You are an Outpatient Senior Coding Specialist at a local hospital system and your supervisor as forwarded you an email from the billing department.

You are an Outpatient Senior Coding Specialist at a local hospital system and your supervisor as forwarded you an email from the billing department. They say that they have received a phone call from a very upset patient who states that their insurance denied paying their claim for a recent surgery, as it was deemed “experimental.” They’ve provided no additional information, but you are to review the coding on the claim and see if you notice any errors. Review both the diagnosis and procedure codes and note any changes that should be made to resubmit the claim for reimbursement. 

Claim:

ICD-10-CM:

L76.32

M25.661

Z96.651

CPT:

10140

27570

PREOPERATIVE DIAGNOSIS:

Postoperative large hematoma, right knee, with right knee stiffness, status post right total knee replacement.

POSTOPERATIVE DIAGNOSIS:

Postoperative large hematoma, right knee, with right knee stiffness, status post right total knee replacement.

PROCEDURE:

Incision, drainage, and evacuation of hematoma, right knee, along with manipulation of right knee under anesthesia.

DESCRIPTION OF PROCEDURE:

After obtaining a satisfactory general anesthetic, the knee was quite stiff prior to prepping and draping, only had about 75 degrees of flexion passively, extension -5.  Tourniquet was placed on the upper thigh.  Prophylactic IV antibiotics were given prior to skin incision.  The right lower extremity was prepped first with alcohol, then DuraPrep.  Tourniquet was inflated only for 9 minutes.  The old incision was marked, opened it only for an inch and a half in the mid incision.  There were large old clots expressed.  No evidence of infection.  Milked this out, suctioned it out, did not appear to be a large effusion present, did not open the joint capsule.  The extensor mechanism was in good condition.  The patella tracked nicely.  Irrigated 3 liters with antibiotic irrigation through pulse lavage and resuctioned any fluid out.  Passively manipulated knee to obtain 110 degrees of flexion and essentially full extension.  Tourniquet was deflated at 9 minutes.  I made sure there were no major bleeders.  Suctioned out after irrigation.  Some vancomycin powder was placed in the subcutaneous space.  Subcu of the new opening was closed with 2-0 Vicryl suture.  Then, 0 Prolene used for the entire length of the incision because had disrupted the subcuticular stitch that was placed previously.  Remanipulated the knee, again obtained 0-110 degrees of flexion.  A light sterile dressing was applied.  The patient was taken to the recovery room in stable condition. 

40 points, possible (hint there are FOUR errors in coding)