UCSF Clinical Enterprise Compliance Program

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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

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CPT CEU Coding Cruises
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Intriguing yet expensive
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Let us take you on a virtual cruise

• More cost effective!
• No shuffleboard!
• But unfortunately no buffet

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And none of this Cruise
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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 Ships Doctor

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First Port of CallScope Procedures

• Know where you are coming from
• Know where you are going
• Know what you are looking for
• Know how far the scope went

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From Top
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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.

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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.

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Esophagus sites (cont.)

• Abdominal
• Considered part of lower thoracic esophagus
  32-40 cm.

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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

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To Bottom

• The Anatomy

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The Measurements
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The Anatomy - Defined

• Parts of Colon and Rectum
• Cecum (proximal right colon)--6 x 9 cm pouch
  covered with peritoneumAppendix--a vermiform
  (wormlike) diverticulum located in the lower
  cecumAscending colon--20-25 cm long, located
  behind the peritoneumHepatic flexure--lies under
  right lobe of liverTransverse colon--lies
  anterior in abdomen, attached to gastrocolic
  ligamentSplenic flexure--near tail of pancreas
  and spleenDescending colon--10-15 cm long,
  located behind the peritoneumSigmoid colon--loop
  extending distally from border of left posterior
  major psoas muscleRectosigmoid segment--between
  10 and 15 cm from anal vergeRectum--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
  theperitoneal reflection), outside the
  peritoneal cavity.Anal canal--most distal 4-5 cm
  to anal verge

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Proctosigmoidoscopy

• examination of the rectum and sigmoid colon
• CPT 45300 through 45327

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Sigmoidoscopy

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

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Colonoscopy

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

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Scope Exercise

• It all makes sense until you see a procedure
  report
• How will you approach the actual report?
• Answer to Practice 1
• a) 45341 Sigmoidoscopy, flexible with endoscopic
  ultrasound examination
• b) 45391 Colonoscopy, flexible, proximal to
  splenic flexure with endoscopic ultrasound
  examination
• 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) 45386 Colonoscopy, flexible, proximal to
  splenic flexure with dilation by balloon, 1 or
  more strictures

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ICD 10
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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.pdf
• CMS ICD-10 Initiative
• http//www.hhs.gov/ocio/capitalplanning/exhibit300
  /FY0920Exhibit2030020pages/cmsicd10initiative.h
  tml

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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

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Is It Really That Difficult?

• Higher degree of specificity
• More codes
• All Alphanumeric
• Continuing changes each year in the refinement
  process

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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?

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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

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• 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

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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

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So What Is Your Answer?

• UTI due to E.coli

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Table of Drugs Chemicals

• One additional column
• Under-dosing
• Use of place holder x
• 1-propanol Poisoning Accidental (unintentional)
  T51.3x1

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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

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Answer to Exercise 1

• Diabetes, type 2 with ulcer
• E11.621
• Diabetic Ulcer, Midfoot, fatty layer exposed
• L97.422

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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

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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

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See You On The Next Cruise

• Skin Procedures or how to beautify on the
  high seas
• Surprise ICD 10 Coding scenarios

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