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Patient

Physician

Unbundled

Missed Procedure

Billed but
Not Done

Wrong Code

Modifiers

Documentation Deficiency

DX

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X

XX

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XX

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XX

X

XXX

XX

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-----

XXXXXXX

XX

XXX

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X

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X

X

XXXXXXX

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X

X

X

X

XXXXXXX

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X

X

XXXXX

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XX

XXX

XXXXX

XXX

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X

X

X

XX

Date of Service: 05/22/03

Physician: llllllllllllllllllllll

Original Coding

28045

28285-51

The Coding Network Coding

28285-T1

28080-LT

28080-LT-59

Discussion

• Billed but Not Done: Excision of tumor from the foot.
• Missed Procedure x 2: Morton’s neuromas were excised from the second and third interspaces of the left foot.
• Modifier: The -51 modifier is not an approved ASC modifier.
• Modifier: Laterality modifier not utilized.
• Modifier: Toe modifier not utilized.

Diagnoses

215.3

735.4

Diagnoses

735.4

355.6

Discussion

• Wrong Diagnosis: The term mass, unless otherwise stated, is not to be regarded as a neoplastic growth 215.3 per ICD9 guidelines.
• Missing Diagnosis: Operative report findings state that the masses were consistent with Morton’s neuromas.

Date of Service: 05/22/03

Physician: lllllllllllllllllllllllll

Original Coding

30520

31276-51

30130-51

The Coding Network Coding

30520

31255-50

31287-50

31267-50

31276-50

30130-RT

Discussion

• Missing Procedure x 7: Bilateral complete ethmoidectomies, bilateral sphenoid antrostomies, bilateral maxillary antrostomies with tissue removal, and the frontal sinus exploration was also performed bilaterally but only one side was coded.
• Modifier x 2: The -51 modifier is not an approved ASC modifier.

Diagnoses

470

473.9

478.0

Diagnoses

470

478.0

471.8

473.8

Discussion

• Wrong Diagnosis: Unspecified sinusitis 473.9 would be inappropriate since the documentation states pansinusitis.
• Missing Diagnosis x 2: Pansinusitis and Sinus Polyps.

Date of Service: 05/29/03

Physician: lllllllllllllllllllll

Original Coding

58661

58120-51

The Coding Network Coding

58558

58662

Discussion

• Billed but Not Done: Laparoscopy with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy – tubes and ovaries).
• Wrong Code: The dilation and curettage 58120 was performed hysteroscopically 58558.
• Missed Procedure: Laparoscopic ovarian cystectomy. The cyst was removed only, not the ovary.
• Modifier: The -51 is not an approved ASC modifier.

Diagnoses

625.9

626.2

Diagnoses

620.2

621.2

621.8

626.2

625.3

625.0

626.7

Discussion

• Missing diagnosis x 6: Ovarian cyst, Bulky uterus, Boggy uterus, dysmenorrhea, dyspareunia, and post coital bleeding.
• Unsupported Diagnosis: Pelvic pain.

Date of Service: 05/19/03

Physician: llllllllllllllllllllllll

Original Coding

29880

The Coding Network Coding

29880-LT

29877-LT-59

Discussion

• Missed Procedure: Chondroplasty was performed in the patellofemoral compartment and is separately reportable.
• Modifier: Laterality modifier not utilized.

Diagnoses

836.2

Diagnoses

836.0

836.1

733.92

717.7

715.96

Discussion

• Wrong diagnosis: 836.2 is tear of cartilage or meniscus of knee not specified as medial or lateral. The documentation states medial and lateral.
• Missing Diagnosis x 4: Medial and lateral meniscal tears, chondromalacia of the medial and lateral condyles, chondromalacia of the patella, and early arthritis.

Date of Service: 05/15/03

Physician: lllllllllllllllllllllll

Original Coding

27403

27331-51

27333-51

The Coding Network Coding

29880-RT

29877-RT-59

Discussion

• Billed but Not Done: Arthrotomy with meniscus repair 27403.
• Billed but Not Done: Arthrotomy with removal of loose bodies 27331.
• Billed but Not Done: Arthrotomy with medial and lateral meniscectomy 27333.
• Missed Procedure: Arthroscopic medial and lateral meniscectomy.
• Missed Procedure: Arthroscopic chondroplasty.
• Modifier x 2: The -51 modifier is not an approved ASC modifier.
• Modifier x 3: Laterality modifier not utilized.

Diagnoses

733.92

836.0

836.1

Diagnoses

836.0

836.1

844.2

823.00

Discussion

• Missing Diagnosis x 2: ACL tear and chondral fracture to the medial tibial plateau.
• Unsupported Diagnosis: Chondromalacia, not patella.