Do be afraid of pregnancy delivery coding. It is one of the most easiest coding as most of the procedures and ICD codes are routine. Usually the patient arrives for supervision or with abdominal pain and then starts getting contractions leading to delivery. Here we will be concentrating on procedure codes only. Here we discuss some of the commonly used procedures during labor and delivery.
ICD 9 CM obstetrical codes: 72-75
If the patient delivers spontaneously without any surgical intervention then we need to 73.59 "Manually assisted Delivery."
Rotation of fetal head
If physician performs rotation of fetal head in case of breech presentation with or without success before delivery and this can be represented by code
72.4 Forceps rotation of fetal head (key-in-lock rotation)
73.51 Manual rotation of fetal head
The physician may choose to induce labor for some reasons and this is represented by
73.01 Artificial rupture of membranes for induction of labor
Also the physician may induce artificial rupture of membranes after the onset of labor and this is represented by 73.09.
Forceps
For low forceps, high forceps, and mid forceps operation appropriate codes from category 72 should be used.
73.3 Failed forceps
This code should be used for failed forceps or trial forceps.
Episiotomy 73.6
If episiotomy if performed then 73.6 should be used. This code includes episiorrhaphy and should not be used if forceps are used or vacuum extraction is used for delivery if which case appropriate forceps and vacuum extraction codes should be used.
Cesarean section
If cesarean section is done along with hysterectomy, myomectomy, and sterlization then these should be coded separately.
Coding Debridements
Debridement codes in CPT are found in intugmentry section even if the debridement is deep into subcutaneous tissue and till the bone level. There are debridement codes in medicine section of CPT also and these codes should be used if debridement is at dermal and epidermal levels. If debridement is beyond dermal layer into the subcutaneous tissue then CPT codes from intugmentry should be used. Intugmentry section debridement codes can be classified as for debridement of fracture, eczamatous skin, and necrotic skin. Debridement codes in the medicine section are as follows:
97597-97598: Selective wound debridement involving waterjets, suction, or scissors.
97602 : Non selective wound debridement involves dressing or enzymatic method.
ICD 9 CM Debridement codes
ICD 9 CM has codes for excisional debridment(86.22) and non excisional debridmenrt( 86.28). Excisional debridement requires removal of tissue with scissors and merely scrubbing by scissor or any sharp object is not called an excisional debridement.
Simple Debridement of skin in preparation of surgery or procedure like suturing should not be coded as it is included in the procedure being done.
97597-97598: Selective wound debridement involving waterjets, suction, or scissors.
97602 : Non selective wound debridement involves dressing or enzymatic method.
ICD 9 CM Debridement codes
ICD 9 CM has codes for excisional debridment(86.22) and non excisional debridmenrt( 86.28). Excisional debridement requires removal of tissue with scissors and merely scrubbing by scissor or any sharp object is not called an excisional debridement.
Simple Debridement of skin in preparation of surgery or procedure like suturing should not be coded as it is included in the procedure being done.
Foot care coding
Routine foot care includes paring and removal of corns and calluses, trimming, cutting, debriding, clipping of nails. Routine foot care is not covered in many policies unless it is medically necessary. Conditions like diabetes, peripheral vascular disease, and/or peripheral neuropathy, or pain due to thickening or infection of nails, or pain due to ambulation need to be documented and related to foot care so as to justify billing the above mentioned services. The following conditions also satisfy the medical necessity for foot care billing:
chronic thrombophlenitis.
Buergers disease
arteriosclerosis obliterans.
CPT has codes for removal of corns and calluses and it should not be confused that since there are codes in the CPT manual to represent these services they can be billed. The removal of corns and calluses should be meet the definition of medical necessity like there is pain due to corns and callus so as to be coded and billed else the claim will be rejected by the payer.
chronic thrombophlenitis.
Buergers disease
arteriosclerosis obliterans.
CPT has codes for removal of corns and calluses and it should not be confused that since there are codes in the CPT manual to represent these services they can be billed. The removal of corns and calluses should be meet the definition of medical necessity like there is pain due to corns and callus so as to be coded and billed else the claim will be rejected by the payer.
Coding Arthroplasties Knee and HIP
Coding arthroplasties can be quite easy if one is aware of the code ranges and their descriptions. Arthroplasty involves the use of prosthetic joint and can be either total i.e. involving the whole joint or partial i.e. hemiarthroplasties involving partial or one compartment of the joint.
Hip Arthroplasty CPT codes 27125-27132
Hip arthroplasties can be total or hemiarthroplasty. Hemiarthroplasty involves either acetabular or femoral component replacement, whereas total hip arthroplasty involve prosthetic replacement of both acetabular and femoral components. Hemiarthroplasty is also called as bipolar arthroplasty. CPT codes are as follows:
Hemarthroplasty 27125
Total hip arthroplasty 27130
Sometimes a previous hip surgery need to be revised to total hip arthroplasty and CPT code 27132 can be used to represent such situations. Hip fractures requiring arthroplasty are coded to 27236. Corresponding ICD 9 CM codes for hip arthroplasty are:
Partial hip replacement: 81.52
Total hip replacement: 81.51
Type of bearing surface(prosthesis): 00.74-00.77
Knee Arthroplasty
Knee arhroplasty is of two types unicompartmental and total. Unicomparmental knee artroplasty involves single compartment whereas total knee arthropalsty involves two compartments. If an arthroscopy is done previous to knee replacement, then it is required to code arthroscopy and related arthroscopic procedure with 59 modifier. If open retinacular release is done during the knee replacement surgery then it should not be reported as it is included in the knee replacement code. The following are the CPT codes:
Unicompartental knee arthroplasty: CPT 27446, ICD 81.54
Total knee arthroplasty: CPT 27447 ICD 81.54
Revision of total knee arthrplasty: CPT 27487, ICD 81.55
Removal of total knee prosthesis: CPT 27488, ICD 80.06
Hip Arthroplasty CPT codes 27125-27132
Hip arthroplasties can be total or hemiarthroplasty. Hemiarthroplasty involves either acetabular or femoral component replacement, whereas total hip arthroplasty involve prosthetic replacement of both acetabular and femoral components. Hemiarthroplasty is also called as bipolar arthroplasty. CPT codes are as follows:
Hemarthroplasty 27125
Total hip arthroplasty 27130
Sometimes a previous hip surgery need to be revised to total hip arthroplasty and CPT code 27132 can be used to represent such situations. Hip fractures requiring arthroplasty are coded to 27236. Corresponding ICD 9 CM codes for hip arthroplasty are:
Partial hip replacement: 81.52
Total hip replacement: 81.51
Type of bearing surface(prosthesis): 00.74-00.77
Knee Arthroplasty
Knee arhroplasty is of two types unicompartmental and total. Unicomparmental knee artroplasty involves single compartment whereas total knee arthropalsty involves two compartments. If an arthroscopy is done previous to knee replacement, then it is required to code arthroscopy and related arthroscopic procedure with 59 modifier. If open retinacular release is done during the knee replacement surgery then it should not be reported as it is included in the knee replacement code. The following are the CPT codes:
Unicompartental knee arthroplasty: CPT 27446, ICD 81.54
Total knee arthroplasty: CPT 27447 ICD 81.54
Revision of total knee arthrplasty: CPT 27487, ICD 81.55
Removal of total knee prosthesis: CPT 27488, ICD 80.06
Integumentary coding made easy
Here are some of the CPT intugmentry system codes that cause confusion and need better understanding.
Paring and Cutting: Paring means debridement of lesion not destruction
CPT codes 11055-11057 represent paring and cutting of benign hyperkeratotic lesions like corns and callus. These codes are not for all benign lesions but only for any benign lesion that can be classified as hyperkeratotic corns and callus are just two examples given in the CPT assistant but these codes can be used for any hyperkeratotic lesions. For destruction of hyperkeratotic lesion 17000-17004 should be used.
Medicare does not reimburse for routine foot care. CPT Codes 11055-11057 will only be reimbursed by Medicare if the treatment is medically necessary. The first of the two ICD-9-CM Codes must be:
700 Corns and callosities
701.1 Keratoderma acquired
757.39 Other specified congenital anomalies of skin
The second ICD-9-CM Code must be one of the following:
686.9 Unspecified local infection of skin and
subcutaneous tissue
729.5 Pain in limb
Skin biopsy codes 11100-11101 are for per lesion so when a physician takes more than one biopsy sample of the same lesion at the same session only 11100 should be coded not 11101. There is a separate code for biopsy of eyelid 67810.
Skin Tags: Skin tags are also known as skin polyps or fibroepithelial polyps, Soft fibromas, or papilloma. Skin tag treatment include excision, cryotherapy, ligation, shave biopsy, electrocautery, laser therapy, curettage and cautery, and skin biopsy. CPT codes 11200 and 11201 can be reported for removal of skin tags by any method.
Excision
CPT defines excision as full-thickness (through the dermis) removal of a lesion and includes a simple closure.
Paring and Cutting: Paring means debridement of lesion not destruction
CPT codes 11055-11057 represent paring and cutting of benign hyperkeratotic lesions like corns and callus. These codes are not for all benign lesions but only for any benign lesion that can be classified as hyperkeratotic corns and callus are just two examples given in the CPT assistant but these codes can be used for any hyperkeratotic lesions. For destruction of hyperkeratotic lesion 17000-17004 should be used.
Medicare does not reimburse for routine foot care. CPT Codes 11055-11057 will only be reimbursed by Medicare if the treatment is medically necessary. The first of the two ICD-9-CM Codes must be:
700 Corns and callosities
701.1 Keratoderma acquired
757.39 Other specified congenital anomalies of skin
The second ICD-9-CM Code must be one of the following:
686.9 Unspecified local infection of skin and
subcutaneous tissue
729.5 Pain in limb
Skin biopsy codes 11100-11101 are for per lesion so when a physician takes more than one biopsy sample of the same lesion at the same session only 11100 should be coded not 11101. There is a separate code for biopsy of eyelid 67810.
Skin Tags: Skin tags are also known as skin polyps or fibroepithelial polyps, Soft fibromas, or papilloma. Skin tag treatment include excision, cryotherapy, ligation, shave biopsy, electrocautery, laser therapy, curettage and cautery, and skin biopsy. CPT codes 11200 and 11201 can be reported for removal of skin tags by any method.
Excision
CPT defines excision as full-thickness (through the dermis) removal of a lesion and includes a simple closure.
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