes Correct coding implies the selection is: Most accurate description of what and why Supported by documentation Consistent with coding guidelines 3

4 Document what was done Document why it was done Code for what you document ICD: INTERNATIONAL CLASSIFICATION OF DISEASES Numerical identification of: Disease Condition Symptom State Justifies the provision of services or procedures Reason for medical care CPT: CURRENT PROCEDURAL TERMINOLOGY Numerical identification of services provided to patient: Cognitive, Procedural Material 4

5 I don t really want a diagnosis. What diseases have you got for under $50? Physicians are paid for medical services they provide Clinical need for each service must be justified by a code from ICD 9/10 CM ICD 9/10 code must support level of service reported All clinically relevant diagnoses should be reported 5

6 Often more than one diagnosis applies Primary diagnosis is the one chiefly responsible for the service(s) Report other diagnoses that are treated at the encounter Report coexisting conditions affecting treatment Do not code a diagnosis no longer applicable! Report history of codes (V10 V19) if influence treatment CONVENTION ICD 9 CM ICD 10 CM # of codes Approximately 13,000 codes Approximately 68,000 available codes # of characters 3 5 digits in length 3 7 characters in length Types of characters Code capacity First digit can be alpha (V, E) or numeric; digits 2 5 are numeric; most codes are numeric Limited space for adding new codes Character 1 is alpha; character 2 is numeric; characters 3 7 are alpha or numeric Flexible for adding new codes Specificity Lacks detail Very specific Laterality: Right vs Left Lacks laterality Has laterality 6

7 V and E codes incorporated into main classifications Injuries classified by by specific site instead of type Postoperative complications moved to system chapters Combination codes: single code that describes 2 diagnoses, diagnosis with associated secondary process or complication ICD 10 CM Chapter Description Code Range Mneumonic Device Equivalent ICD 9Codes 2 Neoplasms C00 D49 Cancer Endocrine, Nutritional and Metabolic Diseases 14 Disease of the Genitourinary System 15 Pregnancy, Childbirth and the Puerperium E00 E89 Endocrine N00 N99 Nephrology O00 O9A Obstetrics Congenital Malformations, Q00 Q99 Questionable Deformations, and Chromosomal Abnormalities 18 Symptoms, Signs, and Abnormal Findings 21 Factors Influencing Health Status and Contact with Health Services R00 R99 Rule Out Z00 Z99 Zebras V01 V91 7

8 Code format XXX.XXX X XXX = Category XXX = Etiology, anatomic site, severity X = Extension First character: always alphabetic letter Second character: always a number Characters 3 7: alpha or numeric, X as place holder Report the highest number of characters available N70 N77 N80 N99 Inflammatory diseases of female pelvic organs Noninflammatory disorders of female genital tract N99 Intraoperative ti and postprocedural complications and disorders, not elsewhere classified 8

9 256.4 Polycystic ovary syndrome E Menstrual migraine G Foreign body in vagina T19.2XXA Amenorrhea Primary amenorrhea N91.0 Secondary amenorrhea N91.1 Amenorrhea, unspecified N91.2 ICD 9 Description ICD Endometriosis i of uterus N Endometriosis of ovary N Endometriosis of fallopian tube N Endometriosis of pelvic peritoneum N Endometriosis of rectovaginal septum and vagina N Endometriosis of intestine N Endometriosis of cutaneous scar N Other endometriosis N Endometriosis, unspecified N80.9 9

10 Abdominal tenderness (ICD 9: 789.6x) 789 Category for sxs 789.x 4th digit describes sx 789.xx 5th digit describes location 0 Unspecified site 1 right upper quadrant 2 left upper quadrant 3 right lower quadrant 4 left lower quadrant 5 periumbilical 6 epigastric i 7 generalized 8 other specified site, multiple sites 9 unspecified Use categories (R00 R99) as provisional diagnoses Urinary frequency: R35.0 Nausea with vomiting R11.2 Findings, abnormal, without ih diagnosis i Abnormal mammogram: R92.8 Nonspecific positive culture R89.9 (nose, sputum, throat, wound) 10

11 Descriptions of reasons for patient encounters other than disease, illness, signs, or symptoms Provide valuable additional information V01.6 (Z20.2) Contact with or exposure to venereal disease V04.81 (Z23) Need for prophylactic vaccination against influenza V10.72 (Z85.71) Personal history of Hodgkin s lymphoma V12.51 (Z86.718) Personal history of venous thrombosis and embolism V 65.3 (Z71.3) Dietary surveillance and counseling V65.5 (Z71.1) Person with feared complaint in whom no diagnosis was made worried well ICD 9 CM V65.3 = dietary surveillance and counseling ICD 10 CM V65.3 = Unspecified occupant of heavy transport vehicle injured in collision with railway train or railway vehicle in nontraffic accident 11

12 ICD 10 code Explanation R46.1 Bizarre personal experience V91.07xD V95.42xA Burn due to water skis on fire, subsequent encounter Forced landing of spacecraft injuring occupant, initial encounter V97.33xD Sucked into jet engine, subsequent encounter W56.21xS Bitten by orca, sequelae Z63.1 Problems in relationship with in laws Z73.1 Type A behavior pattern Z73.4 Inadequate social skills, not elsewhere classified Y33 Other specified event, undertermined intent 12

13 New Codes: Prepubertal vaginal bleeding Congenital asymmetric labia majora enlargement Expanded Codes: Transverse vaginal septum Longitudinal vaginal septum ARE THERE OTHER CODES WE NEED??? Code to the highest degree of specificity Code to the highest degree of certainty Sequence the diagnoses Code only relevant diagnoses Code only what you know to be fact Never code for condition being ruled out Link the ICD 9/10 to the correct CPT 4 13

14 Not documented means Not done Documentation must support type and level of service reported (PROCEDURAL CODING ) NEW: Coding section of NASPAG website Crosswalk tables of commonly used ICD 9 and ICD 10 codes ICD 10 page on ACOG website Free website: ICD10Data.com CMS website: 14

15 Joyce, how much do I charge people when I don t know what s wrong with them?? 15

16 CPT codes are divided into 6 sections: Evaluation and Management (E/M) Anesthesiology Surgery Radiology Pathology and Laboratory Medicine Vulva, Perineum, Introitus ( ) 5 5 Vagina ( ) Cervix Uteri ( ) Corpus Uteri ( ) Oviduct/Ovary ( ) In Vitro Fertilization ( ) 58976) Other Procedures (58999) Incision, excision, repair, endoscopy/laparoscopy or hysteroscopy, manipulation 16

17 Type of service Codes must accurately reflect reason for encounter Level of service Must reflect physician s work necessary to Must reflect physician s work necessary to evaluate or treat the patient for a specific diagnosis or presenting problem 17

18 Includes: Operation per se Local infiltration, topical anesthesia, blocks, etc. Subsequent to the decision for surgery, one related E/M encounter on the date immediately prior to or on the date of the procedure (includes H&P) Typical supplies and materials Immediate postoperative care, dictating operative notes, talking to family and other providers Writing orders Evaluating patient in PACU Typical postoperative follow up care Does not include: Administration of regional anesthesia or conscious sedation (unless specifically noted) Care provided for complications, exacerbations, recurrence, or other diseases or injuries Supplies and materials provided by the physician over and above those usually included Care provided outside the group or by other specialties within the same group 18

19 Pre operative Work Intra operative Work Post operative Work Minor procedures 0 or 10 day global period Major procedures 90 day global period Include: Preoperative: Intra operative: Postoperative: Same day visits All integral procedures Supplies usually used 0 day global: l Related visits on same day 10 day global: Follow up visits for 10 days that are related to recovery from surgery 19

20 Include: Preoperative: E/M services beginning one day prior Intra operative: All usual intra operative procedures Anesthesia administered by surgeon Postoperative: Complications treated outside the operating or procedure room Related visits for 90 days Post surgical pain management by surgeon CPT General Description Global Codes Periods Hysteroscopic myomectomy Laparoscopy with removal of 010 adnexal structures Dilation and curettage (Except 58661) Laparoscopy, surgical

21 Definition: Two digit numeric codes that indicate a basic service has been altered by particular circumstance Purpose: Identify excluded services for Medicare Provide additional information about services provided dd Complete listing with definition in Appendix A of CPT 21

22 25: E/M above and beyond the usual pre and postprocedure care 57: E/M service resulted in initial decision to perform major surgery 51: 5 More than one procedure performed at the same session 22: Work of the procedure is substantially greater than typically required 22

23 Criteria for increased work: Increased intensity Increased time Technical difficulty of procedure Severity of patient s condition Physical and mental effort required 23

24 58661: Laparoscopic p removal of adnexal structures 58662: Laparoscopic fulguration or excision of lesions of ovary, pelvic viscera or peritoneum by any method 56700: Partial hymenectomy 57130: Excision of vaginal septum 24

25 PROCEDURE: Exam under anesthesia, vaginoscopy, ± removal of vaginal foreign body You code for which of the following? 1. EUA 2. Colposcopy 3. Vaginal irrigation 4. EUA, colposcopy/vaginal irrigation PROCEDURE: Exam under anesthesia, vaginoscopy, ± removal of vaginal foreign body EUA: Vaginoscopy? Irrigation of the vagina Colposcopy of the vagina Removal of impacted vaginal foreign body OFFICE: vaginal irrigation? 25

26 PROCEDURE: Bilateral labiaplasty You code for which of the following? 1. Vulvar biopsy 2. Vulvectomy 3. Partial vulvectomy 4. Partial vulvectomy with/without modifier PROCEDURE: Bilateral labiaplasty Simple vulvectomy: Unilateral vs. bilateral? 22 modifier? 26

27 PROCEDURE: laparoscopic p ovarian detorsion, ± oophoropexy You code for which of the following? 1. diagnostic laparoscopy 2. Laparoscopy unlisted procedure 3. Other procedure 4. Laparoscopy with modifier PROCEDURE: laparoscopic p ovarian detorsion, ± oophoropexy Diagnostic laparoscopy: Unlisted laparoscopic procedure, oviduct, ovary: modifier Other? 27

28 PROCEDURE: Laparoscopic p paratubal cystectomy You code for which of the following? 1. diagnostic laparoscopy 2. laparoscopy unlisted 3. Other 4. Laparoscopy with modifier 5. Ovarian cystectomy PROCEDURE: Laparoscopic p paratubal cystectomy 58662: Laparoscopic fulguration or excision of lesions of ovary, pelvic viscera or peritoneum by any method OTHER? 28

29 PROCEDURE: Excision of obstructing longitudinal vaginal septum, drainage of hematocolpos, vaginoplasty You code for which of the following? 1. Excision of vaginal septum 2. Pelvic exam under anesthesia 3. Vaginoplasty 4. All of the above PROCEDURE: Excision of obstructing longitudinal vaginal septum, drainage of hematocolpos, vaginoplasty Excision of vaginal septum: modifier Unlisted procedure, female genital system Other? 29

30 Physicians are paid for services, not visits or diagnoses Keep an accurate, legible medical record Provide excellent medical care Get paid for your work! And SHARE your suggestions about PAGrelevant ICD 10 and CPT codes! 30