33990 or 92970…need your help
if you have any related guideline documentation or link please comment.
The U.S. Department of Health & Human Services (HHS) has released the code changes for ICD-10-PCS coding system. ICD-10-PCS codes were adopted under HIPAA for hospital inpatient healthcare settings to use for reporting procedures. Their guidelines help healthcare providers and coders to accurately identify procedures to be reported on healthcare claims.
The 2018 updates will reflect services from Oct. 1, 2017 through Sept. 30, 2018, so be sure to update your medical records to account for the changes.
There were 75,789 codes in 2017. In 2018, the number jumps to 78,705…
SUPERIOR VENA CAVAGRAM
TUNNELLED CVC INSERTION
DESCRIPTION OF PROCEDURE:
Realtime ultrasonography of the right neck was performend demonstrating
patency of the internal jugular vein which was then chosen for access;
ultrasound images were archived.
A large area of the right neck and upper chest was prepped and draped in
Using 1% lidocaine for local anesthesia and under real-time ultrasonic
guidance, a 21ga. micropuncture set was used to access the right internal
jugular vein at the base of the neck. Ultrasound images were archived.
A small incision was made at the puncture site. The wire could not be
advanced much into the vessel and for this reason a 4 French catheter was
advanced over the wire. Contrast material was injected and digital
angiograms were obtained demonstrating occlusion of the superior vena cava
just beyond the confluence of the azygos vein. Flow in the azygos vein is
Over a wire, the tract was dilated and an introducer sheath was advanced into
A tract of subcutaneous tissue, leading from the incision at the puncture
site to the anterior right chest below the clavicle, was then infiltrated
with local anesthetic. A small incision was made at the chest end of the
tract. A flexible tunneler was then used to pull an 8 cm long dual-lumen
catheter through the subcutaneous tunnel. The tunneler was disconnected and
the catheter was then advanced through the sheath until its tip reached the
central portion of the patent superior vena cava ; as mentioned above the
catheter could not advance be advanced into the right atrium since the cava
is occluded more centrally.
Fluoroscopy of the air at demonstrated a kink in the catheter as it entered
the internal jugular vein. We were unable to resolve the kink and for this
reason the catheter had to be removed and the procedure restarted after re-
prepping and draping of the area.
Using sterile technique under real-time ultrasonic guidance a 21 gauge needle
was placed in the right internal jugular vein. An introducer sheath was
advanced into the vein.
A 6 French dual-lumen central venous catheter was then advanced through the
subcutaneous tunnel and into the internal jugular vein until its tip reached
the central portion of the patent superior vena cava. This time no kinks
were identified along the course of the catheter.
Both ports were capped and heparinized and the catheter was then secured to
the skin with 2-0 nylon sutures. The incision at the base of the neck was
closed with tissue glue and SteriStrips.
There were no complications.
CAN ANYBODY SUGGEST CORRECT CODING FOR THIS?
Good Morning everyone A question was brought up during our monthly CPT meeting concerning a nail biopsy for melanoma – The question was brought up…
Medical Billing and Coding Forum – Pathology & Clinical Laboratory
How to code Encephalopathy secondary to UTI and sepsis? Encephalopathy secondary to dementia? Encephalopathy secondary to delirium?
Medical Billing and Coding Forum – Inpatient Facilities
There is a super cute little toy shop in Coeur d’Alene, ID called Shenanigan’s Toy Emporium that sells vintage toys and other unique items. When traveling there on business, we usually make a stop in to shop from their wall of amazing salt water taffy and check out their selection of toys that don’t come with a power button. You know, the kind of toys we had prior to the Atari and Game Boy era!
Shenanigan’s also has a great display of giant microbes – small plush renderings of everything from the common cold to diarrhea. I am still marveling at how they could create a plush toy out of liquid stool! I’m sure it’s just the geeky coder in me (and my colleagues), but we decided to buy a few and put them out during our training sessions along with our baskets of Play Dough, pipe cleaners, and candy (we like to have FUN in our training sessions!). Needless to say, they were a big hit with our clients and we noticed on one of the tags that there was a website where we could order more. By now your interest is surely piqued, so be sure to check out the online Giant Microbes store.
You’re probably thinking what I’m thinking right about now, which is, wouldn’t these giant microbes make great white elephant gifts for Christmas? My thoughts immediately went to what would be appropriate for my family’s white elephant gift exchange. Don’t worry, my family has a great sense of humor – there’s still a copy of Pamela Anderson’s novel (yes, she wrote one) complete with the “naughty” pages clipped together courtesy of my grandmother who was sheltering her daughter from the filthy parts. And what better gift for someone in 2014 than the Ebola virus? There’s just one problem.
Apparently I am not the only person who thinks that Ebola would make a great Christmas gift. It’s a sign of recent headlines that this virus, which is actually kind of cute in plush form, is unavailable. What’s even more worrisome given that this was the year Ebola came to the US, is that we don’t have an ICD-9-CM code to report it. Here’s the best we can do in ICD-9:
- 065.8, Other specified arthropod-borne hemorrhagic fever
- 078.89, Other specified diseases due to virus
What about ICD-10-CM? How about this?
- A98.4, Ebola virus disease
YESSSSSS! Way more specific!
In previous years as we’ve prepped for ICD-10 implementation, the opponents have given a laundry list of extensive and admittedly ridiculous (yet fun!) ICD-10 codes that begged the question, why do we really need this? And this year, Ebola was delivered to our health system and we have nonspecific codes to report it. But in ICD-10, we have a very specific code. Hmm. Perhaps this ICD-10 thing really could help with reporting and impact patient care. Just a thought.
So Santa, if I can’t have Ebola for Christmas this year, could I please have ICD-10 so that I can code it for those people who did get it?
Author’s Note: I am not affiliated with Shenanigan’s Toy Emporium or giantmicrobes.com in any way. I am just a really big fan!