Question: If a patient receives treatment and the condition was resolved, which ICD-9 code should I report if the patient returns in six months for a follow-up visit? Answer: The most accurate way to code visits to follow up on treatment for a previous...
Question: Many of our ophthalmology patients claim general reasons for their visit, such as “I can’t see well,” or “My vision is foggy.” We code these visits with 368.8 as the primary diagnosis because this is the primary reason for the visit. Any other problems or underlying causes of the blurry vision we report as secondary diagnoses. Is 368.8 the most appropriate code to use in these situations, and should we list it first?
Answer: You should only report 368.8 (Other specified visual disturbances) as a primary diagnosis code when the ophthalmologist doesn’t find a more definitive diagnosis during the course of the visit.
Carriers often consider a visit for blurred vision the same thing as a routine exam— and Medicare will not pay for this service.
Primary vs. secondary: Whenever possible, you should list a more definitive diagnosis as primary and then the patient’s complaint of blurred vision as secondary. For example, if the ophthalmologist discovers that a cataract is causing the patient’s blurry vision, you would first list 366.12 (Incipient cataract) and then 368.8. You should always strive to report the most descriptive and accurate ICD-9 codes possible. If a patient claims her only reason for the visit is a routine exam, experts recommend that the ophthalmologist ask her a series of detailed questions to uncover any other complaints she may have but doesn’t think of right away. In obtaining a comprehensive history when a patient denies any blurriness of vision, the ophthalmologist should also ask, “Do your eyes chronically itch, burn, or water?” This may lead you to report dry eye syndrome (375.15, Tear film insufficiency, unspecified) or allergic conjunctivitis (372.14, Other chronic allergic conjunctivitis).
Do this: Rather than ask if a patient’s vision is blurry, ask if there is...
Hint: You can report complications before or after delivery.
You can receive increased reimbursement when your ob-gyn provides additional visits outside of the normal global ob package, but you’ll have to make sure you’ve coded high-risk or complicated obstetrical care correctly – and that means perfecting your ICD-9 coding skills.
Insist on Perfect ICD-9s
You have to link the ICD-9 code on the CMS-1500 claim form (boxes 21 and 24E) to an E/M code, for example, to demonstrate the reason for the additional service. You can add this to the claim that includes the global service, or you can submit it as an additional claim.
Example: A 33-year-old patient, gravida 3, para 2 (both normal spontaneous vaginal delivery [NSVD] full term), is seen in the office 19 times due to developing pre-eclampsia. After the delivery, you review the case and find that the patient required six additional visits (beyond the usual 13) for this care. The documentation for three of these visits supports reporting 99212 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 10 minutes face-to-face with the patient and/or family), while three of the visits have more extensive documentation that supports reporting 99213 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 15 minutes face-to-face with the patient and/or family).
In addition, after delivery, the patient experiences prolonged pain and irritation due to a hemorrhoid. The ob-gyn sees her for a thrombosed hemorrhoid, which he incises in the office two weeks post-delivery. Finally, the ob-gyn rechecks the patient at her six weeks postpartum visit.
Break it down: When coding for this patient, remember the claim form must note both the CPT codes describing the additional services, as well as the diagnoses that...
If you performed a consult in 2006, the auditor will use 2006 guidelines — not today’s rules.
Most Part B practices have grown accustomed to tucking consult regulations into the backs of their minds, since Medicare no longer pays for...
Keep these additional test rules at your fingertips if your want to keep auditors out of your hair. The Office of Inspector General and Recovery Audit Contractors are out to audit non-compliant ultrasound claims, so knowing the rules is more important than ever. And we’ve got a link and a handy checklist to keep you out [...] Related articles: