Practice Management Alert

Expedite your MVA claims with late effects codes
 
If you don't know when and how to report late effects codes, you could be facing late payments or even denials. Test your billing savvy to ensure optimal payment.
 
Problem: Many coders report an acute condition, such as a fracture, when in reality the physician is treating the patient for a delayed effect of the acute condition, says Marvel Hammer, RN, CPC, CHCO, president of MJH Consulting in Denver. Take, for example, this billing scenario:
 
A trauma patient receives multiple injuries in a car accident, including a fractured femur (821.11, Fracture of shaft of femur, open). Several months after the physician removes the patient's cast, the patient continues to have pain and trouble walking on his injured leg. When he returns to the physician for treatment of his leg pain, a coder in the office reports 821.11 as the ICD-9 code for the visit. Consequently, the carrier denies this claim.
 
Solution: Determine how you would solve the billing problem above.

If you don't know when and how to report late effects codes, you could be facing late payments or even denials. Here's the answer to the late effects billing problem posed on the cover:  Answer: The coder should have reported 729.5 (Pain in limb) as the primary ICD-9 code for the visit because the leg pain is the acute condition the physician was treating. As a secondary diagnosis, the coder should have reported 905.4 (Late effect of fracture of lower extremities) to indicate that the patient's past fracture is the cause of the current condition. To add further specification that would expedite the claim, the coder should have also added the E code for late effects of motor vehicle accident (E929.0).
 
Learn Late Effects and Reap the Benefits  In general, late effects are the long-term effects of an injury or illness after the acute phase is over. Some late effects present early, while others might become apparent months or even years later. "There are no time limits for late effects," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, HIM program coordinator at Clarkson College in Omaha, Neb.
 
Separate section: You can find all the late effects codes in a separate subsection of the ICD-9 manual (905-909), which describes "Late Effects of Injuries, Poisonings, Toxic Effects, and Other External Causes." You should also be familiar with the E929 code series for "Late Effects of Accidental Injury" - especially E929.0 for late effects of motor vehicle accident (MVA).
 
Watch out: But be careful not to confuse the late effects E codes with the E codes for current motor vehicle accidents (E810-819). Use 4 Fail-Proof Tips Here are four expert tips guaranteed to help your late effects coding: 1. Report late effects [...]