ED Coding and Reimbursement Alert

Jaw pain also gets a nod in new code set.

Last month, we brought you some of the most important additions and changes to the ICD-9 2011 manual.

Check out the second part of the ED-relevant ICD-9 codes in the 2011 manual, which takes effect Oct. 1, 2010.

PTS Dx Can Help With Patients Who've Fallen

One of the more useful additions for ED coders in ICD-9 2011 is 780.33 (Post traumatic seizures), or PTS.

Definition: PTS occurs in patients who have suffered a traumatic brain injury (TBI). "These may occur immediately after the injury or after some time. PTS generally occurs with a more severe brain injury, and is more likely to occur in young children and older adults," explains Sarah Todt, RN,CPC, CEDC, director of education and compliance for Medical Reimbursement Systems, Inc., an ED coding and billing company based in Woburn, Mass.

"Here in Washington state, and I believe in other states as well, there are quite a few new laws related to care for post-TBI (traumatic brain injury) patients," explains Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-I, CCC, COBGC, manager of compliance education for the University of Washington Physicians and Children's University Medical Group Compliance Program.

The state laws and diagnosis code changes coincide with a CDC campaign aimed at prevention and early diagnosis of TBI, which has increased PTS awareness.

"These laws and education have had a huge impact on physicians who see patients who have had head injuries from sports or falls, indigent populations, and returning military personnel," says Bucknam.

There is a good chance the ED will see PTS patients; they typically need immediate care, as the seizures "may lead to additional brain damage due to increased intracranial pressure and decrease in oxygen flow," Todt relays.

Consider this detailed clinical scenario from Todt: On Oct. 11, 2010, a 6-year-old girl presents to the ED after falling off a trampoline; she struck her head on a rock when hitting the ground and had a brief loss of consciousness. Shortly after arrival to the ED, the patient began seizing. Parents report that the child does not have a history of a seizure disorder. The physician orders intravenous ativan, which halts the seizure activity. Notes indicate a comprehensive history and exam, which includes a CT scan of the head that showed a small subdural hemorrhage. The ED physician then admits the patient to the neurosurgery unit with diagnosis of subdural hemorrhage and PTS.

On this claim, you'd report the following:

Use 786.30 For Some Pneumonia, Tuberculosis Patient Presentations

There is another new code that will premiere in October: 786.30 (Hemoptysis, unspecified) will help with claims involving patients that report to the ED with hemoptysis, and then end up with a diagnosis of pneumonia (486), explains Lori Cushing, RHIT, CCS, coding supervisor for Redington-Fairview General Hospital in Skowhegan, Maine.

The encounter notes might indicate hemoptysis, or pseudohemoptysis, specifically. If the notes do not spell out the diagnosis exactly, however, consider this advice from Cushing for identifying possible 786.30 patients:

Symptoms: "Hemoptysis is the expectoration of blood or of blood-stained sputum from the respiratory tract. Pseudohemoptysis occurs when blood originates outside of the respiratory tract such as the gastrointestinal tract," she relays.

Causes for hemoptysis vary, Cushing comments; however, these conditions could result in a 786.30 presentation:

Welcome More Specific Pain Dx in 2011

When the physician diagnoses jaw pain after Oct. 1, coders can choose 784.92 (Jaw pain) for the encounter. Previously, consideration included 526.9 (Unspecified diseases of the jaws), "which does not clearly illustrate the complaint," Todt relays.

Benefit: The more specific jaw pain code could help "support some complaints that may be related to dental problems," says Todt.