What are the findings about cpts 66852 and 11043 as assigned

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Reference no: EM133333665

Case Study: Mr. Jones presented to ABC hospital for cataract surgery on his right eye on 06/28/2022. The coder submitted CPT codes 66852 and 11043. With a diagnosis of H25.031. An Outpatient Code Edit (OCE) of 0040 was triggered, and the coder did not know why this edit was being started in the system, so they placed the account on HOLD in the coding work queue and asked for the Coding Analyst to review the report. You are the Coding Analyst for ABC Hospital. After reviewing the code assignments and the edit, you decide what is incorrect with the codes and prepare to educate the coder. You will need to provide a detailed explanation to the coder so that they understand the correct coding for this case and know how to handle this type of edit should they reencounter it.

Questions:

1. CPT CODING: What are the findings about CPTs 66852 and 11043 as assigned for Cataract surgery on the right eye?

2. ICD Coding: What are your findings about the assignment of H25.031?

3. What is the definition of OCE edit 0040, and why is it being triggered by the current code assignment?

4.How will you explain to the coder the necessary steps to fix the coding?

5. Determine when (if) it would ever be appropriate to code these 2 CPTs together. If it were appropriate to code them together, then what would need to be represented on one of the CPTs in order to avoid OCE Edit 0040? Which CPT does this apply to?

6. What recommendations would you make to the Coding Manager about educating the entire coding staff on cases like this one and OCE Edit 0040?

7. How do cases like this, where the account gets held up by an edit in the work queue, affect the Revenue Cycle? How else can RCM be affected by coders holding for a 2nd level review? Be sure to include how certain areas of RCM are affected.

Reference no: EM133333665

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