QuadraMed Quantim Encoder

QUADRAMED QUANTIM ENCODER 5

QuadraMedQuantim Encoder

PartI: Quantim Encoder References Exercise

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Reference

Look-up

Answer

1

Coding Clinic

How do you code severe sepsis (effective 10/1/2003)?

Code 038.9 should be assigned first, then code 995.91, followed by the code for the initial infection.

2

Coding Clinic

How do you code prophylactic organ removal?

Prophylactic organ removal is being seen most frequently in women that have a family history of breast or ovarian cancer. In order to identify these women, and to correspond to a similar code in ICD10, new codes have been developed for encounter for prophylactic organ removal. Code V50.4 is for Breast code V50.42 is for Ovary and code V50.49 is for other organ. The code is anticipated for use in patients that undertake removal of a non-diseased organ in an attempt to prevent disease, usually a malignancy. It must not be used for the amputation of organs intended for the treatment of cancer.

3

Coding Clinic

How do you code multiple organ failure?

There is no specific code for multiple organ failure

4

CPT Assistant

How do you code complex vaginal laceration?

During delivery, if a vaginal laceration occurs and the repair is minimal, the repair of the laceration is an inclusive component of the delivery services it would not be appropriate to coded separately. However, if an extensive laceration occurs, modifier `-22` may be appended to the global vaginal delivery code to identify the additional effort involved in the repair.

5

CPT Assistant

How do you code transnasal endoscopy?

Currently, there is no specific code to report this procedure.

PartII: Summary of Findings

Fromthe findings, it is evident that the coding for different diagnosesand procedures has changed. The findings indicate that the coding forsevere sepsis is supposed to start with the code 038.9 and then code995.91 should be followed by the code for the initial infection. Inthe case of the code for prophylactic organ removal, newcodes have been developed for encounter for prophylactic organremoval. Code V50.4 is for Breast code V50.42 is for Ovary and codeV50.49 is for other organ. However, in there is no specific code formultiple organ failure. This is because multiple organ failure mayoccur as certain diseases or effects of injuries progress and affectthe mechanisms of a number of vital organs or it can be attributed tothe aging process in vital organs of older patients that can nolonger withstand the effect of an illness or injury. On the otherhand, the coding for complex vaginal laceration has a modifier`-22`appended to the global vaginal delivery code to identify theadditional effort required. Furthermore, there is no specific code toreport transnasal endoscopy procedure.

Inthe workplace, it is important for different health care providers tounderstand the NCCI guidelines so as to be capable of controllingimproper coding that may result in making of inappropriate andunnecessary errors for example, it is possible to eliminateinappropriate errors during payment (Ferenc,2014).Therefore, it is critical for an organization to develop policiesthat would aid in the incorporation of the NCCI guidelines. In thiscase, these guidelines would be incorporated at the workplace throughengaging health care practitioners in continuous education that wouldaid them in knowing the NCCI guidelines. For instance, trainingthrough lectures and organizational meetings can help health carepractitioners in understanding the guidelines.

References

Ferenc,D. P. (2014). Understandinghospital billing and coding.St. Louis, Mo: Elsevier.

QuantimEncoder. Retrieved from http://quantim.ahima.org