Wiki Good Diagnosis for J0461

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H@wks F@n

H@wks F@n

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Does anybody know of some good diagnoses that will get CPT J0461 paid? I've sent two or three codes to the billers, but they have sent them back telling me that they aren't good codes :mad:. I'm about ready to tell them to pick one that I've sent them and to send it through. I thought I'd ask on here first to see if anyone has any suggestions. Thanks in advance!
 
You use the code that matches the providers documentation for the diagnosis for that encounter!! You cannot be randomly selecting codes. In the providers note when the drug was administered there must be and indication for this drug. That is the code you must select.
 
Anesthesia

That's the thing, I'm not sure WHY it was used. It was administered as part of the 'anesthesia' for a procedure, probably for nausea and vomiting control, but I can't find any documentation for this.
 
You need to read the documentation carefully as atropine is not administered for nausea and vomiting. And is not routinely used in anesthesia. There had to have been some issue that necessitated the administration of this drug. It may be that it was not documented.
 
I found this online, but again I need to pick apart the documentation and find out why it was used.

"Preoperatively to diminish secretions and block cardiac vagal reflexes

Adults and children weighing more than 40.8 kg (90 lb): 0.4 to 0.6 mg I.M., I.V., or subcutaneously 30 to 60 minutes before anesthesia"

Thanks.
 
Yes that is true that it can be used as a pre op but it is not commonly done. If it was used this way the the only ex you will have is the reason for the procedure. Unless the patient had some pre-existing condition that made this a necessity, in which case I would use that diagnosis.
 
While that may be true, you need the provider to document this. You cannot "hunt" thru the chart for a diagnosis and then apply it. You look for specific documentation of where the atropine was ordered and for why. It is not up to the coder to determine the reason a drug was ordered and administered. If there is no documentation of an order for the atropine with the reason then I feel this is non billable.
 
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