Coding Consult

Answers to your questions about . . .

Unusual lactation

Q: How should I code hyperprolactinemia due to psychological medications? Would 253.7 and/or 790.99 be appropriate? Or does a different ICD-9-CM code better describe the side effect?

A: Several classes of medications can cause elevated levels of prolactin in the blood. In certain cases of pituitary tumors, prolactin may also be elevated and cause spontaneous galactorrhea-amenorrhea syndrome (253.1, disorders of the pituitary gland and its hypothalamic control; other and unspecified anterior pituitary hyperfunction).

In addition, as you indicate, certain medications, such as phenothiazines may cause abnormal nipple discharge. Because the medication caused the unfavorable pituitary response, assign 253.7 (iatrogenic pituitary disorders) along with E939.1 (drugs, medicinal and biological substances causing adverse effects in therapeutic use; psychotropic agents; phenothiazine-based tranquilizers).

Code 790.99 (other nonspecific findings on examination of blood; other) would not apply. The diagnosis would perhaps indicate a high level of prolactin, but would not explain the problem that you are treating—hyperprolactinemia.

Hepatitis B vaccines

Q: Should we still be reporting codes 90740-90748 for hepatitis B vaccines? I've heard rumors of new HCPCS Q codes, but I'm not sure whether they're in effect.

A: You can forget about the HCPCS Q codes. CMS issued program transmittal AB-02-185 late last year, which rescinded some of these 2003 HCPCS Q codes:

• Q3021 (injection, hepatitis B vaccine, pediatric or adolescent, per dose)

• Q3022 (. . . adult, per dose)

• Q3023 (. . . immunosuppressed patients [including renal dialysis patients], per dose).

For hepatitis B—or any vaccine you administer—you need to report two separate codes, one for the immunization administration, 90471, and another for the vaccine product itself (90740-90747).

Although you have to report the administration code, don't expect to get reimbursed for it. According to the Medicare Carriers Manual, hepatitis B immunization injections are not paid under the Medicare Physician Fee Schedule. Instead, payment is made under Section 5202 of the Medicare Carriers Manual, which states that when a separate charge for an injection is reported, the maximum allowable charge may not exceed the ingredient and supply cost plus an additional $2 allowance for the injection service.

Residual urine testing

Q: I know that the new code 51798 replaces HCPCS G0050, but how do I know if our equipment meets the requirements for this code?

A: The key to correctly using code 51798 is all in the imaging. According to the 2003 CPT code, 51798 (measurement of post-voiding residual urine and/or bladder capacity by ultrasound, nonimaging) applies only when you use simple, hand-operated sonographic equipment that gives the volume of residual urine but does not provide an image.

If your practice is using the standard ultrasound machine to calculate the volume of residual urine from imaging, you should report code 76775 (ultrasound, retroperitoneal [e.g., renal, aorta, nodes], B-scan and/or real time with image documentation; limited) instead of 51798.

You don't want to confuse the two, because the difference in reimbursement is substantial: 51798 pays an average of $19.02, while the combined professional and technical components of 76775 pay an average of $80.21.

This information provided by The Coding Institute. For a free sample issue or information on how to subscribe to any of 29 specialty-specific coding newsletters, please contact The Coding Institute, 2272 Airport Road South, Naples, FL 34112; phone 800-508-2582; fax 800-508-2592; or visit www.codinginstitute.com.

Coding Consult: Answers to your questions about. . .. Medical Economics Sep. 19, 2003;80:16.