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

\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.

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.

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

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