Medical Billing and Coding 1

Topics: Immune system, Innate immune system, Childbirth Pages: 6 (1534 words) Published: August 29, 2013
Part A
1. Discuss two differences between inpatient and outpatient coding.

Outpatient coding is much less complicated than inpatient coding. First, outpatient coding is limited to a length of stay less than 24 hours whereas inpatient stays are longer due to the intensity of services. Second, for outpatient services, physicians are paid using CPT/HCPCS codes, whereas, hospitals are paid for their hospitality using a complex formula (MS-DRG) because of housing, feeding and nurturing the patient back to health. During an inpatient stay, the hospital charges based on the amount of time and effort spent on nursing a patient back to health so when it comes to normal birth vs an operation for an elderly person, the hospital will charge based on the severity of the patient’s illness. When it comes to inpatient coding, coders have to be very attentive in order to correctly code the reason for the principal diagnosis because it is crucial to the MS-DRG formula. As for the outpatient coding, the first listed diagnostic code indicates the reason for the encounter. In conclusion, the outpatient coding summarizes all diagnoses and typically includes a single procedure whereas inpatient coding requires daily coding of each service on each day of hospitalization. 2. CPT Code: 21931

ICD-9-CM Code: 239.2 not correct
3. Discuss coding for obstetrics, including items covered by the global fee for antepartum and postpartum periods of normal pregnancy.
Global coding for obstetrics is basically for the services and supplies needed for the antepartum, delivery, and postpartum period of a normal pregnancy. The antepartum period of pregnancy is the time of pregnancy from conception to the onset of delivery. The initial and subsequent history, all physical examinations, recording of blood pressure, weight, fetal heart tones, routine urinalysis, and monthly visits up to 28 weeks gestation are included in antepartum care. After 28 weeks, biweekly visits up to 36 weeks gestation, and weekly visits until delivery are also included in antepartum care. Delivery services included the hospital admission with history and physical, the management of uncomplicated labor, and the vaginal or cesarean delivery. Episiotomy and the use of forceps are also included for antepartum care. For postpartum care, normal, uncomplicated hospital and office visits for 6 weeks after either vaginal or cesarean section delivery are included. Part B

What is the difference between Excludes1 and Excludes2 notes in the ICD-10? 1. Excludes 1 means “not coded here,” which indicates that the code excluded should never be used at the same time as the code in this section. Two conditions may not be reported together.

Excludes 2 means “not included here,” which indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time.

2. What are some of the problems associated with modifiers -51 and -59?

When assigning modifier -51 to multiple procedures, you have to be careful to not add the modifier to each procedure. Instead add it to the primary procedure which is the procedure with the highest relative value unit when the multiple procedures are performed on the same day or at the same session by the same provider. In addition, if the second surgery is incidental to a major procedure then both services would be reported but the modifier -51 would only be added to the lesser of the two services.

As for modifier -59, it is reported with codes from all sections of the CPT manual except E/M codes. This modifier has been abused by providers excessively by submitting the surgery and follow up codes separately when the follow up should be already bundled together. Providers who have used the modifier -59 are claiming that the service was a part of another service but doing that is a lie. 3. What are the two types of immunity and how do they differ?

Innate immunity, or...
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