AHIMA Advocacy Day 2021

by Clarice Warner, RHIA, CCS-P, CPC, CHC
 
Watch my video blog about the AHIMA Advocacy Day 2021:

AHIMA Virtual Advocacy Summit
May 17-18, 2021

The annual Advocacy Summit is an opportunity to advocate directly to your lawmakers for federal legislative issues important to patients and healthcare. 

AHIMA Naming Pledge: https://www.ahima.org/advocacy/take-action/take-action-forms/take-action-ahima-naming-policy-pledge/

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 Board Director and Delegate on the OHIMA FY 2020-21 Board of Directors, overseeing Advocacy strategy. 

Bronchoscopy Coding

“Spotlight on CPT” focuses on bronchoscopy coding this month.

A bronchoscopy is an endoscopic examination of the tracheobronchial tree.  As with all types of endoscopic procedures, if a diagnostic bronchoscopy is performed along with any surgical procedures, the diagnostic portion is considered part of the surgical code when they are performed by the same physician.  A diagnostic bronchoscopy would be coded to 31622 and includes any cell washing when performed.  Another relevant point is that when coding bronchoscopies, the use of fluoroscopic guidance is included in the bronchoscopy codes.    

CPT Assistant has indicated twice (February 2011 Page: 8 and March 2013 Pages: 8 and 9) indicated that bronchoscopy codes are considered bilateral.  Therefore, it is not appropriate to use modifiers with these procedures. 

When assigning bronchoscopy codes, it is important for the coding professional to pay close attention to the definition of the CPT code under consideration.   For example, code 31625, used when an endobronchial biopsy is performed, is for one or more biopsies at either a single site or multiple sites.  So, no matter how many endobronchial biopsies are performed, code 31625 is assigned only once. 

The same is true for code 31628 for transbronchial biopsies.  Additionally, when it comes to 31628, the coding professional needs to recognize the stipulation that this applies to ONE lobe of the lung.  If additional biopsies are performed in a separate lobe or lobes of the lung, then add-on code 31632 may be assigned for each additional lobe where the biopsies take place.  Therefore, it is important that the number of lobes that each lung has is known in order to code properly. 

Lung lobes: 3 on the right; 2 on the left as illustrated below.

Source: https://medicoapps.org/m-fissures-lobes-of-lungs/

 

The same holds true for transbronchial needle aspiration biopsy procedures.  Again, one or more biopsies in a given lobe are included in the code 31629.  Add-on code 31633 is used when additional transbronchial needle aspiration biopsies take place in another lobe.

A bronchial alveolar lavage (BAL) (36124) is different than a bronchial washing (31622).  When a BAL is performed, a large amount of saline is pushed into the passageways and suctioned back out.  This is usually done in aliquots which allow for numbering and sequencing of the retrieved fluid for identification.  Whereas a bronchial washing uses just a small amount of saline which is instilled and then removed from larger passages. 

Endobronchial ultrasound (EBUS) procedures are performed on mediastinal and/or hilar lymph node stations or structures.  EBUS allows for identification of the appropriate node for aspiration or biopsy.  Two EBUS codes are available, with 31652 to be used if one or two lymph node stations or structures are biopsied, and 31653 to be assigned if three or more lymph node stations or structures are biopsied.  These are standalone codes that do not have to be assigned with any other code.  Code 31654, however, is an EBUS add-on code that is assigned when endobronchial ultrasound is used in conjunction with treatment of peripheral lesions.  Coding professionals may only assign any of the EBUS codes once per session and cannot use codes 31652 and 31653 on the same encounter.

Additional bronchoscopy codes may be used to identify tracheal/bronchial dilation and/or stenting, treatment of tumor either by excision (31640) or destruction (31641), and removal of bronchial valves.  Again, remember to which for lobe specification and/or existence of add-on codes.

Now, light has been shed on bronchoscopy coding.

 

 

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.

Arteriovenous Fistulas/Grafts

“In the kNOW” this month is going to review arteriovenous (AV) fistulas and grafts.  We’ll discuss the similarities and differences and how ICD-10-CM and PCS code assignment is impacted by their differences. 

To begin, we need to understand what AV fistulas and AV grafts are.  The two are similar in that they create a new pathway for blood flow between an artery and a vein and are often performed when a patient has end-stage renal disease (ESRD) and is in need of dialysis.  When an AV fistula is created a direct anastomosis occurs between the artery and vein as illustrated in the picture below. 

Source:  https://www.healthgrades.com/right-care/dialysis/arteriovenous-av-fistula-surgery 

This is different than the creation of an AV graft which requires the use of some type of conduit, such as autologous or synthetic material, to make the connection between the artery and vein as shown below.

Source: https://www.azuravascularcare.com/medical-services/dialysis-access-management/av-graft-placement/

When a complication of an AV fistula arises, it might be challenging to know what ICD-10-CM code to assign.  Third quarter 2020 Coding Clinic provides guidance by verifying that a code from category T82, Complications of cardiac and vascular prosthetic devices, implants, and grafts should be assigned for AV fistula complications.  

 

Now let’s clarify how to code an AV pseudoaneurysm which may result from repeated punctures of a fistula or graft.  In order to accurately assign an ICD-10-CM code for this condition, the coding professional must know if the pseudoaneurysm is of an AV fistula or graft.  For pseudoaneurysm of an AV fistula the appropriate code is T82.510A for Breakdown (mechanical) of surgically created arteriovenous fistula, initial encounter.  If, however, the pseudoaneurysm is of an AV graft, the proper code assignment is T82.511A, Breakdown (mechanical) of surgically created arteriovenous shunt, initial encounter. 

Source: https://www.researchgate.net/figure/AV-fistula-aneurysm-repair-a-the-aneurysm-as-was-typically-found-at-the-fistula-site-b_fig1_49603755

Note that in both circumstances described above, if there is bleeding documented, the coding will change to T82.838A for Hemorrhage due to vascular prosthetic devices, implants, and grafts, initial encounter for both the AV fistula and the AV graft.

When coding thrombectomies that occur for a clot in a brachiocephalic AV fistula, what body part value is correct?  The important consideration is that an AV fistula is not a device.  Remember, that an AV fistula is created with direct anastomosis between vessels.  Therefore, code for Extirpation from both the brachial artery and the cephalic vein. 

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.