Obstructive Sleep Apnea versus Central Sleep Apnea
Obstructive sleep apnea is when the airwaybecomes narrowed or obstructed and you're making the effort to breathe but we do notsee any flow in air movement coming from your nose or mouth. Where central sleep apnea occurswhere your brain forgets to tell your body to breathe. If we're looking at it from avery simplistic term and so we do not see the drive to breathe. So the first step isto come into the and be seen by one of our physicians in the sleep medicine .We'll go through a questionnaire and try to determine what risk factors we think you havefor sleep apnea such as obesity, snoring, daytime sleepiness and then if we think thatyou have a high risk for meeting those criteria
then we would set you up for a sleep studyeither in your home to do an overnight sleep study or in our laboratory, depending on yoursituation. The CPAP can be used to treat both conditions and, in some patients, that isenough. However, there are some patients that have more complex types of central sleep apneathat require more complicated types of machines to treat that condition. Obstructive sleepapnea actually has been linked to a lot of other problems such as high blood pressureand then, you know, difficulty functioning during the day. If it goes untreated for along period of time there's an increased risk of early heart problems and those types ofthings.
HCPCS and CPT Codes FAQs Disc Herniation vs Disc Degeneration
Q 16: Will there be at anytime HCPCS andCPT codes togetheré A: Well, yes. I guess so. The only time youreally use HCPCS codes is if you are doing Medicare. They're the other ones that reallylike the HCPCS codes. CPT codes, well, yes they will because EM codes are CPT codes.So, right there you're going to have CPT and HCPCS codes together. HCPCS codes mightbe, if they're giving an injection for Medicare patient in the office, then you would usea HCPCS code. Q 17: Please clarify with disc herniationand disc degenerationé A: OK, well I can do that because that'slike an ICD9 thing. Herniation of a disc
is when it bulges. So, you've got your littlediscs. Think of it as little block squares set up on top of each other with a hole inthose squares, and in those squaresâ€¦ So, think of this as your vertebra, and thinkof this little pearl right here as your spinal cord. So, that's stacked up. A bunch ofthose are stacked up on top of each other. Now, around that is this meaty tissue andfluid to make sure that nothing hurts that spinal cord because it doesn't regenerateitself. So, you've got these little guys stacked up on top of each other. If you havea herniation that's when some of this goo in here pops out, OKé Think of a little balloonof goo sticking out, it's a hernia. Just
like if you have inguinal hernia or a herniain your intestines. Now, a disc degeneration is when this littleguy right here, he's falling apart. So, this starts degenerating. It starts breakingdown. It's not solid anymore. It's getting porousand they can't do the job and it's getting weak. So, they'll stack on top of each otherâ€“ two completely different things. Herniation you got a bulge right there, anddegeneration this is wearing out. Can you have bothé Absolutely, but they are two distinctthings. Q 18: What is the difference between LefortI, II, III from each procedureé Also, is Botox
injection part of the procedureé What is CPTcode for the Botox injectioné A: I don't know. Sorry. First of all betweenLefort I, II, III, I just don't even know what that is without looking it up, and Iapologize that after I said I was so intelligent andawesome that I don't know that; but this is a perfect QA forum question. So, if youwill post this in there I will make sure that it gets answered because now I want to knowwhat Lefort I, II, III, is, and what is the CPT code for a Botox injectioné Again, I'msure it has a specific injection code and we'll find it for you.
Medical Coding Basics Cardiology Part 3
Boyd: You have three questions around this:Won't you want to code the afib as a history because of the current issuesé Alicia: No. He says he doesn't have it andthere isn't a code for a history of afib, so we can't do that. Boyd: Next question: On your first case examplethat had hyperlipidemia listed in the problem list, it was not talked about in the bodyof the report, but he did order a lipid profile in the plan; so would it be wrong to codethat tooé Alicia: In the problem list, again, you'renot going to use the problem list; you can't
code off of the problem list. He is takingmedication, but he really doesn't address it anywhere else in there. He doesn't putit in the assessment, he does call for a lipid panel, you are correct. Now, if I was doingrisk adjustment, absolutely I'd pull that because it does carry an RxHCC, but it doesn'tcarry a standard HCC. Again, could youé Maybe, but no. I don't think so because he didn'tput in the diagnoses. Boyd: Next question: How did you know whatto code as DX 1st, 2nd, and thirdé Alicia: That's a really good question andthat gets to be really fun sometimes. With something like this where you have hyperplasia,hypertension and palpitations, none of this
actually probably would trump the other. Meaning,is one worse than the other or noté Hyperplasia, maybe, but in that case either of these couldbe the first listed diagnosis. These are all outpatient charts, you're not being reimbursedbased on the diagnosis, and there are no rules here, guidelines to tell you that you needto code one in front of the other. So, that's not going to matter for that one. For theother one, same thing. But some coders and some s, if it doesn't matter, thenthey'll start at the top of the body and go down. I've seen them do that.But usually the most severe gets coded first, that's a rule of practice. But who's tosay that their sleep apnea in this one is
a more severe condition than their very highcholesterol, maybe or something. But with these, absolutely, it does not matter. Now,if they have diabetes and hypertension and cholesterol, I'd put the diabetes firstbecause the diabetes tends to affect the overall body; so I would probably code that first.But usually you go from top to bottom or just in the order that the physician wrote themand let the guidelines indicate otherwise.