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518.89 vs 786.6

  1. #1
    Default 518.89 vs 786.6
    Medical Coding Books
    Pt had a CTA chest...impression reads lung nodule. Insurance will not pay for 518.89. I don't agree with using 786.6 but one of my managers asks that I post a message to the AAPC web forum to see what the consensus is.


    Kimberley Tober, CPC
    Franklin, TN

  2. #2
    I would use the 518.89 since the impression states is lung nodule. And you could also use 793.1 (abnormal findings on radiological/other examination of lung field). What was the reason stated for the patient to have the CTA? Is there anything else stated in the impression?

    Kimberely K. Graham, CPC, CPC-H

  3. #3
    Any others want to advise on this question?

  4. #4
    'Lest we forget, we are coding to the highest level of specificity and not for reimbursement. Lung Nodule is 518.89

  5. #5
    Birmingham, Alabama
    Quote Originally Posted by luz.buenaventura View Post
    'Lest we forget, we are coding to the highest level of specificity and not for reimbursement. Lung Nodule is 518.89
    I concur. I would however continue to pursue the payor with documentation ad nauseum. Sounds like they have an edit that is not logical.
    Danny L. Peoples

  6. Unhappy Enough time for state exam?
    Hi I am new in this chat forum. I will be writing my State exam in a week. I am getting nervous towards the end and I was wondering if anyone knows if 5:40 min are enough for the exam? Is it do able? I read that for every question in average you should have 2 min. It is hard to believe! Can anyone tell me?

  7. #7
    I agree you are not to code for reimbursment I would use 518.89 per dictation. I would not use abnormal findings 793.1 just to get paid. It could come back and bite you in an audit.
    Catrina Jacobs, RCC, CPC

  8. Default Cta dx response
    Since you are concerned with the dx 518.89, my suggestion would be to code for the symptoms of why the cta was ordered. Usually it relates to shortness of breath 786.05 which is payable. (for p.e protocol).if patient gave no information, then call the referring physician and ask him what dx he used to get authorization for the cta. If no auth is needed then just ask him what symptoms patient had since this is most likely a stat request.
    Good luck. Paul lawrence, cpc

  9. #9
    Default Abnormal lung
    may also use 793.1 for billing or recent for visit dx for billing

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