CPT 2010 adds More Options to Your Vaccine Administration Coding

Earlier Editions of CPT include vaccine administration codes (90465-90468) for children younger than eight years of age. Now CPT 2011adding more options to your Vaccine Administration.

As winter sets in, CPT 2011 will bring some welcome additions to your observation care and vaccine administration coding options. These vaccine administration codes are expected to help boost physicians' bottomlines.

Earlier editions of CPT included vaccine administration codes (90465-90468) for children younger than eight years of age when the physician counseled the patient/family. This time, CPT introduces two administration codes that expand the concept to include adolescents and teens and does away with the distinction based on route administration:

90460 -- Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component

90461 -- each additional vaccine/toxoid component (List separately in addition to code for primary procedure).
You could find yourself relying frequently on 90460 and 90461 if your physician often provides counseling with vaccinations for patients 18 or under. Perhaps part of the supposed need for these codes was the increasing prevalence of multicomponent vaccines. The physician needs to counsel regarding each component; but the coding did not distinguish that higher amount of counseling from counseling for a single component. The switch allows physicians to get credit for each component on which they counsel, and not the number of shots given.

Note: Components drive vaccine descriptors

The new immunization administration codes this time are based on the number of components in the vaccine.

Get a sneak peek on these vaccine administration codes as well the entire CPT code list (http://www.supercoder.com/cpt-codes) for the coming year by signing up for a medical coding guide like Supercoder!

Correct Date of Service is Imperative

OIG released the results of its audit 'Review of Medicare Parts A and B Services Billed With Dates of Service After Beneficiaries' Deaths

On September 23 this year, the OIG released the results of its audit 'Review of Medicare Parts A and B Services Billed With Dates of Service After Beneficiaries' Deaths', which revealed that CMS paid approximately $8.2 million in benefits for claims with dates of service after the beneficiaries' deaths.

The OIG noted that Medicare will only shell out money for expenses 'reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member as medically necessary items or services can't be provided after beneficiaries'deaths, no items or services are allowable' thereafter.

Since the OIG is tracking dates of service by investigating the date the patient passed away, you should make it a point to ensure your ob-gyn practice records the correct date of service (DOS) on your Medicare claims. In many instances, some practices are still charging for services long after their patients died, and it is costing the Medicare system big money.

Correct date of service is very important : Even though many practices might be surprised to find that they've made a mistake like this, the OIG found some problems with claims for over 69,000 deceased beneficiaries between Parts A and B over a two-year period.

Safeguard your practice by following this advice

Watch your date protocol: Sometimes there are errors where practice employees misinterpret the dates that the physician writes down. If the physician notes down '06-04-10,' he might mean June 4, 2010, while someone else might interpret that as April 6, 2010 as the date is written differently by different people."

Advice: If you enter the DOS into the patient's claim form manually, be sure and have a uniform way of writing the date at your practice, between all providers and back office staff members. To add to it, you should cross-reference the DOS against the records for all deceased patients to ensure that you have recorded all dates correctly.

Follow through with other data: If you are making errors on deceased patients' records, it is likely that you have also applied the wrong date on other patients' claims as well. Ensure that everyone in your practice is using the same criteria to apply DOS. If some doctors still write the date with the numbers for the month and year transposed, it might be a good idea to ask all the practitioners to begin writing out the month instead. For example, instead of 06-04-10, you might have to ask everyone to start writing out June 4, 2010.

For more tips on ways to write the correct DOS and for other medical coding news pertaining to this, sign up for a medical coding guide like http://www.supercoder.com/

93270 Calls for Minimum Transimission

As per CPT Assistant if you going to report 93270 you should have check some conditions.


Often, you may be confused over questions such as this: Question: Should you report 93270 even when the only transmission was the test transmission?


The answer is that you should be able to report 93270 in the situation you describe, assuming you meet certain conditions.



As per CPT Assistant (August 2010), prior to reporting 93270, you should check for the following:

The patient got the monitor from the office or facility, or through mail, such as from a monitoring center.

The doctor or facility instructed the patient on proper monitor use (including hookup, recording, and transmission).

The patient sent at least one transmission; the reason being: Patients must send a test transmission when the monitoring period starts to ensure the device is working.
Lesson learned: According to CPT Assistant, when the patient (1) gets both the device and instructions in the mail and (2) the physician or facility staff never instructed the patient directly, you shouldn't report 93270.


You also shouldn't report 93270 if the patient sends no transmissions. CPT Assistant states, “If no tracing is sent, then there can be no report and no reportable service has been provided although the patient received a monitor for a month.

For more updates on this, sign up for a one-stop medical coding website. Onboard such a site, you can even subscribe to a CPT Assistant to get hands on information that can help you bring in the reimbursements. Here, you'll get the annual CPT Assistant newsletter, along with access to CPT assistant back issues (1990 to 2009), at a good discount.

Myths about MUEs

Beware of MUEs as they occur, and you cannot use ABNs to transfer responsibility for payment to the beneficiary.

See to it that you are not letting medically unlikely edits (MUEs) play havoc on your urology practice's coding and reimbursement by unraveling the truth about four aspects of these edits.

The first myth is that MUE edits do not affect your practice

Some practices think that they do not need to worry about MUEs. However, we should be aware of MUEs as they occur.

The second myth is that you can bill the patient to overcome MUE limits

Some practices think that by having the patient sign an advance beneficiary notice (ABN), you can pass on the cost of procedures you know will be denied owing to MUEs. The reality is that you cannot use ABNs to transfer responsibility for payment to the beneficiary.

The third myth is that you can never override an MUE

Do not think that even if your doctor carries out a legitimate, medically necessary procedure that violates MUE edits, you cannot override the edits.

According to CMS, MUEs reflect the maximum number of units the large majority of properly reported claims for a particular code would have; as such you don't need to override them often. However, you can overide an MUE when your doctor carries out and documents a medically necessary number of services that exceed the limit.

Ignorance as far as medically unlikely edits are concerned could be causing you medical coding(http://www.supercoder.com/) claim denials. To know more about medically unlikely edits and to stop denials, sign up for a one-stop medical coding website. Such a site will ensure that you stay updated on all coding know how.

CPT 2011 - Check out just in CT Codes 74176-74178 AMA just released the CPT code list CT Codes 74176-74178. You will see a collection of stent and ang

AMA just released the CPT code list CT Codes 74176-74178. You will see a collection of stent and angioplasty codes.
CPT code lookups, CPT 2011, CPT Code list, Medical Coding

January 2011 is just round the corner. As a radiology coder, you are likely to witness new CT codes 74176-74178. In addition to it, you will see a collection of stent and angioplasty codes for the coming year.

So for those tired of cluttering up your claims with both abdominal and pelvic CT codes, CPT 2011 has the solution you crave. The AMA has just released the CPT code list that you can expect to go into effect on January 1, 2011.

The CPT code list includes the following:

74176 -- Computed tomography, abdomen and pelvis; without contrast material

74177 -- with contrast material(s)

74178 -- without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions.
For more details on this, sign up for a one-stop medical coding website. Such a site will provide proper use of these codes as well as just-in codes for nonvascular extremity ultrasound, revised codes for stent placement, endovascular iliac artery repair, and angioplasty RS&I, and lots more.

Such a site comes with CPT code lookups to assist you in your coding. What's more, when you get onboard such a website, you will stay up to date with all the code changes – be it CPT, ICD-9 or HCPCS codes(http://www.supercoder.com/hcpcs-codes). Keeping such a site handy will also ensure you stay away from claim denials. Such a site doesn't cost you much either. So register yourself for one today and see the difference it brings to your practice.

Anticipate 4th and 5th digit changes for ICD-10

CMS has pointed out that the need to change from ICD 9 to ICD 10 will be effective. You will have to get used to selecting codes with definitions that may differ from what you are used to.
ICD 9 to ICD 10, ICD 9 codes, ICD 10 2010, ICD-10 bridge, Medical Coding

CMS has pointed out that the need to change from ICD 9 to ICD 10 will be effective from October 1, 2013. When that takes place, you will have to get used to selecting codes with definitions that may differ from what you are used to.

Start researching and preparing a minimum of six months prior to implementation of ICD-10. There is a lot for most of us to learn as there are lots of differences; however the payoff will be much greater specificity. One step you can take as of now is to look at the ICD-10 2010 codes that apply to diagnoses you report most often. Remember whether they require different information than their ICD-9 counterparts, and share that information with providers so that they can get used to including that information in their documentation prior to the transition.

For instance: Here's a list of the ICD-10 2010 codes for Hodgkin's lymphoma:

C81.0

C81.1

C81.2

C81.3

C81.4
Excludes1: Nodular lymphocyte predominant Hodgkin lymphoma (C81.0-)

C81.7

C81.9
Even though ICD 10 as published presently lists all codes individually with the full description ( as opposed to the present ICD-9 tabular format), you can witness that like ICD-9, the ICD-10 2010 Hodgkin's codes call for a fifth character for each of the above classifications. The ICD-10 options are pretty similar to ICD-9 codes, except that that you'll have separate ICD-10 options for unspecified site (0) and extranodal and solid organ sites (9). In ICD-9, the two are lumped together under 0.

Compare ICD 9 to ICD 10: There are various one-stop medical coding websites that offer educational materials that you can review; as such there's a lot of good quality yet free information available. Such a site also offers you an ICD-10 bridge to help you make a smooth transition from ICD 9 to ICD 10.

How to Report Cocaine Poisoning

Know how to report cocaine poisoning in ICD 9 Codes 2011.

What will you do when the emergency department calls your cardiologist to care for patient with cocaine poisoning? Well, a just-in code effective October 1, 2010 changes what you should report. Now, post the ICD 9 codes 2011 changes, there is 970.81 which is available when you need to report cocaine poisoning.

Get on top of this critical care scenario

Patients with cocaine poisoning can be very complex, extremely sick and are potential critical care cases. Here's a detailed example: A 22-year old patient presents with acute chest pain and hypertension. History reveals that he inhaled four lines of cocaine within the past hour and has been abusing cocaine for the past year. The physician carries out and documents a thorough history and exam.

Diagnostics cover a cardiac panel and drug screen, and an electrocardiogram (ECG) reveals ST elevation in the anterior leads. Lab work shows elevated CPK and troponin. The doctor tends to the patient with intravenous valium and starts him on a nitroglycerin drip. The doctor then admits the patient to the critical care unit with anterior wall ST segment elevation myocardial infarction (STEMI) owing to cocaine poisoning and hypertension. The doctor reports 45 minutes of critical care time.

Here's the solution: You should report the following for this particular encounter: 99291, 970.81 and 401.9.

For more information on cardiology-related codes that went into effect on October 1, sign up for a one-stop medical coding website. So if you're looking for all the ICD 9 codes(http://www.supercoder.com/icd9-codes/) 2011 changes that went into effect recently, this is the place to be!



ICD-9, ICD 9 Codes 2011, Medical Coding

Include wound repair in free grafts to stay away from denials

Do you often code separately for wound repair when your dermatologist carries out a free-flap graft procedure? If so, you need to watch out as the latest CCI 16.3 will have you changing this habit soon.
The new revision, that went into effect on October 1, creates a coding bundle naming simple wound repair codes 12001-12007 and and 12041-12047 as intrinsic parts of

15756 -- Free muscle or myocutaneous flap with microvascular anastomosis

15757 -- Free skin flap with microvascular anastomosis

15758 -- Free fascial flap with microvascular anastomosis. What does this mean?

In the above pairings, CCI lists the wound repair codes as column 2 codes, which means they are considered components of the more comprehensive codes under Column 1. Medicare and other private payers who follow Medicare payment rules will not pay for two bundled codes billed for the same patient on the same day; payers will not pay for the Column 2 code and reimburse only for the Column 1 code.

Do not miss: These bundles have a modifier indicator of '1'. As such, you may use a modifier like 59 to override the edit if the clinical circumstances warrant deparate reimbursement like a separate encounter on the same date, a separate anatomical site or a separate indication.

For more on the latest CCI edits and other medical billing training, sign up for a one-stop medical coding website. Such a site comes with a CCI Tool(http://isupercoder.blogspot.in/2010/10/how-to-report-cocaine-poisoning.html) that tells you if CCI bundles a code combination and if the edit allows a modifier. In fact, you can stay tuned to the latest on CCI edits by signing up for this one-stop medical coding website.

Three warnings you need to watch out for when using E codes

E codes point to the external causes of injuries and poisonings as well as the adverse effects of drugs and substances.

If you report injuries or poisonings, then you certainly need to be familiar with E codes. But before you turn to these codes, make it a point to keep these three things in mind that will prevent your claim from getting tripped.

Do not lose the purpose of E codes E codes point to the external causes of injuries and poisonings as well as the adverse effects of drugs and substances. They are thought of as special ICD-9 codes which you can generally use to report accidents, injuries or diseases. You can report E codes with regular ICD 9 codes.

This is a no no: You shouldn't report E codes as your primary code as they only indicate the cause of injury/poisonings and not the resulting injury/condition. Like always, report E codes in addition to a numerical ICD-9 code that describes the injury itself. It might be needed to assign more than one E code in order to explain each cause fully.

Be specific about your E codes Increasing E code reporting can benefit auto insurance companies, disability insurers, health insurance plans, public payers, health care purchasers, employers, businesses, labor unions, schools and other entities interested in injury prevention and safety issues. However does it provide too much 'up-front'know how about the patient's behavior/lifestyle?

Take more risks while reporting certain E codes There are E codes for reporting surgical mishaps, including E876.6, E876.7.

Although you could bill these codes when the need arises, you would want to keep hoping you may never have to come face to face with these 'need'. These two just-in codes describe situations that are considered 'never' events, which means they represent surgical mistakes that should never happen.

For more information on E codes and other ICD 9 codes information, sign up for a one-stop medical coding (http://www.supercoder.com/) website.

We provide you simple, instant connection to official code descriptors & guidelines and other tools for 2010 CPT code, HCPCS lookup that help coders and billers to excel in the work they do every day.

ICD 9 codes, medical coding, E codes

Match your 35475, 35476 Coding to the Latest Change

Latest CCI Codes versions have lot of changes for angioplasty of arteriovenous dialysis grafts. Match your 35475, 35476 coding to the latest change.
CCI Edits, CCI Edit, CCI Codes, Medical Coding

2010 has been a year of changes for coding angioplasty of arteriovenous dialysis grafts. The latest CCI codes version, that went into effect on October 1, 2010, adds to the list with a column swap that could be good news for your practice.

Begin with the 35475, 35476 edit facts

The codes involved in the edit are the following:

35475, 35476

Old way: Until October 1, CCI's edit for 35475 and 35476 resembled something like this:

Column 1 Column 2

35476 35475

As a result, 35475 (arterial) was bundled into 35476 (venous).

Know how column change impacts fee

As per CCI rules, if you report both codes in a column 1/column 2 edit pair to Medicare or another payer who adopts CCI edits, the payer will reimburse you for the code in the column 1 position only. Medicare's national rate for 35475 is more than 35476; as such the column swap places the higher valued code in the column 1 position.

Compare CCI edit to coding recommendations

This new CCI edit column swap comes on the heels of other key 2010 changes for coding percutaneous transluminal angioplasty (PTA) of arteriovenous (AV) grafts and fistulas.

For more on the latest CCI edits(http://www.supercoder.com/coding-tools/cci-edits-checker/), sign up for a one-stop medical coding website. Such a site comes with a CCI tool that helps you keep your claims compliant with the NCCI. This tool tells you whether CCI bundles code combination and if the edit allows a modifier. Sign up for one today and see the difference it brings to your practice reimbursements!

Let Add-on Codes Add to Your 92980 Bottom Line

CPT's parenthetical notes following 92980-+92981 offer rules for proper reporting that you cannot afford to miss.
CPT codes lookup, CPT Code list, CPT Assistant, Medical Coding

Prior to making your coding decision, identify the vessels involved.

CPT's parenthetical notes following 92980-+92981 offer rules for proper reporting that you cannot afford to miss. The notes reveal the following key points on what is and is not included.

Include these same-artery services

CPT's parenthetical notes following 92980-+92981 offer rules for proper reporting that you cannot afford to miss. The notes reveal the following key points on what is and is not included.

Include these same-artery services

CPT states that coronary angioplasty and/or atherectomy in the same artery as the stent placement is not separately reportable for the same encounter.

Separate vessel could mean separately reportable

If your cardiologist carries out stenting in one coronary vessel, and angioplasty or atherectomy procedures in a different coronary vessel, the angioplasty or atherectomy is not included in the stent code. As such, you may report those services separately.

Article Source :- http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/stent-coding-let-add-on-codes-add-to-your-92980-bottom-line-article 

Important: When coding interventions on more than one coronary vessel during the same session, the first code should be for the highest level procedure carried out on any vessel.

The hierarchy is stenting before atherectomy prior to balloon angioplasty.

Bonus tip: Remember that proper reporting for the above two-vessel instance calls for reporting the ‘single vessel' stent code 92980 with ‘additional vessel' code 92982 as the codes represent two different types of procedures. However CPT guides you to the right codes by stating under the stent codes. To report additional vessels treated by angioplasty or atherectomy only during the same session. That apart, CPT Assistant (December 1996) indicates that 92980 with +92984 is proper coding for stent placement in one vessel and angioplasty in another.

For more on this and the entire CPT code list, sign up for a one-stop medical coding website. Such a site comes with a CPT codes lookup tool to assist you in your coding and help you get the rightful reimbursements.

Specificity in Diagnosis Coding is Important in ICD-9 Codes

Specificity in Diagnosis Coding is always important in ICD-9 Codes. Should know the appropriate Codes that can help you handle the situation.
ICD-9 coding, ICD-9-Codes, ICD-9 changes, Medical Coding

Your interventional radiologist may be tending to more patients complaining of chronic pain. Trouble crops up when you don't see documentation of a definitive diagnosis for the visit. You should know the appropriate codes that can help you handle the situation:

Why specificity in diagnosis coding matters

Specificity in diagnosis coding is always important; however it's increasingly vital as third party payers are establishing more stringent coverage criteria for therapies and procedures and are using automated edits to deny claims based on the lack of a covered diagnosis.

Using a non-specific diagnosis code which may be 'close' – however not exact – may mean you won't be paid for a service due to a Medicare LCD or a third-party medical policy. If you opt for non-specific codes, it might also mean you receive payment for a service that would not be covered under the right diagnosis.

Both these situations come up with different problems. Making use of the most specific diagnosis for the patient and ensuring it's well documented in the medical record will help ensure the right reimbursement for the provider and appropriate coverage for the patient.

The reality is: Using the wrong diagnosis may limit coverage or may get you paid for the services that are not covered, which increases your risk during audit.

For more on this, sign up for a one-stop Medical Coding website. Onboard such a site, you can get all the just-in ICD-9-codes under one roof. Pretty soon, you'll realize that staying tuned to the ICD-9-Changes is an easy thing.

Rid 'uncertain behavior' confusion with sure-success tips on 238.2 use

To reduce denials follow experts tips and see it that you are choosing right diagnosis code for all your claims.
updated codes, stop denials, reduce denials, CPT code, Medical Coding

If you always use diagnosis code 238.2 when reporting 11100 for a biopsy procedure your dermatologist carries out, you are setting your practice up for disaster. The key to knowing when to use the 'uncertain behavior diagnosis code is understanding what that code descriptor really means. Follow these expert tips to reduce denials and to see to it that you are choosing the right diagnosis code for all your 11100 claims.
Wait for pathology prior to selecting a code

When your dermatologist carries out as biopsy, you should always wait until the pathology report comes back to select the proper diagnosis and procedure codes to report even though this'll not always have an impact on the CPT code you will choose.

Know the meaning behind 'uncertain' codes

When you report 238.2 as the diagnosis for a biopsy procedure, you are telling the payer what the pathologist said in his path report – that he was uncertain as to the morphology of the lesion. Uncertain behavior doesn't mean that the coder is not certain or that the doctor thinks the lesion looks suspicious although it might be benign.

Uncertain behavior means that a specimen has been examined by a pathologist and that the cells are of mixed types.

Do not rush coding just to get paid

You shouldn't code just to make sure you will be paid for a procedure. In the case of a biopsy, waiting to code until you have the pathology report shouln't affect your reimbursement anyway. You may have to wait a bit longer to get the reimbursement if you need to hold a claim while you wait for the pathology report; however your coding will be more spot on. If you biopsy a lesion and the results come back as precancerous, this is exactly the diagnosis you would use so that it is a perfectly payable diagnosis. On the other hand, insurers are looking for more reasons to deny payment. If you had carried out a biopsy and indicated that the patient has hyperplasia and then the physician found out that the biopsy indicated melanoma and the patient returned to have excision of the melanoma and the insurer ever compared the documentation there could be problems.

CCI Edits 16.3: Include Wound Repair In Free-Flap Grafts or Risk Denials

Latest CCI edits addresses another aspect of your skin graft coding with a new edit bundling 11040 as a component of 15002.
CCI edits, CCI edits 16.3, CCI tool, Medical Coding

The latest CCI edits 16.3 that went into effect on October 1 this year creates a coding bundle naming simple wound repair codes 12001-12007 and 12041-12047 as intrinsic components of 15756, 15757, 15758.

What does this mean? In the above pairings, CCI lists the wound repair codes as column 2 codes, which means they are considered components of the comprehensive codes (15756-15758) under Column 1.

Do not miss: These bundles have a modifier indicator of one; as such you may use a modifier like 59 to override the edit if the clinical circumstances merit separate reimbursement like a separate encounter on the same date, a separate anatomical site or a separate indication.

Catch this debridement/site prep bundle

The latest CCI edits addresses another aspect of your skin graft coding with a new edit bundling 11040 as a component of 15002. This edit indicates that Medicare considers debridement to be an essential component of site prep procedures. But CCI has also marked these bundles with modifier indicator 1 so you may report 11040 along with 15002 or 15004 under appropriate clinical circumstances with an appropriate modifier.

New edits target hematoma, nail repair

From October 1, CPT code 11740 includes 11730. As with other CCI edits, these bundles are marked with modifier indicator '1', allowing separate reporting if clinically necessary, with the right modifier appended to the component (column 2) code.

These would not be used together on the same site. They would have to be carried out on different nails.

For more on the latest CCI edits, sign up for a one-stop Medical Coding website. Such a site comes with a CCI Tools(http://www.supercoder.com/coding-tools/cci-edits-checker/) that tells you whether CCI bundles a code combination and if the edit allows a modifier, among a host of other information pertaining to CCI edits.

Differentiate Wound Repair versus Tissue Transfer to Achieve Proper Coding

Surgeon carries out a wound repair closure, could be miscoding if turn to 12001-13160 automatically.
CPT Code list, CCI guidelines, Medical Coding

When your surgeon carries out a wound repair closure, you could be miscoding if you turn to 12001-13160 automatically. You need to dig deep into the surgeon's documentation to see if the tissue transfer code is more apt. However knowing the difference between wound repairs and tissue transfers is only the start. See to it that your surgeon gets the reimbursement he deserves:

Know the difference between transfers and repairs
For wound closure procedures, you will first need to decide between wound repair codes 12001-13160 and adjacent tissue transfer codes 14000-14300.

Determine overall area and location
According to CPT instructions, once you determine that your surgeon carried out a tissue transfer, you will need to narrow down your code selection by determining the total area of the primary and secondary defects.

After adding up the affected area, look at the repair's anatomical location to narrow your choices further.

Skip separate lesion removal coding

You shouldn't separately report any lesion removals your surgeon carries out during a tissue transfer procedure. The excision of the benigh lesion or of the malignant lesion is not separately reported with the tissue codes. This guidance is reinforced by both CPT and CMS/CCI guidelines.

Exception: If your surgeon carries out an excision on a separate day from the tissue transfer, you may go on to report the procedures separately. You might stand witness to this scenario if your surgeon is waiting for the pathology report to be sure the lesion margins are clear prior to closing the operative wound. If the tissue transfer takes place during the excision's 10-day global period, go for modifier 58 to the tissue transfer code.

Article Source :- http://www.supercoder.com/coding-newsletters/my-general-surgery-coding-alert/wound-repair-differentiate-wound-repair-vs-tissue-transfer-to-achieve-proper-coding-in-just-3-steps-article