Coding Tips: Evaluate Diagnosis and Management to Complete Crohn"s Claims
Focus on the full picture for maximum ethical reimbursement.
In case your gastroenterologist treats patients with Crohn's disease (ileitis or regional enteritis), you are required to be very alert to look at diagnosis, management, as well as the treatment to correctly report your physician's care. Here is a quick medical coding and billing refresher to help guide your Crohn's disease CPT and ICD-9 coding. Usage of Consult Codes for Initial Visits
In most cases, a patient with Crohn's disease will typically present to your gastroenterologist's practice as a referral patient from their primary care physician. In case documentation states that the aim of the visit is for an opinion or advice about the patient's condition, then use consultation codes correct for the place of service. This initial visit must be considered as a consultation and must be reported using correct consultation codes 99241-99245 (Office consultation for a new or established patient... ). CPT and ICD-9 Update: Starting from Jan. 1, 2010, Medicare stopped recognizing consultation codes. They need novel patient or established patient visits to be reported for the accurate place of service. CPT and ICD-9 Coding Tip: Look for Symptoms Indicative of Crohn's Disease
Symptoms of Crohn's disease can contain chronic diarrhea (787.91, Diarrhea), chronic severe lower abdominal pain (789.0, Abdominal pain), blood in stools (578.1, Blood in stool), chronic nausea including or excluding vomiting (787.0, Nausea and vomiting), and weight loss. Signs and symptoms must be reported until Crohn's disease is established. Report Tests Conducted for Diagnosis
Your gastroenterologist might order numerous tests to confirm a diagnosis of Crohn's disease (555, Regional enteritis) prior to initiating any management of the condition. Your gastroenterologist might order simple blood tests to check for ESR and WBC counts.
Moreover, your gastroenterologist might also gather a guaiac-based fecal-occult blood test (FOBT) (82270, Blood, occult, by peroxidase activity [e.g., guaiac], qualitative; feces, consecutive collected specimens with single determination.) as this test is very helpful thinking that the sensitivity levels revealed to lower bowel bleeding. Medical Coding and Billing Tip: Guaiac based FOBT are not at all times ordered on patients. In case the patient only has anemia, your physicians might order the test. If the result is positive, the succeeding step could be endoscopy. Though, in case the patient has iron deficiency anemia or further signs of GI bleeding, we go straight to endoscopy. Only because the FOBT shows negative, it doesn't imply that the patient doesn't have Crohn's. CPT and ICD-9 Expert Coding Advice: Identify Colonoscopy Work
Another diagnostic measure that your gastroenterologist will carry out is a colonoscopy to check for signs of bleeding as well as inflammation. You can report this procedure with 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]).
In case your gastroenterologist treats patients with Crohn's disease (ileitis or regional enteritis), you are required to be very alert to look at diagnosis, management, as well as the treatment to correctly report your physician's care. Here is a quick medical coding and billing refresher to help guide your Crohn's disease CPT and ICD-9 coding. Usage of Consult Codes for Initial Visits
In most cases, a patient with Crohn's disease will typically present to your gastroenterologist's practice as a referral patient from their primary care physician. In case documentation states that the aim of the visit is for an opinion or advice about the patient's condition, then use consultation codes correct for the place of service. This initial visit must be considered as a consultation and must be reported using correct consultation codes 99241-99245 (Office consultation for a new or established patient... ). CPT and ICD-9 Update: Starting from Jan. 1, 2010, Medicare stopped recognizing consultation codes. They need novel patient or established patient visits to be reported for the accurate place of service. CPT and ICD-9 Coding Tip: Look for Symptoms Indicative of Crohn's Disease
Symptoms of Crohn's disease can contain chronic diarrhea (787.91, Diarrhea), chronic severe lower abdominal pain (789.0, Abdominal pain), blood in stools (578.1, Blood in stool), chronic nausea including or excluding vomiting (787.0, Nausea and vomiting), and weight loss. Signs and symptoms must be reported until Crohn's disease is established. Report Tests Conducted for Diagnosis
Your gastroenterologist might order numerous tests to confirm a diagnosis of Crohn's disease (555, Regional enteritis) prior to initiating any management of the condition. Your gastroenterologist might order simple blood tests to check for ESR and WBC counts.
Moreover, your gastroenterologist might also gather a guaiac-based fecal-occult blood test (FOBT) (82270, Blood, occult, by peroxidase activity [e.g., guaiac], qualitative; feces, consecutive collected specimens with single determination.) as this test is very helpful thinking that the sensitivity levels revealed to lower bowel bleeding. Medical Coding and Billing Tip: Guaiac based FOBT are not at all times ordered on patients. In case the patient only has anemia, your physicians might order the test. If the result is positive, the succeeding step could be endoscopy. Though, in case the patient has iron deficiency anemia or further signs of GI bleeding, we go straight to endoscopy. Only because the FOBT shows negative, it doesn't imply that the patient doesn't have Crohn's. CPT and ICD-9 Expert Coding Advice: Identify Colonoscopy Work
Another diagnostic measure that your gastroenterologist will carry out is a colonoscopy to check for signs of bleeding as well as inflammation. You can report this procedure with 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]).
