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Anesthesia Coding Alert

Diagnosis 101:

Search for ICD-9 Specificity When Coding PM Procedures

Published on Mon Mar 21, 2005

Detailed diagnoses can be the difference between acceptance and rejection

Your job as a coder is often like a detective's - you want to dig for the most specific codes possible, whether you're reporting a patient's initial diagnosis or a procedure performed. This is especially important when you're reporting a visit that began as a consultation but also included an unplanned pain management procedure.
 Keep these pointers in mind as you're aiming for specificity:
 

  • Most carriers reject services with unspecified levels. Medicare, Medicaid and some private carriers will deny claims that are not coded to the highest specificity (meaning they want ICD-9 codes extended to the fourth or fifth digits when possible).
     
  • If the physician performs a lumbar epidural injection (62311), don't have 721.90 (Spondylosis of unspecified site; without mention of myelopathy) as the associated diagnosis. Scott Groudine, MD, an Albany, N.Y., anesthesiologist, suggests a diagnosis such as 721.42 (Thoracic or lumbar spondylosis with myelopathy; lumbar region) instead because you know the physician treated the lumbar region.
     
  • Match spinal epidurals with a diagnosis specifying the region.
     
    "Lumbar epidurals should have a lumbar spine ICD-9 code," Groudine says. "The same is true for cervical and thoracic epidurals. If the physician does a procedure at a specific site, justify it with an ICD-9 code that recognizes that site as the source of the pathology (if one is available)."
     
  • Double-check the number of injections you code. If the physician performs a bilateral procedure, be sure to bill both sides instead of only one.
     
  • Bill the correct number of units for the injection. Cervical or thoracic epidurals have a higher base than lumbar epidurals, so don't miss out on reimbursement by charging less than you should.

    Finally, remember you can only code what's documented. If carriers deny claims based on specificity, Margaret Lamb, RHIT, CPC, with Great Falls Clinic in Great Falls, Mont., recommends showing the physician how much revenue is being lost due to poor documentation. Then find a way to involve the physician in the process of ensuring that  documentation is sufficient to adequately code the procedures being performed.

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