Laser Treatment of Vesicle Neck Contracture

You Be the Coder
Question:
Which code should I use for holmium laser of a vesicle neck contracture?

Anwer:
Your coding for treatment of a bladder neck contracture (596.0) by holmium laser depends on the etiology of the bladder neck contracture.

Option 1: If the bladder neck contracture is secondary to benign prostatic hypertrophy present
predominately at the bladder neck, as often seen in younger men with obstructive symptoms, you should report 52450 (Transurethral incision of prostate).
Code 52450 represents an incision of the prostatic urethra, usually extending from and including the bladder neck to the verumontanum, the complete prostatic urethra.

Option 2: If the bladder neck contracture is secondary to a previous prostate surgery, such as an overzealous transurethral resection of the prostate [TURP] at the bladder neck, you'll instead use 52640 (Transurethral resection; of postoperative bladder neck
contracture).

Option 3: If the bladder neck contracture occurs after a radical prostatectomy, which is in fact a urethral stricture at the vesicourethral junction, you should report 52276 (Cystourethroscopy with direct vision internal urethrotomy).

Note: You should use the above codes for any type of therapy and technology used for treating the bladder neck contracture, whether a laser, hot knife, cold knife or a single resection groove.

Insertion of Pain Pump

Do not assign a separate CPT code for the insertion of an "On-Q pain pump".

This is inclusive in the procedure that is being done.

Many times I see the CPT code 37205 used.

Coding Endoscopy px when done on ER pt

Current process to follow:
Some of the facilities have ER patients who are having endoscopy procedures performed in the endoscopy suite or in the ER. We also have some ER patients who go to the operating room for procedures and then are discharged as an ER patient.
* An ER patient who had a proctoscopy performed in the Emergency room
* An ER patient who went to the endoscopy suite and had an endo procedure performed and discharged as ER patient type
* An ER patient who went to the operating room for a procedure and discharged as ER patient type

We went through what would be charged through the charge master and what the ER coders would be responsible for coding and reporting using Power Abstract and came up with the following:
* ER patient type with operating room charges: ER coder will code both ER procedures and operating room procedures and enter in PA

* ER patient type with Endoscopy procedures: ER coder will code endoscopy procedures performed either in ER (proctoscopy) or the endoscopy suite

64483, 64484

Clinical Example: The patient has a herniated disc at the L4-L5 with scar tissue; compatible with an acute L5 radiculopathy. He undergoes a bilateral transforaminal epidural injection of an anesthetic agent and/or steroid at the L5-S1 level.

Correct CPT Codes: 64483-50

Coding tip:
A transforaminal epidural spinal injection technique is a technically different approach from central epidural injection. Because the vertebral artery as well as the spinal cord is close to the nerve root, this procedural technique is more difficult than a central epidural injection.

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Clinical Example: The pt's recent MRI shows acute radiculopathy at the L4 and L5. He undergoes a bilateral transforaminal epidural steriod injection at the L4-L5 and L5-S1 levels.

Correct CPT Codes: 64483-50 and 64484-50

64470

Clinical Example: Pt presented with a long history of cervical spine pain in her neck. A recent x-ray showed cervical spondylosis between the left C5-C6.
Pt undergoes left cervical facet joint injection with corticosteriod into the cervical facet joint at C5-C6.

Correct CPT code assignment: 64470-LT

64470 is a unilateral procedure. When injections are performed at both the right and left paravertebral facet joints or paravertebral facet joint nerves, append modifier 50 to the code.

Treatment of ureteral stricture

Coding Trivia

Q: Which CPT code should you report for a cystourethroscopy with ureteroscopy; with treatment of ureteral stricture (eg, balloon dilation, laser, electrocautery, and incision)?

A: 52344

780.39 vs 345.90

The question asked: When is code 780.39 used anymore? I was told to use 345.90 even if epilepsy wasn't documented.

Answer: So much depends on the MD's documentation for the seizure. As of 10/1/06 the index changed so that now a "seizure disorder" is classified with the epilepsy codes. We have to follow the updated index and use it based on the documentation we have. Indexing: "Disorder / seizure", and "Seizure / recurrent" now go to 345.90, while indexing "Seizure / repetitive" goes to 780.39. Here is what I found out at a Neurology Inservice that I recently attended. The index changes were discussed. The national association of neurologists are in the process of changing the definition of epilepsy. The new definition will be more than one seizure (without any known cause, like a sudden head injury, high fever, or severe metabolic problem) occuring over a period of time (such as months or years.) That's why ICD-9 has classified a seizure disorder or recurrent seizures to 345.90. And it's probably why "repetitive" still codes to 780.39, since the repetitive seizures might actually all be a part of one episode of seizures (given that they probably aren't separated by months or years.)
So make your code assignment of either 780.39 or 345.90 based on what the MD has stated, but if that isn't clear -- then query. Coding Clinic has not addressed the 10/1/06 index changes, but we still have to follow the index as any index change would supercede the older CC92Q4 advice.

V61.5 & V25.2

When a pt comes in for a tubal ligation, use V25.2 as your first listed dx code.

I have seen V61.5 being used. According to the ICD-9-CM Coding book, this is an unacceptable principle dx.

Colonoscopy Guidelines

AHA reply 2/19/09

Assign Code V67.09, Follow-up exam, as the first listed dx for the colonoscopy encounter described below in example #1. Assign code V12.72, Personal history of Colonic Polyps, as a secondary dx.

Ex, #1: Previous h/o polyps. No new polyps are found.

If, however, a condition is found to have recurred on this follow-up visit, then the diagnosis code is assigned in place of the follow-up code. See example #2.

Ex. 2: Previous h/o polyps. New colon polyps are found. First listed dx code will be 211.3
Do not assign V12.72 since polyps are now current.

Favorite weblinks

American Academy of Professional Coders- http://www.aapc.com/

American Health Information Management Association- http://www.ahima.org/

Just Coding - http://www.justcoding.com/ (requires membership to access most items. Let me know if something looks interesting and I can obtain for you)

American Hospital Association - http://www.ahacentraloffice.org/ahacentraloffice/index.html

Advance for Health Information Professionals- http://health-information.advanceweb.com/

For The Record - http://www.fortherecordmag.com/

TrailBlazer - http://www.trailblazerhealth.com/Policies/Local%20Coverage%20Determinations/Default.aspx?

send me any of your favorites...JJ

EGD with polypectomy

A question I submitted to Coding Clinic AHA has been published in their First Quarter 2007 "Coding Clinic for HCPCS" newsletter.
Question: Pt has EGD with gastric polypectomy. Polypectomy performed with cold bx forceps. What is correct CPT code?

Answer: Report CPT code 43258.

LEEP 57522

LEEP procedure is coded 57522. The px is rarely done using a Colposcopy. I have seen CPT code 57460 used but no evidence of a colposcopy being used.