CODING FOR PEDIATRICS...6/30/2015 2 Speaker: Ray Jorgensen, MS, CPC, CHBME Raymond T. Jorgensen is a Co-Founder & Partner at PMG, Inc. (PMG). Ray is responsible for oversight of consulting

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CODING FOR PEDIATRICS

PMG, Inc.700 School StreetPawtucket, RI 02860P: 401-616-2000F: 401-616-2001E: [email protected]

Code Set 4 in the SeriesAnswers to the Assignment

Agenda

© 2015, PMG, Inc. All Rights Reserved

• Coding for Pediatrics - Examples

• Next Steps


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Speaker: Ray Jorgensen, MS, CPC, CHBME

Raymond T. Jorgensen is a Co-Founder & Partner at PMG, Inc. (PMG). Ray is responsible for oversight of consulting operations as well as coding, reimbursement, and payer related issues for the out-sourced billing component of PMG’s services (more than 1.2 million annual encounters). He has personally trained thousands of providers from over 35 states on coding, billing, and reimbursement in addition to authoring several books and dozens of articles.

Ray’s health care experience and education is unique in that he was schooled by the payers. Having worked for Blue Cross and Blue Shield as well as United HealthCare Corporation, primarily in professional relations and contracting, Ray has an understanding and perspective on the payer’s objectives and process unlike other medical business consultants groomed from the provider side. He continues to travel nationally working with clients and strategic partners to enhance opportunities for the success of CHCs around coding, billing, and reimbursement.

• BA from The College of the Holy Cross (Worcester, MA)

• MS from Northeaster University (Boston, MA(

• CPC from the American Academy of Professional Coders (Salt Lake City, UT)

• CHBME from the Healthcare Billing & Management Association (Laguna Cliffs, CA)

© 2015, PMG, Inc. All Rights Reserved© 2015, PMG, Inc. All Rights Reserved

1. The coding guidelines, interpretations, and recommendations set forth as part of this training session are presented as a guide only. Attendees understand and recognize that actual coding decisions are the sole liability and responsibility of the provider(s) and respective billing staff. PMG, Inc. does not accept any liability or responsibility in this regard.

2. The presentation today may include discussion about a particular commercial product/service and the presenter has significant financial interest/relationship with the organization that provides this product/service.

Disclaimer

© 2015, PMG, Inc. All Rights Reserved© 2015, PMG, Inc. All Rights Reserved

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These codes are for patients who do not show any sign or symptom of a disease but are suspected to have been exposed to it by close personal contact with an infected individual or are in an area where a disease is epidemic

A Personal history

indicate that a patient is either a carrier of a disease or has the sequelae or residual of a past disease or condition

B Counseling

testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease

C Aftercare

explains a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring

D Follow-up

for use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease.

E Family history

cover situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase

F Contact/exposure

to explain continuing surveillance following completed treatment of a disease, condition, or injury

G Status codes

used when a patient or family member receives assistance in the aftermath of an illness or injury, or when support is required in coping with family or social problems

H Screening

f

g

h

a

e

c

d

b


Answer: H01.119

1.Contact Dermatitis of the Eye


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Answer: L60.0

2.Infected ingrown toenail, right great toe


3.Bronchial asthma, allergic, due to house dust(1 of 2)


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Answer: J45.909

3.Bronchial asthma, allergic, due to house dust(2 of 2)


4. Mild intermittent asthma with status asthmaticus

Answer: J45.22


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5.Pneumonia, bacterial, left upper lobe (1 of 2)


Answer: J15.9

5.Pneumonia, bacterial, left upper lobe (2 of 2)


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Answer, Part 1: H72.91

6.Perforation of tympanic membrane due to chronic suppurative otitis media, right ear (1 of 3)




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Answer, Part 2: H66.3X1

Final Answer: H66.3X1, H72.91


7.Acute suppurative otitis media, with spontaneous rupture of ear drum, right ear

Answer: H66.011© 2015, PMG, Inc. All Rights Reserved

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8. Swimming-pool conjunctivitis

Answer: B30.1


9. Intractable epilepsy, grand mal type, status Epilepticus (1 of 2)


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9.Intractable epilepsy, grand mal type, status Epilepticus (2 of 2)

Answer: G40.411


10.Type 1 diabetes with ketoacidosis

Answer: E10.10


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11.Type 1 diabetes with diabetic nephrosis


11. Type 1 diabetes with diabetic nephrosis

Answer: E10.21


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12.Visit to change surgical dressing

Answer: Z48.01


13. Dysuria

Answer: R30.0


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14. Syncope, cause undetermined

Answer: R55


15.Well baby exam, baby is 3 months old, without abnormal findings

Answer: Z00.129


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16.Down Syndrome

Answer: Q90.9


17. Feeding problems in a 10 day old infant

Answer: P92.9


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18.Immunization for MMR

Answer: Z23


19.Colic

Answer: R10.83


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20. Cardiac Murmur, in infant

Answer: R01.1


21. Nursemaid’s elbow, left elbow, initial encounter

Answer: S53.032A


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22. Anaphylactic reaction due to eating peanuts initial encounter (1 of 2)


22. Anaphylactic reaction due to eating peanuts, initial encounter (2 of 2)

Answer: T78.01XA


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23.Superficial burns of face and chest due from a tanning bed (1 of 2)


23. Superficial burns of face and chest from a tanning bed (2 of 2)

Answer, Part 1: L56.8

Answer, Part 2: W89.1XXA, D or S- Ask

doc for more info.


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24. Headache due to lumbar puncture

Answer: G97.1


25. Examination for eye and vision without abnormal findings

Answer: Z01.00


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Complete Homework Assignment on next page

Fill in complete first and last name as you wish it to appear on your CEU certificate

Scan completed homework and email to: [email protected]

1.5 CEUs will be emailed to the email address provided on completed homework

Next Steps


Full First and Last Name:_________________________________________________________________ Organization Name_____________________________________________________________________ Email address_________________________________________________________________ MIPCA

Ecourse 4/Set 4 – ICD 10 Coding for Pediatrics Submit Homework to: [email protected]

Page 1 of 3

1. Match the following

These codes are for patients who do not show any sign

or symptom of a disease but are suspected to have been exposed to it by close personal contact with an infected individual or are in an area where a disease is epidemic

A Personal history

indicate that a patient is either a carrier of a disease or has the sequelae or residual of a past disease or condition

B Counseling

testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease

C Aftercare

explains a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring

D Follow-up

for use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease.

E Family history

cover situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase

F Contact/exposure

to explain continuing surveillance following completed treatment of a disease, condition, or injury

G Status codes

used when a patient or family member receives assistance in the aftermath of an illness or injury, or when support is required in coping with family or social problems

H Screening



Page 2 of 3

2. Contact dermatitis of the eyelid

3. Infected ingrown toenail, right great toe

4. Bronchial asthma, allergic, due to house dust

5. Mild intermittent asthma with status asthmaticus

6. Pneumonia, bacterial, left upper lobe

7. Perforation of tympanic membrane due to chronic suppurative otitis media, right ear

8. Acute suppurative otitis media, with spontaneous ear of ear drum, right ear

9. Swimming-pool conjunctivitis

10. Intractable epilepsy, grand mal type, status epilepticus

11. Type 1 Diabetes with ketoacidosis

12. Type 1 diabetes with diabetic nephrosis

13. Visit to change surgical dressing

14. Dysuria



Page 3 of 3

15. Syncope, cause undetermined

16. Well baby exam, baby is 3 months old, without abnormal findings

17. Down Syndrome

18. Feeding problems in a 10 day old infant

19. Immunization for MMR

20. Colic

21. Cardiac Murmur, in infant.

22. Nursemaid’s elbow, left elbow, initial encounter

23. Anaphylactic reaction due to eating peanuts, initial encounter

24. Superficial burns of face and chest due from a tanning bed.

25. Headache due to lumbar puncture

26. Examination for eye and vision without abnormal findings

Documents

CODING FOR PEDIATRICS...6/30/2015 2 Speaker: Ray Jorgensen, MS, CPC, CHBME Raymond T. Jorgensen is a Co-Founder & Partner at PMG, Inc. (PMG). Ray is responsible for oversight of consulting