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In the P/A the provider states s/p CVA- Hypercoag States….s/p thyroid CA…
Do I also code follow up codes with the aftercare for the s/p CVA and s/p thyroid CA? Obviously with the aftercare code being primary. TIA
this is going to be my most detailed question yet ….
I’m not the normal hospital coder and i don’t normally handle insurance pre-qualifications… ok — i don’t do this at all, but i’m the only one left in the building thats a coder.
We have a Pt that has had sepsis (staph susceptible to methicillin) and had surgery at a different facility for the infection in he proximal left thumb.
He is DMII and not sure if it a complication from DMII or not .. records are pending from the other facility. (i think it is — but)
The Pt wants us to continue his care and the our surgeon has debride’d (irrigation yatta yatta) the wound and applied a synthetic skin graft … the graft was a free sample.
We are now wanting to apply another graft to same site …. probably going to be another debridement …
Insurance will deny an unspecified wound left thumb …
and i wanted to code still the sepsis staph type A (im going on memory the next morning — just got in)
The surgeon stated it as a wound .. but i think that is more of an abscess now .. and should be tested again for staph …. We don’t have a lab for staph in our records yet….
anyways ,,, i’m thinking L02.511 and adding history of staph for the insurance pre-qualification
Sorry that i’m not more knowledgeable here …
With our spine fusions and other general orthopedic surgeries (i.e. bunionectomies, meniscectomies, epicondylectomies, etc), we’ve been using Z47.89. I do not see a code that specifically states "encounter for surgical aftercare for musculoskeletal". I see orthopedic NEC which directs me to Z47.89.
UMR is denying these charges stating the diagnosis is not coded to the highest level of specificity and they are denying our appeals when I send them copies of the aftercare section showing that ICD 10 refers us to Z47.89.
UMR reps are stating that they have increased their scrutiny of ICD 10 codes and require specificity but unless I’m missing something, I don’t see how we can code these general procedures any more specifically.
I’m planning to contact them to see if a certified coder or someone responsible for ICD 10 implementation at their organization can review our denials but was wanting to reach out to the coding community to see if anyone else has run into this or done anything with success and can share some advice with me.
Thank you!
Kimberly
(ie. patient had a right knee replacement done 5 years ago and comes to the office to have that knee checked and xrays taken, they have no complaints/problems.)
Thanks for your input!
I found this statement: "7th character D subsequent encounter is used for encounters after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Examples of subsequent care are: cast change or removal, an x-ray to ICD-10-CM check healing status of fracture, removal of external or internal fixation device, medication adjustment, other aftercare and follow up visits following treatment of the injury or condition. "The aftercare Z codes should not be used for aftercare for conditions such as injuries or poisonings, where 7th characters are provided to identify subsequent care. For example, for aftercare of an injury, assign the acute injury code with the 7th character D (subsequent encounter)".
I actually do the coding for DME and Home Care Pharmacy and ‘non-coder’ nurses are doing the home care coding. I am probably overstepping, but I like to point out issues when I see them. I thought that my advice would be well received, but it wasn’t.
Anyway, is the above statement is the evidence that I provided to these nurses.
Thanks so much for your input!
thanks
Thanks