Become Expert in Coding CPT code 97597, 97598 and 97602


We have already learnt a lot in surgery coding. We are now updated with the new spinal epidural injection codes of 2017. To become a perfect in coding, coders really need to remain updated with each and every CPT code. Medical coders need to be more perfect in coding diagnostic and interventional radiology cpt codes. Every year their have been lot of new codes added in the procedure coding. Hence, coders need to be more focused while coding new codes. Earlier we have learnt about selective and non-selective catheterization of veins. We have going to learn more about selective and non-selective techniques in coding debridement procedure.

Coding guidelines for CPT code 97597, 97598 and 97602

There are two types of debridement, selective and non-selective. In Selective debridement techniques, the provider has complete control over the tissue which is being removed. These techniques include the use of high pressure waterjet with or without suction. Also, the use of scissors, a scalpel or forceps is required for selective debridement. We have separate CPT codes for these types of debridement. CPT code 97597 and 97598 are used for coding selective debridement.  These codes are used when the debridement is done on epidermis and/or dermis level of skin only. While the non-selective debridement which involves removal of devitalized tissue from the wound.  These debridement techniques are done without anesthesia and do not involve the use of sharp objects. If you can see the code description, it will include the topical application, dressing, larval therapy as well. CPT code 97602 is used for coding these non-selective debridement procedures. These procedures may require more than one visit.



CPT code description for 97597, 97598 and 97602


97597: Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less

97598; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

(Use 97598 in conjunction with 97597);

97602: Removal of devitalized tissue from wound(s), nonselective debridement, without anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session

Non-selective debridement is used to promote healing using non-selective debridement techniques. These are also sometimes referred as mechanical debridement. This technique includes wet to moist dressing, enzymatic chemicals, abrasion and larval therapy. There is not surface area specified for coding 97602 CPT code.


Use CPT code 11043-11046 for coding debridement of muscle. Only when the epidermis and dermis portion of the skin is debrided, use active wound care management CPT Code 97597 & 97598.

Become perfect in Coding CT colonography CPT codes


The virtual colonoscopy is also referred as CT colonography. You must be aware of coding screening colonoscopy, but for coding CT colonography we have separate codes in radiology section. Same like MRI procedurecodes, CT codes also have to be coded with contrast and without contrast. Till now we have learnt about the ultrasound cpt code, X ray procedures, MRI exam etc. in radiology. But, still few procedure codes were missed to share and today we will learn the procedure codes for Computed tomography colonography.

CT colonography CPT code 74261, 74262 and 74263


Code description of CT Colonography


Since, we are here to gain knowledgein medical coding, the description of CPT codes will be easy to understand these exams very well. Unlike, the diagnostic exam of Lumbar Puncture or arthrocentesis in IVR, these codes are very straight. Here, you don’t need to worry about any ultrasound guidance or fluoroscopy codes. These procedures require only one code to define the exam. Below is the code description of these procedure codes.

74261 Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material

74262         with contrast material(s) including non-contrast images, if performed

74263 Computed tomographic (CT) colonography, screening, including image postprocessing

When to report CPT code 74261 and 74262


This exam helps in the detection of colon polyps and colon cancer. It is diagnostic exam which is performed only after checking the patient’s past medical history and physical examination. CPT code 74261 and 74262 are used frequently for coding these procedures. Presence or absence of intravenous contrast differentiate these procedure codes. The third cpt code 74263 is used specially for screening CT colonography. Interpretation of the full exam should be performed in order to report this procedure code.

Do code report code 76463 in conjunction with codes 72192-72194, 74150-74170, 74261, 74262, 76376, and 76377.


Simple Easy steps to Clear CPC exam in 2017


Medical coding is one the best career option for all the life science graduates. But, to sustain in this field for long time medical coders need to work really hard. I myself have finished 7 years in medical coding and I really enjoyed this journey. One thing you should always remember, whatever you do in life always enjoy it to the fullest. Initially I was very scared that how I will be able to make a career in medical coding. My first year as Medical coder was full of struggle. Since, I was new to this field I have to learn everything about it. But, later I learnt about ICD, CPT, HCPCS codes and got familiar with these medical codes. Few years later I cleared CPC (Certified Professional Coder) exam and I am still trying to learn the other facilities in medical coding. This was in short I told my story. But, today I will share all the tricks I followed for clearing CPC exam and what new things should be followed for 2017 CPC exam.

Simple Easy steps to Clear CPC exam in 2017

CPC Practice Exam - Medical Coding Study Guide Please Click Here!


Be Updated with ICD 10 and CPT codes


From 2017, we have lot of changes in ICD 10 and CPT codes. The diagnosis codes have again increased in number. Since, ICD 10 codes are little difficult to learn, it is very important to focus more on diagnosis coding. Always remember to follow ICD 10 coding guidelines before answering any question in CPC exam. Same goes with the CPT codes, you should always follow the codebook. The CPT codebook will always guide you to the correct CPT codes. Do not forget to read the notes below CPT codes, many answers will be hidden in these sections. Try to highlight all the important section in ICD 10 and CPT codebook, so that you should be easily find them during CPC exam. Time is very important during CPC exam, which needs to be used very carefully. If you give proper time to each question you can easily find answers for most of the questions.


Be Confident with ICD 10 codes


If you want to clear CPC exam in 2017, you should be thoroughly prepared with ICD 10 coding guidelines. For examples, coding for Sepsis, pregnancy complication, use of Z codes, external Cause of injury codes etc. needs to be taken care. These topics generally requires two or more than two ICD 10 codes, hence one should not waste time during exam to find the multiple codes. Hence, be prepared with tough topics of ICD 10 and save your time in exam. Even CPT surgery questions requires lot of time, so divide your time among ICD 10 and CPT codes, to answer each question correctly. Also, in ICD 10 the initial, subsequent and sequela encounter codes need to be taken care. These section of ICD 10 codes might confuse you during CPC exam, hence be prepared with all these chapters in ICD 10.  


Be Prepared with CPT section


The main section for CPT codes in the surgery section. The question paper of CPC exam starts with surgery questions. I always suggest medical coders not to attempt the surgery questions in the beginning. These questions eat lot of time and hence should be attempted at the end. First try to solve the one or two liner questions which will take less than a minute to solve. Once, you have finished answers all the short questions, then go an attempt the big surgery question. Always remember, you have to finish the entire question paper and attempt all the question. Since there is no negative marking, you should be able to answer all the CPC exam questions.


Avoid silly Errors



Most of the time we do not focus on silly errors and these errors decreases our CPC exam score. First of all, finish your question paper before 30 minutes so that you can check your entire answer sheet for any unanswered question. Most of time, coders leave some questions to attempt them in the end, but in the end they might forget to answer those questions. Hence, try to check your answer sheet once before submitting to the invigilator. Secondly, do not waste time on single question, since we have to attempt all the question divide you time in such a way that, you should be able to answer all the questions. CPC exam has no negative marking; hence coders should always attempt all the questions in the question paper. Finally, be focused during CPC exam, if you are scared you will not find the answer but if you concentrate and read the question correctly you can easily find the correct answer. The more stable you are during CPC exam, the more the chances you have to pass CPC exam in 2017.

When to use CPT code 50432 and 50389

Coding for diagnostic nephrostogram can be little complicated sometimes. For example, when there is no clear documentation of new access or existing access, codingfor antegrade nephrostogram for CPT code 50430 and 50431 will be very complicated. This complication will be more when there is an interventional procedure is performed along with antegrade or diagnostic nephrostogram. So, today I am just trying to clear your doubt about how we can use these CPT code together with or without modifier in CPT coding.

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Read also: New CPT codes for 2017 for Spinal Epidural Injection

CPC Practice Exam - Medical Coding Study Guide Please Click Here!


Code description for CPT code 50430, 50432 and 50389


If you see the below description of these codes, you can see the imaging guidance and the radiological supervision and interpretation (RS&I) are included with the main procedure codes.

CPT 50430 : Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; new access 

CPT 50431 : existing access 

50389 Removal of nephrostomy tube, requiring fluoroscopic guidance



Sample coded report for CPT code 50430, 50432 and 50389



VAS/SP GENITOURINARY INTERVENTION
INDICATION:
Bilateral ureteral obstruction, status post bilateral internal
ureteral stents. Left external nephrostomy catheter remains.

EXAM:
GENITOURINARY INTERVENTION

MEDICATIONS:
None.

ANESTHESIA/SEDATION:
None.

CONTRAST:  20 cc Visipaque 320 - administered into the collecting
system(s)

FLUOROSCOPY TIME:  Fluoroscopy Time: 24 seconds

COMPLICATIONS:
None immediate.

PROCEDURE:
Informed written consent was obtained from the patient after a thorough discussion of the procedural risks, benefits and alternatives. All questions were addressed. Maximal Sterile Barrier Technique was utilized including caps, mask, sterile gowns, sterile gloves, sterile drape, hand hygiene and skin antiseptic. A timeout was performed prior to the initiation of the procedure.

Under sterile conditions, the existing left nephrostomy catheter was injected for antegrade nephrostogram. This demonstrates mild left hydroureteronephrosis. Left ureteral stent is patent and in good position. Ureteral jets demonstrated. Bladder is visualized with contrast.

Under sterile conditions, the existing left nephrostomy catheter was cut and removed over a guidewire under fluoroscopy. Sterile dressing applied. No immediate complication.

IMPRESSION:
Antegrade nephrostogram confirms patency of the left internal ureteral stent. Mild residual left hydroureteronephrosis noted.
                                                                                           
Uncomplicated left nephrostomy removal under fluoroscopy.

CPT code: 50431-59
                    50389


Rationale: The above report has some highlighted section. In the first section, you can see clearly an antegrade nephrostogram is performed with the existing access. Also, after the exam the physician has mentioned the finding, hence this will be coded as CPT code 50431.

The second highlighted section, removal of the nephrostomy tube under fluoroscopy, which is coded as CPT code 50489.

When we check for NCCI edit, it is seen that both codes cannot be coded together without a modifier. Hence, 59 modifier is assigned to CPT code 50431-59 to bypass the edit.


Amazing tips for CPT code 62320, 62321, 62322, 62323 in 2017


There are lot of changes in cpt codes in 2017. For example, the old codes for screening and diagnostic mammogram have been deleted and the new CPT code 77065, 77066and 77067 have been added. Also these new codes are bundled codes which includes the Computer aided detection (CAD). Similarly, we have new CPT codes 62320, 62321, 62322, 62323, 62324, 62325, 62326 and 62327 for coding Spinal injection procedures. Earlier we used procedure codes 62310, 62311, 62318, 62319 for coding spinal injection exam till 2016. But from 2017 we will be using new CPT codes for these exams. Let us check when these CPT codes should be used for these exams.
 
Amazing tips for CPT code 62320, 62321, 62322, 62323 in 2017
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Read also: When to use Modifier 47, 50 and 51

CPC Practice Exam - Medical Coding Study Guide Please Click Here!


Coding tips for CPT code 62320 and 62321


If you read the code description, the first basic difference between CPT code 62320 and 62321 is the used of imaging guidance. So, when a spinal steroid injection is performed percutaneously into interlaminar epidural or subarachnoid, cervical or thoracic region, and if it is performed without imaging guidance report CPT code 62320. But when the same exam is performed using imaging guidance like fluoroscopy or CT, use CPT code 62321. Below is the full code description for both these procedure codes.

62320 - Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance

62321- Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT)

Coding tips for CPT codes 62322 and 62323


These CPT codes should be reported only when the spinal steroid injection is performed in the interlaminar epidural or subarachnoid, lumbar or lumbosacral region. Here also, use CPT code 62322 when the exam is performed without imaging guidance and for exam with imaging guidance use CPT code 62323. Below is the full code description for both the procedures codes.

62322 - Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance

62323 - Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)


Sample coded Report for CPT code 62320, 62321, 62322 & 62323


RAD/DG NONSEL EPI INJ LUM/SAC EA
CLINICAL DATA:  Lumbosacral spondylosis without myelopathy. RIGHT
leg radicular symptoms.

FLUOROSCOPY TIME:  13 seconds corresponding to a dose of 10.5 mGy.

PROCEDURE:
The procedure, risks, benefits, and alternatives were explained to
the patient. Questions regarding the procedure were encouraged and
answered. The patient understands and consents to the procedure.
Time-out performed.

LUMBAR EPIDURAL INJECTION:

An interlaminar approach was performed on RIGHT at L5-S1. The
overlying skin was cleansed and anesthetized. A 20 gauge Crawford
epidural needle was advanced using loss-of-resistance technique.

DIAGNOSTIC EPIDURAL INJECTION:

Injection of Omnipaque 180 shows a good epidural pattern with spread
above and below the level of needle placement, primarily on the
RIGHT; no vascular opacification is seen.

THERAPEUTIC EPIDURAL INJECTION:

120.0 Mg of Depo-Medrol mixed with 2 mL 1% lidocaine were instilled.
The procedure was well-tolerated, and the patient was discharged
thirty minutes following the injection in good condition.

COMPLICATIONS:
None.

IMPRESSION:
Technically successful epidural injection on the RIGHT L5-S1 # 1.

CPT code – 62323

Since the above epidural steroid injection exam is performed in the lumbosacral region percutaneously in the presence of fluoroscopic guidance, CPT code 62323 has been reported for this exam.