Question:
What is the correct CPT code for this repair? Is it a simple wound repair code or 43870, or another code all together? and what are the correct ICD-9 diagnosis codes? And also what CPT ED level charge would you use?
Thanks!!!
80-year-old patient presents to emergency room from the nursing home with bleeding from the Gastrostomy site. The ER physician documents multiple minor skin tears around the stoma site. The E.R. physician sutures the skin with 4 0 silk sutures. The patient has a history of hypertension, dysphagia from an old CVA (cerebrovascular accident), and insulin-requiring type II diabetes. The triage nurse listed the patient’s current medications as Hydrochlorothiazide and Insulin, which are verified by the ED physician.
I'm a student, barely breaking through the soil right now. I wanted to let you know that, because I'm not necessarily offering an answer to your question. I hope you don't mind if I just put some of my own thoughts, to try and test what my understanding is so far with what I'm learning. The real coding pros will help you shortly and I'll learn a thing or two more.
536.49 (ICD-10-CM:K94.29) Other gastrostomy complications (536.4 being Gastrostomy complications and 5th digit 9 for "other" as the documentation did not fit into the other specifics.
250.00 (ICD-10-CM:E11.8), V58.67(ICD-10-CM:Z79.4) for the diabetes and insulin.
401.9 (ICD-10-CM:I10) for the hypertension. (I'm truly stumped on the hypertension thing....probably over-thinking it because of the other drug listed.....)
438.82, 787.20 for the late effects of CVA/ dysphagia;
Looking at the CPT index under multiple terms, like repair, suture, and where or what (stoma, stomach) I too am of the opinion that 43870 Closure of gastrostomy, surgical is correct. When I tired to consider it being a simple wound repair code, it seemed that we'd need to know the measurements of the tears repaired. That's my limited understanding there...
Thanks for letting my post my ramblings. I am enjoying my learning experience through CCO. Hope to see you at webinar.
No problem! Yes, those are the exact codes I assigned as well, hopefully, they are correct as this question was on an employment test I recently took. Well let's see if Laureen says these are correct, and your thoughts on why you would not assign the wound repair code was my thought exactly as well, the only thing that I was doubting was that is the tears were minot they would probably be small and fit into the lowest category - but I know we are never to assume anything, so I would imagine the answer is either "query the physician" or 43870.......we'll see
Linda
"You suggested 43870 Closure of gastrostomy, surgical - it would not be this code because the documentation does not say they closed the gastrostomy - they just repaired it around the opening.
Skin sutures usually equals a simple, intermediate or complex repair. Since this said “minor skin tears” and didn’t go into any detail about it being a deep wound we are left with coding for a simple repair.
Since we are not given a measurement for the simple repair we need to go with the smallest amount in CPT for this anatomical area which is the trunk. So this would be coded as a 12001 in my opinion."
Laureen went on to discuss the E/M coding and diagnosis.
If you missed the webinar, consider joining the CCO Club...You may view the replay of this video, as well as all the replays from the past, read the transcripts and answer sheets when you join the CCO Club. For more information, click here.
What is the correct CPT code for this repair? Is it a simple wound repair code or 43870, or another code all together? and what are the correct ICD-9 diagnosis codes? And also what CPT ED level charge would you use?
Thanks!!!
80-year-old patient presents to emergency room from the nursing home with bleeding from the Gastrostomy site. The ER physician documents multiple minor skin tears around the stoma site. The E.R. physician sutures the skin with 4 0 silk sutures. The patient has a history of hypertension, dysphagia from an old CVA (cerebrovascular accident), and insulin-requiring type II diabetes. The triage nurse listed the patient’s current medications as Hydrochlorothiazide and Insulin, which are verified by the ED physician.
- Primary diagnosis code:
- Secondary diagnosis code(s):
- CPT Procedure and Level:
Response from Luna:
Hi Linda,I'm a student, barely breaking through the soil right now. I wanted to let you know that, because I'm not necessarily offering an answer to your question. I hope you don't mind if I just put some of my own thoughts, to try and test what my understanding is so far with what I'm learning. The real coding pros will help you shortly and I'll learn a thing or two more.
- Principal diagnosis: 536.49(ICD-10-CM:K94.29)
- Secondary Dx: 250.00(ICD-10-CM:E11.8), V58.67(ICD-10-CM:Z79.4), 401.9(ICD-10-CM:I10), 438.82, 787.20
- CPT Procedure: 43870
- CPT ED Level: ? (Not familiar with this.)
536.49 (ICD-10-CM:K94.29) Other gastrostomy complications (536.4 being Gastrostomy complications and 5th digit 9 for "other" as the documentation did not fit into the other specifics.
250.00 (ICD-10-CM:E11.8), V58.67(ICD-10-CM:Z79.4) for the diabetes and insulin.
401.9 (ICD-10-CM:I10) for the hypertension. (I'm truly stumped on the hypertension thing....probably over-thinking it because of the other drug listed.....)
438.82, 787.20 for the late effects of CVA/ dysphagia;
Looking at the CPT index under multiple terms, like repair, suture, and where or what (stoma, stomach) I too am of the opinion that 43870 Closure of gastrostomy, surgical is correct. When I tired to consider it being a simple wound repair code, it seemed that we'd need to know the measurements of the tears repaired. That's my limited understanding there...
Thanks for letting my post my ramblings. I am enjoying my learning experience through CCO. Hope to see you at webinar.
Response from Linda Charlwood
Hi Luna,No problem! Yes, those are the exact codes I assigned as well, hopefully, they are correct as this question was on an employment test I recently took. Well let's see if Laureen says these are correct, and your thoughts on why you would not assign the wound repair code was my thought exactly as well, the only thing that I was doubting was that is the tears were minot they would probably be small and fit into the lowest category - but I know we are never to assume anything, so I would imagine the answer is either "query the physician" or 43870.......we'll see
Linda
Response from Ruth Sheets
Laureen covered this is the April 2013 Q&A Webinar. Here are some key points..."You suggested 43870 Closure of gastrostomy, surgical - it would not be this code because the documentation does not say they closed the gastrostomy - they just repaired it around the opening.
Skin sutures usually equals a simple, intermediate or complex repair. Since this said “minor skin tears” and didn’t go into any detail about it being a deep wound we are left with coding for a simple repair.
Since we are not given a measurement for the simple repair we need to go with the smallest amount in CPT for this anatomical area which is the trunk. So this would be coded as a 12001 in my opinion."
Laureen went on to discuss the E/M coding and diagnosis.
If you missed the webinar, consider joining the CCO Club...You may view the replay of this video, as well as all the replays from the past, read the transcripts and answer sheets when you join the CCO Club. For more information, click here.