For patients with severe sepsis, the code for the systemic infection (038.x) or trauma should be sequenced first, followed by either code 995.92, Systemic inflammatory response syndrome due to infectious process with organ dysfunction, or code 995.94, Systemic inflammatory response syndrome due to noninfectious process with organ dysfunction. Codes for the specific organ dysfunction should also be assigned.

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Some patients are now electing to undergo prophylactic organ removal (e.g., mastectomy and oophorectomy) to prevent the occurrence of cancer. This is being seen most often in women who have a family history of breast or ovarian cancer. To identify these women, and to correspond to a similar code in ICD-10, new codes have been created for encounter for prophylactic organ removal (code V50.41, Breast; code V50.42, Ovary; and code V50.49, Other).



The code is intended for use in patients who undergo removal of a nondiseased organ in an effort to prevent disease, generally a malignancy. It should not be used for the removal of organs for the treatment of cancer (e.g., removal of ovaries for treatment of breast cancer or removal of testes for treatment of prostate cancer). Removal of the testes or ovaries for treatment of another malignancy is a therapeutic, not a prophylactic measure and the principal diagnosis is the malignant condition. This advice applies even if the malignancy had been previously excised, and the patient is admitted for therapeutic removal of an organ. Additional codes, as appropriate, may be assigned to identify the reported reason for organ removal such as V16.3, Family history of malignant neoplasm of breast. The use of these new codes replaces advice given in Coding Clinic First Quarter 1992, page 11, regarding the assignment of code V07.8, Other specified prophylactic measure, as the principal diagnosis.




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There is no specific code for organ failure. Code to disease under care or treatment. Multiple organ failure may occur as certain diseases or effects of injuries progress and affect the mechanisms of a number of vital organs or it can be attributed to the aging process in vital organs of older patients that can no longer with- stand the effect of an illness or injury. Multiple organ failure may include respiratory failure, renal failure, cardiac failure, and hepatic failure, along with severe malnutrition. Multiple organ failure usually describes the mechanism of death attributed to the progression of certain types of conditions. The principal diagnosis would be the underlying condition, followed by any complications or coexisting conditions.


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During delivery, if a vaginal laceration occurs and the repair is minimal, the repair of the laceration is an inclusive component of the delivery services it would not be appropriate to coded separately. However, if an extensive laceration occurs, modifier '-22' may be appended to the global vaginal delivery code to identify the additional effort involved in the repair.


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Currently, there is no specific code to report this procedure. Transnasal endoscopy, a procedure where a thin flexible endoscope is passed through the nares into the esophagus, is reported with unlisted code 43499, Unlisted procedure, esophagus. As indicated in the surgery guidelines of the CPT codebook; the use of an unlisted code requires a special report describing the procedure.



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Medicare's three-day window rule and same-day servicesMedicare has clarified that the three-day payment window rule replaced the same-day service rule.  The same-day service rule required all services, both diagnostic and non-diagnostic, to be bundled with the inpatient claim. CMS has indicated that the three-day payment window rule requires that all diagnostic services provided within three days prior to a patient's admission (including the day of admission) must be bundled with the inpatient claim, and the non-diagnostic services to be billed separately to Part B (OPPS).



Further information on this clarification can be found in Transmittal 7643, Change Request 4047, which was issued by CMS on November 25, 2005.




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The Centers for Medicare & Medicaid Services (CMS) has created two new “not otherwise specified” codes to report brachytherapy sources that do not have source-specific codes yet. The newly created HCPCS codes are for stranded and non-stranded sources and are as follows:



? C2698, Brachytherapy source, stranded, not otherwise specified, per source



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It would be appropriate to report CPT code 49325, Laparoscopy, surgical; with revision of previously placed intraperitoneal cannula or catheter, with removal of intraluminal obstructive material if performed, for the procedure. Exploration of the abdominal cavity is an integral part of this procedure and it would not be appropriate to report it separately.