Coding Vitrectomy Procedures with Epiretinal Membrane Stripping

by Tanai S. Nelson, RHIT, CCS, CCS-P

Coding surgical procedures performed on the eye and ocular adnexa can be challenging for both novice and experienced coding professionals. CPT codes 67041–67043, which each describe a pars plana approach vitrectomy, should be assigned to report removal of the epiretinal membrane. These codes were added to the CPT code set in 2008 to better reflect the specificity of the types of vitrectomy procedures that were being performed that involved different levels of physician work and surgical intensity.

A vitrectomy is defined as the surgical extraction of the contents of the vitreous chamber of the eye. The vitreous is the clear gel filling the posterior cavity of the eyeball. These procedures are typically performed via the pars plana, one of the three layers that comprise the eye, about 4-mm long and located near the juncture of the cornea and sclera. Read more.

National Correct Coding Initiative Edits

by Melanie Endicott, MBA/HCM, RHIA, CCS, CCS-P

The Centers for Medicare and Medicaid Services (CMS) has developed a list of coding edits an effort to promote correct coding nationwide and to prevent the inappropriate unbundling of related services. The National Correct Coding Initiative (NCCI) edits help CMS detect inappropriate codes submitted on claims that are based on CPT coding guidelines, current standards of medical or surgical coding practice, and advice from specialty societies. There are three major types of coding edits: the comprehensive/component edit, the mutually exclusive edit, and the medical unlikely edit. Read more.

Crossword Puzzle: Medical Terminology

Complete the crossword puzzle to test your knowledge of medical terminology.

The New CoP

AHIMA’s all-new Communities of Practice (CoP) is launching soon. It is easier to navigate and offers exciting new ways to communicate with your peers. Network, share documents, post ideas and questions, and find helpful links. Here are some of the new features that you will find.

On your Personal Page, you will find “what’s new” and “what’s popular.” These are the top 100 newest items in the communities you belong to and the top 100 most popular items in the public communities.

You can find posted content quicker by using “topics” in each community For each topic, you can add links, documents, collaboration, or threads so everything is in one place. The key is what you want to share, not where. By joining in, you can stay current on all pertinent coding information.

ICD-10 Checkpoint

Check your knowledge. Compare ICD-9-CM codes to ICD-10-PCS codes.

What is the correct code for diagnostic needle biopsy of the right breast?

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Coding Challenges for Discussion

Vitrectomy Procedures with Epiretinal Membrane Stripping in an Ambulatory Surgery Setting

by Tanai Nelson, RHIT, CCS, CCS-P

Preoperative diagnosis: Mature cataract and proliferative diabetic retinopathy, left eye

Postoperative diagnosis: Same

Procedure: Phacoemulsification cataract extraction with intraocular lens implantation, pars plana vitrectomy, membrane peeling, left eye

History: The patient had a visually and functionally significant cataract, left eye. The patient also had advanced proliferative diabetic retinopathy. She presented today for the above procedures.

Details of Procedure: The patient was identified and taken to the operating room. Retrobulbar anesthesia with 2% lidocaine was carried out by the department of anesthesia. The eye was prepped and draped in the usual sterile ophthalmic fashion. A speculum was placed in the fornices and the operating microscope was brought into position. An infusion pump was placed for the vitrectomy. A Thornton fixation ring with a 75 blade was used to create a paracentesis site at the five o’clock position. Air was instilled into the anterior chamber followed by ICG to stain the anterior capsule. The air was replaced with Vitrax. Then a keratome was used to create a temporal 2.75-mm incision in the cornea and anteriorly into the anterior chamber. A cystotome was used to start a continuous curvilinear capsulorhexis, which was completed with O’Gawa forceps, and BSS on a cannula was used to do thorough hydrodissection and hydrodelineation until the nucleus was freely rotating. Primary phacoemulsification was carried out in divide and conquer format, creating four quadrants, subsequently breaking them, and using secondary phacoemulsification aspirating them. A diopter foldable lens was placed into the capsular bag without difficulty and spun into position.

A lid speculum was placed and a peritomy was done nasally and temporally. The instrumentation was found to be in good working order. An incision was made inferotemporally and a 4-mm cannula was placed within the eye and held in place with a 5-0 Dacron suture. The eye was entered superiorly, superonasally, and superotemporally 4 mm posterior to the limbus. The vitrectomy cutter and light pipe were placed within the eye and pars plana vitrectomy was carried out. The peripheral vitreous was removed and moved centrally where there were numerous points of attachment of the posterior hyaloid. These were removed with sharp and blunt dissection until all that remained was too small islands along the superior temporal arcade with the physician elected to leave.

Select the correct procedure codes for this patient.

1. 66984-LT, 67041-LT
2. 66984-LT, 67042-LT
3. 66984-LT, 67043-LT

Feedback

1. Incorrect answer. CPT code 67041 describes a vitrectomy procedure performed to remove a cellular membrane from the anterior surface of the macula (e.g., macular pucker).
2. Incorrect answer. CPT code 67042 describes a vitrectomy procedure performed for the repair of macular holes and for treatment of diabetic macular edema to remove the vitreous and the internal limiting membrane.
3. Correct answer!

References
CPT Assistant, October 2008, Volume 18, Issue 10
CPT 2008 Changes: An Insider’s View
CPT 2010 Professional Edition
2009 Coders’ Desk Reference, Procedures, Ingenix

Tanai S. Nelson (tanai.nelson@ahima.org) is a practice resources specialist at AHIMA

CodeWrite Continuing Education Quiz

To purchase this month’s CodeWrite quiz, visit the AHIMA Store and select “Quizzes,” followed by CodeWrite Community News, March 2010 from the list of available items. Once you have completed your purchase you will be directed to the quiz page.

Register Now for First and Second Quarter Meetings

March 3
Quality Measure Reporting: A Guide to Greater Efficiency (virtual meeting)

Quality measure initiatives continue to accelerate in the healthcare industry. Organizations are challenged by the number of required measures, qualified staff, and methods of reporting the measures. This virtual meeting gives attendees the opportunity to review best practices regarding quality measure reporting and obtaining up-to-date industry information regarding efforts to improve the efficiency of measure reporting.

AHIMA virtual meetings bring valuable educational content to your work or office. Sign up and dial into the virtual meeting to see and hear industry experts provide the latest information on quality measure initiatives. Take advantage of the live Q & A session with the speakers immediately after the meeting. CEUs: 2

March 24–25
Coding Quality and RAC: Partnering for Long Term Success
Hilton Washington, Washington, DC

Attend one or both days of this information-packed conference for updates on the rollout of the RAC program and its associated coding opportunities and challenges. The RAC program is permanent, and a clear understanding of the complete process is essential for an organization’s long-term success. CEUs: 12

April 12–13
2010 ICD-10 Summit: A Strategic Approach to Challenges and Opportunities

The second annual ICD-10 Summit is dedicated to the exploration of the challenges and opportunities of the transition to the ICD-10-CM/PCS coding systems and the 5010 HIPAA transaction. The summit gathers thought leaders from all segments of the healthcare industry to meet this challenge, because all segments are affected by this transition. The industry at large is strengthened through transparency in the exchange of information between every community. Register by March 15 to save $100. CEUs: 12

April 14
Computer-Assisted Coding Summit
Capital Hilton, Washington, DC

Who’s in charge—you or your computer? Technology dominates the HIM field, and what’s state of the art today will be replaced by something more advanced tomorrow. Feeling overwhelmed? Attend AHIMA’s Computer-Assisted Coding Summit to discuss technology’s impact on HIM’s future and discover tools to smoothly make the transition to ICD-10-CM/PCS.

Attend the Computer-Assisted Coding Summit and experience the future of automated coding workflow support firsthand! Register by March 16 for early bird savings of $100.

April 24–25
AHIMA Academy for ICD-10: Building Expert Trainers in Diagnosis Coding
FireSky Resort and Spa, Scottsdale, AZ

Concerned about the switch to ICD-10-CM or in charge of implementing the system at your facility? Remember that the transition isn’t an obstacle, it’s an opportunity—and AHIMA will help you seize it!

The AHIMA Academy for ICD-10: Building Expert Trainers in Diagnosis Coding meeting is established for coding professionals who need immediate, in-depth knowledge of ICD-10-CM, whether as educators or facilitators. An online course on the fundamentals of ICD-10-CM will provide clear, concise training in basic, intermediate, and advanced ICD-10-CM coding, while various healthcare setting case studies illustrate key points and best practices. Register now to take advantage of early bird pricing.         

AHIMA General Information

The coding roundtable process is designed to meet the needs of coding professionals by providing educational and networking opportunities. Our process is designed to be interactive—on the Internet and around the table where you work. AHIMA is the association of professionals engaged in or interested in the practice of health information management. The association, through its component state associations, provides support to members and strengthens the healthcare industry and profession by providing a voice that is 56,000-members strong. AHIMA members strive to ensure that healthcare is based on accurate and timely information.

Facilitation of accurate and consistent coding practice is a key element in carrying out this mission, so as an association we provide educational resources and representation in key national groups to support this goal. To ensure that its members meet professional standards of excellence, AHIMA issues professional credentials in health information management, including both entry-level and specialist certification related to coding. Active, associate, and student memberships are available. You can earn credentials through a combination of education, experience, and acceptable performance on national certification exams. Current AHIMA credentials include:

Registered Health Information Administrator (RHIA)
Registered Health Information Technician (RHIT)
Certified Coding Specialist (CCS)
Certified Coding Specialist-Physician based (CCS-P)
Certified Coding Associate (CCA)
Certified in Healthcare Privacy and Security (CHPS)
Certified Health Data Analyst (CHDA)

Coding roundtable participation is not restricted to membership in AHIMA. The Internet-based Communities of Practice, containing a wealth of coding information and resources, is one of many membership benefits. For more information on AHIMA membership, visit www.ahima.org or call (312) 233-1100.

Participation in the coding community and the coding roundtables ensures an integrated network of coding professionals working together to raise the standard of excellence in the coding profession. By joining together, coding roundtables can solve common problems and provide input to groups and agencies that make a difference in our workplace and the industry we serve.

CodeWrite is published twelve times a year by the American Health Information Management Association (AHIMA), 233 N. Michigan Ave., 21st Floor, Chicago, IL 60601-5809.

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March 2010

Calendar of Events

March 3
Quality Measure Reporting: A Guide to Greater Efficiency virtual meeting

March 4
Coding for Excisional versus Non-Excisional Debridement audio seminar

March 18
Developing Effective Queries audio seminar

March 24-25
Coding Quality and RAC: Partnering for Long Term Success
Washington, DC

March 25
Procedural Coding for Dialysis Services audio seminar

April 8
Coding for Congestive Heart Failure audio seminar

April 12-13
2010 ICD-10 Summit: A Strategic Approach to Challenges and Opportunities
Washington, DC

April 14
Computer-Assisted Coding Summit
Washington, DC

April 15
Stuck in a Vicious Cycle? Revenue Cycle Improvement audio seminar

April 20
Clinical Coding Workout for Acute Care Facilities audio seminar

April 22
Clinical Coding Workout for Outpatient Services audio seminar

April 24-25
AHIMA Academy for ICD-10: Building Expert Trainers in Diagnosis Coding
Scottsdale, AZ

May 5-6
Data Analyst Insitute
Chicago, IL

May 6
Relieve the Pain of Coding for Pain Management audio seminar

May 18
ICD-10-PCS: Getting to the Root of the Procedure, Part 1, audio seminar

May 20
ICD-10-PCS: Getting to the Root of the Procedure, Part 2, audio seminar

For more information and full agendas visit www.ahimastore.org or www.ahima.org/meetings/.

Upcoming AHIMA Convention & Exhibit Dates and Locations

September 25–30, 2010
Orlando, FL

October 1–6, 2011
Salt Lake City, UT

Coding Assessment and Training Solutions

Coding Assessment and Training Solutions, one of AHIMA’s Web-based offerings for experience coders, offers two distinct learning elements that may be used together or separately to meet individual or departmental training goals. Assessments are available for each course of study, providing and unbiased tool to determine strengths and weaknesses in coding ability and define a baseline for evaluating progress. Training Solutions are designed to take the most problematic issues per subject area. For more information and registration, visit http://campus.ahima.org.  

Navigate the Transition to ICD-10

Use AHIMA’s ICD-10 Web pages as a resource to help guide you through the transition to ICD-10-CM and ICD-10-PCS.

Connect and Network with Your Peers

AHIMA offers many opportunities for you to network with others online, ask questions and learn from your peers, and hear about the latest news from AHIMA.

Communities of Practice

(Members only)
Answers, support, and career advice are available through this well-established professional network. AHIMA members enjoy a wide continuum of benefits:

• Current coding news and practices
• Online forums
• Practical research materials
• Relevant education resources

The Communities of Practice is a benefit of AHIMA membership. If you are already a member, go to http://cop.ahima.org. Your user name is your AHIMA member ID including the initial zero(s). For information on becoming a member, click here.

Become a Fan of AHIMA

Check out AHIMA’s Official Facebook page. There is also an AHIMA Careers page dedicated to students and recent graduates pursuing a career in the health information field. Become a fan of one (or both) of these pages and join in the discussions.

Follow AHIMA Resources on Twitter

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