\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.

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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