Wiki Evaluation & Management (CEMC) Round 5 #13 Note 5

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JamieGalloway

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HELP!
The assessment is this:
(1) Diabetes (2) Chronic kidney disease (3) Need of dental care (4) Side effects from Victoza (5) Hypertension (6) Medication management (7) Hyperlipidemia
PLAN: Refer to dentist and schedule mammogram. Return for labs. Follow-up in three months.

Right, so I have 250.00,585.9,401.9,272.4. It will not let me enter anything that I have come up with, having to do with "side effects" (adverse reactions-I even tried entering the symptoms the patient was having from the hpi), nothing for medical management (v58.69?), and goodness knows I can't find anything to use for "needs to see a dentist". I've called the AAPC several times and have been told "someone will call you back", and apparently, no one will call until the end of the day. I've had two other certified coders look at this chart and they're stumped too. What am I not seeing?!
 
I'm having the same problem with round 3. Did you by chance, complete round 3.
chart
HISTORY OF PRESENT ILLNESS: Patient presented with hair spray exposure to right eye.
REVIEW OF SYSTEMS: Complains of pain. No fever, nausea or vomiting.
EXAMINATION: HEENT: Bilateral ear canals: ear drums normal. Oropharynx: unremarkable. Fluorescein stain done of right eye: shows 1 ml area of corneal abrasion. Bilateral pupils reactive. Anterior chamber bilaterally normal. CHEST: Bilateral good air entry, clear to auscultation, no rales, rhonchi, rubs, normally resonant. CVS: CVS — S1, S2 positive, normal split, no thrills, bruits, rubs or murmurs. ABDOMEN: Soft, non-tender, no organomegaly, no free fluid, no abnormal masses, no rebound. CNS: AAO x 3, no focal neurological deficits, no cranial nerve deficits, no cerebellar or meningeal signs, bilateral power 5/5.
ASSESSMENT: Right eye corneal abrasion.
PLAN/EDUCATION: Ciprofloxacin ophthalmic 2 drops q2h while awake x 2 days, then q4h while awake x 5 days. Use dark glasses. Follow up in one week. May take Ibuprofen or Ultram for pain.
I have cpt 99202 and icd-9 code 918.1 for the corneal abrasion. I can not get the system to take anything for the exposure of hairspray to the eye? The only other thing I could think to code is for the fluorescein stain, but from what I have seen, that is included in the office visit. So sorry for posting a question to your question, just hoping you could point me to the right direction. I'm a little frustrated to say the least.:( I hope someone is able to help you with your question.
Thanks
Lorri CPC-A
 
JamieGalloway said:
HELP!
The assessment is this:
(1) Diabetes (2) Chronic kidney disease (3) Need of dental care (4) Side effects from Victoza (5) Hypertension (6) Medication management (7) Hyperlipidemia
PLAN: Refer to dentist and schedule mammogram. Return for labs. Follow-up in three months.

Right, so I have 250.00,585.9,401.9,272.4. It will not let me enter anything that I have come up with, having to do with "side effects" (adverse reactions-I even tried entering the symptoms the patient was having from the hpi), nothing for medical management (v58.69?), and goodness knows I can't find anything to use for "needs to see a dentist". I've called the AAPC several times and have been told "someone will call you back", and apparently, no one will call until the end of the day. I've had two other certified coders look at this chart and they're stumped too. What am I not seeing?!
Click to expand...

You are forgetting that hypertension and kidney disease have a presumed connection without having to be stated as such (in the coding guidelines). Here are the codes I came up with:
250.00
403.90
585.9
272.4
995.29
V58.69
E947.8
E849.X

If you can place the whole note with HPI, etc I can make sure I have given you the correct answers. Without it, this is all I have.
 
Actually after calling the AAPC, and someone calling me back, we got it sorted out. The doctor didn't specifically make a connection between the DM, HTN, or CKD (I know, in the real world, one might do that, but not with this, apparently). V58.69 was also not being accepted. It was an E code for the synthetic insulin (Byetta, etc) and actually a WRONG code for flatulence (the side effect). I was coding 787.3, and their coder coded it as some unspecified disorder of the stomach (the exact code escapes me right now).
 
jimlorri said:
I'm having the same problem with round 3. Did you by chance, complete round 3.
chart
HISTORY OF PRESENT ILLNESS: Patient presented with hair spray exposure to right eye.
REVIEW OF SYSTEMS: Complains of pain. No fever, nausea or vomiting.
EXAMINATION: HEENT: Bilateral ear canals: ear drums normal. Oropharynx: unremarkable. Fluorescein stain done of right eye: shows 1 ml area of corneal abrasion. Bilateral pupils reactive. Anterior chamber bilaterally normal. CHEST: Bilateral good air entry, clear to auscultation, no rales, rhonchi, rubs, normally resonant. CVS: CVS — S1, S2 positive, normal split, no thrills, bruits, rubs or murmurs. ABDOMEN: Soft, non-tender, no organomegaly, no free fluid, no abnormal masses, no rebound. CNS: AAO x 3, no focal neurological deficits, no cranial nerve deficits, no cerebellar or meningeal signs, bilateral power 5/5.
ASSESSMENT: Right eye corneal abrasion.
PLAN/EDUCATION: Ciprofloxacin ophthalmic 2 drops q2h while awake x 2 days, then q4h while awake x 5 days. Use dark glasses. Follow up in one week. May take Ibuprofen or Ultram for pain.
I have cpt 99202 and icd-9 code 918.1 for the corneal abrasion. I can not get the system to take anything for the exposure of hairspray to the eye? The only other thing I could think to code is for the fluorescein stain, but from what I have seen, that is included in the office visit. So sorry for posting a question to your question, just hoping you could point me to the right direction. I'm a little frustrated to say the least.:( I hope someone is able to help you with your question.
Thanks
Lorri CPC-A
Click to expand...



my gosh YES I was stuck on this one for hours. And when I talked to the rep at AAPC, she agreed it was probably coded wrong; you want to code NOT for "foreign object in eye", which would make sense, but instead it coded to "poisoning by..." something...I don't recall the exact term. But thats what it was in, this after I punched in practically every code in the E section...!


ETA: You're right, the stain is included in the E/M level. You're not missing a procedure code, just that funky "poisoning" code. Yeah. Good luck!!
 
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Thanks so much Jaime. They sure don't make the charts easy.LOL. I even looked up ingredients in hairspray . I guess I'm back to looking for the E code again or maybe I will call the AAPC :( Thanks again
 
WOW is all I can say on this. It seems that this is an ongoing issue and not just with the E/M CodeArounds. A coworker had several reports that this happened with. We are taught to code to the highest specificity, but when the answer is as generic and way off the path of normal thinking it makes these more difficult then they should be.
 
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