THE CODING EDGE® ARCHIVES

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Procedure Practice 05/15/98 - Feature Article 05/15/98
   

Procedure Practice 05/15/98:
Coding Recommendations

  
Listed below are the ICD-9-CM diagnosis and procedure codes as well as the CPT-4 procedure codes that we think properly classify this episode of treatment. Please note that modifiers, used only for physician billing purposes, have not been assigned to the CPT-4 codes. If you disagree with our suggestions or have other comments, please send an e-mail to codingedge@lagunamedsys.com.
   

Suggested Codes and Rationale

 
ICD-9-CM Diagnoses: This patient has 2 colonic polyps, a rectal polyp, and bleeding internal hemorrhoids. Three diagnosis codes are needed to identify these conditions:

In the Tabular List under 211, Benign neoplasm of other parts of the digestive system, the code 211.3, Benign neoplasm of the colon, including appendix, cecum, ileocecal valve, and large intestine NOS, correctly identifies the polyps in the large intestine. If you look carefully at the Excludes note accompanying that code, you will see that polyps of the rectosigmoid junction require a different code. Since the operative report indicates that there was a polyp in the rectosigmoid, also assign code 211.4, Benign neoplasm of other parts of the digestive system; rectum and anal canal. To correctly code the hemorrhoids, assign code 455.2, Internal hemorrhoids with other complications; bleeding, prolapsed, strangulated, or ulcerated.

ICD-9-CM Procedures: The physician performed a flexible colonoscopy with snare polypectomy and cautery destruction of the colonic and rectal polyps. Assign 45.42, Eendoscopic polypectomy of large intestine, and 45.43, Endoscopic destruction of other lesion or tissue of large intestine. The bleeding hemorrhoidal tissue was laser coagulated, and code 49.49, Other procedures on hemorrhoids, needs to be added.

CPT-4 Procedures: Three codes are needed to capture all of the surgical procedures performed during this operative episode: 45385, Colonoscopy with removal of tumor(s), polyp(s), or other lesion(s) by snare technique; 45383, Colonoscopy with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technology; and 46934, Destruction of hemorrhoids, any method; internal.
   

Procedure Practice 05/15/98 - Feature Article 05/15/98
Bibliography - References:
Coder’s Desk Reference, Medicode Publishing, Salt Lake City, UT.
Code It Right, Medicode Publishing, Salt Lake City, UT
Coding Clinic, Nov.-Dec. 1985, American Hospital Association.
CPT 98 Physicians’ Current Procedural Terminology, American Medical Association, Chicago, IL.
St. Anthony’s HCPCS Report, Feb. 1994, Dec. 1992
St. Anthony’s Illustrated ICD-9-CM Code Book, St. Anthony’s Publishing, Reston, VA.		 Notice: This part of our web site was prepared to assist in understanding and maintaining good coding skills. For proper use of this feature, reference must be made to official coding guidelines when necessary. The information here presented is only to be used as a supplement to those guidelines. Laguna Medical Systems, Inc., makes no representations or guarantees as to amounts that will be paid by Medicare or other third party payers.

 

Please be aware that the Coding Edge® Archive pages are NOT retroactively updated
to reflect possible coding rules and regulation changes made after the publishing date.