1. UCSF Clinical Enterprise Compliance Program CECP Education Series Wanda T. Ziemba MFA RHIT CHCO CHCC CHC CPC Associate Compliance Officer & Clinical Enterprise Compliance Program Educator

2. CPT CEU Coding Cruises …

3. Intriguing yet expensive

4. Let us take you on a virtual cruise… More cost effective! No shuffleboard! But … unfortunately no buffet …

5. And none of this Cruise

6. Your Cruise Itinerary for the Summer June 19 – Cruising Down the Alimentary Canal July 17 – Beauty Is Skin Deep August 21 – Getting to Know the Ship’s Doctor

7. First Port of Call: Scope Procedures Know where you are coming from Know where you are going Know what you are looking for Know how far the scope went

8. From Top …

9. Esophagus Sites Cervical: –Cervical begins at the lower end of pharynx (level of 6th vertebra or lower border of cricoid cartilage) and extends to the thoracic inlet (suprasternal notch); 18 cm from incisors.

10. Esophagus Sites (cont.) Thoracic: –Upper thoracic: from thoracic inlet to level of tracheal bifurcation; 18-23 cm. –Mid thoracic: from tracheal bifurcation midway to gastroesophageal junction; 24-32 cm. –Lower thoracic: from midway between tracheal bifurcation and gastroesophageal junction to GE junction, including abdominal esophagus; 32-40 cm.

11. Esophagus sites (cont.) Abdominal –Considered part of lower thoracic esophagus; 32-40 cm.

12. Upper GI Endoscopy The Codes: –43234 through 43259 in your CPT book The Exercise: –See handout, first part of procedure report The Prize: –You must participate to find out! –And attend all sessions

13. To Bottom The Anatomy

14. The Measurements

15. The Anatomy - Defined Parts of Colon and Rectum Cecum (proximal right colon)--6 x 9 cm pouch covered with peritoneum Appendix--a vermiform (wormlike) diverticulum located in the lower cecum Ascending colon--20-25 cm long, located behind the peritoneum Hepatic flexure--lies under right lobe of liver Transverse colon--lies anterior in abdomen, attached to gastrocolic ligament Splenic flexure--near tail of pancreas and spleen Descending colon--10-15 cm long, located behind the peritoneum Sigmoid colon--loop extending distally from border of left posterior major psoas muscle Rectosigmoid segment--between 10 and 15 cm from anal verge Rectum--12 cm long; upper third covered by peritoneum; no peritoneum on lower third which is also called the rectal ampulla. About 10 cm of the rectum lies below the lower edge of the peritoneum (below the peritoneal reflection), outside the peritoneal cavity. Anal canal--most distal 4-5 cm to anal verge

16. Proctosigmoidoscopy examination of the rectum and sigmoid colon CPT: 45300 through 45327

17. Sigmoidoscopy examination of the entire rectum, sigmoid colon and may include examination of a portion of the descending colon CPT 45330 through 45345

18. Colonoscopy examination of the entire colon, from the rectum to the cecum, and may include the examination of the terminal ileum 45355 through 45392

19. Scope Exercise It all makes sense until you see a procedure report How will you approach the actual report? Answer to Practice #1 –a–a) 45341 Sigmoidoscopy, flexible; with endoscopic ultrasound examination –b–b) 45391 Colonoscopy, flexible, proximal to splenic flexure; with endoscopic ultrasound examination –c–c) 45378 Colonoscopy, flexible, proximal to splenic flexure; diagnostic with/without collection of specimen (s) by brushing/washing, with/without colon decompression (separate procedure) –d–d) 45386 Colonoscopy, flexible, proximal to splenic flexure; with dilation by balloon, 1 or more strictures

20. ICD – 10

21. Recent Regulatory Developments CMS – all systems for CID-10 compliant by 01-01-2001 and implementation mandatory by 01-01-2012 –http://www.cms.hhs.gov/PerformanceBudget/ Downloads/CMSFY09CJ.pdfhttp://www.cms.hhs.gov/PerformanceBudget/ Downloads/CMSFY09CJ.pdf CMS ICD-10 Initiative –http://www.hhs.gov/ocio/capitalplanning/exhibi t300/FY09%20Exhibit%20300%20pages/cmsi cd10initiative.htmlhttp://www.hhs.gov/ocio/capitalplanning/exhibi t300/FY09%20Exhibit%20300%20pages/cmsi cd10initiative.html

22. What Does It Look Like? Alphanumeric codes 3-7 places, not counting the decimal or placeholders Tabular has 21 chapters Each chapter has subchapters or blocks Each block begins with a letter followed by two numbers The E and V codes are combined into the full classification system

23. Is It Really That Difficult? Higher degree of specificity More codes All Alphanumeric Continuing changes each year in the refinement process

24. Example UTI due to E. coli –21 year old presents with urinary tract infection due to Escherichia coli What is the code for UTI in the ICD-9-CM” How would you add the E.coli infection in the ICD-9-CM?

25. ICD-10 Infection, infected, infective (opportunistic) urinary (tract) N39.0 Due to E/coli: –Infection, infected, infective (opportunistic) Escherichia (E.) coli NEC A49.8 –As cause of disease classified elsewhere B96.2 –Congenital B39.8 »Sepsis P36.4 –Generalized A41.51 –Intestinal – see Enteritis, infectious, due to Escherichia coli

26. N39 Other disorders of urinary system –Excludes 2: hematuria NOS (R31-) – recurrent or persistent hematuria with specified morphological lesion (N02-) N39.0 Urinary Tract Infection, site not specified –Use additional code (B95-B97) to identify infections agent –Excludes 2: Candidiasis of urinary tract (B37.4) Neonatal urinary tract infection (P39.3) Urinary tract infection of specified site

27. Exclusion Notes Exclusion 1: –Not coded here. Two conditions cannot occur together such as a congenital and acquired condition Exclusion 2: –Not included here; two conditions may be coded together

28. So What Is Your Answer? UTI due to E.coli

29. Table of Drugs & Chemicals One additional column –Under-dosing Use of place holder “x” –1-propanol Poisoning Accidental (unintentional) T51.3x1

30. Exercise 1 60 year old male admitted with diabetes mellitus type 2 and a stage 2 left midfoot ulcer; –Diagnosis: Ulcer of left midfoot due to type 2 diabetes mellitus

31. Answer to Exercise 1 Diabetes, type 2 with ulcer –E11.621 Diabetic Ulcer, Midfoot, fatty layer exposed –L97.422

32. Exercise 2 24 year old male patient, professional baseball player, was struck accidentally by a baseball bat while playing ball today at the Oakland Coliseum. Radiographs performed at the UCSF Medical Center show a transverse displaced fracture of the right femoral shaft. He is admitted for open reduction and internal fixation of the right femur. Diagnosis: Right closed displaced transverse femoral shaft fracture

33. Answer to Exercise 2 Closed, transverse right femoral shaft fracture –S72.321A Struck by Baseball bat –W21.11xA Occurring at athletic field –Y92.320 Playing group sport – baseball –Y93.0222

34. See You On The Next Cruise Skin Procedures – or – how to beautify on the high seas Surprise ICD – 10 Coding scenarios