Medical Coding and Billing, ICD-9, ICD-10 Codes

CPT® 2012 Update: Streamline Your PFT Reporting

2012-02-01T23:50:00.000-08:00

CPT® simplifies reporting by combining two codes into one.

Have you ever struggled with distinguishing between pulmonary function tests for instance carbon monoxide diffusing capacity (DLCO) and membrane diffusion capacity (DMCO)? In case your answer to this is yes, then you’ll be happy to hear that effective Jan.1, 2012, CPT® has reduced your burden by combining these two CPT codes into a single code.

Read on for more on this change and how to adjust your reporting of these tests.

Note Advantages of Single Add-on Code

Before the changes initiated in 2012, you were required to report carbon monoxide diffusing capacity and membrane diffusion capacity using dissimilar CPT codes. This necessitated complex understanding of the procedures as well as knowing the difference between the two codes.

There was rumour that the codes were being reported erroneously since the increase in utilization for 94725 was recognized as 14% more than that of 94720 over a six year time period. Given the limited clinical indications and use for 94725, this surge seemed irrational.

The old CPT codes (prior to Jan, 1, 2012) that have now been deleted include the following:

94720 – (Carbon monoxide diffusing capacity [e.g., single breath, steady state])

94725 – (Membrane diffusion capacity)

Under CPT® 2012, you will be required to report these procedures under a single code:

+94729 – (Diffusing capacity [e.g., carbon monoxide, membrane][List separately in addition to code for primary procedure])

Benefit: This CPT 2012 change has made the job stress-free as there is no need to go into the procedure details to know whether it is a test for carbon monoxide diffusing capacity or membrane diffusion capacity. Both are now reported with single CPT code +94729. The reimbursement and relative value units for the new code (~$53, 1.57 total RVUs) are like 94720.

CPT Code Lookup Tip: As a lot of providers consider DLCO and DMCO to be a routine part of PFTs, they have now been collected together as an add-on code, and cannot be reported on its own. You should therefore report CPT code +94729 together with other pulmonary function tests, for instance:

94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation)

94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration)

94070 (Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents [eg, antigen[s], cold air, methacholine]) 94375 (Respiratory flow volume loop)

94726 (Plethysmography for determination of lung volumes and, when performed, airway resistance)

94727 (Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes)

94728 (Airway resistance by impulse oscillometry)

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Abdominal Aortography Interp Might Be Payable With Heart Cath

2012-02-01T23:49:00.000-08:00

Plus, know what CPT codes you must pick for aortography, abdominal, by serialography and more

Added payment may be gained for any abdominal aortography carried out during the same session for example a left heart cath with aortography of the aortic root however only if documentation specifies that the intent of the abdominal aortography was the treatment of a dissimilar problem. This expert medical coding article gives you CPT code lookup tips and more.

Procedure notes thus need to document clearly and accurately (by including, for example, a second diagnosis) that the additional aortography was separate from the heart cath.

When a left heart cath is done, aortography as well as the more distinctive angiography of the left coronary chambers as well as the coronary arteries may be carried out to get images of the aortic root (where the aorta joins the heart). For this particular procedure, once you execute CPT code lookup, 93544 (injection procedure during cardiac catheterization; for aortography) is reported with 93556 (imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; pulmonary angiography, aortography and/or selective coronary angiography including venous bypass grafts and arterial conduits [whether native or used in bypass]).

Any images gained from injections in the ascending aorta (the first section of the aorta, defined as the section from the left ventricle to the arch, or bend) are encompassed in CPT codes 93544/93556. 93544 includes positioning the catheter in the ascending aorta which is above the aortic valve. It does not, though, describe abdominal aortography.

Abdominal aortography may be carried out following a heart cath. For instance, the cardiologist may have trouble passing a guidewire plus catheter from the access site (the femoral artery) to the aorta as the patient has tortuous arteries (defined as twisted and full of turns).

In case the coronary problem needs urgent attention, the cardiologist may carry out the heart cath first. When the catheter is being removed via the aorta, another injection is done to image the abdominal aorta or other arteries (such as the renal, iliac and femoral arteries).

Abdominal aortography and heart cath may as well be carried out simultaneously in case the patient has a supplementary problem (such as hip pain or leg cramps) that the cardiologist wants to evaluate at the same time.

CPT Code Lookup tip: Even though aortography of the aortic root (or elsewhere in the ascending aorta) has already been carried out, and reported using CPT codes 93544/93556, the supervision as well as interpretation of the abdominal aortogram (which reflects the manipulation of the catheter as well as the interpretation of the images) must be distinctly payable using either 75625 (aortography, abdominal, by serialography, radiological supervision and interpretation) if only the aorta is imaged, or CPT code 75630 (… plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation) in case images of the iliac and/or femoral arteries are also gained.

65205-65222 Coding Success Hinge on Location, Penetration Level

2012-01-31T00:01:00.001-08:00

Documented set in corneal FBRs can earn $10 more per procedure.

Are you regularly selecting your foreign-body removal (FBR) code based on what instrument the ophthalmologist used? You might be reporting the wrong CPT code – which results collecting the wrong payments. Get the fact behind this and other FBR myths that consistently trip up your ophthalmology medical coding colleagues.

Myth #1: The sort of instrument the ophthalmologist uses defines what foreign-body removal code to report.

Reality: The CPT codes in the FBR code series (65205-65222) do not specify any exact instrument for removing the FB. Though, CPT code 65222 (Removal of foreign body, external eye; corneal, with slit lamp) does specify the equipment used to improve viewing of the affected area. You must select a code according to the specific location and level of penetration of the FB in the eye.

For instance, for the removal of a superficially penetrating FB in the conjunctiva, you would report 65205 (Removal of foreign body, external eye; conjunctival superficial). On superficial conjunctival FBRs, the ophthalmologist will normally use one of the following listed methods, or a combination of the three:

irrigation

a cotton swab

the tip of a beveled needle.

This does not influence your code choice, however.

Not so fast: In case the ophthalmologist carries out an FBR in the cornea, you will be required to consider whether he uses a slit lamp to visualize the FB. Report CPT code 65220 (Removal of foreign body, external eye; corneal, without slit lamp) in case he did not use the slit lamp; otherwise, report 65222 (... corneal, with slit lamp).

Myth #2: All FBRs in the same eye are bundled, which means you can simply bill a FBR code once per eye.

Reality: This is true in case the ophthalmologist removes multiple foreign bodies only from the same part of the eye. In case he removes FBs from different parts of the same eye -- the cornea as well as the conjunctiva, for instance -- you can distinctly report a code for each location.

Documentation is crucial here, say experts, and the physician must draw a detailed diagram of the eye showing the exact location and depth of the foreign body(ies) removed.

In the Correct Coding Initiative, the CPT codes relating to FBs in the conjunctiva, 65205 and 65210 (… conjunctival embedded [includes concretions], subconjunctival, or scleral nonperforating), are not bundled with corneal FB codes 65220 and 65222, which implies that you are allowed to report both codes -- 65210 and 65222, for example -- separately.

Good news: You can certainly report a higher-paying code in 65210 in case the ophthalmologist removes an embedded conjunctival FBR. In 2012, code 65210 has 2.01 total RVUs. Multiplying this by the 2012 conversion factor (24.6712) produces $49.59 in reimbursement. On the other hand, code 65205 has only 1.61 total RVUs -- leading to a reimbursement total of $39.72.

Anesthesia CPT Codes For Subclavian Central Venous Catheter

2012-01-30T23:58:00.000-08:00

To put it simply, venous catheterization is a technique to access veins. A central venous access catheter or device is used to deliver medications, intravenous fluids or get blood samples. Central venous access catheters as well as central venous access devices (VADs) are two diverse methods of venous catheterization. The correct procedural coding of central venous catheters and central venous devices (CVD) is to a certain extent difficult for many coders.

This is in part owing to the terms used by physicians when defining the catheters and devices inserted. Several physicians use the term "vascular access device" to mean any kind of central venous catheterization without providing sufficient information as to the exact type inserted, whether it is a non-tunneled or it is tunneled central venous catheter or the insertion of a tunneled, implantable, either partially or totally, central VAD. Similarly, the physician may not always document in case the insertion site is central or peripheral. This lack of exact documentation for the procedures leads to confusion and frustration on the part of the coder.

There are two sorts of VADs: one entirely implanted and the other partially implanted. Both types of VADs are intended to offer repeated access to the vascular system devoid of the trauma or complications of multiple veni-punctures.

CPT has distinct codes for non-tunneled and tunneled central venous access procedures. Consequently, the initial words to concentrate on while coding the insertion of central venous access procedures are "non-tunneled" and "tunneled." The subsequent key word is catheter or device. The non-tunneled central venous access catheter might have either the central or peripheral placement, with a dissimilar set of codes assigned as per the insertion site, central or peripheral, plus according to the age of the patient. Non-tunneled, centrally placed venous access catheters as well as non-tunneled peripherally inserted central venous catheters will not be having a port or pump.

The codes are as following: 36555 (insertion of non-tunneled centrally inserted central venous catheter, under 5 years of age), as well as code 36556 meant for age 5 years or older. The insertion of a non-tunneled, peripherally inserted central venous catheter, or PICC, is also broken down by age. The codes are 36568 (insertion of a non-tunneled peripherally inserted central venous catheter, without subcutaneous port or pump, under 5 years of age), and 36569 for age 5 years or older.

CPT has codes meant for the insertion of tunneled central VADs, they could be catheters or devices, along with for peripherally inserted central VADs. The tunneled central venous catheter codes are allocated on the basis of age. The code meant for the insertion of a tunneled centrally inserted central venous catheter, without a subcutaneous port or pump, under 5 years of age is 36557, and code 36558 for age 5 years or older.

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Paravertebral Facet Joint Nerve Destruction: Deleted, Replaced, Reduced Codes In 2012

2012-01-30T00:35:00.000-08:00

CPT code series, from CPT 64622 to CPT 64627, is replaced with CPT code series 64633-64636

Since paravertebral facet joint nerve destructions emerge to see a small reimbursement increase in 2012 as compared to 2011, both physicians and ambulatory surgery centers may take a hit in reimbursement when carrying out these injections. Read this expert medical coding insight n how these CPT codes changes affect your reimbursement.

Effective Jan. 1, 2012, paravertebral facet joint nerve destructions will no longer be reported per nerve. As an alternative, four novel codes have been established to echo the work and anatomical site involved when carrying out these destructions. Remember before 2012, the injection was reported per nerve at a single vertebral level. CPT 2012 requires that the injection will be reported per facet joint. As per the AMA, It is vital to note the number of nerves injected for a single facet joint does not influence code selection

Out with the old (deleted):

CPT code series, from CPT 64622 to CPT 64627, is deleted in 2012.

In with the new (replaced):

CPT code series, from CPT 64622 to CPT 64627, is replaced with CPT code series 64633-64636:

64633 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint (new code in 2012))

+64634 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure) (new code in 2012))

64635 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint (new code in 2012))

+64636 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure) (new code in 2012))

It may not seem to be a reduction until we report the facet joint in spite of of the number of nerves destroyed. Let's compare:

In 2011: A patient goes through a radiofrequency nerve destruction of two medial branch nerves L3 and L4 innervating the symptomatic lumbar facet joint. Reimbursement contemplation is based upon the following listed CPT code selections:

64622 — ($495.72 (approximate 2012 ASC reimbursement))

64623 — ($294.00 (approximate 2012 ASC reimbursement))

In 2012: A patient goes through a radiofrequency nerve destruction of two medial branch nerves L3 and L4 innervating the symptomatic lumbar facet joint. Reimbursement consideration is based upon the following listed CPT code selection:

64635 — ($516.47 (approximate 2012 ASC reimbursement))

CPT 2012 Coding tips:

Image guidance and localization are essential for the performance of paravertebral facet joint nerve destruction by means of neurolytic agent explained by CPT codes 64633 -64636.

You must not report 64633-64636 in combination with 77003 or 77012). Both CPT 77003 and/or 77012 are considered inclusive to the injection procedure in 2012. In case CT or fluoroscopic imaging is not used/documented, report unlisted CPT code 64999.

In case both facet joints at the same vertebral level are treated, then CPT 64633 or 64635 should be reported with modifier -50 appended pending carrier reporting necessities for bilateral procedures (-50 versus RT/LT versus units).

Ondansetron Update: Q0162 Replaces Q0179 in 2012

2012-01-30T00:34:00.000-08:00

Hit these resources on Medicare's oral anti-emetic policy.

In case your practice reports oral anti-emetics, ensure you're up on the latest ondansetron medical coding news or you could start facing denials.

This drug gota new HCPCS code, effective Jan. 1, 2012: Q0162 (Ondansetron 1 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen).

To make room for this novel code, HCPCS deleted Q0179 (Ondansetron hydrochloride 8 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen).

Bottom line: Reporting Q0179 for a 2012 date will bring an instantaneous denial. You must use HCPCS code Q0162 instead.

Zuplenz Factors Into Unit Change

Pay attention to how the HCPCS code change influences unit reporting. For 2011's Q0179, one unit represented 8 mg. In 2012, one unit of Q0162 represents only 1 mg.

The change permits for more precise reporting of the ondansetron oral soluble films sold as Zuplenz. The films are obtainable in 4 mg and 8 mg doses. Even though HCPCS codes specific to the oral films were requested, the novel code was created so that it could be allocated to any oral dose form available.

Brush Up on Oral Anti-Emetic Rules

Prior to reporting HCPCS code Q0162, take heed. There is a precise set of guidelines for oral anti-emetics to be considered payable by Medicare.

Smart idea: You must review Medicare's national resources on reporting oral anti-emetics.

Claims processing jurisdiction is one vital area covered in the MCPM. Practices must bill the oral anti-emetic to their Durable Medical Equipment Medicare Administrative Contractor (DME MAC). In contrast, you'd report an intravenous anti-emetic to your local carrier (Part B MAC).

Read on: For Medicare patients, you also must check for local coverage determinations (LCDs) that address coverage for oral anti-emetics by the suitable region's DME MAC.

The LCD may disclose specific modifiers you must use with the HCPCS code. For instance, modifier KX (Requirements specified in the medical policy have been met) may apply.

Moreover, to support oral anti-emetic coverage, the patient should be receiving what is considered to be a highly emetic chemotherapy agent, for instance Cisplatin or other drugs listed on the DME MAC's LCD," says Martin. (The MCPM provides a list of the chemotherapy agents that support necessity for the oral anti-emetic tri-pack of aprepitant [Emend], a 5-HT3 antagonist [such as ondansetron], and dexamethasone.)

Remember: Commercial insurances also may have entirely different payment policies for oral medications. Confirm the payer policy to see how or even if these would be paid under the patient's medical benefits.

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HCPCS Update: J1561's New Look Discloses Trade Name and Admin Modifications

2012-01-24T22:20:00.002-08:00

Plus: Check out more new HCPCS codes for pain and fracture prevention.

Modifications to acetaminophen, denosumab, and immune globulin coding are sure to keep you on your toes in 2012. Keep a close eye on the administration methods for Ofirmev and Gamunex-C, in particular. Read this expert medical coding article and know more about what HCPCS codes apply.

J0131: Add a New Acetaminophen Code

In 2012, there is an addition of a HCPCS code for acetaminophen administered by infusion: J0131 (Injection, acetaminophen, 10 mg). The brand name for this particluar injectable form is Ofirmev.

Physicians might order the drug for the management of mild to moderate pain; management of moderate to severe pain along with adjunctive opoid analgesics; and also for fever reduction in adults and children 2 years or older.

2012 example: Staff administers 1000 mg of Ofirmev over 15 minutes. You should report J0131 x 100 units (1000 mg administered divided by the 10 mg in the definition). For the administration, report 96374 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; intravenous push, single or initial substance/drug).

J0897: Prolia and Xgeva Get a Specific Code

As of Jan. 1, 2012, you'll be able to report denosumab with ease using new HCPCS code J0897 (Injection, denosumab, 1 mg). This antibody works by decreasing bone resorption and increasing bone density. Brand names for denosumab consist of Prolia and Xgeva.

Prolia is specified to increase bone mass in individuals at high fracture risk because of certain cancer therapies, especially in men getting androgen deprivation therapy to treat nonmetastatic prostate cancer as well as in women with breast cancer who receive adjuvant aromatase inhibitor therapy. According to the HCPCS agenda, Xgeva is intended for prevention of skeletal-related events (SREs) in patients with bone metastases from solid tumors. In 2011, denosumab didn't have a definite HCPCS code for practices to report, so they used J3590 (Unclassified biologics) on Medicare claims.

2012 example: Staff administers a 120 mg subcutaneous injection of Xgeva. You must report 120 units of J0897 for the supply and 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the injection.

J1557 and J1561: Watch IG Brand Names

Don't overslook two changes to immune globulin (IG) used to treat immunodeficiencies. Out of these HCPCS codes, one is a new code and one is a revision of an existing code.

New: Intravenous IG (IVIG) product Gammaplex gets its own individual code for 2012: J1557 (Injection, immune globulin, [Gammaplex], intravenous, non-lyophilized [e.g. liquid], 500 mg).

In 2011, your best option for Gammaplex was J1599 (Injection, immune globulin, intravenous, non-lyophilized [e.g. liquid], not otherwise specified, 500 mg). As per HCPCS agenda, the new HCPCS code was requested as Gammaplex is different from other licensed IVIG products in numerous significant respects that can influence product tolerability and safety.

2012 example: Staff administers a 2-hour, 16,350 mg Gammaplex infusion. You must report 33 units of J1557. (Divide the 16,350 mg administered by the 500 mg in the definition to get 32.7. Round up to 33.) You must report 96365 for the first hour of administration. As far as the second hour is concerned, report +96366 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; each additional hour [List separately in addition to code for primary procedure]).

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CPT 2012: 38230 and 38231 Will Need Knowledge of Bone Marrow Donor

2012-01-24T22:20:00.001-08:00

Change to global days offers new possibility for E/M reporting.

Get ready to track down some donor details before coding bone marrow harvesting. CPT 2012 needs to know.

Concerning 2011 dates of service, in case someone had asked, "Does coding for bone marrow harvesting differ based on whether the patient donates the cells or whether another person donates the cells?" the answer would have been, "No."

However a code revision and a code adding in CPT 2012 change that answer to "Yes," effective Jan. 1, 2012.

Consider this revision of 38230:

CPT 2011: 38230, Bone marrow harvesting for transplantation

CPT 2012: 38230, Bone marrow harvesting for transplantation; allogeneic.

As 38230 is specific to allogeneic harvest in CPT 2012, CPT® similarly created a code for autologous harvest: 38232, Bone marrow harvesting for transplantation; autologous.

Match the CPT Codes to the Procedures

To apply the CPT codes correctly, keep in mind that "auto" means "self" and "allo" means "other."

For bone marrow transplant medical coding, "autologous" specifies the cells are from the same individual.

Thus autologous means a single patient donates the cells (38232) and then receives those cells back at a later date and through a distinctly reportable service (38241, Bone marrow or blood-derived peripheral stem cell transplantation; autologous).

Allogeneic means the cells are from someone other than the patient. The technical definition of allogeneic is "genetically different but from the same species. For allogeneic harvesting (38230), the donor may be either related or unrelated to the patient. Later, when the patient receives the cells donated from a different individual, you should report 38240 (Bone marrow or blood-derived peripheral stem cell transplantation; allogeneic) for the transplant.

Straight from the source: Medicare addresses stem cell transplantation in Claims Processing Manual 100-04, chapter 3, section 90.3. (“Stem cell transplantation is a process in which stem cells are harvested from either a patient's or donor's bone marrow or peripheral blood for intravenous infusion. Autologous stem cell transplants must be used to effect hematopoietic reconstitution following severely myelotoxic doses of chemotherapy and/or radiotherapy used to treat various malignancies. Allogeneic stem cell transplant may also be used to restore function in recipients having an inherited or acquired deficiency or defect. Bone marrow and peripheral blood stem cell transplantation is a process which includes mobilization, harvesting, and transplant of bone marrow or peripheral blood stem cells and the administration of high dose chemotherapy or radiotherapy prior to the actual transplant".)

Capture New Opportunity to Code Follow-Up

Wording changes aren't just the only news you require to know for stem cell harvest coding. The number of global days has a revision for CPT 2012, as well.

In 2011, Medicare gave 38230 a 10-day global period. That meant that E/M services on the day of the procedure and during the 10-day postoperative period normally weren't payable when the visit was related to the outcome of the procedure, as defined by the global surgical package rules.

As per the 2012 Medicare Physician Fee Schedule (Final, in comment period), CPT codes 38230 and 38232 have a global period of 000 for 2012. Reason: "These services rarely require overnight hospitalization and physician follow-up in the days following the procedure."

Provider Requirement: 90460-90461 Show Significance of 'Qualified Health Care Professional' Definition

2012-01-23T22:15:00.000-08:00

For accurate claims, distinguish these professionals from 'clinical staff.'

The definition of "other qualified health care professional" didn't make it into the CPT 2012 manual, but you are required to know and apply this definition all the same. Read this expert medical coding insight to learn more.

The AMA lists the definition as part of the "CPT 2012 Errata" on its website. The definition is as follows: (A 'physician or other qualified health care professional' is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service. These professionals are distinct from 'clinical staff.' A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service. Other policies may also affect who may report specified services.)

Understand Practical Application of the Definition

The definition was in answer to questions at 2011 Symposium related to CPT codes 90460-90461 [Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional …] counseling requirements and helps to clarify healthcare professionals as different from clinical staff.

Key: RNs and LPNs aren't included in the definition as they cannot individually report the professional services that they provide. RNs and LPNs fit the CPT® definition of "clinical staff," as their professional services are typically reported under a physician or other qualified health care professional's identification number (e.g., under Medicare's "incident to" rule). This implies that when certain CPT codes refer to 'other qualified health care professionals' they are not including RNs and LPNs.

Example: Immunization administration CPT codes 90460-90461 denote "counseling by physician or other qualified health care professional." Consequently, counseling by an RN or LPN would not qualify to meet the requirements of these codes.

More information: Understand that this concept is not new. Shortly after the effective date of the 90460 and 90461 CPT codes, CPT® Assistant (March 2011) explained the "other qualified health care professional" concept. As 90460-90461 replaced 90465-90468 (Immunization administration younger than 8 years … when the physician counsels the patient/family …), which by definition needed face-to-face counseling by a physician, the "other qualified healthcare professional" in 90460-90461 was intended to be a billing provider for example a PA or NP.

The CPT Assistant article mentions that the addition of 'qualified health care professional' echoes the recognition that frequently registered nurse practitioners and physician assistants carry out and report these services, however it should not be taken to mean that other types of office clinical staff may deliver the counseling.

Compliance: Streamline Your ICD-10 Implementation Efforts

2012-01-23T22:14:00.000-08:00

Part of your 2012 plan must include concentrating on your most common codes.

In spite of recent rumors, CMS has no intention of delaying the implementation of ICD-10 beyond the Oct. 1, 2013 date. That means every physician group should be taking steps toward the transition of ICD-9 coding to ICD-10 medical coding.

Know Penalties for Nonparticipation

Question: What are the penalties for entities that are covered under HIPAA who decide not to use ICD-10 codes as of Oct. 1, 2013?

Answer: Your claims will be denied -- and you technically could face fines since using the ICD-10 codes falls under the HIPAA transaction code set regulations.

From a practical viewpoint, as of service dates of Oct. 1, 2013, in case you still use ICD-9 codes and don't use ICD-10 codes, most probably your claims will be returned and will be asked to transition to ICD-10.

The penalties are the similar penalties that any HIPAA entity would be subject to. Most of you are acquainted with the ongoing HIPAA transaction code set penalty that calls for a maximum of $25,000 per covered entity per year, however the HITECH legislation of last year in fact upped those transaction and code set penalties, and they can be as much as $1.5 million per entity per year. So evidently it behooves everybody -- Medicare and Medicaid inclusive -- to ensure you are compliant with these ICD-10 codes by the Oct. 1, 2013 date.

LCD Updates Could Come Later

Question: The Medicare local coverage decisions (LCDs) presently list the payable ICD-9 codes that match up to all Medicare-payable procedures. Will contractors issue updated LCDs to the public before the Oct. 1, 2013 implementation date to demonstrate the payable ICD-10 codes for the procedures?

Answer: The answer to that isn't that clear yet. The LCDs will be translated as they will need to be translated, [but] as it relates to having them accessible to the public before the implementation date, that is not certain yet, as CMS is working fast and furious on all of its ICD-10 implementation efforts.

Shape Down Your Code List

Question: What can your practice do to get ready for the ICD-10 conversion?

Answer: One thing you won't need to do is keep in mind a bunch of new codes. In fact, most practitioners perhaps don't know many ICD9 codes by heart, so they won't be expected to memorize ICD-10 codes either.

Strategy: You must use your list of the top diagnoses that your practice gets to find the corresponding ICD-10 codes , and you've got your cheat sheet. Then, make certain that your coders are trained, that your claims are form 5010 compliant, and that your claim submission system supplier is ICD-10-ready. Besides, in case you have an electronic medical record or you plan to get one, make sure it can handle ICD-10. In case you're starting to bring in an EMR, you want to convert to ICD-10 first, not bring one in under ICD9 coding and then convert.

Follow These Deep Sedation Insider Tips

2012-01-23T00:47:00.001-08:00

This year, you might be coding more deep sedation services in the ED, thanks to recent changes. Your claims' accuracy will rest on careful documentation of the duration and level of consciousness attained. Read on for expert medical coding advice on modifier use and payer regulations dealing with anesthesia and also what anesthesia CPT codes you must select.

The advent of fresher sedation drugs, mainly propofol, resulted in greater sedation effectiveness and less recovery time for the patient after deep sedation, therefore making the services a better fit in the ED.

Green light from CMS: CMS released a policy clarification in January 2011 that clearly recognized that it is acceptable to CMS for emergency physicians to provide all levels of sedation.

2012 CPT Lookup Tip: To accurately bill these services, you'll need ED providers to document the patient's level of consciousness through all anesthesia services. CPT® guides coders to the Anesthesia Section of CPT® to code deep anesthesia or monitored anesthesia care.

The CPT® Anesthesia section guidelines state that the Anesthesia CPT codes include the usual preoperative and postoperative visits, the anesthesia care throughout the procedure, the administration of fluids and/or blood and the normal monitoring services for instance EKG, temperature, blood pressure, pulse oximetry, capnography and mass spectrometry.

Modifier 47 alert: When coding regional or general anesthesia services delivered by the same physician carrying out the service for which the anesthesia is administered, CPT® directs the use of modifier 47 (Anesthesia by Surgeon), to be appended to the basic service

Heed Time, Patient Status: Cautious reporting of anesthesia time is critical to the coding and documentation of these services. Per CPT®, anesthesia time begins when the physician begins to prepare the patient for the induction of anesthesia and ends when the physician is no longer in personal attendance.

CPT® also instructs to use both the anesthesia CPT code itself and a physical status modifier. These modifiers contain the letter "P' and a number from 1 to 6:

P1: (A normal healthy patient)

P2: (A patient with mild systemic disease)

P3: (A patient with severe systemic disease)

P4: (A patient with severe systemic disease that is a constant threat to life)

P5: (A moribund patient who is not expected to survive without the operation)

P6: (A declared brain-dead patient whose organs are being removed for donor purposed)

Coding example : For a patient going through mild systemic disease getting deep sedation services for a bronchoscopy, the anesthesia portion would be reported as: 00520-P2.

Qualifying circumstances are additional codes to signify specific situations where anesthesia services are particularly challenging. They are coded along with the primary anesthesia CPT code. For instance, qualifying circumstances code 99100 is defined by CPT® as, "Anesthesia for patient of extreme age, younger than 1 year or older than 70."

CPT 2012: 37191-37193: Banish Unlisted Codes From Your IVC Filter Claims

2012-01-23T00:45:00.000-08:00

Get ready for new renal catheter placement codes, too.

Surgical codes that define the whole package are becoming the norm, and CPT® 2012 continues the trend. Inferior vena cava (IVC) filter procedures and renal angiography have new 2012 CPT codes that combine surgical and imaging services into one neat bundle.

Clarify Your IVC Filter Options

Get ready for an all new way to report IVC filter services, outlining the service as insertion, repositioning, or retrieval:

37191 – (Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed)

37192 – (Repositioning of intravascular vena cava filter ...)

37193 – (Retrieval (removal) of intravascular vena cava filter ....)

Old way: In 2011, you reported IVC filter placement with 36010 (Introduction of catheter, superior or inferior vena cava for catheterization), 37620 (Interruption, partial or complete, of inferior vena cava by suture, ligation, plication, clip, extravascular, intravascular [umbrella device]), and 75940 (Percutaneous placement of IVC filter, radiological supervision and interpretation). As 37191 includes all of these elements, CPT® 2012 deletes the IVC-specific codes 37620 and 75940.

Clarify retrieval: Coding IVC filter removal wasn't as clear in 2011 as it is now. Prior to creation of 37193, payers may have demanded unlisted procedure codes or transcatheter retrieval codes 75961 (Transcatheter retrieval, percutaneous, of intravascular foreign body [e.g., fractured venous or arterial catheter], radiological supervision and interpretation) and 37203 (Transcatheter retrieval, percutaneous, of intravascular foreign body [e.g., fractured venous or arterial catheter) to describe the service. 2012 CPT updates clarify that you must not report 37193 alongside 75961 and 37203.

Replace Your Old Renal Catheter Placement Codes

Renal angiography sports four new 2012 CPT codes effective Jan. 1, 2012. Key elements differentiating the codes include whether the service is first order or it is higher, and whether the service is unilateral or bilateral:

36251 – (Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral)

36252 – (... bilateral)

36253 – (Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral)

36254 – (... bilateral.

Tip: When reporting the new renal 2012 CPT codes, do not report 36254 with 36252.

You also must not report 36253 with 36251 when carried out on the same renal/kidney. The accessory renal arteries only has an impact on medical coding if the catheter placement is in a second or higher order position

Don't miss: The addition of these 2012 CPT codes means you'll no longer use a code from 36245-+36248 (Selective catheter placement, arterial system...) to report the catheterization. And because imaging services are included in the new 2012 CPT codes, CPT® deletes 75722-75724 (Angiography, renal ...).

CCI Policy Manual: 88342, 88360-88361: Report IHC for each Specimen for Medicare Beneficiaries

2012-01-20T04:00:00.000-08:00

Plus, you must update your microdissection guidelines

Just when Correct Coding Initiative (CCI) policy and CPT® 2012 finally agree on the block as the special-stain code unit of service, CCI takes back its equivalent medical coding policy for immunohistochemistry (IHC) stains.

CMS' new NCCI Policy Manual, effective Jan. 1, 2012, takes account of this and numerous other policies that will impact coding and reimbursement for your lab. Read on to make sure you're up to speed on the following 2012 CPT updates that could affect your bottom line.

2012 CPT Update: Contrast 'Specimen' and 'Block'

CPT® definitions clarify that you must bill one unit of the following listed codes for each separate IHC antibody stain:

88342 – (Immunohistochemistry (including tissue immunoperoxidase), each antibody)

88360 – (Morphometric analysis, tumor immunohistochemistry (e.g., Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, each antibody; manual)

88361 – (… using computer-assisted technology)

Nonetheless the formal descriptors don't tell the complete story -- one unit for "each antibody" isn't all you need to consider. Longstanding AMA advice is that the full unit of service prescription for 88342 and 88360-88361, while executing 2012 CPT lookup, may be defined as 'each uniquely identified (reported) antibody per each dissimilar specimen.

Medicare approved this definition until the Oct. 1, 2009 NCCI Policy Manual update, when it departed from the AMA by concentrating on the surgical pathology block instead of specimen.

In a startling reversal of a policy that has been valid since Oct. 2009, Medicare is going back to the specimen as the unit of service for IHC codes 88342, 88360 and 88361 as an alternative of the block.

Example: The pathologist observes a sentinel lymph node biopsy for a breast cancer patient. He processes the node in two blocks, with three pancytokeratin-stained slides from each of three levels in each block for a total of 18 slides. Before Jan. 1 you would bill the special stain as 88342 x 2 for the two blocks, but after that date, after executing 2012 CPT lookup, you'll require to bill only one unit of 88342 for the single specimen. That's a pay cut of $105.52 (2012 physician fee schedule national amount, conversion factor 34.0376).

Never per slide: Although the previous example involves 18 slides and you could legitimately bill one unit of 88342 for a specimen exam involving a single IHC-stained slide, you must never code special stains per slide.

Notice 'Cocktail' Difference

An additional way you stand to lose IHC stain pay involves Medicare's new policy for multiple-antibody stains.

2012 CPT Lookup : Prior to Jan. 1, an IHC stain consisted of multiple antibodies warranted multiple units of service providing you documented that each antibody provided distinct diagnostic information. It's not the case anymore. The latest NCCI Policy Manual mantains that the physicians must not report more than one unit of service per specimen for an immunohistochemical antibody(s) stain (procedure) even though it contains multiple separately interpretable antibodies.

Imaging: 72114 and 72120 Get View Requirement Modifications in 2012

2012-01-20T03:59:00.000-08:00

Start the documentation education now to ease possible 72114 audits.

Where view requirements are concerned, CPT® giveth, and CPT® taketh away for two spine X-ray 2012 CPT codes.

Ensure your medical coding practice applies these key code updates, effective for services on or after January 1.

2012 CPT Codes: Plan Ahead for Tougher 72114 Requirements

To report 72114 for a lumbosacral spine X-ray carried out in 2012, you must fulfil a new requirement for a "minimum of 6 views":

2011: (72114, Radiologic examination, spine, lumbosacral; complete, including bending views)

2012: (72114, Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views)

The above code from the 2012 CPT codes will be applicable to six or more views however the 2011 definition of 72114 did not include any definite number of views.

Potential problem: Some physicians now document complete including bending views, instead of stating the number of views.

Solution: This change is going to necessitate physician education to make certain coders are given adequate information to support this code. Stating the exact number of views has always been a documentation best practice, however this 2012 CPT update makes documenting those views an absolute must.

Alert your physicians and techs to the new prerequisite, and ask for documentation of the number of views, as well as the type of views, so you can support use of 72114.

Example: The radiologist's note documents performance and interpretation of the following listed views:

AP (anteroposterior)

Lateral

Flexion

Extension

LPO (left posterior oblique)

RPO (right posterior oblique)

Left bending view

Right bending view.

As the documentation meets the minimum of six views and comprises of bending views, you should choose 72114. (Reminder: Because the code covers a "minimum of 6 views, you should not report any views beyond the first six with a separate code. A single unit of 72114 will cover all of the lumbosacral spine X-ray views.)

2102 CPT Update: 2 Views Will Now Suffice for 72120

In case you're unhappy about the new minimum view requirement for 72114, you may be cheered by the change to 72120. CPT 2012 actually decreases the required number of views for 72120 from "minimum of 4" to "2 or 3":

2011: (72120, Radiologic examination, spine, lumbosacral, bending views only, minimum of 4 views)

2012: (72120, Radiologic examination, spine, lumbosacral, bending views only, 2 or 3 views)

This change is in line with existing practice as physicians normally don't need four views to capture what they need to see. Every time bending views are ordered, they are almost assured to require/order at least two views. As far as 2012 CPT codes are concerned, meeting the necessities of 72120 will be much easier.

250.00 Only Won't Cut It for Diabetic Patients With Ophthalmic Manifestations

2012-01-18T01:20:00.000-08:00

Confirm to code the specific diabetic Dx your ophthalmologist is providing care for.

In case you're feeling uncertain about filing claims for patients with ophthalmic complications from diabetes, support yourself with diagnosis basics and an understanding of manifestations to ace diabetic patient coding. Read this article to know what ICD-9 codes you must choose.

1. Master Decimal Places for Dx

One of the most common mistakes coders make when filling a claim on a diabetic patient is reporting 250.00 (Diabetes mellitus without mention of complication) for the diagnosis. Code 250.00 on its own usually is not adequate to indicate the diagnosis of patients with diabetes. In its place, you must specify the precise type of diabetes for which the ophthalmologist is providing care.

Why? Medicare and other third-party payers need a highly specific diagnosis to validate payment. That means that you must pay adequate attention to the fourth and fifth places beyond the decimal point, which specify any complications and the exact type of disease.

Fourth place: The fourth place, or the first decimal place, specifies a complication. This includes ICD-9 codes 250.0x-250.9x. The complication indicator normally used in the ophthalmologist's office is 250.5x, which specifies ophthalmic manifestations.

Fifth place: The fifth place, or second decimal place, specifies the sub-classification of disease. In the case of diabetes, it is the "type," such as:

250.50 – (Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled)

250.51 -- (… type I [juvenile type], not stated as uncontrolled)

250.52 -- (… type II or unspecified type, uncontrolled)

250.53 -- (… type I [juvenile type], uncontrolled).

Remember: The diabetes ICD-9 codes are not based on whether or not the patient is insulin dependent or non-insulin dependent, however whether or not it is type I or type II diabetes. In case you are uncertain, the unspecified code 250.50 would be the right choice – in case the patient has some manifestations of the illness.

Watch out: Payers may reject your claim if your diagnosis code doesn't match up with the diagnosis code the patient's primary care physician (PCP) uses. For example, should the PCP use 250.41 (Diabetes with renal manifestations) to describe a patient's diagnosis and you put 250.00 on your claim, the inconsistency could trigger payer questions. But it is more precise to report ICD-9 code 250.5x as the primary diagnosis and reason for the encounter with the ophthalmologist.

Your claim may also demonstrate secondary diabetes diagnosis ICD9 codes when known.

2. Make Underlying Disease Primary Dx

Some coders are unsure how to code for diabetic patient care once the patient's primary physician hasn't so far diagnosed the disease.

You be the coder: The ophthalmologist discovers diabetic retinopathy in a patient identified as "pre-diabetic." Would you code 250.5x for diabetes along with ophthalmic complications, and 362.0x for the diabetic retinopathy or simply code for retinopathy since the PCP hasn't formally diagnosed the patient as diabetic?

Answer: Accurate medical coding requires you to report the 250.5x diagnosis as primary, then the retinopathy 362.0x diagnosis as secondary whether the patient has officially been diagnosed with diabetes or not.

Why? Diabetic retinopathy is evidently a manifestation of the much larger systemic disease of diabetes, so you must identify diabetes as the primary diagnosis.

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CCI 18.0: Avoid Catheterization Coding With Still More Procedures

2012-01-18T01:19:00.000-08:00

And more, you'll find 51597 bundles several procedures now as well.

Every year at this time you're confronted with new and revised codes you are required to learn and just when you think you have the 2012 coding updates aced, the Correct Coding Initiative (CCI) comes along and throws coding restrictions at you.

The CCI came up with the version 18.0 at the end of 2011, with 15,530 new active pairs and 6,197 code pair deletions.

2012 Medical Coding Update: A lot of the novel code pair additions involve new 2012 CPT codes that were introduced on Jan. 1, with CCI now denying payment in case you report certain procedures together. For example, you'll find skin repair 2012 CPT codes 12001-12021 bundled into new skin substitute grafting codes 15271-15278, but in most cases, a modifier can separate the edit.

Good news: There are not too many edits to learn and apply to your urology coding, although this is the first round of bundling for 2012. Here are the ones you essentially need to know.

Add Urethral Catheterization Bundles to Your CCI Lists

Thanks to CCI 18.0, you'll find the following listed urethral catheterizations 2012 CPT codes bundled with column one codes 29582-29584 (Application of multi-layer compression system ...):

51701 – (Insertion of non-indwelling bladder catheter (e.g., straight catheterization for residual urine))

51702 – (Insertion of temporary indwelling bladder catheter; simple (eg, Foley))

51703 – (… complicated (eg, altered anatomy, fractured catheter/balloon)).

Consequently, as with so many other procedures, catheterization of the urinary bladder at the same time as a primary procedure must not start an additional charge.

Silver lining: These edits have a modifier indicator of "1." That means you can sidestep the edit with a modifier under definite clinical circumstances.

But remember: You cannot just add a modifier (such as 59, Distinct procedural service) any time you wish to separate a bundle like this -- you have to validate it with the physician's documentation.

Watch These Urogynecology Edits

In case your physician implants a biological implant, for instance an acellular dermal matrix, you won't be able to report the new add on code +15777 (Implantation of biologic implant [e.g., acellular dermal matrix] for soft tissue reinforcement [e.g., breast, trunk] [List separately in addition to code for primary procedure]) with any of the following listed 2012 CPT codes when the procedures are carried out at the same encounter:

57240 – (Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele)

57250 – (Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy)

57260 – (Combined anteroposterior colporrhaphy)

57265 – (... with enterocele repair)

57285 – (Paravaginal defect repair (including repair of cystocele, if performed); vaginal approach.

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CCI 18.0 Edits Update: Latest CCI Edits Nix Anesthesia With New Neurostim Array Codes

2012-01-17T02:38:00.001-08:00

TPI and tendon injections overrule 100+ other procedures.

Now that 2012 has arrived, it's high time to put those novel procedure and diagnosis codes to use -- and understand which ones are affected by the latest Correct Coding Initiative (CCI) edits. CCI 18.0 effective Jan. 1, 2012, modifies how you should report anesthesia services for two new Category III anesthesia CPT codes as well as some long-time injection procedures and ensure accurate medical coding.

Report Anesthesia, Not Neurostim Electrode Array

CCI 18.0 comprises of 544 edits listing an anesthesia code in Column 1 and 154 edits with anesthesia as the Column 2 component.

CPT® 2012 presents two Category III anesthesia CPT codes for implantation and/or removal of a trial or permanent percutaneous neurostimulator electrode array:

0282T – ( or open implantation of neurostimulator electrode array(s), subcutaneous (peripheral subcutaneous field stimulation), including imaging guidance, when performed, cervical, thoracic, or lumbar; for trial, including removal at the conclusion of trial period)

0283T – ( permanent, with implantation of a pulse generator)

CCI 18.0 pairs anesthesia CPT codes with 0282T and 0283T, with a clarification of "Standard preparation/monitoring services for anesthesia". The anesthesia procedure is the Column 1 code of every single pair, meaning you'll report the appropriate anesthesia code in place of 0282T or 0283T. All edits carry a modifier indicator of "1," so you might sometimes be able to bypass the edit with a modifier and be paid for both services (such as modifier 59, Distinct procedural service). Ensure that you have good documentation supporting the use of both codes before making an attempt to be paid.

Check Out Changes to Injection Procedures

In case your physician administers trigger point, joint, or tendon injections, be sure to scroll further down the CCI edits for certain changes affecting those anesthesia CPT codes:

Trigger point injection codes 20552 and 20553 are the Column 1 codes with new codes 29582 (Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed) and 29584 ( upper arm, forearm, hand, and fingers).

Joint injection codes 20600, 20605, and 20610 are the Column 1 codes with novel procedures 20527 (Injection, enzyme [e.g., collagenase], palmar fascial cord [i.e., Dupuytren's contracture]), 29582, 29583 (Application of multi-layer compression system; upper arm and forearm), and 29584.

Tendon injection procedures 20526 and 20527 are chosen as the Column 1 code for more than 130 edit pairs. The coupled procedures vary from abscess aspirations and therapeutic injections to cast applications, venipuncture, as well as anesthetic injections, to name a few. Sort through the edits to understand which ones might be applicable to your providers.

PM Generator: 33221 Joins 33212 and 33213 for Just Battery Insertion

2012-01-17T02:36:00.000-08:00

Keep your distance with these codes when patient presents to switch the old battery for a new one.

CPT® 2012 brings code changes, revised guidelines, as well as new definitions to the Pacemaker and Pacing Cardioverter-Defibrillator section. This expert medical coding article focuses on 2012 coding updates on pacemaker (PM) pulse generator insertion codes 33212, 33213, and 33221.

Get started: One significant change to remember is that radiological supervision and imaging is now encompassed in PM and pacing cardioverter-defibrillator codes 33206-33249.

2012 coding update: Get a Quick View of Revisions and Additions

CPT® 2012 reviews the definitions of 33212 and 33213 as shown below, effective Jan. 1, 2012:

CPT® 2012 furthermore adds a third code to this family:

33221, with existing multiple leads.

'Replacement' Removal Is Key Change

The 2012 CPT codes' first modification of note is the deletion of "or replacement" from the common portion of the definition shared by 33212, 33213, and (in 2012) 33221.

Removing "replacement" makes way for the addition of three novel 2012 CPT codes that you must use in 2012 when the physician removes a PM pulse generator (battery) and replaces the battery at the same session:

33227, Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system

33228, dual lead system

33229, multiple lead system.

Compare 2011 to 2012: As an instance of how these changes impact coding, recall that in 2011 you reported a single-chamber PM generator change using 2011 codes 33233 (Removal of permanent pacemaker pulse generator) for the removal of a battery and 33212 for replacing a battery at the same session. As far as 2012 CPT codes are concerned, you, as a replacement, must report 33227 to capture both the removal as well as the replacement.

Subsequently, in 2012, you'll report 33212, 33213, and 33221 only when a patient who already has electrodes (leads) in place presents simply for insertion of the PM pulse generator. You are no longer supposed to use 33212, 33213, or 33221 together with 33233 for a battery change. To further lay emphasis on this change, 33233 has a revised definition in 2012, adding the term "only" at the end: Removal of permanent pacemaker pulse generator only. This means that 33233 is a stand-alone code.

Helpful instruction: A parenthetical note with the 2012 CPT codes makes certain you understand that 33212, 33213, and 33221 are not suitable for replacement services: You must not report 33212, 33213, 33221 in combination with 33233 for removal and replacement of the pacemaker pulse generator. Use 33227-33229, as suitable, when pulse generator replacement is indicated.

96110: Use This Tool to Combat Medicaid Denials for Developmental Screening

2012-01-16T04:06:00.000-08:00

Even though CMS originally suspended RVUs for this code, you'll now find an update.

In case your Medicaid provider is sending back your developmental screening claims and marking them "denied," there's a powerful new tool that can help you combat those zero-reimbursement situations for error-free medical coding.

Issue Lies in Testing vs. Screening Difference

Although most yearly CPT manual updates have the potential to help your practice considerably, others can cut your income to a halt. Unfortunately, that's been the case for a lot of pediatric practices that have been thwarted by the latest adjustment to the developmental screening code 96110 (Developmental screening, with interpretation and report, per standardized instrument form).

Owing to the fact that this code was earlier referred to as a developmental "testing" code in the CPT manual, reimbursement was under no circumstances an issue for it. However, since a lot of Medicaid payers don't pay for "screening," some practices had to fight their payers for hours over the denial of these services. To control this issue, CMS released an "Informational Bulletin" on Dec. 28 that advises how to collect for these services.

As per the bulletin, a lot of State Medicaid agencies have developed fee schedules based upon Medicare billing codes and associated relative value units. Since Medicare does not pay for screening or preventive services…CMS changed the active status of code 96110 and did not take account of associated value units in the 2012 Medicare Resource Based Relative Value Scale physician fee schedule (PFS).

This change stemmed a lot of questions and potentially unintended consequences for other payers. CMS maintains that it wants to be clear that Medicaid and other private payers will be able to carry on using code 96110 although it is a statutorily non-covered service under Medicare. In addition, a lot of State Medicaid programs rely upon Medicare-published relative value units, including those related with code 96110 in the CPT manual.

Owing to this confusion, CMS announced that Medicare will update its 2012 Fee Schedule to signify the 2012 payment rate for 96110, which is 0.28 RVUs. The code will be noted status "N," demonstrating that code 96110 in the CPT manual is a non-covered service for Medicare payers. It must be recognized and covered by other payers, including Medicaid.

Use CMS Letter as Your Appeal Tool

In case your Medicaid or private payer is following the original 2012 CMS directive to assign zero RVUs to 96110, you'll require to appeal any denials based on that wrong value assignment.

Along with your appeal letter, you must also include a copy of CMS's clarification, which evidently states the new RVUs for 96110.

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E/M Coding: 99058: ‘Walk-in' Patients Only Won't Qualify You for This Emergency Code

2012-01-16T04:03:00.000-08:00

Stress on the phrase "in addition to basic service."

Pediatricians don't always see patients during scheduled office a visit, which implies that you perhaps see walk-in patients almost every week. Even though some practices instantly stamp a 99058 code on all walk-in claims, you must avoid adding this code to your visit except you can prove that the patient's visit is truly emergent. Go through this expert medical coding article for learning more.

Office Emergency Points to 99058

While CPT code lookup, you must think "emergency" and "interruption" when considering whether to include 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service) on a claim.

It requires to really be an emergent or urgent problem that be applicable to to walk-ins in case they have a triage assessment and have a severe problem that needs to be worked up instantaneously and they are seen by a doctor as soon as possible; however, it doesn't apply in an unvarying way to walk-ins. Reviewers have seen 99058 linked to ICD9 codes for pharyngitis, upper respiratory infections, and different other conditions that are normally considered non-emergent.

CPT Code Lookup Tip: Cases that worth 99058 are urgent care situations that disturb the office schedule, for instance a child who is suffering from asthma and also going through active wheezing as well as shortness of breath (493.02, Extrinsic asthma; with [acute] exacerbation).The patient's parent could bring the child himself, or a different physician office could call saying the it is essential for the patient to be seen right away. You must ensure the pediatrician sufficiently documents the situation, however, prior to submitting 99058 -- payers want to know that the physician treated the patient for an emergent problem, disrupting their schedule.

Remember to Include E/M Codes

At first glimpse, when you execute CPT code lookup, 99058 seems complete enough to stand on its own. You must, however, always take a closer look and the phrase "in addition to basic service" is your hint that more codes are required.

Once you perform CPT code lookup, you will find that CPTdoesn't designate the status with a plus sign, however the code technically is considered add-on. As a result, you can only report it in combination with the suitable E/M code.

Some payers, including Medicare, do not reimburse for the after-hours codes -- but others do. Reimbursement rates might not be high, but every little bit adds up. You can also use the fact that few payers are reimbursing you for this code to help negotiate for payment from non-paying insurers.

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Apply These Added Tips for EEG Reporting Success

2012-01-13T03:48:00.001-08:00

Do not look at frequency and never overlook a hidden bundle.

Learn how to report the digital analysis and time the physician attendance. This article also review show to identify Correct Coding Initiative (CCI) bundling edits in the EEG codes. Read this expert medical coding article to further learn how to report EEG recording in situations like coma and polysomnography.

Identify Any Digital Analysis

For digital services, after CPT code lookup you turn to code 95957 (Digital analysis of electroencephalogram [EEG] [e.g., for epileptic spike analysis]). You, nonetheless, would not universally bill this particular code for digital recording of and/or use of an automated spike and seizure detector on a routine EEG, ambulatory EEG or video-EEG monitoring. You execute CPT code lookup and precisely report 95957 once your physician uses specialized digital services similar to three-dimensional (3D) dipole localization or alike techniques for the EEG recording. Digital analysis is frequently used for presurgical planning as epileptic spike onset must be localized. It would not be suitable to bill 95957 for source localization when the EEG is normal, i.e. no spikes to analyze.

Time the Physician Attendance

When your neurologist uses surface electrodes in the brain to provoke seizures and obtain a mapping, you should use your physician's attendance time, not the recording time, to determine the coding. In this case, after CPT code lookup, you would report 95961 (Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of physician attendance) for the first hour of physician attendance.

Following the CPT® 'passing the time requirement, you would append modifier 52 (Reduced services) with the 95961 CPT® code if the neurologist's physical attendance time is 30 minutes or less.

Once you execute CPT code lookup, you report +95962 (… each additional hour of physician attendance [List separately in addition to code for primary procedure]) along with the 95961 CPT code for every additional hour of physician attendance time.

Beware Hidden Bundles

An EEG might be bundled in some medical procedures and these may not indicate the EEG in code descriptors. An instance of such a procedure is the recording of circadian respiration in infants reported with 94772 (Circadian respiratory pattern recording [pediatric pneumogram], 12 to 24 hour continuous recording, infant). CPT® precisely mentions that "separate procedure codes for electromyograms, EEG, ECG, and recordings of respiration are excluded when 94772 is reported." "This parenthetical note is not payer specific, for instance Medicare's CCI edits. It applies to all payers that use CPT® codes to process their claims.

Distinguish Routine Polysomnography

Your neurologist may perform other diagnostic testing during the process of investigating the patient for the seizures, so you should know when to separately report the EEG testing.

Medicare's CCI edits bundle the extended EEG monitoring codes, 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes) and 95813 (Electroencephalogram [EEG] extended monitoring; greater than 1 hour), as components of the sleep staging investigation codes, 95808 (Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist)-95811 (Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist).

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CCI Edits 18.0: Get Well-Versed with New Bundled Codes

2012-01-13T03:43:00.000-08:00

Plus: 94150 'separate procedure' doesn't every time mean separate coding.

New codes aren't just the only things that affect your coding in 2012 -- you also need to cull through the most recent Correct Coding Initiative (CCI) edits to make certain you appropriately report multiple procedures. CCI edits 2012 went into effect Jan. 1, 2012, with substantial changes to how you should code familiar injection or incision/drainage procedures.

Report Injection Over Compression, Aspiration

CCI edits 2012 includes 15,530 new edit pairs. In case your physician manages trigger point, joint, or tendon injections, don't miss the CCI edits involving those procedures:

Trigger point injection codes 20552 and 20553 are the Column 1 codes with novel codes 29582 (Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed) and 29584 (… upper arm, forearm, hand, and fingers).

Tendon injection procedures 20526 and 20527 are selected as the Column 1 code for more than 130 edit pairs. The coupled procedures range from abscess aspirations and therapeutic injections to cast applications, venipuncture, and anesthetic injections, to name a few. Search through the CCI edits to see which ones might apply to your providers.

Reminder: When CCI edits pair two codes together, you'll normally report the Column 1 code in place of the Column 2 code. The Column 1 code either signifies a procedure that involves the services of the Column 2 code, or denotes a procedure that "outweighs" the Column 2 code and should be reported alone.

I&D or Debridement Override Compression

A number of other CCI edits are also applicable to novel code 29582 (Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed). The compression system application is part of the service represented by incision/drainage or debridement codes for instance:

10060 – (Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single)

10061 – (… complicated or multiple)

10140 – (Incision and drainage of hematoma, seroma or fluid collection)

10160 – (Puncture aspiration of abscess, hematoma, bulla, or cyst)

11000 – (Debridement of extensive eczematous or infected skin; up to 10% of body surface.)

The CCI edits 2012 keep your medical coding consistent with CPT guidelines. Each edit pair carries a modifier indicator of "1," however, which implies that you might occasionally be able to sidestep the edit with a modifier and be paid for both services (such as modifier 59, Distinct procedural service).

Vertebroplasty: 22520-+22522 Contain Bone Biopsy, Says CPT® 2012

2012-01-10T04:00:00.000-08:00

You’ll have to check the guidelines in case you want to study the exception.

A 2012 wording change brings the code definitions meant for percutaneous vertebroplasty in agreement with Correct Coding Initiative (CCI) edits. Here’s the expert medical coding article on what you need to know.

Vertebroplasty, Kyphoplasty, and CCI All Agree

CPT® 2012, effective Jan. 1, 2012, modifies the definitions of 22520-+22522 in the CPT manual to explain that you must not code same-level bone biopsies carried out at the same session. Compare the definitions below given in the CPT manual:

2011: (Percutaneous vertebroplasty, 1 vertebral body, unilateral or bilateral injection ...)

2012: (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection ...)

The updated wording in CPT manual makes the vertebroplasty codes more stable with the wording for the kyphoplasty codes, which also explicitly include bone biopsy when carried out: 22523-+22525 (Percutaneous vertebral augmentation, including cavity creation [fracture reduction and bone biopsy included when performed] using mechanical device, 1 vertebral body, unilateral or bilateral cannulation [e.g., kyphoplasty] …).

The update is also in agreement with CCI edits, which bundle 20225 (Biopsy, bone, trocar, or needle; deep [e.g., vertebral body, femur]) into 22520 (... thoracic) and 22521 (... lumbar).

Tip: Don’t be astonished that 20225 isn’t bundled into +22522 (...each additional thoracic or lumbar vertebral body [list separately in addition to code for primary procedure]). As +22522 is an add-on code, you might never report +22522 alone. You at all times will report it along with either 22520 or 22521, and 20225 is bundled into those codes.

Watch for: Just in case you still have the wish to report a bone biopsy code with vertebroplasty, a novel note following 22520-+22522 highlights the bone biopsy bundle by telling you not to report those vertebroplasty codes with bone biopsy code 20225. There is one exception, though, as described below.

Uncover the Bone Biopsy Exception

The grouping of code descriptor changes, CCI edits, and CPT® guidelines clarifies that you must not report bone biopsy with percutaneous vertebroplasty. But that’s not the end of the story.

CPT® guidelines mention that you must bundle the bone biopsy only "when performed at the same level." That implies that in case the physician carries out bone biopsy at a level not addressed by the vertebroplasty, you may report the biopsy distinctly.

How: Append modifier 59 (Distinct procedural service) to the bone biopsy code to specify the physician carried out the bone biopsy at a dissimilar site.

Capture Guidance Using 2 Specific Codes

To complete coding the vertebroplasty service, remember to report the guidance the radiologist uses. Once you do CPT code lookup, you will find that CPT , offers two codes that are applicable specifically to vertebroplasty:

72291 (Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation (sacroplasty), including cavity creation, per vertebral body or sacrum; under fluoroscopic guidance)

72292, (... under CT guidance)

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Are you aware of These CPT 93000 Requirements?

2012-01-10T03:49:00.000-08:00

Experts disclose 4 secrets of component-ECG coding

Family physicians (FPs) don't always carry out the same electrocardiogram (ECG) service - the differences in where and what they provide decide your CPT 93000, 93005 or 93010 selection.

In case an in-office machine spits out the information, and then the FP issues a report, you must report the complete code CPT 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report), which certainly pays more than $26. However, determining which code to report when your practice doesn't deliver the tracing or interpret the results is more challenging.

You shouldn't fall into the trap of using modifiers -TC (Technical component) and -26 (Professional component) on CPT 93000. You should as an alternative report 93005 (… tracing only, without interpretation and report) for the technical component and 93010 (… interpretation and report only) for the professional service.

Why does CPT use 93000-93010 rather than modifiers -TC and -26 for ECG component coding? When CPT developed the ECG codes, many payers didn't recognize modifiers. To avoid insurers ignoring the modifiers and in turn rejecting claims for what would then appear as duplicate CPT 93000 billing, CPT assigned precise codes for the services. To decide when to use 93000-93010, medical coding experts mention four guidelines:

1. Bill 93005 for In-Office Procedure

In case your FP carries out an in-office ECG without interpreting the report, you must assign 93005 for the technical component. Code 93005 contains of the FP or his staff placing the 12 leads on the patient, carrying out the standardization process and taking the gel off the patient at the end of the ECG.

2. Use 93010 for Report Only

Occasionally the FP carries out the ECG in the hospital however still issues the report. In this case, you must bill 93010 for the professional component.

To get the $9 for carrying out the professional component, your FP needs to document that he interpreted the ECG's printout. As the technical component (93005) contains the machine's report, the FP should show that he did more than look at the printout.

Medicare and other carriers anticipate the FP to write report interpretations on the machine's 8 x 11 sheet or strip report. Appropriate documentation comprises stating why the doctor agrees or disagrees with the machine's description and signing and dating the report.

3. Assign 93000 for Procedure and Report

You must bill the global code CPT 93000 when your FP carries out the ECG and documents his findings. You will have no problems with Medicare and other insurers reimbursing you for ECGs, provided you follow these rules.

4. Employ Other-Physician Interpretations Options

A number of FPs do not feel contented reading the ECG reports and hire a cardiologist or internist to interpret the printout. In this case, each doctor must bill for his own role.

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Prepare Yourself With Novel Codes To Report Neurolysis in 2012

2012-01-09T03:11:00.002-08:00

Keep a count of joints, irrespective of the numbers of nerves.

While reporting the paravertebral facet joint nerve injections in 2012, you will no more be counting nerves that your surgeon targeted. You have up to now been reporting injections for every nerve at a single vertebral level. Effective Jan. 1, you'll require adjusting your method to look for the precise anatomical site involved and also the work that your surgeon did. Read on for more on what changes to expect for these injections in CPT 2012: what goes obsolete and what new comes in.

Know the CPT 2012 Deletions

Here are four CPT codes that will be deleted in CPT 2012:

64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level)

+64623 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level [List separately in addition to code for primary procedure])

64626 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level)

+64627 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level [List separately in addition to code for primary procedure])

Look at New Codes

You will find four novel CPT codes in CPT 2012. These include the following:

64633 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; cervical or thoracic, single facet joint)

+64634 (Destruction by neurolytic agent, paravertebral facet joint nerve [s], with imaging guidance [fluoroscopy or CT]; cervical or thoracic, each additional facet joint [List separately in addition to code for primary procedure])

64635 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single facet joint)

+64636 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, each additional facet joint [List separately in addition to code for primary procedure])

Don't Distinctly Report Image Guidance

While reporting neurolysis defined by new CPT codes 64633-64636, ensure that your surgeon has used and documented the image guidance used to carry out the paravertebral facet joint nerve destruction. The CPT codes for 2012 are inclusive of the image guidance, so you do not individually report the fluoroscopy or CT guidance used for the paravertebral nerve localization.

Medical Coding Tip: You are not supposed to report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, subarachnoid, or sacroiliac joint], including neurolytic agent destruction) for fluoroscopic guidance and 77012 (Computed tomography guidance for needle placement [eg, biopsy, aspiration, injection, localization device], radiological supervision and interpretation) for CT guidance with 64633-64636.

Thyroid Coding: Learn When to Report Dissections Distinct From Thyroidectomy

2012-01-09T03:11:00.001-08:00

Remember, "Functional," "selective," and "radical" denote the same procedure.

Believing you know thyroidectomy codes completely may set you up for disaster. You actually have to study the code descriptors and identify the terminology related with neck dissection to precisely code these procedures. Follow this expert medical coding advice and know what CPT codes you should select in this case.

Medical Coding Tip: While coding for thyroidectomy procedures (60240-60271), keep a close watch on the code descriptors. A lot of of them include all of the procedures that the otolaryngologist carried out, thus you won't have to report further codes for the auxiliary services.

Decide Whether to Report Dissections

Test yourself with the following example.

Assume your otolaryngologist does away with both thyroid lobes with the isthmus and pyramid lobe tissue. He furthermore classifies and excises all enlarged lymph nodes. The malignancy has not spread considerably, thus the otolaryngologist excises merely a few selection of lymph nodes. Accordingly, he carries out a thyroidectomy with restricted neck dissection. What CPT codes must you report, and should you report a distinct code for the dissection?

Answer 1: You must report only 60252 (Thyroidectomy, total or subtotal for malignancy; with limited neck dissection). You must not report a distinct code for the dissection. This code comprises reimbursement for the thyroidectomy as well as the limited dissection.

What in case the physician states in the operative note that she carried out a "central neck dissection?" What would you code in this particular situation?

Answer 2: A central neck dissection is alike the example above and signifies a limited neck dissection, not a radical neck nor a modified radical neck dissection. Consequently, in case it is stated that a central neck dissection is carried out with a total thyroidectomy, you would report 60252 (Thyroidectomy, total or subtotal for malignancy; with limited neck dissection).

Let's try a different example. Throughout a total thyroidectomy, an otolaryngologist dissects all the levels of lymph nodes and should sacrifice the spinal accessory nerve, jugular vein along with the sternocleidomastoid muscles to eliminate a malignant lymphatic chain. What CPT codes should you report, and should you report a distinct code for the dissection?

Answer 3: In the above case, you must report only the thyroidectomy along with radical neck dissection with 60254 (Thyroidectomy, total or subtotal for malignancy; with radical neck dissection). By definition, you must not distinctly report the radical neck dissection (38720, Cervical lymphadenectomy [complete]).

CPT, though, throws you a curve ball once your physician combines thyroidectomy along with modified radical neck dissection. None of the thyroidectomy CPT codes identify this combination, which you'll have to code out distinctly.

G0105, 45378: Use This Coding Combination For Your High-Risk Patients

2012-01-05T23:55:00.000-08:00

Irrespective of findings, stick to V10.05 to define condition.

Correctly reporting colorectal cancer screenings on patients at high risk for the disease can depend on fine points like allocating the right V code. Read this expert medical coding article and know what ICD-9 codes apply in this scenario.

Examine the following given scenario and the medical coding advice that follows to ace these claims -- and recover your deserved reimbursement for these services:

Scenario: A patient has a personal history of colon cancer, went through treatment for colon cancer six years before, however she is presently facing no symptoms. Her 2006 colonoscopy came out clear, as well as her recent one carried out about a month ago. You billed 45378 for the procedure, and then you selected V10.05, from the ICD-9 codes, for the diagnosis. Though, the patient called complaining you should've billed the procedure as routine as her last two colonoscopies were clean. How would you resolve this?

Choose G0105 Or 45378, But Get The History Diagnosis Right

In case you're billing Medicare, you smust report the procedure as a high risk screening with code G0105 (Colorectal cancer screening; colonoscopy on individual at high risk). Then, from ICD-9 codes, report V code V10.05 (Personal history of malignant neoplasm of large intestine) as the primary diagnosis.

Code V10.05 fits the bill for primary diagnosis as the patient presents to the office for a screening exam and not precisely for follow-up assessment of the cancer. In case the encounter's purpose is for cancer surveillance and follow-up at an interval close by the surgical treatment, you could, as an alternative, code V67.09 (Follow-up examination following other surgery) as your primary diagnosis. Though, keep in mind that this ICD-9 code is seldom used.

On the contrary, certain commercial carriers would need the code 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) with modifier 33 (Preventive services) appended to signify that the service was preventive, and the V code V10.05 as diagnosis.

Don't forget: From ICD-9 codes, you must list V10.05 as your primary diagnosis for both circumstances (Medicare and commercial payers), irrespective of the fact that the results were clear or not. Use this ICD-9 code if all treatment focused toward the cancer is complete and there are no symptoms of current disease . Don't make the error of reporting a cancer code (153.3, Malignant neoplasm of sigmoid colon) or the family history code (V16.0, Family history of malignant neoplasm of gastrointestinal tract).

Draw On Diplomacy To Confer With Patients

Complaints like this from patients on a screening colonoscopy are common in the gastroenterology practice. The best guidance is to talk it out with your patient, and make clear how their cancer history influences the medical coding.

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Ace Routine And Extended EEG Coding With These Pointers

2012-01-05T23:54:00.000-08:00

Exact timing of EEG monitoring is crucial, frequency is not important.

While reporting EEG recording, the most vital factor is to time the procedure. In case your physician uses advanced methods, video and digital recordings; you may be faced with added medical coding challenges for these services. Read on to prepare yourself on how to accurately time the procedure along with code the routine, extended, and special monitoring.

Look For How Long the Diagnostic Study Continued

While reporting EEG, you must look for how long your neurologist took to perform the monitoring. Monitoring that lasts 20 to 40 minutes is taken as routine. You will report CPT codes for extended monitoring in case the procedure goes beyond 40 minutes in duration. For EEG recording that lasts 41 to 60 minutes, you must report 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes), and in case it lasts more than an hour, you would report 95813 (Electroencephalogram [EEG] extended monitoring; greater than 1 hour).

It is significant that your neurologist's report evidently documents the actual EEG recording time. Medical coding is based on the recording though it is underway and the neurologist or technician is collecting data. You do not involve the set-up and take-down time..

Exception: CPT® does not include EEG CPT codes 95824 (Electroencephalogram [EEG]; cerebral death evaluation only), 95827 (Electroencephalogram [EEG]; all night recording), and 95829 (Electrocorticogram at surgery [separate procedure]) from a time component as these are unique services rendered by the physician to monitor a certain pathological condition or diagnose one.

Important note: You can report CPT codes 95812 or 95813 instead of 95816 (Electroencephalogram [EEG]; including recording awake and drowsy), 95819 (… including recording awake and asleep) or 95822 (… recording in coma or sleep only), however you cannot report them together. There is a thin line between drowsy and asleep. You report 95819 when the patient in reality slept during the monitoring. In case the patient did not achieve sleep in a procedure that intended monitoring in sleep, you report 95816 as an alternative.

In case the neurology specialist carries out the global diagnostic service, i.e. owns the equipment, employs the technical staff as well as interprets the diagnostic findings, then the EEG code would be billed without any modifiers. On the other hand, you would append modifier 26 (Professional component) to the EEG CPT® code, in case your neurologist only carries out the professional interpretation of the diagnostic study.

Scan For Video and Channels in Extended Monitoring

For 24-hour EEG monitoring, you should assess CPT codes 95950 (Monitoring for identification and lateralization of cerebral seizure focus, electroencephalographic [e.g., 8 channel EEG] recording and interpretation, each 24 hours)-95953 (Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic [EEG] recording and interpretation, each 24 hours, unattended) or 95956 (Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, electroencephalographic [EEG] recording and interpretation, each 24 hours, attended by a technologist or nurse).

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Prepare Yourself With Novel Codes To Report Neurolysis in 2012

2012-01-05T04:44:00.002-08:00

While reporting the paravertebral facet joint nerve injections in 2012, you will no more be counting nerves that your surgeon targeted. Till now, you have been reporting injections for each nerve at a distinct vertebral level. Effective Jan. 1, you'll require adjusting your technique to look for the particular anatomical site involved along with the work that your surgeon did. Read this expert medical coding article for more on what changes does CPT 2012 brings for these injections in: what goes obsolete and what new comes in.

CPT 2012: Know the Deletions

Here are four CPT codes that will be deleted in 2012:

64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level)

+64623 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level [List separately in addition to code for primary procedure])

64626 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level)

+64627 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level [List separately in addition to code for primary procedure])

CPT 2102: Look at Novel Codes

You will find four new CPT codes in 2012. These include the following:

64633 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; cervical or thoracic, single facet joint)

64635 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single facet joint)

Don't Distinctly Report Image Guidance

When reporting neurolysis described by new CPT codes 64633-64636, ensure that your surgeon has used and documented the image guidance used to carry out the paravertebral facet joint nerve destruction. The CPT 2012 codes are inclusive of the image guidance, so you do not individually report the fluoroscopy or CT guidance used for the paravertebral nerve localization. Keep in mind that image guidance with either fluoroscopy or CT is both required and is bundled into the new CPT codes.CPT 2012 Tip: You do not report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, subarachnoid, or sacroiliac joint], including neurolytic agent destruction) for fluoroscopic guidance and 77012 (Computed tomography guidance for needle placement [eg, biopsy, aspiration, injection, localization device], radiological supervision and interpretation) for CT guidance with 64633-64636.

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CPT 2012: Don't Skip These Explanations About New Patients plus 'Qualified Healthcare Professional'

2012-01-05T04:44:00.001-08:00

Learn how changes influence your use of 99201-99205, 99460-99461, and more.

Medical coding guidelines can at times seem puzzling when you're trying to decide whether to categorize a patient as new or established. For instance when an established patient comes to your practice to see a new physician, would you report a new patient office visit code?

CPT 2012 tries to clarify this question and one other E/M question: Who counts as a "qualified healthcare professional" to administer that vaccine or deliver prolonged service?

'New Patient' Classification Goes to a New Level

At present, CPT® indicates that a "new patient" refers to a patient who has not received any professional services, for instance an E/M or other face-to-face service, from the physician or another physician of the same specialty in the similar group practice in the past three years.

Clarification: CPT 2012 takes that definition a step further, by stating, "A new patient is one who has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years." The parts of the description that are novel for 2012 are underlined.

What it means: In case your practice employs several subspecialists, CPT® now clarifies that claims for patients who see dissimilar doctors with different subspecialties can be billed using a novel patient code (such as 99201-99205).

RN Doesn't Fit 'Other Qualified Healthcare Professional'

In case your payer follows CPT® rules, you can now eliminate registered nurses from the list of professionals who can administer vaccinations or offer prolonged services for patients.

At the demand of many physicians, CPT 2012 now describes the term "other qualified healthcare professional." Although this definition didn't make it into the 2012 manual, the AMA lists it as part of the "CPT 2012 Errata" on its Web site.

The definition("A 'physician or other qualified health care professional' is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service. These professionals are distinct from 'clinical staff.' A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service. Other policies may also affect who may report specified services.)

Result: RNs and LPNs are excluded in the definition, as they cannot individually report the professional services that they offer. RNs and LPNs suit the CPT® definition of "clinical staff," as their professional services are normally reported under a physician or other qualified health care professional's identification number (e.g., under Medicare's "incident to" rule). This implies that when certain CPT codes refer to 'other qualified health care professionals' they are not including RNs and LPNs.

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33202-33211 Get Numerous Guidelines in 2012

2012-01-05T04:43:00.000-08:00

Hint: Understanding RS&I coding is the important for denial prevention.

The enormous changes to CPT®'s pacemaker (PM) along with implantable cardioverter-defibrillator (ICD) section are challenging even to expert coders. You can streamline the switch by breaking the changes into convenient chunks and mastering one group before going to the next. This expert medical coding article will focus on changes to CPT codes 33202-33211.

Confirm Provider Before Reporting 33202-33203

When reviewing CPT codes 33202-33211 in the 2012 manual, the first change you'll find is a revision to the parenthetical note following 33202-33203 (Insertion of epicardial electrode[s] ...). Compare the 2011 and 2012 descriptions of the note:

2011: ("When epicardial lead placement is performed by the same physician at the same session as insertion of the generator, report 33202, 33203 in conjunction with 33212, 33213, as appropriate.")

2012: ("When epicardial lead placement is performed with insertion of the generator, report 33202, 33203 in conjunction with 33212, 33213, 33221, 33230, 33231, 33240.")

The major change to the instruction is the list of CPT codes you may report along with epicardial lead placement CPT codes 33202 and 33203. The longer list is the outcome of CPT® 2012 adding and revising a number of codes for the insertion of a PM pulse generator (33212, 33213, 33221) or the insertion of a pacing ICD pulse generator (33230, 33231, 33240).

33206-33208 Join Other Codes for Full Replacement

The subsequent change you'll notice for this code range is a revision to 33206-33208. CPT® 2012 includes the following bold text to the definitions: "Insertion of new or replacement of permanent pacemaker with transvenous electrode(s) ..."

What does not change: As in 2011, the codes vary based on the electrode location:

33207, ... ventricular

33208, ... atrial and ventricular.

Similarly just as in 2011, 33206-33208 comprise subcutaneous insertion of the pulse generator as well as a transvenous placement of electrode[s], as per a parenthetical note with the codes.

Scratch 71090 Off Your Medical Coding Aids

One code you may have noticed absent from the above discussion is 71090 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation). The reason behind that is in 2012, radiological supervision as well as interpretation associated with the pacemaker or pacing cardioverter-defibrillator procedure is included in 33206-33249, as per CPT® guidelines. In fact, 71090 is no longer in the list if valid CPT codes in 2012.

Example: In 2011, you would have reported dual lead pacemaker insertion in fluoroscopy by the means of CPT codes 33208 and 71090. In 2012, you'll report that similar service using only 33208.

The removal of fluoroscopy while placing devices is another instance of addition for routine services. Fluoro is required to place the PM or ICD so CPT® may have streamlined that it is a component part of the service and not distinctly billable.

CPT® 2012: You'll Get Closure With Novel Skin Repair Guidelines

2012-01-05T04:34:00.000-08:00

Also, don't overlook separate debridement opportunity.

Feeling dazed by all the changes in the CPT 2012 integumentary section? Read this expert medical coding article to keep your skin repair claims clean and earn all the pay you deserve.

Note New Modifier Advice for Repairs

CPT 2012 proposes new introductory notes that offer guidance on how to report skin closures (12001-13160). Though the guidelines earlier advised the use of modifier 51 (Multiple procedures) when reporting dissimilar wound repair classifications together, that guidance is old news as of Jan. 1.

In black and white: The 2012 CPT® manual reads, "When more than one classification of wounds is repaired, list the more complicated as the primary procedure and the less complicated as the secondary procedure, using modifier 59."

What's "complicated? As CPT 2012 proposes simple, intermediate, and complex repairs, you'd think through the "simple" repair the minimum complicated, and the "complex" repair the maximum complicated. Consequently, in case the surgeon closes a leg wound with a simple repair for instance 12001(Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less) and an intermediate repair, for instance 12032 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm), you'll report the intermediate repair first, which should be followed by the simple repair with the modifier: 12032, 12001-59.

Know When Debridement is ‘Separate'

When surgeons carries out skin grafting, it's normal for coders to spend a lot of time and work trying to decide whether they can bill debridement distinctly, as a lot of physicians request.

Debridement is taken as a distinct procedure only when gross contamination needs a prolonged cleansing, when considerable amounts of devitalized or contaminated tissue are removed, or when debridement is performed separately without immediate primary closure.

CPT 2012 Tip: Your documentation must fully explain the surgeon's work cleansing the contamination and eliminating the devitalized tissue prior to you distinctly bill your insurer for debridement.

Skin Substitute Coding Renovation Simplifies Processes

Even though you may have been surprised when you saw that CPT 2012 made enormous changes to the skin substitute coding section (15271-15278, Application of skin substitute graft …), you must know that the AMA's goal was to make your life stress-free, not more difficult,

For wounds that are lesser than 100 square centimeters, you'll follow one code structure – in case your wound is 100 square centimeters or greater, you'll follow a different code structure. It has been felt that about 80 percent of the wounds would fit into the ‘less than 100 sq. cm' description.

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ICD-9 Coding: Welcome the New Year with a Reminder of Alcohol Related Diagnoses

2011-12-30T02:34:00.002-08:00

Ensure that you choose the accurate diagnosis code when alcohol is a factor of an ED visit

The New Year is approaching and with it comes an upsurge in alcohol-related presentations to the ED. Even though a lot of presenting problems are injuries or illnesses to which alcohol was a reason, it may be worth reviewing the numerous alcohol-related diagnoses that are available and when are they applicable in the ED setting. Read this article to know what ICD-9 codes apply for stress-free medical coding.

Take a look at some common patient types:

1. Patients who are brought in as they are impaired

It is not unusual for a highly intoxicated person to be brought to the ED by concerned friends, parents, or law enforcement officers as the patient seems to be unresponsive or dangerously intoxicated.

First let’s consider the patient, for whom no other diagnosis is probable, has come under medical care owing to the maladaptive effect of a drug on which he is not reliant on, and that he has taken on his own initiative to the damage of his health or social functioning, for instance a New Year’s Eve or a Super Bowl party. In this case, the patient has no history of alcohol dependency, but seems to have considerably exceeded his limit on this occasion.

ICD-9 codes that might apply are as following:

1. 305.0 (Nondependent alcohol abuse)
2. 305.00 (Nondependent alcohol abuse, unspecified drinking behaviour)
3. 305.01 (Nondependent alcohol abuse, continuous drinking behaviour)
4. 305.02 (Nondependent alcohol abuse, episodic drinking behaviour)
5. 305.03 (Nondependent alcohol abuse, in remission)

2. Patients whose condition is caused by long time alcohol abuse

The other end of the range is the long time alcohol abuser whose medical problems are directly credited to that history. Probable presentations involve hallucinations, seizures or delirium tremens. These patients may or may not be impaired at the time of their visit.

Frequently seen ED presentations can be reported with the following diagnosis ICD-9 codes:

291 (Alcohol induced mental disorders)

291.0 (Alcohol withdrawl delirium)

291.1 (Alcohol induced persisting amnestic disorder)

291.2 (Alcohol-induced persisting dementia)

291.3 (Alcohol-induced psychotic disorder with hallucinations)

291.4 (Idiosyncratic alcohol intoxication)

291.5 (Alcoholic-induced psychotic disorder with delusions)

291.8 (Other specified alcohol-induced mental disorders)

291.81 (Alcohol withdrawl)

291.9 (Unspecified alcohol-induced mental disorders)

Is it time for an Intervention? Deliberate behavior change intervention ICD-9 codes

Occasionally the trip to the ED for an alcohol-related injury turns into a chance for a screening and intervention to occur. Consider the patient who fell down the stairs because they were intoxicated or when alcohol appears to have contributed to MVA related injuries. Even though a busy ED is not the best place for this service, check the chart documentation to find if there is support for reporting the following ICD-9 codes:

99408 {Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes (Do not report services of less than 15 minutes with 99408}

99409 {greater than 30}

Improve Your Common ED Airway Procedure Accuracy

2011-12-30T02:34:00.001-08:00

Seconds count with airway tube insertions, however take a few minutes to learn these significant tips.

A recurrent presenting problem in the emergency department is a patient having trouble breathing owing to pulmonary disease, injury, or swelling of the throat tissues. You would normally report these encounters as high level ED visits or critical care due to the nature of the presenting problem; however you may also be able to report a procedure code in case it is correctly documented. Read on for advice on correctly documenting to support your airway services procedure medical coding.

1. Define Reason for Airway

The most general airway related procedure in the ED setting is endotracheal intubation where the patient has a compromised airway that requires stabilization.

Sample scenario: You should look for documentation describing tube placement similar to the following medical coding example:

A 24 year old female is brought in by her boyfriend from a picnic in a neighbouring park. Her face depicts signs of increasing swelling and she complains of having trouble breathing as if her throat is closing. She then reports a history of reactions to bee stings that have intensified in severity since she was a child. She is unclear that she was actually stung, but the boyfriend reports that there were bees present in the area and that they were seated near a large flower garden.

The emergency physician then orders an epinephrine injection, and as the patient had established increasing respiratory distress, places a tube down her throat to maintain her airway. After obtaining that limited history due to her breathing issues, an examination shows no other indication for the allergic reaction and he finds a likely sting site on the back of her neck. The patient reacts well to the epinephrine and then the swelling starts to subside after 40 minutes once she is admitted to the hospital. The physician afterwards documents 32 minutes of critical care time outside of distinctly billable procedures and then gives a diagnosis of anaphylaxis because of the bee sting.

On the claim, you would report the following for error-free medical coding:

99291 {Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes}

31500 {Intubation, endotracheal, emergency) for the tube placement}

989.5 {Toxic effect of other substances, chiefly non-medicinal as to source, venom}

E905.3 {Venomous animals and plants as the cause of poisoning and toxic reactions, hornets, wasps, and bees}

Medical Coding Tip: Apply the modifier 25 to 99291 to demonstrate that the intubation is distinct from the critical care services.

2. Critical Care? Scan for Time Details

You must keep in mind that in case the patient was reported as critical care, you should back out the time spent providing other procedures, for instance intubation, from your entire patient care time. A lot of payers require a statement in the documentation to that effect. Fortunately, most emergency physicians can place a tube rather rapidly.

Perfect Your Fibroid Claims By Knowing These Removal Methods

2011-12-29T02:59:00.000-08:00

Reporting uterine fibroid removals can be hard if you do not know the way the ob-gyn used to take care of the growth. Read this article and learn about each method of fibroid treatment, so you will be ready for whatever your ob-gyn chooses to carry out.

Medical Coding Method 1: Count Hysterectomy As Most Common Procedure

Hysterectomy is when the ob-gyn does away with the uterus completely. Even though this is the most common approach, it is used only when the fibroids are producing problems, for nstance abdominal pain or heavy bleeding. In case the uterus is not removed, there are chances are that the fibroids will reappear. When you execute the CPT lookup, the code assignment will hinge on on the type and extent of the hysterectomy.

Coding example: As the patient is older than 50 years and has multiple fibroids, your ob-gyn carries out a total abdominal hysterectomy (58150, Total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]). You would not code the fibroid removal distinctly if the ob-gyn is eliminating the uterus.

Medical Coding Method 2: Hem in Your Hysteroscopy Choices

Fibroids can also be treated using the hysteroscopic procedure. Hysteroscopic submucous resection gets rid of a portion of the protruding fibroid and preserves fertility.

The procedure needs “the close monitoring of distention media, electrosurgical devices, along with a patient’s anatomy to circumvent perforating the uterus. Ob-gyns normally carry out this straightforward approach for intracavitary (submucosal) fibroids.

Medical Coding Method 3: Master These Myomectomy Codes

Myomectomy (58140-58146, 58545-58546) is one more choice for fibroid treatment. A myomectomy is the removal of uterine fibroids only, which preserves fertility.

Example 1: The ob-gyn sees a 32-year-old patient who has never given birth to a child but wishes to. She goes through heavy menses with anemia.

On examination, the physician finds a 15-cm uterus with manifold fibroids that distort the endometrium. As the patient wants to have children, she chooses to have a myomectomy, which the ob-gyn carries out by the means of an laparoscopic approach. The pathology report shows six intramural myomas.

For this case, when you execute the CPT lookup, you must report 58545 (Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 g or less and/or removal of surface myomas).

Medical Coding Method 4: Make Use of UAE Option

You may see additional uterine fibroid embolization or uterine artery embolization (UAE) procedures. UAE is a nonsurgical, minimally invasive procedure that will shrink the fibroids by cutting off the blood supply.

The ob-gyn inserts a catheter through an artery in the leg to the arteries in the uterus. The physician then inserts tiny particles of plastic or gelatin through the arteries to cease the blood flow inside the fibroids. Devoid of blood flow, the fibroids shrink or may even disappear over time.

In case this method is followed, once you do the CPT lookup, you’ll report using 37210 (Uterine fibroid embolization [UFE, embolization of the uterine arteries to treat uterine fibroids, leiomyomata], percutaneous approach inclusive of vascular access, vessel selection, embolization, and all radiological supervision and interpretation, intraprocedural roadmapping, and image guidance necessary to complete the procedure).

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Hone Your Neuroendoscopy Coding Skills With These Easy Steps

2011-12-29T02:58:00.000-08:00

You should ever use these codes for open surgery and endoscopy together.

In case your neurosurgeon carries out neuroendoscopy services during cranial procedures, you must never report the service with open procedures or else you might end up missing on reimbursement opportunities. Read this article to side-step errors in medical coding.

Codes to remember: While reporting the neuroendoscopy procedures, you will require choosing from the CPT codes 62161 (Neuroendoscopy, intracranial; with dissection of adhesions, fenestration of septum pellucidum or intraventricular cysts [including placement, replacement or removal of ventricular catheter]) – 62165 (Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or trans-sphenoidal approach) and the add-on code + 62160 (Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage [list separately in addition to code for primary procedure]).

1. Segregate Endoscopy from Open Codes

The surgeon may adopt either of the two choices to treat the problem, but he will never use both of them at the same time. He may either insert an endoscope to treat the underlying condition or may adopt an open approach for instance the affected area is surgically opened up to address the pathology. Neuroendoscopy CPT codes are definitive and independent. So, you cannot report neuroendoscopy codes with codes for parallel open procedures.

Example: In case your neurosurgeon undertakes an open approach to obliterate a supratentorial tumor which is not a meningioma, you would report 61510 (Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma). On the other hand if he adopts a neuroendoscopic procedure to accomplish the excision of the tumor, you would report 62164(Neuroendoscopy, intracranial; with excision of brain tumor, including placement of external ventricular catheter for drainage). This includes placement of a ventricular catheter for drainage.

Cautionary tip: You must be cautious to not report the codes for open and neuroendoscopic stand-alone procedures at the same time. Remember that you cannot report 61510 and 62164 together. The reason being that in one session, the surgeon can adopt either approach but not both to address the underlying pathology.

Exception: If your surgeon provides a detailed explanation of an accompanying procedure in the operative note, you can report 62160. CPT® allows this add-on code to be reported with primary procedure CPT codes like 62220, 62223, 62225 and 62230. CPT® made the neuroendoscopy codes to stand apart from open procedures, again, with the exception of 62160.

2. Beware the Bundles

You must never report a twist drill, cranial burr hole, or trephine along with the neuroendoscope code; NCCI bundles these access CPT codes with the endoscopy itself. The burr hole is assumed or included in the neuroendoscopy code(s), as you can’t do the neuroendoscopy excluding a burr hole, however you can do a burr hole excluding neuroendoscopy. In case twist drill, cranial burr, or trephine are carried out at the same time neuroendoscopy is, you would report only neuroendoscopy

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CPT® 2012 Clarifications: Pediatric Hospital Rounds Will Be Stress-free to Code

2011-12-28T02:19:00.000-08:00

Distinguish the common types of pediatric hospital visits and you'll be on the road to correct medical coding.

Though most pediatricians assess newborn inpatients as part of their fixed weekly work, some practices struggle with how to code such services. However once you break it down into the below listed most common categories of inpatient E/M rounds, you could be sending claims out the door sooner and more competently. Read this article for correct medical coding and know what CPT codes apply in this situation.

Check NICU Changes for CPT 2012

Two of the most severe types of infant hospital visits include time with intensive care or critical care. In both of such cases, the pediatrician has to go above and beyond what's needed when seeing a healthy newborn--and coding such visits can be a challenge.

The issue of level of care delivered is not specific to the site of service. Though, neonatal critical and intensive care services are normally provided in a NICU.

Intensive care: Assume that a baby is tachypneic with a fever as a newborn and is worked up and is getting treatment for sepsis. The pediatrician gives a neonatal intensive level of care, carrying out daily intensive care services. In these situations you'll report a code from the 99477-99480 series of CPT codes.

Critical care: After the pediatrician examines a patient for more austere issues—for instance organ system failure or serious respiratory distress--he might decide that the patient is in need of critical care, which you'll code using the 99468-99469 series of CPT codes. In a lot of cases, critical care would be administered by a neonatologist.

Changes for CPT 2012: Earlier, in case a patient was transferred from neonatal intensive to critical care--or vice versa--the coding rules were blurred. But, CPT 2012 clarifies that issue with parenthetical notes to guide you in making the correct CPT codes decision.

What CPT® now makes clear is that in case an infant recovers after the initial day and is transferred to a lower level of care, the transferring physician does not report a per-day intensive care service. In its place, the transferring doctor will report a code from the subsequent hospital care section (99231-99233) of CPT®. The receiving physician will report subsequent intensive care (99478-99480) or subsequent hospital care (99231-99233) as suitable based on the condition of the neonate or child.

In case the physician provides intensive care services but then the patient becomes critically ill and then is transferred to a dissimilar physician, the transferring physician reports either the critical hourly care service (99291-99292) or the daily intensive care service carried out , but not both.

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Welcome Car Seat Testing Codes Effective Jan. 1

2011-12-28T02:16:00.000-08:00

Plus: You'll find explanation on developmental testing codes 96110-96111.

Previous year, coders got a good dose of updates--and confusion--with the inclusion of numerous new vaccine administration codes. CPT 2012 goes lenient on pediatric practices with a few modifications to the code set which will generate the necessity for updates, but not overhauls. Read this article for stress-free and accurate medical coding.

At the top of the list this year, you'll find the following new CPT codes for car seat testing:

94780 – (Car seat/bed testing for airway integrity, neonate, with continual nursing observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with interpretation and report; 60 minutes)

+94781 – {...each additional full 30 minutes (List separately in addition to code for primary procedure)}

The car seat testing services will mainly be done in facility settings; however will be valued with facility and non-facility payment amounts. These tests are usually essential before premature or at-risk babies (with conditions such as heart disease or congenital malformations) are discharged home from NICU settings.

There are occasions where follow-up testing may be indicated. "This would normally be provided in a neonatal follow-up clinic, however could be carried out in the office setting, in case the setup is complete to offer all the necessities for the code. As more services shift to the medical home, this could happen more in the future. Having the CPT codes and the anticipated relative value payments should facilitate the process.

Developmental 'Testing' Modifies to 'Screening'

New CPT codes are always great to find in CPT®, however occasionally you'll find changes that make significant explanations to present codes. Such is the case with existing developmental testing CPT codes 96110-96111. The new descriptors for these codes are listed below:

96110 – (Developmental screening, with interpretation and report, per standardized instrument form)

96111 – (Developmental testing, (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments), with interpretation and report)

Medical Coding Tip: Take Note of Vaccine Revisions

Last year, in pediatric medical coding, CPT® threw many practices for a loop with the adding of several new vaccine administration codes, which most payers finally began processing efficiently within the last few months. Luckily, such a main overhaul has not taken place this year. Instead, CPT® makes slight adjustments to how you'll report your vaccines for accurate medical coding.

For instance: CPT® will change meningococcal conjugate vaccine code 90644 to get rid of mention of "Hib-MenCY-TT." In its place, the new code descriptor reads "Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine (Hib-MenCY), 4-dose schedule, when administered to children 2-15 months of age, for intramuscular use.

404.0x is Different From I13.- in Use of Malignant and Benign

2011-12-27T03:45:00.001-08:00

ICD-10-CM reduces your code choices from 12 to 4 codes for hypertensive heart as well as CKD.

You can look ahead to ICD-10-CM to provide you with combination codes for definite chronic conditions as ICD-9-CM does, but that doesn't imply that the code definitions will be exactly the same. Read this article for accurate and error-free medical coding when ICD-9 to ICD-10 transition takes place.

To see a realistic example, re-examine the codes below, which you assign when a patient is suffering from hypertensive heart disease (documentation indicates hypertension causes heart disease) as well as hypertensive chronic kidney disease (hypertension with chronic kidney disease [CKD] even though no relationship is indicated in the documentation).

ICD-9 medical coding rules: The terms "benign" and "malignant" are present in the ICD-9 hypertensive heart disease codes. While the physician doesn't document benign or malignant, you should select an "unspecified" code.

In addition, you must report the heart failure type (428.x), if identified and the CKD stage (585.x) as secondary codes.

The ICD-9 codes include:

404.0x (Hypertensive heart and chronic kidney disease; malignant)

404.1x ( ... benign)

404.9x ( ... unspecified)

ICD-9 fifth digit options are listed as following:

0 (without heart failure and with chronic kidney disease stage I through stage IV, or unspecified)

1 (with heart failure and with chronic kidney disease stage I through stage IV, or unspecified)

2 ( without heart failure and with chronic kidney disease stage v or end stage renal disease)

3 (with heart failure and with chronic kidney disease stage v or end stage renal disease)

ICD-9 to ICD-10 changes: You'll see a change from 12 ICD-9 options to four ICD-10 options. This is owing to the fact that under ICD-10 you won't have to differentiate between "benign" and "malignant."

ICD-10 2011 codes include:

I13.0 (Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease)

I13.10 (Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease)

I13.11 (Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease)

I13.2 (Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease)

ICD-9 to ICD-10 transition tip: In case you've found a method of tell the team to code heart failure and CKD types besides 404.xx codes, stick with it and apply it to I13.- when ICD-9 to ICD-10 transition goes into effect. Moreover, let the coding team know that in case the documentation doesn't talk about heart failure or the stage of CKD, the suitable code will be I13.10.

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CCI Edits 17.3: 32422, 71010 Bundle -- And More -- Enhance Your Pulmonary Coding Options

2011-12-27T03:44:00.001-08:00

Immunotherapy code Q2043 is anot an area of concern for pulmonologists, and should be an oncology issue.

The most recent Correct Coding Initiative (CCI) edits bundle chest radiologic guidance along with numerous procedures on the lungs and pleura, and even though CCI edits 17.3 assemble immunotherapy code Q2043 with lots of ventilation and gas procedures, you must not worry -- here's why. Read this article for accurate medical coding.

Establish Chest X-ray Distinctness From Thoracentesis To Ignore Bundle

For the newest CCI edits version, you must keep an eye on bundled chest x-rays as well as chest tube procedures. Particularly, both 71010 (Radiologic examination, chest; single view, frontal) along with71020 (Radiologic examination, chest, 2 views, frontal and lateral) become parts of:

32422 – {Thoracentesis with insertion of tube, includes water seal (e.g., for pneumothorax), when performed (separate procedure)}

32550 – {Insertion of indwelling tunneled pleural catheter with cuff}

32551 – {Tube thoracostomy, includes water seal (e.g., for abscess, hemothorax, empyema), when performed (separate procedure)}

93503 – {Insertion and placement of flow directed catheter (e.g., Swan-Ganz) for monitoring purposes.}

CCI edits mention the motive for the bundle as wrongly using column two code with column one code. These CCI edits have a modifier indicator of "1", consequently you may overrule the edits with a modifier (i.e., modifier 59, Distinct procedural service) on the column 2 code when the services are different.

Example: A patient with COPD (490-496) gets admitted with shortness of breath (786.05) along with chest pain (786.5), deteriorating with inspiration. A chest x-ray (71010) prove pneumothorax (512.x) and the patient must go through thoracentesis with insertion of tube (32422) to get rid of the excess air and let the lung re-expansion. In this sceanrio, you would report 32422, 71010-59 to point out that the chest x-ray was different from the thoracentesis.

Take note: Pulmonary specific guidelines preside over the abovementioned Column 1 codes. For example when coding 32422, you must consider a dissimilar radiologic guidance code for catheter placement/confirmation (e.g., 76942, 77002, 77012), which more precisely reflects the service description, method as well as service time linked with the procedural guidance provided.

The similar guidelines are applicable to 32550-32551. In other words, you must consider code 75989 (Radiological guidance [i.e., fluoroscopy, ultrasound, or computed tomography], for percutaneous drainage [e.g., abscess, specimen collection], with placement of catheter, radiological supervision and interpretation) to signify radiologic guidance for catheter placement/confirmation.

Medical Coding Tip: Remember that you must use 71010 and 71020 simply for radiologic examination of the chest, and not to assist or substantiate needle placement.

Discover Site-Specific Bx Codes and Net $78 or More

2011-12-23T03:29:00.001-08:00

Enhance claims accuracy by side-stepping these common biopsy coding difficulties.

In case you automatically assign 11100 when your dermatologist lays down the biopsy site, you could be losing deserved pay. Read this article to know what ICD-9 codes and CPT codes apply to this situation and ensure medical coding accuracy.

Site-specific codes increase medical coding accuracy. Besides, they pay more than the most extensively used code, 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion).

Don't Miss More Pay for More Work

Site-specific biopsy codes inform the payer that the dermatologist carried out a biopsy at a specific site, instead of a generic integumentary based biopsy (11000). A site-specific biopsy code also signifies a more complex procedure than 11000 does.

Result: The dermatologist is worthy more pay for the gretaer level of complexity of these site-specific procedures. Your practice is missing income and accuracy in medical coding in case your dermatologists ignore these site specific codes, which is easy to do as dermatology practices depend on on the integumentary segment of the CPT® manual.

Example 1: A patient comes to your practice with a papular lesion of the lip. Once the dermatologist examines the patient, he decides that he must carry out a biopsy.

In this scenario, you must report 40490 (Biopsy of lip) in place of of 11100. Provided that the dermatologist notes the site-specific biopsy within the documentation, you must get nearly $78 more for the procedure on the patient's lip than in case you had reported 11100 as this biopsy needed more work from the dermatologist.

Don't miss: For accurate medical coding, ensure that the biopsy is of the lip, not the skin surrounding.

Example 2: A patient with a pigmented lesion that is of the nail bed presents to your practice. The dermatologist doubts trauma but feels he should carry out a nail bed biopsy to rule out melanoma.

Your initially thought in coding this scenario could be to bill 11100. However, you should bill 11755 (Biopsy of nail unit [e.g., plate, bed, matrix, hyponychium, proximal and lateral nail folds] [separate procedure]).

Code 11755 is more precise and also pays around $25 more than code 11100 (3.81 non-facility RVUs x $33.9764 = $129.45).

Report Multiple Biopsies for Separate Sites

While your dermatologist carries out multiple biopsies, you require a tool to unravel the claim's payment. You must clarify the conditions to the payer by the means of modifiers.

Wait for Path Report to Choose Dx

ICD-9 Codes and CPT Codes: You must always wait until the pathology report comes back to select the appropriate codes to report, although this will not always affect the CPT codes you will wind up selecting.

Reason: The biopsy specimen's pathology will affect the ICD-9 codes you report, but most CPT codes are not based on the specimen's outcomes. There are a few CPT codes which are connected to definite diagnoses (for instance, excision of benign and malignant lesions).

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Tact Your EKG Interpretation Claims With This Can't Miss Documentation Guidance

2011-12-23T03:26:00.000-08:00

Does your chart include the needed elements to stand up under audit?

In case you're getting repeat denials when your ED physician reads electrocardiograms [EKG], it's time to ask yourself some serious questions, comprising whether the documentation meets Medicare's definition of interpretation and whether the notes clearly classify which ED provider did the reading and reason behind the EKG was ordered. Read this article to ensure accurate medical coding.

Reality: One of the most commonly reported non-E/M services in the emergency department is for EKG interpretation; unfortunately, if you execute CPT Lookup, you will find that these CPT codes also fall under the most commonly contested services as well.

E/M link: A review of a formerly interpreted EKG has value in E/M code Medical Decision Making, but in a totally diverse way from being distinctly billable.

Watch Out for Rhythm Report Reason

CPT Lookup: The CPT® book includes two CPT codes defining interpretation as well as report of diagnostic cardiographs or the tracings of heart rhythms.

93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only)

93042 (Rhythm ECG, 1-3 leads; interpretation and report only)

In the case of the 93042 code, you would not report it when the ED physician just reviews the telemetry monitor strips taken from a monitoring system. The needed definite order for 93042 must be supported by a diagnosis or symptom as the starting event. For supporting medical necessity for the service, clinical information representing the need to assessing for the presence or absence of an arrhythmia, cardiac ischemia, or further cardiovascular problem must exist within the medical record.

In the ED, the physician would not normally report the global CPT codes 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) or 93040 (Rhythm ECG, 1-3 leads; with interpretation and report) as the physician does not usually own the EKG machine nor employ the staff who in fact administers the test.

Code choice aside, some payers reject to reimburse for diagnostic interpretations in the ED setting, stating they are bundled into the E/M service and counted in the amount and difficulty of data reviewed component of medical decision making.

CPT Lookup Tip: EKG services must be distinctly reimbursed except there was simply a "review" of the tracing delivered rather than the CPT® defined independently distinctly identifiable signed written report. CPT® is quite specific in the E/M services guidelines that the actual presentation and/or interpretation of diagnostic tests/studies ordered in a patient encounter are not involved in the levels of E/M services. Physician presentation of diagnostic tests/studies for which definite CPT codes are available may be reported distinctly, as well as the suitable E/M code if correctly documented.

Concentrate on A&P When Prepping for ICD-10 Conversion

2011-12-21T03:12:00.002-08:00

Analyze your practice's top 30 diagnoses to get a head start toward compliance.

Education is the significant part of getting ready for ICD-10 implementation, but you should not spend your time trying to memorize code sets. Read this article to know the details about ICD-9 to ICD-10 conversion to ensure accurate medical coding.

It's too early to learn code sets, and more, there's not much sense in learning them right now as final codes won't go into play until January 2012. However, you must start watching out how some of your common diagnoses will change.

A lot of practitioners perhaps don't know a lot of ICD-9 codes by heart, so they won't be expected to memorize ICD-10 codes either.

Concentrate on Foundations

Physicians get ready for ICD-10 by looking at the codes they use most frequently in their offices and creating novel job aids or superbills for those procedures. Select the top 30 diagnoses you see and deliberate on knowing how to code those correctly.

Example: Common diagnoses for anesthesiologists may include obstetrics cases for instance 669.7X (Cesarean delivery without mention of indication) or 654.21 (Previous cesarean delivery with delivery with or without antepartum condition), or surgical cases for instance 550.90 (Unilateral or unspecified inguinal hernia without obstruction or gangrene).

Every form will need updating. In case you actually need to see the impact of ICD-10, take one of your most frequent diagnosis codes and follow it through your entire practice/system. Watch out where it comes into play to help check everything you'll require to update.

ICD-9 to ICD-10 Conversion Tip: Revise A&P Knowledge

Your top focus should be on anatomy and physiology. Coders will need a good understanding of so many A&P nuances with ICD-10. Work on skill sets to get to that level of specificity so you can read your physician's documentation and pull the information you require in place of stopping the physician to ask him all the time.

In the process of ICD-9 to ICD-10 conversion, many ICD-10 codes will be more comprehensive than their ICD-9 codes counterparts, which is why ample A&P knowledge will help coders. For instance, coders will need a decent understanding of bones and different types of fractures with ICD-10. In the process of conversion of ICD-9 to ICD-10 , novel diabetes codes will clarify underlying manifestations however will no longer include controlled/uncontrolled options. Neoplasm choices will increase by site (including 54 codes for male/female malignant neoplasm of breast, for example).

A&P knowledge, though, won't compensate for poor documentation. Physicians must take the opportunity to improve their documentation skills. As there are more chances for coders to pick from a list, they're going to be coming back to physicians at an early stage to say ‘Wait, I require more definition to help me select A or B.'

Coders need to understand that physicians don't document for medical coding. They document for health care. Things that weren't on their radar as important before will need to be important now. It's a great time for coders to learn new things, even if they're not accountable for training or implementation.

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HCPCS Codes May Spell Respite for Undefined CPT® Services

2011-12-21T03:12:00.001-08:00

Even though pediatricians aren't accustomed of using HCPCS codes, the level-two S codes provide potential medical coding and reimbursement for services that CPT does not outline. Once a pediatrician offers a service that CPT does not define, follow the following listed three steps to use HCPCS level-two S codes to resolve the reimbursement hitch.

1. Know Who Admits S Codes

Blue Cross/Blue Shield (BCBS) established the S codes for reporting drugs, supplies and services. You must use these HCPCS codes at that time when no CPT code is present, when the HCPCS code is more precise, or when the third-party payer necessitates it. The codes are entirely for use with private payers. Medicare does not admit them.

In case an S code correctly describes the service provided, make certain the carrier will accept it. You must read material for instance newsletters and carriers' local medical review policies to stay well-informed. It's also significant to evaluate the HCPCS codes in the insurance fee or payment schedule. In case the code is not listed, it's generally not payable.

2. Watch Out for Common Areas of Use

Coders regularly have problems billing for suture removal delivered by a different physician. As far as these services are concerned, you must consider using a HCPCS code.

To bill for suture removal by a physician except the physician who initially closed the wound, you should bill S0630 (Removal of sutures by a physician other than the physician who originally closed the wound) to BCBS of Michigan. To all other carriers, we report a problem-oriented E/M code (99201-99215), and link ICD-9 code V58.3 (Attention to surgical dressings and sutures) with it.

Use the similar diagnosis medical coding for HCPCS codes as you would for the CPT code. There is no dissimilarity.

3. Generate a System of Payer-Appropriate Codes

Using the codes that individual insurers identify can help get claims paid on the first try. On the other hand, keeping track of the numerous codes to use for each carrier can pose a logistical nightmare. To solve this logistical problem, design an encounter form to help your pediatricians and billers keep the codes straight. Group the CPT or HCPCS code by the major insurance companies. Under the category of suture removal by dissimilar physician, the biller chooses from the following:

ALL OTHER INSURANCE

99201-99215 - Sick visit office code (V58.3).

Provided that you did the research described in step 2 and made a chart of your findings (step 3), carriers should not reject your claims. In case you have to appeal, you must send copies of the HCPCS book to prove that the code is not a deleted or an obsolete code.

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Medicare Slip-Ups: Providers Underbilled More Than $1 Billion to Medicare in the Previous Year

2011-12-19T23:57:00.001-08:00

CERT results disclose $34.3 billion in inappropriate Medicare payments--$1.1 billion of which was underpaid.

In case your practice's collections rate was off by 10.5 percent, you'd be in big worry, right? In fact, that's the 2010 Medicare Fee-for-Service improper payment rate, and your MAC might come looking for money you still owe to them. Read this article and guarantee accurate medical coding.

CMS's novel Comprehensive Error Rate Testing (CERT) results, which were out in November, explain that practices in fact made fewer errors in 2010 than in the preceding year. Maximum of the errors were revealed as overpayments—implying that CMS recognized $33.2 billion that went out to Medicare providers in mistake, and there are chances that MACs will be asking for much of that money back, if they haven't by now. Furthermore, CMS noted that it still owes $1.1 billion to providers who were underpaid in 2010.

To generate the CERT report, CMS revised 30,965 Part B claims, together with claims from Part A and DME, as per the "Medicare Fee-for-Service 2010 Improper Payment Report." Auditors then pored over the claims to decide which had no documentation, inadequate documentation, incorrect medical coding, or was a medically unnecessary service.

Documentation: Part B practices were the complete worst of the provider types as far as documentation was concerned, with a 2.1 percent error rate in the "insufficient documentation" category, greater than both Part A and DME providers.

Warning: In case a reviewer reviews your claim and discovers only a listing of the CPT® and ICD-9 codes that you reported, you have not proven medical necessity for the service, or even established that you in reality saw the patient. In these circumstances, the MAC could request the whole payment back.

Incorrect medical coding: Part B providers also rated the maximum among incorrect medical coding errors, with a 0.8 percent error rate, which topped the Part A and DME rates. Once more, not all of these errors reflected overpayments to practices--in few cases, doctors in reality shorted themselves by coding erroneously.

Avoid These Top 5 Physician Documentation Errors To Ensure Accurate Medical Coding

CMS found that physicians inappropriately billed $6.22 billion in claims that were later found to have inadequate documentation. In case you want to evade that type of error--which will lead to inaccurate medical coding--check out the top five errors:

1. No signature. Medicare needs that the author of a note validates it with a handwritten or electronic signature, however found that $1.3 billion worth of claims in reality had no signature at all.

2. Several errors. CMS noted that it inappropriately paid $1.1 billion on claims that had numerous dissimilar types of documentation errors.

3. Documentation does not go with code billed. "If it wasn't documented, it wasn't done." Medicare reviewers wholeheartedly agree with this sentiment, and said that physicians may have billed a particular code to the MAC, however the documentation didn't support it, causing $0.9 billion in errors in this category.

4. Effective physician order missing. Many services need a physician order. CMS discovered that the order was absent in $0.7 billion worth of claims.

5. Illegible identifier. In case a physician's signature is illegible or missing, CMS will give the provider an opportunity to attest to his signature. But, if the doctor does not return the attestation, the practice has to return the money it collected for the visit. CMS discovered $0.7 billion worth of errors in this category in 2010.

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Avoid Compliance Challenges: Apply CCI Edits Appropriately With This Primer

2011-12-19T23:56:00.000-08:00

Evaluate these guidelines to completely understand how CCI influences your code selection.

Write an easy catchy lead sentence that encapsulates the challenge with CCI for ED coders. You must actually make this ED-focused.

What's CCI? National Correct Coding Initiative (CCI) policies were established by The Centers for Medicare and Medicaid Services (CMS) based on coding conventions that are described in the AMA's CPT® manual, local and national policies and edits, guidelines established by national societies, study of standard medical and surgical practices, and an evaluation of existing medical coding practices.

What're edits for? Edits were established to avoid incorrect medical coding, which in turn could cause inappropriate payments for services. These CCI edits are utilized by Medicare claims processing contractors to evaluate claims for physician services as well as outpatient hospital service. The National Correct Coding Initiative Manual for Medicare Services is updated yearly in October and is a reference to clarify the rationale for the code edits. However, the CCI edits are updated on a quarterly basis.

Providers along with coders must be conscious that the CCI does not involve all probable combinations of correct medical coding CCI edits. Furthermore, these edits do not replace any other CMS national coding, coverage or payment policy.

There are a couple of global classifications of CCI edit sets: CCI code pair edits (Column 1/Column 2 and Mutually Exclusive Codes) and Medically Unlikely Edits (MUE). Both sets of edits are then outlined into: 1) physician or practitioner edits and 2) facility outpatient edits. The outpatient facility edits are found in the Outpatient Code Editor (OCE). CCI edits are integrated into the OCE and normally appear one calendar quarter behind the CCI. The edit tables are restructured on a quarterly basis.

ED coding example: A patient continued to have an injury to the finger nail when a rock fell on to his right index finger. The procedure documented involved removal of the nail (11730, Avulsion of nail plate, partial or complete, simple; single) as well as repair of the nail bed (11760, Repair of nail bed). 11760 is deliberated as a column 1 code to 11730. This code pair generates a CCI column 1/column 2 edit. Of note, there are also sub-modifiers inside the CCI edits. The sub modifiers are defined as follows:

Modifier 0 specifies that there are no conditions in which a modifier would be suitable. The services signified by the code combination will not be paid distinctly.

Modifier 1 specifies that a modifier is permitted in order to distinguish between the services provided. Supposing the modifier is used properly and correctly, this specificity delivers the basis upon which distinct payment for the services billed may be considered justifiable.

HCPCS Codes 2012: Novel HCPCS Code Will Get You $32,000 x 3 – Only If You Bill It Appropriately

2011-12-18T23:33:00.001-08:00

HCPCS Codes 2012: Novel HCPCS Code Will Get You $32,000 x 3 – Only If You Bill It Appropriately

In case your urologist carries out a novel treatment carried out for asymptomatic or minimally symptomatic metastatic castrate resistant carcinoma of the prostate by means of the drug Provenge or drug Sipuleucel-T, pay attention to new HCPCS codes 2012.
HCPCS Codes 2012, Medical Coding, Hcpcs Codes

Include correct primary and secondary diagnosis codes to guarantee payment.

In case your urologist carries out a novel treatment carried out for asymptomatic or minimally symptomatic metastatic castrate resistant (hormone refractory) carcinoma of the prostate by means of the drug Provenge or drug Sipuleucel-T, pay attention to new HCPCS codes 2012. Read this article to safeguard your payment and accurate medical coding.

Get to Know the Procedure

Medicare permits a patient one treatment with Provenge in their lifespan, which involves three distinct infusions within a two week period,

Blood is taken from the patient and then it is exposed to prostate cancer cells, preparing the patient's white blood cells to attack the cancer cells when reinfused into the patient. This also stimulates a recruitment of added white blood cells to put an end to the tumor. Provenge is the first in a new class of therapy that is intended to activate a patient's individual antigen-presenting cells to stimulate an immune response against prostate cancer.

Report the New Code 3 Times For Full Treatment

From the HCPCS codes 2012, the code for this particular procedure is Q2043 (Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion). This code signifies the anti-neoplastic treatment for this specific type of tumor.

You must keep in mind that the code descriptor states "per infusion," implying that in case the patient gets three infusions throughout the two-week treatment period, you must report HCPCS code Q2043 three distinct times. You bill this once for every single infusion, and Medicare will reimburse you $32,000 per infusion. The purchased price for the drug is approximately $30,189 per treatment. Medicare will reimburse this cost and above a six percent increase/profit.

Don't miss: While you report Q2043, from the HCPCS codes 2012, for this particular cancer treatment, keep in mind that this HCPCS code covers all additional preparatory procedures, for instance the collection of cells from the patient, the preparation as well as transportation of the cells to a specialized lab, and then the infusion itself.

Support Claim With Appropriate Diagnostic Codes

While reporting HCPCS code Q2043, the diagnosis codes should include 185 (Malignant neoplasm of prostate) as the primary diagnosis and no less than one metastatic diagnostic code as the secondary diagnosis, Potential secondary diagnostic codes involve the following:

196.1 – (Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes)

196.2 – ( intra-abdominal lymph nodes)

196.5 – ( lymph nodes of inguinal region and lower limb)

196.6 – ( intrapelvic lymph nodes)

196.8 – ( lymph nodes of multiple sites)

197.0 – ( Secondary malignant neoplasm of lung)

198.1 – ( other urinary organs)

198.5 – ( bone and bone marrow)

198.7 – ( adrenal gland)

198.82 –( genital organs.)

New CCI Edits Inverse 'No-Go' Status of Injections With Some Vascular Procedures

2011-12-18T23:31:00.000-08:00

New CCI Edits Inverse 'No-Go' Status of Injections With Some Vascular Procedures

The newest edition of Correct Coding Initiative (CCI) edits holds some pleasant revelations for neurology and pain management coders.

CCI Edit, Medical Coding

Go to 'deleted edits' section for updates to paravertebral facet joint injections.

The newest edition of Correct Coding Initiative (CCI) edits holds some pleasant revelations for neurology and pain management coders. In place of being burdened with added CCI edits that limit your claims filing, most pairs linked to neurology or pain management in fact fall under the "deleted edits" category. Read this article for accurate medical coding.

As far as the terminated pairs are concerned, 218 were retroactively ended back to the last quarter release and one back to January 1, 2010. This simply implies that, in case you were denied payment owing to these edit pairs in the past, you would probably be able to resubmit the claim for payment at this time.

Medical Coding Tip: Verify Deletions for Injection/ Vascular Procedure Bundles

Terminated bundles have influence on three groups of procedures carried out by neurologists or pain management specialists: therapeutic or diagnostic injections, paravertebral facet joint injections (with either image or ultrasound guidance), as well as somatic nerve injections.

The affected diagnostic or therapeutic injection codes involve the following:

96372 – i.e. Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); along with subcutaneous or intramuscular

96374 -- i.e.Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); along with intravenous push, single or initial substance/drug

96375 -- i.e.Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); every additional sequential intravenous push of a novel substance/drug (List separately in addition to code for primary procedure)

A couple of Category III codes also come into the "deleted pairs" group:

0213T – {Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level}

0216T – {Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level.}

Furthermore, preceding CCI edits bundled the bulk of somatic nerve injections 64400-+64484 (Injection, anesthetic agent …) as well as paravertebral facet joint injections 64490-+64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT] …) into an extensive range of intra-arterial as well as venous procedures. As per new CCI edits, those bundles are deleted. .

Example: Previous CCI edits listed the listed injections as constituents of vascular procedures for instance 36000 (Introduction of needle or intracatheter, vein), 36410 (Venipuncture, age 3 years or older, necessitating physician's skill [separate procedure], for diagnostic or therapeutic purposes [not to be used for routine venipuncture]), as well as 36425 (Venipuncture, cutdown; age 1 or over). For error-free medical coding, You must verify your claims after Oct. 1 to double-check whether some of the preceding bundles might now be permitted, and if you can refile claims owing to retroactive changes.

285.3 vs. 284.89: Documentation of 'Aplastic' Can Lead to Accurate Coding

2011-12-16T01:53:00.001-08:00

Know which condition is more probable to be caused by chemotherapy.

Patients with cancer might develop anemia from numerous cases. Here are some clues to help you identify the source and keep your medical coding compliant.

This article digs into proper anemia medical coding, looking at ICD-9 codes for anemia caused by treatment and at how guidelines are expected to change when ICD-10 use becomes mandatory in 2013.

Reassess Documentation Before You Assign 284.89

When documentation shows that antineoplastic chemotherapy caused a patient's anemia, you need to consider two ICD-9 codes:

285.3 (Antineoplastic chemotherapy induced anemia)

284.89 (Other specified aplastic anemias, due to drugs)

The main dissimilarity between the two is that 284.89 mentions "aplastic" anemia. Aplasia implies that the bone marrow is wiped,as per Coding Clinic for ICD-9-CM (2009, vol. 26, no. 4).

Antineoplastic chemotherapy induced anemia is not generally an aplastic process. The anemia is likely to be short term, however it might range from mild to severe. Thus 285.3 may be applicable to your patient's claims more often than 284.89, however you must let documentation direct your choice. Before you assign 284.89, ensure that the documentation shows the anemia is aplastic and due to drugs.

Expect a Shake-Up When ICD-10 Begins

Paying close attention to diagnosis coding guidelines will become even more vital as you get ready to use ICD-10 in place of ICD-9. To be specific, the ICD-10 2011 guidelines for anemia coding are different from those you know for ICD-9.

Example 1: A patient comes for treatment of just anemia. The physician documents that the patient's neoplasm caused the anemia to develop.

In ICD-9 2012 guidelines, your first-listed code must report the anemia (285.22). The correct malignancy code(s) must follow (ICD-9, Section I.C.2.c.1).

In case you were instead applying ICD-10 2011 guidelines, you would report the malignancy code first and then the anemia code, D63.0 (Anemia in neoplastic disease) (ICD-10, Section I.C.2.c.1).

Example 2: Another patient comes for treatment of just anemia. For this patient, the physician documents that the anemia is because of chemotherapy or immunotherapy.

Using ICD-9 guidelines, your first-listed code must denote anemia (such as 285.3). You smust report the neoplasm as an added code (ICD-9, Section I.C.2.c.2).

On the other hand, the 2011 ICD-10 guidelines ask you to use an adverse effect code as your first-listed code. Your anemia and neoplasm codes must follow that (ICD-10, Section I.C.2.c.2).

Remember: The guidelines given above reflect ICD-10 2011 guidelines. When ICD-10 goes into effect on Oct. 1, 2013, you will apply the official ICD-10 coding guidelines in effect for the pertinent date of service.

Accurate Sphenopalatine Artery Ligation Coding

2011-12-16T01:52:00.000-08:00

Make the maximum of surgical procedure modifiers when looking for the correct code.

Where conservative treatment is unsuccessful, endoscopic transnasal tactic for ligation of the sphenopalatine artery might be the best surgical technique for control of a severe epistaxis. But did you know that there are no medical CPT codes that exist precisely for this operative procedure? Read this article for expert insight on accurate medical coding.

Let's assume a scenario where a patient with coagulopathy also has epistaxis which has not been controlled with nasal packing. The bleeding starts from the posterior nasal cavity of the posterior ethmoid artery or a branch of the sphenopalatine artery. In order to gain control over the nose bleed, the otolaryngologist chooses to conduct an endoscopic transnasal sphenopalatine artery ligation.

When you're left without a certain CPT® code to label the procedure, you should go for other similar medical CPT codes, and try to work around it. Let's explore your options with the following medical CPT codes.

31238: Improve Endoscopic Control of Nasal Hemorrhage With Modifier 22

Medical CPT® 2011 guidelines for modifier 22 maintain that when the work needed to provide a service is significantly greater than typically needed, it may be recognized by the addition of modifier 22 to the typical procedure code.

Documentation should support the substantial added work and the reason for the added work.

In case of an endoscopic transnasal sphenopalatine artery ligation, you might report 31238 (Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage) appended by modifier 22 (Increased procedural service). This particluare ligation procedure includes interrupting the nasal vasculature at a place distal enough to avoid direct, retrograde, and anastomotic blood move from the ipsilateral and contralateral carotid systems.

Disadvantage: Though 31238-22 is a practical and correct medical coding option, payer reimbursement may be lesser than what surgeons feel is regular with the related physician work: about $200.46 (5.9 facility RVU, multiplied by the 2011 conversion factor of 33.9764).

Remember: 31238 a surgical endoscopy code. Ensure that you pay close attention to how the operative note (OR) explains the endoscopic use.

31299: Go The Safe Way With Unlisted Medical CPT Codes

You may also choose to use unlisted procedure code 31299 (Unlisted procedure, accessory sinuses). Several coders would in fact commend this option; however you must be careful of the hitches:

A lot of the claims don't get paid the first time they are submitted and processed. They need appeal with documentation describing what was done.

Documentation necessities (paperwork) may prove to be demanding.

Some experts endorse to use an unlisted code when conducting a procedure that has a medical CPT code meant for an open method however does not have a CPT code for an endoscopic approach.

Fungal Sinusitis: 2 Guaranteed Medical Coding Formulas That Work

2011-12-15T02:48:00.000-08:00

The two areas you must focus on should be manifestation and kind of fungus.

Though unusual, some sinus infections are caused by fungus. When the otolaryngologist makes a diagnosis that a patient is infected with fungal sinusitis, a lone code will not be your easy way out. Read this article and learn from the experts what ICD-9 codes you must select in such a case for accurate medical coding.

In its place, you should depend on a grouping of ICD-9 codes, and a careful examination of the physician's notes for manifestations.

Scenario: A patient visits and reports to the office with the complain of severe headaches, loss of appetite as well as postnasal discharge into the throat. An ENT then diagnoses the patient with fungal sinusitis confirmed on culture. She then also writes down that a chronic ethmoidal kind of sinusitis owing to aspergillosis troubles the patient.

In case you check the ICD-9 codes manual for a code for fungal sinusitis, you would be directed to 117.9 (Other and unspecified mycoses). However a single code may not correctly describe the patient's condition. Here's what you should do:

1. List Manifestation As Primary Diagnosis

The first instruction for category 110-118 (Mycoses) directs you to use added code to classify manifestation. Mycoses pertain to any disease caused by fungi. In the scenario specified above, the ENT classifies the fungi as aspergillosis, and further the condition as chronic ethmoidal sinusitis. The specific fungi will not be identified until a culture is taken and sent to pathology for identification. You would use 117.9 while waiting for the definite fungi to be identified.

When you have this information, then you must go on by reporting the appropriate sinusitis code for sinus membrane lining inflammation. As far as chronic sinusitis is concerned, you would report 473.x, choosing the fifth-digit code based on where the sinusitis takes place. Keep in mind that you should pick the code 461.x for acute sinusitis.

In case of ethmoidal chronic sinusitis, you must report ICD-9 code 473.2 (Chronic sinusitis; ethmoidal). This is a situation that attacks the ethmoid sinuses, which are situated within the human skull between the eye sockets and above the nose.

2. Don't Leave Out Underlying Fungal Infection Code

Once you've coded the manifestation, after that you must report the ICD-9 code that best characterizes the fungal infection. Some types of mycoses consist of dermatophytosis (110), candidiasis (112), as well as blastomycotic infection (116). The fungus aspergillus (117.3, Aspergillosis) is found in compost heaps, air vents or airborne dust. Inhaling it may lead to ethmoidal sinusitis owing to aspergillosis.

On your claim, you must write down 117.3 as diagnosis 1 and 473.2 as diagnosis 2, specifically in Box 21 of the CMS-1500 form.

ICD-9 Quick fact: The condition produced by fungus aspergillus is generally marked by inflammatory granulomatous lesions in the skin, ear, orbit, nasal sinuses, lungs, and occasionally in the bones and meninges.

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47490 Modification Changes Your Cholecystostomy Coding

2011-12-15T02:47:00.000-08:00

Read this article and correct a dangerous error in your manual.

After a 2011 code revision, 47490 joined the ranks of "complete" surgical codes -- meaning the encounter needs just one code to signify the procedure and associated radiology services. Read on for significant info on why CPT reviewed this code and how you're expected to use it to ensure accurate medical CPT coding.

See What Updated 47490 Includes to Earn $365

From the wide range of medical coding CPT codes, CPT 2011 reviewed 47490 so that it now signifies the "complete" service required for percutaneous creation of an opening in the gallbladder:

2010: 47490 (Percutaneous cholecystostomy)

2011: 47490 ( Cholecystostomy, percutaneous, complete procedure, including imaging guidance, catheter placement, cholecystogram when performed, and radiological supervision and interpretation.)

Percutaneous cholecystostomy is essentially a life-saving procedure which is used to buy time for those patients who are way too ill to undertake gallbladder removal.

Medicare's national rate for 47490 runs around $365, and CMS allocated the code a 10-day global period. That implies that associated E/M services on the day of the procedure (following decision for surgery) and for the 10 days subsequent to the procedure aren't payable distinctly. Actually, two post-procedure visits are factored into the fee.

Don't Unbundle Radiological Guidance

Code 47490 isn't the only one for this new "inclusive" emphasis. Medical CPT is continuing their preceding arrangement of bundling the given ancillary services that are normally part of procedures, including radiological guidance.

As a measure of the change to a "complete" code, CPT 2011 further adds a note along with 47490 informing you not to report the code along with 47505 (Injection procedure for cholangiography …) or with radiology medical coding CPT codes 74305, 75989, 76942, 77002, 77012, and 77021.

Caution: You might find that your medical CPT coding manual challenges itself in the notes under 47490. As stated above, the manual states you must not report 47490 with 75989 (Radiological guidance [i.e., fluoroscopy, ultrasound, or computed tomography], for percutaneous drainage [e.g., abscess, specimen collection], with placement of catheter, radiological supervision and interpretation). But instantly under that, a lot of manuals have the following line, ‘For radiological supervision and interpretation, use 75989.'

Strike through: That last sentence was printed mistakenly in medical CPT coding manual 2011, as per AMA's published errata. In order to correct this erroneousness, you must delete the information that directs you to report code 75989 for radiological supervision.

Medical CPT Coding Tip: Carry on with Errata

The AMA provides provisional corrections to the published CPT manual.

Other existing corrections that could have an influence on your surgery practice consists of a note following 49419 (Insertion of tunneled intraperitoneal catheter, with subcutaneous port [i.e., totally implantable]). The modification directs coders to medical coding CPT codes 49020-49081 (Drainage … or Peritoneocentesis…) meant for open or percutaneous peritoneal drainage or lavage.

J9043 Leads the Pack of Novel Chemotherapy Codes for 2012

2011-12-14T01:57:00.001-08:00

The 2012 examples demonstrate which novel drug code you're likely to pair with a push admin code.

HCPCS has three all new J9xxx codes offered for 2012 dates of service. If you run HCPCS code search, you will find that Jevtana, Halaven, and Yervoy all of these now have definite codes you can report when your practice supplies those drugs. Read this article for accurate HCPCS medical coding.

How to prepare? Ensure that you update your charge master, electronic dictionaries, as well as charge slips to reflect any code and/or unit changes. In case drug unit calculations are carried out electronically, make certain that those fields are current in the charge master or electronic billing system so the quantity is appropriately reflected in billing.

Smart move: The code changes are effective Jan. 1, 2012, so complete your updates along with education before that date to exclude errors

J9043 Applies to New Prostate Cancer Treatment

Cabazitaxel will get a definite code for 2012: J9043, Injection, cabazitaxel, 1 mg. If you run a HCPCS code search, you will find that there was no exclusive HCPCS code to report cabazitaxel in 2011.

The brand name you'll see related with this anti-cancer medication is Jevtana. Physicians order it, normally together with daily oral prednisone, for treating metastatic prostate cancer that has progressed despite previous treatments, with docetaxel (J9171, Injection, docetaxel, 1 mg).

2012 example: Thirty minutes after the patient takes oral pre-medications (antihistamine, corticosteroid, and H2 antagonist), staff governs 47.25 mg of Jevtana via 1-hour infusion. You must report 48 units of J9043 for the Jevtana supply as well as 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the administration.

Expect to Pair J9179 With IV Push Code

In case your practice provides Halaven injections, take note of novel code J9179 (Injection, eribulin mesylate, 0.1 mg). If you run a HCPCS code search, you will find that Eribulin mesylate also did not have an exclusive code in 2011.

Physicians might order eribulin mesylate (sold as Halaven) to treat locally advanced or metastatic breast cancer in patients who have previously received at least two chemotherapeutic regimens, with an anthracycline and a taxane.

2012 example: Staff gives 2.41 mg of Halaven by a 4-minute IV push. You must report the supply with 25 units of J9179, and report the administration by the means of 96409 (Chemotherapy administration; intravenous, push technique, single or initial substance/drug).

HCPCS Says Yes to J9228 for Yervoy

You'll also have a novel 2012 CPT code for ipilimumab, which is sold as Yervoy: J9228, Injection, ipilimumab, 1 mg. If you run a HCPCS code search, you will find that it did not offer a distinct code for ipilimumab in 2011.

2012 example: Staff gives 210.93 mg of Yervoy via a 90-minute IV infusion. You must report 211 units of J9228 for the drug. For the administration you must report 96413, which covers the first hour plus up to an additional 30 minutes of administration time, a total of 90 minutes. (CPT® requires at least 31 additional minutes to report +96415, ... each additional hour [List separately in addition to code for primary procedure], so you should not report +96415 in this example which involves a 90-minute infusion).

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Avoid Radiology Codes For Rectal Drug Supervision

2011-12-14T01:56:00.001-08:00

ICD-9 564.0x should define constipation, but keep in mind to report comorbid conditions, too.

Not every enema is an imaging procedure. Occasionally the gastroenterologist will choose to administer an enema for treating constipation. The challenge that you face in such cases is whether you should cover the enema tubing in an E/M or bill it as a separate procedure. Take help of the following situation -- with the bonus tips -- to help you with accurate ICD-9 coding.

Scenario: Our nursing staff carried out an enema for an elderly gentleman because of severe constipation post an office visit with his physician. The patient already has history of encopresis as well as constipation. What code options do you have?

Avoid Imaging Services 74283, 74270

Seeing the word 'enema' can at times mislead you to consider 74283 (Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction [e.g., meconium ileus]), however, you must stop right there.

Why: You should not report medical CPT®74283 because this code wouldn't be appropriate for this particular scenario. Medical CPT® 74283 comes under the "Diagnostic Radiology (Diagnostic Imaging) Procedures of the Gastrointestinal Tract" section of your manual, and is classified as a radiology service. You would then use 74283 for imaging enhancement (e.g., barium enema), which has nothing to do with what we consider as a therapeutic enema in the physician's office.

Nor is 74270 (Radiologic examination, colon; contrast [example, barium enema, with or without KUB]) the appropriate medical CPT® code.

Incorporate Therapeutic Enema Into Your E/M

Enema administration may also be carried out therapeutically to relieve intussusceptions or intestinal obstructions. Once the provider injects liquid through the anal canal, fluid soaks and then loosens hardened waste matter lying in the patient's colon.

Enema carried out for removal of impacted feces is not reported distinctly and is included when an E/M code is reported.

Since this is the case with the given scenario, you would likely use any of the E/M established outpatient visit medical CPT codes 99213-99215 to describe the E/M and the rest of the procedure -- including the administration of enema.

There is also an additional code for E/M visits for prolonged service time that does not need direct patient face-to-face contact.

Someone might also consider that they can bill 99358 (Prolonged evaluation and management service before and/or after direct [face-to-face] patient care; first hour) or +99359 (Prolonged evaluation and management service before and/or after direct [face-to-face] patient care; each additional 30 minutes [List separately in addition to code for prolonged physician service]). Though, Medicare contractors will not pay (nor can providers bill the patient) for these prolonged services medical CPT codes. These are Medicare covered services and reimbursement is included in the payment for other billable E/M services.

Append correct dx: As for the appropriate ICD-9 code, you must report 564.00 (Unspecified constipation) as the primary diagnosis, and then 789.0x (Abdominal pain) as secondary diagnosis to define pain from the stomach or another of the patient's comorbid situations.

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81200-81408: Payment Hurdles Postpone New Molecular Diagnostics Codes

2011-12-13T02:59:00.002-08:00

Keep using 83890-83914 for most payers.

Don't expect 101 new medical CPT® molecular diagnostics codes to resolve your specificity and payment problems -- CMS has declared that they won't price the codes for 2012.

As Medicare goes, so go most payers. A lot of insurers clearly plan to carry on accepting the "stacking codes" (83890-83914, Molecular diagnostics; ...) in the coming year for tests they cover.

Read on to learn when and how you might start to use the new medical CPT® molecular pathology codes.

Look for CMS Staged Implementation

CMS points out in the 2012 Medicare Physician Fee Schedule (PFS) that the AMA Relative Value Scale Update Committee (RUC) reviewed over 100 new medical CPT® 2012 codes defining molecular pathology services, but they will not be effective for Medicare purposes for 2012.

The novel molecular pathology codes appear in Addendum B to Medicare's PFS final rule with the procedure status indicator of I (Not valid for Medicare purposes. Medicare uses another code for the reporting and payment for these services).

Use ‘Stacking Codes' Now

CMS sates that for CY 2012, Medicare will continue using the existing ‘stacking' codes meant for the reporting and payment for [molecular pathology] services.

That means for Medicare and most other payers, you'll ignore the new codes and report these tests just as you have in past years.

In other words, report molecular assesses using suitable codes from the range 83890-83914. Each code describes a distinct technique, for instance nucleic acid extraction, gene amplification, or nucleic acid probes.

Add them up: You must bill a lone molecular assay by reporting every code (sometimes in multiple units) that defines every step that the lab carries out. As per AMA workgroup, these are stacking codes.

Pitfall: "The stacking code system has some problems," Dettwyler says. "Coders often have difficulty linking the highly technical test protocols to specific codes, resulting in a lack of reporting uniformity. Also, payers often deny the tests because they can't identify the genetic or cancer test."

Although most payers won't take them in 2012, you need to start getting acquainted with the novel molecular pathology codes.

Medical CPT 2012 introduces 92 specific codes for commonly-used genetic markers. The remaining new molecular pathology codes describe resource-based tests not listed in the first group. These are the "Tier 1" and "Tier 2" codes, respectively.

Tier 1: These codes define higher-volume tests for instance breast cancer evaluation for BRCA1 as well as BRCA2, along with genetic cystic fibrosis tests for instance CFTR common variants.

Tier 2: For less-commonly carried out molecular pathology tests, medical CPT® 2012 introduces resource-based codes (levels 1-9). The nine levels signify the range of technical resources along with physician interpretive work needed to carry out a given test.

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V Codes Might Hold the Answers to Complex Anesthesia Situations

2011-12-13T02:59:00.001-08:00

Don't be reluctant of submitting the similar V code as surgeons.

In case you ignore the V code section of ICD-9 for the reason that you are unsure whether the choices are applicable to anesthesia claims, it's time to take a closer look. V codes provide added information and specificity, which can help get a claim paid. Read this article for expert guidance on accurate medical coding.

Remember Both MDs Can Report V's

The surgeon as well as anesthesiologist can both submit the similar V code for a patient's chief diagnosis or to help clarify the patient's medical history.

Example: Your anesthesiologist might be involved with prophylactic removal of a patient's ovary. Both physicians could report V50.42 (Prophylactic organ removal; ovary). If applies, you could also include V16.41 (Family history of malignant neoplasm; ovary).

Watch for Chart Clues

Anesthesia coders from time to time trust on V codes in diverse ways from other specialties. Information that you find in the anesthesia provider's notes can point you to V codes that might go disregarded.

Example: ICD-9 expanded the body mass index (BMI) choices in 2011 to show higher BMIs with five novel ICD-9 codes (V85.41-V85.45). Patients with a high BMI can result in additional work for an anesthesiologist in the procedure, so including BMI ICD-9 codes in your claim can help validate your provider's service.

Tip: You must think ahead for possible V code usage, even during the pre-operative anesthesia assessment. BMI has become a significant health tool. There are those who are of the belief that BMI should be an eighth option while counting important signs for the ‘constitutional' bullet in the E/M physical exam, specifically in bariatrics and orthopedics/sports medicine.

Double Check Guidelines

Payers can have dissimilar guidelines as regards their use or acceptance of V codes.

For instance: Aetna policies permit V58.64 (Long term [current] use of non-steroidal anti-inflammatories [NSAID]) as a possible diagnosis supporting trigger point injections or radiofrequency facet denervation in case certain criteria are fulfilled. Code V58.64 is not listed as a feasible option, though, for back pain treatments for example percutaneous lumbar discectomy or facet joint injections.

Tip: You must check your payer's policies prior to submitting claims with V codes. Experts also commend that you must, from time to time, review the ICD-9-CM Official Guidelines for Coding and Reporting since it never hurts to remind yourself of medical coding basics.

A lot of of the Medicare Administrative Contractors [MACs] propose free ICD-9 coding as well as refresher courses. You can earn AAPC credits and learn more about how you should report any of the ICD-9 codes appropriately.

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Ph + Impedance Testing: The CCI Edits Can Ease Things for You

2011-12-12T02:06:00.000-08:00

Time is a crucial element while selecting between 91037 and 91038.

When your physician's note proposes impedance and pH tests being carried out together, you would turn to the 9103x series of your medical CPT manual. Easy? Not exactly. Take the following scenario in point.

Scenario: The motility specialist carries out impedance + pH test for over an hour. The patient, who complains of recurrent as well as painful heartburn, leaves the office with the catheter in position till the next day.

Dilemma: Can you bill 91038 by itself, or do you require to add 91034 at all?

The key is to recognize what each code involves, but you should not just base your choice on the obvious. You must give weight to Correct Coding Initiative (CCI) edits, too. These guidelines should keep you on the right track.

1. Look for 91037-91038 for Impedance Catheter

While reporting esophageal function (impedance) tests, you would define it using two medical CPT codes:

91037 –- i.e. Esophageal function test, gastroesophageal reflux test including nasal catheter intraluminal impedance electrode(s) placement, recording, analysis as well as interpretation

91038 -- i.e. ...prolonged (greater than 1 hour, up to 24 hours)

Keep in mind the descriptors for 91037 and 91038 represent a time measurement, which implies that you must apply 91037 for testing that goes up to one hour. In case the monitoring goes for more than one hour, bill 91038 as a substitute. You should not bill both codes for the same test. You should apply only a single code to report the session.

What happens: In an impedance test, the catheter goes in the patient's body transnasally. This particular test measures bolus transit dynamics along with either pH measurement or esophageal muscular function in the assessment of symptoms involving chest pain, swallowing trouble, or chronic heartburn which is unresponsive to medication. At times, physicians would carry out these tests in conjunction with manometry or pH testing.

Together motility study (manometry) as well as esophageal function testing uses a nasal catheter. Though, the impedance probe is multi-purpose and measures more much more than the motility test (91010, Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study with interpretation and report; 2-dimensional data) or the gastroesophageal reflux test (91034, Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode[s] placement, recording, analysis and interpretation).

2. Single Code Defines Cather-Based pH Test

When a gastroenterologist carries out an esophageal acid reflux test using either a disposable or a reusable nasal catheter, you would then report medical CPT 91034.

Pointer: Medical CPT 91034 should be your go-to code irrespective of how long the nasal catheter remains in place. Generally, though, the physician will leave the catheter in place for about a day. Earlier, you had to differentiate between standard and "extended" pH monitoring. Currently, only single code (91034) defines a catheter-based pH service.

CPT 2012: Implanon Insertions in 2012

2011-12-12T02:04:00.000-08:00

Learn about novel pathology codes that reflect the tests your ob-gyn can order.

In case you were concerned that 2012 might be an important year for ob-gyn code inclusions, then you relax -- but it's not that easy. You still need to check out these fresh skin substitute graft codes and possible gyn oncology services.

Getting to know these medical CPT 2012 changes now clearly means that you won't be confused any more when that ob-gyn claim comes to you.

1. Get Ready to Change How You Report Implanon Insertions

CPT 2012 gets rid of 11975 (Insertion, implantable contraceptive capsules) and 11977 (Removal with reinsertion, implantable contraceptive capsules).

What this means for you: With the removal of medical CPT codes 11975 along with 11977, you will now have to turn to the existing code 11981 (Insertion, non-biodegradable drug delivery implant) once your ob-gyn inserts Implanon for contraception.

The code 11976 (Removal, implantable contraceptive capsules) remains a valid medical CPT code, though; as few patients still have Norplant systems that an ob-gyn will require to get rid of.

2. Study These Skin Substitute Graft Additions

You'll have some novel skin substitute graft codes to get acquainted with in 2012, and the key here is to pay attention to the guidelines. These codes are meant for the topical application of a skin substitute graft to the wound surface and would not be reported in case the graft was used internally. The novel codes are:

15271 -– i.e. Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less surface area

15272 -- i.e.... every added 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

15275 -- i.e. Application of skin substitute graft to face, scalp, genitalia, eyelids, ears, orbits, mouth, neck, hands, feet, and/or multiple digits, (total wound surface area up to 100 sq cm; first 25 sq cm or less)

15276 -- i.e. ... each added 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

15277 -- i.e. Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, (total wound surface area more than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children)

15278 -- i.e.... each added 100 sq cm wound surface area, or part thereof, or every added 1% of body area of infants as well as children, or part thereof (List separately in addition to code for primary procedure)

3. Have Claims For a Gyn Oncologist? Implement 2 New Codes

In case you code for a gynecology oncologist who see patients with ascites, then you must be aware of three new incision medical CPT codes . They are:

49082 –- i.e. Abdominal paracentesis (diagnostic or therapeutic); excluding imaging guidance

49083 -- i.e. .... including imaging guidance

Avoid 'Uncertain Behavior' Confusion With Expert Tips on 238.2 Use

2011-12-07T22:52:00.001-08:00

You should wait for the path report to avoid payer scrutiny.

In case you always use diagnosis code 238.2 (Neoplasm of uncertain behavior of skin) while you're reporting 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) for a biopsy procedure your physician carries out, you're jeopardizing your practice. The key to knowing when ou should use the "uncertain behavior" diagnosis code is knowing what that code descriptor actually means. Follow these expert tips to ensure you're choosing the accurate code, after medical procedure codes lookup, for all your 11100 claims.

Wait For Pathology Before Selecting a Code

When your physician conducts a biopsy you must always wait until the pathology report gets back to you to select the appropriate diagnosis and procedure codes to report after medical procedure codes lookup -- even though this will not always have an impact on the CPT billing codes you will wind up choosing.

Reason: The biopsy specimen's pathology will influence the ICD-9 code you report, however maximum CPT procedure codes are not based on the specimen's results. There are a few CPT codes which are related to particular diagnoses (for instance, excision of benign and malignant lesions), but generally CPT is about what you did; whereas ICD-9 is about the result or the reason for it.

Identify the Meaning Behind 'Uncertain' Codes

Once you report 238.2 as the diagnosis, post medical procedure codes lookup , for a biopsy procedure, you're telling the payer that the pathologist stated in his path report that he was unclear regarding the morphology of the lesion.

Uncertain behavior doesn't imply that the coder is unclear or that the physician considers the lesion looks suspicious but it might be benign. Uncertain behavior actually means that a specimen has been examined by a pathologists and also that the cells are of mixed types.

How it works: Uncertain behavior diagnoses are suitable for specimens recognized as hyperplastic (hyperplasia) or precancerous. In case you submit a claim with 238.2 as a diagnosis prior to you have the pathology report back, you might have in fact communicated to the insurer that the patient has a disease process that he doesn't really have or may have but has not yet been established.

Example: Your physician finds an irregular lesion on patient's face. The color and shape troubles him and he doubts the lesion may be malignant, however does not want to completely do away with it owing to its size and location unless it is essential. Thus, he simply takes a biopsy of the skin and subcutaneous tissue (11100) and sends the sample to pathology. On pathological evaluation the pathologist cannot decide if the cells from the lesion are malignant or benign, thus, he allocates the diagnosis of "uncertain behavior." In this case, after medical procedure codes lookup, you would validly report 238.2 as the diagnosis code after getting the pathology report.

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Get Ready For These Key Changes in Observation and Prolonged Services Codes

2011-12-07T22:51:00.001-08:00

And look into new guidance on wound, burn and ultrasound services that could have an impact on your revenue.

ED coders turn to E/M section of the 2012 CPT® manual for most of the related changes and additions. But beware: Most of these are slight references to time in related E/M codes for medical billing, frequently concealed in preambles along with parenthetical references that are likely to miss.

Read on for guidance on recognizing the ED changes that could have an impact on your claims, come Jan. 1.

Notice Revised Definitions of New and Established Patients

2012 brings new wording to the New and Established Patient section in the E/M services guidelines in the front of the CPT® book.

Although the new language does not influence the 9928xemergency department E/M codes for medical billing directly, more and more groups are being tasked with increasing their services outside the Emergency Department. As ED groups grow in their search for another revenue streams and the healthcare delivery system evolves towards larger integration, a lot of groups are staffing different urgent care clinics where the dissimilarity between new and established patient status will play a significant role in determining code selection and subsequent reimbursement.

Note New ED Time Tip Included for 2012

You must search for new "Coding Tips" advice in the CPT E/M section on the significance of time as a factor in making your E/M code selections. "This is not new information but serves as a reminder that the inclusion of time is there to assist physicians in selecting the appropriate codes for medical billing and that the listed times are averages and consequently represent a range of times that may be higher or lower, depending on clinical circumstances.

Key: The ED coding tip repeats that time is not an aspect in choosing ED E/M codes for medical billing.

Use Prolonged Services Codes With Initial Observation

These typical time add-ons to the initial observation codes come into play with novel language relating to the prolonged services codes for medical billing . The preamble to the prolonged services section includes novel language explaining direct patient contact as face-to-face, involving additional non-face-to-face services on the patient's floor or unit of the hospital during the same session. Therefore, the term "face-to face" no longer has a place in the title of the prolonged services code preambles.

More importantly, code +99356 (Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service; first hour [List separately in addition to code for inpatient Evaluation and Management service]) has a parenthetical list of related code ranges that now involve the initial admit to observation codes.

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Factors That Affect Reimbursement for Wart Removal

2011-12-02T04:56:00.000-08:00

There are few distinct factors that influence your wart removal coding, and each element has a noteworthy bearing on payment. Warts are generally benign growths and, as removal is frequently viewed as a routine procedure, family practices at times assign the similar sets of codes without considering ways to capitalize on their reimbursement. The following listed questions may help coders as they assess documentation and choose which codes are most useful to assign.

1. What is the technique of removal?

Warts are nearly always removed by destruction, described in the CPT 17000 series of codes. Techniques of treatment contain cryosurgery, laser, chemical treatment as well as electrosurgery. Occasionally, in case the physician doubts that a wart-like growth might be something but a wart, the lesion may be excised and biopsied. You will find the excision codes listed in the 11000 segment of CPT and these are assigned as per the technique used, the location of the excision and, in few cases, the number of warts removed.

Family practice coders must note that in case warts and further lesions are removed from diverse sites, destruction and excision codes can be further billed on the similar date of service. For instance, in case a physician excises a growth on a patient's arm, however destroys a series of warts on the patient's foot, you can report codes from both the CPT 17000 series and the CPT 11000 series.

2. What sort of wart has been removed?

The physician should document the definite type of wart being removed as that determination could have a considerable impact on reimbursement.

As CPT 17110 (destruction by any method of flat warts, molluscum contagiosum, or milia; up to 14 lesions) as well as CPT 17111 (… 15 or more lesions) in detail mention flat warts in their descriptions, a lot of practices automatically allocate them for all wart removal. Though, three other codes, CPT 17000 (destruction by any method, including laser, with or without surgical curettement, all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions, including local anesthesia; first lesion), 17003 (… second through 14 lesions, each [list separately in addition to code for first lesion]) and 17004 (… 15 or more lesions), may be allocated for common as well as plantar wart removal – and may lead to maximized reimbursement in case multiple lesions are destroyed.

3. What is the number of warts that have been removed?

The figure of warts removed may have a considerable impact on the codes assigned – and the payment. This is mainly the case when reporting the destruction of common or plantar warts, is different from flat warts.

The flat wart destruction codes, which are, 17110 and 17111, define removal of multiple warts. That means the coders would assign 17110 once once the physician does away with one to 14 warts. In case more than 14 flat warts are destroyed, coders would allocate 17111 once.

Though, CPT permits destruction codes for several common or plantar warts to be assigned several times. Code 17000 would be given for the first wart and additional code 17003 would be assigned for every following wart removed up to 14. That means that in case the patient who presented with eight plantar warts, coders will then report CPT 17000 once and 17003 seven times.

CPT 2012: Improve Your Medicine, Cardiothoracic Surgery Reporting

2011-12-02T04:54:00.000-08:00

Part with diagnostic thoracoscopy code 32602 in favor of new codes 32607-32609.

Don't forget to check for deleted codes for CPT while preparing to use your CPT® 2012 manual, not just novel codes as well as revised descriptors. Next year's set of procedure codes will involve new additions for coding certain common medicine/pulmonary procedures. Simultaneously, you will be missing the resistance to airflow determination code, and also a few additional familiar pulmonary procedures.

Gauge Potential Opportunities With Brand New Medicine Codes

You and your pulmonologists should pay special attention to the subsequent novel codes for CPT in the medicine/pulmonary section of CPT® 2012 manual:

94726 -- i.e. Plethysmography meant for determination of lung volumes and, when carried out, airway resistance

94727 -- i.e. Gas dilution or washout meant for determination of lung volumes and, when carried out, distribution of ventilation as well as closing volumes

94728 -- i.e. Airway resistance by means of impulse oscillometry

+94729 – i.e. Diffusing capacity (e.g., carbon monoxide, membrane) (List separately in addition to code for primary procedure)

94780 -- i.e. Car seat/bed testing for airway integrity, neonate, with incessant nursing observation and incessant recording of pulse oximetry, heart rate along with respiratory rate, including interpretation as well as report; 60 minutes

+94781 -- i.e. …every added full 30 minutes (List separately in addition to code for primary procedure).

Certain of these codes for CPT were formulated in an effort to try to adapt to existing practice and elucidate earlier confusion while reporting PFTs. One instance is plethysmography. Earlier options for reporting this particular service was 93720 (Plethysmography, total body; with interpretation and report) or 94360 (Determination of resistance to airflow, oscillatory or plethysmographic methods). Effective Jan. 1 a noval code will now reflect the more correct testing method.

2012 will introduce 18 noval cardiothoracic surgery codes for CPT . These codes for CPT include:

32096 – i.e. Thoracotomy, including diagnostic biopsy(ies) of lung infiltrate(s) (e.g., wedge, incisional), unilateral

32097 -- i.e. Thoracotomy, including diagnostic biopsy(ies) of lung nodule(s) or mass(es) (e.g., wedge, incisional), unilateral

32098 -- i.e. Thoracotomy, including diagnostic biopsy(ies) of pleura

32505 -- i.e. Thoracotomy, including therapeutic wedge resection (e.g., mass, nodule), initial

+32506 -- i.e.... including therapeutic wedge resection (e.g., mass or nodule), each additional resection, ipsilateral (List separately in addition to code for primary procedure)

+32507 -- i.e. ... including diagnostic wedge resection followed by anatomic lung resection (List separately in addition to code for primary procedure)

32607 -- i.e. Thoracoscopy; including diagnostic biopsy(ies) of lung infiltrate(s) (e.g., wedge, incisional), unilateral

32608 -- i.e.... including diagnostic biopsy(ies) of lung nodule(s) of mass(es) (e.g., wedge, incisional), unilateral

32609 -- i.e.... including biopsy(ies) of pleura

32666 -- i.e.... including therapeutic wedge resection (e.g., mass, nodule), initial unilateral

+32667 -- i.e.... including therapeutic wedge resection (e.g., mass or nodule), each additional resection, ipsilateral (List separately in addition to code for primary procedure)

+32668 -- ... including diagnostic wedge resection with subsequent anatomic lung resection (List separately in addition to code for primary procedure)

32669 -- ... including removal of a single lung section (segmentectomy)

32670 -- ... including elimination of two lobes (bilobectomy)

32671 -- ... including removal of lung (pneumonectomy)

32672 -- ... including resection-plication for emphysematous lung (bullous or non-bullous) meant for lung volume reduction (LVRS), unilateral involves any pleural procedure, when carried out

32673 -- ... including resection of thymus, could be unilateral or bilateral

+32674 -- ... including mediastinal as well as regional lymphadenectomy (List separately in addition to code for primary procedure).

The codes are cardiothoracic surgery codes. It looks as if they [CPT®] have expanded all of these series to involve more detail, and more precisely capture the amount of effort related to unilateral vs bilateral services along with procedures including multiple (ipsilateral) biopsies.

Common Wart Removal Codes Doubles Your Reimbursement

2011-12-01T03:21:00.000-08:00

Internists deal with forthright integumentary complaints that were once voluntarily referred to dermatologists and this includes wart removal. However all too often internists carry out wart removal procedures excluding distinguishing between wart categories and without knowing that those differences can impact their rightful reimbursement. Also, coders who aren’t vigilant to the intricacies of coding terminology may be extending or perpetuating the misapprehension.

Codes For Wart Removal

The problem lies in a misunderstanding of the applicable CPT codes ,. When internists and coders go for a wart removal code, a lot of them only see 17110 [destruction by any method of flat warts, molluscum contagiosum, or milia; up to 14 lesions] or 17111 [ 15 or more lesions].

Though, using 17110 and 17111 often result in underbilling as reimbursement is not different (1.69 relative value units [RVUs] for 17110) for removing one wart as it is meant for 14 warts, though the single-claim RVU for 17111 is 2.11 for 15 or additional warts, irrespective of whether its 15 or 50 warts.

Read Code Descriptors Cautiously

Remember that the destruction of common warts must be coded CPT 17000 (destruction by any method, including laser, with or without surgical curettement, all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions, including local anesthesia; first lesion) and 17003 ( second through 14 lesions, each [List separately in addition to code for first lesion]).

The word wart does not exist in the descriptor for these particular codes and that’s the chief reason why so many internists and coders are unsuccessful in using them properly. You have to go through the guidelines under Destruction (page 56 in CPT 2001), just prior to the description for the 17000 series of codes to realize that they are applicable not only to several lesions but also to warts.

The words in parentheses subsequent to the explanation for 17111 state, For destruction of common or plantar warts, look for 17000, 17003, 17004. So, until you do a little investigation, its not clear that the accurate way to bill for the destruction of these common warts is to use 17000 and 17003.

Note: Never use 17003 individually. It should be used with CPT 17000. Moreover, you should not report 17004 (15 or more lesions) along with 17000-17003. Code 17004 is always reported individually.

Reimbursement Can Increase

Putting the CPT 17000 series codes to work makes a big difference in reimbursement. For instance, in case a patient comes with eight common warts on the back of one hand, then the internist can code CPT 17000 (1 unit, 1.67 RVUs) for the first wart, and 17003 (7 units, 0.39 RVUs each) for the outstanding warts.

CPT® 2012: 33227-33229 Transform Pacemaker Battery Change Coding

2011-12-01T03:20:00.000-08:00

Celebrate an easierr way to report lone electrode repair in a dual-chamber system.

Each CPT® update brings an enormous overhaul of a diverse cardiology coding area, and 2012 will definitely be no exception. Starting January 1, you’ll report pacemaker as well as pacing cardioverter-defibrillator surgical services in a completely different way.

To help ease the task of acing these changes, here is the big picture view of the new codes for CPT.

Complete System: 33206-33208 and 33249 Get a Makeover

Pacemaker and pacing cardioverter-defibrillator codes for CPT are in the limelight in 2012, and the updates start with codes for comprehensive systems.

CPT® will include the following bold, italicized text to the definitions of 33206-33208: "Insertion of new or replacement of permanent pacemaker with transvenous electrode(s) ..."

For a pacing cardioverter-defibrillator, 33249 modifies as follows:

2011: Insertion or repositioning of electrode lead(s) for single or dual chamber pacing cardioverter-defibrillator as well as insertion of pulse generator

2012: Insertion or replacement of permanent pacing cardioverter-defibrillator system including transvenous lead(s), single or dual chamber.

Electrode Repair Receives a Needed Update

When you require to code electrode repair, you’ll select between these revised codes for CPT:

33218, i.e. Repair of single transvenous electrode, along woth permanent pacemaker or pacing cardioverter-defibrillator

33220, i.e. Repair of 2 transvenous electrodes meant for permanent pacemaker or pacing cardioverter-defibrillator.

Helpful: The change solves confusion over how you should code repair of a single electrode in a dual-chamber system. In 2011, the code definitions propose no clear solution as 33218 references repair of one electrode in a single-chamber system and 33220 refers to repair of two electrodes in a dual-chamber system.

2 Codes No Longer Required for Battery Change

In 2012, coding for removing as well as replacing a pulse generator at a single session will turn very different. This service is frequently called a battery change. In 2011, you report a single code for the removal and then a second code for inserting the new pulse generator. In 2012, you’ll report a single code that captures both the removal and the insertion.

The following listed new codes for CPT will define pacemaker pulse generator removal with replacement:

33227, i.e. Removal of permanent pacemaker pulse generator including replacement of pacemaker pulse generator; single lead system

33228, i.e.... dual lead system

33229, i.e.... multiple lead system.

CPT similarly adds codes to explain the replacement of a pacing cardioverter-defibrillator pulse generator:

33262, i.e. Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator; single lead system

33263, i.e. ... dual lead system

33264, i.e. ... multiple lead system.

J9265 and More Are Applicable To This Ovarian Cancer Scenario

2011-11-30T03:56:00.000-08:00

Test yourself by selecting the appropriate codes and units for this particular encounter.

Looking for the proper codes -- even if it is for well-documented visits -- can necessitate some detective work. Take a look at the following scenario and make your selections for the suitable ICD-9-CM, HCPCS, and CPT® codes. Read this expert ICD-9 CPT insight and take a step closer towards accurate claims.

Scenario: Documentation demonstrates the patient visits for her very first day of chemotherapy, intended at treating stage III epithelial ovarian cancer (primary).

The tracking form for the patient shows the following listed infusions:

0817-0833, i.e. dexamethasone sodium phosphate (20 mg IV, in 50 mL NS)

0834-0854, i.e. diphenhydramine (50 mg IV, with ranitidine, 50 mg IV, in 50 mL NS)

0924-1226, i.e. paclitaxel (233.55 mg IV, in 500 mL NS)

ICD-9-CM: Take It 1 Code at a Time

The first-listed diagnosis code would be V58.11 (Encounter for antineoplastic chemotherapy). As per ICD-9-CM official guidelines, V58.11 should be the main code when the visit is only for chemotherapy

Next: You must report the code for the neoplasm being treated. In this case, you must use 183.0 (Malignant neoplasm of ovary) to define the stage III epithelial ovarian cancer.

You can identify from "stage III" that the neoplasm is malignant. In the system used for staging, stage III ovarian cancer implies that the cancer is in one or both ovaries and has spread to the abdominal lining, the lymph nodes, or both.

Knowing that the treated neoplasm is primary is also significant, as then you would use 198.6 (Secondary malignant neoplasm of ovary) in case the neoplasm were a secondary malignancy.

ICD-9 CPT Tip: A note including 183.0 says to use additional code to classify any functional activity. A different possibility for ovarian cancer "might be an elevated CA-125 before surgery, thus you can add this code as a secondary diagnosis. The suitable code would be 795.82 (Elevated cancer antigen 125 [CA 125]).

HCPCS: Bring Out the Units Calculator

Prior to you can select the suitable infusion codes, you'll require to classify the specific agents administered. The nature of the agent will influence your ICD-9 CPT infusion code selection.

The suitable code for chemotherapy drug paclitaxel is J9265 (Injection, paclitaxel, 30 mg). In order to define the number of units, you must divide the amount administered (233.55 mg) by the amount in the code definition (30 mg). The answer is 7.785. Since Medicare permits you to round up to find your final number for units, the accurate number of units is 8.

Note that in case the record displays the drug is instead paclitaxel protein-bound, you must report J9264 (Injection, paclitaxel protein-bound particles, 1 mg). You would report this code per milligram (for instance, 234 units for 234 mg).

For the dexamethasone (a steroid), you must report J1100 (Injection, dexamethasone sodium phosphate, 1 mg). You report the code per milligram, so you should report 20 units to represent the 20 mg administered.

The appropriate code for the antihistamine diphenhydramine is J1200 (Injection, diphenhydramine HCl, up to 50 mg). One unit will report the 50 mg administered.

The above ICD-9 CPT expert advice is brought to you by SuperCoder.com. Click here to read the whole article and for more expert medical coding and billing guidance, news and information http://www.supercoder.com/articles/articles-alerts/onc/case-study-j9265-and-more-apply-to-this-ovarian-cancer-scenario-108708/

Procedure's Intent Decides Your 11100 Reimbursement

2011-11-30T03:55:00.000-08:00

Know When You Should Use CPT 11100: Key to biopsy pay

In case you're puzzled about when you should report a biopsy and also when you should select an excision code, ask these simple questions to know when you are supposed to report CPT 11100 and avoid this common dermatology denial trap.

1. Why did the dermatologist do away with the skin abnormality?

When your dermatologist examines a patient who has a suspicious lesion, for instance a mole that transformed it's shape over time or has uneven borders, the dermatologist should remove that lesion.

Caution: Just for the reason that the dermatologist removed the lesion, he didn't essentially conduct a biopsy. Dermatologists send both excisions along with biopsies to pathology, but you must report a biopsy: CPT 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) only in case the dermatologist gets a diagnosis (for instance, 172.x, Malignant melanoma of skin) from the pathology report.

In case the dermatologist actually carried out an excision and did not performed a biopsy, you must report the procedure with an excision code (11400-11646)

2. What is the quantity of the lesion that the dermatologist removed?

The lesion's size or depth generally dictates the removal method. Dermatologists generally carry out superficial shaves to entirely remove lesions for instance surface moles. However in other occurrences, the dermatologist will carry out an excision to get a portion of a more serious lesion, for instance a cyst-like lesion underneath the skin's surface.

In this case, the dermatologist excises a part of the lesion and then sends the specimen to pathology. Then should you code an excision or a biopsy?

Answer: You must report a biopsy code as the dermatologist took only a portion of the lesion meant for a pathology diagnosis. Consequently, in this case, you must bill code CPT 11100 for a single lesion, and add-on code +11101 (… each separate/additional lesion [list separately in addition to code for primary procedure]) in case the dermatologist takes a sample from more than one lesion.

Don't miss: As add-on codes denote the procedures the physician carried out along with a primary service/procedure, you should never report them as individual codes or you will face denials.

Ensure that you look at CPT's parenthetical instructions, which generally inform you which procedure codes you can use along with the add-on code.

Extra: In case the documentation does not evidently state the specimen's size (for instance, the whole lesion or just a sampling), you can always wait for the particulars of the pathology report before you define which code to use: CPT 11100 or CPT 11400 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less).

CPT® 2012 Contains Intradermal Flu Vaccine Option With 90654

2011-11-29T02:28:00.000-08:00

Don't overlook revisions to other vaccine, E/M codes.

CPT® 2012 will go into effect in a few weeks, so you must prepare yourself now for new and revised choices associated with vaccine administration and prolonged E/M service to make sure your claims stay correct. Read this article for an ICD-9 and CPT 2012 expert insight for accurate claims and maximized ethical reimbursement.

Official Addition of 90654

CPT® 2012 adds a different option to your flu vaccine coding by adding 90654 (Influenza virus vaccine, split virus, preservative-free, for intradermal use). The inclusion expands on the code family 90655-90668 that at present addressed influenza vaccines.

A couple of factors separate 90654 from a lot of of the other flu vaccine codes:

Code 90654 is not age specific, while codes 90655-90658 do identify the patient's age (either 6 to 35 months of age, or age 3 years and older).

Code 90654 denotes an intradermal injection (administered to the dermal layer of skin), however additional codes (e.g. 90655-90658 and 90662) describe intramuscular injections (administered to muscle tissue) as well as intranasal administration (e.g. 90660).

ICD-9 and CPT Tip: Code 90654 signifies just the vaccine product. Include the fitting administration code (90460-90474) on your claim. In case your physician delivers a noteworthy, distinctly identifiable E/M service in the encounter for the vaccine, also report the suitable E/M code (99201-99205 for a new patient or 99211-99215 for an established patient).

Though 2012 will be the first time 90654 is covered in the CPT® book, the code has been present for more than a year.

Ace ICD-9 and CPT 2012: Note Extra Specificity of 90460-90461

A number of additional vaccine as well as vaccine administration codes go through revision for CPT® 2012. Revised codes involve (underline indicates change):

90460 -- Immunization administration over 18 years of age through any route of administration, including counseling by a physician or added qualified health care professional; first or only component of each vaccine or toxoidadministered.

+90461 -- ... every single additional vaccine or toxoid component which is administered (List separately in addition to code for primary procedure)

90581 -- Anthrax vaccine, meant for subcutaneous or intramuscular use

90644 -- Meningococcal conjugate vaccine, as well as serogroups C & Y along with Hemophilus influenza B vaccine (Hib-MenCY), a 4 dose schedule, while administered to children who are 2-15 months of age, for intramuscular use.

ICD-9 and CPT Expert Tip: CPT 2012 removes vaccine codes 90470 (H1N1 immunization administration [intramuscular, intranasal [including counseling when performed) and 90663 (Influenza virus vaccine, pandemic formulation, H1N1). These codes were possibly considered no longer required, particularly with the inclusion of codes 90664-90668 in 2011.

Use 11100/11101 for pathology specimens only

2011-11-29T02:27:00.000-08:00

In case you're reporting biopsy codes CPT 11100 and CPT 11101 distinctly from excisions or additional biopsies, you're unknowingly going in the trap of denials and even a possible audit. In order to side-step these problems, you must use 11100/11101 when the surgeon gets a portion of a lesion for pathology only. Read the following article and know when you should use these biopsy skin add-on codes to ensure accurate claims.

Instructional notes make it clear that you must not report CPT 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) and +11101 (… each separate/additional lesion [list separately in addition to code for primary procedure]) along with excision or other biopsy codes,

Notes prior to the “Biopsy" portion of CPT say:

You should report CPT 11100 as well as CPT 11101 only when the physician gets hold of a specimen: For instance, the surgeon does away with a part of a patient's skin lesion (709.1, Vascular disorders of skin) and then sends the specimen to pathology. In that particular case, you would certainly use CPT 11100. You must then allocate add-on code 11101 in combination with 11100 when the surgeon conducts a biopsy of a second lesion. You may report one added unit of CPT 11101 for each additional biopsy the surgeon carries out.

You can't report CPT 11100 and CPT 11101 when you bill for a different procedure, for instance an excision. For instance, assume that the surgeon get rid of a whole lesion and after that submits it to pathology, you must then use only 11400 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less). You are not supposed to use a biopsy code, as according to CPT, the biopsy is a component of 11400.

When the surgeon carries out a biopsy on a dissimilar site from the excision, you may separately assign CPT 11100 and CPT 11101. For instance, your surgeon does away with an all-inclusive benign lesion from a patient's arm, and also a part of a lesion on a patient's neck. As far as the arm lesion is concerned, use 11400, and as far as neck biopsy is concerned, report 11100-59 (Distinct procedural service). By means of appending modifier -59 to the second code, you specify that the biopsy took place at a distinct location from the lesion removal.

Have Comprehensive Knowledge of CPT, HCPCS, and ICD-9-CM

2011-11-27T23:50:00.000-08:00

The interest in ICD-10-CM training is at a high level with most coders, which is not going to stop till October 1, 2013, implementation date. We are constantly seeing the drive for education careening to ICD-10-CM; however, but ICD-9-CM isn't supposed to be left behind.

Coders should be well-versed with their coding manuals. Remember, outpatient coding is not simply about CPT coding, but it is relatively about conceptualizing the whole picture in conjunction with CPT and ICD-9-CM codes. ICD-9-CM has a comprehensive listing of guidelines similar to the CPT manual. Interpreting ICD-9-CM knowledge prevents coders from fully understanding why diagnosis codes are used or sequenced in a specific way to produce complete claims. A coder must have a well-rounded knowledge of CPT, HCPCS, and ICD-9-CM. This will lead to fewer denials owing to ICD-9-CM mismatches with the CPT codes chosen.

The basics of ICD-9-CM should be well known; though, let's evaluate the important steps coders are required to take in order to correctly report the diagnosis for the following example.

A patient was admitted after developing severe diarrhea on day 50 following a living donor kidney transplant. A stool sample revealed a significant number of donor lymphocytes due to acute graft-vs.-host (GVH) disease. The physician diagnosed the patient with acute GVH disease.

First, find the main entry term; in this scenario, let's look at GVH disease. Keep in mind, conditions are expressed in the documentation as well as the index as nouns, adjectives, and eponyms. Numerous synonyms are also used for some circumstances, letting a coder to find the precise code through numerous lookup methods.

The next step is to look at the code found in the tabular section of the index to confirm correct code selection. Here, you will find the code 279.50. If you look under this code, it explains that in case this is a complication because of organ transplant not somewhere else classified, see Complications, transplant, organ. Although this is a complication arising from a kidney transplant, you will still necessitate reporting the GVH disease, so look at the tabular section for code 279.50, where you will get 279.51, which precisely reports the disease documented at the maximum specificity.

Prior to applying 279.51 to the claim, you need to carry out one additional step. Most coders overlook to look around the code to see in case there is any parenthetical information that may affect the coding. Possibly an added code is needed to report a manifestation or if the code comprises or not comprises a condition or disease. It may also have the instruction to code the underlying disease first.

This example requires the use of an ICD-9 information is brought to you by SuperCoder.com. Log on to www.supercoder.com for more accurate and profitable expert medical coding and billing advice.

Whether it's a powerful code reference tool, a real-time claims auditor to help you reduce denials or step-by-step guidance from CPC certified experts, we've got you covered. Some of our unique products provide you the update information on ICD-9 and HCPCS codes , the ammunition you need to get instant success.

CPT 2012: 62310, 62318 Revisions Help Simplify Your Single Shot vs. Indwelling Catheter Coding

2011-11-24T23:09:00.000-08:00

Plus: Get ready for changes to 77003, too.

Though you won't report new or revised CPT® anesthesia codes until January 2012, get ready -- and your anesthesia providers -- at this time for revisions that can impact your everyday coding, for instance the rewording of two general epidural codes.

Observe the Descriptor Differences

The chief modifications are applicable to epidural codes 62310 along with 62318. The existing and upcoming descriptors are as follows:

The novel descriptors include several changes:

62310 specifies that it can be used for more than one single injection.

62310 no longer statesthe possible use for epidurography. Epidurography is a distinct procedure that doesn't need to be associated with this code.

The existing version of 62310 doesn't involve catheter administration, however the revised descriptor does. Physicians were placing catheters for single shots and trying to bill 62310 or 62311. The dissimilarity is that one pair of anesthesia codes is for constant or continuous bolus (62318/62319). The other is for a single distinct dose at a time (62310/62311), irrespective of catheter use.

The revised 62318 explains "indwelling" catheter and changes from "injection" to "injections".

Keep in mind: Anesthesia codes 62311 as well as 62319 now read "lumbar or sacral (caudal)" in place of "lumbar; sacral (caudal)."

Don't Miss Fluoro and Nerve Destruction Changes

In case you occasionally report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, subarachnoid, or sacroiliac joint], including neurolytic agent destruction) in combination with diagnostic or therapeutic injections, make certain that you note the descriptor change, come January.

The novel descriptor will read "Fluoroscopic guidance and localization or needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid)."

Change: The code no longer covers guidance for sacroiliac joint injections or neurolytic agent destruction.

Replacements: Codes 64622-64627 for paravertebral facet joint nerve destruction have been deleted and replaced with following listed four novel anesthesia codes :

64633 – i.e. Destruction by means of neurolytic agent, paravertebral facet joint nerve(s) including imaging guidance (fluoroscopy or CT); cervical or thoracic, as well as single facet joint

64634 -- i.e.... cervical or thoracic, every additional facet joint (List separately in addition to code for primary procedure)

64635 -- i.e.... lumbar or sacral, as well as single facet joint

64636 -- i.e.... lumbar or sacral, every additional facet joint (List separately in addition to code for primary procedure).

The above anesthesia coding information is brought to you by SuperCoder.com. Click here to read the whole article and for more expert medical coding and billing guidance, news and information http://www.supercoder.com/articles/articles-alerts/aca/cpt-2012-62310-62318-revisions-help-clarify-your-single-shot-vs.-indwelling-catheter-coding-108625/

ICD-9 Coding: 700 Basics: Simplify Corn and Callus Coding

2011-11-24T23:08:00.000-08:00

Learn what to do when these lesser-known terms show up in your doctor's documentation?

For dermatologists who are treating the skin of a patient's foot, one of the most generally coded diagnoses is corns (and calluses). This particular condition has a slew of puzzling names that may be difficult to find -- or may not be present in your ICD-9 coding book -- and could quickly overturn your claims.

Decoding all of the corn and callus terminology can be particularly complex in case you work for numerous physicians and each one has his own particular way of naming the same thing, or in case you've lately started working at another practice. But you no longer have to be ignorant as far as a callus-related term is concerned.

Watch out: "Tylosis" could lead you down the erroneous coding path if you're not cautious. The ICD-9 index present in the front of the coding book presents numerous options, for instance 757.39 (Other specified amomalies of skin; other; includes accessory skin tags, congenital; congenital scar; epidermolysis bullosa; keratoderma [congenital]), and this is the incorrect path for a basic corn or callus. The best way you encounter this particular term present in the documentation is to ask the dermatologist to explain the condition.

ICD-10: Once ICD-9 changes to ICD-10 in October, 2013, code 700 become invalid. In its place, you would report ICD-10 code L84 (Corns and callosities).

Ace the Definitions

In case you're still uncertain about your dermatologist's everyday explanation of these general conditions, learning the definitions of "corn" and "callus" will help. Remember, a corn is a small, horny area of the skin produced by local pressure (e.g., a shoe or hosiery) irritating the tissue over a bony prominence.

Corns normally takes place on a toe, where they form "hard corns." (Between the toes, pressure can form a soft corn of macerated skin, which often yellows.)

Moreover, a callus is localized thickening and enlargement of the horny layer of the skin because of pressure or friction. Normally, calluses as well as corns can result in pain, and soft-tissue inflammation may take place around the base of the lesion.

Knowing these definitions is also supportive in case you plan to ask the dermatologist for explanation.

For instance: You're struggling with how you should code a patient diagnosis that defines a "keratosis" of the bottom of the great toe and the heel. You've learned the synonyms for corns/calluses and recall that this is one more name for a callus, however you notice that a different nearby code has the identical word in its descriptor: 701.1 (Keratoderma, acquired; Keratosis [blennorrhagica]).

For an error-free ICD-9 coding , you request the dermatologist for more particulars about the patient's condition so you can code it correctly, and he defines a basic thickening of the skin owing to bad shoes. After studying the definitions, now you know that it's just a callus and you can further code it as 700.

The above expert ICD-9 insight is brought to you by SuperCoder.com. Click here to read the entire article and have more accurate and profitable expert medical coding and billing advice: http://www.supercoder.com/articles/articles-alerts/der/icd-9-coding-700-basics-take-the-rough-edge-off-corn-and-callus-coding-108680/

Get Well-Versed With NCCI v17.1: The Version Includes Thousands of New Edits

2011-11-24T00:51:00.000-08:00

The Centers for Medicare & Medicaid Services (CMS) has released the latest National Correct Coding Initiative (NCCI) update this year. Version 17.1 comprises more than 700,000 code pair edits. Amongst those NCCI edits, nearly 12,000 are new to Version 17.1. About 350 code pair edits have been removed, the majority of which are retroactive to earlier dates of service.

Retroactive code pair deletions may imply that you're entitled for payment on past claims, in case those claims were overruled based on the now-deleted code pair edits.

Version 17.1 is noteworthy for another reason: For the first time ever, Medicaid payers will have to observe NCCI edits. The Patient Protection and Affordable Care Act (H.R. 3590, section 65607) necessitates that state Medicaid programs must include NCCI methodologies into their claims processing systems.

The objective of NCCI is to stop payments when inappropriate code combinations (unbundling) are reported. NCCI comprises two types of NCCI edits: The first of these edits are essentially the bundling edits, named "column 1/column 2" or "correct coding" edits. Codes which are listed in column 2 generally are bundled to the code listed in column 1, which is essentially the "more extensive" procedure. For instance, "CPT® code 36000 Introduction of needle or intracatheter in a vein is essential to every nuclear medicine procedure necessitating injection of a radiopharmaceutical into a vein. CPT® code 36000 is not distinctly reportable with these sorts of nuclear medicine procedures. Though, CPT® code 36000 might be reported alone in case the lone service delivered is the inclusion of a needle into a vein, as per the Correct Coding Initiative Policy Manual.

The second kind of NCCI edits, named "mutually exclusive edits," defines code pairs that will not practically be conducted at the same session along with anatomic location for the similar patient. As per the Correct Coding Initiative Policy Manual clarifies, "An instance of a mutually exclusive condition is the repair of an organ that can be carried out by two dissimilar methods. Merely one method can be selected to repair the organ. A second instance is a service that can be reported either as an ‘initial' service or a ‘subsequent' service. With the exclusion of drug administration services, the initial service along with subsequent service should not be reported at the same patient encounter."

You'll certainly want to ensure that you always refer to the most current version of NCCI when checking for code bundles. CMS updates the NCCI each quarter and posts the broad list of NCCI edits as a free download. You also may buy a subscription to NCCI, in either an electronic or a paper format, from National Technical Information Service (NTIS).

The above NCCI information is brought to you by SuperCoder.com. Log on to supercoder.com for more accurate and profitable expert medical coding and billing advice.

ICD-9 2012: 173.xx Leads List of ICD-9 Updates

2011-11-24T00:41:00.000-08:00

With the subsequent round of revisions, ICD-9 might provide a chance to report skin neoplasm types more precisely.

Though the complete list of suggested ICD-9 updates is fairly short, a number of these are applicable to your oncology and hematology claims. Here are the main proposals to watch for when the codes are finalized in the fall.

Get Precise About Basal and Squamous Cell

CMS's recommended changes to ICD-9 2012 comprise of an expansion of 173.x (Other malignant neoplasm of skin). Every code in that series will get novel fifth digit options, which will deliver added details of the skin neoplasm type.

The modifications in the 173.xx skin cancer codes have a pattern where the fifth digit of "0" discusses about an indefinite malignant neoplasm, "1" signifies basal cell cancer (BCC), "2" denotes squamous cell carcinoma (SCC), and "9" defines "other" definite malignant neoplasm. BCC and SCC are the two most general types of skin cancer.

The ICD-9 Coordination and Maintenance Committee extended the code series resulting from a request from the New York State Cancer Registry to help differentiate reportable skin cancers from non-reportable skin cancers, for instance BCC and SCC. The way these general neoplasms behave clinically is dissimilar enough that separating them would be beneficial.

Caution: The expansion implies that the four-digit 173.x codes become invalid in October as each code in the range will want a fifth digit to be complete. Getting ready for the new and revised ICD-9 code modifications needs you to create better documentation habits.

Not only will refining documentation let you code these situations more precisely, but it will also help prepare you for ICD-10's overall increase in documentation requirements

Acquired Hemophilia Gets Its Own Code

You also must plan for ICD-9 2012 to increase existing four-digit code 286.5 (Hemorrhagic disorder due to intrinsic circulating anticoagulants) into a novel range of five-digit codes:

286.52, i.e. Acquired hemophilia

286.53, i.e. Antiphospholipid antibody including hemorrhagic disorder

286.59, i.e. Added hemorrhagic disorder because of intrinsic circulating anticoagulants, antibodies, or inhibitors.

The changes agree to more precise identification and will help monitor "trials on the cause, self-correction, along with pharmaceutical treatment of these disease categories of haemophilia.

Terms you may see associated with 286.52 involve autoimmune hemophilia, autoimmune inhibitors to clotting factors, as well as secondary hemophilia. Code 286.53 might be used most frequently to report the hemorrhagic disorder with an antibody called lupus anticoagulant or systemic lupus erythematosus.

Update Your Anaphylaxis Terminology

In case you require coding anaphylactic or serum reactions under ICD9 2012, ensure that you must check the index. A range of new codes will shift the options you may be used to.

The above expert ICD-9 insight is brought to you by SuperCoder.com. Click here to read the entire article and have more accurate and profitable expert medical coding and billing advice: http://www.supercoder.com/category/articles/articles-alerts/onc/?select_month=07&select_year=00

Simplify CABG Coding With These Expert Tips

2011-11-22T23:15:00.000-08:00

Surgeon's documentation also helps boost your coding accuracy.

While coding for anesthesia during coronary artery bypass graft (CABG) procedures, aspects like the patient's age and whether physicians' usage of specialized equipment while carrying out surgery can affect your reporting.

Do Examine the Code Choices

CPT® includes three anesthesia codes during CABG procedures:

00562 – i.e. Anesthesia carried out for procedures on heart, pericardial sac, along with great vessels of chest; including pump oxygenator, with age 1 year or older, meant for all non-coronary bypass procedures (for instance valve procedures) or for carrying out re-operation for coronary bypass more than 1 month after original operation

00566 -- i.e. Anesthesia carried out for direct coronary artery bypass grafting; excluding pump oxygenator

00567 -- i.e. Anesthesia for direct coronary artery bypass grafting; including pump oxygenator.

The associated base units differ according to the procedure. Code 00562 carries 20 base units, code 00566 carries 25 base units, and code 00567 carries 18 base units.

Do Watch for Pump Documentation

The first question you are required to answer when coding anesthesia during CABG is whether the anesthesiologist carried out the use of a pump oxygenator during the procedure.

Definitions: A case is deliberated "on pump" once the physician uses a pump oxygenator to stop the patient's heart and lungs during surgery. An "off pump" case takes place when the surgeon carries out the operation on the patient's still-beating heart.

The physician should document ‘off pump' prior to you can report the anesthesia codes that have higher base unit values. It can be worth almost $85 more for a normal Medicare case, but you must ensure that your anesthesiologist has rightfully earned it before you code it.

Don't Always Add Qualifying Circumstances

Some payers permit coders to report "qualifying circumstances" anesthesia codes that clarify features of the patient's situation that made the anesthesiologist's work complicated. Three of these anesthesia codes might apply to cardiovascular cases:

99100 – i.e. Anesthesia meant for patient of extreme age, for patients younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure)

99116 -- i.e. Anesthesia which is complicated by utilization of entire body hypothermia (List separately in addition to code for primary anesthesia procedure)

99135 -- i.e. Anesthesia which is complicated by utilization of controlled hypotension (List separately in addition to code for primary anesthesia procedure).

Don't automatically include these anesthesia codes with all CABG procedures.

Do Look for Notes That Add Units

Go through your anesthesiologist's notes and the operative report sensibly, as documentation can occasionally justify extra base units.

For instance, in case the surgeon sews a graft in an off -pump procedure, the anesthesiologist is due one additional unit owing to the increased risk. You can also shift from 18 base units with 00567 to 20 base units with 00562 in case the CABG procedure involves another heart procedure for instance valve placement or in case the patient is having a re-do CABG more than one month post an original CABG surgery.

The above anesthesia coding information is brought to you by SuperCoder.com. Click here to read the whole article and for more expert medical coding and billing guidance, news and information http://www.supercoder.com/articles/articles-alerts/aca/cardiac-anesthesia-clarify-cabg-coding-with-4-dos-and-donts-108338/

ICD-9 to ICD-10 Conversion: Simplify Pain Dx: Get Confident on G89

2011-11-22T23:13:00.000-08:00

Go for site specific codes and involve psychological factors.

You must be careful while reporting the codes that come from the G89 category. These particular codes are never allocated in case the definitive diagnosis is recognized. The lone exception is when the purpose for the encounter is mainly pain control and not the management of the original condition per se. See the examples listed below for neurosurgery applications you might face in the ICD-9 to ICD-10 conversion:

1) In case the neurosurgeon implants a neurostimulator for control of pain, you then report the pain code as the major or firstlisted diagnosis.

2) In case the patient comes to the neurosurgeon for management of pain post a displaced intervertebral disc, you report G89 code and the primary condition can be reported as an added diagnosis.

3) In case the patient reports to the neurosurgeon for spinal fusion, you, then, do not report the G89 category code. In its place, you report the chief diagnosis; like the spinal stenosis or a vertebral fracture.

G89 Should Be Combined with Site-Specific Pain Codes

When ICD-9 to ICD-10 transition takes place, you can use the G89 category code together with codes that explain the site of pain. You arrange the two codes according to the conditions.

Example: In case a patient withstands an acute neck injury in an accident and your neurosurgeon offers treatment for pain, you assign code G89.11 (Acute pain due to trauma) and you also report M54.2 (Cervicalgia) to explain the site of pain. Though, in case your neurosurgeon is treating the patient for a different reason, then you assign the G89 code only as a secondary diagnosis.

Note the One-To-One Match

ICD-10 includes a one-to-one match for numerous pain codes in ICD- 9. Below are the selections you will have once ICD-9 to ICD-10 transition goes into effect in October 2013.

Distinguish Postoperative vs. Postprocedure

In ICD-9, you have 338.18 (Other acute postoperative pain) which matches to G89.18 (Other acute postprocedural pain) in ICD-10. Likewise, 338.28 (Other chronic postoperative pain) matches up to G89.28 (Other chronic postprocedural pain) in ICD-10. There is a modification from ‘postoperative' to ‘postprocedure' in these pairs. G89.18 includes both postoperative pain NOS along with postprocedural pain NOS. The presence of postprocedure pain recognizes those conditions where a procedure for instance lumbar puncture or further percutaneous treatment leads to acute or chronic pain.

Involve Psychological Factors

Pain is essentially an emotional experience. There may be an additional psychological component which you are not supposed to miss. When ICD-9 to ICD-10 transition take place, the ICD-10 code for the psychological factors is F45.42 (Pain disorder with related psychological factors) which matches to 307.89 (Other, pain disorder related to psychological factors) in ICD-9. Ensure that you have backup documents for the psychological factors.

The above ICD-9 to ICD-10 transition information is brought to you by SuperCoder.com. Click here to read the whole article and for more expert medical coding and billing guidance, news and information http://www.supercoder.com/articles/articles-alerts/nec/icd-10-made-easy-take-the-pain-out-of-pain-dx-get-confident-on-g89-107633

ICD-9-CM: Master the Changes in Respiratory Conditions

2011-11-21T00:17:00.000-08:00

Don't reports 488.12 until physician approves H1N1 influenza.

If you're intimidated by the thought of arranging through all the diagnostic coding modifications that went into effect on Oct. 1, 2011, you shouldn't worry more. Get the insider's info with this rundown on some of the novel respiratory system diagnosis codes.

Quick reference: You should always check the diagnoses index along with the tabular list for selection of the suitable codes to include on your encounter form.

New Novel Influenza Code Amendments

With this condition frequently developing new forms, ICD-9-CM has made modifications to new influenza codes for three years in line.

A novel subcategory 488.8 (Influenza owing to novel influenza A) along with related codes have been created in order to report Novel influenza A. They are:

488.81 -- Influenza because of identified novel influenza A virus including pneumonia

488.82 -- Influenza because of identified novel influenza A virus with added respiratory manifestations

488.89 -- Influenza because of identified novel influenza A virus with added manifestations.

Definition: Novel influenza comprises all human infections along with influenza A viruses which are novel or dissimilar from presently circulating human influenza viruses. These involve viruses which are subtyped as nonhuman in beginning, and those that cannot be subtyped with standard laboratory methods.

Providers frequently denote the 2009 pandemic influenza as 2009 H1N1 influenza instead of novel H1N1 influenza, consequently ICD-9-CM has reviewed the following listed codes, with earlier references to "novel" in their descriptors to change to "2009." The codes involve:

488.11 -- i.e. Influenza because of identified 2009 H1N1 influenza virus with pneumonia

488.12 -- i.e. Influenza because of identified 2009 H1N1 influenza virus with other respiratory manifestations

488.19 –- i.e. Influenza because of identified 2009 H1N1 influenza virus with other manifestations.

Change To 512.2 When You Report Postoperative Air Leaks

ICD-9-CM has applied revisions along with novel codes through Category 512 to distinguish air leaks from pneumothorax. This classification is currently labeled pneumothorax along with air leaks.

New code: You can at the present report postoperative air leaks with 512.2 (Postoperative air leak). You earlier reported this condition using code 512.1 (Iatrogenic pneumothorax), which was deceptive since a patient can go through a postoperative air leak devoid of significant air in the pleural space leading to pneumothorax. ICD-9-CM prevents reporting 512.1 or 512.2 without the physician documentation precisely specifies postoperative or owing to a procedure.

ICD-9-CM states that, though, patients might also have an insistent air leak which is not postoperative, for instance when a chest tube has been positioned for a spontaneous pneumothorax along with the lung re-expands however the air leak continues. Spontaneous pneumothorax might be primary or secondary and associated with numerous other conditions for instance cystic fibrosis, spontaneous rupture of the esophagus, lung cancer, etc.

The above ICD-9-CM expert guidance is brought to you by SuperCoder.com. Click here to read the whole article and get more expert medical coding and billing guidance: http://www.supercoder.com/articles/articles-alerts/puc/diagnosis-code-update-icd-9-cm-take-a-sneak-peek-on-changes-in-3-respiratory-conditions-108566/

Flu, BMI, Jaw Pain Diagnosis Codes Are More Direct

2011-11-21T00:14:00.000-08:00

Think through: Where do BMI codes exist in pulmonology?

Proficient billing is not only about getting your CPTs right. You are required to have an in-depth knowledge and use of modifiers as well as diagnosis codes prior to you can come full circle on competent billing and reimbursement.

While latest additions on influenza ICD-9 codes seem to be confusing, it's not what it seems to be. Catch up with these newest flu codes, together with some other pulmonology-related diagnosis codes with these beneficial tips.

Choose From 6 Extra Flu Codes

As the introduction of six new ICD-9 codes on influenza in October 2010, you should have been using the more detailed codes in the 488.0x (Influenza due to identified avian influenza virus) as well as 488.1x (Influenza due to identified novel H1N1 influenza virus) subcategories.

In case you used to satisfy yourself with the old code category 487 (Influenza) which didn't deliver the detail you required for more kinds of the flu, now you must be using six new ICD-9 codes growing from the 488.0 and 488.1 subcategories:

488.01: i.e. Influenza owing to identified avian influenza virus including pneumonia

488.02: i.e. Influenza owing to identified avian influenza virus including further respiratory manifestations

488.09: i.e. Influenza owing to identified avian influenza virus including further manifestations

488.11: Influenza owing to identified novel H1N1 influenza virus including pneumonia

488.12: i.e. Influenza owing to identified novel H1N1 influenza virus including further respiratory manifestations

488.19: i.e. Influenza owing to identified novel H1N1 influenza virus including further manifestations.

Remember: With 487.0 (Influenza with pneumonia), when you code 488.01 or 488.11, you should be using an added code to categorize the type of pneumonia (480.0-480.9, 481, 482.0-482.9, 483.0-483.8, 485)

Caveat: You must not use one of these new ICD9 codes except the cause of the pneumonia is established. Influenza symptoms may rest on which virus lead to the infection however regularly is alike those connected with seasonal influenza. Laboratory tests can be carried out to approve influenza infection. Prescription antiviral drugs confirmed for influenza (based on seasonal outbreak data) may be of some advantage in treating avian or H1N1 flu infection.

Search for Jaw Pain Codes

How are you presently addressing to report a patient's jaw pain? You must be coding 784.92 (Jaw pain) to define this symptom.

Jaw pain may be an indication of a pulmonary embolism (415.19), or additional conditions not related with TMJ. ICD-9 code 784.92 was created to categorize the patient, and validate the essential testing/evaluation for patients who come with this complaint.

The above ICD-9 codes expert guidance is brought to you by SuperCoder.com. Click here to read the whole article and get more expert medical coding and billing guidance: http://www.supercoder.com/articles/articles-alerts/puc/icd-9-coding-flu-bmi-jaw-pain-diagnosis-codes-become-more-straightforward-106140/

Two Novel Paracentesis Codes For 2012

2011-11-18T00:53:00.000-08:00

CPT obliterates intraperitoneal catheter insertion code.

Do you know what CPT changes will have an influence on your gastroenterology practice in 2012? Here's a clue: a couple of peritoneocentesis CPT codes will be absent in your CPT manual. You need to be ready to report new CPT codes as substitutes.

Substitute Old Peritoneocentesis CPT Codes With Three Novel Ones

The change will remove 49080 (Peritoneocentesis, abdominal paracentesis, or peritoneal lavage [diagnostic or therapeutic]; initial) along with 49081 (…subsequent), and will substitute them with three new CPT codes:

49082 –- i.e. Abdominal paracentesis (diagnostic or therapeutic); excluding imaging guidance

49083 -- i.e ....including imaging device

49084 -- i.e. Peritoneal lavage, including imaging guidance, when carried out.

When fluid between abdominal structures in the abdomen gathers, the physician may carry out abdominal paracentesis. CPT 49082 defines the procedure in which a needle is used to take away a sample of fluid or to drain fluid that has gathered. This procedure should be carried out excluding image guidance (49083 describes image-guided diagnosis or therapy).

CPT manual instructs not to report 49083 in combination with 76942, 77002, 77012, and 77021 because these radiologic codes define the possible imaging devices that your physician can use to help with assistance of the paracentesis needle and the services are involved within code 49083.

Meanwhile, a physician carries out 49084 to define the presence or absence of internal bleeding in the abdomen. Injury to the abdomen can be initiated by blunt forces as well as penetrating objects. The physician performs the test by inserting a long, flexible plastic tube in the abdomen over a small incision in line to the belly button. After that he places fluid into the abdominal cavity over the tube and does away with it through the tube for examination. The procedure may involve the use of image guidance.

Get ready For Category III Code 0288T

A novel Category III code on anoscopy will get introduced in 2012: 0288T (Anascopy with radio frequency delivery). This code defines an examination of the rectum wherein the physician inserts a small tube into the anus to screen, diagnose, and assess problems of the anus as well as anal canal. The physician then applies radio frequency energy delivery to close or ablate diverse abnormalities in the rectal area.

Revive Your Deleted Code List To Involve 78220-78223

Further gastroenterology-related CPT codes changes that will take place in 2012 involve the deletion of codes:

49420 – i.e. Inclusion of intraperitoneal cannula or insertion of catheter meant for drainage or dialysis; temporary

78220 -- i.e. Liver function study including hepatobiliary agents, along with serial images

78223 -- i.e. Hepatobiliary ductal system imaging, with gallbladder, including or excluding pharmacologic intervention, including or excluding quantitative measurement of gallbladder function

91012 -- i.e. Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study; including acid perfusion studies.

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Coding Nondefinitive Diagnoses Continue to be Your Prime Challenge

2011-11-18T00:51:00.000-08:00

All you require is to report signs as well as symptoms when diagnostics come back normal.

You consider that you may have aced most ICD-9 challenges, however do you aware with how to manage a diagnostic test which comes back without a final diagnosis? Once you make sure to convey to payers precisely what you found, you'll come out of these challenges. Here are guaranteed ways how to do that and the related ICD-9-CM guidelines.

Follow 3 Rules for Normal Diagnostics Results

Scenario 1: The gastroenterologist refers a patient to a radiologist for an abdominal CT scan (74150-74170) with an indication of abdominal pain (789.0). The CT scan, when read by the GI, discloses the occurrence of an abscess. Both the radiologist -- while reporting for the technical part of the CT scan, along with the gastroenterologist -- when reporting for the professional component of the same test, must report a diagnosis which is "intra-abdominal abscess" (567.22, Peritoneal abscess).

Challenge: What are you supposed to do in case the diagnostics came out normal?

Beware of three different rules:

Rule 1: ICD-9-CM guidelines state that in case the diagnostic test did not deliver a conclusive diagnosis or came out normal consequences, you must code the sign and symptom that encouraged the treating physician to order the study. Roughly, in the preceding scenario, the CT scan results came back minus any abnormal findings, at that time you would report the symptom 789.0 (Abdominal pain) in place of 567.22.

Rule 2: In case the diagnostic test was normal, however the referring physician accounts a suspected (a.k.a. probable, suspected, questionable, rule out, or working) diagnosis, you must not code the referring diagnosis. In its place, you must report the presenting signs and symptoms, according to ICD-9-CM guidelines.

Rule 3: In case the patient is getting only diagnostic services in the outpatient visit, you would list first the condition that is the chief reason for the visit on the claim. According to ICD-9-CM guidelines, this code must be your primary diagnosis. After that, code for further diagnoses (such as chronic conditions) on the following lines.

Tackle This Chronic Condition Scenario

Scenario 2: A patient already diagnosed with liver cancer came to the gastroenterologist for esophageal varices. On the first line of your claim, you would list 456.1 (Esophageal varices without bleeding) for the presenting problem (varices), and after that report 155.0 (Malignant neoplasm of liver primary) meant for the chronic disease (hepatocellular carcinoma).

Challenge: Are you supposed to report the chronic condition?

ICD-9-CM guidelines maintain that you should not code the chronic condition in case it is not related to the primary reason for the visit. For example, the liver cancer patient in Example 2 comes with dyspepsia, you should code only 536.8 (Dyspepsia and other specified disorders of function of stomach), and never 155.0.

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414.4 Lets You Get Precise About Calcified Coronary Lesions

2011-11-17T02:37:00.000-08:00

But 425.1 will take along instant denials

Don’t think that your ICD-9 2012 update lists final till you’ve studied these late additions for coronary atherosclerosis and hypertrophic cardiomyopathy.

Even though coders get information about ICD-9 changes each summer in CMS’s suggested Inpatient PPS rule, those specific changes aren’t the last word for updates. The codes below got effective Oct. 1, 2011.

414.4 Helps Identify Coronary Lesions

ICD-9 2012 adds 414.4 (Coronary atherosclerosis due to calcified coronary lesion).

The goal was to be able to differentiate a calcified lesion from other ischemic lesions. Calcified lesions are different as lipid rich plaque (414.3, Coronary atherosclerosis due to lipid rich plaque) as well as chronic total occlusions (414.2, Chronic total occlusion of coronary artery). And 414.8 (Other specified forms of chronic ischemic heart disease) is too common to identify the nature of the lesion.

Calcified lesions can be identified both by x-ray during coronary angiography along with intravascular ultrasound, and might be more challenging to treat than further coronary lesions. In case the physician is unable to cross the calcified lesion, he might have to stop the treatment and the patient may then need medical management or an extra invasive procedure.

Term tip: The code definition maintains calcified coronary lesion, however a note with the code explains that it is suitable when the physician documents coronary atherosclerosis owing to severely calcified coronary lesion.

"Severely" is a significant part of the diagnosis. However coders may not find the term "severely" in the documentation.

One more instruction with 414.4 informs you that you should code first coronary atherosclerosis (414.00-414.07). Consequently your first-listed code must specify the atherosclerosis (for instance 414.01, Coronary atherosclerosis of native coronary artery). After that report 414.4 in case the physician documents the situation is linked to a calcified coronary lesion.

425.1 Now Necessitates a 5th Digit

ICD-9 2012 offers novel coding selections for hypertrophic cardiomyopathy.

Reason: Hypertrophic cardiomyopathy can have two planes of demonstration, obstructive or nonobstructive. Whether or not it is obstructive can influence the requirement for dissimilar medical or surgical treatments.

2011: In ICD9 2011 , 425.1 was a binding code defined as "Hypertrophic obstructive cardiomyopathy." In case you required reporting nonobstructive hypertrophic cardiomyopathy, you reported 425.4 (Other primary cardiomyopathies).

2012: The update reviews 425.1 (now defined as Hypertrophic cardiomyopathy) so that it is no longer a valid code -- you should add a fifth digit for it to be valid:

425.11, Hypertrophic obstructive cardiomyopathy Hypertrophic subaortic stenosis (idiopathic)

425.18, further hypertrophic cardiomyopathy Nonobstructive hypertrophic cardiomyopathy.

The changes offer you one code meant for hypertrophic obstructive (425.11) and then the other code meant for other hypertrophic, containing nonobstructive (425.18). To follow with the changes to the 425.1x range, ICD-9 erases the terms "hypertrophic" and "nonobstructive" from under 425.4.

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Ace Your HTN Coding

2011-11-17T02:36:00.000-08:00

Keep these strategies on assumptions, renal disease, and heart disease within reach.

Hypertension (HTN) is rising -- possibly a third of the U.S. population is at present affected. That implies that if your HTN coding skills aren’t top notch, a lot of your claims are at danger of errors.

For a compliant coding, apply these rules based on the ICD-9 official guidelines and know what ICD-9 codes you should choose.

1: ICD-9 Has a Hypertension Table; Use It

Coding HTN diagnoses can be challenging, however the Hypertension Table, listed in the ICD-9 index entry "Hypertension," helps streamline your search.

The table demonstrates not just the basic 401.x (Essential hypertension) ICD-9 codes, but also the ICD-9 codes for situations owing to or linked with HTN. Furthermore, the table helps explain when your code choices differ for malignant, benign, or unspecified conditions. After you’ve found the code in the index, don’t forget to check it in the tabular list.

2: Documentation Determines 401.x 4th Digit

ICD-9 official guidelines propose an important rule for compliant HTN coding. While reporting ICD-9 codes from 401.x, you should select a fourth digit to complete the code: "malignant (.0), benign (.1), or unspecified (.9). You should not use either .0 malignant or .1 benign without medical record documentation supporting such a designation.

3: ‘Hypertensive’ Supports 402.x Use

When a patient is going through HTN and heart disease, knowing whether the HTN resulted in the heart condition is vital to proper coding.

Look to find whether the patient has a situation defined under heart disease ICD-9 codes 425.8, 429.0-429.3, 429.8, and 429.9, official guidelines maintain. Moreover scrutinize the documentation for a stated or implied underlying relationship to HTN (for example, "due to HTN" or "hypertensive heart disease"). You should never suppose that the HTN resulted in the heart disease.

4: Assume HTN and CKD Are Connected

In direct contrast to the rules for coding HTN as well as heart disease, ICD-9 does assume a fundamental relationship between HTN and chronic kidney disease (CKD).

Translation: In case documentation demonstrates that a patient has HTN and a condition that falls under 585.x (Chronic renal failure) or 587 (Renal sclerosis unspecified), then you must report a code from 403.x (Hypertensive renal disease), even though there’s no sign that one lead to the other. You also should report the pertinent 585.x code to specify the CKD stage.

5: Unclutter Coding for Hypertensive Heart and CKD

A particular code from 404.xx (Hypertensive heart and renal disease) specifies that the patient has hypertensive heart disease along with hypertensive CKD. You again should presume a relationship between the HTN and CKD.

Crucial: When the patient is going through hypertensive heart disease and CKD, you must select a code from 404.xx. You must not report 402.x (hypertensive heart disease) along with 403.x (hypertensive CKD).

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704.4x, 286.5x: Get Precise With Cyst, Hemorrhagic Disorder Coding

2011-11-17T02:33:00.000-08:00

Besides, 999.4x alters 'shock' to 'reaction.'

If, at all, your lab bills transfusion medicine services or pathology exams meant for some particular cysts, or blood tests meant for hemorrhagic disorders, this article will help you get your 2012 ICD-9 coding in control.

The proposed codes took effect on Oct. 1, and establish the last full set of ICD-9 changes prior to the shift to ICD-10 diagnosis coding on Oct. 1, 2013.

Be Familiar with Cyst Differences

ICD-9 2012 presents a couple of novel codes meant for common hair-follicle cysts -- 704.41 (Pilar cyst) and 704.42 (Trichilemmal cyst). Pilar cysts are frequently mistaken with sebaceous cysts even though they have distinct characteristics.

Such as: Pilar cysts form by means of keratinizing epithelium related with a hair follicle. These cysts don't have a granular layer, which is distinctive of sebaceous cysts.

The ICD-9 update adds an "excludes" statement for novel codes 704.41 along with 704.42 under 706.2 (Sebaceous cyst).

Clarify Serum Reactions with New 999 Codes

If you particularly ever bill transfusion medicine codes (86850-86999), you can't afford to oversee ICD-9 revisions that will transform how you code serum reactions. The code update will nullify 999.4 (Anaphylactic shock due to serum) as well as 999.5 (Other serum reaction, not elsewhere classified) and substitute them with the following listed new codes:

999.41 –- i.e. Anaphylactic reaction because of administration of blood as well as blood products

999.42 -- i.e. vaccination

999.49 -- i.e. other serum

999.51 -- i.e. Other serum reaction because of administration of blood as well as blood products

999.52 -- i.e. vaccination

999.59 -- i.e. Other serum reaction

New ICD-9-CM codes 999.41 as well as 999.42 will help differentiate anaphylaxis because of transfusion or vaccination, such as; ICD-9 2012 offers similar differences in new codes 999.5x.

The novel codes will improve the accuracy of recording transfusion related adverse reactions and improve the ability to perform active surveillance of transfusion safety.

Shock too narrow: An anaphylactic reaction is a type of allergic hypersensitivity leading to symptoms for instance hives, wheezing, as well as perhaps a drop in blood pressure, which is anaphylactic shock. ICD-9 has used the term anaphylactic shock to involve all anaphylactic reactions in the past, which lead to some mix-up among clinicians. That's why ICD-9 2012 changes the terminology for 999.4x as well as other codes for instance 995.0 (Other anaphylactic reaction) from "anaphylactic shock" to the wider term, "anaphylactic reaction."

Labs will also have advantage from a novel "V" code that will assist your anaphylaxis coding with V13.81 (Personal history of anaphylaxis).

The above ICD-9 information is brought to you by SuperCoder.com. Click here to read the whole article and get more expert coding guidance: http://www.supercoder.com/articles/articles-alerts/pac/icd-9-2012-704.4x-286.5x-get-specific-with-cyst-hemorrhagic-disorder-coding-107697/