We are living through an unprecedented time in society today. It has been discussed for years with many predicting cataclysmic results. SARS-CoV-2 has seemingly stopped the world from spinning. There are many resources available describing individual responses to the crisis; however, I will discuss this from a general surgery perspective.
The coding aspects are as follows: The vast majority of morbidity related to COVID-19 is respiratory:
• Pneumonia, J12.89
• Bronchitis, J20.8
• Lower respiratory, J22
• Acute respiratory distress syndrome, J80
When a relationship to COVID-19 is known, B97.29 is attached. The following also may be documented:
• Cough, R05
• Shortness of breath, R06.02
• Fever, R50.9
“Possible” and known exposure have separate, distinct codes:
• Possible exposure, Z03.818
• Known exposure, Z20.828
The point of coding is to be as specific as possible, and, in these trying times, it is critical to be able to track, test and treat this scourge. Surgeons become involved for a number of reasons, namely critical care support, but the diseases that we routinely treat do not disappear in deference to the coronavirus.
The practice of surgery, as for many other medical professions, has become severely curtailed, limited to urgent and emergent treatment at most facilities. Shortages of personal protective equipment (PPE), fear of surface contact where known cases exist, and exposure of the already limited staff are just a few of the reasons for the curtailment.
For many employed surgeons, who are paid a regular salary plus productivity incentives, the financial damage may be limited. For private practice surgery the impact is substantial. Although many laypeople may not accept the fact that physician offices are not always flush with cash, it is the hard truth. At my office, we are applying for small business relief to be able to continue paying our employees. Likely there will be weeks and even months ahead in which the physicians will get no paychecks at all.
Just as in health care facilities, there are limitations on PPE used in daily care in our offices. Surgeons are accustomed to judging conditions that are potentially life-threatening, so scheduling now forces that behavior. Stay-at-home orders are in place. One strategy being employed with increasing frequency is telehealth, or telemedicine, to conduct patient appointments. The restrictions for billing during the national emergency are relaxed at this point. We are using Skype or FaceTime in our office to accomplish off-site visits in which the direct physical exam is not performed. If, despite best efforts, the patient simply cannot participate by videoconferencing, and the surgeon documents this clearly, a phone conversation may be billable as a visit. Obviously, the current crisis is the perfect storm to work out the particulars of televisits.
Our society has been exposed to virus exposures presumably since the beginning of time. Notables include the Spanish flu of 1918 in which 50 million people perished, flaviviruses, West Nile and Zika, and coronaviruses SARS and MERS. Approximately 34 million people contracted influenza A last year with more than 34,000 deaths. The speed with which this one spreads and the fear of outstripping our ability to treat the consequences has made this episode particularly vexing. If nothing else, the current crisis has taught everyone to respect what the medical world has feared viral pandemics can do. Stay safe.
—Dr. Newman is a general and vascular surgeon in Gadsden, Ala. He is a chief medical information officer of Nuance Surgical CAPD (Nuance.com).
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Photo courtesy of: General Surgery News
Originally Published On: General Surgery News
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