First quarter 2024 Coding Clinic update by AHA

The first quarterly release of Coding Clinic focused on the changes and new codes effective April 1, 2024. If you wish to review the updated Official Guidelines for Coding and Reporting, they can be accessed here. Notable changes to the ICD-10 CM coding guidelines include: Section C.1.d.5.b, which speaks to the reporting of sepsis due to a post-procedural infection. This entry reminds us to sequence codes that identify the site of infection first, then follow with the appropriate codes related to sepsis. In addition to the already published listing of codes (grouping T81.41-T81.43 classifying an…

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Coding guide for CPT Fracture Care in ED facility

  Most of the fracture cases are coded in emergency department (ED) facility, hence it is important to understand the different scenarios that a coder come across for these fracture care.   Scenario 1 A patient presents to the ED after falling and fracturing his tibia. The emergency physician calls an orthopedic surgeon for a consultation. The orthopedic physician evaluates the patient and performs a closed reduction of the tibia and applies a long leg cast. The orthopedist then takes over managing the patient’s fracture care. In this case the…

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CPT code 27405, 27407, 27409, 27427, 27428 and 27429 Coding tips

Basics of CPT code 27405, 27407 and 27409 A surgical reconstruction means that the remnant of the torn ACL/PCL is removed, and a new ligament is created with tissue from elsewhere in the body or donated from a cadaveric donor. ACL/PCL reconstruction surgery has been very successful, but there are concerns that it may not be the ideal solution for people who have injured their ACL/PCL. A repair does not require harvest of graft tissue and may provide a shorter recovery time for the patient. These procedures are done by…

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CPT code 23410, 23412, 23420 and 29827 coding tips

Basics of Rotator cuff CPT code CPT code 23410, 23412, 23420 and 29827 The rotator cuff is a group of muscles in the shoulder that allow a wide range of movement while maintaining the stability of the glenohumeral joint. The rotator cuff includes the following muscles: Subscapularis Infraspinatus Teres minor Supraspinatus A helpful mnemonic to remember these muscles is “SITS“. Rotator cuff tears occur when tendons weaken and pull away from the bone. Acute rotator cuff tears are caused by trauma such as falls on an outstretched hand or throwing…

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Coding guide for CPT code 23105, 23106, 29820 and 29821

  Basics of CPT code 23105 & 23106 Definitions: Arthroscopy: Use of an endoscope to examine the interior of a joint (diagnostic) or to perform surgery on joint structures (therapeutic) Arthrotomy: Surgical incision into a joint that may include exploration, drainage, or removal of a foreign body Synovectomy: Removal of the synovial membrane lining of a joint   Diagnosis and Indications for CPT code 23105, 23106, 29820 and 29821 Primary osteoarthritis Rheumatoid arthritis Rheumatoid myopathy with rheumatoid arthritis Rupture of synovium Shoulder arthritis Synovial hypertrophy Coding guidelines for CPT code…

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Coding Guide for Arthrodesis & Vertebral corpectomy CPT codes

Basics of Lateral Extracavitary Approach (LECA) Spinal exam The lateral extracavitary approach (LECA) requires resection of the ribs, pleura and/or peritoneum and dissection of spinal/paraspinal tissues to access the vertebral bodies/disc. The advantage of this technique is that it provides the surgeon with access to both the posterior and lateral aspects of the spinal canal through the same incision. Documentation of manipulation of the pleura and/or peritoneum is the clue that a LECA was used. Medical terms used in coding LECA spinal exams: Arthrodesis: Surgical fixation or fusion of a…

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Coding guide for CPT code 64400-64448 ( nerve injection procedures)

Basics of CPT code CPT code 64400 – 64448 The physician injects one or more anesthetic agents and/or steroids near a branch of the trigeminal nerve (ophthalmic, maxillary, or mandibular) in CPT code 64400 or the greater occipital nerve in 64405. The trigeminal nerve supplies sensory and motor fibers to the face, and is usually blocked superficially. The greater occipital nerve supplies sensory fibers to the scalp; nerve blocks are often administered to provide relief from occipital neuralgia, migraines, and chronic headaches. The physician draws a local anesthetic and/or steroid…

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Advanced ICD-10 Coding Guide for Pregnancy

Basics about Pregnancy ICD-10 codes Before going ahead to learn about pregnancy code we have to first learn about some the common medical terms used to assign a pregnancy ICD-10 codes. Antepartum – The duration from LNMP / Day of conception till the day before delivery Childbirth – aka labour and delivery is Day of delivery Postpartum (Puerperium) – The duration from delivery to 6 weeks after delivery Gravida – The total number of confirmed pregnancies, regardless of the outcome Para –The  total number births a female has had after…

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What is the difference between HCPCS modifiers JW and JZ?

HCPCS Level II modifiers JW, Drug amount discarded/not administered to any patient, and JZ, Zero drug amount discarded/not administered to any patient, are required by the Centers for Medicare & Medicaid Services (CMS) to report drugs and biologicals that are separately payable under Medicare Part B. Modifier JW must be reported on a claim for the amount of a drug that is discarded and eligible for payment. Modifier JZ is reported to attest that no amount of drug was discarded. Effective July 1, 2023, either modifier JW or JZ is…

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Commode CPT code guide for coders

  Coding for Commode HCPCS or cpt code is quite confusing for coders since their are different variety of commode used by old age patients depending on their requirement. If coders can understand the which type of commode of used by the patient then it will be easy to assign the correct and right code. Below I am sharing the HCPCS codes used for commode which might clear your doubts. E0163 Commode chair, mobile or stationary, with fixed arms E0165 Commode chair, mobile or stationary, with detachable arms image credit…

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