Wiki Beginner resources for Neurology, Pulmology and Allergy coding

[lgardner]

Good Afternoon fellow coders-

I have been assigned a project to gather information and create PowerPoints for Neurology, Pulmonology and Allergy coding.
I am to include any relevant: coding guidelines, CPT updates, and denial trends (which I will discuss with our revenue cycle team).

I have very little knowledge about these specialties, so I am wondering if any one can point me to some resources that can help a beginner.

I wouldn't mind something similar for other specialties, since I am in a new position, providing education to providers and coding staff, and want to expand my knowledge base.

thank you!

 

[TThivierge]

Hi lgardner,
Here are some tips on Pulmonology might help you. Documentation tips on severity of COPD J44 is it mild, moderate or end stage level. Add infection if is the lab result see B95 -B97 dx blocks. Asthma needs to be documented if mild, moderate, severe, and unspecified see dx Block J45 Bronchitis document of acute vs chronic see Dx J40 and J41 dx blocks? Document respiratory failure chronic J96.1 or acute J96.0 and if due to hypoxia vs hypercania too. Document if the patient smokes current F17 & Z72 vs past history Z87.891or in remission F17.211 with any respiratory illness if appropriate. Add if pt. on ventilatory z99.1 or aspirator Z99.0 has tracheostomy Z93.0 or has Oxygen supply Z99.81 too. If pt gets Covid 19 use dx U07 and vs dx U09 if got COVID 2 time. Also encounter for COVID lab test dx J98 and Z11.52 lab test for COVID if negative results. Lab CPT for checking for COVID is dx B97.21. A patient can have COPD and Asthma together. Reactive Airway Ds J68 and ILPO Lung Ds. dx J84.9

Pulmonary testing must be documented CPT 94010-94799 and be used with Eval mgnt codes then add modifier 25 .
Pneumonia J69 & J15 if got in hospital should add dx Y95. Ventilator associated Pneumonia is dx J95,851 Also illness Endstage COPD use 2 dx codes J44.9 AND Z99.81
Sleep Medicine testing needs to be by someone familiar with guidelines. You bill testing by date of results on claim not date of treatment. CPT 95803-95857. Also coding for this procedure medical sleep treatment by longer than 6 hours of sleep vs less than 6 hrs and age of pt. The dx codes range using dx G47 blocks, R06.83, F51 and Z72. It can be related to Depression and Pain too.

Any previous military overseas in Iraq or Afghan of veterans can be treated for ongoing or chronic respiratory illness or Cancers due to breathing Burn Pits where exposed trash burned nonstop. The dx related to these conditions are J98, or Z77.098 ,T59.891, Y37.3 or Y99.1 dx codes.
Well I hoped helped you.
Lady T

 

[lgardner]

I should have specified. I am really looking for more procedure/cpt coding, examples of proper and improper use of Modifier -25, common coding issues.

But, I do appreciate the info you have provided.

thank you, Lady T.

 

[TThivierge]

Hi Again lgardner,
Here are some tips on billing and coding for Neurology. Neurology diagnosis codes can range in Paralysis due to sequela illness from injury or strokes/CVA I63-I69. Parlaysis G82 ,S34.115s, W11.xxs , Dementia G31 R41 use 2 codes, Parkinson Ds G20 and Huntington Ds dx G10 very similar ds. Also Sundown is F05 works wiht Dementia F02 and usually need 2 dx code together. Late dementia is after age 65 years old and early dementia is before age of 65 years. Headaches R51 Menstrual HA G43.82, Migraines G43, and Cluster HA G44 . dx. G30 Polyneuropathy Idiopathic, Nerve problems with limbs Polyneuropathy dxG63 DM neuropath or LOPS (loss of sensitivity) dx E08-E13 .40 plus L98 blocks Neuralgia M79.2 . Also Pressure Ulcers can happen due to DM or Paralysis Pressure Ulcers dx L97 to L98 specific area buttocks, legs, arms feet and stages. Pressure Ulcers have 3 stages. Try to get provider or use document the stages of the pressure ulcers. Also ensure documents laterality of limbs, describe problems and given final dx .If past history on past illness, ask provider put some kind of date range so coder knows past medical illness not current.

Eva Mgnt codes can be used CPT 99203 to 99214 with documentation of past HO, current symptoms and assessments. Modifier 25 can be added if injection for pain, or xrays given. Phone calls for MD, NP and PA are CPT 99441-99443 but must add minutes in documentation to be valid. Other QHP professional nurses and tech can use CPT 99211 and 98968 if contact pt by phone; need assessment of what checking on too. Video or Zoom use CPT codes add modifier 95 but must document time in record and type of connection to pt used phone or video plus pt demographic info in top of record.

If pt referred to medical specialist provider as consult CPT codes add this in documentation too. Or if pt referred from family doc add referring doc in record and on claim
I hope I helped you a little bit
Lady T