FAQ's
Frequently Asked
Questions
New Q: When
using V54.81 Aftercare
following joint replacement
does the V43.6X joint code need to directly follow it or can it be
placed further down to allow for other comorbidities?
A: Official
coding guidelines state that certain single conditions require
more than one code and are usually identified by "use additional
code". The sequencing rule is the same as manifestation coding:
condition code first, followed by the additional code.
New Q: Is
there a new code for the H1N1 influenza virus
(swine flu)?
A: New: A new
code was added after the publication of the 2010 codes and was added
to the ICD-9 government website on 6/03/09. The correct code
is 488.0, Influenza due to identified avian influenza virus and
488.1, Influenza due to identified novel H1 N1 influenza virus.
Q1: Do I
always need to use secondary diagnosis codes with a
late effect
code?
A1: A late effect
describes a residual effect of an illness and usually requires two
codes. The first code identifies the condition followed by the
residual/late effect. Example: Late effects CVA with dysphagia
438.82 dysphagia 787.20(PPS category 6&7). When looking up Late
effects CVA with dysphagia 438.82, code instructions state to
identify the type of dysphagia, thus identifying the need for an
additional code.
Exceptions occur
when the ICD-9 code is expanded at the 4th or 5th digit that
includes the residual/late effect. Example: Late effects CVA
with hemiplegia 438.20
Q2: MO650 - upper body dressing.
We have some discrepancies about how you would score
a patient's ability for the following scenarios:
The
patient puts all of his clothes in a dresser because he can
no longer use the closet safely. This adaptation was made
by the patient prior to us doing the assessment.
Some of us say he is a "0" because his usual place
for his clothes is now his dresser and he can manage without
assist. Some of us say he is a 1
because he can not get his clothes out of his closet without
assist.
A2: MO
650 identifies the patient’s ability to obtain, put on &
take off clothing. Where the patient keeps his clothing,
closet or dresser, is not the issue. He currently keeps his
clothing in a dresser and is able to obtain, put on & take
off. Correct MO response would be “0”
Q3: We
have always used 414.00 for CAD but are now hearing that we
should be using 414.01.
A3:
414.01 describes CAD of the native coronary artery (the
patient's own original anatomy) 414.00 is used when the
patient had a bypass with CAD without mention of what
artery was bypassed. 414.02-414.05 are used for forms
affecting grafted tissue vessel.
Q4: Our
therapist sees things slightly differently than our nurse.
We have a patient that can walk indoors with a rolling
walker independently. On the stairs, they use a rail, cane
and supervision. They also need supervision when ambulating
outside. The therapist feels that 2 is most representative
of the patient and the nurse disagrees.
A4: To
be scored a 2, they walk only with the supervision or
assistance of someone at all times. In this case the
correct response would be 1.
Q5: Do
you have any guidelines for the use of
V66.7? We have been using this code only for our
hospice patients, might it apply for other patients?
A5: The
Coding Clinic Magazine Third Quarter 2008 states, "Code
V66.7 can be used for any terminally ill patients receiving
palliative care. It is always a secondary code. The terminal
diagnosis should be the primary diagnosis. It may be used
when a patient is brought in for aggressive treatment for a
terminal condition and during the encounter it is determined
that further aggressive treatment is no longer appropriate
and palliative care is initiated."
Announcements:
Joan L. Usher has
been elected to serve on the Hospice & Palliative Care Federation
of MA Board of Directors, for the 2009-2011 term.
Joan L. Usher has
been appointed to serve on the Massachusetts Health Information
Management Association's Board of Directors, as chair of the Awards
Committee for the 2009-2010 term.
2008 MaHIMA’s Professional
Achievement Award Winner :
Joan L. Usher, BS, RHIA, COS-C, ACE Given to
individuals who have worked tirelessly to support the HIM profession
by advancing American Health Information
Management Association's (AHIMA)
leadership position and/or who have developed or refined practice
theory, demonstrated leadership, or introduced innovation and
creativity to current practice. These are best characterized as
individuals who go above and beyond in their quest to make the HIM
profession thrive.
Helpful Resources
(for more
information click on link below)
Massachusetts Record Retention Changes
Massachusetts Cost Containment Law (chapter 305 of the Acts of
2008)
Important changes the law provides
for include:
a. the revision of the legal
medical record to include paper or hard copy records, records
created in various electronic and digital mediums as well as those
hard copy records that are converted to a digital media
b. reduction of retention of
medical records from 30 years to 20 years (impacting hospitals and
ambulatory surgical centers, records may be destroyed 20 years after
the discharge or final treatment of the patient)
c. a notification process for the
DPH and patients regarding the destruction of records
Massachusetts Medical Record
Copying Fee updated 2008 -2009
Effective October 1, 2008 Chapter 135 of the Acts of 2003 allows
Massachusetts medical record copying fees to be increased
for FY2008 by 4.9%. The maximum rate that providers may charge for medical records
starting October 1, 2008 is:
-
$18.04 base charge for the clerical and other
administrative expenses related to complying with the request
for making a copy of the record; (excludes requests made by a
patient) ****
-
$0.61 per-page charge of the first 100 pages
copied;
-
$0.32 per-page charge for each page in excess of
100 pages;
-
Provider is allowed to charge an additional fee
related to the cost of postage (regular or priority/next day
mailing);
-
The provider is allowed to charge for the cost of
developing a summary of the medical information if requested.
Providers should be aware that fees must be waived for any request
that is made by a patient for a record used for an administrative,
claims, or eligibility review with Medicare, MassHealth, or other
public assistance programs. Requests made by any party other than patient or patient’s personal
representative, may be charged the base free for administrative
expenses.
The law establishes basis for which the fees may be set and may be
set lower than base charge but not higher.
****Massachusetts Hospital Association recommends that providers
should only charge the per page rate as the base rate is preempted
by HIPAA provisions.
