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March 27, 2018

Spring OPPS Update Released

The Centers for Medicare and Medicaid Services (CMS) summarized the spring update to the outpatie... Learn More

Therapy Caps Repealed and Payment for Therapy Assistant Services Lowered

Medicare payment caps on outpatient therapy were permanently repealed effective January 1, 2018. ... Learn More

OIG Update Work Plan, Studies Cardiac Device Credits

In March, the Office of Inspector General (OIG) posted several updates to its existing Work Plan,... Learn More

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Medical Coding News Archives

April Coding Corner

April 12, 2017:

In the Optum360 Coding Corner, we highlight areas in which medical coding professionals are struggling for uniformity and correct coding amongst their peers. In this article, we discuss coding variances for ICD-10-CM, ICD-10-PCS and/or CPT® found on a monthly basis and explore the codes, coding concepts and conventions for those variances. We also highlight new coding information when applicable, to keep the coding community informed.

ICD-10-CM (both inpatient and outpatient settings)

Signs and symptoms of cataracts

According to the Merck Manual, symptoms of cataracts are glare and halos. This is not all of the symptoms of cataracts but these two were chosen to illustrate this point. Diagnosis codes such as H53.71 (glare sensitivity) and H53.19 (other subjective visual disturbances) are symptoms of cataracts and should not be reported separately. According to ICD-10 guidelines for chapter 18, signs and symptoms should not be reported as additional codes when routinely associated with a disease.

Incidental findings on radiology reports

According to Coding Clinic 2017 first quarter, incidental findings documented in a radiology report are not to be reported by the facility. For example, if a physician orders a chest x-ray with a diagnosis of chest pain and the radiology report documents no acute findings of a hernia then the diagnosis of hernia should not be reported by the facility as an additional diagnosis.


Occupational therapy

New occupational evaluation CPT® codes have been added to the medicine section that began on January 1, 2017. The previous CPT® code (97003) that was used to report an initial evaluation has been deleted and replaced with new CPT® codes of 97165 (occupational therapy evaluation, low complexity), 97166 (occupational therapy evaluation, moderate complexity) and 97167 (occupational therapy evaluation, high complexity). The previous code (97004) used to report a re-evaluation has been replaced with new code 97168 (re-evaluation of occupational therapy established plan of care). Each new evaluation code has components that must be properly documented to accurately report the code.

ICD-10-PCS guidelines

External heart assist devices

Coding clinic 2017 first quarter addresses questions regarding the coding of an external heart device such as an Impella ® used during a procedure. When an external heart device such as an Impella ® is inserted and removed intra-operatively, then a PCS code for assistance (5A0) should be reported. According to PCS guideline B6.1a, a device PCS code is reported if the device remains after the completion of the procedure. When the device remains a few hours post-operatively and is subsequently removed, then a PCS code is assigned for the insertion (02H), assistance (5A0) and removal of the device (02P).

PCS guideline B6.1b

When sutures, radiological markers and temporary post-operative wound drains are used during a procedure, these materials are considered integral to the procedure and are not coded separately as devices.

CPT is a registered trademark of the American Medical Association.


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