Avoid Leaving Split Antepartum Care Dollars On The Table

If you ob-gyn's providing only one-two visits, here's what you should submit.

When it comes to coding split antepartum visits, do not shortchange your practice. Depending on the number of visits your ob-gyn provides, you'll report either an evaluation & management visit or one unit of an antepartum visit code. Take this challenge and see how you fare:

Question 1: Establish antepartum care definition

According to CPT, antepartum care is inclusive of monthly visits up to 28 weeks gestation, bi-weekly visits up to 36 weeks gestation, and weekly visits until delivery.

Answer is true. Ob services include obtaining the patient's history, carrying out a physical exam, recording vital statistics, and doing other examinations required to provide safe and proper care for the mother and fetus.

Question 2: Splitting visits mean no global is it?

When you split out antepartum care for a patient halfway through her pregnancy, you should totally throw out global ob package codes.

Answer is true.

When your obstetrician shares routine maternity care with a doctor outside a group practice owing to transferring into or out of your practice, you'll have to get rid of the following global codes: 59400, 59510, 59610 and 59618.

Don't break the package just because a maternal fetal specialist also tends to the patient for a few visits during pregnancy owing to complication.

Question 3: Depend on evaluation & management code for this number of visits

If the patient had a total of one to three antepartum visits, report the proper level of evaluation & management service for each visit when the DOS that the visit took place and the diagnosis for why the patient was seen.

The answer is true. This is correct as per the American Congress of Obstetricians and Gynecologists (ACOG) and CPT guidelines.

For instance, if the physician sees an ob patient a couple of times prior to moving to a different area, you would use the proper E/M code (99201-99215) for each visit with V22.0 or V22.1.

Question 4: Be careful of your antepartum visits

If the ob-gyn tends to the patient four to six times prior to leaving his care, you'll report 59425 for each instance the ob-gyn sees the patient.

The answer is false. You should use 59425 one time only. Since this code represents the total work involved with all the visits, you should submit it only once with '1' in the units box of the CMS-1500 claim form. What's more, be sure to include the 'to' and 'from' dates during which the services took place. Enter the first prenatal visit in box 15 and enter only the last visit the patient was seen for prenatal care in box 25a.

394.2's ICD-10 Replacement Specifies 'Rheumatic'

I05.2 gives you a good lesson in why your superbill's font matters.

Valve disease diagnosis codes are confusing without a doubt. Get a head start on mastering these diagnoses under ICD-10 with a look at how one of your ICD-9 choices will change when ICD-10 goes into effect in a couple of years' time.

394.2- (Mitral stenosis with insufficiency) - ICD 9 CM code

I05.2- (Rheumatic mitral stenosis with insufficiency) - ICD 10 CM code

Dx definition: Mitral stenosis refers to narrowing (stenosis) of the heart's mitral valve, situated between the left atrium and left ventricle. When the doctor additionally documents insufficiency (or incompetence or regurgitation), you should take a look at the codes listed above. "Rheumatic" happens to be a reference to rheumatic fever, a disease which may end up in heart damage.

Rheumatic: 394.2 is not specific to "rheumatic" mitral stenosis with insufficiency. The ICD-10 descriptor for 105.2 includes the term 'rheumatic', however the 'includes' note under I05 (Rheumatic mitral valve disease) specifies that the range is proper for conditions 'whether specified as rheumatic or not'. Therefore of the documentation specifies the case is rheumatic or if it does not mention the cause, I05.2 will be proper. On the contrary, of the documentation states the disease isn't rheumatic, you'll go for a code from I34.-.

Multiple valve involvement: For 394.x (Diseases of mitral valve), ICD-9 has an excludes note telling you to instead use 396.x if the patient also has aortic valve involvement.

Likewise, ICD-10 guides you to use a different code range (not I05.-) for mitral valve disease if there's aortic valve involvement. You'll instead use I08.- (Multiple valve diseases). This is the same range ICD-10 guides you to use if the patient has tricuspid valve involvement apart from mitral valve disease.

Documentation: In order to ensure you'll be able to choose the most proper ICD-10 code, your clinicians' documentation must point to whether the condition is rheumatic. Also it should specify whether the mitral valve alone is involved.

When you make your ICD-10 coding tools, ensure the "rheumatic/nonrheumatic/unspecified" rules clear, and refer coders to I34.- for non-rheumatic cases. Similarly emphasize that I05.2 is for mitral disease only. If other valves are concerned, the proper code will be found in the I08.- range.

Tip: Just as 394.2, I05.2 is right for mitral stenosis with incompetence or regurgitation; as such stay alert for those terms.

As such, is that a 1 or an I? A 0 or an O? You should distinguish between similar looking characters when you are assigning ICD-10 codes. Code I05.2 is great example of a code that comprises easily confused characters. Bear in mind that your first character is a letter and will be followed by digits. As such I05.2 is the letter "I" followed by the number "0."

Bear in mind: When ICD-10 goes into effect, you should apply the code set and official guidelines in effect for the DOS reported.

Source URL :- http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/icd-10-3942s-replacement-specifies-rheumatic-get-the-details-here-article

Joining an ACO Will Benefit Practices: CMS Outlines How

Going by the "shared savings program, accountable care organization (ACO) participants will collect a part of the amount the agency saves.

You have probably heard about Medicare's proposed 'shared savings program,' which will utilize ACOs to boost patient outcomes and bring down costs. However, that changed this week as the agency announced that it wrote a proposed rule for the program outlining what it'll cover.

What are ACOs?

ACOs aim to use coordinated care between health care providers to put the 'beneficiary and family at the center of care'. ACOs include several healthcare professionals who work together, including physicians, hospitals, and other members of the patient's care team. This 'case management' approach is meant to offer patient-centric care, thus resulting in better outcomes and lower costs.

As per the proposed rule, that appeared in the April 7 Federal Register, health care providers who participate in ACOs will be rewarded since Medicare will link payment rewards to patient outcomes. For example, the proposed rule notes that providers should be accountable for the cost of care, and be paid for reducing unnecessary expenditures and be responsible for excess expenditures.

Healthcare providers won't be required to join ACOs, however those who join will share the funds that CMS saves by using the system. Physicians will gather their portion of the shared savings as bonuses under the system. The ACOs are eligible to share in savings up to 52.5 percent under the one-sided model; however up to 65 percent under the two-sided model.

The one-sided model refers to a standard shared savings kind of plan in which ACOs wouldn't be responsible for any portion of the losses above the expenditure target. The agency recommends this model for "ACOs not immediately ready to accept risk, say for instance, physician-driven organizations and smaller ACOs, the proposed rule points to.

While the two-sided model explains a shared savings/losses plan, in which the ACO would share in savings and risk liability for any losses. All one-sided ACOs will mechanically become two-sided ACOs by the third year of the program.

ACOs would gather their bonuses based on how they meet 65 quality performance standard measures separated into the following five categories:

Patient/caregiver experience

Care coordination

Patient safety

Preventive health

At risk population/frail elderly health

You can submit comments on the ACO program through early June through email to www.regulations.gov or through the mail.

Incident to Services for Allergy Shots?

Here is a question and answer that will help you while doing your daily otolaryngology coding job.

Otolaryngology coding scenario: I would like to get verification on billing for allergy testing (95004), allergen prep (95165), and allergy injections (95115 or 95117). In actuality, our nurse is the person doing all of these procedures and then the physician takes a look at the information at a separate time. Does a physician need to be present in the office at the time any of these procedures are being carried out?

Allergy shots are a therapeutic service and therefore fall under incident to services. Therefore, this falls under the incident to rules. This means that a doctor or a non physician practitioner must be in the office suite when the injections are administered. As per Medicare rules, you should bill the injections codes (95115 and 95117) under whatever provider is present in the office – the physician or the non physician provider.

Preparation of the allergen serum (95165) and allergy testing are diagnostic services; they don't fall under incident to rules, instead fall under the Medicare supervisory rules for diagnostic services, which happen to look exactly like incident to services. As the supervisory level for the diagnostic services for most of the allergy testing looks exactly like incident to level, many people get the two rules confused. As such, for most of the codes, a physician or non physician practitioner must be in the office. Some of the higher risk allergy testing codes, such as 95065, (Direct nasal mucous membrane test) have a supervision level of ‘personal supervision', which means that the doctor must be in the exam room with the patient when the testing takes place.

CPT 95165, (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) doesn't require physician per the supervision guidelines from Medicare.

As far as other payers are concerned, it is dependable on their policies for billing for the supervision of diagnostic procedures and incident to services for the allergy shots. You should get all your non Medicare policies in writing.

Do's And Don'ts of E-Prescribing Program

As CMS published the first set of adopted standards, known as the foundation standards, in January 1, 2006, common misconceptions have clouded practices' awareness of eScribing. Here's the inside scoop on what you should do and what you should know to turn your ePrescribing program into a success by finding out if the following claims are true of false.

Claim 1: Faxing Prescription to a pharmacy will meet the requirements of eScribing

Well, this is false. You need to send the prescription electronically, and not by fax. Some network that sends the electronic prescription to a pharmacy would convert it into a fax since the pharmacy does not have the capability to get an electronic prescription. In this instance, the process still counts as eScribing.

On the contrary, if your eScribing system is only capable of sending a fax directly to the pharmacy, the system is not qualified as an eScribing system. For CMS' detailed system requirements on eScribing at the Measures Specifications information online (Measure #125), go to www.cms.gov/ERxIncentive.

Claim 2: CMS needs a fully implemented EMR or EHR before you can use and take advantage from eScribing

False: You have two types of system to look at:

1) A system for e-prescribing only (a "stand-alone" system)

2) An EHR system with eScribing functionality

Key: Do not rush in buying your EHR and implementing it when you're not ready, just get it up in time to stay away from your eScribing penalties. You are going to be wasting more money in both purchasing the wrong EHR and spending resources implementing the wrong EHR just to avoid penalties.

You want to ensure that you select the right EHR for you: You research to choose the proper EHR which takes a great deal of time and investigation, then you order the right system; you gear up for the implementation; and you do a good staged implementation of the system for a successful EHR that will be used rightly in the practice. This takes time – somethimes up to a year for selection, training, and implementation.

You can select from a number of stand-alone eScribing systems that're independent of EMR or EHR.

Claim 3: You should not have a tough time implementing eScribing

True: eScribing is technology light and comparatively easy to implement within the office. As a matter of fact, you only have meet four criteria in order for your eScribing system to qualify for the eScribing Incentive Program. According to CMS, it must:

Generate a complete medication list that incorporates data from pharmacies and benefit managers

Choose medications, transmit prescriptions electronically using the applicable standards, and caution the prescriber of possible undesirable or unsafe situations

Provide information on lower-cost, therapeutically-appropriate choices (for 2009, tiered formulary information( if available) meets this requirement);

Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements got electronically from the patient's drug plan.

For further details on this, sign up for a one-stop medical coding guide like Supercoder.com

Consider DOS while Billing 43235 with 91035

Recently, in a particular volume of a gastroenterology coding alert, a reader enquired about which codes to use when billing a Bravo capsule placed during EGD. To my knowledge, 91035 includes endoscopy. But then the answer provided in the question was to bill 43235 and 91035. Can you throw some light on this?

Answer: Well, what was not made clear in the simple answer provided was the billing dates for each code. Normally, a physician needs to carry out an EGD to assess the symptoms which are also prompting the use of a Bravo capsule. To place a Bravo capsule, the doctor needs to be aware of the location of the lower esophageal sphincter or squamocolumnar junction. You should be careful here as this is where it gets dicey.

When an endoscopy is performed to look into symptoms then the endoscopy procedure will be billed on the date it was performed with the ICD-9 code representing the patient's symptoms. Depending on the service, the CPT code might be 43235 or 43239. During the same session, the doctor might also decide to place a Bravo capsule using the measurements got during the endoscopy (billable with 91035). The date of service for the claim for the Bravo capsule will be when the recorder is retrieved two-four days later and the doctor is sure that data was captured for analysis.

But then, if the gastroenterologist carried out an endoscopy recently (roughly within several months) to assess the symptoms at some date prior to Bravo placement, then it shouldn't be necessary to repeat it just to get the location needed for the Bravo capsule placement. The second endoscopy would not be medically necessary and as such not separately billable. You should make it a point to include this in the Bravo claim.

Don't Fall a Victim to Modifier 22 Catch-22

Remember that details or the lack of it on physician's notes can make or mar your claim.

If you overuse modifier 22 (Increased procedural services) you could face increased scrutiny from your payers or even the OIG. However if you stay away from the modifier completely or use minimally, you are likely missing out on payments your otolaryngologist deserves. What's more, if and when the modifier 22 is used, it's the documentation that'll hold the pillars that support the case for additional payment.

How it functions: When a procedure calls for significant additional time or effort that falls outside the normal range of services described by a particular CPT code and no other CPT code better describes the work involved in the procedure, you should turn to modifier 22. This modifier represents those extenuating circumstances that don't merit the use of an additional or alternative CPT code however instead when used will raise the payment for a given procedure.

Take a look at this case and see to it that you don't fall victim to the modifier 22 catch-22.

Here's a scenario: A morbidly obese patient with abnormally small tonsils and a small mouth requires the otolaryngologist to reposition the tongue blade from one area to the next in order to see the tonsils in their totality.

For morbid obesity do not tag automatic 22

In the provided situation, it is proper to add modifier 22 to 42145 (Palatopharyngoplasty [e.g., uvulopalatopharyngoplasty, uvulopharyngoplasty]). But then it is not proper to assume that just because the patient is morbidly obese you can always append modifier 22.

This modifier is about extra procedural work and even though morbid obesity might lead to extra work, it is not enough in itself. Unless time is significant or the intensity of the procedure is increased owing to the obesity, then modifier 22 shouldn't be added.

Do not tag automatic 22 for morbid obesity

In this situation, it's proper to add modifier 22 to 42145 (Palatopharyngoplasty [e.g., uvulopalatopharyngoplasty, uvulopharyngoplasty]). However, it's not appropriate to assume that just because the patient is morbidly obese you can always append modifier 22.

Modifier 22 is about extra procedural work and even though morbid obesity might lead to more work, it's not enough in itself. Unless time is significant or the intensity of the procedure is increased owing to the obesity, then modifier 22 shouldn't be added.

Take a look at the notes: In order to support adding the modifier, your otolaryngologist should document how the patient's obesity increased the complexity of that particular case. CPT specifically recommends that physicians document the reason for the added effort such as increased intensity, time, technical difficulty of procedure, increased risk, severity of patient's condition, physical and mental effort needed.

Even though you can (in theory) add modifier 22 based only on the description of the work in the body of the note, practically, it's not possible to get the payments if you do not quantify the extra effort.

Remember: Indicate the patient's BMI in the documentation and on the claim to support your modifier 22 use as well when you're basing the modifier use on obesity. Report the proper code from the 278.0x (Overweight and obesity) range and the matching V code (V85.0-V85.54, BMI).

Four Best Practices to Set Your Practice on an Improved A/R Track

If you are not following up on details, you are leaving money on the table.

The economic downturn in addition to impending healthcare changes means that your practice and all other dollars are under more pressure than ever to gather every penny you deserve.

Accounts receivable defined: A/R is the money that is owed to the practice. Here are four best practices to set your practice on an improved A/R track and stay away from thousands in lost reimbursement.

Keep a tab on each claim you send out

The first thing in perfecting you're A/R process is to ensure someone in your practice is paying heed to what happens to every claim you submit. Ask questions like "Did the patient pay her copay portion of the bill?", "Did the insurance company even get the claim?"

There are companies out there which many refer to as 'code it, bill it, and forget it companies'. They code the claim, bill the claim and then forget about it. They leave it out there and do not do anything to bring in the money.

Following up on your submitted claims early in the game can save you time. Therefore you should first ensure that once your practice submits a claim that is accepted. If the claim is rejected, the first thing you need to do is find out why. Catching it in the initial submission phases saves you time in the long run and in the end gets your money in the door faster.

Set a reminder: Place an event reminder on your Outlook or Web calendar every week that reminds you to check all accounts receivable for the past 30 days. Print a report, and go online or call to check claim statuses.

Follow up on unpaid and denied claim

The number one way to ensure your practice is hemorrhaging money is to follow up on denials and appeal as called for. Almost every practice has hidden money waiting to be discovered. According to him, money is in the form of the following issues:

Unpaid claims

Claims paid incorrectly

Denials not appealed or appealed incorrectly

Denials appealed with no follow-up.

You should therefore continually review and monitor your EOBs, paying special attention to your denials. You can glean a lot of information from your EOBs; say for instance how quickly insurers are paying you, whether your fee schedule is adequate, if your coders are coding right, etc.

Bottom line: Appealing denials can be time consuming; however it's vital to ensure correct reimbursement.

Source URL :- http://www.supercoder.com/coding-newsletters/my-medicare-compliance-reimbursement-alert/part-b-coding-coach-boost-collections-with-these-4-quick-tips-122606-article

Run reports and update you're A/R procedures

You cannot manage your A/R is you cannot measure it. As such you need to produce a variety of reports to help you assess you're A/R.

Tip: Invest in a good practice management system and get to know all of its capabilities. Pay special attention to the reporting abilities of the system you use to ensure you get the data you need to manage your practice's A/R such as the practice's gross collection rate, net collection rate, and average days in A/R for claims. Then you can use this information to assess the effectiveness and efficiency of your practice's A/R management.

37228-+37235: Four Steps to get TP trunk Services Pay

With a new section for endovascular revascularization in this year's CPT, you'll need to ensure your practice is up to date while billing for tibial/peroneal revascularization services.

Remember initial/additional designation

CPT 2011 divides the just-in codes by initial or additional vessel -- each including angioplasty in the same vessel, when the surgeon performs it -- as here:

Initial vessel: The first four codes apply to the initial tibial or peroneal vessel treated in a single leg:

Angioplasty: 37228

Atherectomy (and angioplasty): 37229

Stent (and angioplasty): 37230

Stent and atherectomy (and angioplasty): 37231

Additional vessel: Report the remaining four add-on codes to report services on each additional ipsilateral (same side) vessel treated in the tibial/peroneal territory:

Angioplasty: +37232

Atherectomy (and angioplasty): +37233

Stent (and angioplasty): +37234

Stent and atherectomy (and angioplasty): +37235
Revascularization general rule: You should report the one code that represents the most intensive service performed in a single lower extremity vessel. All lesser services in that vessel are included in that one code.

Count vessels carefully – more so for TP Trunk

The just-in revascularization codes (37220-+37235) apply to different "territories." Each territory has its own specific set of guidelines. Codes 37228-+37235 come under the tibial/peroneal vascular territory.

The tibial/peroneal arteries include anterior tibial (AT), posterior tibial (PT) and peroneal. This means the just-in codes relate to three vessels in each leg for the tibial/peroneal territory. Since you may report one code per vessel, you may use one initial code and up to two add-on codes per leg (for a total of three vessels). The three-vessel approach is somewhat similar to the iliac territory; however differs from the femoral/popliteal territory, which counts as a single vessel for coding.

Master coding for two legs or two territories

The just-in revascularization codes are unilateral, which means they apply to a service on a single side of the body. CPT indicates that if the doctor treats the identical territory in both legs at the same session, you should add modifier 59 (Distinct procedural service) to show both legs are involved.

However, watch out for payers' modifier preferences. Some may prefer you to use modifier 50, modifiers RT and LT or some combination of modifiers for procedures on both legs.

On the contrary, If the surgeon treats more than one territory in the same leg, you should report multiple codes, says CPT.

Consider included services

According to CPT guidelines, the endovascular revascularization codes include these services: accessing and catheterizing the vessel, crossing the lesion, any radiological supervision or embolic protection, arteriotomy closure, and imaging of the completed intervention.

Extras: If the doctor caries out mechanical thrombectomy (such as 37184-+37185, primary, or +37186, secondary), thrombolysis (such as 37201, 75896), or both to restore blood flow to the occluded area, according to CPT, you may report those services separately.

Article Source :- http://www.supercoder.com/coding-newsletters/my-general-surgery-coding-alert/cpt-2011-37228-37235-4-steps-garner-tp-trunk-services-pay-article

Code-Specific Primer to Work for Your Claims

Getting on top of the new codes and pages of new guidelines this year's CPT introduced for cardiology is no easy task. Therefore to make it easy for you, here's a code-by-code as well as a briefing on when you shouldn't assign these codes on your claim.

Begin here: The codes in spotlight are:

93451 - Right heart catheterization (RHC) including measurement(s) of oxygen saturation and cardiac output, when carried out

93452
93453

Tip: Right Heart Catheterization: 93451 applies to a narrow group

Code 93451 approximately replaces 2010 code 93501 (RHC). However, prior to choosing new code 93451, you need to be sure you understand when it applies and the many cases when another code would be more apt.

RHC defined: As per CPT guidelines, RHC includes cath placement in the right-sided cardiac chambers or structures. This includes the right atrium (RA), right ventricle (RV), pulmonary artery (PA), and wedge locations.

According to CPT 2011 guidelines , RHC also includes taking blood samples to measure blood gases and measuring cardiac output if the doctor performs them. This may include oxygen saturations, wedge pressures, and thermodilution studies.

Coding tip: Medical coders who had pre-2011 RHC, reviewed note that auditors wanted to see all right heart chambers and structures documented to support the RHC code. This means that if the doctor cannot enter one of the structures or chambers, he should explain briefly why to make the documentation complete.

Beyond 93451: CPT includes an instruction under 93451 telling you not to report the code with 93453 (combined RHC and LHC) or with 93456, 93457, 93460, or 93461 (which all include RHC apart from other services). One more time you should stay away from reporting 93451 is if the RHC is for a congenital case. After this you should report 93530 (RHC, for congenital cardiac anomalies) in place of 93451.

Bonus tips: According to CPT guidelines, you shouldn't report 93503 with 93451 or any other diagnostic cardiac cath codes. What's more, you should not append modifier 51 (multiple procedures) to 93451. And if you code manually, take extra care not to swap your digits.

Left Heart Catheterization: 93452 Covers ventriculography, too

If the cardiologist catheterizes only left heart structures, you will need to find out whether your 93452 is proper for your LHC case. Code 93452 roughly covers the same services you would have coded last year using 93510 and 93555.

LHC defined: The main indicator for LHC is that the doctor crossed the aortic valve. According to CPT guidelines, LHC involves catheter placement in a left-sided (systemic) cardiac chamber(s) (left ventricle or left atrium) and includes left ventricular injection(s) when carried out." Also it includes taking left ventricular pressures.

This means left ventriculography injection, supervision, interpretation and report are all included when performed. Consequently, you should not report +93565 in addition to 93452.

Report separately: Even though CPT includes multiple services in 93452, there are some services you may report separately. In some instances, the cardiologist may carry out LHC using a transapical puncture of the left ventricle or a transseptal puncture when the septum is intact. CPT guidelines instruct that in that case, apart from the appropriate LHC code, such as 93452, you should report +93462.

More comprehensive options: Be sure to watch for cases where a code that is more comprehensive than 93452 is proper. Particularly, CPT instructs you not to report 93452 with 93453 (RHC and LHC) or 93458-93461 which specify that they include LHC along with coronary angiography and other services.

93453 brings 93451 and 93452 together

The services 93453 describe would in effect have been covered by 93526, 93543 and 93555 (imaging S&I) last year. Since the procedure involves LHC, remember that the key identifier for that procedure is that the physician crossed the aortic valve.

Code 93453 involves both RHC and LHC as such once you understand when 93451 is proper for an RHC service and 93452 is proper for an LHC service, you are well on your way to mastering when to report 93453. Many of the same rules apply, as do many of the same restrictions.

CCI 17.1: Get on Top of These Three Key Highlights for Cardiology This Quarter

Take a look at these major pointers to comply with the just-in cardiology-related edits, including cardiac catheterization, radiological supervision and interpretation, cardiac rehabilitation, and more.

Avoid denials by remembering 93454-93461 are diagnostic

Just-in edits will prevent you from reporting heart catheter/angiography codes 93454- 93461 (column 2) with the following cardiovascular therapeutic services and procedures (column 1):

92975, 92980, 92982, 92995

Take away: In column 1, the 929xx codes describe coronary therapies. You shouldn't use the 934xx diagnostic codes in column 2 to report catheter placement and coronary angiography performed as an integral part of the therapeutic column 1 services.

Opportunity: The edits have a modifier indicator of 1; as such you may override them with a proper modifier when the procedures are distinct. If you report both codes in the edit pair and do not add a modifier to the column 2 code, Medicare will reimburse you for only the column 1 code.

The AMA, via CPT Assistant (April 2005), indicates that you may report a true diagnostic catheterization apart from the therapeutic procedures described by 92980 and 92982:These two distinct procedures, therefore, should be reported separately when carried out at the same session or on the same day at a different session."

When the cardiologist does carry out a distinct 93454-93461 diagnostic service on the same date as a cardiovascular therapeutic service, you should append modifier 59 (Distinct procedural service) to the diagnostic code. You may also require to add modifier 51 (Multiple procedures).

Modifier 59 identifies the procedure as being a distinct procedural service while modifier 51 identifies multiple procedures were performed during the same session. Even though CPT identifies many codes as modifier 51 exempt, 93454-93461 are not currently exempt. But then, Medicare and other payers may tell you not to use modifier 51 since they'll apply the multiple procedure rule themselves.

Hints: You should also add modifier 26 (Professional component) to 93454-93461 when you need to indicate you're reporting only the professional component of the service. The Medicare physician fee schedule shows different PC and TC for these codes.

Follow S&I instructions to stay compliant

Like many other existing edits, a large number of the just-in cardiology-related edits help keep your coding in line with CPT guidelines for using radiology codes with procedure codes.

Example 1: Code 0236T includes radiological supervision and interpretation (S&I) in its definition. As such, you should not be surprised to know that the latest CCI bundles radiology codes 75600-75630 (Aortography … radiological supervision and interpretation) into 0236T.

Example 2: Now CCI bundles 75600-75774 and 75810-75891 into 37205. But then this should not restrict your coding since a CPT instruction with 37205 tells you that the proper code for S&I related to 37205 is 75960.

Good move: To stay away from denials, check code definitions, CPT guidelines, and CCI edits prior to reporting an S&I code with a procedure code – both to ensure you report the proper S&I code for the procedure and to be sure you comply with CCI edits.

Watch for blood draw, pulmonary services, EEG and others

In the latest CCI, it bundles many of the same column 2 codes into the following column 1 codes:

93660, 93724, 93797-93798

While the column two codes in the edits are not entirely identical for each of the column 1 codes above, there is a definite pattern. Here's a sampling of the column 2 codes:

364xx, 366xx, 37202, 43752, 94xxx, 958xx, 95955

Bottom line: Before you report a tilt table exam, an antitachycardia-pacemaker analysis, or outpatient cardiac rehab code, take a look at the CCI edits to verify that you haven't included one of the many bundled codes on your claim.

For Repeat Procedure, Turn to Modifiers 76 Or 77

Point to remember: When the physician carries out exactly the same procedure a couple of times, modifier 59 won't be applicable.

Here's a question: Is modifier 76 or 59 proper when the radiologist reviews two studies on the same date of service (DOS), but the scans don't merit the same codes?

Answer: Well, unless your payer tells you in a different way, go for modifiers 76 (Repeat procedure or service by same doctor or other qualified health care professional) and 77 (Repeat procedure or service by another doctor or other qualified health care professional) only when the provider(s) carry out the exact same exam twice.

First example: If a patient in the intensive care unit (ICU) has two single-view chest X-rays (71010, Radiologic examination, chest; single view, frontal) on the same day, use the second exam with modifier 76 or 77 (depending on whether both exams involved the same doctor).

Second example: If a patient has a complete ankle exam (73610, Radiologic examination, ankle; complete, minimum of three views) followed later in the day by a limited exam (73600, … two views) go for modifier 59 (Distinct procedural service) in order to tell the payer the provider carried out the exams in separate encounters.

Source URL :- http://www.supercoder.com/code-lookup/modifiers/

Catch this:

2011 CPT code changes the descriptors for modifiers 76 and 77 to clarify that the modifiers do not apply only to physician services. Other qualified health care professionals are now clearly included, as well. CPT made the same revision to modifier 78 (Unplanned return to the operating/ procedure room by the same doctor or other qualified health care professional following initial procedure for a related procedure during the postoperative period).

Which CPT And HCPCS Codes for MOPP?

While coding for your oncology practice, you may sometimes question – which CPT and HCPCS codes are appropriate for MOPP? Answer: Well, the MOPP (also called MVPP) combination chemotherapy regimen includes:

M: Mechlorethamine (Mustargen)
O: Vincristine (Oncovin or Vincasar)
P: Procarbazine (Matulane)
P: Prednisone.

You should code mechlorathemine using J9230 (Injection, mechlorethamine hydrochloride,
[nitrogen mustard], 10 mg). Since it's an antineoplastic, you should report administration using the appropriate chemotherapy administration code(s) (96401-96549).

You should report vincristine using J9370 (Vincristine sulfate, 1 mg). Bear in mind that HCPCS 2011 deleted J9375 (Vincristine sulfate, 2 mg) and J9380 (Vincristine sulfate, 5 mg). Since vincristine also happens to be a chemotherapy drug, you should again use the proper chemotherapy administration code(s) (96401-96549). Do not report these drugs: As part of the MOPP regimen, Procarbazine and prednisone are given orally. HCPCS offers S0182 (Procarbazine hydrochloride, oral, 50 mg) and J7506 (Prednisone, oral, per 5mg), however you shouldn't report supply (HCPCS) or administration (CPT) codes for these drugs on your Part B claims. CMS doesn't cover ‘self-administered' drugs under Part B. (Take a look at Medicare Benefit Policy Manual, chapter 15, section 50.5, www.cms.gov/Manuals/IOM/list.asp.) Exception: The provider may consider it necessary to administer the injectable form of prednisone, such as J1030 (Injection, methylprednisolone acetate, 40 mg). In that rare instance, you may be able to code the drug and administration.

Medicare benefit Policy Manual, chapter 15, section 50.4.3, explains that Medicare does not cover a medication's injectable form if the oral route is standard and medically proper. However the manual indicates there could be an exception if special medical circumstances justify an injection rather than the oral form. If the injectable form is utilized, the provider should briefly document the reason why to help support your code choice.

Note of caution: See to it that you code based on the detailed documentation rather than from a protocol's abbreviation. For instance, the oncologist may change the order based on white blood and platelet counts. For more on this and for other medical coding updates pertaining to CPT and HCPCS codes, sign up for a one-stop medical coding guide like Supercoder.com

How Lyme disease, ear pain diagnosis will change in 2013

Suggestion: Your diagnosis coding will depend on which ear was affected once ICD-10 hits. Since CMS has reiterated that it'll not push back the deadlines for the conversion to ICD-10, you will need to have your ICD-10 coding skills ready by October 1, 2013. Here are some examples of how ICD-10 will change your coding choices for two common conditions. Lyme disease Dx will need thorough documentation of attributable conditions

Right now, if a patient is confirmed to have Lyme disease, you report code 088.81 (Lyme disease). ICD-10 changes: With effect from October 1, 2013, you will find that the Lyme disease diagnosis codes have been expanded to include symptoms due to confirmed cases of Lyme disease, as below:

A69.20 (Lyme disease, unspecified)

A69.21 (Meningitis due to Lyme disease)

A69.22 (Other neurologic disorders in Lyme disease)

A69.23 (Arthritis due to Lyme disease)

A69.29 (Other conditions associated with Lyme disease) Documentation: Your doctor will need to clearly note whether the patient has Lyme disease alone (A69.20) or Lyme disease with other contributing factors (A69.21- A69.22). For example, you cannot use A69.21 unless the documentation includes confirmation that the patient ails from meningitis as well as Lyme disease, and that the two conditions are related. You shouldn't report the Lyme disease diagnosis code unless your practice gets confirmation from a lab test indicating that the patient tested positive for a Lyme disease. If you do not have a positive lab test confirming strep throat, you should simply use the diagnosis codes for the symptoms. As such, your documentation must include a copy of the laboratory report confirming that the patient had Lyme disease before you select your diagnosis code. ICD-10 coding tips: teach your practitioners about the just-in ICD-10 codes and let them know that documentation must indicate which specific Lyme disease diagnosis the patient has. Otalgia will need identification of affected ear To put it simply, otalgia refers to an ear ache. Part B practices often report otalgia diagnoses when patients complain of ear pain however no more definitive diagnosis is found. Presently, the ICD-9 manual offers just one code for unspecified otalgia: 388.70 (Otalgia, unspecified). ICD-10 coding changes: From October 1, 2013, you will be dealing with a series of four codes that describe otalgia, organized according to the location of the diagnosis, as here: Documentation: Doctors should already include the affected ear in their documentation. All you require to do as a coder to capture this already present information is to format your superbill to see to it that physicians document the additional anatomical information. Tips: You can arrange your superbill in a way that ensures that the physician documents all information applicable for you to submit the most proper code. For example, you can print it like this: H92.0x (x=1 for right ear, x=2 for left ear, x=3 for bilateral, and x=9 for unspecified ear) Or you can simply list "H92.0x" and have the doctor circle "left ear," "right ear," or "bilateral" on the form.

Article  Source  :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/icd-10-preparation-get-to-know-how-lyme-disease-ear-pain-diagnoses-will-change-in-2013-article

Strategies to Ease Your Spinal Osteotomies

When your orthopedic surgeon carries out spinal osteotomies, you have a much better chance of achieving full reimbursements if the procedure note clearly defines the surgeon's intent and approach. Particularly, you should look cautiously for whether the doctor carried out decompression beyond the osteotomy and scrutinize the operative note for indications that a discectomy has been carried out.

Spinal osteotomy is carried out when fusion alone wouldn't make proper a spinal deformity like a change in anterior or lateral curvature of the spine. Osteotomies are indicated only when a corrective fusion isn't enough. If the degree of deformity is serious, only then is an osteotomy indicated.

When the operating surgeon removes a portion of the vertebral segment(s) using codes in the 22206 to 22226 range, go for spinal osteotomy.

Important: Spot on selection depends on three factors: a) the approach, b) the anatomical location of the procedure in the spine, and c) the number of vertebral segments operated upon. Remember that location refers to the area of the spine which is being worked on - which can be cervical (C1-C7), thoracic (T1-T12), lumbar (L1-L5) or sacral (S1-S4).

Find out the approach

Go through the notes to identify the patient's position (supine or prone) to get started. When doctors add information about the approach to the operative report, ‘this helps the coder to choose the proper code to be billed.

Report code 22206, 22207 or 22208 when the neurosurgeon uses a posterior or posterolateral approach for pedicle subtraction osteotomy (PSO), three column closing wedge posterior osteotomy, and vertebral column resection (VCR).

These codes are to be used for osteotomies that remove a V-shaped wedge from the vertebral body, at least two-thirds, along with all of the posterior elements - pedicles, articulating facets, lamina and spinous process.

Depending upon location, you'd use code 22210, 22212 or 22214 for posterior approach in the cervical, thoracic, and lumbar regions, respectively for Ponte osteotomy, posterior closing wedge osteotomy (with or without opening of the anterior column), Smith-Peterson osteotomy, and polysegmental osteotomy. These codes describe osteotomies that remove part or all of the posterior elements but do not remove the vertebral body.

Likewise, if the approach is an anterior one for osteotomy and discectomy and the procedure involves a single vertebral segment, you'd report codes 22220 for the cervical region, 22222 for the thoracic region and 22224 for the lumbar region.

Built in add-ons for multiple levels

For every additional vertebral segment in the posterior or posterolateral approach after the first segment operated upon, report 22216 apart from the primary procedure code.

The CPT book lists the add-on code under each primary approach code for each additional vertebral segment that would need to be billed. For instance, for primary code 22210 for cervical osteotomy of spine posterior approach, 1 vertebral segment, the add-on code for additional vertebral segment would be 22216. Osteotomy procedures are reported as per vertebral level. If the posterior elements were removed from T10, T11 and T12 as in the Ponte or Smith-Peterson osteotomies, you'd report 22212 for T10, 22216 x2 for T11 and T12.

Do not report decompression separately

Decompression of the spinal cord, cauda equina, and/or single or multiple nerve roots is meant in osteotomies and the codes for osteotomies are inclusive of these. Decompression is basically inherent to an osteotomy. These Osteotomy procedures involve removing a piece of the vertebrae to rectify spinal alignment; these codes replace laminectomy, laminotomy, and discectomy procedures and should not be reported at the same levels.

The levels of decompression need to be stated clearly in all operative notes. Minus this documentation, you'd not be able to bill for the decompression separately from the osteotomy. In order to report the right number for every root being decompressed, you should be on the lookout for details for every level to avoid any overlap or to miss reporting a procedure.

Select codes 63047 and 63048 for decompressions that are separate and distinct in anatomical locations from the osteotomy.

+33225: Find out Which Primary Code this Case Study Supports

Here's a real-life case study to see if you can pinpoint the codes this documentation does – and does not – back up.

Start by analyzing the report excerpt

An incision was made along the left deltopectoral groove, and an ICD pocket was dissected out, was prepared with extensive dissection.

Three different guidewires were advanced into the left subclavian vein utilizing the Seldinger technique across the open pocket. Then the middle of these wires was used to further a coronary sinus sheath for placement of the left ventricular lead. With some difficulty, we're able to further the coronary sinus sheath in the mid coronary sinus and an angiogram was got. After this a left ventricular lead was then advanced in the lateral cardiac vein and the tip was advanced to the near LV apex. Electrical testing was carried out at three difficult locations and the rest of these noted a lead impedance of 840 ohms and an R wave value of 17.1 mV.

After this, the bipolar right ventricular defibrillator active fixation lead was advanced to the right ventricle, various areas were checked and the lead was finally fixated along the RV.

Hereafter the bipolar right ventricular defibrillator active fixation lead was advanced to the right atrium. Various areas checked and the lead was finally fixated along the RV septum and tested.

Then a bipolar screw in type right atrial lead was advanced to the right atrium while the lead was fixated to the right atrial wall. After this the coronary sinus sheath was removed with the cutting device maintaining a good lead position of the LV lead.

After this, all the three leads were then sutured to the pectoral fascia over the Silastic sleeves. The ICD pocket was irrigated. Soon the leads were then attached to the ICD/BiV device. Post this, the ICD was placed in the pacer pocket after a standard dose of thrombin material in the pocket. The ICD pocket was sutured closed.

The patient was provided propofol and the following establishment of sufficient general anesthesia. Ventricular fibrillation was encouraged. The advice analyzed and delivered three separate DC countershocks, at last at 36V and the patient converted back to normal sinus rhythm. Patient was made to wake up from sedation without obvious side effects.

Add-On Code

The case study appears to be a new implant of a Biventricular Defibrillator with follow-up testing at implant. While going through the first two paragraphs, you should focus on the terms describing placement of the left ventricular lead via the coronary sinus. The right code for this portion is +33225.

Tips for documentation: You may see this lead referred to as either a left ventricular (LV) lead or coronary sinus lead.

For that add-on code, add the primary code

The next few paragraphs of the documentation describe lead fixation for the RV and RA. What's more, the cardiologist attaches the leads to the device, places the device in the pacer pocket, and sutures the pocket closed. One code 33249 covers all of this.

Add-on note: CPT lists 33249 as a proper primary code for add-on code +33225.

Defib Testing gets you the final code

The last paragraph of the case study excerpt describes 93641. As far as defib testing is concerned, you want to see impedance in the documentation.

Term tip: The defibrillation threshold is the minimum energy amount required during ventricular arrhythmia to defibrillate the heart dependably. Being aware of the patient's DFT helps the cardiologist confirm that the cardioverter-defibrillator (ICD) programming will provide enough of a shock to defibrillate the patient's heart.

Add modifiers to at least one code

Code 93641 requires modifier 26 (PC) to indicate you are claiming only the physician work (and practice expense and malpractice expense) for this service. For this code, the Medicare Fee Schedule (Physician) lists a PC/TC indicator of "1". This means you may use modifier 26 with the code.

You may require a modifier on 33225 because it is an add-on code for 33249. However you may need a 59 modifier on the 93641, depending on the carrier. You should not need one, however you never know with carrier's software.

Source URL : - http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/electrophysiology-33225-decide-which-primary-code-this-case-study-supports-article

Your practice should hit these points

In a case such as this, the doctor would normally use fluoroscopy, too; but again it is not documented in this case.

No documentation of fluoroscopy means you shouldn't bill fluoroscopy. When fluoroscopy is documented, you should report 71090-26.

ICD-9: The case-study excerpt also does not mention indications for you to choose ICD-9 diagnosis codes.

What's more, check your local requirements for diagnosis codes that support medical necessity for 33225.

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

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 (Source "http://www.supercoder.com/coding-tools/cci-edits-checker/") 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.

Differentiate Wound Repair versus Tissue Transfer to Achieve Proper 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.    Source URL :- 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

Criteria for Observation Codes' Use for Physician Services

Don't use discharge code 99217 in all observation situations

Oftentimes deciding on what observation code to use can be a challenge more particularly since you have to look into two sets of this type. One set (99234-99236) pertains to the care provided on a single calendar date whereas another set concerns care that spans two calendar dates (99218-99220).

Figure out the criteria for observation codes' use for doctor services by debunking these three errors.

Fallacy 1: Observation services aid extended inpatient care

First and foremost, you'd want to ensure that the service carried out by your gastroenterology qualifies as an observation. The doctor should choose for observation to prevent a lengthy inpatient admission. For example, an observation status is proper when:

The encounter certainly lacks diagnostic, where a more precise diagnosis could decide admission or discharge.

The patient's condition requires extensive therapy in order to possibly be abated.

For instance: The gastroenterology tends to a patient at the hospital who experiences abdominal pain and nausea with vomiting. The doctor admits the patient to observation status to run tests and make sure the patient does not need inpatient care for gastric issues.

Fallacy 2: Documentation just another paperwork

The doctor's notes on the encounter would tell you how many calendar days the observation service lasted.

Take into consideration this scenario: For example, the gastroenterologist admits the patient to observation at 9 p.m. on Wednesday. The doctor orders blood tests to check the patient's enzyme levels and performs a hydrogen breath test to check for any traces of bacterial overgrowth. The results of both tests turn out to be normal. The doctor keeps the patient overnight for monitoring; her notes indicate a level two observation.

Report it: You'd report the Wednesday services with 99219. To add to it, one more important component of coding multi-calendar date observation codes is reporting 99217 on the date of discharge service. Link 789.00 and 787.01 to both CPTs to describe the patient's symptoms.

Go for 99218-99220 for all the care rendered by the admitting physician on the date the patient was admitted to observation.

For the documentation requirements, the CMS Claims Processing (Source "http://www.supercoder.com/scrubber/cms1500/") Manual indicates that a doctor can bill the initial observation care codes, provided he finishes a medical observation record for the patient. This record should contain dated and timed admitting orders of the doctor, and mirror the care the patient gets while in observation, nursing notes, and progress notes made by the physician while the patient was in observation status.

This record should be in addition to any record prepared as a result of an emergency department or outpatient clinic encounter.

Fallacy 3: Same-day observation codes require a discharge code

What happens when your gastroenterologist admits a patient to observation status and discharges him on the same calendar date? Then you would go for 99234-99236. In this situation, you would not have to code the 99217 discharge code. CPT allows the use of 99217 “if the discharge is on other than the initial date of ‘observation status'," as specified on the code's descriptor.

Same-day observation services 99234-99236 involve documenting the time of the visit in hours (with a minimum of eight hours documented on the same calendar date, also referred to as the 8-hour rule).

Five Common Pitfalls you Should be Arare of While Using PQRS

Whether you are new to CMS's Physician Quality Reporting System program or you have been gathering bonuses from it for a while, you can use some tips on ways to stay away from common PQRS mistakes. CMS representatives throw light on these issues and shared the following information about the five most common PQRS pitfalls.

Missing your suitable population. When you are opting for measures to report, you should carefully review all ICD-9-CM diagnoses and CPT service codes that'll qualify claims for inclusion in physician quality reporting measurement calculations.

Remember that some measures have specified patient demographics that must be met prior to reporting them such as age or gender parameters.

For those measures that need you to capture specific clinical values for coding, see to it that the people in your practice who code your claims have access to them or else they won't know the claims are eligible for PQRS.

Reporting wrong information. This means that you have used wrong specifications, quality data codes or individual NPI numbers.

See to it that you use correct measure specifications for the current year and reporting method. For measures that need more than one QDC (quality data code, which refers to a CPT or G code), make sure that you have reported all of the codes on the claim, and that any applicable modifiers are applied.

Make sure you include the individual rendering NPI number(s) on the claim. quality data codes should be submitted on the line item of the claim as a zero charge. If your billing software doesn't allow a zero charge line item, you can enter one cent as your charge as you can't leave the submitted charge field blank.

Missing the reporting frequency. Each and every PQRS measure has its own reporting frequency or time frame requirement for each eligible patient seen during the reporting period per eligible professional (NPI). Some measures need you to report once per patient, per NPI, each reporting period whereas others may need to be reported once per procedure carried out, once per acute episode or once per visit.

You can find the reporting frequency in the instructions section of each measure specification – however even if you know the frequency requirements, you won't be able to find them if the practitioner's documentation is not thorough. See to it that all members of the team understand and capture this information in the clinical record to facilitate reporting.

Confusing PQRS with other CMS programs. PQRS is different from the EHR program, however because the programs have similar requirements, many professionals become confused. The programs have different materials and requirements and you will need to call a separate help desk for assistance on them.

Knowing who to call for help. If you have questions about PQRS, do not just abandon the program. In its place, get in touch with the QualityNet Help Desk at 866-288-8912 or send an email to qnetsupport@sdps.org.

Remember: Various reporting errors can be avoided. Therefore report carefully since all diagnoses listed on the CMS-1500 (http://www.supercoder.com/scrubber/cms1500/) or electronic equivalent at an encounter during the reporting period will be counted in analysis.

Hone Your Colonic Polyp Vocabulary with these two Tips

Find out how a pathology report can save your claim.

Remember that not all patients who present to the office with colon polyps will be diagnosed with colon cancer. This is the second-leading cause of cancer-related deaths in the United States and normally starts as small, benign adenomatous lump, and becomes cancerous overtime.

Colon cancer (colorectal cancer as it is regularly called) is a cancer which starts in the large bowel portion of the gastrointestinal (GI) system. Since it comes in many forms and symptoms, coding the definitive diagnosis might be risky. Safeguard your practice's deserved dollars with these three tips:

1. Do not go looking for 'benign', 'malignant'

Irrespective of whether or not you are dealing with a full-blown colorectal cancer, you should be looking at the different terms used to describe benign or malignant colonic polyps. Some of these cover:

Adenomas including tubular adenomas and tubulovillous adenomas

Hyperplastic polyps

Inflammatory polyps

Familial adenomatous polyposis, a rare hereditary disorder that causes hundreds of polyps in the lining of the colon starting in the teenage years. If this is not treated, the patient becomes high risk to develop colon cancer.

Hereditary nonpolyposis colorectal cancer, a hereditary disorder that leads to an increased risk of developing colon cancer.

However first, you have to achieve the task of determining, without a doubt if a polyp is benign or malignant. If you think you'd find the clues in the pathology report (PR), think again. Normally, the PR will not use the term 'benign" or 'malignant'. But then it'll use a description that points to the usual behavior of the polyp. It is up to you to interpret those descriptions into benign or malignant.

Key: Experts tell you that you always wait for the pathology report to come back before deciding on a particular ICD-9. Even the gastroenterologists, themselves normally defer to the pathology report prior to making a recommendation.

2. Check with ICD-9 Neoplasm table

The ICD-9 codes Alphabetic Index to Diseases (Volume 2) features a neoplasm table where you can choose a definitive diagnosis code for a polyp. All diagnosis codes for neoplastic polyps -- and some non-neoplastic polyps -- will come from this table. Consider three things when choosing the right polyp code:

a) Body part. For malignant primary neoplastic polyps in the colon, you should look for the specific site of the colon which the doctor should mention in the procedure report.(I'e., traverse, sigmoid, ascending and descending).

For all other behaviors, the code descriptions make a general reference to the colon, large intestine or for that matter digestive system.

b) Behavior. In particular, behavior refers to the polyp's capacity to spread. If the polyp happens to be benign, it's noncancerous; of it is malignant, it's cancerous. A polyp can also be defined as 'uncertain' (235.2, Neoplasm of uncertain behavior of stomach, intestines and rectum) if its behavior is unpredictable and requires further investigation. On the contrary, an unspecified polyp (239.0, Neoplasm of unspecified nature of digestive system) needs to be determined further by lab tests.

c) Malignant polyp's nature. Further, you'd classify a malignant polyp into primary, secondary or in situ. A primary malignant colonic polyp (153.0-154.0) is one where the colon is the original site of the cancer. Secondary (197.5, Secondary malignant neoplasm of large intestine and rectum) means the cancer has metastasized from another site to the colon. An in situ malignant colonic polyp (230.3-230.4) is one where the cancer is remains confined to the colon.   Source URL  :- http://www.supercoder.com/coding-newsletters/my-gastroenterology-coding-alert/diagnosis-coding-2-tips-to-hone-your-colonic-polyp-vocabulary-106130-article

Modifier 51 or 59? Choose Carefully

The physician controlled a patient's hemorrhage (30901) and removed a benign lesion from patient's temple (17110) during the same encounter. How should you go about this situation – report modifier 51 or 59?

As per coding rules, you should append modifier 51 (Multiple procedures) only when the doctor completes multiple procedures during the same encounter, and to add modifier 59 (Distinct procedural service) only when the two procedures you want to submit are not usually submitted together but are proper under the circumstances. Often modifier 59 is used to code pairs that have an active bundling edit through the correct coding initiative (CCI). Present CCI edits don't bundle codes 30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method) and 17110 (Destruction [example laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions).

You will most likely find different opinions on whether to add modifier 51 or 59. Some medical coders go for modifier 51 since most payers will process the encounter as a multiple surgical reduction irrespective of whether you include the modifier or not. Other medical coders recommend modifier 59 since reporting 51 could set you up for one of three undesirable (or at least aggravating outcomes); the payer does not bring down the payment correctly; the payer denies the entire claim; or the payer requests additional documentation prior to considering payment. Of the two modifiers, most probably modifier 51 is most appropriate in this example.

Source URL :- http://www.supercoder.com/coding-newsletters/my-family-practice-coding-alert/reader-questions-choose-carefully-between-modifiers-51-and-59-article

Tip you can follow: Whichever modifier you choose, add it to the lowest relative value units – (RVUs) -- in this instance, code 30901 with 2.82 relative value units.

What's more, double-check the code you are submitting for the lesion removal. As noted, the code you indicated (17110) is for destruction of a lesion by one of various methods. If the doctor removed the lesion through excision, you'll need to use a code from the series of codes for excision of benign skin lesions, 11400-11446.

Four Phases to Help you Begin Your ICD-10 Preparations Right Way

Start your initial plan of conversion straight away so you can project your practice's timeline.

Medical practices that have got an early start to ICD-10 transition say that it's not an easy task as far as the process's vast nature is concerned. So if your practice has been putting off its preparations, it is time to get onboard the ICD-10 train.

Procrastinators should be careful: ICD-10 will go into effect on October 1, 2013, and CMS will not provide you a grace period post that date. To put it in other words, you will be better placed of you have your ICD-10 systems ready prior to that date so that your claims continue to flow smoothly. Experts warn that if you're not ready, your claims may not flow at all.

Key: The transition will have no effect on CPT code or HCPCS code use. Both of these coding systems will remain to be used as they are now.

4 phases help you begin preparing right away

At a medical practice, every month is a busy month. But then it's very important that you make time for your ICD-10 preparation sooner rather than later. An important takeaway message from today's session is the totally critical importance of not delaying in getting this implementation process started.

You should institute a well-planned implementation process to be ready in year 2013 rather than hastily scrambling your ICD-10(http://www.supercoder.com/icd-10/icd-10-bridge) program together at the last minute.

Here's how you should do it: break your ICD-10 implementation planning program into four phases. Here're the goals for each phase with suggested timelines:

Phase 1: Implementation plan development and impact assessment, suggested to span from the first quarter of year 2009 through the second quarter of this year

Phase 2: Implementation preparation, suggested to take place between the first quarter of this year and the second quarter of 2013

Phase 3: "Go live" preparation, should potentially take place between the 1st and 2nd quarters of 2013

Phase 4: Post-implementation follow-up, suggested to occur between the fourth quarter of 2013 and fourth quarter of 2014.

Normally, your phase one work should be approaching completion or at least be well on its way. For those of you who may not have gotten started yet or who have hardly gotten started, I urge you to move forward with this as soon as possible.

Reason: You will not be able to schedule phases through four until phase one is done, and you need to be able to calculate the resources you will require for those subsequent phases. Till you know the scope of the effect of ICD-10 in your organization, you do not know how much time and resources will be required to finish the preparation activities; as such you do not want to wait too long prior to making that assessment.