August 25, 2014

CPT Code 99214,99213 E/M Coding Established Office Patient Correctly for Medicare Reimbursement

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Learn how to correctly bill CPT Code 99214 instead 99213 or 99212 for Evaluation and Management (E/M) Coding of Established Office Patient to increase revenue through legitimate Medicare reimbursement.

The CPT Code 99214, if billed correctly, can increase revenue for the practice. By only using CPT code 99212 and CPT code 99213 many providers are losing thousands of dollars in legitimate revenue yearly. Which can be avoided with the correct billing of the 99214 E/M Code.

CPT Code 99214,99213  E/M Coding Established Office Patient Correctly for Medicare Reimbursement

CPT Code 99214 is assigned to the medical service that complies with the following requirements:
  1. The patient is an established one, meaning is not their first visit.
  2. It must be an outpatient visit, meaning it must not incorporate a day of hospital time.
  3. It must meet or exceed to of the following three points:
    1. A detailed medical history
    2. A detailed medical exam
    3. A medical decision that entails moderate complexity.
  4. The severity of the problem that brings the patient to the clinic must be from a moderate to a high one. 5. And last, the doctor and the patient should have a maximum of 25 minutes face time.

CPT code 99214 Increases Medicare Revenue

Medicare and other Insurance are pleased to pay the lesser money to providers if they (the doctors) are willing to under use the CPT code 99214. The key to using this code correctly is to understand the proper use and the components required to fully capture the most out of all of your encounters. As a provider, you will be rewarded the fruits of your labor when you take the time to learn the components of this code and use it properly.

When you consider CPT code 99214 it has a higher return rate linked to it, however, it must fall under the purview of a moderate complexity to a high severity problem. The physician, if using time as a factor must have spent at least 25 minutes in a face to face scenario with the patient. However, the time component is only a guide and not completely required if the components are included in the visit and the required medical necessity is present. The physician must be able to furnish the two or three areas which include history, physical exam and medical decision making with the proper documentation when filing for the CPT code 99214.

The patient encounter, composed of a detailed history, detailed patient exam and moderate complexity in the medical decision making will justify the use of CPT code 99214 as long as the medical necessity is apparent.

For example, you have an established office patient with hypertension, diabetes and a history of dyslipidemia who you are seeing on follow up in the office. Under the 1997 guidelines you can use three chronic and stable conditions to qualify for the higher code within the history component.

Document the medications and the review of systems along with the proper past medical, family and social history and the first component is met. Document the proper physical exam using appropriate organ system approach six areas with two bullets each and you have met the requirement for the complexity on this area.

At this point, technically you have reached the level 4 criteria since there only needs to be two out of three components required for an established patient.

However, we feel that it is difficult to not have a medical decision making component so we include that into our progress note. You can document the lab results for the patient and further solidify the visit to qualify at the higher code. As long as the medical necessity is present to justify the work done during the visit the coding can be at the higher level.

99214 vs 99213 CPT Codes Billing

In above Example, most providers will code the example as a CPT 99213, however, the qualifiers are present for the higher 99214 code.

While evaluating three different medical problems such as Hypertension, Diabetes and Hyperlipidemia, using the 1997 rules, you have met the medical necessity component as well, due to the need to monitor these diseases and help the patient with his/her control.

However, meeting the proper criteria required to code the encounter will enable a medical biller to get the rewards for the his career and his practice. It also become important, becaue now days Medical Billing and Coding Business are facing potential cuts in the reimbursements for the services the bill.

August 18, 2014

Sentinel Node Biopsy (SNLB) Coding for Breast Cancer/Melanoma

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Coding Sentinel Node Biopsy (SNLB) is a surgical procedure in Melanoma and Breast Cancer Screening to determine if the cancer has spread beyond a primary tumor into the lymphatic system. Sentinel Node Biopsy in Breast Cancer Evaluation reveals cancer spread, then patient needs additional lymph nodes removed.

The Sentinel Nodes are the first few lymph nodes into which a tumor drains. Lumpectomy with Sentinel Node Biopsy for Melanoma involves injecting a tracer material that helps the surgeon locate the sentinel nodes during surgery. The sentinel nodes are removed and analyzed in a laboratory. If the sentinel nodes are free of cancer, then cancer isn't likely to have spread and removing additional lymph nodes is unnecessary.
Sentinel Node Biopsy (SNLB) Coding for Breast Cancer/Melanoma

Sentinal node biopsy is not the same as Lymphadenectomy. Thus and confusing the two could have direct effects on the accuracy of your Medical Billing Claims.

Sentinel Node Biopsy (SNLB) Coding

Please follow given points to be sure you get all your Sentinel Node Biopsy procedures billing claims reimbursed:

Sentinel Node Biopsy is Billable when Results Lead to Subsequent Excisions

When the surgeon performs a sentinal lymph node biopsy prior to an unplanned partial mastectomy (either with or without lymphadenectomy) and the subsequent excisions are a result of biopsy findings, you may report the sentinal node biopsy separately. As according to guidelines set forth in Chapter 3 of the National Correct Coding Initiative Policy Manual for Medicare Services:

Sentinal Lymph Node Biopsy is separately reported when performed prior to a localized excision of breast or a mastectomy without Lymphadenectomy.

Therefore you can report both sentinal lymph node biopsy and lymphadenectomy during the same session as long as:
  1. The lymphadenectomy is unplanned at the time of the biopsy.
  2. The decision to perform lymphadenectomy (at the same or a later session) is based on the results of the biopsy.
For Example: The surgeon takes a biopsy of the sentinal axillary node (38525, Biopsy or excision of lymph node[s]; open, deep axillary node[s]). The pathology report indicates that the malignancy has spread, so the surgeon follows up with a lymphadenectomy (for example, 38745, Axillary lymphadenectomy; complete) to remove the affected tissue.
In this case, because the biopsy led to the decision to perform the mastectomy, you may report both 38525 and 38745.

Many payers will require that you append modifier 59 (Distinct procedural service) to the appropriate biopsy code (38500-38530) to further differentiate the procedure from the follow-up lymphadenectomy. In addition, your documentation should make clear that the biopsy results provided the justification for and led to the decision to perform the subsequent excisions.

Bundle Sentinal Node Biopsy with Lymphadenectomy

You should not separately report Sentinal Node Biopsy (38500-38530) and a planned lymphadenectomy (38700-38780) in the same region during the same operative session. Instead, you should include the sentinal node biopsy in the more extensive, same-location lymphadenectomy. Medicare says:
Sentinal lymph node biopsy for malignant melanoma is eligible for reimbursement unless a regional lymphadenectomy is planned, regardless of the findings of the [biopsy].

If the surgeon prospectively plans to perform lymphadenectomy, you should not separately report a sentinal node biopsy. In this case, the complete lymphadenectomy automatically includes removal of any lymph nodes that would qualify as sentinal nodes.

You should consider sentinal node biopsy (38500-38530) to be a more "targeted" and less invasive procedure than lymphadenectomy (38700-38780).

The sentinal node is the first lymph node to receive drainage from a cancer-containing area of the breast (or other site). If the sentinal lymph node is negative for metastases, the surgeon need not perform a complete lymphadenectomy (which removes a much greater volume of tissue), thereby avoiding the morbidity and complications associated with that procedure.

Keep in mind, however, that the above sequence of events would be rare. The purpose of a sentinal node biopsy is to avoid a lymphadenectomy, if possible. Therefore, surgeons generally perform lymphadenectomy only if the results of the sentinal node biopsy show malignancy.

Excisions, not Incisions, Count for Sentinal Node Coding

When the surgeon performs more than one sentinal lymph node biopsy, you should realize that the number of incisions, not the number of biopsies, determines the number of codes and/or units.

If the surgeon performs two biopsies through the same incision, you may report only a single code. If the surgeon takes three biopsies from two different incisions, you may report two codes, etc.

When reporting more than one biopsy code, append modifier 59 (Distinct procedural service) to the second and subsequent codes.
Example: Using one incision, the surgeon biopsies a superficial node and a deep axillary node. In this case, because the surgeon accesses the node through a single incision, you may report only the more extensive (higher-paying) code -- in this case, 38525.
If the surgeon performs the same procedures through different incisions, you may report 38525 and 38500, attaching modifier 59 to the lesser (lower-valued) procedure here, 38500 to indicate a separate anatomic area.

Watch for Mastectomy/Lymphadenectomy Unbundle

If the surgeon performs a mastectomy and lymphadenectomy during the same session, you should report 19302 (Mastectomy, partial [e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy]; with axillary lymphadenectomy) for the combined procedure rather than reporting 19301 and 38745 separately.

Often, with partial mastectomy, the surgeon will perform a limited axillary lymphadenectomy to remove some lymph nodes. The surgeon may also remove the nodes in the axilla through a separate incision at the same time.

Look out for the Staged Exception

Following some partial mastectomies (19301), the surgeon may return during the postoperative period to see if there has been any lymph node involvement and, if so, may choose to remove the nodes at that time.

In such a case, you would report the lymphadenectomy as a staged procedure using 38745 with modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) appended.

Sentinel Node Biopsy CPT Codes

Sometimes when performing a partial mastectomy it is necessary to remove axillary lymph nodes or biopsy the sentinel node. A sentinel node is the first node in a lymphatic chain to receive fluid from the primary tumor site which contains the metastisizing cancer cells.

CPT code 19301 is reported for a partial mastectomy or lumpectomy when the tumor is removed and specific attention is paid to the surgical margins. The lymph node excision code is determined by the type of procedure performed.

There are 3 levels of axillary lymph nodes Levels I-III. CPT code 38500 is reported for open excision or biopsy of superficial lymph nodes - these nodes are usually palpable under the skin. Levels II and III are deep and reported with CPT code 38525 (open, deep axillary nodes). The depth of dissection should be documented in the op note for coding accuracy.

Injection of dye to confirm a sentinel node is separately reported with CPT code 38792 (injection procedure for identification of sentinel node).

CPT code 19302 is only reported when "all identifiable axillary lymph nodes are removed" – A separate incision may be made but that is not what determines coding, reporting is based on the extent of axillary lymph node dissection.

Sentinel Node Biopsy ICD 9 Code

While coding Sentinel Node Biopsy/Surgery , the ICD 9 diagnosis code(s) must be represent the condition of the patient.

When the ICD-9-CM diagnosis codes 172.0-172.9 are used to identify malignant melanoma of the skin. The patient records must document that the tumor is Clinical Stage I.

When ICD-9-CM codes 174.0-174.9, 175.0, or 175.9 are used to identify breast cancer, the patient records must document that the tumor is Clinical Stage I or II.

August 11, 2014

CVA Stroke (Cerebral Vascular Accident) Coding and Billing

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A cerebral vascular accident (CVA), commonly referred to as a stroke, is a general term used to describe any disturbance in cerebral circulation that results in ischemia and anoxia. Stroke is a major cause of death and disability in the United States. It is also one of the top 10 conditions leading to hospital admission in the United States, involving more than 1 million hospitalizations in 1998. This column will cover various aspects of coding cerebrovascular diseases and will prepare you for questions on the certified coding specialist (CCS) or CCS-P (physician-based) exams related to them.

CVA Stroke (Cerebral Vascular Accident) Coding and Billing

A stroke occurs when blood vessels carrying oxygen to a part of the brain suddenly burst or become blocked. When blood fails to get through to the affected parts of the brain, the oxygen supply is cut off and brain cells begin to die. Strokes fall into several major categories, based on whether the disrupted blood supply is caused by a blocked blood vessel (ischemic stroke) or a hemorrhage. Ischemic strokes account for 80 percent of all strokes. As part of the medical evaluation for stroke, doctors regularly use head CT to rule out hemorrhagic stroke.

Nonhemorrhagic Stroke

Thrombosis: A blood clot (thrombus) forms inside an artery in the brain, blocking blood flow. The clot may occur in the cerebral, carotid or vertebral arteries.

Embolism: A clot, originating somewhere other than the brain, breaks loose and is carried by the blood stream to the brain. The clot reaches a point where it can go no further and plugs the vessel, cutting off the blood supply.

Hemorrhagic Stroke

Subarachnoid hemorrhage: The bleeding occurs in the space between the brain and the skull.

Intracerebral hemorrhage: A defective artery within the brain bursts, flooding the surrounding brain tissue with blood.

Hemorrhagic strokes are frequently caused by aneurysms. Another cause of hemorrhagic strokes is an arteriovenous malformation (AVM), which is a cluster of abnormal blood vessels.

The symptoms of CVA vary in type, severity and permanency. Some of the symptoms eventually subside, while others are never completely resolved. Warning signs of a stroke include:
  • Sudden weakness or numbness of the face, arm or leg on one side of the body.
  • Sudden dimness or loss of vision, particularly in one eye.
  • Sudden difficulty speaking or understanding language.
  • Sudden severe headache with no known cause.
  • Unexplained dizziness, unsteadiness or sudden falls, especially with any of the other signs.

Coding Cerebrovascular Disease

Codes from categories 430-434 should be used when coding the initial episode of care for an acute cerebral hemorrhage, occlusion, thrombosis, infarction or stroke.
  • 430, Subarachnoid hemorrhage
  • 431, Intracerebral hemorrhage
  • 432, Other and unspecified intracranial hemorrhage
  • 433, Occlusion and stenosis of precerebral arteries
  • 434, Occlusion of cerebral arteries
The coding of strokes has been problematic for coders because the record may not be clear on whether the cause was hemorrhagic or nonhemorrhagic. In ischemic or nonhemorrhagic strokes, the artery affected should be identified. Documentation must also indicate whether or not there is an infarction. An infarct is an area of necrosis, or tissue death, due to obstruction of a blood vessel by a thrombus, embolus or a hemorrhagic or ischemic event. In hemorrhagic strokes, the site of the hemorrhage should be documented.

Codes from Categories 433, Occlusion and stenosis of precerebral arteries and 434, Occlusion of cerebral arteries use a fifth digit to indicate the presence or absence of an infarct during the current episode of care. A fifth digit of 1 is reported when there is documentation of a cerebral infarction. A fifth digit of 0 is used when a cerebral infarction is not documented. The coder should never assume that an infarction has occurred without this being clearly identified in the medical record. Always query the physician when the documentation is incomplete or unclear.

For example: A 62-year-old male is diagnosed with an acute cerebral infarction due to thrombosis. The patient also has a known history of bilateral carotid stenosis. Assign code 434.01, Cerebral thrombosis with infarction, as the principal diagnosis. Assign code 433.30, Bilateral carotid stenosis without infarction, as an additional diagnosis. The fifth digit "1" cannot be applied to the bilateral carotid stenosis because the physician has made no mention of an infarction in that specific location.

Code 436, Acute but ill-defined cerebrovascular disease, is used when the medical record documents apoplectic attack, cerebral apoplexy, apoplectic seizure or cerebral seizure. It is very important to remember that code 436 is no longer the "default" code for CVA or stroke, not otherwise specified. Effective Oct. 1, 2004, the inclusion terms of stroke and CVA under code 436 have been removed and re-indexed to code 434.91, Cerebral artery occlusion, unspecified, with cerebral infarction. An embolic stroke or CVA will now code to 434.11, Cerebral embolism with cerebral infarction, and a thrombotic stroke or CVA will now code to 434.01, Cerebral thrombosis with cerebral infarction. With these changes, stroke and CVA not otherwise specified will always be coded as with infarction.

It is very important to note that even though this is an addenda change, and does not involve code changes, it has significant consequences for the coding professional. This change was made because physicians use the clinical terms of stroke and CVA synonymously with cerebral infarction. Records also lack specificity in the documentation and the change will allow improved uniformity and statistical data, and prevent unnecessary queries to the physician. Because coders had been accustomed to assigning code 436 for a diagnosis of CVA, when no additional information is available, care must be taken to break this habit because reimbursement will be affected.

The Medicare Grouper assigns code 434.91 to DRG 14 as it did in the previous version; however, because CVA now codes to 434.91 instead of 436 the reimbursement is higher because DRG 14 will be assigned not DRG 15.

Codes from category 437 are used to identify other and ill-defined cerebrovascular diseases such as cerebral arteriosclerosis, nonruptured cerebral aneurysms and arteritis and transient global amnesia.

Each component of the diagnosis documented by the physician identifying cerebrovascular disease should be coded unless the alphabetic index or the tabular list instructs otherwise.

For example: cerebrovascular arteriosclerosis with subarachnoid hemorrhage due to ruptured aneurysm is coded to 430 and 437.0. When codes from the 430-437 series are used, additional codes are needed to identify any sequelae or neurological deficits such as hemiplegia or aphasia. To be coded, residual neurological deficits must be present on discharge. For example, a patient admitted because of a CVA with associate aphasia would have only the CVA code if the aphasia cleared by discharge. However, if the aphasia is still present at discharge both codes 434.91 Cerebral artery occlusion, unspecified, with cerebral infarction and 784.3, Aphasia are assigned.

If there are no residual deficits and the symptoms abated in less than 24 hours, query the physician to ascertain the diagnosis of a CVA vs. transient cerebral ischemia or attack (TIA). Use an appropriate code from the category 435, Transient cerebral ischemia, when neurological deficits are of sudden onset and brief duration due to insufficiency of cerebral circulation. The deficit may last from 5 minutes to 24 hours and is referred to as reversible. By the time of discharge, the deficits have subsided with the possible exception of some weakness. Impending CVA, intermittent cerebral ischemia and TIA are synonymous with transient cerebral ischemia.

For example: A patient is admitted because of repeated, brief episodes of light-headedness and left-sided tingling over the past week. An emergency CT scan reveals no evidence of hemorrhage, fluid collection, mass or recent infarction. The physician documents impending CVA. The correct code assignment for the principal diagnosis is 435.9, Unspecified transient cerebral ischemia.

Once a patient has completed the initial treatment or is discharged from care, codes from category 438, Late effects of cerebrovascular disease should be assigned to identify the residual neurologic deficits or late effects of cerebrovascular disease.

Coding Late Effects of Cerebrovascular Disease

Category 438 is used to identify residuals or late effects of cerebrovascular disease when a patient is seen or admitted at a later date. These late effects include neurological deficits that persist after the initial onset of the cerebrovascular event.

For example: A patient is seen with hemiplegia on the dominant side due to an old CVA. Code 438.21, Late effects of cerebrovascular disease, hemiplegia affecting dominant side is assigned. Codes from category 438 may be assigned as the principal diagnosis when the reason for admission is to deal with the late effect.

However, if the admission is for rehabilitation a code from category V57, Care involving use of rehabilitation procedures is assigned as the principal diagnosis with an additional code from category 438.

For example: A patient is admitted for rehabilitation consisting of speech therapy, occupational therapy and physical therapy for residual aphasia and hemiplegia following a CVA. In this instance code V57.89, Other specified rehabilitation procedure, is assigned as the principal diagnosis. Codes 438.11, Late effects of cerebrovascular disease, Aphasia, and 438.20, Late effects of cerebrovascular disease, Hemiplegia affecting unspecified side are assigned as additional diagnoses.

Codes from category 438 may also be assigned as additional diagnoses when a patient is admitted with a new CVA and residuals from a previous episode remain at the conclusion of the visit.

When appropriate, a code from category V12.59, Personal history of other diseases of circulatory system may be used when a patient has a prior CVA but has no residual conditions. Personal history codes explain a patient's past medical condition that no longer exists and is not receiving any treatment. A history of an illness, even if no longer present, is important information that may affect the type of treatment ordered.

In some cases, the neurologic deficits diminish or disappear within weeks or months of the CVA, while in others the neurologic deficits persist. The degree of impairment varies from case to case. For example: A patient is admitted for routine cataract extraction and the history and physical examination indicates weakness of the left arm.

The physician documents old CVA as a secondary diagnosis. There is no other supporting documentation regarding this diagnosis. In this instance, query the physician to determine the source of the left arm weakness because the physician did not state that the weakness was the result of the old CVA. If the physician documents that the arm weakness is not due to the old CVA, assign code V12.59, Personal history of other diseases of the circulatory system, for the history of old CVA.

August 4, 2014

ICD 9 Codes for Cholelithiasis and Gallstones

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Radiology coding has all types of charts from x-rays, Ultrasound, CT, MRI, Nuclear Medicine etc, to code. Ultrasound procedures are the most commonly found charts in radiology.

Whenever a patient comes with abdomen pain, physicians prefer to go for Ultrasound. Abdomen ultrasound is done either limited or complete. Complete ultrasound (76700) includes all eight organs including Gallbladder, Liver, Spleen, Pancreas, Right Kidney, Left Kidney, Aorta, Inferior Vena Cava and Common Bile Duct. However, physician can also order Limited Ultrasound (76705) to check only single organ or single quadrant.

Abdomen is divided into four quadrant. Right upper quadrant of abdomen includes gallbladder which has been studied mainly when the patient is having right upper quadrant pain. The main diagnosis for gallbladder includes cholelithiasis or cholecystitis.

ICD 9 Codes for Cholelithiasis, Gallstones Pancreatitis

The ICD 9 codes for cholelithiasis are mostly used during coding such charts. Cholelithiasis is presence of calculi in gallbladder which is also called as gallstones.

ICD 9 Codes for Gallstones

Gallstones can cause obstruction in the gallbladder. Cholecystitis may be acute or chronic, which generally cause inflammation of gallbladder. While coding icd 9 codes for cholelithiasis one has to check the presence of cholecystitis has well, since there are some combination codes for both in icd 9 code book. Let’s have a look at the ICD 9 code for cholelithiasis and similar diagnoses.
  • 574.00 Calculus of gallbladder with acute cholecystitis; without mention of obstruction.
  • 574.10 Calculus of Gallbladder with other cholecystitis; without mention of obstruction.
  • 574.20 Calculus of Gallbladder without mention of cholecystitis; without mention of obstruction.
  • 574.30 Calculus of Bile Duct with acute cholecystitis; without mention of obstruction.
  • 574.40 Calculus of Bile Duct with (chronic) cholecystitis; without mention of obstruction.
  • 574.60 Calculus of Gallbladder and bile duct with acute cholecystitis; without mention of obstruction.

ICD 9 Codes for Cholelithiasis

The specific ICD 9 code for Cholelithiasis is 574.20, without any obstruction and cholecystitis. All other ICD 9 codes are having a combination of obstruction or cholecystitis with cholelithiasis. Hence, medical biller should be more careful with searching a code. Most of the times coders land up coding individual code for cholelithiasis (574.20) and cholecystitis unspecified (575.10) which is not correct, as we have a combination code for these diagnosis (574.00 and 574.01).

Same thing goes with the Calculus of bile duct which has combination code with icd 9 code for cholelithiasis and with cholecystitis (574.30, 574.40, 574.60). Whenever there is presence of cholelithiasis, calculus in bile duct and cholecystitis in the report, one should not code them individually since we have combination code for them (574.60).

The main symptoms causing this diagnosis are generally pain in right upper quadrant of abdomen (789.01). The pain is generally followed by the nausea and vomiting (787.01) which can lead to cholecystitis and cholelithiasis. Hence when the patient comes with pain, nausea and vomiting physicians tried to look for gallstones and cholecystitis in the pathology report.

CPT Code for Gallbladder Treatment Procedures

Once the diagnosis is confirmed, doctors use following CPT surgical procedures for the treatment of such disorders:
  • 47562 Laparoscopy, Surgical; Cholecystectomy.
  • 47563 Laparoscopy, Surgical; Cholecystectomy with Cholangiography.
  • 47564 Laparoscopy, Surgical; Cholecystectomy with Exploration of Common Duct.
  • 47570 Laparoscopy, Surgical; Cholecystoenterostomy.
  • 47579 Unlisted Laparoscopy Procedure, Biliary tract.
These laparascopy surgical procedures are done mainly with cholecystectomy to remove the gallbladder. Removal of gallbladder can treat many of the disorder especially the neoplasm.

July 14, 2014

Gastrostomy Tube Placement CPT Procedure, ICD 9/10 Codes

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Learn all about Gastrostomy Tube Placement interventional radiology CPT Procedure Codes and ICD 9/10 Codes.

Some patients are not able to take food by mouth or cannot swallow properly. They may have some congenital abnormalities of mouth, esophagus, stomach, or intestines. Physician inserts G-tube in those patients so that they can take adequate nutrition by mouth.

However, some patients (mostly children) are unable to tolerate feeding of food directly into the stomach. The G-tube is required to be converted into GJ tube in these cases. This article covers all the ICD Codes and CPT Codes required for the medical billing of this conversion procedure under fluoroscopic guidance.

Gastrostomy Tube Placement CPT Procedure, ICD 9/10 Codes

There are some adult patient, who cannot take enough food through mouth or have swallowing food problems, such patients has to go through Gastrostomy Tube Placement.

Gastrostomy Tube Placement Procedures

The patient is placed supine on the procedure table and prepped and draped sterilely. The physician places a tube through the skin and into the stomach and uses x-rays to make sure it is in the right place.

Contrast dye is injected into the tube and fluoroscopic imaging technique is performed to confirm proper placement and to make sure that contrast
travels freely through the tube freely, without any obstruction.

Gastrostomy Tube (G-Tube) Procedure

This is a tube inserted into the stomach through a small incision in the abdomen. The tube goes through the skin (percutaneous) to the stomach wall and then into the stomach. This tube feeding into the stomach is called gastrostomy tube (G-Tube).

Gastro Jejunostomy Tube (GJ-Tube) Procedure

This is a feeding tube which is inserted through the gastrostomy stoma in the abdominal wall, passes through the stomach and advances into the jejunum. This tube feeding directly into the intestines is called Gastrojejunostomy tube (GJ-Tube).

Documentation of the image produced by the fluoroscopic guided imaging technique and report are included in this CPT.

Gastrostomy Tube Placement CPT Codes

The most common Percutaneous Gastrostomy Tube Placement CPT codes used for the insertion of tube in stomach region are given below:
  • 49440 Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report.
  • 49441 Insertion of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report.
  • 49442 Insertion of cecostomy or other colonic tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report.

Gastrostomy Tube Placement ICD 9/10 Codes

Find below the list of the common ICD 9 diagnosis codes with their ICD 10cm conversion codes; used for Percutaneous Gastrostomy Tube Placement:
  1. 530.11 Reflux Esophagitis (ICD 9)
    K21.0 Gastro-esophageal reflux disease with esophagitis (ICD 10)

  2. 530.12 Acute Esophagitis (ICD 9)
    K20.9 Esophagitis, unspecified (ICD 10)

  3. 530.19 Other Esophagitis (ICD 9)
    K20.8 Other Esophagitis (ICD 10)

  4. 530.20 Ulcer of Esophagus without bleeding (ICD 9)
    K22.10 Ulcer of Esophagus without bleeding (ICD 10)

  5. 530.21 Ulcer of Esophagus with bleeding (ICD 9)
    K22.11 Ulcer of Esophagus with bleeding (ICD 10)

  6. 530.3 Stricture and stenosis of esophagus (ICD 9)
    K22.2 Esophageal Obstruction (ICD 10)

  7. 530.4 Perforation of Esophagus (ICD 9)
    K22.3 Perforation of Esophagus (ICD 10)

  8. 530.5 Dyskinesia of Esophagus (ICD 9)
    K22.4 Dyskinesia of Esophagus (ICD 10)

  9. 530.6 Diverticulum of Esophagus, acquired (ICD 9)
    K22.5 Diverticulum of Esophagus, acquired (ICD 10)

  10. 530.7 Gastro Esophageal Laceration Hemorrhage Syndrome (ICD 9)
    K22.6 Gastro Esophageal Laceration Hemorrhage Syndrome (ICD 10)

  11. 530.81 Esophageal Reflux (ICD 9)
    K21.9 Gastro-Esophageal Reflux Disease without Esophagitis (ICD 10)

  12. 530.82 Esophageal Hemorrhage (ICD 9)
    K22.8 Other Specified Diseases of Esophagus (ICD 10)

  13. 530.83 Esophageal Leukoplakia (ICD 9)
    K22.8 Other Specified Diseases of Esophagus (ICD 10)

  14. 530.84 Tracheoesophageal Fistula (ICD 9)
    J86.0 Pyothorax with Fistula (ICD 10)

  15. 530.85 Barrett's Esophagus (ICD 9)
    K22.70 Barrett's Esophagus without Dysplasia (ICD 10)

  16. 530.89 Other specified disorder of the esophagus (ICD 9)
    K22.8 Other specified diseases of esophagus (ICD 10)

  17. 536.8 Dyspepsia and other specified disorders of function of stomach (ICD 9)
    K30 Functional dyspepsia (ICD 10)

  18. 787.20 Dysphagia, unspecified (ICD 9)
    R13.10 Dysphagia, unspecified (ICD 10)

  19. 787.21 Dysphagia, oral phase (ICD 9)
    R13.11 Dysphagia, oral phase (ICD 10)

  20. 787.22 Dysphagia, oropharyngeal phase (ICD 9)
    R13.12 Dysphagia, oropharyngeal phase (ICD 10)

  21. 787.23 Dysphagia, pharyngeal phase (ICD 9)
    R13.13 Dysphagia, pharyngeal phase (ICD 10)

  22. 787.24 Dysphagia, pharyngoesophageal phase (ICD 9)
    R13.14 Dysphagia, pharyngoesophageal phase (ICD 10)

  23. 787.29 Other dysphagia (ICD 9)
    R13.19 Other dysphagia (ICD 10)
Hope, this article help you in the medical billing and coding of Gastrostomy Tube Placement by learning the CPT procedure codes and ICD 9, ICD 10 diagnosis codes.

July 7, 2014

ICD 10 Codes for Autism and Autistic Spectrum Disorder

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Autism spectrum disorder and autism are terms used to refer to complication in the development of the brain, beginning in childhood.

The disorders are normally characterized by the difficulties in social interaction, verbal and nonverbal communication. Autism symptoms includes
presence of markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interest.

Children with autism might have problems talking with you, or they might not look you in the eye when you talk to them. They may spend a lot of time putting things in order before they can pay attention, or they may say the same sentence again and again to calm themselves down. They often seem to be in their "own world."because people with autism can have very different features or symptoms, health care providers think of autism as a "spectrum" disorder.

Manifestations of the Autistic disorder vary greatly depending on the developmental level and chronological age of the individual. The Autistic spectrum disorder is associated with difficulties in motor coordination, as well as physical health issues associated with sleep and gastrointestinal disturbance.

ICD 10 Codes for Autism and Autistic Spectrum Disorder

Statistics in the U.S indicate that 1 in 68 American children suffer from the condition. There is tenfold increase in Autistic children for the past 40 years, mostly prevalent in boys than girls.

The exact cause of autism is not known but the main reason of this common type of mental condition is gene mutation, as well as environmental factors that influence early brain development. Some of the other risk factors include parental age at the time of conception, maternal illness or difficulties during birth.

Autism lasts throughout a person's lifetime. There is no cure, but treatment can help. Treatments include behavior and communication therapies and medicines to control symptoms. Starting treatment as early as possible is important.

Autism and Autistic Spectrum Disorders ICD 10 Codes

Below are some of the most common Autism and Autistic Spectrum Disorder's ICD 10cm Codes that will be required for Medical Coding and Billing after ICD 10 Implementation:

F84.0 Childhood Autism

A type of pervasive developmental disorder that is defined by:
(a) The presence of abnormal or impaired development that is manifest before the age of three years, and (b) the characteristic type of abnormal functioning in all the three areas of psychopathology: reciprocal social interaction, communication, and restricted, stereotyped, repetitive behavior. In addition to these specific diagnostic features, a range of other nonspecific problems are common, such as phobias, sleeping and eating disturbances, temper tantrums, and (self-directed) aggression.

F84.1 A typical Autism

A type of pervasive developmental disorder that differs from childhood autism either in age of onset or in failing to fulfil all three sets of diagnostic criteria. This subcategory should be used when there is abnormal and impaired development that is present only after age three years, and a lack of sufficient demonstrable abnormalities in one or two of the three areas of psychopathology required for the diagnosis of autism (namely, reciprocal social interactions, communication, and restricted, stereotyped, repetitive behavior) in spite of characteristic abnormalities in the other area(s). Atypical autism arises most often in profoundly retarded individuals and in individuals with a severe specific developmental disorder of receptive language.

299.00 Autistic Disorder

ICD-10 code 299.00 is used to define autistic disorder with various characteristic. The code further characterizes autistic disorder into:

A total of six (or more) items from (1), (2) and (3), with at least two from (1), and one each from (2) and (3):
  1. Qualitative Impairment in Social Interaction as manifested by at least two of the following:
    1. Marked impairment in the use of multiple nonverbal behaviours such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.
    2. Failure to develop peer relationships appropriate to developmental level.
    3. A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest).
    4. Lack of social or emotional reciprocity.
  2. Qualitative Impairments in Communication as manifested by at least one of the following:
    1. Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gestures or mime).
    2. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others.
    3. Stereotyped and repetitive use of language or idiosyncratic language.
    4. Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.
  3. Restricted Repetitive and Stereotyped Patterns of Behaviour, Interests and Activities as manifested by at least one of the following:
    1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.
    2. Apparently inflexible adherence to specific, non-functional routines or rituals.
    3. Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole body movements).
    4. Persistent preoccupation with parts of objects.
Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
(1) social interaction, (2) language as used in social communication or (3) symbolic or imaginative play

The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.