# Help Coding



## Kslide (Sep 2, 2014)

I need help with a big homework assignment. I need icd9 /cpt codes for the following:
A patient presents to the orthopedic office with his index fingers curling of his right hand. The provider diangnosed him with trigger fingers and scheduled him for trigger finger release. He presents to the OR for the trigger finger release of both fingers.

My take is 727.03/26055 ??

2. Patient has severe bilateral wrists pain as well as left elbow pain. He was discovered to have carpal tunnel syndrome and cubital tunnel syndrome. The provider scheduled him for release. He presents to the or where a bilateral endoscopic release was performed and a left cubital tunnel release.

Not sure

3. A patient accidentaly cut the insode of her hand, while cutting food. The laceration measured 5 cm in length. It required a simple laceration repair. While she was there she also had a TDAP injection.
Diagnosis:  ?   CPT  ?

4. Mr. Smith is an 89 year old resident of local nursing home. While eating steak she began to choke at which tshe felt as if she had something stuck in her throat. She currently has breast cancer which she is being treated with chemotherapy which has also spread to her bones, diabetic retinopathy, legal blindness, and AKA of her right leg. She was brought to the ER at which time an EGDY was performed and the foreign body for white residue. The pathology report reported candidal Esophagitis
Diagnosis?  CPT ??

Any and all help is greatly appreciated, Thank you in Advance.


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## chelle511 (Sep 3, 2014)

Hi.. I will offer some assistance.  But, it is important that you are able to code these cases on your own for optimal learning. so I will assist you with getting started and determining main terms and then you should be able to find the appropriate codes.

Are you having issues with main terms?  That is the key to finding the diagnoses and procedures.

For ICD-9 your main term is the condition, disease or symptom.  

For CPT the main term could be the condition, name of procedure or medical service, name of anatomic site or organ, OR synonyms, eponyms or abbreviations.

1.  You are correct....  just to find the diagnosis you went to main term trigger finger 727.03
For the procedure.. main term release, trigger finger and you correctly got 26055.  It stated this was index finger.  Which is the pointer finger.  You stated bilateral... would need to code bilateral.. since we have finger modifiers I would assign 26055-F6 and 26055-F1

2.  Did you have trouble locating diagnosis.. carpal tunnel and cubital tunnel just decribe the location/body part involved.. the problem is syndrome..
So just go main term syndrome, carpal tunnel and syndrome cubital tunnel..
Be sure to verify codes in tabular to see location of these conditions.. may be needed for procedure coding..

Not clear what you stated the procedures were.. 

I saw bilateral endoscopic  and cubital tunnel release...   Was the carpal tunnel repair endoscopically bilateral..

If you just go release, carpal tunnel.. you get the open procedure code.. but when you verify it in the tabular it will give you a note as to the endoscopic code..

But. to find the endoscopic code via the index.. you have to go to the endoscope of the wrist joint.  joint endoscope is medical term arthroscopy...    so arthroscopy, surgical, wrist... 
and would need to append a 50 modifier to code since bilateral.

For the cubital tunnel release... you will not find cubital tunnel subterm under the release main term.. so have to look at the diagnosis to see what is the issue with this condition.. what is the anatomic site involved and then code release of that anatomic site..  That would be for open procedure...   If endoscopic.. you would go arthroscopy, surgical,elbow... and if no code found would have to use unlisted arthroscopy code.. pg 63 of 2014 CPT codebook..


3.  Are you having trouble finding the diagnosis code?  Look up main term laceration. and this sends you to main term  Wound, open, and then you select hand

For laceration repair.... if you go to this in the code book it sends you to specific site.. in this case it was skin.  For anything done to the skin usually I start with main term skin.    So.. for this one follow route of main term Skin, wound repair, simple...   then select code based upon anatomic site and size.

For the vaccine. diagnosis.. just go to main term vaccination. It was DTAP.
So...  Vaccination, Tetanus, with Diptheria with pertussis and you get your Vcode. 

For vaccine procedure..  Go to Vaccines, Diptheria, Tetanus, Acellular Pertussis (Dtap)... You get a code... but note the age of less than 7.  was the age given?  If not.. I would note on test  both codes.. and say one is if patient is less than 7 and the other is for age greater than 7.

Reading the instructional information at the beginning of the vaccine codes..it tells you that codes 90476-90748 describe vaccine only... you need additionally a code for administration of vaccine 90460-90474.  You can locate these codes under main term administration.  

4.  On this one.. was something left out of your typing of the procedure?.. what was the procedure.. ?

Was it EGD with biopsy... since they diagnosed candidal esophagitis I assumed a biopsy was done in order to arrive at this diagnosis... did they remove the foreign body..?.  I am going to assume they did..

For diagnosis..   main term foreign Body.... throat.. (verify code in tabular to see what anatomical site throat indexes to).   then in index to external causes you main term is foreign body and the site of throat for your E-code.  Looks like this occurred in nursing home.. so can assign place of occurrence e-code using main term accident, occurring  in the index to external cause.

then you have esophagitis, candidal...  easily found in index following those words.
For your cancers you are going to neoplasm table.. site breast, and pick primary column.. then for bone.. you will go to secondary column..
Diabetic, retinopathy in index using those words and assign both codes..
blindness, legal....use those words..     for AKA.. which is above knee amputation..  main term for history of procedures is "status".. .  going to status removal of organ sends you to absence by site, acquired..  same if you went to main term amputation, status... You will get a V-code.

Then for the procedure. you need to know what EGD stands for.. simple google will get you that answer..  Going to this term in the index sends you to Endoscopy, gastrointestinal, upper.. and then you pick subterm for what was performed.. biopsy.. and then foreign body...


I hope this helped... Michelle Cowart, MPH, RHIA, CCS, CPC, CPC-I
                            All About Coding, LLC


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