Tuesday, January 21, 2020

Coding Vaccinations


With flu season upon us, this installment of “Spotlight on CPT” presents information on coding for vaccinations.

Coding professionals who assign CPT codes for vaccinations must be aware that two codes will be needed in order to capture the entirety of the procedure; one code is for the administration of the vaccine (the actual injection itself), and the second code is for the vaccine or toxoid that is being given.  Let’s talk about the administration codes first.

CPT codes for the administration of a vaccine are broken down into two distinct groups.  The first group of codes (90460-90461) require that the physician or qualified healthcare professional provide counseling regarding the component(s) of the vaccine to the patient.  For this code group, the age of the patient is a factor with the age being through 18 years.  The second group of codes (90471-90474) are to be used when there is no counseling performed.  The breakdown of these codes is by the route of administration: either percutaneous, intradermal, subcutaneous, or intramuscular injection or via intranasal or oral route.  There is an add-on code for each of the base codes to identify any additional vaccines that may be administered.

Once the appropriate administration code has been chosen, the coding professional will need to determine the appropriate vaccine or toxoid code that should also be assigned.  In this coding step, it is important that the precise code for the vaccine/toxoid is assigned.  Different CPT codes exist for vaccines that have variations in chemical formulation (influenza vaccines for example), dosage (hepatitis A-adult vs. pediatric dosage for example), or route of administration (rabies-intradermal vs. intramuscular for example).

When assigning the vaccine/toxoid code, coding professionals should be aware that there are combination codes available.  Like with all other combination code guidelines, it is inappropriate to separately code for the individual components of a vaccine if a combination code exists.  For example, if an adult patient was to receive an intramuscular Hib-HepB vaccine, the appropriate code is 90478 and not 90739 and 90647.

As previously mentioned, it is important to assign the precise vaccine/toxoid code.  Should a coding professional encounter a vaccine that does not have a specific CPT code, an unlisted code (90479) should be reported instead.  Also, be aware that the coding for immune globulins does not fall into any of the previously mentioned categories of codes.  Instead, those codes are in the ranges of 90281-90399 (immune globulin) and 96365-96375 (administration).

Let’s look at a specific scenario in order to apply the concepts noted above.  A 60 year-old female goes to a local pharmacy to get a Shingrix vaccine.  The pharmacist administers the vaccine intramuscularly in the left shoulder and provides information on possible side effects.  The CPT codes to assign are 90471 for the administration and 90750 for the Zoster vaccine.

Now, light has been shed on coding for vaccinations.


About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

Monday, January 13, 2020

G. I. Bleeding


G. I. bleeding will the topic explored in this “In the kNOW” conversation.  Ever since Coding Clinic clarification of the term “with” in the Index a few years ago, questions have continued to arise about appropriate linking, and coding for G.I. bleeding has been part of that discussion.  

First, it is important to remember that as coding professionals we are always to rely on the Official Coding Guidelines as a primary source of information and assistance for code assignment.  In this circumstance, Section I.A.15 explains the term “with” to mean “associated with” or “due to” when it appears in one of three places:

- A Code title
- Alphabetic Index
- Instructional note in the Tabular List

The definition goes on to state that coding professionals are to assume a causal relationship between the linked terms, and unless the provider specifically indicates another cause, we are to assign the linked code even without provider documentation stating such a linkage exists.  So, in plain English, what does that mean?  If the provider states the patient is a Type 2 diabetic and has neuropathy, the appropriate code assignment would be E11.40.  

This same definition applies to coding for G.I. bleeding conditions.  Let’s look at diverticulosis as an example.  Here is the Alphabetic Index for diverticulosis:


Diverticulosis K57.90
- with bleeding K57.91
- large intestine K57.30
- - with
- - - bleeding K57.31
- - - small intestine K57.50
- - - - with bleeding K57.51
- small intestine K57.10
- - with
- - - bleeding K57.11
- - - large intestine K57.50
- - - - with bleeding K57.51

As you can see, the first entry is “with bleeding” meaning that if the physician documents the patient has a G. I. bleed and diverticulosis, the code K57.91 is correct to assign.  We can use the same reasoning to code for diverticulosis in the large or small intestine with bleeding at K57.91 or K57.11, respectively.  Coding Clinic, which is a secondary source for coding knowledge, supports this coding as well as documented in the 3rd Qtr. 2017 publication.

The same rationale applies if we are coding multiple conditions, such as diverticulosis and angiodysplasia of the intestine, and there is bleeding.  Combination codes for both conditions exist for “with bleeding”, as seen below:

Angiodysplasia (cecum) (colon) K55.20
- with bleeding K55.21
- duodenum (and stomach) K31.819
- - with bleeding K31.811
- stomach (and duodenum) K31.819
- - with bleeding K31.811

In this case, both the diverticulosis and angiodysplasia with bleeding codes should be assigned (K57.91 and K55.21).  The same applies to upper G.I. conditions as well.

Remember that the bleeding does not have to be occurring during the admission in order to assign the “with bleeding” code.  Bleding does not have to be found during an endoscopic exam either in order to assign the code.  This is explained in the 3rd Qtr. 2018 Coding Clinic.  

Keep in mind, that when providers perform procedures to address these bleeding issues, coding professionals should be assigning a “Control” procedure.  This is true even if the condition is not currently bleeding as documented in the 4th Qtr. 2017 and 1st Qtr. 2018 Coding Clinics.
 
Now you are In the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

Tuesday, January 7, 2020

OHIMA Membership Benefits 101: Career Assist


by Lauree E. Handlon, MHA, RHIA, CHFP, CCS, COC, FAHIMA 

Did you know… AHIMA offers several benefits to assist with your HIM Career!  The available career resources include:
  • Career Prep Tools 
  • Job Bank 
  • Mentor Program 
  • HIM Career Map
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Career Prep Tools


Whether you are a Premier, Active, New Graduate, or Student Member, AHIMA offers a few prep tools to help you with next steps in your career. 

The Career Prep Workbook supports:

MAPPING out your career
Preparing yourself for your IDEAL position
Getting you started on SEARCHING
Provides pointers on how to ACCEPT the perfect position!
 


The workbook is a one-stop shop for tools necessary for career progression.  The workbook is designed to assist in making the tasks a little easier for steps involved in career search or change process with initiating new beginnings and moving forward.  Perfect for students, new grads or ANYONE looking for a change.

Career Prep Webinars empowers you to seek that promotion or apply for that new position you’ve had your eye on.  These webinars include archived seminars that teach you interview tips, resume building, networking, and so much more.

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Job Bank


The AHIMA Job Bank allows members to:
  • Access a career coach 
  • Post your resume 
  • Find a job on AHIMA’s job board 
  • Search for your next employee if you have an open position within your organization!
The site provides a way to search by job function or state.  With more than 30,000 employers involves, you are bound to find your next career or with over 85,000 job seekers, you are certain to find your next employee. 

To expand your job search even more, check our the OHIMA Career Center where one can sign up for job alerts, post resumes for employers to view, and find additional career building resources.

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Mentor Program


Learn from lifelong professionals or take an up-and-coming talent under your wing to help navigate their career path.  Mentor Match is for those who are new to the HIM field and looking for guidance or for seasoned members interested in helping others. Mentor Match provides a medium to connect mentees and mentors. 

Here is a link to the Mentor Match Tutorial: https://vimeo.com/81138515

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HIM Career Map


https://my.ahima.org/careermap/index.html
 
The HIM Career Map will help you:

Better understand the HIM profession 
Chart your next career step
Map out a whole career-long plan for yourself

With detailed information including roles and responsibilities, average salaries, and career pathways for careers in: 

  • Coding and Revenue Cycle 
  • Data Analytics 
  • Informatics 
  • Information Governance

The HIM Career Map is a perfect way to see current and emerging positions as well as transition and promotion opportunities.

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Regardless if you have been in the profession for some time, or are brand new, or have not even started yet – check out these career resources! These are just a few of the excellent and useful benefits AHIMA offers the membership. So, if you did not know, now you know!

 

About the Author

Lauree Handlon serves as the Director of Data Quality + Reimbursement at Cleverley + Associates, where she has worked since 2002. She primarily analyzes third party payer contractual arrangements for strategic pricing, payment assessments, and regional comparisons.  Ms. Handlon also conducts frequent regulatory research, monitors data integrity by identifying anomalies in the Medicare public claims data and client submitted claims data, and provides Medicare prospective payment system and coding & billing education.

Ms. Handlon received her Masters of Health Administration from the University of Cincinnati in Spring 2017. She received her Masters in Allied Health Management through the School of Health and Rehabilitation Sciences from The Ohio State University in 2008. She received her undergraduate degree in Health Information Management and Systems from The Ohio State University in 2000.  She holds several certifications from AHIMA, HFMA, and AAPC.

Ms. Handlon also has been instructing part-time for the HIMS department in the School of Health and Rehabilitation Sciences at The Ohio State University since 2007 and has served as a Preceptor since 2003. She was awarded Fellowship status from the American Health Information Management Association in 2011.  Ms. Handlon is a Past-President and past 2-term role as Delegate for the Ohio Health Information Management Association. She is also the current Membership Chair for the Central Ohio chapter of HFMA as well as President of The Ohio State University School of Health and Rehabilitation Sciences Alumni Society.



Friday, December 20, 2019

It’s a Wonderful Life?

by Dianna Foley, RHIA, CHPS, CCS 


Test your ICD-10-CM coding skills with this Klutz family experience.

Each year the Klutz family observe the tradition of watching “It’s a Wonderful Life” together during the holiday season.  Each of the children has a favorite part, related of course, to an injury or poisoning.  For some coding fun, assign the ICD-10-CM codes to each Klutz child’s preferred section of the beloved movie.

Egon is partial to the part where George gets a bloody (cut) lip from a punch by the bartender in the bar brawl.

Janine favors George’s loss of hearing (left ear) related to being in the icy pond water while saving his brother from drowning.

Peter chooses the drowning of Harry in the pond, which would happen if George never existed.

Raymond prefers the scene between George and Mr. Gower in the drugstore, when the old pharmacist strikes George and causes his sore ear (left) to bleed.

Little Dana, although very young, has been taught about Mr. Yuk and poisonings, so she is fixated on the child that was poisoned and died at home as a result of Mr. Gower’s medication error in the alternate universe of a Bedford Falls without George Bailey.

Click HERE for the answers.





Tuesday, December 3, 2019

Endovascular Revascularization


This edition of “Spotlight on CPT” examines endovascular revascularization of the lower extremities.  These procedures are performed when patients have occlusive peripheral vascular disease.  All the codes in this section (37220-37235) apply regardless of whether the procedure is performed via an open or transcatheter percutaneous approach.  Every code in this section includes balloon angioplasty if it is performed.

This series of codes has several inclusive components:

  • Access and/or selective catheterization of vessel
  • Radiological supervision and interpretation related to intervention
  • Embolic protection
  • Arteriotomy closure by pressure 
  • Application of closure device 
  • Imaging which documents the intervention and completion of the procedure

The procedures that are included in these revascularizations are transluminal angioplasty, atherectomy, and stent placements.  Three arterial vascular territories are addressed with these codes: iliac, femoral/popliteal, and tibial/peroneal. 

  • Iliac vessels-common iliac, internal iliac, and external iliac
  • Fem/Pop vessels-this territory is considered one vessel for these procedures
  • Tibial/Peroneal vessels-anterior tibial, posterior tibial, and peroneal (the common tibio-peroneal trunk is part of this territory, but not considered a separate vessel)

Each of these vascular territories have specific coding guidelines.  For example, in the fem/pop territory there are no add-on codes, only the most extensive procedure is coded.  More specifics can be found in the notes that precede this series of codes. 

These revascularization procedures are built on a hierarchy.  Coding professionals should assign a code for the most intensive services provided per vessel treated.  Add-on codes are used to assign codes for additional vessels within a territory, not when distinct lesions are treated in the same vessel.  Multiple stent insertions in the same vessel are only reported once.  When an occlusion traverses two vessels, for example the common iliac and into the internal iliac, and is treated with one intervention (stent) across both vessels, only one procedure is coded.  This would be coded to 37221 and no additional code would be assigned.  However, if there are bifurcation lesions requiring intervention in distinct branches of the iliac or tibial/peroneal territories, then two codes would be assigned. 

If procedures such as mechanical thrombectomy or thrombolysis are performed to address the occlusion, they should be separately reported. 

Now, light has been shed on coding endovascular revascularizations.



About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.