ICD-9-CM Diagnosis Code options

Transcription

1 ICD-9-CM Diagnosis Code options Diagnosis codes are used by both physicians and facilities to document the indication for the procedure. Intrathecal drug delivery is directed at managing chronic, intractable pain. Pain can be coded and sequenced several ways depending on the documentation and the nature of the encounter. Regardless of the site of service, ICD-9-CM diagnosis codes do not change. Codes from the 338 series can be used as the principal diagnosis when the encounter is for pain control or pain management, rather than for management of the underlying conditions. Additional codes may then be assigned to give more detail about the nature and location of the pain and the underlying cause. When a specific pain disorder is not documented or the encounter is to manage the cause of the pain, the underlying condition is coded and sequenced as the principal diagnosis.

2 The table below gives a breakdown of commonly billed ICD-9-CM diagnosis codes used in all settings. Category Code Code Description Chronic Pain Disorders Reflex Sympathetic Dystrophy and Causalgia 2 Underlying Causes of Chronic Non-Cancer Pain Underlying Causes of Cancer Pain Attention to Device and 733.0X , , , , , , , , plus or Central Pain Syndrome Other Chronic Pain Neoplasm-related pain Chronic Pain Syndrome Reflex sympathetic dystrophy of the lower limb (CRPS Type I) Causalgia of the lower limb (CRPS Type II) Postherpetic neuralgia Arachnoiditis, chronic Arachnoiditis, other and unspecified Phantom limb syndrome Peripheral neuropathy of lower limb Radiculitis due to herniated disc, lumbar Radiculitis due to degenerative disc disease, lumbar Postlaminectomy syndrome, lumbar region (failed back syndrome) Radicular syndrome of lower limbs Collapsed vertebra due to osteoporosis Esophageal Cancer Stomach Cancer Colon and rectal Cancer Liver Cancer Pancreatic Cancer Lung Cancer Bone Cancer Breast Cancer Cervical Cancer Uterine Cancer Ovarian Cancer Prostate Cancer Testicular Cancer Bladder Cancer Kidney Cancer Brain and Spinal Cord Cancer Pathological fracture due to bone cancer V Fitting and adjustment of devices related to nervous system 1. Pain must be specifically documented as chronic to use code Similarly the diagnostic term chronic pain syndrome must be specifically documented to use code If these terms are not documented, then other symptom codes for pain may be assigned instead. However, they cannot be sequenced as a principal diagnosis. Rather, the underlying condition would ordinarily be used as the principal diagnosis in this circumstance.

3 2. CRPS not specified by type defaults to type 1. Codes from the 338 series should not be assigned with CRPS as pain is a known component of these disorders. 3. V53.09 is used as the principal diagnosis when patients are seen for routine device replacement and maintenance. A secondary diagnosis code is then used for the underlying condition. HCPCS II Device and Drug Codes Commonly billed HCPCS II Device and Drug Codes used in all settings. However, in the outpatient hospital setting these codes are used in conjunction with Device C codes when billing Medicare. Device/Drug Code Code Description Programmable Pump and Catheter E0783 Programmable Pump Only (Replacement) Intraspinal Implantable Catheter Only Preservative- Free Morphine Sulfate Anesthetic drug administered through IV E0786 E0785 J2275 J7799 Infusion pump system, implantable, programmable (includes all components) Implantable programmable infusion pump, replacement, does not include implantable catheter. Implantable intraspinal catheter used with implantable infusion pump, replacement Injection, morphine sulfate, 10 mg NOC drugs, other than inhalation drugs, administered through DME Refill Kit A4220 Refill Kit for implantable infusion pump

4 All ASC s utilize ICD-9-CM diagnosis codes, CPT procedural codes, and HCPCS II Device and Drug Codes. Unlike the outpatient hospital setting C-Codes do not need to be associated with CPT codes when billing Medicare. It is important to remember that Medicare has special rules and a separate payment system in ASCs regarding reimbursement for devices and drugs. Under Medicare s ASC payment system, ASCs usually should not assign or report HCPCS II codes for devices and drugs on claims sent to Medicare Medicare generally does not make a separate payment for devices and drugs in the ASC. Instead, payment is packaged into the payment for the ASC procedure. ASCs are instructed not to bill HCPCS II codes to Medicare for devices and drugs that are packaged. Of the devices and drugs, only Prialt is not packaged. For this reason, Prialt should be coded separately but none of the other drugs and devices should. At this time, the Prometra pump is not labeled for the use of any drug except morphine. ASCs should report all charges incurred. However, only charges for non-packaged items should be billed as separate line items. For example, the ASC should report its charge for the implantable infusion pump. However, because the pump is a packaged item it should not be reported on its own line. Instead the ASC should bill a single line for the implantation procedure with a single charge, including not only the charge associated with the operating room but also the charges for the pump, catheter, morphine, and all other packages items.

5 CPT Procedure Codes Medicare payment for procedures performed in an ambulatory surgery center is based on Medicare s ambulatory patient classification methodology for hospital outpatient payment. Each CPT code designated as a covered procedure in an ASC is assigned the same relative weight, or a comparable weight, as under the hospital outpatient APC system. This is then converted to a flat payment amount using a conversion factor unique to ASCs. Multiple procedures can be paid for each claim. Certain ancillary services, such as imaging, are also covered when they are integral to covered surgical procedures, although they may not be separately payable. In general, there is no separate payment for devices; their payment is packaged into the payment for the procedure. Also, when multiple procedures are coded and billed, payment is usually made at 100% of the rate for the first procedure and 50% of the rate for the second and all subsequent procedures. Procedure Code Code and Description Payment Multiple Indicator* Procedure Discount Trial Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrasts (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opiod, steroid, other solution), epidural or subarachnoid; cervical or thoracic 2009 Medicare National Average Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrasts (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opiod, steroid, other solution), epidural or subarachnoid; lumbar, sacral (caudal) Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opiod, steroid, other solution), epidural or subarachnoid; cervical or thoracic

6 62319 Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opiod, steroid, other solution), epidural or subarachnoid; lumbar, sacral (caudal) Implantation, revision, or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy $1,066 Implantation, Revision, or Replacement of Catheter Implantation, Or Replacement of pump Removal of Catheter or pump Implantation, revision, or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion/pump; without laminectomy Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming Removal of previously implanted intrathecal or epidural catheter $1,066 H8 $10,941 $ Removal of Subcutaneous reservoir or pump previously implanted for intrathecal or epidural infusion $943 Fluoroscopy for catheter placement and injection Fluoroscopic guidance and localization of needle or catheter tip for diagnostic or therapeutic injection procedures (epidural, subarachnoid) Drug J2275 Injection, morphine sulfate (preservative-free sterile solution), 10 mg N1 N/A N/A N1 N/A N/A * ASC Payment Indicator = ASC payment based on OPPS relative payment weight H8 = Device intensive procedure ; paid at adjusted rate N1 = Packaged service/item; no separate payment made Note: Refill and maintenance are not payable in the ASC setting.