CODING Q&A Coding Symptoms of Infections, Modifiers for X-rays, and Counseling Family Members ■ DAVID STERN, MD, CPC Q. Our doctor saw a patient for a sore throat. The rapid strep screen was positive, so she placed the following diagnoses on the chart: Ⅲ 034.0: Streptococcal sore throat Ⅲ 780.61: Fever presenting with conditions classi- fied elsewhere Ⅲ 784.1: Throat pain Ⅲ 780.79: Other malaise and fatigue I told her that since we had a specific infection that was the cause of second, third, and fourth diagnoses, we should code the confirmed infection, but not the sore throat. She said that she was addressing each symptom in her plan (for example, acetaminophen for the pain and fever and rest for the malaise), so it was appropri- ate to code the symptoms as well as the diagnoses. Who is right? Question submitted by Jenni Rosenbalm, CPC, PV Billing A. You are right. In general, the physician should code symptoms when the underlying diagnosis that is causing the symptom has not yet been determined. In your example above, the second diagnosis (780.61: “fever presenting with conditions classified elsewhere”) does seem to be correct at first glance, since strep throat is a “condition classified elsewhere.” When you look at the spe- cific definition of the code, however, this code specifically excludes: David E. Stern, MD, CPC, is a certified professional coder. He is a part- ner in Physicians Immediate Care, operating 12 urgent care centers in Oklahoma and Illinois. Stern serves on the Board of Directors of the Ur- gent Care Association of America and speaks frequently at urgent care conferences. He is CEO of Practice Velocity (www.practicevelocity.com), providing urgent care software solutions to more than 500 urgent care centers. He welcomes your questions about coding in urgent care. w w w. j u c m . c o m Ⅲ [fever as an] effect of heat and light Ⅲ [fever] associated with a confirmed infection. Rather, this code is for use with conditions that are fre- quently associated with fever but are not the specific cause of the fever. Often, there is an associated and presumed in- fection, but there is not yet a specific “confirmed infection.” These conditions “classified elsewhere” include neutropenia, leukemia and sickle-cell disease. Q. We do x-rays at our urgent care and would like to know if there are different modifiers for the pro- cedures that we do in the office. Could you provide me with a list of modifiers used with x-rays? Question submitted by Michelle, Defiance Family Physicians A. Modifiers for x-rays are not unique to the urgent care setting. Commonly used modifiers for x-ray proce- dures in the urgent care setting include: Ⅲ -R: right—Use this modifier for a film series per- formed on the right side of the body. Ⅲ -L: left—Use this modifier for a film series performed on the left side of the body. Ⅲ -TC: technical component—Use this modifier when coding only for performing the technological procedure of taking the x-ray; the physician reading is not in- cluded in the code. Ⅲ -26: professional component—Use this modifier when coding only for the physician reading; perform- ing the technological procedure of taking the x-ray is not included in the code. Ⅲ -52: reduced services—Use when performing fewer views than the code stipulates. For example, you use modifier -52 when performing a single-view ankle x-ray and the lowest number of views for an ankle x-ray JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | D e c e m b e r 2 0 0 8 41