Tuesday, November 15, 2011

Rewarding H-Reflex Test Coding

Start by marking a difference from F-wave studies.

You might flip Appendix J of the CPT® manual most frequently to review the most number of nerve conduction studies you normally report for definite indications. Don't ignore the next column that addresses H-reflex (or Hoffmann's reflex) studies, though, as these tests have definite considerations to keep in mind while side-stepping denials. Read this neurology billing and coding expert insight on what neurology CPT codes you should use to ensure flawless split night claims.

1. Study Difference Between Tests

H-reflex along with F-wave studies both test the patient's late response reflex and evaluate the whole length of a nerve, but in dissimilar ways. F-waves evaluate motor nerve fiber function along a nerve and are typically conducted grouped with conventional motor nerve conduction studies. H-reflex studies, though, include both the sensory as well as motor nerve fibers as well as test both connections in the spinal cord.

Tip: Your physician's report should classify the nerves assessed with the site of nerve stimulation as well as muscle recording, along with the test characteristics, involving latency. Looking at notations of the tested nerves in your neurologist's documentation will help you decide when you should code for an H-reflex study in place of an F-wave study.

2. Verify Muscle Tested to Determine Code

Once you've decided that you're coding for an H-reflex study, CPT® covers two self-explanatory neurology CPT codes meant for the procedure:




  • 95934 -- H-reflex, amplitude and latency study; record gastrocnemius/soleus muscle






  • 95936 -- Record muscle other than gastrocnemius/soleus muscle.


  • If you know that the muscle your neurologist tests is the significant to selecting accurate neurology CPT codes.
    H-reflex studies generally include assessment of the gastrocnemius/soleus muscle complex in the calf. In rare occurrences, H-reflexes require to be tested in muscles except the gastrocnemius/soleus muscle, for instance in the upper limbs or the intrinsic small muscles located in the hand and foot."

    Result: A lot of of your reporting for H-reflex studies will involve 95934 as physicians test the gastrocnemius/soleus muscle complex more regularly than rest of the areas. Validate documentation, though, prior to automatically allocating 95934 for every H-reflex study.

    3. Correct Diagnoses

    H-reflex studies are very general for the lower extremities, predominantly when the patient goes through radicular pain. The late response studies are regularly used in the evaluation of radiculopathies, plexopathies, polyneuropathies as well as proximal mononeuropathies. In few cases, these studies might be the lone abnormal diagnostic test.

    4. Look Out for Modifier Opportunities

    The neurology CPT codes for H-reflex studies undertake unilateral procedures, however don't stop with a single code.

    H-reflex studies are generally carried out bilaterally as symmetry of responses is an essential standard for abnormality. Bilateral studies are specified when an abnormal response is seen in a unilaterally symptomatic limb or when there is a problem that the response may possibly be abnormal for causes except pathology, for instance advanced age.

    Want to have more neurology billing and coding expert tips and know everything about neurology CPT codes? Click here to read the entire article and to get access to our monthly Neurology & Pain Management Coding Alert: Your practical adviser for ethically optimizing coding, payment, and efficiency in neurology and pain management practice

    Friday, November 11, 2011

    \Should Assistant Surgeon Billing Each time Match Lead Surgeon's?

    Read on the following medical billing question and the expert answer.

    Question: You work in a general and laparoscopic surgeon's office. Once he helps other surgeons you get the medical billing information from the other surgeon's coders to bill as the assist.

    Occasionally there is inappropriate medical billing relating to the CPT codes as well as ICD-9 codes billed, as per the documentation from the operative report. There is contact made to have them prove and correct, but it is not always followed through with by the lead surgeon's office.

    In effort to get the claim submitted in a timely matter you have submitted the claimyou're your doctor as the assist. You have done it in two methods: 1) submitted as billed by the lead surgeon, making notes on the explanation for the errors/problems and 2) submitting the claim with the precise medical billing information.

    What is the correct way to handle this problem?

    Answer: You must never deliberately send in the wrong codes just to get paid. That is a clear coding and compliance violation.

    Your practice of calling the other surgeon's coder and trying to clarify why you will be submitting not the same coding is a good start. In case they don't agree or follow through with the proper coding, though, you must still submit the codes you consider are accurate.

    Tip: Send an email to the lead surgeon's practice clarifying the codes you will be submitting and the reason why you are submitting these codes. This makes certain you have your contact with the other coder in writing, and demonstrates you informed them that you planned to submit distinct codes.

    You won't probably know what the other surgeon ends up submitting or if they get paid -- but it's not really your area of concern. Given that you are compliant and getting in the reimbursement your surgeon deserves, you're performing your job properly.

    Warning: Getting paid might be a bit more challenging when the other surgeon is submitting different codes. You might require appealing a denial that comes from the surgeons submitting dissimilar codes, however in the appeal process if your coding is precise you should get paid.

    Bottom line: You should all the times code appropriately and avoid knowledgeably submitting an improper claim just to match the other surgeon's medical billing. In case you think about it, when there is an assistant surgeon, there are three sets of codes the payer gets: the primary surgeon, the assistant surgeon, and the facility as well as not all three are always in sync. Facilities and surgeons don't talk over the coding and work collectively to ensure they have the same result. Each individually codes the case. Why shouldn't the assistant surgeon carry out the same, particularly if they already have a highly qualified coder.

    Get more medical coding and billing tips like these. Click here to read get access to our monthly Medical Office Billing & Collections Alert newsletter: Your practical adviser for ethically optimizing billing and collections for your medical practice.

    Tuesday, November 8, 2011

    Be Cautious Before Reporting Neonatal Hypothermia During Heart Procedures

    Latest CCI edits have a say on hypothermia

    In case your anesthesiologist carries out controlled hypothermia in neonatal heart surgery cases, you must only report the anesthesia code, and never the "T" code as far as hypothermia is concerned. The latest Correct Coding Initiative (CCI) edits brought changes in the hypothermia(plus edits related to injection procedures). Read on this expert anesthesia coding and billing advice for cleaner claims.

    Anesthesia Outweighs Hypothermia

    Every single edit pair linked to anesthesia concentrates on codes 0260T (Total body systemic hypothermia, per day, in the neonate 28 days of age or younger) as well as 0261T (Selective head hypothermia, per day, in the neonate 28 days of age or younger).

    The edits associated with 0260T and 0261T use the description "Misuse of column two code with column one code." CCI 17.2 specifies that you should not report neonatal hypothermia codes using the cardiac anesthesia codes:



  • 00560 -– i.e. Anesthesia used for procedures on heart, pericardial sac, as well as great vessels of chest; excluding pump oxygenator





  • 00561 -- i.e Anesthesia used for procedures on heart, pericardial sac, as well as great vessels of chest; including pump oxygenator, younger than 1 year of age





  • 00562 -- i.e Anesthesia used for procedures on heart, pericardial sac, as well as great vessels of chest; including pump oxygenator, age 1 year or older, meant for all non-coronary bypass procedures (for instance., valve procedures) or for re-operation for coronary bypass more than 1 month following original operation





  • 00563 -- i.e Anesthesia used for procedures on heart, pericardial sac, as well as great vessels of chest; including pump oxygenator by means of hypothermic circulatory arrest





  • 00566 -- i.e Anesthesia used for direct coronary artery bypass grafting; excluding pump oxygenator





  • 00567 -- i.e Anesthesia used for direct coronary artery bypass grafting; including pump oxygenator





  • 00580 -- i.e Anesthesia used for heart transplant or heart/lung transplant.


  • Note: CPT® consists of a qualifying circumstances code you can occasionally report once your anesthesiologist treats patients of extreme age: +99100 (Anesthesia for patient of extreme age, younger than 1 year and older than 70 [List separately in addition to code for primary anesthesia procedure]). For anesthesia coding, never use +99100 in combination with codes that specify patient ages, though, such as 00561.
    Caution: Cardiac anesthesia codes that are not age specific and do not specify that the service involves hypothermia might be qualified for circumstances codes.

    Plus: Each of the hypothermia edits has a modifier indicator of 1, implying you can use a modifier to isolate these bundles when both services were medically essential and conducted as separate procedures. Look out for notations in the patient record maintaining that anesthesia was complex by utilization of total body hypothermia or a description of the procedure used to lower the patient's body temperature lower than 35C/95F.

    Want to get more expert advice like this for perfect anesthesia coding and billing ? Click here to the entire read article and to get access to our monthly anesthesia Coding Alert newsletter: Your practical adviser for ethically optimizing anesthesia billing and coding, payment, and efficiency for anesthesia practices

    Cardiology Coding: Tips to boost +92973

    Cardiology coding involves a lot of difficult-to-sail-past challenges. For instance, if you have been using coronary thrombectomy code +92973 to report a variety of methods, you need to take note of. Thrombectomy by aspiration catheter is included in the intervention. +92973

    For years, many resources have based their coding recommendations on the plain face of the definition of +92973. If you read the descriptor, you will find that it does not specify anything apart from 'Percutaneous transluminal coronary thrombectomy.

    As a consequence, a common recommendation has been that you use +92973 for a number of methods used to remove thrombus, including both fragmentation and aspiration catheters.

    Cardiology information: A number of firms sought clarification from the AMA about the right way to go about coding for +92973. Recently the firms have reported individually that the AMA's response has been to aid the information in the ACC/AMA publication: +92973 is not proper for thrombectomy by aspiration catheter.

    The reported AMA responses also indicate that non-mechanical coronary thrombectomy is included in any other intervention performed. As per that interpretation, "thrombectomies performed with aspiration devices such as Pronto and Fetch are included in the intervention and not separately reportable.

    There are confusions still. Many coders say they want to see clearer guidance for +92973 in the CPT® manual as well as published guidance from CMS to settle the issue as it could involve changing practice policy on these services. According to some industry experts, until CMS issues guidance, practices should code the service constantly across the board. To put it in other words, the recommendation is that in the absence of written guidance, you should not code in a different way for different payers.

    Tips to boost +92973 accuracy

    When your documentation does support reporting +92973, don't report it as a stand-alone code. It's an add-on code and must accompany either 92980 or 92982.

    Bust these Common Modifier 24 Myths

    Medical Billing Tip: Know your payer's policies on billing complication treatment.

    To ensure payment for E/M services that your physician carries out within the global period of a surgical procedure, you should know the particulars of modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period). Read on for expert medical billing tip.

    Let our medical coding and billing experts tell you how to tackle these three modifier 24 myths to make certain that you're submitting clean, successful claims.

    You Can Never Use Modifier 24 For Compliation-Related Services

    While you report postoperative services to payers that follow CPT guidelines, you'll require appending modifier 24 to the E/M code in order to show that the service took place during the surgery's global period.

    Example: In case a patient is going through abdominal surgery and returns to your office with a postoperative wound infection along the suture line, you might be able to collect from private payers for an established patient visit as well as for the physician's treatment of the infection.

    Our medical coding and billing experts maintain that in case the physician carries out the treatment o the infection in his office, you may be able to file a claim with the help of modifier 24 to those payers following CPT guidelines.

    Pointer: Complications of surgery can be distinct and billable in certain cases, except the payer is following Medicare rules. Medicare disallows post-operative complications (hematoma, seroma, infection, etc) to be reimbursed except there is a requirement to return to the operating room. At that point, a separate modifier comes into play.

    There Should Be a New Diagnosis If You Use Modifier 24

    Though a different ICD-9 diagnostic code might specify that the E/M service carried out in a global period was not linked to the surgery, you do not have to have different diagnoses to append modifier 24 and to obtain payment for those services.

    According to medical billing experts, it is not essential that the two services have a dissimilar diagnosis but it should be well specified that the service is carried out to discuss results, prognosis as well as treatment options and that any work done related to the surgery (change bandages, check wound, etc.) is not used to support the level of service billed.

    You Should Never Use Modifiers 24 and 25 Together

    You may catch yourself in situations where you require to combine the forces of modifiers 24 and 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) in order to avoid a denial of a claim.

    To ensure clean medical coding and billing claims , you can use 24 as well as 25 on the same claim, in case you are seeing a patient for an entirely new issue in the post op period, a procedure was carried out that same day, and the E/M code is important and distinctly identifiable from the procedure

    Medical Billing Tip: You should always use the postoperative modifier (24) first, before you use other modifiers. Most computers sequence their edits, putting the postoperative period edits as the primary edit.

    Wednesday, November 2, 2011

    Cardiology Coding Alert: 3224-93227 Take on Extra Jobs to Make Up for Code Deletions

    12, 24, and 48 hour services all play a part in this coding shake-up.

    Cardiology codes keep on changing, trying to keep pace with technology and existing practice. That's why; Holter monitor codes saw big changes this year. Read this article and get an expert cardiology coding insight on what you should know.

    Dynamic electrocardiography (ECG), also termed as Holter monitoring, includes ECG recording, generally over 24 hours. The objective is to get hold of and analyze a record of the patient's ECG activity all through a typical day.

    The medical record generally will include the reason for the test, also the copies of ECG strips depicting abnormalities or symptomatic episodes, the patient's diary of symptoms, statistics meant for abnormal episodes, the physician's interpretation, as well as documentation of recording times.

    Be Aware of Your Newly Reduced Cardiology Coding Options

    In 2010, you selected among the following code series for these services:




  • 93224-93227, i.e. Wearable electrocardiographic rhythm derived monitoring for a period of 24 hours by incessant original waveform recording as well as storage, including visual superimposition scanning






  • 93230-93233, i.e. Wearable electrocardiographic rhythm derived monitoring for a period of 24 hours by incessant original waveform recording and storage excluding superimposition scanning utilizing a device able of producing a full miniaturized printout






  • 93235-93237, i.e. Wearable electrocardiographic rhythm derived monitoring for a period of 24 hours by incessant computerized monitoring as well as noncontinuous recording, as well as real-time data analysis using a device able of producing discontinuous full-sized waveform tracings, possibly patient activated

  • In 2011, your coding options have certainly changed. A new note in 93229 informs you that "93230-93237 have been deleted. In order to report external electrocardiographic rhythm derived monitoring for up to 48 hours, see 93224-93227."

    Result: The definitions of 93224-93227 now start with: "External electrocardiographic recording up toa period of 48 hours by incessant rhythm recording and storage " You can see yourself that one of the foremost changes to 93224-93227 is that they now on the record refer to "up to 48 hours" in place of "24 hours."

    Stay in the Comfort Zone

    Now that you got the broad outline, dive into the detailed services described by these codes, evaluating how to report 2010 and 2011 services.

    Earlier, in 2010, you were using 93224-93227 for services associated with specially trained technicians visually scanning patient waveforms created by the monitor. The technicians used to compare these waveforms to a normal waveform in order to identify discrepancies. Codes 93224-93227 varied depending on whether they represented the global service or dissimilar components of the service:




  • Global: i.e. 93224, consists of recording, scanning analysis including report, physician review as well as interpretation






  • Recording: i.e. 93225, recording (consists of hook-up, recording, as well as disconnection)






  • Scanning: i.e. 93226, scanning analysis including report






  • Interpretation: 93227, ... physician review as well as interpretation.

  • Thus, codes 93225-93227 stood for dissimilar components of the work related to the Holter monitor service. After your physician group furnished all three of these listed services, you reported 93224.

    Want to have more expert tips like this and latest cardiology billing and coding updates? Click here to read the entire article and to get access to our monthly Cardiology Coding Alert: Your practical adviser for ethically optimizing cardiology billing and coding, payment and efficiency in cardiology practices. With Cardiology Coding Alert, you get the updated cardiology -specific coding and Medical billing information delivered to you every month

    About the Editor: Deborah Dorton, JD, MA, CPC, CHONC, concentrates on radiology and Cardiology Coding and compliance- including the tricky world of interventional procedures - as well as oncology and hematology. Since joining The Coding Institute in 2004, she's also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more. Deborah received her Certified Professional Coder® (CPC™ certification from the American Academy of Professional Coders (AAPC) in 2004 and her Certified Hematology and Oncology Coder™ (CHONC™) credential in 2010.

    Cardiology Coding Alert: +92973 Debate Goes Up Around Aspiration Catheters

    New information lays emphasis on a 'mechanical' necessity for the thrombectomy code.

    In case you've been using coronary thrombectomy code +92973 for reporting a range of methods, pay attention. Thrombectomy by means of aspiration catheter is included in the intervention, as per the American Medical Association (AMA) as well as American College of Cardiology (ACC). Read this article and get an expert cardiology coding insight for accurate claims and maximized ethical reimbursement.

    Take a Closer Look at +92973

    The code being discussed is +92973 (Percutaneous transluminal coronary thrombectomy [List independently other than code for primary procedure]).

    For years, a lot of resources have based their coding recommendations on the simple face of the definition of +92973. If you go through the descriptor, you'll find that it does not specify anything but 'Percutaneous transluminal coronary thrombectomy.

    Accordingly, a general recommendation has been that you may give +92973 for a range of methods used to eliminate thrombus, including both fragmentation and aspiration catheters.

    Consider the Aspiration Catheter Question

    The issue: The 2011 CPT® Reference Guide meant for Cardiovascular Coding (co-published by the AMA and ACC) mentions that +92973 is correct only when the physician uses a mechanical device that fragments the thrombus and removes the clots.

    What's new: A number of firms required clarification from the AMA about correct coding for +92973. The firms have lately reported independently that the AMA's response has been to back the information in the ACC/AMA publication: +92973 is not suitable for thrombectomy by aspiration catheter.

    The reported AMA responses also point out that non-mechanical coronary thrombectomy is included in any other intervention carried out (for instance coronary angioplasty or stent placement). Under that interpretation, "thrombectomies performed along with aspiration devices such as Pronto and Fetch are incorporated in the intervention and not independently reportable, Thus you would require to see proof that the physician fragmented (broke up) the thrombus versus aspirated (suctioned) it to report +92973.

    Confusion remains: A lot of coders maintain that they want to see a more clear guidance in the CPT® manual for +92973 and published guidance from CMS to settle the issue since it could involve changing practice policy on coding these services. Some industry experts have recommended that until CMS issues written guidance, practices should code the service consistently across the board. In other words, the recommendation is that in the absence of written guidance, you shouldn't code differently for different payers.

    Bonus: Additional Tips Aid +92973 Correctness

    When your documentation does support reporting +92973, keep in mind that you must not report it as an individual code. It is an add-on code and should go with either 92980 (Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) or 92982 (Percutaneous transluminal coronary balloon angioplasty; single vessel).

    Want to have more expert tips like this and latest cardiology billing and coding updates? Click here to read the entire article and to get access to our monthly Cardiology Coding Alert: Your practical adviser for ethically optimizing cardiology billing and coding, payment and efficiency in cardiology practices. With Cardiology Coding Alert, you get the updated cardiology -specific coding and Medical billing information delivered to you every month

    Tuesday, November 1, 2011

    784.0 or 723.8? Headache Choice Depends on Provider Notes

    Know the best diagnosis and injection codes.

    In case your neurologist or pain specialist administers greater occipital nerve blocks, don't allow coding turn into a headache. Confirm specifics about the patient's headache as well as the service your provider provided to pin down the accurate diagnosis and procedure codes each time. Read this neurology billing and coding expert insight and know what neurology CPT codes apply in such a scenario.

    Location of the Occipital Nerve

    The greater occipital nerve (GON) starts from the subsequent medial branch of the C2 spinal nerve and supplies sensory innervations to the posterior area of the scalp going to the top of the head. Physicians normally inject the GON at the point of the superior nuchal line which exists just above the bottom of the skull for occipital headaches or neck pain.

    Tip: Some physician practices have a little illustration in the chart that the physician can mark with a range of injection sites. Counting this type of tool helps your physician unmistakably document the injection location, which further helps you select the correct nerve injection neurology CPT code as well as submit more accurate claims.

    Kind of Headache

    Your physician's documentation may have notes covering "occipital headache" to "occipital neuralgia" to "cervicogenic headache." Your job is to make certain that you interpret the notes and then assign the most precise diagnosis.

    Occipital headache: ICD-9's alphabetic index does not contain a definite listing meant for occipital headache. Owing to this, you should report the general code 784.0 (Headache), which involves "Pain in head NOS." Further details in your provider's notes may result in diagnoses like 307.81 (Tension headache), 339.00 (Cluster headaches), 339.1x (Tension type headache), or 346.xx (Migraine).

    Occipital neuralgia: You have certainly a more definite diagnosis to code when your provider documents occipital neuralgia. Greater occipital neuralgia lead to an aching, burning, or hammering pain or sensation a tingling or numbness all along the back of the head. You'll, in such a case, report diagnosis 723.8 (Other syndromes affecting cervical region).

    Cervicogenic headache: The alphabetic index doesn't involve a listing requiring coders to reassess a definite ICD-9 code . A lot of coders report 784.0 (Headache) because of lack of a better option.

    Handling Bilateral Injections

    Once your provider administers bilateral GON injections, confirm the patient's insurance company prior to completing your claim.

    Reason: A lot of Medicare contractors need you to report bilateral procedures as simply a single line item along with a single unit of service as well as modifier 50 (Bilateral procedure) appended. Private payers, though, regularly need two lines for bilateral claims:





  • Line 1 including the neurology procedure code, modifier RT (Right side), as well as one unit of service






  • Line 2 including the neurology procedure code, modifier LT (Left side), as well as one unit of service.


  • Want to have more neurology Medical billing and coding expert tips and know everything about neurology CPT codes ? Click here to read the entire article and to get access to our monthly Neurology and Pain Management Coding Alert: Your practical adviser for ethically optimizing neurology billing and coding, payment, and efficiency in neurology and pain management practice


    About the Editor: Leigh DeLozier, BS, CPC, moved from the world of hospital public relations to writing Specialty Alerts in the year 1999. She launched the Anesthesia Coding Specialty Alert and is presently the editor for three other publications including Neurology and Pain Management Coding Alert, Family Practice Coding Alert, and Anesthesia Coding Alert. She has written for pain management, pulmonology, oncology, and other specialties along the way. Leigh re-launched newsletters for podiatry and dermatology in 2009.
    She became a Certified Professional Coder® (CPC®) through the American Academy of Professional Coders (AAPC) in 2002.

    Pin down Common Acronyms to Code More Precisely

    Make out how well you understand these abbreviations.

    In case the charts you code occasionally seem like alphabet soup owing to specialized acronyms or abbreviations your providers use, it's time to re-acquaint yourself with some common terms to help improve your coding. Read on this expert anesthesia billing service insight and for perfect anesthesia claims and maximized reimbursements.

    Here's why: When the physician documents a chart, he doesn't at all times have time to elucidate phrases like "past history" (PH) and "present illness" (PI), however knowing which is which can make a remarkable difference in the correctness of your charts. In case you code a chart thinking that the patient presently suffers from every condition listed as "PH," you'll be certainly coding the wrong diagnoses for the present illness.

    Does 'TKA' Mean Visualizing or Replacing?

    The physician documents "TKA" in the patient' chart, which could mean "total knee arthroplasty" or "total knee arthroscopy." In arthroplasty, the surgeon repairs or replaces a joint. Through arthroscopy, on the other hand, the surgeon utilizes minimally invasive techniques to look inside the patient's joint to better diagnose problems and probably provide some treatment.

    Possibility 1: The right CPT® surgical code meant for total knee arthroplasty is 27447 (Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing [total knee arthroplasty]). Code 27447 crosses to anesthesia CPT code 01402 (Anesthesia for open or surgical arthroscopic procedures on knee joint; total knee arthroplasty), which has a base value of 7 units.

    Possibility 2: CPT® covers a variety of codes meant for total knee arthroscopy, resting on the detailed procedure. Each choice crosses to anesthesia CPT code 01400 (Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified), which is valued at 4 base units.

    Does 'I&D' Point to Clean Up or Incision?

    Assume the doctor documents "I and D" on the chart that means he has documented this for both 'irrigation and debridement' as well as 'incision and drainage, This is a different example of two dissimilar types of procedures with two seperate surgical codes, so make certain that you know what your provider means.

    Possibility 1: You code irrigation and debridement along with the suitable selection from a huge range of codes, dependent on which level of skin the surgeon reaches. A number of of the options meant for surgical codes cross to either 00300 (Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified) with 5 base units or 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified) with 3 base unit value. Though, other options send coders to more detailed anatomical codes, so ensure that you do understand which code selection is suitable.

    Possibility 2: You code incision and drainage, though, with a choice from 10060-10180. The code descriptors differ in accordance with what the surgeon incised as well sd the level of complexity. Each code crosses to anesthesia CPT codes 00300 or 00400, as the irrigation and debridement procedures.

    Want to get more expert advice like this for perfect anesthesia billing service and know everything about anesthesia CPT codes ? Click here to read the entire article and to get access to our monthly Anesthesia Billing Alert newsletter: Your practical adviser for ethically optimizing anesthesia billing service, coding, payment and gaining expertise on anesthesia CPT codes

    Tuesday, October 25, 2011

    74176-74178 Challenge Exposes How 2011 Coding Links to 2010

    Test yourself to ensure you've aced this year's coding changes.

    ICD-9 codes for abdominal and pelvic CTs are amongst those most regularly reported to Medicare by radiologists. In 2011, the adding of several codes implies you have to select among a combination of old and new selections to report these services.

    Read this sample case study, selecting the ICD-9 codes you report for 2011 and finding if they line up with the study below.

    Read the Report and Choose Your ICD-9 Codes

    Header: Abdominal as well as pelvic CT including enhance, CT reformation body

    Dictated report: CT of abdomen as well as pelvis

    Indication: 26-year-old female presenting with abdominal pain, exclude acute appendicitis

    Technique: Adjoining axial images were found from the lung bases over the pubic symphysis followed by the ordinary administration of oral as wll as intravenous contrast, 150 cc Isovue-300 at 3 cc/sec. FOV=32 cm.

    Findings: Lung windows reveal subpleural opacity present in the right lower lobe, probably demonstrating atelectasis. No parenchymal nodule or mass inside the visualized lung bases. Besides, no pleural or pericardial effusion found.

    The liver, gallbladder, adrenal glands, spleen, pancreas, as well as the kidneys are normal. The bladder is amply bloated devoid of evidence for thickening of bladder wall. Both ovaries are envisioned, comprise normal-appearing follicles. Besides, there is also a 2.1- x 1.4-cm physiologic cyst inside the right ovary.

    The appendix is swollen, comprises a few 3- to 4-mm appendicoliths, establishes abnormal bowel wall augmentation, and is connected with moderate nearby periappendiceal fat stranding. The left over bowel is normal. No periappendiceal fluid collection or abscess is found.

    Impression: Acute appendicitis.

    Narrow Code Choices Based on Anatomic Area

    In our sample report, the radiologist keeps a note of the state of the abdominal structures (liver, gallbladder, pancreas, intestines) as well as the pelvic structures (bladder, ovaries).

    Old way: Prior to 2011, this info would motivate you to narrow your CPT® choices to 74150-74170 (Computed tomography, abdomen ...) as well as 72192-72194 (Computed tomography, pelvis ...).

    New way: Your options change with the addition of 2011 codes that symbolize both abdominal and pelvic CTs in just a single code:



  • 74176, i.e. Computed tomography, abdomen as well as pelvis; excluding contrast material





  • 74177, i.e.Computed tomography, abdomen as well as pelvis; including contrast material(s)





  • 74178, i.e. Computed tomography, abdomen and pelvis; excluding contrast material in one or both body regions, trailed by contrast material(s) and additional sections in one or both body regions.

  • CPT 2011 keeps 74150-74170 (abdomen only) and 72192-72194 (pelvis only), but as the sample case denotes an abdominal as well as pelvic CT in the similar session, you will be selecting from new ICD-9 codes 74176-74178, supposing this case has a 2011 date of service.

    Monday, October 24, 2011

    37224-37227 Develop Your Femoral/Popliteal Coding Choices

    CPT's description of a 'single vessel' for this particular territory is certainly an exception to the rule.

    Getting yourself updated on the current year's revascularization CPT changes necessitates more than simply changing your old codes for the new ones -- though that alone is sufficient to keep you busy. You furthermore have to take a watchful look at the guidelines that are applicable to the individual codes to ensure you're using the new codes properly. Read on this expert radiology medical coding article and take a step closer towards accurate and profitable radiology coding.

    In the sphere of radiology coding, CPT 2011 adds new codes meant for lower extremity endovascular revascularization including angioplasty, atherectomy, as well as stenting. This radiology medical coding article will concentrate on the femoral/popliteal codes 37224-37227.

    Ace the Single Code Approach Meant for Fem/Pop Coding

    The newly listed femoral/popliteal service codes are as following. Remember that all of the codes involve angioplasty in the similar vessel when that service is carried out:




  • Angioplasty: 37224 –i.e. Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; including transluminal angioplasty




  • Atherectomy (as well as angioplasty): 37225 -- i.e. including atherectomy, with angioplasty in the same vessel, when carried out




  • Stent (as well as angioplasty): 37226 -- i.e. including transluminal stent placement(s), with angioplasty in the same vessel, when carried out




  • Stent and atherectomy (as well as angioplasty): 37227 -- i.e. including transluminal stent placement(s) as well as atherectomy, with angioplasty in the same vessel, when carried out

  • Remember: The broad rule for 37224-37227 is that you must report the one code that denotes the most intensive service conducted in a single lower extremity vessel. All other lesser services are covered in that one code.
    Look into the Change from Component Coding

    CPT guidelines maintain that -- besides the intervention performed -- the codes include:




  • To get into the vessel





  • Selectively catheterizing the given vessel





  • Crossing the given lesion





  • Radiological supervision as well as interpretation or understanding for the intervention carried out





  • Every embolic protection used





  • Closure of given arteriotomy (incision in the artery)





  • Imaging carried out to document the intervention was accomplished.


  • Remember: In case the physician carries out either mechanical thrombectomy (for instance 37184-+37185, primary, or +37186, secondary), or thrombolysis (for instance 37201, 75896), or both of these, in order to help restore blood flow to the blocked area, CPT says that you might report those services distinctly.
    Apply This Territory Rule to Sidestep Denials

    The new codes (37220-+37235) are applicable to dissimilar "territories." Each territory has its own individual detailed set of guidelines. Codes 37224-37227 come under the femoral/popliteal vascular territory.

    Key rule: CPT denotes that the entire femoral/popliteal territory in one lower extremity thought as a single vessel for CPT reporting."

    Accordingly, you must report a single code even though the radiologist carried out several interventions for numerous lesions in the popliteal artery as well as inside the common, deep, and superficial femoral arteries located in the similar leg at the similar session.

    Sunday, October 23, 2011

    71010 and 71020: Look out For Common Documentation Downfalls

    Enhance Your X-Ray Services by Understanding Views

    A chest X-ray's professional fee is simply $10 or so. Multiply this amount of $10 by the number of services you carry out, however, and you'll then realize how accomplishing these claims right is imperative to your practice's financial health. Read on this expert radiology medical coding article and take a step closer towards accurate and profitable radiology coding.

    Actually, 71010 (Radiologic examination, chest; single view, frontal) as well as 71020 (Radiologic examination, chest, 2 views, frontal and lateral) come second and third on the list of the topmost 10 codes radiologists described to the CMS database.

    Below, you'll find 71010 and 71020 basics, with example services, typical supporting diagnosis codes, as well as expert radiology coding advice on sidestepping the most common causes of audit-related denials.

    Improve Your X-Ray Services by Understanding Views

    Every 71010 or 71020 service might involve simply a few minutes of the radiologist's time. Normally, she makes a rapid review of the patient's history, understands the exam conducted by the technician, dictates and then signs the report, and finally shares the results with the ordering physician.

    The important element differentiating 71010 from 71020 is certainly that the first signifies a single "frontal" view and the second signifies two views, "frontal and lateral."

    71010: Remember, the documentation process for a 71010 service may denote an "AP view." AP means anterior-posterior, meaning the X-rays goes from the anterior (front) to the posterior (back) of the patient.

    You also might find reference to a "PA view" (posterior-anterior), wherein the X-rays pass from the back to the front of the patient. The AP view could be more challenging to read than a PA view as quality issues and the way the heart seems enlarged on an AP view. Therefore, providers often have a preference to the PA view over the AP view.

    You normally will find an AP view while the patient is unable to stand for the imaging service. Accordingly, a different term you'll regularly see related to 71010 services is "portable," implying that the tech carries out the X-ray with the help of a portable machine. You might find this mainly for services carried out at bedside for inpatients.

    71020: You might find a 71020 service mentioned as a 'PA & Lat.' The abbreviation talks about the PA (posterior-anterior) view as well as the Lat (lateral) view. Lateral implies "side." Normally, the tech will take a left lateral X-ray, implying that the patient's left side is nearer to the film than the right side is. However the ordering physician might request for a right lateral X-ray instead.

    For instance: A patient with a history of lung cancer comes with a complaint of fever and shortness of breath. Her oncologist orders PA and lateral X-ray imaging. The interpreting radiologist must report 71020. Keep in mind that you should append modifier 26 only if you're reporting the professional component.

    Podiatry Billing: Give These Modifier 24 Myths a Miss

    Podiatry billing guidelines: You need to train eyes on podiatrist's documentation and not the appointment book.

    In order to seal your payments for services your podiatrist carries out after a major procedure while you are still billing in the global period of the procedure, you need to be well-versed with the ins and outs of modifier 24.

    Here are some myths relating to this modifier that you can stay away from:

    Modifier 24 is applicable to any service done in the post-op period – this is a no.

    You should add modifier 24 to an appropriate E/M code when an evaluation & management service takes place during a postoperative global period for reasons not related to the original procedure. This modifier tells the payer that the surgeon is treating the patient for a new problem. As such, the plan shouldn't include the evaluation & management service in the previous procedure's global surgical package.

    This modifier is only for use on E/M codes and only for use during the post-operative period (10 or 90 days).

    As a rule, you cannot bill separately for evaluation & management related services pertaining to the original surgery during the global period. This surgical package includes routine postoperative care during the global period.

    Scheduled office visit means no modifier 24

    Don't assume you are unable to bill separate services using modifier 24 just because of the fact that a patient was scheduled to visit related to the surgery.

    Here's an example to substantiate this: A patient has a lumpectomy. When the patient comes back in to the office for sutures pathology has found out that the lump turned out to be cancer. As such, the doctor does an extensive E/M service/office visit with the patient to discuss.

    Here, you should be able to use modifier 24 to describe an evaluation & management service not related to the surgery. CPT would always allow this, however even Medicare says that care directed at the underlying disease process is billable separately in the global period.

    Wednesday, June 29, 2011

    ASC Payments: These 5 Tips Will Make Your Derm ASC Coding A Snap

    Check out the new 2011 payment rates for dermatology procedures performed in an ambulatory setting.

    True or false: Modifier SG is required for all ambulatory surgical center (ASC) claims.

    The answer is false for claims with dates of service after Jan. 1, 2008 -- and if you got that one right, you're on your way to ASC reimbursement bliss.

    CMS has issued its latest quarterly update to the ASC Payment System, which includes HCPCS codes , modifiers, drugs and supplies that are payable for ASCs effective April 1.

    With so many changes affecting ASCs every year, it's enough to make your head spin -- but despite all of the changes, some aspects of ASC reimbursement have remained the same. We've got the lowdown on how the ASC rules affect you.

    1. Know where to find ASC-allowed services. CMS maintains a very specific list of codes payable for ASCs, but if you don't know how to access the list, you could be flying blind when it comes to reimbursement.

    Resource: You can download the most recent ASC-allowable codes at www.cms.gov/ASCPayment/11_Addenda_Updates.asp, which includes not only the current quarter (which began on Jan. 1), but also any previous quarters in case you're battling older claims.

    2. Remember the 'same-day global' rule. Every procedure the ASC bills has a "same-day" global period. This makes sense because the ASC is not reporting physician work services -- only facility fees. This applies to the coder working for the ASC, but not the physician who performed the service.

    For instance, if a patient experiences postoperative bleeding after the repair of a superficial wound (12001-12018, Simple repair of superficial wounds …) and the physician must return the patient to the ASC for control of bleeding on the same day, both the physician's coder and the ASC's coder should report the appropriate control-of-bleeding code appended with modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified healthcare professional following initial procedure for a related procedure during the postoperative period) because the procedure occurred within the "same-day" global period for the ASC.

    If, however, the physician returned the patient to the ASC the day after the initial surgery, the ASC coder would report the appropriate control-of-bleeding code with no modifier. For the ASC's purposes, the initial surgery's global period has expired, even though the surgery includes a 90-day global period for physician services. On the other hand, the surgeon's coder would report the bleeding-control code with modifier 78 appended because the physician's services follow the standard global rule.


    Tuesday, June 14, 2011

    99360 Is Certainly Payable If You Follow The Rules

    Take a look at documentation of four areas prior to submitting claims. Also keep an anesthesia code crosswalk handy to assist you in your coding.

    CPT's evaluation & management section includes only one code for standby time, however limited choices do not ensure payment. Here are four areas our experts suggest and do not leave your claims hanging in the wings.

    You should code based on availability and not care

    Your first step in gearing up to submit a claim for standby service is to know what you are reporting and what you are not. Code 99360 doesn't represent patient care, rather it represents availability.

    You should document three key factors

    Even though CPT includes a standby code, many payers don't reimburse for the service. Comprehensive documentation of your provider's service is key as you might be faced with an appeal. Here are three documentation tips you should heed to when coding 99360 for standby care.




  • Another doctor must request that your anesthesiologist make himself available for standby time. You need this request in writing along with justification for why the other physician requests anesthesia standby.
  • The chart should cover a note by the anesthesiologist documenting that his service might be necessary.
  • Know how about the anesthesiologist's involvement in the case.

    Check times and locations twice

    Being able to report standby service hinges on two more important factors: time and location.

    Your anesthesiologist must be in attendance for standby for at least 30 minutes - and he must document that time. According to CPT, if the time is less than half an hour, you do not report it separately. However, it is always a good idea to document patient care whether it is billable or not.

    Pay no attention to 99464 for your claims

    Some materials that teach about standby coding for labor and delivery (L&D) patients also mention 99464. Even though 99464 goes hand-in-hand with 99360, since it represents newborn care, you will not report 99464 as an anesthesia coder.

    Rationale: Anesthesia providers care for the mother and not the baby. The American Society of Anesthesiologists even has policies to this effect. One more provider should be available to offer neonate care, so 99464 applies to that professional.

    For further details on this and for other specialty-specific articles to assist your anesthesia coding, sign up for a good medical coding resource like TCI. Such a site comes with products like Anesthesia Analyst that comes with anesthesia code crosswalk to assist your coding.


  • Family practice coding & proper modifier 25 use

    You should stop omitting modifier 25 because of same day diagnosis.

    Recently, someone told me that we do not require different diagnosis codes to use modifier 25 for reporting an Evaluation & management service on the same date as a procedure. However, I have been told many times in the past by certified coders that when I bill more than a procedure that I need to add modifier 25 to the evaluation & management and point the primary diagnosis to the evaluation & management and point a secondary diagnosis to the other procedure. Can you help clear up my doubt?

    Answer: Proper modifier 25 use doesn't need a different diagnosis code. As a matter of fact, the presence of different diagnosis codes attached to the E/M and the procedure doesn't support a separately reportable E/M service.Your key to reporting the E/M service lies in whether your doctor carried out and documented work beyond what's considered to be part of the procedure.

    How if functions: The information about modifier 25 in the CPT manual distinctly indicates that you don't need to have two different diagnosis codes to use the modifier. As per the CPT manual description of modifier 25, the evaluation & management service may be prompted by the symptom or condition for which the procedure and/or service was provided. Therefore, different diagnoses are not required for reporting of the E/M services on the same date."

    Both CPT and Medicare rules will allow the same diagnosis for the evaluation & management service with modifier 25 and the procedure on the same day, and Medicare will pay for both with the same diagnosis, assuming both are reasonable and necessary and otherwise meet Medicare coverage criteria. The catch is that your physician's documentation should establish clearly that the evaluation & management involved work over and above that typically associated with the procedure done at the same encounter and that the encounter's sole intention was not to carry out the procedure. So if you get denials on modifier 25 claims just because you use the same diagnosis code for the Evaluation & management and the procedure, you should appeal, assuming your physician's documentation supports reporting separate services.

    Monday, June 13, 2011

    Ob-Gyn Coding: Ensure You've Got Well-Documented Adhesions Ob-Gyn Coding: Ensure You've Got Well-Documented Adhesions

    In a particular scenario, my ob-gyn carried out an "operative laparoscopy adhesiolysis, abdominal myomectomy." How should you report this?

    Well, to put it in other words, your ob-gyn carried out laparoscopic lysis of adhesions, then converted to an open myomectomy. For the laparoscopic lysis of adhesions, you should code 58660. In order to report this code, you should ensure that the type of adhesions your ob-gyn addressed is the kind that payers normally pay. If your ob-gyn doesn't describe the adhesions in the op report thoroughly, trying to report the lysis is a waste of your time and a line item on the claim form.

    You should either report 58140 or 58146 for the abdominal myomectomy.

    While listing the codes on your claim, list 58140 or 58146 first followed by the lysis code (58660). You do not require a separate procedure modifier since you will not find this code combination bundled in the National Correct Coding Initiative (NCCI).

    Heads up: See to it that you include V64.41 as a diagnosis for the open procedure in addition to the diagnosis for the surgery itself.

    Remember: If the ob-gyn intended to do a laparoscopic myomectomy and found adhesions but did not remove them laparoscopically, then converted to carry out the abdominal myomectomy, you should bill the myomectomy code (Increased procedural services) with modifier 22 (Increased procedural services) only. Payers will bundle the lysis in this situation.


    Tuesday, June 7, 2011

    Family practice coding: Which code for emphysema visit?

    Here's a family practice coding scenario: When an established patient with emphysema presents complaining of shortness of breath, which CPT code should you go for? The physician provides inhalation treatment, teaches the patient on using the nebulizer at home, and provides an expanded problem-focused examination and medical decision-making of low complexity.

    Well, you'll require more than one CPT code for this encounter. Use 94640 to cover the all-encompassing service the physician provided.

    Since the doctor also carried out an office visit, go for 99213 based on your documentation of an expanded problem-focused exam with low-complexity decision-making. You might require to add modifier 25 to 99213 to indicate that the evaluation & management service was significant and separately identifiable from 94640.

    Go for 94640 in place of 94664 as the physician's main intent was to treat the obstruction.

    A word of caution: If you bill 94664 with 94640 on the same day to Medicare, see to it that you justify that the doctor provided the 94664 service distinctly separate from the treatment. In this instance, add modifier 59 to 94664 to notify the payer that the FP carried out 94664 separate from 94640. The documentation should include details on the medical necessity for separately providing this service.

    Here's an instance: The doctor determined that the patient's plan of care should include inhalation therapy or the patient is new to this therapy and doesn't know the administration techniques involved in the procedure. The note should clearly show that the doctor demonstrated the inhaler to the patient separate from the administration for treatment. Or else, the insurer may think you're trying to report one service twice.

    Note: even though it's technically not required, it may link separate diagnosis codes to the E/M and the nebulizer treatment. Say for instance, you could link 786.05 to 99213, and link the emphysema code (492.8, Other emphysema) to 94640.


    Pain management coding: does injury codes apply to pain?

    Here's pain management coding scenario to help your understanding: When can you report an acute injury ICD-9 code rather than a chronic injury code? We treat patients for generalized pain (not necessarily a recent injury) and are not sure what to code.

    Answer: When coding some conditions such as kidney disease (584.x and 585.x), you can many a time easily figure out when the patient's condition is chronic as the diagnosis codes differ based on the patient's lab results. However, coding for pain can be trickier.

    Say for instance your patient presents with shoulder pain, which came on slowly; that she says she had for some time. You think about 840.4; however it's from ICD-9's ‘injury' chapter. In this instance, the patient did not have an injury – in its place she had nine months of pain. As such, you should avoid 840.4 and choose another code based on the rest of your physician's documentation. You'd most likely look for notes pertaining to the patient's signs and/or symptoms, such as 719.41 of your provider has not determined what is causing the patient's shoulder pain and hasn't given a definitive diagnosis. And once a definitive diagnosis has been reached, you no longer code the symptoms.

    Here's why: Acute pain normally results from disease, surgery, inflammation or injury. The pain is immediate and normally of a short duration. By contrast, chronic pain typically persists beyond three to six months and can last from weeks to a lifetime. Chronic pain can originate with an initial trauma or injury; however continues beyond the time of normal healing. Many practices use the ‘three months or longer' guideline for coding chronic pain conditions versus acute problems. A definitive guideline hasn't been addressed by CMS, even though it has identified coverage of electrical stimulation for chronic wounds as longer than a month.

    Friday, June 3, 2011

    Pain management coding: Do injury codes apply to pain?

    You could be using the wrong code if you are not aware what differentiates an acute condition from a chronic one, or how many diagnosis codes you can report. Here's a common question to help your pain management coding (ICD-9).

    When can you report an acute injury ICD-9 code rather than a chronic injury code? We tend to patients for generalized pain (not necessarily a recent injury) and are not sure what to code.

    Answer: While coding some conditions like kidney disease (584.x and 585.x), often you can easily figure out when the patient's condition is chronic since the diagnosis codes differ based on the patient's lab results. However, coding for pain can be trickier.

    Here's an instance: Think that your patient presents with shoulder pain, which came on slowly, that she says she has had for the last nine months. You can think about 840.4; however it is from ICD-9's "injury" chapter. In this instance, the patient did not have an injury; in its place she had nine months of pain. As such, you should stay away from 840.4 and choose another code based on the rest of your physician's documentation. Most likely you'd look for notes pertaining to the patient's signs and/or symptoms, such as 719.41 if your provider hasn't determined what is causing the patient's shoulder pain and hasn't given a definitive diagnosis. Once a definitive diagnosis has been reached, you no longer need to code the symptoms.

    Here's why: Generally acute pain results from disease, surgery, inflammation, or injury. The pain happens to be immediate and normally short-lived. By comparison, chronic pain can originate with an initial trauma or injury however continues beyond the time for normal healing. Many practices use the ‘three months or longer' guideline for coding chronic pain conditions in comparison to acute problems. "A definitive guideline has not been addressed by Centers for Medicare & Medicaid; but it has identified coverage of electrical stimulation for chronic wounds as ‘longer than one month'.

    Bottom line: You should leave the determination of acute versus chronic to the physician. If an ICD-9 or CPT code compels you to differentiate between whether the patient's condition is acute or chronic, show both descriptors to the pain specialist and ask him to take a stance.

    ICD-9 includes code family 338.xx for acute and chronic pain diagnoses. However, as per Section 1.B.6 of the ICD-9 Guidelines, do not assign codes from category 338.xx if you don't have an "acute" or "chronic" distinction. The sole exception to this guideline lie with post-thoracotomy pain, postoperative pain, neoplasm related pain, or central pain syndrome. If acute or chronic is not specified, you need to look elsewhere for the code.




    00918 is primary anesthesia code for procedures 52352-52355


    However don't make it your automatic choice.

    While coding for your anesthesia practice, you may find yourself in various tight situations such as this: Say for instance you may find yourself asking: How should I code for anesthesia during a cystourethroscopy with lithotripsy for a diagnosis of kidney or ureteral stones?

    Answer: Well, the anesthesia code crosswal lists   00918 (anesthesia for transurethral procedures [including urethrocystoscopy]; with fragmentation, manipulation and/or removal of ureteral calculus) as the primary anesthesia code for procedures 52352-52355 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy …) however you should not make that your automatic choice.

    Notes below each code from 52352-52355 state that you should report 00862 (Anesthesia for extraperitoneal procedures in lower abdomen, inclusive of urinary tract; renal procedures, including upper one-third of ureter, or donor nephrectomy) when lithotripsy involves the kidney or upper one-third of the ureter. Owing to this ‘upper one-third' distinction, you will need a copy of the operative report to code properly.

    Many a medical coder gauge their condition by the stone's location. They submit 00910 (Anesthesia for transurethral procedures [including urethrocystoscopy]; not otherwise specified) for a bladder stone, 00918 for a ureter stone, and 00862 for a kidney stone.

    For more on this and for other specialty-specific articles to assist your anesthesia coding, sign up for a good coding resource like TCI. Onboard such a site, you can have access to the anesthesia analyst that provides you with anesthesia codes, tools, and resources you need for successful coding. It also comes with an anesthesia code crosswalk to help you choose the proper anesthesia code for each CPT procedure code in the record. Basically, the anesthesia crosswalk is a listing of CPT procedure codes and their corresponding anesthesia codes.


    Tuesday, May 31, 2011

    Late or no-show patients? Take a look at these options

    Take a look at this ophthalmology coding scenario:

    There are some patients who regularly miss appointments or show up late. We would like to focus on the importance of keeping appointments without alienating the patients. As such, can you bill for no-show visits and/or charge a fee for being late?

    Well, whether you can bill for no-show visits or charge a late fee will depend on your payer contracts and the laws in your state. Some contracts bar no-show charges or fees not related to patient services. Take a look at your contract and state laws and if both allow such charges, go ahead and bill the patient for this difficulty.

    There are many practices that charge a fee for missed appointments; however there are other choices to consider. Take a look at these suggestions from other practices: if you charge for missed appointments or a certain number of late arrivals, post that information so that patients know about the policy. Cover notices on the registration form, in the registration area and in the waiting room. Some practice writes off the first occurrence and take it as part of patient education.

    You should have a financial policy that mentions the fee in writing. You should also have the patient sign a copy of the policy, which he keeps, in addition to one you will keep. This way, he can't claim he was never told or didn't see the notification.

    You should tell late arrivals that your staff will fit them in as best you can; however that patients who are on time for appointments will get preference. Give the patient the choice of rescheduling later.

    If the patient happens to miss an appointment, you need to send a follow-up letter. Set guidelines for the practice and send a stronger letter every time until you reach the predetermined point of dismissing the patient (normally three missed or late arrival appointments).

    Remember: You should be sure to note the missed or late arrival appointment in the patient chart especially when the patient is coming in for diagnostic tests like visual fields or optical coherence tomography (OCT). This may be helpful in safeguarding the practice from abandoned patient lawsuits. Going through how your practice handles this issue is a good opportunity to assess scheduling and other issues from an internal perspective. If you are in a larger multispecialty clinic or in an area where traffic and parking are a recurring problem, realize that these issues might be impacting your patient's ability to be on time. What's more, take a look at how you schedule sick visits; many will be ‘no shows' of you book them a day or two ahead because the patient encourage your physicians to be on time. Some patients think that if the doctor is getting late, it will not matter or will not be noticed if they are late for the scheduled time.

    Cpt 2011 Brings Two New Codes For Home Study Among Other Key Changes

    If you perform sleep studies, you need to upgrade your coding style this year.

    This time, CPT brought some big changes as far as pulmonology coding is concerned. Here are some codes you will have know this year. As such, if you have been using inactive or unrevised codes, you are risking denials for sure.

    Two new codes for Sleep Study

    The good news is home sleep studies type II had made a straight transition from Code G0398 to 95806 in last year's CPT. Now the codes for home sleep studies type III and IV now have their own category I codes for this year: 95800 and 95801.

    These sleep study codes have been established for reporting unattended sleep study testing services. These codes appear with a number (#) symbol to indicate that they are out of numerical sequence.

    Other new pulmonology codes on focus

    For trachea and bronchi, a new code has been created to report bronchoscopy with balloon occlusion, with assessment of air leak, with the administration of occlusive substance, if performed. Other codes that have been included this year are: 90470, 0250T -, 0251T and 0252T.

    CPT codes 0250T, 0251T, 0252T have not been assigned any physician work relative value units. This means that payment is only received by the facility for these services.

    There are revisions to Photodynamic Therapy Guidelines and Others

    CPT has also revised photodynamic therapy coding. So from January 1 this year, you need to pay attention to the documented time in case a modifier is necessary. CPT also adds various parenthetical guidelines after codes 96570 and 96571. If the pulmonologist carries out 96570 for less than 23 minutes, you should report modifier 52. For each increment after the first 30, you have to get to the eighth minute for each interval. Other CPT 2011 revised codes include 90662, 90663 , and 90670.

    Evaluation and management changes offer a sneak peak.

    This year, CPT has made significant revisions to the hospital observation services section, including the addition of three new resequenced codes in the subsequent hospital observation subsection. More revisions have also been made in the hospital inpatient services, pediatric critical care patient transport, and inpatient neonatal and pediatric critical care subsections.

    Here are three new evaluation and management codes that can impact your pulmonology practice's coding success: 99224, 99225 and 99226.

    Monday, May 30, 2011

    Backache example to help your ICD-9 coding

    With not much time to go for October 1, 2013, there is no denying that now everyone is training eyes on ICD-10. However, in doing so, you should not ignore your ICD-9 coding options. Here's a scenario to help your understanding of ICD-9 codes:

    Patient A comes to your office for treatment of severe, chronic pain in the right side of his back. The pain had started about 10 months ago. In the right lumbar multifidus muscle for pain relief, your interventional radiologist uses ultrasound guidance to administer two trigger point injections (TPIs). But then his chart notes only say that the patient had 'pack pain'.

    You get the chart and also get to see your radiologist performed trigger point injections on other patients in the past, using 20552 and 76942. The most recent injections carried out on the other patients' backs were for myofascial pain.

    Minus more specific diagnosis, you should assume that Patient A also has myofascial pain, and report one unit of 20552 with a diagnosis of 729.1?

    Well, the answer here is no. Making assumptions does not support compliant coding. From a clinical standpoint, pain can be caused by various reasons. Even if the diagnosis seems obvious, coders are not clinicians and should never make presumptions.

    If your radiologist did not specifically document myofascial pain or myalgia and you use one of those codes, you could land in trouble in case of a payer audit. Such mistakes are just the kind of thing that auditors watch out for. In its place, you may be required to report an unspecified code, such as 724.5.

    Remember payers may not always accept 'unspecified' codes in assistance of a service; however some payers will reimburse for 724.5 for trigger point injections. As such, be sure to study your payer coverage policies well prior to determining if the diagnosis fits the payer's rules. As a coder, you should be aware of payer policies and LCDs to be able to convey that information to the physician.

    Bear in mind that spot on medical coding requires that you select code based on the documentation you must never report a diagnosis code just because you are aware the payer will pay the service if you report that diagnosis.
    Link

    Friday, May 27, 2011

    Pediatric Coding: Key Things You Need To Consider While Using 2011 Icd-9

    While choosing the proper influenza diagnosis, two details are key.

    Do not let rumors of some ICD-9 changes in preparation for ICD-10 make you blind to the top pediatric diagnosis code change . Minus the scoop on expansion to the 488 category, denials for invalid codes will disrupt your claims delaying your payments.

    ICD-9 2011 codes continue to become more and more specific requiring a provider to document clearly and thoroughly to allow for selection of the most specific and spot on code.

    Here are some key points you need to consider while using ICD-9 2011 codes.

    a) While assigning ‘swine flu' DX, look at manifestation. When a patient has H1N1 (swine flu), you need to pay attention to a couple of details. The medical record will have to identify the proper influenza and you'll have to capture the proper manifestation to choose the codes to the degree of specificity now called for. With the change, category 488 mirrors the structure of category 487.

    There has been a tremendous expansion of the H1N1 category. Now you will no longer be able to use 488.0 and 488.1 as ICD-9 2011 has deleted these codes. Instead it has come up with six new five-digit codes. This year's ICD-9 codes 488.0x (Influenza due to identified avian influenza virus) and 488.1x (Influenza due to identified novel H1N1 influenza virus) allow you to uniquely capture pneumonia, other respiratory manifestations and manifestations taking place with these types of influenza. Now you need to assign the proper code 488.xx code based on the type of comorbid manifestation the avian or H1N1 influenza involves.

    Remember: When you report 488.01 or 488.11, as with 487.0, you will report an additional code to identify the type of pneumonia.


    Otolaryngology Coding: Physicians Will Finally Get Paid For Crp Coding

    This year, CPT brought good news for ENT coders. Finally, physicians will get paid for canalith repositioning procedure (CRP) coding after a two-year struggle.

    When we look back, CPT 2009 excited ENT coders with new CPT code 95992. However the 2009 Medicare Physician Fee Schedule played spoilsport. CMS assigned the codes ‘B' status or bundled it always, making payment for CRP or the Epley maneuver using the new code impossible to get.

    However the fight for payment of CRP came to an end because of the 2011 Medicare Physician Fee Schedule.

    Note: If the ENT carries out and documents a medically necessary E/M that's significant and separately identifiable from the CRP, add modifier 25 to the evaluation & management service. What's more, Medicare doesn't allow payment for audiologists performing therapeutic procedures, such as CRP.

    2011 CPT dictates you can use the code closet to the documented time. And this advice is nothing new. Your documented time must be equal to or exceed the average time given to bill that level. Your documented time must be equal to or get past the average time provided to bill that level. For a 35 minutes spent on a medically necessary counseling-dominated visit is a 99214, per CPT you could report 99215.

    If the ENT carries out and documents a medically necessary E/M that's significant and separately identifiable from the CRP, add modifier 25 to the evaluation & management service. What's more, Medicare doesn't allow payment for audiologists carrying out therapeutic procedures, such as CRP.

    Always Medicare has taken the times indicated in CPT's code descriptors to represent minimums. The doctor would opt for the lower code unless the time was greater than or equal to the higher-level code's required time.

    So will Medicare change its position? At this juncture, it's not sure.

    Thursday, May 26, 2011

    Gastroenterology Coding: 43255 And Control-Of-Bleeding Situations

    Gastroenterology coding: 43255 and control-of-bleeding situations

    Coding for excessive blood loss? If so, modifier 22 may not be the ally you are looking for. Your answer may lie on more spot on CPTs such as 43255 and critical care codes.

    In the first scenario, the doctor injects epinephrine into a duodenal ulcer to control active bleeding during endoscopy with biopsy (43239). Earlier, you may opt to use 43239 added with modifier 22 if the physician required significant effort to control the patient's bleeding.

    However this option would need you to submit additional paper documentation to support your modifier 22 claim. So instead if submitting yourself to potential hassles, you can correctly describe this session by reporting 43239 for the biopsy and 43255 for the control of bleeding provided that the bleeding was not caused by the biopsy.

    As is obvious from 43255's descriptor, this procedure describes control of bleeding by “any method," including injection.

    Necessity: On your claim, you should add modifier 59 to 43255, and then report 43239. If you leave out the modifier, it would give payers the impression that the biopsy (or physician) caused the bleeding and bundle 43255 into 43239.

    In the second scenario, when the gastroenterologist is about to carry out an upper GI endoscopy, the patient undergoes very severe gastrointestinal bleeding; so much so that the physician must suspend the endoscopy and spend 40 minutes lavaging blood from the gastro-intestinal tract before continuing.

    Report it: This time round, the critical care code 99291 is your best choice.

    Here's why: if the gastroenterologist caused the bleeding, you can't bill for the control of bleeding procedure. You should ask control-of-bleeding codes only when treatment is required to control bleeding that takes place spontaneously or as a consequence of traumatic injury (noniatrogenic), and not as a consequence of another type of operative intervention.

    You should bear in mind that the time spent at the bedside carrying out services including lavage of gastric blood isn't included in the performance of a subsequent endoscopic procedure and isn't part of the evaluation & management service that might be carried out on the same day.

    Nonetheless, you should not report a critical care code carelessly for an excessive bleeding situation that is not out of the ordinary. Extra time for emergency bedside services less than 30 minutes does not count as billable critical care service. For prolonged critical care services, the doctor should exclusively note the amount of time in his notes.

    Cardiology Coding: Femoral/Popliteal Coding Options

    We are almost mid way through the year, and by now you should be well-versed with all the CPT changes affecting your cardiology practice this year. However, if you're not up to speed with these changes, read on and get more insight.

    This time CPT has added new codes for lower extremity endovascular revascularization covering angioplasty, atherectomy, and stenting.

    Here we take a look at femoral/popliteal codes 37224-37227. The new femoral/ popliteal service codes are angioplasty: 37224, Atherectomy (and angioplasty): 37225, Stent and atherectomy (and angioplasty): 37227.

    The general rule for 37224-37227 is that you should report the one code that represents the most intensive service carried out in a single lower extremity vessel. In that one code, all lesser services are covered. When the cardiologist carried out a stent placement, atherectomy, and angioplasty in the left popliteal vessel, you should use only 37227. That code covers stent placement, atherectomy, and angioplasty. You should code 37224, 37225 or 37226 separately or in addition to 37227 in this situation.

    Last year, you reported a superficial femoral artery angioplasty via antegrade puncture using just-deleted code 35474 and 75962. This year you need to report only 37224 to cover all of the services.

    If the doctor performs mechanical thrombectomy, thrombolysis or both to help restore blood flow to the occluded area, according to CPT, you may report those services separately. If the physician carries out mechanical thrombectomy, thrombolysis or both to help restore blood flow to the occluded area, you should report those services separately, says CPT. Codes 37220-+37235 apply to different territories and each territory has its own specific set of guidelines. Codes 37224-37227 fall under the femoral/popliteal vascular territory.

    According to CPT, the entire femoral/popliteal territory in 1 lower extremity is considered a single vessel for CPT reporting. Therefore, you should report a single code even if the cardiologist carried out various interventions for various lesions in the popliteal artery and in the common, deep, and superficial femoral arteries in the same leg at the same session. In situations such as these, you should use the code for the most complex service. If the cardiologist carries out angioplasty in the left popliteal artery and atherectomy in the left common femoral, you should report atherectomy code 37225 only.

    Wednesday, May 25, 2011

    Twin deliver coding? Here's how you should go about it

    Ob-gyn coding presents a lot of coding challenges before you. Sometimes you may find yourself in a fix trying to report twin cesarean delivery.

    If so, you should take a dig at 59510 with modifier 22 attached. However, that may not always be the case. You will need to adjust your twin delivery reporting depending on an insurance company's preference.

    So how should you report twin delivery?

    Whenever a patient has twins, most ob-gyns first make an attempt at a vaginal delivery as long as the physician has not figured out any complications. Here in this situation, you should go for 59400 for the first baby and 59409-51 for the second.

    Keep this in Remember: Both CPT and the American Congress of Obstetricians and Gynecologists (ACOG) recommend you use modifier 51 (Multiple procedures) for the second delivery. But then you may come face to face with some payers who want to see modifier 59 instead. Other coders report appending modifier 22 to the global delivery (59400) if the patient had more than the average of 13 visits and to account for the second delivery in instances where the payer does not permit separate billing for the additional delivery. When this piece of guidance is in writing, you should follow it.

    Best option: Send a letter of explanation with the claim to stay away from immediate denial by the claim processor. A simple form letter talking about the high-risk nature of multiple-gestation pregnancies will routinely go straight to medical review and save the hassle of denial resubmissions or lost reimbursement through write-offs.


    Otolaryngology Coding: How To Report Fungal Sinusitis

    Your otolaryngology coding practice throws open many challenges and presents a lot of questions. Say for instance you may be asking yourself questions like "Is there a specific diagnosis code for fungal sinusitis?"

    Well, even though looking up "Sinusitis: due to: fungus, any sinus" in the Alphabet Index, Volume 2 of ICD-9-CM directs you to "117.9," a single code does not describe fungal sinusitis. You should instead use a combination of ICD-9 codes to represent the condition.

    According to the initial instruction for category 110-118, Mycoses, you should use additional code to identify manifestation. List the chronic or acute sinusitis for the primary diagnosis. After this code the underlying fungal infection as the secondary diagnosis.

    The following steps will tell you how:

    One: Report the proper sinusitis code for sinus membrane lining inflammation. Code 461.x for acute sinusitis. For chronic sinusitis (frequent or persistent infections lasting more than three months) report 473.x. select the fifth-digit code based on where the sinusitis takes place.

    For instance, for ethmoidal chronic sinusitis, you should choose Code 473.2 (Chronic sinusitis; ethmoidal).Most likely, your otolaryngologist will prescribe a decongestant, pain reliever or antibiotics to treat sinusitis.

    Two: Report the ICD-9 code that represents the fungal infection. Category 117 lists various types of mycoses that offer a more specific diagnosis than 117.9 (Other and unspecified mycoses).For example, think that a patient has chronic ethmoidal sinusitis due to aspergillosis (117.3), an infection that can affect the sinuses and is caused by inhaling the fungus aspergillus, which is found in compost heaps, air vents and airborne dust. You need to enter 473.2 as diagnosis 1 and 117.3 as diagnosis 2 in Box 21 of the CMS-1500 form.

    Even though the otolaryngologist may treat aspergillosis with antifungal drugs, such as amphotericin, itraconazole or voriconazole, some forms of aspergillus oppose these drugs. Therefore the physician may need to treat the patient with caspofungin, a newer antifungal drug. Your otolaryngologist can tend to more serious aspergillosis cases in the sinuses by scraping out the fungus and applying antifungal drug drops.

    Tuesday, May 24, 2011

    Anesthesia coding and modifier 23 use

    Here are some tips to help you get rid of modifier 23 confusions.

    First, you need to know where the service took place. You can add modifier 23 to many procedures that take place outside the OR if your physician provides sufficient documentation. Radiologists carry out an ever-growing range of procedures, many of which require anesthesia because of their invasive nature. But then they might also require anesthesia for MRI procedures, which cross to 01922.

    Even though technically part of the radiology department, the cath lab staff carries out many involved procedures that could require anesthesia.

    Anesthesia during a cast change or removal is an exception more than the rule; however it could be important for small children. You should choose the anesthesia code based on the cast site, such as 01490 or 01680.

    Second, you should know which special circumstances existed. Many procedures that qualify for modifier 23 doesn't normally need anesthesia. Documentation of medical necessity will help justify modifier 23. You should keep a watch for circumstances such as this:

    Parkinson's disease, mental retardation, claustrophobia and cerebral palsy are all valid diagnoses for anesthesia during MRIs, line removals, or other seemingly simple procedures.

    For anesthesia services during non-invasive or invasive radiological procedures and pain management services, children are often considered as special circumstances. Even though the procedure may be relatively painless from an adult perspective, a young child may not be able to remain still or may have been poked and prodded so many times they must be sedated for the procedure.

    Third, you should be aware of what payer guidelines apply. Just like in all cases, you need to check your payer guidelines prior to submitting claims with modifier 23 to see to it that you file right. Modifier 23 definition indicates a procedure which normally requires no anesthesia or local anesthesia, however because of unusual circumstances must be done under  general anesthesia coding. The physician or CRNA must administer general anesthesia and not monitored anesthesia care (MAC) – for the procedure prior to qualifying for modifier 23.

    Remember: It's not enough to know the rules. It does not lead to automatic acceptance. Gear up to appeal any claims with modifier 23 with documentation of medical necessity. What's more include a letter of medical necessity from the patient's primary care physician or surgeon to help boost your position.

    Cpt 2011 And Pediatric Critical Care Bundles

    This year, we saw a whole new crop of bundles with pediatric critical care and transport services. From January 1 this year, CPT changed ( Source cpt http://www.supercoder.com/cpt-codes/ ) which services are bundled into critical care codes 99291-99292 based on whether a facility or professional reports the services. What's more, now CPT returns the list of services bundled into 99466-99467 to the bundles that were in effect as of 2007.

    This year, pediatricians from your practice will still face the following services as being bundled into critical care:




  • Interpretations of cardiac output measurements





  • Chest X-rays
  • Pulse oximetry
  • Blood gases
  • Information data stored in computers
  • Gastric intubation
  • Temporary transcutaneous pacing
  • Vent management
  • Vascular access

    But then, facilities will be able to report these services separately from critical care and will not face the bundles.

    Note: This says that you can use the critical care code only, even if the facility is reporting the critical care codes as well as the separate x-rays, intubation, and other services for that matter separately.

    You should now also stay away from reporting new observation care codes with other evaluation & management. This year CPT has added 99224-99226. Even though confusion surrounded these new codes when CPT first debuted them, some rules have recently come to light on ways you can report them.

    Subsequent observation care: Subsequent observation care starts on the same date as initial observation care codes (99218-99220); nor can you report observation services on the same date as office or emergency department services. What's more, you cannot report the new subsequent observation codes on the same date as observation care discharge (99217).

  • Monday, May 23, 2011

    Family Practice Coding: Foot Claims Success Tips

    So your anatomic terminology tripping up your foot and ankle claims? If so read on for more about some of the more common foot procedures your family physician might face and you will be coding those services like a pro.

    You should build coding foundations with basic knowledge. Sudden impacts, say for instance those from jumping during sports) or simple wear-and-tear can lead to toe, foot and ankle problems. You should know the differences between these diagnoses or you may miss a subtle difference and report the wrong code.

    Medical coding tip: You might need modifiers to help differentiate work on different areas of the feet or toes. These modifiers include LT, RT, TA-T9 and sometimes 59, depending on the service your physician provides. These modifiers become all the more important if the FP performs the same procedure on more than one foot or toe.

    You should check differences between bunions and hallux valgus. A bunion happens to be an enlargement of bone or tissue around the metatarsophalangeal (MTP) joint of the great toe. It's often caused by patients wearing shoes that are too narrow around the toe box and can lead to pain and deformity of the toes.

    You should verify injection rules for Morton's Neuroma, TTS

    Morton's neuroma (355.6) is a thickening of the plantar nerve lying between the heads of the metatarsals. Normally, symptoms include pain, tingling, burning or numbness in the area. This can be caused by wearing shoes with a narrow toe or box or due to sports.

    Doctors conduct a physical exam and many a time use x-rays to diagnose a Morton's neuroma. Rest, orthotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and changing shoes will normally help lessen the patient's pain, however corticosteroid injections may be necessary. In some instances, the family physician might refer the patient to a surgeon for excising the neuroma surgically.

    Compression or entrapment of the posterior tibial nerve causes tarsal tunnel syndrome (TTS, 355.5). This condition is similar to carpal tunnel syndrome in the wrist, however causes pain and numbness at the bottom of the foot. Extreme standing on the feet, varicose veins, bone spurs, athletic injuries, and other issues can lead to tarsal tunnel syndrome.

    Physicians depend on a physical exam to diagnose TTS, normally along with studies including electromyography (95860- 95872) or nerve conduction studies (95900-95905). Once the physician confirms the diagnosis, she'll usually begin conservative treatments such as injections, NSAIDs, rest, and footwear changes. However in some cases, the patient may need surgery. The most common surgical treatment happens to be a tarsal tunnel release (28035).

    PTTD, Plantar Fasciitis may need surgery. Posterior tibial tendon dysfunction (PTTD) takes place when the posterior tibial tendon becomes inflamed, stretched out, or torn because of wear-and-tear or a sudden injury. Normally physicians can diagnose this condition using a physical exam, x-ray, or MRI.