ICD10 Coding of Osteoarthritis ICD10 Coding Guidelines
Chandra: A: For the ICD10 for osteoarthritis,the guidelines actually state that you should use the multiple osteoarthritis code unlessthe specific codes are more appropriate for the circumstantial coding, and basically itcomes down to the payer rules. If you're seeing a patient simply to manage their osteoarthritisand they've got osteoarthritis in multiple joints, maybe they got in their left shoulder,their right shoulder, their left elbow and their left hip. Most providers are going toreport that with a multiple osteoarthritis code. The times that you would break into the specificjoint and laterality would be when you're
trying to prove or substantiate medical necessityfor certain things, like if you were evaluating a patient or planning to do a hip replacementon that same patient, they may have osteoarthritis and all these different joints but you'refocused on the hip joint, specifically the left hip joint. So, your claim should havethe specific code to say, â€œSpecifically we're dealing with osteoarthritis of theleft hip,â€� then you could add additional codes, say â€œthey also have it here, here,and here,â€� but for our purposes we want that specificity. That's really the onlytime that she usually going to come into play, it all comes down to payment, unfortunately.
Laureen: Is this the guidelineé Alicia: M15 â€“ M19 are the codes that we'relooking at, that's it. Chandra: Yeah. Usually there's a multiplesites option, for categories where there's no multiple site, code should be used to indicatethe different sites involved. Alicia: M15.3 secondary multiple arthritisé Chandra: That's secondary. When you'retalking M15, remember secondary is the result of something else. These are more than likely,I think they're M19s if I remember correctly. Alicia: Yeah, I was thereâ€¦
Laureen: I just wanted to share this is howyou can be your own consultant and basically answer your own questions. Not that we don'tlove doing it, but this is what I typed in as they were talking â€œICD10 guidelinessite and lateralityâ€� boom! It brought me right here, I opened it up. I typed in â€œsiteand lateralityâ€� and it brought me right to it. Google is your friend, double checkit, but when you have questions like that, that's how we startall of these questions and then we try double check each other. Chandra: Especially when you have ICD10 questions.My colleagues and myâ€¦
Medical Billing Bone Marrow What Code to Use
Q: This is more a billing question. If the performs at the , as an outpatient procedure a bone marrow which is code 38221,can he add an EM code along with a modifier 25é This is a Medicare established patient.He is a hematologistoncologist. A: The code we are speaking about in the codedescriptor is 38221 which is bone marrow; biopsy, needle or trocar. A needle is insertedthrough the skin and advanced until the bone is actually penetrated. Then, a small chipof bone marrow is removed for biopsy by a trocar needle. This code can be used only once a day. Thereare a few times when you would need to do
it morethan once a day, but it is a once a day code. I want to talk about modifier 25 a bit andI've learned so much about modifier 25 through theBlitz tutorials with Laureen, but it is a global package modifier. It's used if there isan EM on the same day as the procedure and that EM isfor a significant, separate service. You can't use it as amodifier for an EM for a decision to perform surgery. This is not happening here for a scenariowhere the patient is coming into the
to have anoutpatient procedure done. When a patient does go into the for that, usuallyan EM is not performed. You don't usually put anEM on an outpatient procedure. It's just not usuallydone, because if the comes in and sees you before the procedure usually he is justlooking, â€œOK, everything is cool.â€� It doesn't constitute an EM. If the came in and he looked at youand you were having some kind of reaction that didn'tseem normal or you were sick or your temperature
was 105, he may need, at that point, toevaluate you. If he does, then of course he can be paid for that, because it's a separatething. He's looking at, â€œWhat's going on rightnow and maybe we shouldn't be doing this proceduretoday.â€� In that case you can use that procedure. Basically, procedures do have built into thema quick overview of the day of the procedure, but like I said if there's a huge worseningof symptoms or they're having new symptoms then that is another issue when we could useit. The main question remains, â€œWas a separateidentifiable EM service necessary and performedéâ€�
If the just came in and said, â€œHey,you are good to go for the procedure today,â€� then it's included in the global package.Remember, the global package includes preop, the procedure, and postop.If the person, the day of the surgery, had a situation going on like we said a big exacerbationof symptoms or a problem that may interfere with the procedure, then an EM would be warranted,you would use your modifier 25. You have to be careful about billing too many EM in aday. Also, this procedure code can only be reported once a day.Alicia: That's all good stuff. Laureen: You did it. Awesome! Seems like modifier25 is coming up a lot tonight.
Alicia: Yeah, really. I like that 105 temp,yeah. Thanks, Dawn. Laureen: Thank you, Dawn. Another little thingthat I share with my students for modifier 25 and EM to really visualize having a procedurenote and then a separate, significant EM note. That's what 25 is saying, so I'llsay â€œYou can't bill an EM unless you have a HEM,â€� meaning that you can clearly seea history, exam, and medical decision making, then, you can feel comfortable reporting itand not getting in trouble. Alicia: Dawn is the instructor and coach forour billing course, and she is real savvy with billing, so I've asked her several questionswith billing. Thanks, Dawn.