Wiki Case #8 Winner, Answer Key, & Rational

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alex.mckinley@aapc.com

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Case #8 Winner, Answer Key, & Rationale

Ramesh D. is the winner of case #8. See below for the answer key and rationale.

ANSWER KEY
CPT: 99283, 29515
CPT Modifiers: 25
ICD-9: 845.00, E007.0, E849.4 or 845.00, E007.0, E849.6

RATIONALE
Expanded problem focused history: extended HPI (location, timing, context, severity), problem focused ROS, and complete PFSH (past and social). In the ED setting, the documentation of two of three elements in PFSH is a complete PFSH.

Detailed exam: an exam of four systems (constitutional, cardiovascular, respiratory and extended musculoskeletal of the right ankle and leg)

Moderate MDM: New problem with no additional workup, acute injury, moderate MDM for prescription drug management.

The provider applies a splint which is reported separately. Modifier 25 is appended to the E/M service. The splint codes have 0 global days.

An interpretation is not provided so the X-ray services are not coded.

Select a code for the ankle sprain and the E codes for how the injury occurred and where the injury occurred.

CPT: 99283-25, 29515 or 99283-25, 29515-RT or 99284-25, 29515 or 99284-25, 29515-RT

Steps to look up: Expanded problem focused history: Extended HPI, Problem Pertinent ROS, Complete PFSH); Detailed Exam; Moderate MDM. Splint/Leg/Short. Modifier 25 is appended to the E/M. Splint codes have a 0 global period.

99284 was also accepted in case the allergies were counted as an ROS instead of a past history making the history detailed.

ICD-9-CM: 845.00, E007.0, E849.4 or 845.00, E007.0, E849.4 or 845.00, E007.0, E849.6 or 845.00, E928.9, E007.0, E849.4

Steps to look up: Sprain, strain/ankle; External Cause Index/Activity/football; Accident/occurring (at) (in)/recreational.
 
Last edited:
E code

hello why couldn't it be E007.1 which is also football, it doesn't state if it was touch football or tackle football? are we to assume because the injury happened at school?

:confused:
 
ANSWER KEY
CPT: 14020
CPT Modifiers: none
ICD-9: 173.72


You should probably correct this to have the correct answers... Thank you, Alex.
 
Hi Guys,

I accidentally posted case #1 answers. It is now updated correctly with case #8 answers.

Thanks for catching that.

Alex
 
what about the E code E000.8 - other external cause status -also being on the claim. In the descriptions it includes "for recreation or sport not for income or while a student?"
 
"An interpretation is not provided so the X-ray services are not coded. "


Couldnt the xrays have been coded with the TC modifier?
 
Case #8 application of splint dispute

I am writing disputing your answer for Case #8. You have stated that the application of the splint 29515 was to be coded. In the description of code 29515 from the Coders Desk Reference for Procedures (Ingenix/Optum), this clearly states that it is an application of a man made splint using ace wraps and plaster, not a fabricated splint. The second reference I have is from Noridian that also clearly states that they do not recommend coding for the application of a splint for a "off the shelf" or pre-packaged splint.
I would love to hear back from you on a guideline showing that we can code for an application of a splint by applying a "off the shelf" splint.
I have also sent an email to your info email with copies of the above references as I was unable to attach them to this.
Thank you so much!


Deana White, CCS, CPC (member ID # 01078441)
Curry Health Network
 
Case # 8 clinical added for Answer key & Rationale

Case # 8 clinical added for Answer key & Rationale
Since the clinical info wasn't included in posting of answer & rationale; and the link to case clinical info given now is not accessible (error page shows up) .... I thought it wise to include the missing clinical info.


Hint: The patient is a 15 year old football player with an ankle injury. Using your E-codes and CCI Edits will get you through this one!


Case #8

Time seen by clinician. 2035

Chief Complaint: Ankle and leg injury

History present illness

15-year-old male patient complains of an injury to the leg and foot. The injury occurred shortly prior to arrival. The injury allegedly occurred while playing football at local high school field. Patient did not continue playing any more football, mother states he's not walking on his leg at all secondary to pain. No other complaints of pain, injury or illness.

Patient's allergies: NKDA

Patient's current medications: no routine prescription medications

Social History. Public school, lives with family

Physical Exam, Vital Signs: Afebrile, VSS

General, well appearing, well nourished

Patient Status. Alert and cooperative

Heart: RRR, no MRG

Lungs: CTAB

Ankle: Right ankle, diffuse tenderness medial and lateral malleolus, minimal swelling laterally, ROM normal flexion, normal plantarflexion , no obvious deformity, skin is intact. Neurovascular status: 2+ pedal pulses, capillary refill less than 2 seconds Achilles tendon non tender, no step off. The foot, knee and hip are without pain or tenderness and with full range of motion

Leg: Right, diffuse pain tibia-fibula, no obvious swelling. Patient has poison ivy bilateral lower legs, no infection. Mother states he has medication for his poison ivy.

Intervention X-ray: Right tibia fibula and foot negative for acute bony injury

Immobilization was achieved by the application of OCL stirrup short leg splint applied by ERMD

Immobilization device was then check to assure good neurovascular flow and effectiveness of positioning by me before the patient was discharged

Crutches dispensed. Crutch walking safely with good use of crutches

Diagnosis:

Acute sprain right ankle

Disposition: The patient was discharged 2045. Discussion regarding radiology to review xrays and in the event of a discrepancy we will notify patient/family.

Prescriptions: Prescription for Vicodin

Discussion regarding ice, elevation, rest leg and ankle, nonweightbearing until follow up

Follow up: Instructions given to follow up with MD or orthopedics in 4-5 days. May return to ER or orthopedics sooner for worsening symptoms

Treatment plan discussed with patient/family who are in agreement.


https://www.aapc.com/code/aapc-coding-challenge/cases.aspx
 
whitegirl03 said:
I am writing disputing your answer for Case #8. You have stated that the application of the splint 29515 was to be coded. In the description of code 29515 from the Coders Desk Reference for Procedures (Ingenix/Optum), this clearly states that it is an application of a man made splint using ace wraps and plaster, not a fabricated splint. The second reference I have is from Noridian that also clearly states that they do not recommend coding for the application of a splint for a "off the shelf" or pre-packaged splint.
I would love to hear back from you on a guideline showing that we can code for an application of a splint by applying a "off the shelf" splint.
I have also sent an email to your info email with copies of the above references as I was unable to attach them to this.
Thank you so much!


Deana White, CCS, CPC (member ID # 01078441)
Curry Health Network
Click to expand...


Did you ever get a response about this?
 
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