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Monday Q&A: Your Top Five Coding QuestionsAnswered - May 23, 2022

Welcome to our coding tips for medical billing weekly! Every week we collect five interesting questions medical billing professionals asked, and that we’ve answered.

Let’s get started with our Q&As below:

Guessing Games With Dx Codes On Lab Orders

Q:

Hello, I am trying to find an answer or a direction. Our hospital gets lab orders from local providers. Some come with only Dx descriptions, others come with only ICD-10-CM codes, others have both code and description. But sometimes they do not provide the correct Dx codes.

An order came in with "D63.1, I10" on the order. Since D63.1 cannot be primary, but I do not know what CKD to use (N18._), do I just code N18.9 or instead just use D64.9?

My initial thoughts are just to code N18.9 since the provider is indicating the patient's anemia is due to CKD and I just don't have documentation to determine anything other than the CKD NOS but also I don't know what the guidelines are to adding Dx codes to the order, provider didn't provide. Appreciate it! - Caleb

A:

Hi Caleb,

I would never advise to code based on a guess or unclear information. I think the best thing to do here would be to send a query asking for diagnosis clarification. I would not simply ask for the level of CKD, as that would be considered “leading” since the diagnosis isn't already present, even though it's clearly known that you need it.

I would say something along the lines of:

"Please provide diagnosis clarification for lab XXX."

How To Code For A Lasting Impression

Q:

I'm hoping someone might be able to help.

We are seeing a patient that had an impression done at a dentist's office that resulted in some of the impression gel being left/stuck in the patient's cleft palate. Our ENT provider is going to see the patient to evaluate for foreign body removal.

I have been combing for a potential CPT for this foreign body removal. There are codes for foreign body removal from the vestibule of mouth (40805), pharynx (42809), and larynx (31511), but none of these feel appropriate.

I'm thinking that we will need to end up using 42299 for "Unlisted procedure, palate or uvula", but wanted to see if anyone else might have any insight?

A:

I believe 40804 (Removal of embedded foreign body, vestibule of mouth; simple) would be correct, given that the others are clearly the wrong anatomy.

If it is a complicated procedure, then 40805 would be appropriate.

The Case Of The Missing Zero

Q:

I have received a ton of denials lately regarding code M54.5 being invalid. I work for an Ortho Spine Sx and assign it for "low back pain" ..... Denials are from Cigna, BCBS mainly.

Am I missing something??

A:

First, I would ask the organization to perform an update to your coding software, as it seems the newest coding guidelines may be outdated.

Secondly, M54.5 was updated with a specified place holder, including zero. So, M54.5 is now M54.50.

Hope this helps!

Acute On Chronic Coding Uncertainty

Q:

My provider has listed I50.21 & I50.22 in his progress note. Would this automatically be considered acute on chronic and should be reported with I50.23 or can the patient have both acute and chronic and I50.21 & I50.22 would be appropriate?

If so, what is the difference and does the provider need to specify something in the note to clearly indicate if it is acute or chronic or if they have both?

I cannot seem to find clarification on if it’s always acute on chronic when both are being reported or if the patient can have both reported with individual codes.

A:

I50.21 and I50.22 can be coded separately.

There is a 'code also' note if I50.84 is documented and present.

I would not assume that it is acute on chronic unless otherwise stated as such. You can always query if needed.

Getting To The Bottom Of Medicare Non-Payment

Q:

We have a post transplant patient who had a colonoscopy in 2016. We used Z12.11 and Medicare paid. Patient did not have any other dx findings on report.

Our transplant patients need to have routine colonoscopies every 5 years. Medicare denied her recent claim with Z12.11 and G0121.

What ICD-10 code and CPT code should I use to get Medicare to pay?

A:

Is the patient considered to be at high risk for colon cancer and/or post-colon cancer?

G0105 is Colorectal cancer screening; colonoscopy on individuals at high risk.

I would suggest using:

Z12.11 Colon Cancer Screening

Z94.82 Intestine Transplant Status

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