Eli's Rehab Report
Coding Late Effects of CVA
The February 2003 article "Use Just One Diagnosis Code for Late Effects of Stroke" advised coders to report 434.0x (Cerebral thrombosis) with V12.49 (Personal history of certain other diseases; other disorders of nervous system and sense organs) when a prior stroke patient presents to the hospital with a subsequent stroke but has no residual defects from her first cerebrovascular accident (CVA). However, Section 1.7 of ICD-9 advises coders to report V12.59 (Personal history of certain other diseases of circulatory system; other) instead of V12.49 in this scenario. In addition, "Many PM&R auditors recommend coding the late effects which may be present from the onset or may arise at any time after the onset of the condition," advises Janet O'Connor, CPC, billing/coding and compliance manager at the University of Virginia's department of physical medicine and rehabilitation. "If a patient is transferred from an acute hospital to our rehab service and the physiatrist is treating the patient's hemiparesis, I assign the 438.2x series (Late effects of cerebrovascular disease; hemiplegia/hemiparesis) as the primary diagnosis instead of 436 (Acute, but ill-defined, cerebrovascular disease) because you should always report the treating diagnosis first."
Eli's Rehab Report
- Multiple Diagnoses, High Risk May Increase Inpatient Code Level
According to CMS data, physiatrists report 99231 more than any other CPT code, which indicates [...] - You Be the Coder:
Use V67.09 for Annual Visit
Test your coding knowledge. Determine how you would code this situation before looking at the [...] - Know CMS Guidelines for Subsequent Hospital Care
The following are CMS'documentation guidelines for the three subsequent hospital care codes:
99231 Subsequent hospital [...] - High-Risk Patients May Warrant 99233
The following scenarios illustrate typical examples of when physiatrists use subsequent hospital care codes: Scenario [...] - Bier Block Coding Can Be Painless
Although you should choose 01995 when administering Bier blocks for surgical anesthesia, some payers do [...] - Clarification:
Coding Late Effects of CVA
The February 2003 article "Use Just One Diagnosis Code for Late Effects of Stroke" advised [...] - Reader Question:
Append -51 to Block With SI Injection
Question: Our physiatrist administered a caudal epidural block and a left sacroiliac (SI) joint injection [...] - Reader Question:
Use 64622 for Nerve Destruction
Question: Our physiatrist performed a radiofrequency thermal coagulation (RFTC) to disable the nerves in a [...] - Reader Question:
Mental Assessment Differs From MME
Question: One of our physiatrists performed a mental assessment on a patient who exhibited symptoms [...] - Reader Question:
Dont Code Both Injection and Nurse Visit
Question: When our nurses administer injections, we usually report the codes for injection administration, the [...] - Reader Question:
Report New MNT Codes for Changes
Question: A dietitian comes to our rehab facility once a week to meet with some [...] - Reader Question:
Medicare Will Deny Prolotherapy
Question: We have been performing an increasing number of prolotherapy injections in our practice, but [...] - Reader Question:
Report 99271 Series for Second Opinions
Question: One of my former patients, whom I havent seen in more than a year, [...]
