Wiki MASSES AND I&D's!?!?!

[JWash618]

I code for several groups of Anesthesiologists and in my particular groups the doctor includes the ASA he would like to use on the charge ticket.
99% of the time they want to code masses and I&D's the following way:
"excision foot mass......asa 01480"
or
"I&D infected foot.....01480"
I feel like a mass is ALWAYS going to be 00400 no matter how deep it is..even if it is on the bone....but im not sure.
Also, I will use the 01480 if the diagnosis is gangrene or osteomyelitis or something that signifies that the infection went into the bone, so thats how deep the procedure was.
When I get a code that says "infected ______" I always want to code skin.
SO my question is...am i correct in thinking that these doctors are upcoding or can a mass be a 01480(or other bone ASA)
and what documentation is REQUIRED to be on the record in order to code these the way the doc wants them rather than coding them to a 00400 if it really was a deep procedure.

PS...they are anesthesiologists...the documentation does not get very descriptive AT ALL..so i am trying to find key words for them to include so that I feel more comfortable about coding the 01480(for example.) if that is in fact a correct way to code these procedures.

 

[dwaldman]

Did you look at the op report? Do know the CPT the physician who performed it is biling? Have pointed to your MD that this is for open procedures and this might not apply to all cases?

 

[JWash618]

Did you look at the op report? Do know the CPT the physician who performed it is biling? Have pointed to your MD that this is for open procedures and this might not apply to all cases?

Thank you for replying!!
In my case (I work in a billing/coding office in an entirely different state than the docs) the Op reports do not come to us unless we request them or need them for further detail, which it takes a few days for them to get them to me anyway. Unfortunatley this is not a document I feel I would be able to request very often and for such "minor" procedures.
The documents I get per patient are the charge sheet, face sheet, and anesthesia record.
I think I may be the only one who feels this way about these codes so Im trying to find grounds to justify my request for more information.

 

[gost]

You are correct, Jenn. If the documentation just says "foot mass," you cannot assume this means any one part of the foot. Since you have more than one option, it would be best to either review the op report or ask the anesthesiaologist for clarification. If you can't do either of these, you don't really have a choice but to code the lesser option.

Does your company have a mechanism in place to let the anesthesiologists know any problems like this your coders are finding? If not, maybe you can suggest it. Sometimes the doctors aren't happy when you ask for more info, especially if they are providing you with codes. I find it helps to remind them that:

1) They are experts at what they do and you are the expert at what you do. Maybe they are correct with their codes but it helps to have a second pair of eyes to make sure.
2) The codes they provide are not sufficient documentation for CMS or other payers. If an audit is done, the documentation provided will result in penalties for upcoding because:
3) IF IT ISN'T DOCUMENTED, IT WASN'T DONE!

 

[JWash618]

Thank you VERY much!
I will continue to search for resources stating that it is incorrect to code that way as well as print your response out!
Thanks again!