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Please post initial responses and peer responses to the following discussion questions listed below:In regards to Endoscopic Procedures: What does it mean to “code to the furthest extent of the procedure (Tip – think about when the procedure ends)? Endoscopic procedures are divided by the purpose of the procedure. If a patient is fully prepared for an endoscopic procedure, other than colonoscopy, but the procedure is not completed how would you code for this situation? [Tip: You might append using a modifier (Fill in the blanks, 5_ ), as a discontinued procedure with the endoscopic code].James is diagnosed with a femoral neck hip fracture that requires fixation to hold the bone in place. What aspects of the procedure will determine the code(s) that will be used? [Tips: Is it internal or external, which physician does the application or removal, is the routine adjustment of the external fixation device included in the application code? etc.]
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Module 4 Question 1
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Cami Williams posted Nov 6, 2023 11:11 AM
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In regards to Endoscopic Procedures: What does it mean to
“code to the furthest extent of the procedure (Tip – think about
when the procedure ends)? Endoscopic procedures are divided
by the purpose of the procedure. If a patient is fully prepared
for an endoscopic procedure, other than colonoscopy, but the
procedure is not completed how would you code for this
situation? [Tip: You might append using a modifier (Fill in the
blanks, 5_ ), as a discontinued procedure with the endoscopic
code].
•
Coding to the furthest extent of the procedure is the
point at which the procedure terminates. For example, if
the procedure begins with an endoscope being placed
into the mouth, through the esophagus, and terminating
in the stomach, the full extent of the procedure is the
stomach. Although the operative report will state the
procedure performed in the identifiers of the report, such
as “Procedure Performed,” it is important to always read
the full operative report to ensure the full extent is
reported. Endoscopic procedures are divided into
therapeutic and diagnostic by the purpose of procedure. If
a procedure is not completed, then the code that you
would use is modifier -53 for a discontinued procedure
after induction of anesthesia. An endoscopic procedure
can be discontinued or cancelled if a patient has abnormal
diagnostic test results or lab results. Complications during
the procedure can also arise suddenly, which may force
the planned procedure to be discontinued and another
procedure may be required. It is quite important to use
the correct approach, and properly code to the fullest
extent of the procedure.
Module 4- Q1
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Chailan Campbell posted Nov 6, 2023 12:35 PM
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1. In regards to Endoscopic Procedures: What does it mean to
“code to the furthest extent of the procedure (Tip – think about
when the procedure ends)? Endoscopic procedures are divided
by the purpose of the procedure. If a patient is fully prepared
for an endoscopic procedure, other than colonoscopy, but the
procedure is not completed how would you code for this
situation? [Tip: You might append using a modifier (Fill in the
blanks, 5_ ), as a discontinued procedure with the endoscopic
code].
Coding to the furthest extent of the procedure in the context
of endoscopic procedures means accurately and
comprehensively documenting and assigning medical billing
codes for all the components or steps of the procedure. This
ensures that all aspects of the procedure, including any
additional work or complexity, are properly accounted for in
the billing and coding process. It helps ensure appropriate
reimbursement and billing accuracy. In addition to this,
Continuum states that, “insurance carries often deny claims for
not being coded to the highest level of specificity or they may
consider the diagnosis truncated or shortened (Continuum
2023). Now, in the situation where a patient is fully prepared
for an endoscopic procedure other than a colonoscopy, but the
procedure is not completed, you would typically use a modifier
to indicate that the procedure was discontinued. Specifically,
you would use modifier “53” to signify a discontinued
procedure. This modifier is added to the endoscopic code to
indicate that the procedure was started but not finished for
reasons such as patient tolerance, complications, or other
factors that prevented its completion. Using modifier “53” helps
in accurate billing and reimbursement for the services provided
up to the point of discontinuation. Regence states, “CPT
modifier 53 indicates procedure discontinued by physician or
other qualified health care professional and may not be
reported by facilities (Regence 2023). With that being said, it’s
important to remember that the appropriate use of codes and
that it is essential for both accurate billing and ensuring that
healthcare providers are fairly reimbursed for their services
when a procedure cannot be completed as initially planned. It’s
crucial for healthcare professionals to document the reasons
for discontinuation clearly.
Casarez, Carlos. “Coding to the Highest Level of Specificity to
Reduce Denials.” Continuum, Continuum, 25 May
2021, www.carecloud.com/continuum/coding-to-the-highestlevel-of-specificity-to-reduce-denials/.
Modifier 53; Discontinued
Procedure, www.regence.com/provider/library/policiesguidelines/reimbursement-policy/modifier53#:~:text=CPT%20modifier%2053%20indicates%20procedure
,25%25%20of%20the%20allowable%20amount. Accessed 6
Nov. 2023.
Module 4 Question 1
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Tara Sepe posted Nov 6, 2023 12:32 PM
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1. In regards to Endoscopic Procedures: What does it mean
to “code to the furthest extent of the procedure (Tip think about when the procedure ends)? Endoscopic
procedures are divided by the purpose of the procedure.
If a patient is fully prepared for an endoscopic procedure,
other than colonoscopy, but the procedure is not
completed how would you code for this situation? [Tip:
You might append using a modifier (Fill in the blanks, 5_
), as a discontinued procedure with the endoscopic code].
The surgical approach determines the code of the endoscope.
Coding to the fullest extent when it comes to endoscopic
procedures is the point at which the procedure terminates. If
the procedure begins with an endoscope being placed into the
patient’s mouth, through their esophagus, and terminating in
the stomach, the full extent would be the stomach. Although
the operative report will state the procedure that was
performed in the report, such as “procedure performed”, you
must always read the full operative report to ensure the full
extent is reported. You must use the correct approach and code
to the fullest extent of the procedure to ensure the coding is
accurate (Koesterman & Buck, 2021).
When a procedure is started or initiated but not completed, it is
coded using a specific CPT code that denotes the attempted
procedure. To code an attempted but incomplete procedure, it
would typically depend on the type of endoscopic procedure as
well as the circumstances of the procedure. Modifier -52 means
reduced services, and modifier -53 means discontinued
procedures. These may potentially be used to report that the
procedure was started but not finished.
Reference
Koesterman, J. L., & Buck, C. J. (2021). Buck’s the next step:
Advanced Medical Coding and Auditing, 2021/2022. Elsevier.
Module 4 Question 2
Pamela Nyagah posted Nov 6, 2023 7:04 PM
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James is diagnosed with a femoral neck hip fracture that requires fixation to hold the
bone in place. What aspects of the procedure will determine the code(s) that will be
used? [Tips: Is it internal or external, which physician does the application or
removal, is the routine adjustment of the external fixation device included in the
application code? etc.]
When coding for a medical procedure, especially one as critical as femoral neck hip
fracture fixation, several key aspects come into play. Properly coding this procedure
ensures accurate representation, billing, and documentation of the healthcare services
provided. Let’s delve into the various factors and considerations that determine the
codes to be used in the case of a femoral neck hip fracture fixation. Internal vs.
External Fixation: One of the primary considerations is whether the fixation is
internal or external. In the context of femoral neck hip fracture fixation, internal
fixation is the most common approach. It involves the use of implants such as screws,
plates, or nails to stabilize the fractured bone. Internal fixation is typically used for
more complex fractures that require a high degree of stability. If the procedure
involves internal fixation, you will need to select the appropriate Current Procedural
Terminology (CPT) code that corresponds to the specific technique employed. The
CPT code should reflect whether the fixation was performed percutaneously, with an
open approach, or with or without manipulation of the fracture.
External fixation, which involves the use of an external frame or device to stabilize
the fractured bone, is less common in hip fracture cases. If external fixation is used,
you will use a different set of CPT codes, which will correspond to the application
or removal of the external fixation device. Physician Responsible for Application or
Removal: The choice of CPT code also depends on the physician responsible for
performing the fixation procedure. In many cases, orthopedic surgeons or trauma
surgeons are the ones who perform the surgery for femoral neck hip fractures. It’s
crucial to select the CPT code that aligns with the physician’s specialty, as there may
be specific codes for procedures performed by different specialists. Routine
Adjustment of External Fixation Device: If external fixation is involved, you must
consider whether the routine adjustment of the external fixation device is included
in the application code. Some CPT codes for external fixation include the routine
adjustment, while others do not. If adjustments are separately billable, you will need
to code for them as well. Bilateral Procedures: In some cases, a femoral neck hip
fracture fixation may be performed bilaterally if both hips are affected.
In such instances, you may need to apply specific modifiers (e.g., modifier 50 for
bilateral procedures) to ensure that both sides are appropriately documented and
reimbursed. 1. Surgical Approach and Complexity: The specific CPT code to use for
internal fixation may also depend on factors such as the surgical approach (e.g., open
or percutaneous) and the complexity of the procedure. More complex procedures,
which may involve additional steps or challenges, may require specific codes that
account for this complexity. (Loeb et al., 2020) 2. Intraoperative Imaging: In some
cases, the use of intraoperative imaging techniques, such as fluoroscopy, may be
necessary during the fixation procedure to ensure accurate placement of implants.
The use of such imaging can impact the coding, and there are specific codes and
modifiers to account for it. 3. Documentation: Thorough and accurate
documentation of the procedure is essential for proper coding. The medical record
should clearly outline the nature of the fracture, the procedure performed, the
implants used, any complications or additional procedures, and other relevant
details. Clear and comprehensive documentation supports the coding process and
justifies the services The case for decreased surgeon-reported complications due to
surgical volume and fellowship status in the treatment of geriatric hip fracture: An
analysis of the ABOS database.
Part #2
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Elizabeth Krueger posted Nov 6, 2023 2:01 PM
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Module #4
Part #2
2. James is diagnosed with a femoral neck hip fracture that requires fixation to
hold the bone in place.
What aspects of the procedure will determine the code(s) that will be used?
[Tips: Is it internal or external, which physician does the application or
removal, is the routine adjustment of the external fixation device included in
the application code? Etc.]
Fixation can be internal or external and is used to hold a bone in place. James is
diagnosed with a femoral neck hip fracture that likely requires an internal fixation.
An internal fixation is the placement of wires, pins, screws, plates, or rods onto or
into the bone to repair bones. In particular, if the patient’s fracture is not displaced,
the most common treatment is in-situ pinning. In-situ pinning requires surgical pins
or screws that are passed across the fracture site to hold the ball of the femur in place
while the fracture heals (300).
In external scenarios, an external fixation is the application of a device that holds the
bone in place from the outside. Fasteners are driven in to the bone percutaneously,
and the external fixation device is attached to the fasteners. Percutaneous fixation
(skeletal fixation) is a type of external fixation that serves as attachments for traction
devices (300).
Both application and removal of the device are reported with one code. If a physician
other than the physician who applied the device removes the device, the removal is
reported separately; however, use caution when reporting the repair and application,
because some fracture codes include application of devices in the code description
(so then you would not report the services separately). Routine adjustment of the
device is included in the application code unless the adjustment requires
anesthesia (300).
Additionally, it is crucial to note the differences between closed and open fractures.
Closed fractures are those in which the bone does not protrude outside the skin and
usually include terms such as comminuted, compound, depressed, elevated, fissured,
greenstick, impacted, linear, simple, or spiral. Open fractures are those in which the
bone does not protrude outside the skin and include terms such as compound,
infected, missile, puncture, or with foreign body. If the documentation indicated both
open and closed fracture terminology, assign an open fracture code (299).
The type of treatment does not necessarily correlate to type of fracture; for example,
an open reduction of a closed fracture- meaning that the closed fracture can be
repaired by means of an open procedure. The terminology describing the type of
fracture and the type of treatment must be carefully abstracted from the
documentation to correctly report the fracture type (299).
Fractures are reported with S codes based on the area of injury, such as fractures of
the facial bones, S02, or fracture of lumbar spine and pelvis, S32 (299). Vertebral
column fractures are reported with S12, S22, S32. Spinal cord injury is reported
separately in addition to the fracture code. If the injury was only of the spinal cord,
the injury would be reported with one of these codes: S14, S24, and S34. Cervical
fractures are reported with S12.1—A for a closed fracture, and S12.1—B for an open
fracture. Multiple cervical fractures are reported individually for each vert ebral
fracture (299).
Fractures of the upper limbs (S42, S52, S62) are divided by the specific location, as
are the fractures of the lower limbs (S72, S82, S92). All fractures codes require a
7th character to indicate the episode of care, such as “A” for the initial encounter,
“D” for subsequent encounter, or “S” for sequelae. Not all codes have the same
7th characters available for assignment. Turn to the Tabular to S82 and review all of
the 7th characters available for assignment. There are also more specific instructions
on episode of care in the Official Guidelines for Coding and Reporting, Section I.A.4
and 5. External cause codes are assigned for the length of treatment. A 7 th character
is assigned to indicate initial encounter, subsequent encounter, or sequela for each
encounter as long as the injury or condition is being treated (299).
External cause codes are only reported at the time of initial episode of care and only
if the facility policy indicates that external cause codes will be assigned. If, as per
facility policy, external cause codes are assigned, and since fractures usually are a
result of an accident of some type, an external cause code would be assigned to
indicate the way in which the accident happened (circumstances of the
accident) (299).
Throughout the Musculoskeletal System subsection, there are excision codes. These
codes are used to report excisions from the deeper levels. Recall that excision codes
are also located in the Integumentary System subsection. It is the origin of the
excision that differentiates the codes. For example, if a benign lesion was removed
from the skin of the leg, the service is reported with a code from 11400-11406
(Integumentary System). If the excision was of a lesion located on the muscle of the
leg, the service is reported with 27619 or 27934 (Musculoskeletal System),
depending on the size of the tumor (5 cm). Watch for terms that indicate the
origin of the neoplasm, such as melanoma (skin) or sarcoma (connective tissue) to
direct you to the correct code selection (301).
Most of the anatomic subheadings (e.g., Shoulder or Humerus [Upper Arm] Elbow)
in the Musculoskeletal System subsection include a Repair, Revision, and
Reconstruction category. The procedures are osteoplasty, osteotomies, arthroplasty,
tendon transplants or transfers, and various other repairs, revisions, and
reconstructive procedures with numerous grafting procedures for bones, tendons, and
muscles. In James’ scenario, if he is experiencing a displaced femoral neck hip
fracture then a hip arthroplasty would likely be recommended. A good medical
dictionary is an important tool as you report muscle repairs, as only by understanding
all of the medical terminology in each report can you be certain to report the service
accurately (306).
Sometimes an injury like James can leave patients with residual health problems that
remain after the injury or illness has resolved. The residual effect or manifestation is
coded first, and then the late effects code is assigned to indicate the cause of the
residual. An example would be scars (residual) that remain after a severe fracture
(cause). In most instances, two codes will be assigned- one code for the residual that
is being treated (chief complaint) (and one code that indicates the sequela/late effect
(cause). There is no time limit for the development of a residual. It may be evident
at the time of the acute illness, or it may occur months after an injury. It is also
possible that a patient may develop more than residual. For example, a patient w ho
has had a stroke may develop right-sided hemiparesis (paralysis of one side) and
aphasia (loss of ability to communicate). However, a person cannot have a current
hip fracture (S72.009A) and a late effect of hip fracture (S72.009S) at the same site.
The code is either a current injury or a condition caused by a prior injury. (The only
exception to this rule I in category I69, Sequelae/Late effects of cerebrovascular
disease.) The late effects code is assessed in the Index under the main term
“Sequelae”. When reporting codes for late effects of an injury, the initial injury code
is reported with the 7th character “S” to indicate sequelae. Report the specific type of
sequelae (e.g., scar) followed by the injury code with the 7 th character “S” (310).
It is also important to note that several methods are employed to repair fractures.
Open treatment of a fracture is when a surgeon opens the tissue, and the fracture is
exposed; the fractured bone can then be visualized by the physician. Closed treatment
is when the fracture is repaired without the physician directly visualizing the fracture.
Fractures are reported by the specific anatomic site and the reason for the repair.
Manipulation is manually returning the bone (pushing or pulling) to proper alignment
without an incision. The codes are often divided based on whether or not
manipulation was performed in closed treatment of a fracture (311).
Source
Elsevier. (2020). Buck’s The Next Step: Advanced Medical Coding and Auditing,
2021/2022 Edition. Saunders. pp. 299-311.
Mike Wade Module 4 Question #1
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Michael Wade posted Nov 6, 2023 11:09 PM
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1. In regards to Endoscopic Procedures: What does it mean
to “code to the furthest extent of the procedure (Tip think about when the procedure ends)? Endoscopic
procedures are divided by the purpose of the procedure.
If a patient is fully prepared for an endoscopic procedure,
other than colonoscopy, but the procedure is not
completed how would you code for this situation? [Tip:
You might append using a modifier (Fill in the blanks, 5_
), as a discontinued procedure with the endoscopic code].
In regard to endoscopic procedures, it is essential to accurately
document the entire process of a medical procedure, from its
start to finish. This means you need to describe every step of
the procedure. In the case of inserting an endoscope from the
mouth through the esophagus into the stomach, the “full
extent” refers to the stomach.
Our text “Buck’s The Next Step: Advanced Medical Coding”
gives an excellent example. Noting that although the initial
procedure description may provide some information, it’s
crucial to carefully read the complete report to ensure all the
necessary details are included. For instance, the initial
description may mention “esophagogastroscopy” (with the full
extent being the stomach), but the report may reveal that it
also involved the duodenum, making it an
“esophagogastroduodenoscopy” (with the full extent extending
to the duodenum).
You should always select the right code that covers the entire
extent of the procedure.
Endoscopic codes are organized based on the scope and
purpose of the procedure. Some examples of that are:
•
•
•
Proctosigmoidoscopy: Endoscopic examination of the
rectum and the sigmoid colon (45300-45327)
Sigmoidoscopy: Endoscopic examination of the sigmoid
colon and may include the descending colon (4533045350)
Colonoscopy: Endoscopic examination of the colon (from
rectum to cecum, which is the uppermost portion of the
large intestine and may include the lower portion of the
small intestine, ileum) (45378-45392)
Following the guidelines outlined in the CPT (Current
Procedural Terminology) and the Colonoscopy Decision Tree, if
a patient was fully prepared for a procedure other than a
colonoscopy you should code the procedure modifier -53,
indicating a discontinued procedure. Depending on the type of
procedure and when it was stopped you could also consider
modifier -52 as being a reduced service. Some insurers such as
Medicare will require the modifier -53 “discontinued
procedure”
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