CT Scan CPT Codes

Here are CT scan CPT codes for various anatomical sites. CPT has distinct codes for CT scans without contrast, CT scan with contrast, and CT scan following contrast for all anatomical sites. For example CT Scan of abdomen without contrast, CT scan of abdomen with contrast, and CT scan of abomen following contrast will have three different codes.

Head and soft tissue of neck: 70450-70498
Chest: 71010-71555
Thorax: 71250-71270
Spine(cervical, lumbar, thoracic,: 72125 -73202
Lower Extremities: 73700-73702
Abdomen and pelvis: 74150-74170

Inpatient Patient Coding Training Courses

If you are looking for getting into inpatient coding then followiing are some of the training courses available for getting trained in inpatient coding.

The Certified Coder Boot Camp from HCPRO
This course is designed for individuals with outpatient coding experience. It focuses on Inpatient Hospital Coding. The course emphasizes inpatient coding guidelines, abstracting inpatient medical records and DRG ("Diagnosis Related Grouping") assignment. It is a full time one week course and costs arouns 200 USD.
For more information Contact Customer Service at 800/780-0584 or bootcamps@hcpro.com.

Inpatient Coding: DRG Assignment training course from HCPRO
It is an online training course intended to master DRG coding costs $49.00. Contact: customerservice@hcpro.com.

Careerstep Inpatient Coding traning courses
Career Step has a training course for inpatient medical facilities. You'll be fully trained to accurately code inpatient diagnosis and procedures from medical records and complete the billing and reimbursement process. The Career Step Inpatient and Outpatient Medical Coding and Billing program can be completed in 640 hours, or 4 months of full-time study. It is an online programme costs around $2250.
Tags: Inpatient Patient Coding Training Courses, DRG training,

Inpatient coding vs Outpatient coding

Medical coding is broadly divided into two categories inpatient coding and outpatient coding. Here are some of the differences. Outpatient coding involves coding charts where the hospital stay is limited to 24 hours. The patient is treated and discharged within 24 hours. Outpatient coding is far easier than inpatient coding. In inpatient coding, the patient is admitted and remains in the hospital til he recovers thus making the hospital stay more than one day. Inpatient coding requires coding of services of each day of the hospital stay thus making is more and more difficult if the hospital stay becomes longer and longer. For procedural coding in outpatient CPT codes are used whereas in inpatient coding ICD procedure are used. In outpatient coding dignosis like suspected, ruleout, probable, or consistent are not coded and instead respective symptoms are codes whereas in inpatient coding all such diagnosis are coded as current conditions. In outpatient coding, abnormal findings are coded as given by the physician whereas in inpatient coding abnormal findings are not coded and reported unless the provider indicates their clinical significance.

Inpatient operative reports are very exhaustive and may have hundreds of pages.
One more difference between inpatient and outpatient coding is the usge of DRG coding in inpatient coding so the skill sets required for inpatient coding also include DRG expertise.

Tags: difference between inpatient outpatient coding, inpatient outpatient coding similar different, medical coders, americal academy of professional coders, healthcare industry, ICD 9

CPT Modifiers

CPT Modifier definition: CPT modifiers are combination of two characters letters or alphanumeric codes that are meant to convey additional information regarding the procedure or services offered by the physician or hospital. These codes are appended to CPT codes. The additional information that can be conveyed by these codes includes wheather a procedure is discontinued, done on the left or right side, reduced, multiple procedures done in the same session, etc.

Proper use of CPT code modifiers: Proper use of CPT modifiers is necessary for accurate billing. Modifiers used inappropriately will affect the payment.

Some of the examples of CPT modifiers are
CPT mdifier 59 for distinct services
CPT modifier 51 for Multiple services
CPT modifiers LT and RT to indicate left and right side
CPT modifier 25 to be used with E/M code along with any other distinct CPT service provided on the same day of service.
CPT modifier 52 for reduced services.
CPT modifier 26 to identify professional component in radiology.
CPT modifier 76 for repeat procedure by the same physician
CPT modifier 53 for discontinued procedure

Coding infusions and injections

Coding infusions and injections in ICD and CPT

CPT has the following CPT codes for infusions
96365 IVPB initial hour
96366 IVPB each subsequent hour same drug
96367 IVPB each subsequent new drug(sequential infusion)
96368 Concurrent infusion
96374 IVP initial substance or drug
96375 IVP new substance or drug
96372 Intramuscular Injection

CPT code 96368 is reported only once per encounter.
CPT code 96367 is used only once per sequential infusion of same infusate mix
To qualify for each additional hour code "96366" infusion should be more than 30 minutes else it is includes in previous hour. For infusions of 15 minutes or less 96374 should be used.

CPT has the following CPT codes for injections
Injection with physicians supervision 96372 (physician coding)
Injection without physician supervision 99211 (physician coding)
Hospital coding report 96372 when the physician is not present.
Non-antineoplastic hormonal therapy injections: 96372
Anti-neoplastic nonhormonal therapy injection therapy: 96401
anti-neoplastic hormonal therapy injection therapy: 96402
Allergen immunotherapy injections: 95115-95117

Modifier 59 should be used with 96372 if used with infusion codes.

ICD procedure codes for infusions and injections
99.21 Antibiotic injection
99.23 Steroid Injection
99.17 Insulin Injection
99.29 Injection other substance

Secondary Malignant Neoplasm ICD codes

Here is a list of diagnosis codes for secondary malignant neoplasms that are usually encountered.

secondary malignant neoplasm lung: 197.0
secondary malignant neoplasm brain: 198.5
secondary malignant neoplasm axaillary lymph nodes: 196.3
secondary malignant neoplasm brain: 198.3
secondary malignant neoplasm bone and bone marrow: 198.5
secondary malignant neoplasm kidney: 198.0

Tags: icd code secondary malignant neoplasm of lung
diagnosis code 197.0 secondary malignant

ICD 9 Cancer codes

Here is a list of ICD 9 codes for commonly encountered cancers

icd 9 breast cancer: 174.9
icd 9 skin cancer: 173.9 (skin cancer NOS)
icd 9 basal cell carcinoma: 173.x (fourth digit is site specific)
icd 9 cervical cancer: 180.9
icd 9 ovarian cancer: 183.0
icd 9 uterine cancer: 179
icd 9 code for prostate cancer: 185
icd 9 bladder cancer: 188.9
icd 9 colon cancer: 153.9
icd 9 kidney cancer: 189.0
icd 9 rectal cancer: 154.9
icd 9 colorectal cancer: 154.0
icd 9 lung cancer: 162.9
icd 9 liver cancer: 155.0
icd 9 squamous cell carcinoma: 173.9 ( squamous cell carcinoma NOS is considered as skin cancer)
icd 9 melanoma: 172.x (Melanoma NOS is considered as skin carcinoma)
malignant melanoma icd 9: 172.x (fourth digit is site specific of skin)
icd 9 basal cell carcinoma: 173.9
icd 9 code stomach cancer: 151.9
icd 9 code pancreatic cancer: 157.9

icd 9 codes

icd 9 code for asthma 493.90
icd 9 code fpr end stage copd 491.20
icd 9 code for emphysema 492.8
icd 9 code for chf 428.0
icd 9 code for gerd 530.81
icd 9 code for chronic bronchitis 491
icd 9 code hiatal hernia 553.3
icd 9 code ibs 564.1
icd 9 code gastritis 535.50
icd 9 code heartburn 787.1
icd 9 code eosinophilic esophagitis 530.13
icd 9 code barrett's esophagus 530.85

Coding Wound Care in ICD and CPT

Wound care coding in CPT and ICD

Wound in ICD refers to open wound even if the documentation does not mention the word "open wound." CPT has the following code sets for repair or suturing of open wounds. These codes include Adhesives (surgical) (tissue). Application of adhesive strips (butterfly) is included in E/M and ICD will guide you to omit code.

Repair-Simple 12001-12021
Simple repair includes single layer closure.
Repair-Intermediate 12031-12057 (Multilayer closure or simple repair with extensive cleaning or debridement)
Repair-Complex 13100-13160

CPT also has codes for closure of wound dehisence
12020 Simple closure of superficial wound dehiscence
12021 Simple closure of superficial wound dehiscence with packing
13160 Secondary closure of surgical wound or dehiscence, extensive or complicated

Simple debridement is included in repair codes, but if extensive debridement or prolonged cleanseing is carried out with intermediate or complex repair then it sholuld be reported seperately. Full thickness repair of lip and eyelid are not included in these series.

ICD 9 repair codes
08.81 Eyelid/Eyebrown
08.83 Eyelid Laceration partial Thickness
18.4 External Ear
21.81 Nose
24.32 Gum
27.51 Lip
27.52 Mouth
86.59 Skin any other sites

Tags: Coding Wound Care in ICD and CPT, Coding Wound repair, Meical Coding Wound Care

Vaccination Diagnosis Codes

Pediarix vaccination is a serum of five vaccines Diphtheria, Tetanus, Pertussis, Hepatitis B, and Poliomyelitis. It is coded to V06.8. DTaP + HCB + IPV is a serum of Diphtheria, Tetanus, Pertussis, HCB, and Poliomyelitis. This is coded to V06.8. H1N1 vaccine is coded to V04.81.
RotaTeq Rotarix is coded to V04.81.
Hepatitis A & Hepatitis B vaccines are both coded to V05.3

ICD 9 CM has codes for vaccination not carried out for various reasons. This codes are in subcategory V64.0x


Tags: Vaccination Diagnosis Codes

ICD 9 code follow up

If the encounter is for follow-up of a condition and the condition is still present (not resolved) the condition would be coded and not the V67.59. The physician may used terms like "improved" and "resolving" for a condition that that still needs treatment. If the encounter is to follow-up a chronic condition, such as HTN, asthma, obesity, code the chronic condition as the first listed dx - do not assign the V67.59 in these types of cases.

When a follow-up examination is conducted to determine if there is any evidence of recurring or metastasizing cancers and no evidence of malignancy is found, the case is classified to the V67 category.

V67.09 Surgery only
V67.1 Radiation therapy only or radiation therapy following surgery
V67.2 Chemotherapy only or chemotherapy following surgery or radiation

If the follow-up examination reveals recurrence or metastasis, category code V67 would not be used.

Follow-up Postop total knee replacement is coded to V54.81
Following treatment of healed fracture is coded to V67.4
Follow-up examination following psychotherapy and other treatment for mental disorder is coded to v67.3
Unspecified followup exam is coded to V67.9

Tags : ICD 9 code follow up ICD 9 followup

Medical Coding Abbreviations

Some of the commenly used medical coding abbreviations are

TTP - Tender to palpation
RRR - Regular rate and rhythm
AODM - Adult onset diabetes mellitus
IDDM - Insulin dependent diabetes mellitus
NIDDM- Non Insulin Dependent diabetes mellitus
BA- Bronchial Asthma
GERD - gastroesophageal reflux
C - with
S - without
IM - Intramuscular Injection
IV Intravenous infusion
IVP - Intravenous push
IVPB - Intravenous push Bolus
URI - Upper Respiratory Infection
UTI - Urinary tract infection
OM - Otitis Media
CXR - Chest Xray
MRI - Magnetic Resonence Imaging
CT - Computer Tomography
PO - Per Ora
PRN - As Required
F/U - Follow up
Rx - Prescription
W/ - With
W/O - With out
BMI - Body mass Index
DM - Diabetes Mellitus
HTN - Hypertension
HPL/HL - Hyperlipidemia
H/O - History of
CP - Chest pain
SOB - Shortness of Breath
SX - Symptoms
LMP - last menstrual period
CAD - Coronary Artery Disease
WNL - within normal limits
bid - twice
npo - Nothing per mouth
u/a - Urine analysis
tsp - tablespoon
q6h - every 6 hours
WCC - well child check
sz - seizures
r/o - ruleout
d/o - disorder
s/p - status post

Medical Coding Abbreviations, Medical Coding Abbreviations

ER CPT and ICD Procedure Codes

Coding Emergency Rooom visits, here are some of the commonly used ER CPT and ICD Procedure Codes

CPT code ICD procedure codes

36415 Blood draw 38.99
94760 Pulse Ox single 89.38
94761 Pulse Ox multiple times
93005 EKG 89.52
94150 peak flow (vital capacity) 89.37
87880 rapid strep
94640 Nebulizer treatment (Use modifier 76 if more than once) 93.94
81025 urine HCG
82962 finger stick
81002 urine dip stick
10060 Incision and drainage 86.04
10061 Incision and drainage with packing 86.04
36600 arterial bloog gasses (ABG) 38.98
82962 glucose blood test (fasting glucose)
92950 cardiopulmonary resuscitation (CPR) 99.60
92960 defibrillation 99.62
31500 Endotracheal intubation 96.04
30901 Epistaxis control any approach anterior 21.0x
90935 Hemodialysis 39.95
36556 Insertion of central venous cath nontunnedled
49450 Gastrostomy replacement 97.02
90801 Psychiatric interview 94.19

Vaccinations immunogloblin codes mostly Td and rabiess 90703,90718, 90714, 90471, 90801

Splints: Posterior splint is short leg splint
ICD 9 procedure code: 93.54
29125 Short arm splint
29130 Finger splint, static
29505 Long leg splint
29515 Short leg splint
29530 knee immobalizer

Skin repair and suturing codes
12001-16036 86.59
Pressure dressing 93.56

Radiology codes for CT, X-ray, Ultrasound, MRI, KUB

Modifier AI Principal Physician of Record

Modifier “-AI,” defined as “Principal Physician of Record,” is used by the admitting or attending physician who oversees the patient’s care, as distinct from other physicians who may be furnishing specialty care. The principal physician of record shall append modifier “-AI” in addition to the initial visit code. All other physicians who perform an initial evaluation on this patient shall bill only the E/M code for the complexity level performed.

The primary purpose of this modifier is to identify the principal physician of record on the initial hospital and nursing home visit codes. It is not necessary to reject claims that include the “-AI” modifier on codes other than the initial hospital and nursing home visit codes (i.e., subsequent care codes or outpatient codes). Follow-up visits in the facility setting may be billed as subsequent hospital care visits and subsequent nursing facility care visits as is the current policy. In all cases, physicians shall bill the available code that most appropriately describes the level of the services provided.

Tags: modifier AI decision chart, cms modifier AI

ICD Screening mammogram coding

ICD 9 CM Catagoty V76 is for screening examination of breast including screening mammograms. ICD 9 CM Catagoty 793 describes abnormal mammogram findings.

V76.11 Screening mammogram for high-risk patient
V76.12 Other screening mammogram
793.81 Mammographic microcalcification
793.82 Inconclusive mammogram
793.89 Other (abnormal) findings on radiological examination of breast

High risk patient are those who have a history of breast cancer or there is a family hstory of breast cancer. Here are some examples of screening mammograms with normal results i.e normal mammogram.
1. Screening mammogram for a patient with history of breast cancer: V76.11, V10.3
2, Screening mammogram for a patient with family history of breast cancer: V76.11, V16.3
3. Screening mammogram : V76.12

Here are some examples of screening mammograms with abnormal findings i.e calcifications, dense breast, nodules, microcalcifications.

1. Screening mammogram for a patient with history of breast cancer and mammographic findnigs include clacifications: V76.11, 793.89, V10.3
2. Screening mammogram for a patient with history of breast cancer and mammographic findnigs include nodules: V76.11, 793.89, V10.3
3. Screening mammogram for a patient with history of breast cancer and mammographic findnigs dense breast: V76.11, 793.82, V10.3
4. Screening mammogram for a patient with family history of breast cancer and mammographic findnigs dense breast: V76.11, 793.82, V16.3

If the patient has a history of breast cancer with resection and came for diagnoistic mammogram with is normal then the codes will be: V67.09, V10.3


Tags:
ICD 9 unspecified abnormal mammogram
screening mammogram ICD 9 code
ICD 9 screening mammogram
other screening mammogram v76 12
diagnosis code other screening mammogram

Emergency Room/Department Coding Guidelines

Emergency Room/Department coding is one of the most simple type of coding. It involves diagnostic coding and simple procedural coding(CPT/HCPCS).

Assign ICD-9-CM diagnosis codes for the Admitting Dx and all Other Dx. Other diagnoses would include all chronic conditions that the patient may have and other documented diagnoses that would justify the tests performed in the ER. These codes are picked up for medical necessity purposes. The first listed diagnosis should be the primary diagnosis for which the patient came to the ER for. ICD-9-CM and CPT procedure codes need to be assigned for procedures. E-codes need to be assigned as per ICD-9-CM Official Guidelines for Coding and Reporting (for injuries, poisonings and adverse effect of drugs).

Some common Emergency Room/Department (ER/ED) procedures are:

Sutures
Casting/Splintings/Strappings
Any scopes (ie: EGD, Laryngoscopy)
Reductions/Manipulations
IV’s, IVP’s and IVPB
SQ & IM Injections
Arthrocentesis
Drainage of Abscess
Cardioversion
Transfusions
Hemodialysis
Shots/Vaccines (administration and vaccine product)
Foreign Body Removal
Nasal Packings/Cautery
Foley Caths
Spinal taps
ABG (36600)
Nebulizer Treatments
X-rays, CT, Ultrasounds, MRI
Labs
EKG
Pulse Ox
Venous Puncture/Lab Draw (36415)

These are general Emergency Room/Department (ER/ED) guidelines. However guidelines vary slightly from facility to facility. Also some of the procedures will be chargemastered so no need to code them.

Tags: Emergency department coding, emergency medicine coding, urgent care coding, career emergency room coding, emergency room coding guidelines

IV Infusions and Hydration coding guidelines

What are the guidelines for sequencing IVPD, IVP, and hydration infusions?
According to CPT for facility coding chemotherapy services are primary to
theraputic, prophylactic and diagnostic services which are primary to hydration services. Infusions are primary to pushes, which are primary to injections. Hydration codes are facility reporting only. For physician reporting initial code that best describes the primary reason for the encounter should be reported irrespective of the order in which the infusions or injections occur.

According to CPT we can report 96374 and 96361, but we cannot report 96360 and 96375 so 96374 is primary to 96360.

What are the guidelines for coding Hydration ie. how to determine hydration Vs Infusion?
Hydration may be billed separately only if it is given prior to or subsequent to drug infusion. If it is given concurrently to facilitate drug delivery, it is considered included in the drug infusion. If hydration is less than 30 minutes then it is not billable and the reson is that if it is less than that then it is not therapeutic and cannot be dehydration. Also look at the rate the fluids are running at, that will tell you if it is for hydration and not just for convenience. Therapeutic rate is 125cc/hr. Heplock and KVO(keep vein open) are not coded.

Saline soluton, D5W(dextrose 5% water), Hypotonic solution, Ringer Lactate, DW( Distilled water) are some of the solutions used along with other drug infusions and also as hydration. If any medication is used along with these then it is therapy 90765 not hydration 90760 and any saline fluid use is incidental and not to be reported.

Here are the CPT codes for infusion and hydration

IV infusion Bolus (IVPB) is an infusion that runs more than 15 minutes. Less than or upto 15 minutes is coded as IVP.

96365 Inital drug first hour
96366 Same drug each additional hour
96367 New drug each additional hour
96368 Used to indicate concurrent infusion of two or more drugs

Intravnous Push (IVP) is an infusion which runs up to 15 minutes
96374 (This code should not be used if 96365 or 96360 are in use instead use 96375 with appropriate units for number of drugs)
96375

Salne infusion that run for more than 30 minutes are considered as theurapeutic hydration. Saline infusion for less than 30 minute is not coded.
96360 (This code should not be used if 96365 is in use instead use 96361 with appropriate units for number of hours of hydration)
96361

Intramuscular Injection
96372 (Need to use 59 modifier in if used conjunction with above codes)

Medicare HCC Coding

These are CMS Hierarchical Condition Categories. Medicare has classified about 3,000 of the 14,000 ICD-9 diagnosis codes into HCCs or categories designating chronic conditions that end up costing them more money over the long run, such as diabetes, kidney failure, old MI, etc. When patients are assigned these ICD-9 codes, Medicare sees those beneficiaries as being more severely ill than the "average" Medicare beneficiary. For the Medicare Advantage members, this could result in higher reimbursement. Some of the conditions included in the model are status conditions, like s/p BKA or artificial openings (i.e. colostomy, tracheostomy, etc.). Certain fractures and conditions like respiratory failure are part of the model, but may or may not be chronic in nature.

In this program you are funded by diagnosis codes, not CPT codes. The sicker the patient (the more diagnoses) the more funding you receive. Never paid on CPT code level.

HCC codes are given a severity ranking. More specific codes have a higher ranking than unspecified codes. You code as you normally would but just make sure that you are coding with ICD-9 codes as specific as possible and using all the codes that apply to that visit per the documentation. If you use codes with a higher HCC ranking, you get more "credit". For example, if a patient is diabetic and they have other problems associated or caused by the diabetes, use the most specific codes 250.4x or 250.5x, etc instead of 250.0x.

Tags: HCC Coding. Medicare HCC Coding, HCC coding jobs