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

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.