Alaska Native Tribal Health Consortium NEWSLETTER Business Resource Center SEPTEMBER IS PROSTATE

Alaska Native Tribal Health Consortium
Business Resource Center
NEWSLETTER
Services Provided
by the Business
Resource Center
•
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Coding
•
CODING
•
CODING
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Yes, we can code for you!
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Coding Audits
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Medical & Dental Billing Support
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Coding & Billing Mentoring
BRC MISSION STATEMENT
To support, educate and train
members of the Alaska Tribal
Health System in coding, reimbursement and revenue cycle
management, thereby empowering tribal facilities to sustain their
operations and improve cash
flow.
GET READY FOR NEW
ICD-9-CM CODES
OCTOBER 1
206 NEW CODES
55 REVISED CODES
AND 28 DELETED
CODES
September 30, 2006
A
50 year old male
presents to clinic with the
need to urinate frequently
during the night, but with inability to urinate. Blood is
drawn for PSA. Results show
elevated PSA levels. The provider performs a digital rectal
exam of the prostate and a
diagnosis of acute prostatitis
is made. The provider recommends the patient undergo
a biopsy of the prostate. Patient agrees and appointment
is scheduled for the following
day.
What are the correct
ICD-9-CM codes for this
visit?
(Customized, on-site)
Analysis of accounts receivable
Volume 12, Issue 1
SEPTEMBER IS PROSTATE
CANCER AWARENESS MONTH
Business Office Training to
include medical billing, dental
billing and oversight.
•
Business Office and
Coding Support
A. 601.0; 790.93;
B. 788.41; V13.09; 601.0
C. V76.44; 601.0
Answer on page 3
Who needs to know about Prostate Cancer?
All men need to be Real Men and know about prostate cancer and take
a greater interest in their general health. Prostate cancer is the most
common form of cancer in men - finding out about it could save your
life.
The risk of getting prostate cancer gets higher as you get older. Most
men are diagnosed over the age of 50, but it can affect men from the age
of about 40. You are two and a half times more likely to get prostate
cancer if your father, brother or son has been diagnosed. The risk is also
higher if you are of African American background.
However, prostate cancer does not just affect men - it also affects their
friends and family. During Prostate Cancer Awareness Week it's important that information about this disease reaches as many people as possible, so that we can all help our fathers, grandfathers, uncles, brothers,
sons, husbands and partners know about it.
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Volume 12, Issue 1
To Code or Not to Code:
That is the question….
Article this month is by Kevin Maier CPC.
Coder’s
Corner
Happy Fall everyone. At this time of year I’m sure that a few of you out there are seeing some coding situations related to seasonal related physical exams.
Quite often they are called things like “Sports Physicals” or “School Physicals” and you may be wondering what codes should be used? These exams are
preventative in nature but often times they don’t meet the requirements for coding the Preventative service codes. Even so the AMA states that the Preventative Service codes are to be used only when the History, Physical and Examination are “Comprehensive”. While this is well and good the CPT book
doesn’t supply clear guidelines about how to code these visits if the requirement of “Comprehensive” is not met. This is where we find ourselves looking
to other resources to come up with clear consistent guidelines for our facility. The AMA has officially addressed the issue of such "sports physicals" on
three separate occasions: the first was in the July 1996 issue of The CPT Assistant, the second was in the August 1997 issue of The CPT Assistant, and the
third was in the 1999 edition of The CPT Companion book. Here are the sightings:
CPT Assistant July 1996:
Question: What code should I use to report a "sports" physical?
AMA Comment: If the physician performs a comprehensive history and examination, then you should report the age appropriate code from the Preventive Medicine series. If the physician performs a brief, detailed, or extended history and examination, then report the appropriate level office or other
outpatient evaluation and management visit code.
CPT Assistant August 1997:
Question: What code should I use to report a "sports physical" or a "school physical?"
If the physician performs a comprehensive history and examination, then you should report the age appropriate code from the preventive medicine series.
If the physician performs a problem focused, expanded problem focused or detailed history and examination, then report the appropriate level office or
other outpatient evaluation and management visit code.
The CPT Companion book 1999:
Question: What code should I use to report a "sports" physical?
AMA Comment: If the physician performs a comprehensive history and examination, then you should report the age appropriate code from the preventive medicine series. If the physician performs a problem focused, expanded problem focused or detailed history and examination, then report the
appropriate level office or other outpatient evaluation and management visit code.
Now keep in mind that these articles address specifically “sports physicals”. But in essence the guidelines should be applied to any preventative services
that do not meet the requirements of the preventative service codes. Have a great Fall and remember to think healthy both physically and fiscally.
KEVIN AND CHERI NEED A BREAK!
CONTEST!
Would you like to be the author of next month’s Coding Article? Would you
like to come up with next month’s Coding Quiz question/answer? Do you
have a question that needs an answer? Submit your stuff to
[email protected] and the winners will get an E/M Coding Wheel!
Please send a picture of yourself if you have it and we’ll publish your photo
along with your winning submission and you will be FAMOUS!
ANOTHER GREAT WEBSITE THAT YOU SHOULD CHECK OUT IS
www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp
There are some great “cheat sheets” for coding preventive services and immunizations!
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Volume 12, Issue 1
10 THINGS EVERYONE SHOULD
KNOW ABOUT PROSTATE CANCER
1. 1 in every 6 men will get prostate cancer sometime in his life. Over 234,460 new cases are expected this year—more than breast cancer.
2. The chances of getting prostate cancer are 1 in 3 if you have just one close relative (father,
brother) with the disease. The risk is 83% with two close relatives. With three, it’s almost a
certainty (97%).
3. African American men are at special risk for the disease, with the highest rate of prostate cancer
in the world: 1 in 4 men. African American men are 2.5 times more likely to die from the disease.
4. Prostate cancer is the second-leading cause of cancer-related death in the US.
5. There are no noticeable symptoms of prostate cancer while it is still in the early
stages. This is why screening is so critical.
6. Every man age 50 or over should resolve to be screened annually. African American men or
those with a family history of the disease should start annual screening at 40.
7. Before early detection through PSA screening, only 1 in 4 prostate cancer cases were found
while still in the early stages. With the widespread use of screening, about 9 out of 10 cases are
now found early—giving men a fighting chance.
8. Nearly 100% of men diagnosed with prostate cancer while it is still in the early stages are still
alive 5 years from diagnosis. Of men diagnosed in the late stages of the disease, 33.4% survive 5
years.
9. Screening for prostate cancer involves a simple blood test and a physical exam. It takes about 10
minutes and is covered by most health insurance.
10. Obesity is a significant predictor of prostate cancer severity. Research levels show high cholesterol levels are strongly associated with advance prostate cancer.
www.FightPRostateCancer.org
Answer to coding quiz from page 1: The correct answer is A. 601.0—Acute
Prostatisis; 790.93—Elevated PSA.
Cheri’s Coding Quiz is developed each month by the BRC’s Cheri Carter,
CPC
Medicaid Task Force FORUM meetings are being held every other week to discuss proposed changes to existing Medicaid policy specific to the
tribes in Alaska. For more information, please contact Gwen Obermiller at: [email protected]
UPCOMING EVENTS
The Alaska Chapter of the American Academy of Professional Coders (AAPC) is hosting their
semi-annual educational seminar on Saturday, October 28 at the Senior Center in Anchorage.
Cheri Carter, CPC is on the planning committee, so call her (907-729-2894) for more information.
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Volume 12, Issue 1
PROSTATE CANCER CODES
IN THE KNOW
V16.42
FAMILY HISTORY PROSTATE CANCER
V10.46
PERSONAL HISTORY PROSTATE CANCER
V13.09
PERSONAL HISTORY URINARY SYSTEM DISORDER
V76.44
SPECIAL SCREENING FOR MALIGNANT NEOPLASMS-PROSTATE
595.2
600.00
OTHER CHRONIC CYSTITIS
HYPERTROPY (BENIGN) OF PROSTATE WITHOUT URINARY
OBSTRUCTION
602.3
DYSPLASIA OF PROSTATE
601.0
PROSTATITIS
185
MALIGNANT NEOPLASM PROSTATE
G0102
SCREENING PROSTATE CANCER DIGITAL RECTAL (MEDICARE)
G0103
PROSTATE SPECIFIC ANTIGEN TEST (PSA)
S0605
DIGITAL RECTAL EXAM, ANNUAL (NON-MEDICARE)
SCREENING VS DIAGNOSTIC
Screening—Patient has no abnormality or symptom
Family history can be coded if documented
Diagnostic—Patient has an abnormality or symptoms
The symptom or abnormality is coded
If any test results are available, code the definitive diagnosis
CHECK OUT THESE WEBSITES
www.prostatecancerfoundation.org
www.prostatecommons.com
www.prostateinfo.com
www.healthcentral.com
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