Wednesday, July 25, 2007

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

Monday, July 23, 2007

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.