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Mastering Coding for Operative reports (part 3)

Jul 13, 2024

Lecture Notes: Coding Procedures and Updates

Introduction

  • Speaker: Hong, the coding expert
  • Focus: Real-world coding experience, CPC, COC, CCS, CCSP exam prep
  • Importance: Accurate and efficient coding of operator reports

Homework Review

Operative Report #6

  • Pre-op Diagnosis: Post-coital bleeding, thickened posterior endometrial wall
  • Post-op Diagnosis: Same as pre-op
  • Procedure Performed: Hysteroscopy, dilation, and curettage
  • Important Elements:
    • Pre-op and post-op diagnosis for correct ICD-10-CM primary call assignment
    • Procedure name for understanding treatment
    • Narrative description to validate and support procedure codes
    • Pathological findings for crucial information on diagnosis and procedure co-assignment

Coding Details

  • ICD-10-CM Codes: (Looked up in index and double-checked in tabular list)
    • Post-coital bleeding: N93.0
    • Thickening of endometrium: R93.89
  • CPT Code: Hysteroscopy, surgical with biopsy: 58558
  • Key Takeaway: Only one CPT code (58558) for hysteroscopy with D&C, biopsy, or polypectomy

Operative Report #7

Pre-op and Post-op Details

  • Pre-op Diagnosis: Small lung incision area, history of cholecystectomy
    • Procedure to be performed: Robotic incisional hernia repair with mesh
    • Key elements: Whether hernia is initial or recurrent, reducible or incarcerated/strangulated, and defect size (cm)

Coding Changes 2023

  • Hernia Repair Codes: Codes streamlined to include all approaches (open, laparoscopic, robotic)
  • Key Factors:
    • Initial vs. Recurrent
    • Reducible vs. Incarcerated/Strangulated
    • Defect size: <3 cm, 3-10 cm, >10 cm
  • Deleted CPT Code: CPT 49568 for implantation of mesh

Report Analysis

  • Details: (Key elements obtained from body of the report)
    • Procedure: Robotic, via small incisions
    • Diagnosis: Initial incisional hernia, incarcerated, 3 cm defect
  • ICD-10-CM: K43.0 for incarcerated hernia without gangrene
  • CPT Code: 49593 for robotic incisional hernia repair with mesh

Key Takeaway

  • CBD Code Changes 2023: Focus on type (initial/recurrent), condition (reducible/strangulated), and size of hernia defect. No need to differentiate between approach or mesh usage.

New Homework Assignments

Operative Report #8

  • Pre-op Diagnosis: Benign prostatic hyperplasia with urinary obstruction, bladder calculi
  • Post-op Diagnosis: Benign prostatic hyperplasia with urinary obstruction, bladder calculi
  • Procedure Performed: Aquablation, cystolitholapaxy

Operative Report #9

  • Pre-op Diagnosis: Recurrent ventral hernia
  • Post-op Diagnosis: Recurrent ventral hernia
  • Procedure Performed: Laparoscopic ventral hernia repair, mesh explant

Conclusion

  • Next Steps: Review and practice homework
  • Appreciation: Thank you for watching, liking, and sharing.
  • Feedback: Encouraged to leave comments for suggestions
  • Next Session: Homework review and further learning