8D-The ABCs of Coding for Pediatric Clinic Procedures [gjv ...

1 CPT is copyright 2005 American Medical Association' CPT 2011 American Medical AssociationAll Rights Reserved1 TheABCs of CodingThe ABCs of Coding Pediatric Clinic ProceduresFacilitated byFacilitated byJoAnne M. Wolf, RHIT, CPCO bjectives and Agenda To network with colleagues To understand the Coding and required documentation of common ped Procedures To prevent denials by understanding theCPT 2011 American Medical AssociationAll Rights Reserved2To prevent denials by understanding the appropriate use of modifiers, and the operational steps you can implement at your practiceCPT is copyright 2005 American Medical Association' CPT 2011 American Medical AssociationAll Rights Reserved2 Disclosure StatementThe information presented and responses to questions posed are not intended to serve as Coding or legal advice.

2 Although every reasonable effort has been made to assure the accuracy of the information provided, the ultimate responsibility lies with the attendees to ensure they are Coding appropriately. The CPN makes no guarantee that this information is error-free and will bear no responsibility or liability for the results or consequences of the use of this 2011 American Medical AssociationAll Rights Reserved3 Common Clinic Procedures Abscess Drainage Ingrown Toenail Abscess Drainage Cerumen Removal Circumcision Cord CauterizationForeign Body Ingrown Toenail Laceration Repairs Wart Destruction Nail HematomaSupernumerary DigitCPT 2011 American Medical AssociationAll Rights Reserved4 Foreign Body Removals Supernumerary DigitCPT is copyright 2005 American Medical Association' CPT 2011 American Medical AssociationAll Rights Reserved3 Abscess DrainageI&D of abscess (eg, carbuncle, suppurative hidradenitis, cutan/subcutan abscess, cyst, furnacle, or paronychia)

3 10060simple or single10061complicated or multiple Use for I&D of sebaceous cyst Documentation: location, units, techniqueCPT 2011 American Medical AssociationAll Rights Reserved5 Post-op period: 10 days 2010 RVUs: >10060: >10061: Removal69210 Removal impacted cerumen (separate procedure), one or both earsp) Use ICD-9 code List only once (inherently bilateral) Documentation: impactedcerumen and specific technique usedby the providerCPT 2011 American Medical AssociationAll Rights Reserved6specific technique used by the provider Postop Period: 0 days 2010 RVU: is copyright 2005 American Medical Association' CPT 2011 American Medical AssociationAll Rights Reserved4 Cerumen Removal Do not report cerumen removal for: Quick removal of small amt to examine the ear Quick removal of small amt to examine the ear Cerumen removal may be reported if: Impacted cerumen removal is med neccessary Removal requires significant effort by the provider E/M can be billed in addition to 69210 if:CPT 2011 American Medical AssociationAll Rights Reserved7 E/M can be billed in addition to 69210 if: There is a signif, sep identifiable E/M documented Different diagnosis is used for the E/MCerumen RemovalExample #1 Pt is seen for an URI MD clears Pt is seen for an URI.

4 MD clears cerumen to examine ears & performs an EPF history and exam w/low compl MDM Coding ? 99213 with 465 9 Code 69210 would not beCPT 2011 American Medical AssociationAll Rights Reserved8 99213 with Code 69210 would not be appropriate in this case because documentation did not show that the cerumen was impactedCPT is copyright 2005 American Medical Association' CPT 2011 American Medical AssociationAll Rights Reserved5 Cerumen RemovalExample #2 Pt is seen for an URI and plugged ears. MD pggremoves impacted cerumen, which involves considerable work. MD performs an EPF H&P w/low compl MDM. Coding ? 9921325 i h 465 9 CPT 2011 American Medical AssociationAll Rights Reserved9 99213-25 with 69210 with OK to bill because it required the skill of the physician and cerumen was impactedCircumcisions54150 Circumcision, using clamp or other device with regional dorsal penile or ringdevice with regional dorsal penile or ring block Do not report the regional block separately (eg, 64450) Issues with medical necessityCPT 2011 American Medical AssociationAll Rights Reserved10 Issues with medical necessity Recommend obtaining a waiverCPT is copyright 2005 American Medical Association' CPT 2011 American Medical AssociationAll Rights Reserved6 Circumcisions Use ICD-9 code for a routine circumcisioncircumcision Documentation.

5 Specifics of the procedure as well as any regional block performedPt Pid0dCPT 2011 American Medical AssociationAll Rights Reserved11 Postop Period: 0 days 2010 RVU: Cauterization17250 Chemical cauterization of granulation tissue (proud flesh sinus or fistula)tissue (proud flesh, sinus, or fistula) For cord cauterization using silver nitrate Documentation: specifics of procedure including the cauterization techniqueCPT 2011 American Medical AssociationAll Rights Reserved12 Postop Period: 0 days 2010 RVU: is copyright 2005 American Medical Association' CPT 2011 American Medical AssociationAll Rights Reserved7 Foreign Body RemovalsEar69200 Removal FB from external auditory lith tlth icanal; without general anesthesia Do not use for removal of vent tubes Use ICD-9 code 931 FB in ear Documentation: specifics of procedure & FB (k)CPT 2011 American Medical AssociationAll Rights Reserved13FB (eg, rock) Postop Period: 0 days 2010 RVU: Body RemovalsEye65205 Removal of FB, external eye; jtilfi i lconjunctivalsuperficial Use of operating microscope is included Use ICD-9: (conjuctival sac)or (other and combined sites on external eye)Dt tiififdd FBCPT 2011 American Medical AssociationAll Rights Reserved14 Documentation: specifics of procedure and FB Postop Period: 0 days 2010 RVU: is copyright 2005 American Medical Association' CPT 2011 American Medical AssociationAll Rights Reserved8 Foreign Body RemovalsNose30300 Removal FB, intranasal.

6 Office type proc Topical vasoconstrictive agents and local anesthesia is included Documentation: specifics of procedure and FB (eg, Lego )CPT 2011 American Medical AssociationAll Rights Reserved15 Use ICD-9: 932 Foreign body in nose Postop Period: 10 days 2010 RVU: Toenail11765 Wedge excision of skin of nail fold (eg, for ingrown toenail)for ingrown toenail) Topical or regional anesthesia is included and not reported separately Use ICD-9 code Ingrowing nailCPT 2011 American Medical AssociationAll Rights Reserved16 Documentation: specifics of the procedure Postop Period: 10 days 2010 RVU: is copyright 2005 American Medical Association' CPT 2011 American Medical AssociationAll Rights Reserved9 Laceration RepairsDocumentation Documentation must show: The body location of the laceration repair Sum of length(s) of wound(s) in centimeters Type of repair (simple, intermediate, complex) You will be unable to code if provider only documents the number of stitches placedCPT 2011 American Medical AssociationAll Rights Reserved17documents the number of stitches placedLaceration RepairsCoding Simple laceration repairs (most common)

7 Are db b d l tigrouped by body location12001-12007 Scalp/neck/axilla/ext/genit/trunk/extrem 12011-12018 Face/ears/eyelids/nose/lips/muc membr Then broken down by length of wound within the set of codes for body locationCPT 2011 American Medical AssociationAll Rights Reserved18the set of codes for body location All simple laceration repair codes have a 10 day postop periodCPT is copyright 2005 American Medical Association' CPT 2011 American Medical AssociationAll Rights Reserved10 Laceration Repairs 12001-12007 CodesLength of Wound2010 RVUC odesLength of Wound2010 cm or cm to cm to 6 cm to 20 0 cm600 CPT 2011 American Medical AssociationAll Rights cm to cm to Repairs 12011-12018 CodesLength of Wound2010 RVUC odesLength of Wound2010 cm or cm to cm to 1201576cmto125cm665 CPT 2011 American Medical AssociationAll Rights cm to cm to cm cm to cm CPT is copyright 2005 American Medical Association' CPT 2011 American Medical AssociationAll Rights Reserved11 Laceration RepairsCoding Guidelines If removing a lesion that requires intermediate repair the repair can be billed inintermediate repair, the repair can be billed in addition to the skin lesion removal code Laceration repair codes include.

8 Sutures StaplesCPT 2011 American Medical AssociationAll Rights Reserved21 Staples Tissue Adhesives (eg, dermabond)Laceration RepairsCoding Guidelines When repairing multiple wounds, add the lengths of those wounds in the classificationlengths of those wounds in the classification (type of repair and body location) and report only 1 code If only using adhesive strips to repair, the laceration repair codes should not be used CPT 2011 American Medical AssociationAll Rights Reserved22report an E/M code for this serviceCPT is copyright 2005 American Medical Association' CPT 2011 American Medical AssociationAll Rights Reserved12 Laceration RepairsExample #1 Provider uses dermabond to repair a lhhld fcm laceration on the child s forearm Coding ? 12001 Repair codes can be used when utilizing sutures, staples or tidh i(db d)CPT 2011 American Medical AssociationAll Rights Reserved23tissue adhesives (eg, dermabond)Laceration RepairsExample #2 Provider sutures 2 lacerations: 1stis hlff2dcm on the left forearm, 2ndis cm on the right thigh Coding ?

9 12002 and 2011 American Medical AssociationAll Rights Reserved24 Add up the sum of the lengths of the repairs (per code family) and submit 1 codeCPT is copyright 2005 American Medical Association' CPT 2011 American Medical AssociationAll Rights Reserved13 Destruction of WartsDestruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical )fbi lih h kicurrettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 17110up to 14 lesions1711115 or more lesionsCPT 2011 American Medical AssociationAll Rights Reserved25 Report with only 1 unit Use 17110 or 17111 based on # of lesionsDestruction of Warts Use ICD-9 codes for plantar wartsor 078 19 forcommon or flat wartsor 078 0 for common or flat warts or for molluscum contagiosum Documentation: technique used, body location and the # of lesions PostopPeriod: 10 days (for both codes)CPT 2011 American Medical AssociationAll Rights Reserved26 PostopPeriod: 10 days (for both codes) 2010 RVU.

10 >17110 > 17111 is copyright 2005 American Medical Association' CPT 2011 American Medical AssociationAll Rights Reserved14 Nail Hematoma11740 Evacuation of subungual hematomaEl ttdliild Electrocautery needle pierces nail and pressure is applied to force the blood out If done on mult digits, use finger or toe modifiers to show specific locations Documentation: specifics of proc & locationCPT 2011 American Medical AssociationAll Rights Reserved27 Documentation: specifics of proc & location Postop Period: 0 days 2010 RVU: Digit11200 Removal of skin tags, mult fibrocutaneoustags, any area; up to and including 15 lesionstags, any area; up to and including 15 lesions Index in CPT under supernumerary digit shows code 26587 Reconstruction of polydactylous digit, soft tissue and boneCPT 2011 American Medical AssociationAll Rights Reserved28 Additional instructions in tabular section: (For excision of polydactylous digit, soft tissue only, use 11200) CPT is copyright 2005 American Medical Association' CPT 2011 American Medical AssociationAll Rights Reserved15 Supernumerary Digit Use 11200 for removal of supernumerary di itili ttl tidigit using ligature strangulation Usually performed on newborns Postop Period: 10 days 2010 RVU.