Help! a coding case that is a stumper for me! (I am just learning)

[Tina]

Here is the situation:

47 year old patient
kidney failure RT
LT kidney status post transplant
CA of kidney LT due to
OVARIAN CANCER
dialysis
biopsy LT kidney
removal of LT kidney

(this was a true case) Where do I start? What is the breakdown and why. If someone could help me step by step with this one, it would be sooooo appreciated!

 

[Carolyn Heath]

I will try to take a shot at this:
Kidney Failure RT -- 586 -- this is an ICD-9 code
LT Kidney Status Post Transplant -- V42.0 -- this is also an ICD-9 code
Ovarian Cancer -- 183.0 -- the pt had this before the kidney cancer
Cancer of LT Kidney -- 189.0 -- the ovarian cancer caused the kidney cancer
Dialysis -- 90935 for hemodialysis or 90951 for ERSD dialysis -- that is the question, hemodialysis or ESRD dialysis
Biopsy of LT Kidney -- 50200 (needle) or 50205 (surgical) -- the question of whether the biopsy is done by a needle or surgical
Removal of LT Kidney -- 50220 to 50240 -- is it a partial removal or a total removal

 

[Tina]

Thank you very much Carolyn for your help. One thing which I should of mentioned is that the instructor told us that with this story, which was true, and happened years ago, is this- A Male 47 yr old patient received a kidney transplant which was harvested from a woman who had ovarian cancer. The kidney was never checked, and as a result was cancerous as well. The other kidney was failing,so sadly to say, the patient ended up passing away. Thank you so much for pointing out whether it was hemodialysis or ERSD as well as if the biopsy was needle or surgical. I will be able to email my instructor and ask those specifics since it was not mentioned in the case. Thank you again for the help! It is so frustrating at times being so wet behind the ears. I keep telling myself that I can do it. I just feel myself stressing at times because I only have 4 weeks left of school. I am here in California and attending a Adult school which has these "specialty" vocational courses. Our Governor Jerry Brown will be closing all of these schools down. I am so thankful though that I have found this website, and have been telling my fellow students about it!

 

[Carolyn Heath]

You are so welcome. Glad I can help. Let us know what your instructor says.

 

[Alicia Scott]

I see some things I might change here. First you don't have enough information.

What is your patient being seen for? If it is for the Kidney Failure you will code that first of course. You don't need to code the Ovarian CA because the patient 1st is a man and second it is from a donor. It is the primary CA for your patient which will change the code. There is also a V code for a pt who is on Dialysis. V45.11 if I remember right. That is the code you need instead of the CPT code.

ESRD is 585.6
Renal failure is 586
Kidney CA is 189.0 but if this had been a female and she actually had been the one with the Ovarian CA this would be a secondary CA code. 198.0 which makes a big difference.
In my opinion if they pt got the CA from the kidney though it is his first CA so 189.0 is the proper code. Besides, can you imagine trying to explain to the payer that your male pt has Metastatic ovarian CA?

This is an excellent case.

 

[Carolyn Heath]

I see some things I might change here. First you don't have enough information.

What is your patient being seen for? If it is for the Kidney Failure you will code that first of course. You don't need to code the Ovarian CA because the patient 1st is a man and second it is from a donor. It is the primary CA for your patient which will change the code. There is also a V code for a pt who is on Dialysis. V45.11 if I remember right. That is the code you need instead of the CPT code.

ESRD is 585.6
Renal failure is 586
Kidney CA is 189.0 but if this had been a female and she actually had been the one with the Ovarian CA this would be a secondary CA code. 198.0 which makes a big difference.
In my opinion if they pt got the CA from the kidney though it is his first CA so 189.0 is the proper code. Besides, can you imagine trying to explain to the payer that your male pt has Metastatic ovarian CA?

This is an excellent case.

So you don't code the ovarian cancer at all. Did I code the rest of the case correctly? And you are right: this is an excellent case to code and the most challenging one at that.

 

[Alicia Scott]

I would say you do not code the ovarian Ca if you know if came from the donor. Now there might be some type of guideline out there that I am not aware of. We should look into this. Everything else looked good. I didn't check the CPT codes very closely. Sorry. Because I like ICD better.

 

[Carolyn Heath]

I like ICD better, too. I can understand it better than CPT.

 

[Tina]

Well here is the answer I had gotten from my instructor:
first would be code 586
199.2 (she said you wouldn't list the ovarian cancer 198.0)
996.81
585.6
V42.0 thoses were the ICD-9's
then, for the CPT's
90970
50205
50225

I did alright for the most part, but I certainly didn't get all of these that the instructor had.

I have another question, what is a good method or some sort of "que" which would let you know when you should use a modifier? My instructor has a teaching style which I will describe as teaching you part A and part C, but it leaves you scratching your head wondering what happened to part B.(for example the case I presented above, that has not so many specifics, and leaves you with further questions) So I thank you so much for your help! I just hope I pass this class! My final will be at the end of this month.