Question:
Laureen
From the CCO Facebook Wall
"I was referred to this page to get help with my coding classes. The question states: This 80-year-old female patient was admitted with fever, malaise, and left flank pain. A urinalysis was performed and showed bacteria more than 100,000/mL. This was followed by a culture, showing Escherichia coli growth documented as E. coli urinary tract infection. On day 2 the patient had an exacerbation of COPD and was treated with inhaler. This resolved the same day. Patient is also on current medication therapy for hypertension and arteriosclerotic heart disease. What codes with POS indicator are assigned for this encounter?
My answer is 780.60-Y(R50.9)
, 780.79(R53.8)-Y, 789.04(R10.32 )-Y, 041.49(B96.20), 599(N39.0), 496(J44.9). If anyone could tell me if this is even close to being right (just hints like to many codes or not enough codes). Guidence to understanding how to code is all I am asking for, not for anyone to do my work for me. THANK YOU TO ANYONE THAT HELPS!!!!!"
Answer thread:
Alicia Scott
Inpatient coding is different then physician based but I have some hints for you. Don't code signs and symptoms when you have a diagnosis that causes those signs and symptoms. Fever malaise and flank pain are all S/sx of the UTI. Pay special attention to the comment, "E. coli urinary tract infection" because you have only coded E. Coli. Without even going to the manual to look I suspect this is a heads up that there is a code for the UTI with E. Coli.
599.0(N39.0)
Urinary tract infection site not specified
Excludes: Candidiasis of urinary tract (112.2)(B37.49)
urinary tract infection of newborn (771.82)(P39.3)
Use additional code to identify organism, such as Escherichia coli [E. coli] (041.41-041.49)(B96.20 -B96.29)
You left the last digit off of 599(N39.0). Always pay attention to the "Use additional note"
Now, 496(J44.9) is the correct code for COPD but note that this was resolved the same day. You still get to code it because this is a dx that doesn't go away. It is a chronic disease.
Since your patient is taking medication for HTN that means you are going to get to code 401.9(I15.9). The same goes for the heart disease. You have support for the diagnosis because it is noted they are taking medication for them. Do they affect the treatment? Most likely because of medication interaction etc.....
Those are just a few thoughts. I am not as up on Inpatient coding but the general rules apply.
Hope this helps and am thrilled to welcome you to the world of coders.
It is a fun place to be.
Carolyn Heath
Why is the "Y" in the ICD-9 code? Is there a reason it is in the ICD-9 code? I have never saw this before or even heard of it.
Laureen
I think she was trying to indicate a Type of Service code. Hopefully she will reply here and let us know for sure.
It's not a place of service (POS) code as those are numbers (2-digits).
I did find this link on TOS codes.
Carolyn Heath
What is the link for the TOS codes?
Laureen
Rats - not sure what happened there
http://www.findacode.com/medical-code-sets/type-of-service-codes.html
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c26.pdf (this has POS and TOS codes and if an official document)
Laureen
From the CCO Facebook Wall
"I was referred to this page to get help with my coding classes. The question states: This 80-year-old female patient was admitted with fever, malaise, and left flank pain. A urinalysis was performed and showed bacteria more than 100,000/mL. This was followed by a culture, showing Escherichia coli growth documented as E. coli urinary tract infection. On day 2 the patient had an exacerbation of COPD and was treated with inhaler. This resolved the same day. Patient is also on current medication therapy for hypertension and arteriosclerotic heart disease. What codes with POS indicator are assigned for this encounter?
My answer is 780.60-Y(R50.9)
, 780.79(R53.8)-Y, 789.04(R10.32 )-Y, 041.49(B96.20), 599(N39.0), 496(J44.9). If anyone could tell me if this is even close to being right (just hints like to many codes or not enough codes). Guidence to understanding how to code is all I am asking for, not for anyone to do my work for me. THANK YOU TO ANYONE THAT HELPS!!!!!"
Answer thread:
Alicia Scott
Inpatient coding is different then physician based but I have some hints for you. Don't code signs and symptoms when you have a diagnosis that causes those signs and symptoms. Fever malaise and flank pain are all S/sx of the UTI. Pay special attention to the comment, "E. coli urinary tract infection" because you have only coded E. Coli. Without even going to the manual to look I suspect this is a heads up that there is a code for the UTI with E. Coli.
599.0(N39.0)
Urinary tract infection site not specified
Excludes: Candidiasis of urinary tract (112.2)(B37.49)
urinary tract infection of newborn (771.82)(P39.3)
Use additional code to identify organism, such as Escherichia coli [E. coli] (041.41-041.49)(B96.20 -B96.29)
You left the last digit off of 599(N39.0). Always pay attention to the "Use additional note"
Now, 496(J44.9) is the correct code for COPD but note that this was resolved the same day. You still get to code it because this is a dx that doesn't go away. It is a chronic disease.
Since your patient is taking medication for HTN that means you are going to get to code 401.9(I15.9). The same goes for the heart disease. You have support for the diagnosis because it is noted they are taking medication for them. Do they affect the treatment? Most likely because of medication interaction etc.....
Those are just a few thoughts. I am not as up on Inpatient coding but the general rules apply.
Hope this helps and am thrilled to welcome you to the world of coders.
It is a fun place to be.Carolyn Heath
Why is the "Y" in the ICD-9 code? Is there a reason it is in the ICD-9 code? I have never saw this before or even heard of it.
Laureen
I think she was trying to indicate a Type of Service code. Hopefully she will reply here and let us know for sure.
It's not a place of service (POS) code as those are numbers (2-digits).
I did find this link on TOS codes.
Carolyn Heath
What is the link for the TOS codes?
Laureen
Rats - not sure what happened there
http://www.findacode.com/medical-code-sets/type-of-service-codes.html
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c26.pdf (this has POS and TOS codes and if an official document)