# It there too many codes?



## codingchick (Aug 3, 2010)

I was coding this: female presents to the ED with laceration of the wrist due to self inflicted knife wound.  ED physician determines after discussion that the patient is suicidal.  Her wound is 3.5 cm in length and he repairs the wound with sutures in a layered closure fashion.  She is transferred to the local mental health clinic for additional treatment. and this is what I coded
881.2, E956 and 86.59 I was unsure about that one. Can someone help.  Thanks


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## shandellw (Aug 4, 2010)

codingchick said:


> I was coding this: female presents to the ED with laceration of the wrist due to self inflicted knife wound.  ED physician determines after discussion that the patient is suicidal.  Her wound is 3.5 cm in length and he repairs the wound with sutures in a layered closure fashion.  She is transferred to the local mental health clinic for additional treatment. and this is what I coded
> 881.2, E956 and 86.59 I was unsure about that one. Can someone help.  Thanks



Hi Codingchick,
This is the manner in which I would code this information you provided:
881.02, E956, 300.9(suicidal attempt), 12002; I would not use the Volume 3 procedure code, but I could be incorrect. Hope that helps you some. Don't you just love coding


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## mitchellde (Aug 4, 2010)

Do not use the Volume 3 code for the procedure as that code is for inpatient only use.  Er uses CPT codes for the procedures.  Also the physician has not documented a nonpshychotic mental disorder so we cannot code it.  The suicide attempt is covered by the E code so code only the wound (881.02) , the E code (E956), and the repair as 12032 since it is documented as a layered repair.


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## shandellw (Aug 4, 2010)

I would code the 300.9 code even if the E code is used due to the fact that the physician documented or as you noted patient is suicidal; the E code in its self would describe the cause of injury, which is the wrist laceration, however, the 300.9 code in my opinion provides greater detail that the patient has tendecies or risk of suicide. As for the CPT procedure code I do agree after seeing the layered fashion technique that is 12032 2.6 to 7.5cm.


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## mitchellde (Aug 4, 2010)

I sorry but I still must disagree, the coder may not make diagnosis decisions like that.  The physician stated it was self inflicted and the patient is suicidal, there is no mention of a mental disease, nonpsychotic or psychotic. The E code states it is an attemted suicidal event.  There is not enough documentation to support the use of the 300.9 code.  Suppose the patient is psychotic or bipolar or has any other mental disease or maybe none at all. Maybe it is just a reaction to a one time event.  There are too many unanswered issues so we can code only what we know.


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## codingchick (Aug 9, 2010)

*Thanks a million!!!*

Thank you Debra and Shadelw I was stuck on this one for a while.  But what if it tells you not to use CPT only ICD then what?


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## shandellw (Aug 9, 2010)

mitchellde said:


> I sorry but I still must disagree, the coder may not make diagnosis decisions like that.  The physician stated it was self inflicted and the patient is suicidal, there is no mention of a mental disease, nonpsychotic or psychotic. The E code states it is an attemted suicidal event.  There is not enough documentation to support the use of the 300.9 code.  Suppose the patient is psychotic or bipolar or has any other mental disease or maybe none at all. Maybe it is just a reaction to a one time event.  There are too many unanswered issues so we can code only what we know.



I agree,we can only code what we know, and your rationale was helpful!


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## mitchellde (Aug 9, 2010)

codingchick said:


> Thank you Debra and Shadelw I was stuck on this one for a while.  But what if it tells you not to use CPT only ICD then what?



What are you coding for?  Is this for a test or a real workplace issue?  You never use volume 3 codes for physician or ER coding only inpatient.  If this is for testing purposes then is sounds like they want only the diagnosis.  However I do not think it is appropriate to post test questions on the forum.


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## bjw1980 (Aug 13, 2010)

I would have to agree with Debra on this and only code the laceration and E code with the layered closure. But at our facility we are required to input the volume 3 procedure code so I would have that on there also


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## mitchellde (Aug 13, 2010)

I would really have to question why you are using Volume 3 codes in the ER.


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## eadun2000 (Aug 14, 2010)

Because most ER facility coding, you use the dx procedure codes.  Been trying to tell you that for a while.  The volume III codes are not just for inpatient.. they are for FACILITY, which also includes inpatient.


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## mitchellde (Aug 15, 2010)

Sorry but volume 3 codes are inpatient only.  From the coding guidelines:
"The diagnosis codes (Volumes 1-2) have been adopted under HIPAA for all healthcare settings. Volume 3 procedure codes have been adopted for inpatient procedures reported by hospitals".
Volume 3 codes do not belong on an outpatient claim ever.
They are not dx procedure codes either.
Vol 1&2 are diagnosis codes 
Vol 3 are procedure codes for inpatient procedures
I am so looking forward to ICD-10, and there will no longer be a volume 3.


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## eadun2000 (Aug 15, 2010)

Like trying to talk to a brick wall.  I guess the thousands of ER facilities that use volume III codes on the FACILITY procedures are all wrong and you are the only right one.  Why does this not surprise me?


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## mitchellde (Aug 15, 2010)

I am not sure why you find it necessary to be so rude in your replies.  However I have given you numerous sources that support why you do NOT use vol III codes for ER facility.  I am really interested in what OFFICIAL source you are using.  Just because your facility uses them with your encoder does not mean these are used for reporting facility outpatient procedures.  Per the federal register:
B. ICD–9–CM, Volume 3 (Procedures)
Inpatient hospital services procedures
are currently coded using ICD–9–CM
Volume 3, which was adopted as a
HIPAA standard in 2000 for reporting
inpatient hospital procedures. Current
Procedural Terminology, 4th Edition
(CPT–4) and Healthcare Common
Procedure Coding System (HCPCS) are
used to code all other procedures. The
ICD–9–CM procedure codes, which are
maintained by CMS, are three to four
digits long and organized into chapters
by body system (for example,
musculoskeletal, urinary and circulatory
systems, etc.). For a discussion of the
structure of the ICD–9–CM procedure
code set, please refer to the August 22,
2008 proposed rule (73 FR 49798).

Also I worked in the facility ER and we did not use Vol III ever for the ER procedures.   The encoder however was set for DRG reporting and did report and require the Vol III codes until we pointed out that this was incorrect.  The IT department then corrected this so that the encoder could be set for APC reporting and the Vol III codes never appeared again.  This is what I referr to in your case a facility specific issue.  If you are putting them in your system them someone in the billing department must remove them before the claim can be submitted or it will reject.  This is inefficient and can be corrected at the coding level.
Please try to be professional and respectful in your comments in the future.


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## eadun2000 (Aug 15, 2010)

Yet again, you keep telling people they are wrong when they use the volume III codes on the facility side of the ER.  However, do you ever think that possibly you are wrong, being I have told you this many times before.  I have coded for over 250 ERs both professional and facility.  A good 75% or more use the volume III codes on the procedures, again on the facility side.  I do not code with an encoder.  Exactly how many hospitals have you performed ER facility coding for?


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## mitchellde (Aug 16, 2010)

I am only asking from what official reporting source are you obtaining this information?  It is wrong to report volume III codes for the ER on the facility side.  The claim will not process for payment with these codes.  ER reimbursement is based on HCPCS codes.  I have given you the HIPAA statemnt from both the coding guidelines and the federal register that support this position.  My resume is not up for discussion.


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## RebeccaWoodward* (Aug 16, 2010)

I'm a little disturbed by the tone in some of these threads.  I've always found Debra to be very helpful and I'm not sure why some of the comments in these threads sound so harsh.  

I don't work on the facility side but Debra's information sounds accurate.

"Volume 3 procedure codes have been adopted for inpatient procedures reported by hospitals."

http://www.cdc.gov/nchs/data/icd9/icdguide09.pdf

*- ICD-9-CM Procedure Codes*

"ICD-9-CM procedure codes are required for inpatient hospital Part A claims only."

https://www.cms.gov/transmittals/Downloads/R126CP.pdf

If I'm missing something, please share...


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## mitchellde (Aug 16, 2010)

Thank You Rebecca, I always appreciate your support and links.


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## cmcgarry (Aug 16, 2010)

This forum is no place for personal attacks.  I have always found Debra's answers helpful and respectful (even if my question might have seemed "stupid" to someone else).  

That said, I worked for the payer side for many years - if an OP or ER claim was filed to us with Vol 3 codes, we denied it - if filed electronically, the claim would not make it past the clearing house because of the edits, and would be returned to the billing entity.  Only if the type of bill indicated IP would the Vol 3 codes be allowed to come through.

Please, no more personal attacks - it is so unprofessional, and these forums are here for us to help one another.


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## mitchellde (Aug 16, 2010)

Thank You Cindy, I do appreciate your support and view from the payer side.


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