Week 4 SeminarWeek 4 Seminar

Hospital Inpatient CodingHospital Inpatient Coding

andand

Outpatient Physician CodingOutpatient Physician Coding

Inpatient Diagnosis CodingInpatient Diagnosis Coding

• What are the types of diagnosis on inpatient What are the types of diagnosis on inpatient claims?claims?

• What is the UHDDS?What is the UHDDS?• What is POA?What is POA?• What is DRG?What is DRG?• What are CC?What are CC?• What is optimizing reimbursement What is optimizing reimbursement versusversus

maximizing reimbursement?maximizing reimbursement?

ICD-9-CM Volume 3ICD-9-CM Volume 3Inpatient Procedure CodingInpatient Procedure Coding

• How is volume 3 set up?How is volume 3 set up?• What services/facilities are considered What services/facilities are considered

“inpatient”“inpatient”• Do we still use CPT/HCPCS codes on Do we still use CPT/HCPCS codes on

inpatient claims?inpatient claims?• What are observation patients? How are What are observation patients? How are

they coded and billed?they coded and billed?• What are professional fees?What are professional fees?

UB04UB04oror

CMS1450CMS1450

Principal and Significant ProceduresPrincipal and Significant ProceduresPage 209Page 209

• What is the principal procedure?What is the principal procedure?1.1. ________________________________________________

2.2. ________________________________________________

3.3. ________________________________________________

• What is a significant procedure?What is a significant procedure?1.1. ________________________________________________

2.2. ________________________________________________

3.3. ________________________________________________

4.4. __________________________________________________

Exercise 5.2Exercise 5.2pg. 211pg. 211

11. Patient admitted for treatment of AIDS-related conditions and underwent diagnostic 11. Patient admitted for treatment of AIDS-related conditions and underwent diagnostic fiberoptic bronchoscopy with cell washings for specimen collection. Final diagnoses fiberoptic bronchoscopy with cell washings for specimen collection. Final diagnoses included AIDS-related Pneumocystis carinii and oral candidiasis.included AIDS-related Pneumocystis carinii and oral candidiasis.12. Patient admitted with slurred speech and weakness on the right side. Patient is 12. Patient admitted with slurred speech and weakness on the right side. Patient is right-handed. Ct scan reveals carotid artery occlusion with cerebral infarction. Patient right-handed. Ct scan reveals carotid artery occlusion with cerebral infarction. Patient discharged to inpatient rehabilitation facility for continued treatment of dysphasia and discharged to inpatient rehabilitation facility for continued treatment of dysphasia and hemiparesis.hemiparesis.13. Patient sustained a closed fracture of the distal radius, left, due to a fall from the roof 13. Patient sustained a closed fracture of the distal radius, left, due to a fall from the roof of his house while cleaning gutters. X-ray of the left lower arm revealed nondisplaced of his house while cleaning gutters. X-ray of the left lower arm revealed nondisplaced fracture of distal radius with fracture fragments in good alignment. The physician fracture of distal radius with fracture fragments in good alignment. The physician determined that reduction was unnecessary, and a plaster splint was applied as a determined that reduction was unnecessary, and a plaster splint was applied as a stabilizing device.stabilizing device.14. Patient admitted for treatment of diabetic toe ulcer that had become gangrenous. 14. Patient admitted for treatment of diabetic toe ulcer that had become gangrenous. The underlying cause was type 1 diabetic peripheral neuropathy. Patient underwent a The underlying cause was type 1 diabetic peripheral neuropathy. Patient underwent a forefoot amputation.forefoot amputation.15. Patient admitted following repeated temporal lobe seizures. History revealed that 15. Patient admitted following repeated temporal lobe seizures. History revealed that the patient had had 18 seizures within the past 24 hours. He has had seizures since the the patient had had 18 seizures within the past 24 hours. He has had seizures since the age of 16, previously well controlled with phenobarbital. Blood levels indicate an age of 16, previously well controlled with phenobarbital. Blood levels indicate an acceptable therapeutic level. During hospitalization, patient continued to seize at least acceptable therapeutic level. During hospitalization, patient continued to seize at least hourly Patient was immediately transferred to the neurology unit of tertiary care hourly Patient was immediately transferred to the neurology unit of tertiary care hospital due to the intractability of partial epilepsy with impairment of consciousness.hospital due to the intractability of partial epilepsy with impairment of consciousness.

Exercise 5.2Exercise 5.2pg. 211pg. 211

11. Patient admitted for treatment of 11. Patient admitted for treatment of AIDS-related conditions AIDS-related conditions and underwent and underwent diagnostic diagnostic fiberoptic bronchoscopy with cell washingsfiberoptic bronchoscopy with cell washings for specimen collection. Final diagnoses for specimen collection. Final diagnoses included AIDS-related included AIDS-related Pneumocystis carinii Pneumocystis carinii and and oral candidiasisoral candidiasis..12. Patient admitted with slurred speech and weakness on the right side. Patient is 12. Patient admitted with slurred speech and weakness on the right side. Patient is right-handed. Ct scan reveals right-handed. Ct scan reveals carotid artery occlusion with cerebral infarctioncarotid artery occlusion with cerebral infarction. Patient . Patient discharged to inpatient rehabilitation facility for continued treatment of discharged to inpatient rehabilitation facility for continued treatment of dysphasiadysphasia and and hemiparesishemiparesis..13. Patient sustained a 13. Patient sustained a closedclosed fracture of the distal radiusfracture of the distal radius, , leftleft, due to a , due to a fall from the roof fall from the roof of his of his househouse while cleaning gutters. X-ray of the left lower arm revealed while cleaning gutters. X-ray of the left lower arm revealed nondisplaced nondisplaced fracture of distal radiusfracture of distal radius with fracture fragments in good alignment. The physician with fracture fragments in good alignment. The physician determined that reduction was unnecessary, and a determined that reduction was unnecessary, and a plaster splint was appliedplaster splint was applied as a as a stabilizing device.stabilizing device.14. Patient admitted for treatment of 14. Patient admitted for treatment of diabetic toe ulcerdiabetic toe ulcer that had become that had become gangrenousgangrenous. . The underlying cause was The underlying cause was type 1 diabetic peripheral neuropathytype 1 diabetic peripheral neuropathy. Patient underwent a . Patient underwent a forefoot amputationforefoot amputation..15. Patient admitted following repeated temporal lobe seizures. History revealed that 15. Patient admitted following repeated temporal lobe seizures. History revealed that the patient had had 18 seizures within the past 24 hours. He has had seizures since the the patient had had 18 seizures within the past 24 hours. He has had seizures since the age of 16, previously well controlled with phenobarbital. Blood levels indicate an age of 16, previously well controlled with phenobarbital. Blood levels indicate an acceptable therapeutic level. During hospitalization, patient continued to seize at least acceptable therapeutic level. During hospitalization, patient continued to seize at least hourly. Patient was immediately transferred to the neurology unit of tertiary care hourly. Patient was immediately transferred to the neurology unit of tertiary care hospital due to the hospital due to the intractability of partial epilepsy with impairment of consciousnessintractability of partial epilepsy with impairment of consciousness..

Exercise 5.2Exercise 5.2pg. 211pg. 211

•Why don’t we assign procedure codes for ancillary Why don’t we assign procedure codes for ancillary tests? tests? •Should there be a space between each code? Why Should there be a space between each code? Why or why not?or why not?

11 = 042, 136.3, 112.0, 33.2411 = 042, 136.3, 112.0, 33.24

12 = 433.11, 784.5, 342.9112 = 433.11, 784.5, 342.91

13 = 813.42, E882, E849.0. 93.5413 = 813.42, E882, E849.0. 93.54

14 = 250.61, 250.81, 357.2, 707.15, 785.4, 84.1214 = 250.61, 250.81, 357.2, 707.15, 785.4, 84.12

15 = 345.4115 = 345.41

Outpatient DepartmentOutpatient DepartmentDiagnosis CodingDiagnosis Coding

• What is an outpatient?What is an outpatient?• What is the main difference in coding What is the main difference in coding uncertain uncertain

diagnosis diagnosis between inpatient and outpatient between inpatient and outpatient encountersencounters

• What claim form is used for inpatients?What claim form is used for inpatients?• What claim form is used for outpatients?What claim form is used for outpatients?• How do we decide what is the first-listed How do we decide what is the first-listed

diagnosis?diagnosis?

This is where we show codes and linkageThis is where we show codes and linkage

•What is linkage?What is linkage?

•Where do we indicate the linkage? How?Where do we indicate the linkage? How?

CMS1500CMS1500

Exercise 6.3Exercise 6.3pg. 240 – First Listed Diagnosispg. 240 – First Listed Diagnosis

1. Patient is referred to a radiologist for an abdominal CT scan with a diagnosis 1. Patient is referred to a radiologist for an abdominal CT scan with a diagnosis of abdominal pain. The CT scan reveals the presence of an intra-abdominal of abdominal pain. The CT scan reveals the presence of an intra-abdominal abscess. abscess. 2. Patient is referred to a radiologist for a chest x-ray because of a persistent 2. Patient is referred to a radiologist for a chest x-ray because of a persistent cough. The chest x-ray reveals a 3cm peripheral pulmonary nodule. The cough. The chest x-ray reveals a 3cm peripheral pulmonary nodule. The patient’s physician documents “persistent cough due to pulmonary nodule.” patient’s physician documents “persistent cough due to pulmonary nodule.” 3. Patient is referred to a radiologist for a chest x-ray because of wheezing. 3. Patient is referred to a radiologist for a chest x-ray because of wheezing. The x-ray is normal except for scoliosis and degenerative joint disease of the The x-ray is normal except for scoliosis and degenerative joint disease of the thoracic spine. What does the testing facility or interpreting physician report thoracic spine. What does the testing facility or interpreting physician report as first listed diagnosis?as first listed diagnosis?4. Patient is referred to a radiologist for magnetic resonance imaging (MRI) of 4. Patient is referred to a radiologist for magnetic resonance imaging (MRI) of the lumbar spine due to possible L4 radiculopathy. MRI reveals degenerative the lumbar spine due to possible L4 radiculopathy. MRI reveals degenerative joint disease at L1 and L2.joint disease at L1 and L2.5. A sputum specimen is sent to a pathologist, who confirms growth of 5. A sputum specimen is sent to a pathologist, who confirms growth of streptococcus, type B. A diagnosis of pneumonia due to streptococcus, Group streptococcus, type B. A diagnosis of pneumonia due to streptococcus, Group B, is documented in the patient’s medical record.B, is documented in the patient’s medical record.

Exercise 6.3Exercise 6.3pg. 240 – First Listed Diagnosispg. 240 – First Listed Diagnosis

1. Patient is referred to a radiologist for an abdominal CT scan with a diagnosis 1. Patient is referred to a radiologist for an abdominal CT scan with a diagnosis of abdominal pain. The CT scan reveals the presence of an of abdominal pain. The CT scan reveals the presence of an intra-abdominal intra-abdominal abscess. abscess. 2. Patient is referred to a radiologist for a chest x-ray because of a persistent 2. Patient is referred to a radiologist for a chest x-ray because of a persistent cough. The chest x-ray reveals a 3cm peripheral pulmonary nodule. The cough. The chest x-ray reveals a 3cm peripheral pulmonary nodule. The patient’s physician documents “persistent cough due to patient’s physician documents “persistent cough due to pulmonary nodulepulmonary nodule.” .” 3. Patient is referred to a radiologist for a chest x-ray because of 3. Patient is referred to a radiologist for a chest x-ray because of wheezingwheezing. . The x-ray is normal except for scoliosis and degenerative joint disease of the The x-ray is normal except for scoliosis and degenerative joint disease of the thoracic spine. What does the testing facility or interpreting physician report thoracic spine. What does the testing facility or interpreting physician report as first listed diagnosis?as first listed diagnosis?4. Patient is referred to a radiologist for magnetic resonance imaging (MRI) of 4. Patient is referred to a radiologist for magnetic resonance imaging (MRI) of the lumbar spine due to possible L4 radiculopathy. MRI reveals the lumbar spine due to possible L4 radiculopathy. MRI reveals degenerative degenerative joint disease at L1 and L2.joint disease at L1 and L2.5. A sputum specimen is sent to a pathologist, who confirms growth of 5. A sputum specimen is sent to a pathologist, who confirms growth of streptococcus, type B. A diagnosis of streptococcus, type B. A diagnosis of pneumonia due to streptococcus, Group pneumonia due to streptococcus, Group BB, , is documented in the patient’s medical record.is documented in the patient’s medical record.

Why are these the first diagnosis?Why are these the first diagnosis?

Review Coding PracticeReview Coding Practicepg. 246 - #24 Ambulatory Surgery Centerpg. 246 - #24 Ambulatory Surgery Center

53-year-old male admitted with right inguinal hernia. 53-year-old male admitted with right inguinal hernia. Laboratory results within normal limits (WNL). Right inguinal Laboratory results within normal limits (WNL). Right inguinal herniorrhaphy was performed, and the patient did well. There herniorrhaphy was performed, and the patient did well. There were no complications. He was discharged to be seen in the were no complications. He was discharged to be seen in the office in several days for suture removal. No specific diet or office in several days for suture removal. No specific diet or medication was prescribed. The patient was advised to avoid medication was prescribed. The patient was advised to avoid any strenuous activities. DIAGNOSIS: Right inguinal hernia.any strenuous activities. DIAGNOSIS: Right inguinal hernia.

Code and sequence the ICD-9 diagnosis codes including any V- or E-Code and sequence the ICD-9 diagnosis codes including any V- or E-codes as appropriate.codes as appropriate.Break down the surgical medical term to identify what was done.Break down the surgical medical term to identify what was done.

Review Coding PracticeReview Coding Practicepg. 246 - #24 Ambulatory Surgery Centerpg. 246 - #24 Ambulatory Surgery Center

ANSWERSANSWERS550.90550.90

53-year-old male admitted with right inguinal hernia. 53-year-old male admitted with right inguinal hernia. Laboratory results within normal limits (WNL). Right Laboratory results within normal limits (WNL). Right inguinal inguinal herniorrhaphyherniorrhaphy was performed, and the patient was performed, and the patient did well. There were no complications. He was did well. There were no complications. He was discharged to be seen in the office in several days for discharged to be seen in the office in several days for suture removal. No specific diet or medication was suture removal. No specific diet or medication was prescribed. The patient was advised to avoid any prescribed. The patient was advised to avoid any strenuous activities. DIAGNOSIS: strenuous activities. DIAGNOSIS: Right inguinal Right inguinal herniahernia..

Review Coding PracticeReview Coding Practicepg. 248 - #32 Hospital Emergency Departmentpg. 248 - #32 Hospital Emergency Department

SUBJECTIVE: SUBJECTIVE: 25-year-old male was working with a heavy sledgehammer when he 25-year-old male was working with a heavy sledgehammer when he noted pain in his right shoulder area. The pain developed suddenly as he was swinging noted pain in his right shoulder area. The pain developed suddenly as he was swinging the hammer rather vigorously. The pain has persisted over the past three weeks. At the hammer rather vigorously. The pain has persisted over the past three weeks. At certain times, it was somewhere better but it became painful once again. The patient certain times, it was somewhere better but it became painful once again. The patient has continued working, which involves swinging this sledgehammer.has continued working, which involves swinging this sledgehammer. OBJECTIVE: OBJECTIVE: Physical examination reveals tenderness over the anterior joint line. Physical examination reveals tenderness over the anterior joint line. There is no swelling or abnormal mass present. The rotator cuff does not seem There is no swelling or abnormal mass present. The rotator cuff does not seem involved as the patient can tolerate extreme downward pressure on his elbows involved as the patient can tolerate extreme downward pressure on his elbows without any pain whatsoever. What really causes pain is bringing the arms apart when without any pain whatsoever. What really causes pain is bringing the arms apart when they are in the midline in front of his chest. Distal neurovascular status is intact. X-ray they are in the midline in front of his chest. Distal neurovascular status is intact. X-ray of the shoulder was negative.of the shoulder was negative.DIAGNOSIS: DIAGNOSIS: Pain, right shoulder. Probable strain, deltoid muscle, and possibly the Pain, right shoulder. Probable strain, deltoid muscle, and possibly the deeper muscles of the anterior shoulder area.deeper muscles of the anterior shoulder area.TREATMENT: TREATMENT: The patient was given a prescription for Motrin 600 milligrams three The patient was given a prescription for Motrin 600 milligrams three times daily and advised to apply heat to the area once or twice a day. He is also to rest times daily and advised to apply heat to the area once or twice a day. He is also to rest the arm as much as possible; however, he says he must work and will not take time off. the arm as much as possible; however, he says he must work and will not take time off. He was told this pain may last for a number of weeks before it resolves completely. He was told this pain may last for a number of weeks before it resolves completely.

Review Coding PracticeReview Coding Practice pg. 248 - #32 Hospital Emergency Departmentpg. 248 - #32 Hospital Emergency Department

ANSWERSANSWERS

719.41, E927, E849.9719.41, E927, E849.9

• What kind of case is this? What kind of case is this? • Why did we choose this code? Why did we choose this code? • What are the E-codes for?What are the E-codes for?NoteNote: The shoulder is a joint. Therefore, in the index : The shoulder is a joint. Therefore, in the index

to Diseases, go to main term to Diseases, go to main term PAINPAIN, subterm , subterm JOINTJOINT, , and 2and 2ndnd qualifier qualifier SHOULDER SHOULDER to assign the codeto assign the code