jfolz
Networker
We just had an audit and I am really questioning the auditor on this ruling regarding the Dx code T85.113A.
What would indicate that this diagnosis code was appropriately applied or inappropriately applied? Does anyone have a guideline or some literature that would help me determine if this diagnosis code was warranted in this situation?
From the chart, "Pt has a Medtronic neurostimulator in place that was put in 10 years ago and is no longer functioning. She comes in for removal of the old neurostimulator with replacement of a new one."
The auditor gave this advice: "Recommend revising T85.113A to T85.890A (other specified complication of nervous system prosthetic devices, implants, and grafts, initial encounter. The documentation of nonfunctioning neurostimulator is not enough information to specify that the nonfunction is due to a breakdown. Diagnosis codes are to be used and reported to the highest level of specificity supported by the medical record documentation. Ref I.B.2. Level of detail in coding & I.V.F.3 Highest Level of Specificity."
I reviewed the 2 guidelines the auditor has specified and I continue to think that the documentation clearly states that the neurostim is no longer functioning...indicating a breakdown has occurred. The patient had great relief of her other symptoms when the neurostimulator was functioning correctly and came in when the mechanism failed to have it replaced.
What else could a "mechanical breakdown" mean to specify...? If not appropriate in this situation, when would it be appropriate to code T85.113A?
Thanks for any insight you may have!
What would indicate that this diagnosis code was appropriately applied or inappropriately applied? Does anyone have a guideline or some literature that would help me determine if this diagnosis code was warranted in this situation?
From the chart, "Pt has a Medtronic neurostimulator in place that was put in 10 years ago and is no longer functioning. She comes in for removal of the old neurostimulator with replacement of a new one."
The auditor gave this advice: "Recommend revising T85.113A to T85.890A (other specified complication of nervous system prosthetic devices, implants, and grafts, initial encounter. The documentation of nonfunctioning neurostimulator is not enough information to specify that the nonfunction is due to a breakdown. Diagnosis codes are to be used and reported to the highest level of specificity supported by the medical record documentation. Ref I.B.2. Level of detail in coding & I.V.F.3 Highest Level of Specificity."
I reviewed the 2 guidelines the auditor has specified and I continue to think that the documentation clearly states that the neurostim is no longer functioning...indicating a breakdown has occurred. The patient had great relief of her other symptoms when the neurostimulator was functioning correctly and came in when the mechanism failed to have it replaced.
What else could a "mechanical breakdown" mean to specify...? If not appropriate in this situation, when would it be appropriate to code T85.113A?
Thanks for any insight you may have!