Hot Coding Topics

Sharpen Your Colonic Polyp Vocabulary With These Tips

Not all patients who present to the office with colon polyps will be diagnosed with colon cancer. This second-leading cause of cancer-related deaths in the US usually begins as small, benign adenomatous lump, and becomes cancerous overtime.

Colon cancer, or colorectal cancer as it’s regularly known, is a cancer which starts in the large bowel portion of the gastrointestinal (GI) system. Because it comes in many forms and symptoms, coding the definitive diagnosis might be risky. Guard your practice’s deserved dollars with these 3 tips.

1. Don’t Go Looking For ‘Benign’, ‘Malignant’

Whether or not you’re dealing with a full-blown colorectal cancer, you should be looking at the different terms used to describe benign or malignant colonic polyps. Some of these include:

  • Adenomas including tubular adenomas and tubulovillous adenomas
  • Hyperplastic polyps
  • Inflammatory polyps
  • Familial adenomatous polyposis, a rare hereditary disorder that causes hundreds of polyps in the lining of the colon beginning in the teenage years. If this is left untreated, the patient becomes high risk to develop colon cancer.
  • Hereditary nonpolyposis colorectal cancer, a hereditary disorder that causes an increased risk of developing colon cancer.

But first, you have to accomplish the task of determining — without a doubt — if a polyp is benign or malignant. If you think you would find the clues in the pathology report (PR), think again. Usually, the PR will not use the term “benign” or “malignant.” However, it will use a description that points to the usual behavior of the polyp. It’s up to you to interpret those descriptions into benign or malignant.

Experts advise that you always wait for the pathology report to come back before deciding on a particular ICD-9. Even the gastroenterologists, themselves, usually defer to the pathology report before making a recommendation.

2....

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March 31, 2011
Coding Challenge / Hot Coding Topics

Primary vs. Secondary Diagnosis

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...

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January 3, 2011
Hot Coding Topics

ICD-9 2011: 799.51 Answers Your PreADD Diagnosis Dilemma

Pediatric and family practice coders are all too familiar with ADD-like complaints minus a definitive diagnosis. ICD-9 2011 holds the key to alternative options until further testing is complete. ICD-9 2011 adds the 799.5x family to the “Ill Defined ...

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September 20, 2010