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.

Monday, November 25, 2019

Black (and Blue) Friday

by Dianna Foley, RHIA, CHPS, CCS 


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



An annual Klutz family tradition is a Christmas shopping excursion to the nearby mall on Black Friday.  Each child is tasked with finding a gift for a child their age, which they then donate to their church for distribution to a needy family for Christmas.  Of course, no Klutz outing is complete without some injury or another, so read on to see what befalls the children this year.  Try your hand at coding the ICD-9-CM diagnosis and external cause codes for each injury.

Raymond was the first to find his gift, which was the last small tin full of toy soldiers.  As he grabbed it from the shelf, he was shoved from behind by another child who was reaching for the same toy, striking his forehead on the shelf, and netting himself a rather large contusion in the process.     
Little Dana found a “Little Miss Muffet” doll for her gift.  Unfortunately, as she was carrying it over to the cash register with her mother, she dropped it and when she reached to pick it up with her left hand, someone in the crowd stepped on her little finger.  Tears welled in her eyes, and her mother, who was an old hand at such injuries having four other children, realized that while it was going to be bruised, there was no broken bone. 

Janine decided on a coloring book of nature with an assortment of colored pencils.  Her injury came when she removed the pencils from the metal peg they were hanging from and accidentally jabbed her right thumb on the peg.  As a Klutz child, she knew to examine the area for a puncture, but saw the thumb was only developing a mild bruise, so it wasn’t going to require a tetanus shot, thank goodness!

Egon chose a football for the gift he would donate.  He was passing it to Peter (just to try it out, mind you!) when Peter became distracted by spotting the gift he would give, and the football hit him in the right eye.  Since, this wasn’t the first time Peter had had a black eye, he went to the vending machines, got a cold can of pop, and put it by his eye to help reduce the swelling.  On his way back, he picked up the robot building kit he’d seen earlier for the gift he would give. 

On the way back to the car, in the mall parking lot, Egon, who was carrying all the wrapping paper, boxes, and bows for the gifts, tripped and landed on his left knee.  It was clear there was a small hematoma over his left patella, but nothing broken. 

Mr. and Mrs. Klutz loaded the children into the car and went back home.  Pleased with their children and their spirit of the holidays as well as relieved there were no major injuries…on this excursion anyway!


Click HERE for the answers.




Tuesday, November 19, 2019

Diabetes 1.5


This edition of “In the kNOW”  shares information on proper coding for diabetes 1.5.  Most coding professionals are familiar with type 1 and type 2 diabetes.  Type 1 diabetes occurs when the pancreas does not produce insulin at all or very little.  This prevents cells from absorbing glucose necessary to produce energy and requires insulin administration for treatment.  Type 2 diabetes on the other hand can be due to either insulin resistance or insufficient insulin production with treatment either oral hypoglycemic medications or insulin.  
 
Diabetes 1.5 is also known as latent autoimmune diabetes in adults or LADA.  Where type 1 diabetes usually is diagnosed in childhood, type 1.5 diabetes is most often being identified in patients over 30.  Progression of the disease is slow, with initial management being similar to that for type 2: weight reduction, exercise, proper diet, and possibly oral medications.  As the disease progresses, which could be months to years, it will become necessary to switch to insulin as the main treatment.

Patients should be aware of the three P’s of diabetes.  These symptoms can often indicate that the patient is a diabetic: polyphagia (excess hunger), polyuria (excess urination), and polydipsia (excess thirst). 

Coding professionals know that type 1 diabetic conditions will fall into the E10 category: Type 1 diabetes.  Type 2 diabetes is found in category E11.  Type 1.5 diabetes will be category E13; Other specified diabetes.

A recent Coding Clinic from 2018, the third quarter, shares that if a physician indicates a patient has both type 1 and type 2 diabetes, that correlates to type 1.5 with category E13 being the appropriate category for coding that type of diabetes.

Coding professionals are reminded to use combination codes for diabetes “with” conditions.  Using type 2 diabetes in the following examples it would include conditions such as neuropathy (E11.40), hyperglycemia (E11.65), chronic kidney disease (E11.22), etc.  

It should also be mentioned, when the type of diabetes is not specified by the provider in the record, the default is type 2.  

Capturing the long-term use of insulin (Z79.4) or oral hypoglycemic medications (Z79.84) is also important when coding for diabetes.  While the classification does not require the use of the Z79.4 for insulin usage in type 1 diabetic patients, other types of diabetes have an instructional note reminding coders to add the long-term use of medication code as appropriate.  The long-term use of insulin may be coded for type 1 diabetics if a facility chooses.  A reminder that when insulin is used temporarily for a short-term control of type 2 diabetes, it should not be coded. 
 
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.

Thursday, November 14, 2019

Professional Practice Experiences in an Evolving HIM World

All HIM students are required to complete professional practice experience (PPE) time in a HIM practice environment.  The most typical PPE environment is a HIM department at a healthcare organization (hospital, long term care facility, physician’s office, etc.), but many other opportunities exist, such as insurance companies, software vendors, or government agencies.  In recent years, the number of sites willing and available to host student PPEs have declined, so students and/or preceptors may need to get creative.  PPEs are critical learning experiences for students who have little to no background in the HIM field.

The traditional PPE is a one-on-one encounter between student and preceptor spread across days or weeks.  It covers a variety of topics and may include meetings, completing a project, or answering specific questions from the student’s homework assignments.  With the “do more with less” staffing approach that’s prominent in various industries, it’s becoming more complicated to get dedicated PPE preceptors for students.

One way to combat the lower number of PPE sites/preceptors is to hold group sessions.  In this manner, an organization will schedule dates, times, and topics for students to attend.  Instead of traveling around to meetings or visiting different physical departments at the organization, sessions are held in a conference or training room, and speakers are rotated through.  This experience is not as personalized as the traditional PPE but allows for many students to meet with a variety of professionals while minimizing the time commitment of the professionals.




 

With the increasing availability of technology, students are completing some PPE hours remotely.  CAHIIM does not allow the entire PPE time to be replaced with simulated activities; however, it has been possible for students to attend meetings or see a demo of the software via WebEx or similar teleconferencing programs.  This may be a more tailored discussion between preceptor and student than the group option, but it may not share important contextual information the student would likely see if he/she were present on site.

Although it takes much time and effort to be a PPE preceptor (been there, done that), it can lead to potential new employees, greater networking, and even earn you CEUs.  PPE preceptors and mentors can earn one CEU for every 60 minutes of direct contact with a maximum of five CEUs per student, and a maximum of ten CEUs allowed in each recertification cycle.

As with anything else in healthcare (and to go along with the 2020 Annual Meeting theme), change is inevitable.  We must learn to adapt without compromising the integrity of student education since the students of today are the workforce of tomorrow. 
 

About the Author 


Carol Barnes, MS, RHIA is currently a Director on the OHIMA FY19-20 Board in charge of the Professional HIM Development strategy.  Carol is an adjunct faculty with The University of Cincinnati HIM program.

Monday, November 4, 2019

Ask HIM: I'm looking for a coding job. What's the difference between a Coder II, III and IV position?


Question from Anonymous: Hi!  I recently obtained my CCS credential. As I look for jobs, I see Coder II and III and IV.  I've searched google and see different answers with no definitive answers.  Could someone please tell me the differences in those coding jobs? Thanks for your help!


Answer from OHIMA: Hello! Different coder levels may vary a bit from facility to facility.  But generally speaking, these are different experience levels.  If you look within the job description, each title/level should have a different set of skills and experience that is required. For example - if a facility has levels from I-IV, Coder I would be an entry level position; Coder IV would be the most experienced. 

Make sure you check out the OHIMA Career Center for job opportunities!  It's free for Job Seekers!



Do you have a question??  Ask an HIM expert!  We will do our best to answer questions on any topic ranging from HIM, management, beginning your HIM career, CEUs, OHIMA, AHIMA, etc.!  Submit your question HERE.

Monday, October 28, 2019

Halloween Howlers

by Dianna Foley, RHIA, CHPS, CCS 


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

This Halloween each Klutz child went to a different party and of course, ended up with an injury.  See what transpires.

Raymond participated in a donut-eating race at the church party he attended and choked on the donut.  Quick thinking with some swift slaps on the back dislodged the offending food from his throat.  Little Dana went to a party at her friend Julia’s house where there was a mummy wrapping event.  Her partner wound so much toilet paper around her feet and ankles that little Dana tripped and fell on the sidewalk ending up with a big abrasion and bruise on her nose.  At the Boy Scout party Peter attended in the nearby forest, each child was carving a small pumpkin.  He slipped with the knife and had a superficial laceration on the palm of his left hand.  Egon went to the party at the high school where he dislocated the left side of his jaw while bobbing for apples.  It just so happened that one of the parents chaperoning the party was a dentist and knew just what to do to pop it back into place. Finally, Janine and a few girlfriends had a sleepover where they decorated each other with face paint in the bedroom of her best friend’s trailer.  Unfortunately, Janine developed an allergic urticaria to the paint and had to go home.  All-in-all minor mishaps for the Klutz children…at least this Halloween.

Click HERE for the answers.




Monday, October 21, 2019

Coding Hysterectomies


This installment of “Spotlight on CPT” presents information regarding the coding for hysterectomy procedures.  There are several different types of hysterectomy procedures: total/partial, abdominal/vaginal, and laparoscopic/open.  Some hysterectomy procedures include other procedures as well necessitating a combination code.  So let’s review.

A hysterectomy is the surgical removal of the uterus.  Most often, the procedure also includes the removal of the cervix.  When a total hysterectomy is performed, both the uterus and cervix are removed.  If only a partial hysterectomy is done, the cervix remains.  This is also called a supracervical hysterectomy.   


These procedures may be performed via a laparoscopic approach or through an open incision in the abdomen while others can be done vaginally.    


Once a coding professional determines the methodology of the procedure, then other details are needed to complete the coding.  For example, often the size of the uterus is a component of the code assignment.  CPT determines the cut-off point to be 250 grams.  Anything over that weight moves the code to another level.  Once the size has been determined and the appropriate category found, then a coder must look to see if any other procedures were done concomitantly.  Those other procedures could be removal of tubes and/or ovaries (which is the most common); the repair of enteroceles; partial vaginectomy; and lymph node procedures.   


Now, let’s look at some examples.  A patient has an open total abdominal hysterectomy for uterus 312 grams.  The code would be 58150.  If this was a laparoscopic procedure, the code changes to 58572, and if it was a vaginal procedure the code becomes 58290.  


There are times when a hysterectomy is performed vaginally but with laparoscopic assistance.  There is a specific section of codes (58550-58554) for those procedures.  


Just a quick mention about radical hysterectomy procedures.  These procedures are usually performed when there is a diagnosis of cancer.  This procedure will entail the removal of the uterus, cervix, bilateral fallopian tubes and ovaries, lymph nodes, part of the vagina, and possibly other surrounding tissue.  CPT has specific codes for radical hysterectomy procedures.

Now, light has been shed on coding for hysterectomies. 

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, October 14, 2019

OHIMA Receives the 2019 AHIMA Advocacy Triumph Award





At the AHIMA Convention in Chicago, AHIMA recognized the 2019 Triumph Awards recipients during the 80s themed Appreciation Celebration on September 17, 2019.  This honor is presented to members who have demonstrated excellence in their dedication and service to the health information management profession.  The ADVOCACY AWARD honors those who have exhibited long-standing and enthusiastic support of policy advocacy for the purpose of advancing the health information management (HIM) profession and practices.

AHIMA selected the Ohio Health Information Management Association (OHIMA) as the recipient of the 2019 AHIMA Advocacy Triumph Award.  While not a typical method of legislative advocacy for the profession, OHIMA’s application communicated a compelling case describing how OHIMA advocated for the HIM profession by creating a short, animated video that showcased the diverse job settings, skills, and functions that make up the HIM profession in an effort to help others to answer that question which is common to us all: “What exactly IS health information management?”  The purpose of the video creation by the OHIMA Board of Directors was to aid potential students, human resource departments, and the general HIM profession in understanding and communicating the HIM profession.

The video was revealed during the OHIMA 2019 Annual Meeting and Trade Show where members were encouraged to share the video broadly with employers, human resource departments, and HIM colleagues. Members and other CSAs helped to achieve almost 2000 views of the video within a few months of release. Kristin M. Nelson, MS, RHIA; Lauren W. Manson, RHIA; and the OHIMA Board are credited with leading this strategic advocacy project.  The video can be viewed on the OHIMA website under the “What Is HIM?” link.  AHIMA congratulated OHIMA as the recipient of the 2019 AHIMA Advocacy Triumph Award for successfully advocating for the profession, explaining exactly what HIM professional do, and encouraging others to join OHIMA to showcase the talent and importance of the HIM professional.

To view the video, visit the OHIMA website:
http://ohima.org/whatishim.html


http://ohima.org/whatishim.html
 








Tuesday, October 8, 2019

If You Don’t Know, Now You Know… Membership Benefit 101: Education

In case you didn’t know, OHIMA implemented a new membership engagement strategy this year. What exactly IS membership engagement? It is "a collaborative investment between an organization and its members." The organization’s supporters contribute money, time, and passion, and the organization devotes energy to the member experience.  When I think about AHIMA and OHIMA, this definition holds true. Therefore, we wanted to showcase some of the benefits of being an AHIMA and OHIMA member. 


First up is access to education, which ends up more than covering the cost of the membership itself.

  • Stay on top of news, developments, best practices, and updates in the field with the award-winning Journal of AHIMA - both digital and print. I don’t know about all of you, but I still enjoy getting the printed version in the mail. Having something right in front of me forces me to read and stay up-to-date on the profession and what other colleagues are doing.

  • There are a variety of e-newsletters. One in particular is the AHIMA Smart Brief delivered daily showcases targeted news and information in sections that are leading in HIM. The first section is titled “Top Stories,” and then range from “technology and innovation” to “legislative and regulatory,” and ends with “news from AHIMA.” There is also a “featured content” section from SmartBrief.com that offers insights, analysis and best practices for the education professional.
      

  • AHIMA’s HIM Body of Knowledge provides resources and tools to advance health information professional practice and standards for the delivery of quality healthcare. It enables HIM professionals to access quickly and easily information needed to be successful. Click on the large topic buttons and then further narrow your search by author, source, publication date or more specific topic. This is a vast improvement over pages of links that we have seen in the past.

  • There are also a wealth of AHIMA discounted on-demand webinars in CDI, Coding, and Privacy and Security.  You can organize a group in order to make the cost minimal. In addition, OHIMA continually offers discounted webinars like tomorrow's Getting Clued In: 7th Character Coding for Injuries, Poisonings, and Fractures brought to you by Dianna Foley, OHIMA’s Coding Education Coordinator for only $25. This webinar counts for one AHIMA CEU and one AAPC CEU.

So if you didn’t know now you know…

 

About the Author 


Kristin Nelson, MS, RHIA is the currently President-Elect on the OHIMA FY 2020-21 Board of Directors, in charge of Membership Engagement strategy.  Kristin is a Clinical Instructor at The Ohio State University School of Health and Rehabilitation Sciences HIMS Division.

Monday, September 30, 2019

AHIMA 2019 House of Delegates Meeting


AHIMA held its 73rd House of Delegates (HoD) meeting on Sunday, September 15, 2019 in Chicago Illinois.  This is an all- day event that kicked off the AHIMA 19 Health Data and Information Conference.    The morning kicked off with a networking breakfast and welcome from Christopher Wheat, CSA President for ILHIMA.  Shawn Wells, Speaker of the House provided an overview of the agenda and plan for the day.

Dr. Wylecia Wiggs Harris, CEO of AHIMA also provided an update on the AHIMA strategy, highlighted the successes of the organization as well as spoke to the transformation plan.  Seth Jeremy Katz and Breian Meakens provided a financial of AHIMA.  Dr. Valerie Watzlaf, President of AHIMA provided an overview of the role of the House in regards to moving the strategies forward.

I attended Action Forum 2: Health Information Professional Champions facilitated by Shawn Ambruster, RHIA and Laura Douresseaux Collins, MSHCM, RHIA, CHPS.  This purpose of this session was to address advocating for health information professionals to keep us at the forefront of the industry and reference existing HIM Awareness and HIM Reimagined resources to redefine HIM as champions in transforming health and healthcare. 
 

During the forum we were broken up into five (5) groups and tasked with coming up with a thirty (30) second elevator pitch to be utilized if you as an HIM professional are asked what you do.  Each group worked together and came up with pitches.  Five elevator pitches were created.  As a group we then reviewed all of the elevator pitches with an end goal of creating one.  We struggled coming up with because the five that were created were really good.  As time started winding down we collectively took bits and pieces from each elevator pitch to create one.  

The facilitator presented the elevator pitch that we put together to all attendees of the HoD. Those of us that were in the forum felt that all of the pitches were viable and worthy of being utilized.  We decided to submit all six elevator pitches to the House.  The premise for this was that we concluded that the elevator pitch may vary dependent upon your audience.  This gives you options.  


Overall, the meeting was very informative and a great networking opportunity. 





About the Author 

Tonya L. Bates, RHIA is the currently Board President of the OHIMA FY 2020-21 Board of Directors.  She can be reached at tla511j2@att.net.

Tuesday, September 24, 2019

The Elephant in the Tense Room: Trust



As the 73rd AHIMA House of Delegates (HoD) meeting approached, I remembered the passionate discourse of last year’s meeting. Well, it appears I wasn’t alone. Last year’s meeting was the talk of this year’s meeting, especially since there were some new action items that could potentially foster the same level of discussion.

To prepare for the HoD 2019 meeting, Robert Rules of Order was provided and discussed, a parliamentarian was included in the meeting and AHIMA’s General Counsel was in attendance. As a result of these efforts, we had a very orderly meeting, discussion and voting process. People were able to ask questions, get answers and clarification without being insulted and belittled. The vote was a standing vote and each person standing, either for or against the issue, was counted.
 

Even with all the preparation to ensure an orderly discourse, there was still an elephant in the room that had to be discussed- trust.
 

AHIMA leadership talked about trust, the lack of confidence and lack of belief in the organization and its leadership. It is important that even during debate and discussion, everyone should feel appreciated and at a minimum heard. 

As a member of AHIMA and OHIMA, we have a responsibility to vote, engage, trust the process and articulate our value in a respectful manner. As AHIMA pivots into the new transition, we must prepare ourselves by staying updated to information and announcements regarding changes, sharing our voice and advocating for our profession. We must remember to trust the process as we navigate the upcoming years of change and beyond.


 

About the Author


Clarice Warner, RHIA, CCS-P, CPC, CHC is the Corporate Director of Corporate Responsibility for the Mercy Health Corporate Office in Cincinnati, Ohio.  She is also the Founder and Education Director for the Professional Reimbursement Network.  Clarice serves as a 1st-year Director and Delegate on the OHIMA FY 2018-19 Board of Directors, overseeing the Public Good strategy and Advocacy Committee.   

Tuesday, September 10, 2019

Cystoscopy and Ureteroscopy Procedures


Cystoscopy and ureteroscopy procedures will be discussed in this episode of “Spotlight on CPT”.  These procedures are similar as they both begin with the insertion of a scope through the urethra and into the bladder.  

When coding procedures that involve the urinary system, terminology is vital.  Organs have similar names and it is important for accurate coding that we differentiate between the terms correctly.  So let’s start this discussion with an overview of the urinary system beginning externally.
 

    1 Urethra
    Leads to
    1 Bladder
    Leads to
    2 Ureters
    Leads to
    2 Kidneys 



And the Urinary System looks like this:

Source: https://www.yourdictionary.com/urinary-system

When a cystoscopy or cystourethroscopy is performed, the catheter is inserted in the urethra and then into the bladder.  Inspection occurs there.  This is often done for patients that have bladder neoplasms.  Biopsies can be taken or fulguration/resection which can destroy/remove abnormal tissue.  These destruction or removal codes are based on the location and size of the lesion.  Biopsies taken from the same area that is being destroyed, in the same encounter, are not separately coded.  However, it the biopsy comes from a different area of the bladder, it can be coded with an appropriate modifier.

Ureteroscopy procedures may include a pyeloscopy as well.  A code from this section could be assigned for a ureteroscopy with lithotripsy and double-J stent insertion with a combination code of 52356.

If one is not careful, it would be easy to be in the wrong section of the CPT manual when assigning codes.  This could result in code 52204 cystourethroscopy with biopsy being assigned instead of 52354 for cystourethroscopy with ureteroscopy with biopsy. 

Now, light has been shed on coding cystoscopy and ureteroscopy procedures.


 

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, September 3, 2019

CSA Leadership Conference - Listening Session on AHIMA Election

During the 2019 CSA Leadership Symposium there were many options in regards to breakout sessions.  One of the many options was, “Listening Session-AHIMA Election”.  I attended this session out of curiosity.   This session was facilitated by Dr. Valerie Watzlaf, Shawn Wells and Ralph Morrison.  The purpose of this session was to discuss concerns from the CSAs represented in regards to the rationale for having only one (1) candidate for President of AHIMA on the 2019 ballot.  

When entering the meeting I was expecting the facilitators to just explain why there was only one candidate on the ballot and that would be the end of it.  That is not what happened.  The facilitators allowed the audience to drive the meeting.  The biggest area of contention was the fact that of some of those present felt as though they were being forced to select a president.
 

Every year the Nominating Committee are tasked with going through all submissions for those that are to appear on the ballot.  This year was a rather difficult year as the committee did not feel as though they had more than viable, well-qualified candidate for President.  The committee felt there was only one candidate that was exemplary in comparison to all other applicants.  The committee went to the AHIMA Board and asked for a change in the policy.  The policy calls for more than one candidate to be on the ballot.  The board agreed.  When Shawn Wells was asked if the board could do things over would they make the same decision?  He responded that they would not have made the same decision if given the opportunity do over. 




About the Author 

Tonya L. Bates, RHIA is the currently Board President of the OHIMA FY 2020-21 Board of Directors.  She can be reached at tla511j2@att.net.

Monday, August 26, 2019

Coding Hernia Repairs in ICD-10-PCS


The previous installment of “In the kNOW”  presented information on hernia diagnosis coding.  Now our attention is going to turn to appropriately hernia repairs.  Let’s start with a basic piece of information which has been provided in Coding Clinic which states that when a hernia is manually reduced it is not separately reported.  So no code assigned for a manual hernia reduction.   

Hiatal hernias can be repaired either through an open or percutaneous endoscopic approach.  Additionally, a determination will have to be made on the correct root operation to assign.  Was it a repair only, in which case the root operation is Repair, or was it with the use of mesh or other augmentative agent, in which case the root operation would be Supplement.

Hiatal hernias repaired through a percutaneous endoscopic approach with mesh = 0BUT4JZ

Hiatal hernias repaired through a percutaneous endoscopic approach without supplement = 0BQT4ZZ

Inguinal hernia repairs have similar determinations that must be made:  Open or Percutaneous endoscopic approach; Repair or Supplement root operation.  If it is a Supplement, what type of material: autologous, non-autologous, or synthetic substitute?  A coding professional will also have to distinguish whether the procedure was done on the left side, right side, or bilaterally.

Inguinal hernia repaired via an open approach with mesh = 0YU60JZ

Inguinal hernia repaired via an open approach without supplement = 0YQ60ZZ

Parastomal hernias are a type of incisional hernia occurring at the site of an ostomy.  These can be repaired either with an open or laparoscopic approach.

Parastomal hernia repair with an open approach = 0WQF0ZZ

Internal hernias are seen in patients who have undergone bariatric surgery.  Those who have bariatric procedures performed laparoscopically have a greater incidence of internal hernias often located in Petersen’s space.  That is an area between the mesentery and the transverse colon.  The primary consideration regarding this type of hernia repair is whether it was done with an open or laparoscopic approach.  It is important to keep in mind that the hernia defect is in the mesentery so that is the correct body part that should be coded.

Internal hernia repair done laparoscopically = 0DQV4ZZ

In ICD-10-PCS, incisional, ventral, and umbilical hernia repairs are all coded to repair of the abdominal wall.  Approach and root operation determinations are critical to assigning the correct code for these repairs as with the others we have already discussed.

Repair, abdominal wall, open approach = 0WQF0ZZ

Occasionally, for patients who have already had an incisional hernia repair, a second repair becomes necessary.  A surgeon may perform an abdominal component release.  This procedure separates the layers of the abdomen (components) in order to primarily close the hernia.  This is done with what are called relaxing incisions, which effectively free the abdominal muscle making that the body part for the root operation Release.  It is not uncommon to see the use of mesh in this procedure as the now single layer abdominal area will be weakened. 

Right abdominal component separation = 0KNK0ZZ

Ventral hernia repairs may require an abdominoplasty along with plication.  If dermal and fat layers are removed, coding professionals should be sure to code the root operation Excision for the abdominal subcutaneous tissue and fascia taken out, in addition to the root operation Repair for the plication of the abdominal wall.

Questions have arisen regarding the appropriateness of assigning an additional code(s) for lysis of adhesions during hernia surgery.  The official advice provided indicates that should the lysis of adhesions go beyond what must be done to get to the operative site then the lysis can be separately coded.  Apply the root operation Release and assign the code(s) for the body part that is freed. 
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, August 20, 2019

August Adversities

by Dianna Foley, RHIA, CHPS, CCS 


Test your ICD-10-CM seventh character for injury/external cause coding skills with this short scenario.

August has brought some interesting adversities to the Klutz children.  See for yourself.

Last winter, little Dana suffered superficial frostbite to both her hands.  She is now experiencing numbness from that injury and her pediatrician is looking into Botox injections as a potential treatment.

Meanwhile, it appears that Raymond has a nonunion of his distal tibial fracture, which occurred when he fell out of a tree last fall.  He is going to have to have surgery to correct the initially closed fracture.

Janine is continuing to go to rehab for the bilateral biceps strain she developed as a result of scrubbing floors during spring cleaning.  Janine continues to suffer from the strains caused by the repetitive circular movements she used for scrubbing.

Egon has developed a keloid scar on his palm from a laceration he got last year when he accidentally cut his right palm with a bread knife.

Peter rounds out the children’s’ issues as he is going to the wound clinic this week to get a dressing change for the second degree burn he got by reaching across the steam from a boiling tea kettle to reach for the cookie jar.  That resulted in his right wrist burn.

That’s all the lingering issues for the Klutz children…at this time!

 
Click HERE for the answers.


Wednesday, August 14, 2019

AHIMA's Transformation: Change Isn't Linear


Hello my name is Ms. Shelia Robertson and I’m your OHIMA 1st year Delegate.  I had the extreme pleasure of attending my first Leadership Conference earlier this month and where do I begin!  The Leadership Conference was more than I ever imagined. The energy and excitement of the presenters was electrifying.
 
AHIMA’s Transformation Story: Mission, Vision & Strategy presented by Valerie Watzlaf and Wylecia Wiggs-Harris was insightful and inspiring!  Their dedication and commitment are very encouraging to me.  One of the things I took away from their session was that, “change can happen quickly however transformation isn’t linear.”
 
They discussed being a Transformational Leader and likened it to petrified wood which in time becomes rock (solid).  The message was to “be centered” and support others through the change.

 
There were so many dynamic sessions and I wanted to attend them all but that was impossible.  I had a great experience in Chicago and ate some of the best food the city had to offer.  Until next time, remember in regards to leadership, “failure is an event to learn from.”  



About the Author 


Shelia Robertson, RHIA is the currently a 1st Year Delegate on the OHIMA FY 2020-21 Board of Directors.  Shelia is a Supervisor in the Release of Information department at University Hospitals in Cleveland, Ohio.

Tuesday, August 6, 2019

Coding Hernia Repairs


This edition of “Spotlight on CPT” presents information on coding hernia repairs.  Correctly assigning hernia repair codes requires coders to first determine what type of hernia is being repaired.  A coder must identify if the hernia is inguinal, femoral, incisional, umbilical, ventral, hiatal, etc.  Based on the type of hernia being repaired other factors may need to be considered such as:
  • Initial vs. recurrent
  • Reducible vs. incarcerated/strangulated/obstructed
  • Unilateral vs. bilateral
  • Laparoscopic vs. open
  • Age
  • Mesh usage
  • Sliding

To begin, let’s take a deeper look at inguinal hernias.  Determine the approach (open or laparoscopic) of the repair first.  Next, the age of the patient is an important consideration.  There are four age groups that a patient could fall into as noted here:

  • Preterm infant (<37 weeks at birth up to 50 weeks postconception age)
  • Full term infant (< 6 months of age) or preterm infant (> 50 weeks postconception age but younger than 6 months)
  • 6 months to < 5 years
  • 5 years and older   

Let’s take just a minute to look at calculating the weeks for preterm infants.  Imagine that an infant was born at 35 weeks of gestational age.  Two months later he is coming in for an inguinal hernia repair.  You would take the 35 weeks and add 8 weeks (two months) to arrive at 43 weeks of postconception age.  This means the codes for this repair will be either 49491 for a reducible hernia or 49492 for an incarcerated hernia.  Now if the same preterm infant was coming in four months after birth you would take the 35 weeks of gestational age at birth and add 16 weeks (4 months) to arrive at 51 weeks postconception age.  The correct category of codes would be 49495-49596 again based on reducibility. 

Once a coding professional knows the correct age group to focus on, a determination must be made as to whether this is the first repair of the hernia or if it is a recurrent repair.  Finally, coders need to identify from the provider documentation if the repair was performed on a reducible or incarcerated hernia.    

A final consideration regarding inguinal hernia repairs is to know if it was considered sliding or not.  A sliding hernia is one that has a retroperitoneal organ protruding into the sac.  When sliding inguinal hernias are repaired, no matter what the age, the code to be assigned is 49525.  If a sliding hernia is described as incarcerated, coders are directed to use the codes for incarcerated hernia repair.

Coders can apply the previous method for coding other hernias as well.  Determine approach, identify initial or recurrent, and consider the reducibility of the hernia in order to assign the appropriate code. Open umbilical hernias are the only other hernia type besides open inguinal where age is a factor. 

An important reminder when coding hernia repairs is that the use of mesh is considered integral to these procedures unless the hernia is incisional or ventral.  When incisional or ventral hernias are repaired with an open method using mesh, assign two codes; one for the hernia repair itself and a second (49568) which is an add-on code for the insertion of the mesh.  However, coding professionals should recognize that if an incisional hernia is repaired laparoscopically, the use of mesh is included in the code (49654 or 49655) and the add-on code should not be reported. 

Now, light has been shed on coding hernia repairs.
 

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.