If your compassion's letting patients off the payment hook, it's time you took some action. Here's a medical billing and coding case study to help your understanding.
In a particular scenario, a physician tends to quite a few patients who were released because a local company shut shop. However, the physician wants to see those patients and also wants to ignore their copayments and deductibles.
Healthcare billing predicament: The physician wants to send the patient two bills, however he also wants them to ignore them. He wants the biller to write off the 'bad debt' after the second bill's sent out.
Here are three tips to ensure you are not setting yourself up for major troubles:
Stay away from potentially fraudulent exceptions
You should never tell patients to ignore the bills you send because you will write off the charges sooner or later. Although waiving of a fee for a professional courtesy or financial hardship may be nice, you may land yourself in a soup.
Reason: You must make a good faith effort in order to collect from your patients. Most practices send at least three statements to a patient to try to collect on an outstanding bill. It depends on your practice of how you make the good faith attempt.
What you need to do: Document your efforts – that's what you need to do.
Not only do you run the risk of hurting other patients who could not find out about the unfair policy, you could also be violating your payer contracts or even anti-kickback laws. You need to check your contracts with the insurers. Find out whether it's a violation to let go of these fees. You should not try this with federal programs. You may end up paying a heavy amount as the anti-kickback statute carries stiff fines.
In case you do waive payments, keep proof of financial hardship
You shouldn't think that you can write off a patient balance. If you have patients who cannot pay their balances owing to financial hardship, then you might want to consider writing off the balance after you've made an attempt to try to collect and you have got proof of financial hardship.
If your practice wants to write off a patient's bill owing to financial hardship, the patient needs to be able to prove he's unable to pay. For this, you should ask the patient to provide you with information like gross monthly income, assets, monthly household expenditures and number of dependants.
Your collection processes should be consistent
You also need to apply a consistent collections policy to all of your patients. If your normal process is to send a patient to collections if they do not shell out money, you have to follow the same medical coding guidelines( source "http://www.supercoder.com") with this patient.
Wednesday, August 31, 2011
Tuesday, August 30, 2011
ICD-9 Coding: Each Code in 173.X Series Will Get Fifth Digit Options
Although there are fewer changes to ICD-9 codes this year, oncology and hematology coders will have their hands full.
Here are the main proposals you need to keep an eye on when they go into effect on October 1, 2011. This time you can see an expansion of 173.x (Other malignant neoplasm of skin) as each code in that series will get fifth digit choices, which will provide further details of the skin neoplasm type.
The changes in skin cancer codes (173.xx) follow a pattern where the fifth digit of '0' refers to an unspecified malignant neoplasm, '1' denotes basal cell cancer (BCC), 2 refers to squamous cell carcinoma (SCC) while "9" describes "other" specified malignant neoplasm. The two most common types of skin cancer are basal cell cancer and specified malignant neoplasm.
Why the expansion? The code series was expanded following a request from the New York Cancer Registry to help distinguish reportable skin cancers from non-reportable skin cancers – say for instance BCC and SCC. These common neoplasms behave differently – so it would be more useful to separate them.
Right now, you use ICD code 173.0 for any non-melanoma malignant lip neoplasm; however using the proposed codes, you'll choose from: 173.00, 173.01, 173.02 and 173.09.
Four-digit 173.x codes will no longer be valid with effect from October 1, 2011
This is because each code in the range will need a fifth digit to be complete.
Better documentation habits: Preparing for the just-in and revised ICD-9 code changes, you need better documentation habits. You should encourage practitioners to document the type, specific location and nature of the disease process. You'll have a two-pronged advantage as improving documentation will not only allow you to code these conditions more specifically starting October this year but will also help you gear up for ICD-10's general increase in documentation requirements after it goes into effect on October 1, 2013.
What's more, you should also plan for ICD-9 2012 to expand the present four-digit code 286.5 into these five-digit codes: 286.52 (Acquired hemophilia ), 286.53 (Antiphospholipid antibody with hemorrhagic disorder), 286.59 (Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors).
The changes will help track trials on the cause, self-correction and pharmaceutical treatment of these disease types of hemophilia.
Here are the main proposals you need to keep an eye on when they go into effect on October 1, 2011. This time you can see an expansion of 173.x (Other malignant neoplasm of skin) as each code in that series will get fifth digit choices, which will provide further details of the skin neoplasm type.
The changes in skin cancer codes (173.xx) follow a pattern where the fifth digit of '0' refers to an unspecified malignant neoplasm, '1' denotes basal cell cancer (BCC), 2 refers to squamous cell carcinoma (SCC) while "9" describes "other" specified malignant neoplasm. The two most common types of skin cancer are basal cell cancer and specified malignant neoplasm.
Why the expansion? The code series was expanded following a request from the New York Cancer Registry to help distinguish reportable skin cancers from non-reportable skin cancers – say for instance BCC and SCC. These common neoplasms behave differently – so it would be more useful to separate them.
Right now, you use ICD code 173.0 for any non-melanoma malignant lip neoplasm; however using the proposed codes, you'll choose from: 173.00, 173.01, 173.02 and 173.09.
Four-digit 173.x codes will no longer be valid with effect from October 1, 2011
This is because each code in the range will need a fifth digit to be complete.
Better documentation habits: Preparing for the just-in and revised ICD-9 code changes, you need better documentation habits. You should encourage practitioners to document the type, specific location and nature of the disease process. You'll have a two-pronged advantage as improving documentation will not only allow you to code these conditions more specifically starting October this year but will also help you gear up for ICD-10's general increase in documentation requirements after it goes into effect on October 1, 2013.
What's more, you should also plan for ICD-9 2012 to expand the present four-digit code 286.5 into these five-digit codes: 286.52 (Acquired hemophilia ), 286.53 (Antiphospholipid antibody with hemorrhagic disorder), 286.59 (Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors).
The changes will help track trials on the cause, self-correction and pharmaceutical treatment of these disease types of hemophilia.
Monday, August 29, 2011
99211 Coding Quiz: Can You Identify Which of These Quick-Visit Services Qualify for 99211?
Hint: You can't automatically tack 99211 on to every service just because the nurse was present.
Most practices agree that 99211 is a ubiquitous code, reported nearly every day for visits ranging from blood pressure checks to medication updates. But the so-called "nurse visit" code may not always be appropriate. Many MACs are scrutinizing these claims and targeting them as "areas of concern," as WPS Medicare did this past April. Check out these common clinical scenarios and determine whether 99211 is appropriate for the circumstances.
Know Whether 99211 Applies to X-Rays
Question 1: A patient comes to see the physician for a leg problem. The staff performs x-rays and then the patient waits in the exam room for the doctor, but gets a call and has to leave before she actually sees the physician. Does 99211 apply to this visit?
Answer 1: "What is unanswered is was the x-ray ordered by the doctor?" asks Ruby Woodward, BSN, ACS-OR, coding and research specialist at Twin Cities Orthopedics in St. Louis Park, Minn. "If the physician ordered and read it, bill the x-ray unmodified. If the physician did not order the x-ray, then nothing can be billed."
In short, Woodward says, you cannot report 99211 unless an actual evaluation and management service was provided.
Will 99211 Cover Vaccines?
Question 2: A patient presents for vaccines only. The nurse administers two vaccines and the patient leaves. Should you report 99211 with the vaccine administration codes?
Answer 2: Not as a rule, no. If the nurse simply administers a vaccine and the patient leaves, the nurse most likely has not met the criteria for billing 99211. If, however, the nurse spends a lot of time counseling the patient or the patient has other diagnoses that the nurse goes over, then 99211 might be appropriate.
In some cases, depending on the CCI edits for the specific vaccine codes you're using, you may need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99211.
In black and white: "Services billed to Medicare under CPT code 99211 must be reasonable and necessary for the diagnosis and treatment of an illness or injury," says a policy on 99211 written by Part B MAC WPS Medicare.
Like the article? Click here to read the entire article and to get access to our monthly Part B Insider newsletter.
http://www.supercoder.com/category/articles/articles-alerts/pbi/
Most practices agree that 99211 is a ubiquitous code, reported nearly every day for visits ranging from blood pressure checks to medication updates. But the so-called "nurse visit" code may not always be appropriate. Many MACs are scrutinizing these claims and targeting them as "areas of concern," as WPS Medicare did this past April. Check out these common clinical scenarios and determine whether 99211 is appropriate for the circumstances.
Know Whether 99211 Applies to X-Rays
Question 1: A patient comes to see the physician for a leg problem. The staff performs x-rays and then the patient waits in the exam room for the doctor, but gets a call and has to leave before she actually sees the physician. Does 99211 apply to this visit?
Answer 1: "What is unanswered is was the x-ray ordered by the doctor?" asks Ruby Woodward, BSN, ACS-OR, coding and research specialist at Twin Cities Orthopedics in St. Louis Park, Minn. "If the physician ordered and read it, bill the x-ray unmodified. If the physician did not order the x-ray, then nothing can be billed."
In short, Woodward says, you cannot report 99211 unless an actual evaluation and management service was provided.
Will 99211 Cover Vaccines?
Question 2: A patient presents for vaccines only. The nurse administers two vaccines and the patient leaves. Should you report 99211 with the vaccine administration codes?
Answer 2: Not as a rule, no. If the nurse simply administers a vaccine and the patient leaves, the nurse most likely has not met the criteria for billing 99211. If, however, the nurse spends a lot of time counseling the patient or the patient has other diagnoses that the nurse goes over, then 99211 might be appropriate.
In some cases, depending on the CCI edits for the specific vaccine codes you're using, you may need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99211.
In black and white: "Services billed to Medicare under CPT code 99211 must be reasonable and necessary for the diagnosis and treatment of an illness or injury," says a policy on 99211 written by Part B MAC WPS Medicare.
Like the article? Click here to read the entire article and to get access to our monthly Part B Insider newsletter.
http://www.supercoder.com/category/articles/articles-alerts/pbi/
Medicare Fee Schedule 2012: Train Eyes on Potential Imaging Fee Cuts
CMS released its proposed MPFS for the coming year on July 1 this year.
The Centers for Medicare & Medicaid Services (CMS) payment proposals for the coming year indicate the situation could get all the more challenging. Here's a proposed fee schedule update you need to be aware of.
Train eyes on potential imaging fee cuts
A couple of months back, CMS released its proposed Medicare Physician Fee Schedule ( Source "http://www.supercoder.com/coding-tools/fee-schedules")(MPFS) for the coming year. The 621-page document provides you insight on how the agency configures its relative value unit (RVU) assignments.
If the proposed rule becomes final, imaging pay will see more cuts. Presently, when you carry out multiple radiological procedures on the Multiple Procedure Payment Reduction (MPPR) list during a single session, Medicare brings down the technical component (TC) of the lower paid procedure(s) by half. However, the agency wants to bring down those payments further.
In the coming year, the agency is laying down that it will not only cut the TC of subsequent radiological procedures by 50 percent, but will also slash the PC by half. Total payment would be made for the PC and TC of the highest procedure, and payment would be brought down by 50 percent for the PC and TC for each additional procedure provided to the same patient in the same session. It also points to the fact that payment cuts to radiology procedures could be even more in two years from now, and beyond that.
Professional societies were critical of the agency's radiology cuts. The American Medical Association (AMA) vehemently opposes a proposal to use major cuts to Medicare payments for diagnostic imaging to pay off the cost of a trade agreement. Diagnostic imaging specifically has already seen significant reductions over the last five years. In fact, payments for some services have gone down over 60 percent and more cuts are likely to take place.
What's more, a lot of radiologists have laid down that multiple interpretations of exams carried out on one patient are not less work-intensive than multiple interpretations of different patients. The time, intensity and mental effort it takes to interpret an individual exam is relatively constant irrespective of whether the patients' exams are interpreted separately or at the same session. Medicare should make an effort to support such quality care and not try to weaken it repeatedly.
The Centers for Medicare & Medicaid Services (CMS) payment proposals for the coming year indicate the situation could get all the more challenging. Here's a proposed fee schedule update you need to be aware of.
Train eyes on potential imaging fee cuts
A couple of months back, CMS released its proposed Medicare Physician Fee Schedule ( Source "http://www.supercoder.com/coding-tools/fee-schedules")(MPFS) for the coming year. The 621-page document provides you insight on how the agency configures its relative value unit (RVU) assignments.
If the proposed rule becomes final, imaging pay will see more cuts. Presently, when you carry out multiple radiological procedures on the Multiple Procedure Payment Reduction (MPPR) list during a single session, Medicare brings down the technical component (TC) of the lower paid procedure(s) by half. However, the agency wants to bring down those payments further.
In the coming year, the agency is laying down that it will not only cut the TC of subsequent radiological procedures by 50 percent, but will also slash the PC by half. Total payment would be made for the PC and TC of the highest procedure, and payment would be brought down by 50 percent for the PC and TC for each additional procedure provided to the same patient in the same session. It also points to the fact that payment cuts to radiology procedures could be even more in two years from now, and beyond that.
Professional societies were critical of the agency's radiology cuts. The American Medical Association (AMA) vehemently opposes a proposal to use major cuts to Medicare payments for diagnostic imaging to pay off the cost of a trade agreement. Diagnostic imaging specifically has already seen significant reductions over the last five years. In fact, payments for some services have gone down over 60 percent and more cuts are likely to take place.
What's more, a lot of radiologists have laid down that multiple interpretations of exams carried out on one patient are not less work-intensive than multiple interpretations of different patients. The time, intensity and mental effort it takes to interpret an individual exam is relatively constant irrespective of whether the patients' exams are interpreted separately or at the same session. Medicare should make an effort to support such quality care and not try to weaken it repeatedly.
Friday, August 26, 2011
ICD-10 Updates: Check Out New Options for Thyroid Disorders
While coding for thyroid disorders, here's what you need to keep in mind when ICD-10 goes into effect on October 1, 2013.
Although general rules of coding for both the code sets - ICD-10 and ICD-9 - will remain the same except for some subcategory variations, you need to stay up to date with these ICD 10 coding changes.
When it comes to thyroid disorders, here's how ICD-10 changes will have a say in your coding.
About thyroid gland: The thyroid gland is located in the front part of the neck; it produces the thyroid hormone which is important to normal metabolism. These disorders range from:
Hyperthyroidism: The thyroid gland becomes overactive here. It produces excess thyroid hormone and speeds up the body's metabolism. For hyperthyroidism, ICD-9 presently uses 242.
Hypothyroidism: On the other hand, here the thyroid gland becomes underactive. This happens if the thyroid does not produce enough hormones. ICD-9 currently uses 244 to report this.
In ICD-10-CM( Source "http://www.supercoder.com/icd-10/"), thyroid gland disorders are classified to these categories: E00 (Congenital iodine-deficiency syndrome), E01 (Iodine-deficiency related thyroid disorders and allied conditions), E02 (Subclinical iodine-deficiency hypothyroidism), E03 (Other hypothyroidism),E04 ( Other nontoxic goiter), E05 (Thyrotoxicosis [hyperthyroidism), E06 (Thyroiditis) and E07 ( Other disorders of thyroid).
Difference between the two code sets when it comes to coding for thyroid disorders:
Even though the coding rules related to thyroid diseases will be generally the same in ICD-10-CM as in the present code set, ICD-10-CM will classify some conditions to different chapters or different blocks. Say for instance ICD-9-CM's code for postsurgical hypothyroidism is 244.0, which is in the hypothyroidism category. In the new code system, you will not locate postsurgical hypothyroidism under category E03. In its place, you'll code it with E89.0, which is under category E89.
Tips for coders: A patient recently underwent surgery and radiation therapy for her thyroid cancer. The physician tends to this patient and carries out a level-two evaluation & management (E/M) and diagnoses her with hypothyroidism caused by the recent treatments. In this situation, you should opt for a more specific ICD-9 code than E03.9. When the patient has recently underwent thyroid surgery radiation therapy that caused the hypothyroidism, select the fourth digit based on the most recent factor affecting the hypothyroidism. For example , if the patient had surgery recently, choose E89.0. And if the radiation therapy was more recent, ICD-10 guidelines state that you would choose the same code.
Although general rules of coding for both the code sets - ICD-10 and ICD-9 - will remain the same except for some subcategory variations, you need to stay up to date with these ICD 10 coding changes.
When it comes to thyroid disorders, here's how ICD-10 changes will have a say in your coding.
About thyroid gland: The thyroid gland is located in the front part of the neck; it produces the thyroid hormone which is important to normal metabolism. These disorders range from:
Hyperthyroidism: The thyroid gland becomes overactive here. It produces excess thyroid hormone and speeds up the body's metabolism. For hyperthyroidism, ICD-9 presently uses 242.
Hypothyroidism: On the other hand, here the thyroid gland becomes underactive. This happens if the thyroid does not produce enough hormones. ICD-9 currently uses 244 to report this.
In ICD-10-CM( Source "http://www.supercoder.com/icd-10/"), thyroid gland disorders are classified to these categories: E00 (Congenital iodine-deficiency syndrome), E01 (Iodine-deficiency related thyroid disorders and allied conditions), E02 (Subclinical iodine-deficiency hypothyroidism), E03 (Other hypothyroidism),E04 ( Other nontoxic goiter), E05 (Thyrotoxicosis [hyperthyroidism), E06 (Thyroiditis) and E07 ( Other disorders of thyroid).
Difference between the two code sets when it comes to coding for thyroid disorders:
Even though the coding rules related to thyroid diseases will be generally the same in ICD-10-CM as in the present code set, ICD-10-CM will classify some conditions to different chapters or different blocks. Say for instance ICD-9-CM's code for postsurgical hypothyroidism is 244.0, which is in the hypothyroidism category. In the new code system, you will not locate postsurgical hypothyroidism under category E03. In its place, you'll code it with E89.0, which is under category E89.
Tips for coders: A patient recently underwent surgery and radiation therapy for her thyroid cancer. The physician tends to this patient and carries out a level-two evaluation & management (E/M) and diagnoses her with hypothyroidism caused by the recent treatments. In this situation, you should opt for a more specific ICD-9 code than E03.9. When the patient has recently underwent thyroid surgery radiation therapy that caused the hypothyroidism, select the fourth digit based on the most recent factor affecting the hypothyroidism. For example , if the patient had surgery recently, choose E89.0. And if the radiation therapy was more recent, ICD-10 guidelines state that you would choose the same code.
Thursday, August 25, 2011
ICD-9 Coding: Generalized Complaints for Blurry Vision Can Lead to Confusion
Having trouble getting to the proper ICD 9 diagnosis code for blurred vision? That should not be a problem if you know the reason behind the blurred vision.
A person complains of blurred vision and visits an eye-care specialist. But when a patient comes with hazy, generalized complaints, say for instance blurry vision, dry eyes, and the like – coders find it difficult to report these. ICD-9 codes that describe blurred vision specifically and similar diagnoses that relate to refractive error sometimes are not covered. So how do you go about this situation? Many coders use 368.8 (Visual disturbances; other specified visual disturbances).
The ICD-9 manual covers the note “blurred vision not otherwise specified" (NOS). This points to the fact that this is a good option for blurred vision. But then some carriers do not agree using the logic that there must be something leading to the blurriness and insisting you report the cause and not the symptom.
Rule for coders: You need to use the final diagnoses if a patient has a medical problem; however if the patient has only blurred vision, you should go for 368.8. Here’s an instance: A patient reports with a blurry vision and the ophthalmologist finds a cataract. Here you need to report cataract (366.xx) as the primary diagnosis and blurred vision (368.8) as the secondary diagnosis. This gets more confusing when the patient does not specifically complain of blurred vision and asks for a regular eye exam instead. Experts say that how you code depends on the insurance. If the patient visits for a routine vision exam and you know you are going to bill a vision insurance, report with a routine diagnostic code for refractive error [367.x]. But if the patient does not have a vision plan, then you may choose 368.8 to report it.
According to some coders, while billing with a symptom code like 368.8, their carrier also needs the use of V80.2. And in case you are have some confusion, ask the carrier for its written policy.
Dry-Eye Syndrome
The most common ICD-9 diagnosis code related to dry eye is 375.15. One more code would be 370.33. A word of caution though: Many believe they can report 375.15 and 370.21 interchangeably; however this is not true.
A person complains of blurred vision and visits an eye-care specialist. But when a patient comes with hazy, generalized complaints, say for instance blurry vision, dry eyes, and the like – coders find it difficult to report these. ICD-9 codes that describe blurred vision specifically and similar diagnoses that relate to refractive error sometimes are not covered. So how do you go about this situation? Many coders use 368.8 (Visual disturbances; other specified visual disturbances).
The ICD-9 manual covers the note “blurred vision not otherwise specified" (NOS). This points to the fact that this is a good option for blurred vision. But then some carriers do not agree using the logic that there must be something leading to the blurriness and insisting you report the cause and not the symptom.
Rule for coders: You need to use the final diagnoses if a patient has a medical problem; however if the patient has only blurred vision, you should go for 368.8. Here’s an instance: A patient reports with a blurry vision and the ophthalmologist finds a cataract. Here you need to report cataract (366.xx) as the primary diagnosis and blurred vision (368.8) as the secondary diagnosis. This gets more confusing when the patient does not specifically complain of blurred vision and asks for a regular eye exam instead. Experts say that how you code depends on the insurance. If the patient visits for a routine vision exam and you know you are going to bill a vision insurance, report with a routine diagnostic code for refractive error [367.x]. But if the patient does not have a vision plan, then you may choose 368.8 to report it.
According to some coders, while billing with a symptom code like 368.8, their carrier also needs the use of V80.2. And in case you are have some confusion, ask the carrier for its written policy.
Dry-Eye Syndrome
The most common ICD-9 diagnosis code related to dry eye is 375.15. One more code would be 370.33. A word of caution though: Many believe they can report 375.15 and 370.21 interchangeably; however this is not true.
Medical Billing & Coding: Hardware is a Vital Cog in 5010 & ICD-10 Implementations
From January 1 next year, your practice will have to make the required changes or enhancements to your practice management system, EMR system and/or medical billing and coding. Keeping this in mind, you need to work with your vendors to ensure your healthcare billing and practice management systems are up and running for the conversions to 5010 and ICD-10.
Communication with vendors a vital cog
It's very important that you get in touch with outside vendors to ensure the success of your practice's transition to version 5010 and ICD-10.
One more key to success is to test early and that too often
You should make it a point to test transactions and claim submissions with your vendor, clearing house and payer prior to the 5010 version deadline next year and the ICD-10 deadline in 2013. This step is very important for you to make a smooth transition.
Don't wait too late to test as your task will be tougher if you detect a flaw in your system in the last minute.
How to go about it: Get in touch with your software vendors well ahead of time to ensure that no issues will be there as far as claims submissions using ICD-10 are concerned. First you need to find out whether your vendors are all geared up for the transition to the just-in 5010 format.
Hardware requirements for your practice
Hardware is a vital peg for the 5010 and ICD-10 implementations. As such you need to assess the hardware your practice or vendor use. Find out the present age of your practice's hardware, the dual-processing capability for the two code sets (ICD-9 and ICD-10), storage capacity, processing power, and the like.
Also, you will need to see to it that your system is able to handle alphanumeric codes, seven characters, code descriptions which are long, just-in edits based on age, sex, and more, separate data entry programs for dual processing.
Your system is very important to be able to process both the soon-to-go ICD-9 code set and the soon-to-come ICD-10 code set concurrently to allow for claims processing, reporting and analysis.
The time required for maintaining both ICD-9 and ICD-10 will depend on your individual practice's requirement.
Source URL :- http://www.supercoder.com/icd-10/icd-10-bridge
You also need to see that your practice or vendor has a hardware that can handle the increased file and database storage you will need when the new code system goes into effect.
Communication with vendors a vital cog
It's very important that you get in touch with outside vendors to ensure the success of your practice's transition to version 5010 and ICD-10.
One more key to success is to test early and that too often
You should make it a point to test transactions and claim submissions with your vendor, clearing house and payer prior to the 5010 version deadline next year and the ICD-10 deadline in 2013. This step is very important for you to make a smooth transition.
Don't wait too late to test as your task will be tougher if you detect a flaw in your system in the last minute.
How to go about it: Get in touch with your software vendors well ahead of time to ensure that no issues will be there as far as claims submissions using ICD-10 are concerned. First you need to find out whether your vendors are all geared up for the transition to the just-in 5010 format.
Hardware requirements for your practice
Hardware is a vital peg for the 5010 and ICD-10 implementations. As such you need to assess the hardware your practice or vendor use. Find out the present age of your practice's hardware, the dual-processing capability for the two code sets (ICD-9 and ICD-10), storage capacity, processing power, and the like.
Also, you will need to see to it that your system is able to handle alphanumeric codes, seven characters, code descriptions which are long, just-in edits based on age, sex, and more, separate data entry programs for dual processing.
Your system is very important to be able to process both the soon-to-go ICD-9 code set and the soon-to-come ICD-10 code set concurrently to allow for claims processing, reporting and analysis.
The time required for maintaining both ICD-9 and ICD-10 will depend on your individual practice's requirement.
Source URL :- http://www.supercoder.com/icd-10/icd-10-bridge
You also need to see that your practice or vendor has a hardware that can handle the increased file and database storage you will need when the new code system goes into effect.
Friday, August 19, 2011
ICD-10 Updates: Report ‘Other’ and ‘Unspecified’ Hyperlipidemia Separately
ICD-10 offers a one-to-one code match with the previous code set for pure hypercholesterolemia, pure hyperglyceridemia, and mixed hyperlipidemia. Read on for a comparative study of how coding for the two code sets will affect you.
When ICD-10 goes into effect on October 1, 2013, there are good chances that high cholesterol will still be a hurdle for your patients. Take a look at how coding for this and similar diagnoses compares between the two code sets (ICD-9 and ICD-10).
ICD-9-CM codes include 272.0, 272.1, 272.2 and 272.4 while soon to go into effect ICD-10-CM codes include E78.0, E78.1, E78.2, E78.4, and E78.5.
ICD-10 coding changes
ICD-10 offers a one-to-one code match with ICD-9 for pure hypercholesterolemia (272.0, E78.0), pure hyperglyceridemia (272.1, E78.1), and mixed hyperlipidemia (272.2, E78.2). However where ICD-9 code offers one code for 'other and unspecified hyperlipidemia" (272.4), ICD-10 offers one code for 'other' E78.4) and a different code for “unspecified" (E78.5).
Don't change your clinicians' documentation from its present form
When it comes to clinicians' documentation you should not change it from its present form. All that you need to do as a coder to capture this already existing information is to format your superbill to capture the difference between 'other' and 'unspecified' hyperlipidemia. By 'others' it means the physician documented the type; however the new code set does not offer a code specific to the documented type. By 'Unspecified' it means that the physician didn't document the type of hyperlipidemia.
Differences between ICD-9 and ICD-10 codes for lipid metabolism disorders
Although the notes with the ICD-9 and ICD-10 codes for lipid metabolism disorders are very similar, there are a few differences though.
Example: Say for instance while 272.1 includes “hypertriglyceridemia, essential," E78.1 includes “elevated fasting triglycerides." Under E78.2, ICD-10 adds 'combined hyperlipidemia NOS', elevated cholesterol with elevated triglycerides NEC and “Hyperlipidemia, group C. Code E78.2 also has an Excludes1 note, asking you to code E78.4 for “familial combined hyperlipidemia" and E78.5 for “cerebrotendinous cholesterosis".
Bear in mind: When the new code system goes into effect on October 1, 2013, you should apply the code set and official guidelines in effect for the date of service (DOS) reported. (You can get more information here www.cdc.gov/nchs/icd/icd10cm.htm#10update.).
When ICD-10 goes into effect on October 1, 2013, there are good chances that high cholesterol will still be a hurdle for your patients. Take a look at how coding for this and similar diagnoses compares between the two code sets (ICD-9 and ICD-10).
ICD-9-CM codes include 272.0, 272.1, 272.2 and 272.4 while soon to go into effect ICD-10-CM codes include E78.0, E78.1, E78.2, E78.4, and E78.5.
ICD-10 coding changes
ICD-10 offers a one-to-one code match with ICD-9 for pure hypercholesterolemia (272.0, E78.0), pure hyperglyceridemia (272.1, E78.1), and mixed hyperlipidemia (272.2, E78.2). However where ICD-9 code offers one code for 'other and unspecified hyperlipidemia" (272.4), ICD-10 offers one code for 'other' E78.4) and a different code for “unspecified" (E78.5).
Don't change your clinicians' documentation from its present form
When it comes to clinicians' documentation you should not change it from its present form. All that you need to do as a coder to capture this already existing information is to format your superbill to capture the difference between 'other' and 'unspecified' hyperlipidemia. By 'others' it means the physician documented the type; however the new code set does not offer a code specific to the documented type. By 'Unspecified' it means that the physician didn't document the type of hyperlipidemia.
Differences between ICD-9 and ICD-10 codes for lipid metabolism disorders
Although the notes with the ICD-9 and ICD-10 codes for lipid metabolism disorders are very similar, there are a few differences though.
Example: Say for instance while 272.1 includes “hypertriglyceridemia, essential," E78.1 includes “elevated fasting triglycerides." Under E78.2, ICD-10 adds 'combined hyperlipidemia NOS', elevated cholesterol with elevated triglycerides NEC and “Hyperlipidemia, group C. Code E78.2 also has an Excludes1 note, asking you to code E78.4 for “familial combined hyperlipidemia" and E78.5 for “cerebrotendinous cholesterosis".
Bear in mind: When the new code system goes into effect on October 1, 2013, you should apply the code set and official guidelines in effect for the date of service (DOS) reported. (You can get more information here www.cdc.gov/nchs/icd/icd10cm.htm#10update.).
Thursday, August 18, 2011
On-Call Services: Avoid On-Call Fraud Accusations with These FAQs
Beware: You can't capture ER coverage services with after-hours codes.
If you bill incorrectly when your physician covers for others -- or when another physician covers for your physician -- you could be setting yourself up for charges of fraud.
Don't stress: Remember just a few simple answers to the top three on-call medical billing questions, and you'll be ready to correctly file claims.
1. Which Physician Bills for the Services?
If your physician is on call and handling patient services for another physician, don't fall into the trap of letting the other physician bill for the services. Even though a patient sees a particular physician, that does not mean that physician can bill for any services related to that patient's care. When your physician provides a service, even while on call for another doctor, you should bill the services.
Check the NPI: Each doctor who sees a patient should bill for the appropriate services rendered, under his/ her own NPI (National Provider Identifier) number.
The key: Whoever sees the patient face to face and documents and signs his/her name should be the one billing for those services provided regardless of who the admitting surgeon is.
2. How Do You Report On-Call ER Services?
Often, physicians see patients in the emergency department while on call. Don't turn to the after-hours codes to bill for these services when the hospital pays your physician for on-call status.
Reasoning: If the hospital is already paying the physician to be the on-call physician in the emergency room (ER), you cannot double-bill for his services. You should bill the after-hours codes 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed [e.g., holidays, Saturday or Sunday], in addition to basic service) and 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service) only when your physician sees a patient in your office outside regular office hours andanother third party is not compensating him for his time.
Example: If your office closes at 5 p.m. but your physician sees a patient on an emergency basis at 7 p.m., report 99050 in addition to any other services provided. If your physician saw the patient in the emergency room at 7 p.m., you should not report 99050. Keep in mind: Not all insurers will pay you for the after-hours codes.
Like the article? Click here to read the entire article and to get access to our monthly Part B Insider newsletter.
http://www.supercoder.com/coding-newsletters/part-b-coding-alert
If you bill incorrectly when your physician covers for others -- or when another physician covers for your physician -- you could be setting yourself up for charges of fraud.
Don't stress: Remember just a few simple answers to the top three on-call medical billing questions, and you'll be ready to correctly file claims.
1. Which Physician Bills for the Services?
If your physician is on call and handling patient services for another physician, don't fall into the trap of letting the other physician bill for the services. Even though a patient sees a particular physician, that does not mean that physician can bill for any services related to that patient's care. When your physician provides a service, even while on call for another doctor, you should bill the services.
Check the NPI: Each doctor who sees a patient should bill for the appropriate services rendered, under his/ her own NPI (National Provider Identifier) number.
The key: Whoever sees the patient face to face and documents and signs his/her name should be the one billing for those services provided regardless of who the admitting surgeon is.
2. How Do You Report On-Call ER Services?
Often, physicians see patients in the emergency department while on call. Don't turn to the after-hours codes to bill for these services when the hospital pays your physician for on-call status.
Reasoning: If the hospital is already paying the physician to be the on-call physician in the emergency room (ER), you cannot double-bill for his services. You should bill the after-hours codes 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed [e.g., holidays, Saturday or Sunday], in addition to basic service) and 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service) only when your physician sees a patient in your office outside regular office hours andanother third party is not compensating him for his time.
Example: If your office closes at 5 p.m. but your physician sees a patient on an emergency basis at 7 p.m., report 99050 in addition to any other services provided. If your physician saw the patient in the emergency room at 7 p.m., you should not report 99050. Keep in mind: Not all insurers will pay you for the after-hours codes.
Like the article? Click here to read the entire article and to get access to our monthly Part B Insider newsletter.
http://www.supercoder.com/coding-newsletters/part-b-coding-alert
Hospital Coding Scenarios to Help You Avoid Denials
Hospital coding and billing mistakes can cost your hospitals thousands of dollars. Here are a couple of hospital billing & coding scenarios to help your understanding and save you from unnecessary denials.
Scenarios: After treating a patient in the office, our physician admitted her to the hospital later the same day. How should we go about this situation? Can we bill for the office visit and the first day of admission? Or do we just bill for the hospital stay?
Well, it all depends on whether your physician tends to the patient on the same day in the hospital.
Two face-to-face visits on the same date
If the physician tends to the patient in the hospital on the same day he saw her in the office, you are looking at two face-to-face visits on the same date. Go for only the proper initial hospital care code - (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ).
CPT coding guidelines ( Source "http://www.supercoder.com/cpt-codes/") lay down that all initial hospital care services that start in another place of location (say for instance the physician's office) should be combined and coded using the proper level of initial hospital care. As the 99221-99223 code will include the evaluation & management provided in the office, you will go for an initial hospital care code that includes the work done in both sites of the service.
Bill each encounter separately
However if your physician doesn't see the patient in the hospital until the next day, you should bill each encounter separately. Select the proper office visit code (99201-99205 or 99212-99215) for the visit on day one. After this add an initial hospital care code 99221-99223 for day two when the physician tends to the patient in the hospital for the first time.
Bear in mind: CPT uses initial hospital care codes to code the first hospital inpatient encounter by the admitting physician. Soon after that, you will report subsequent hospital care codes - 99231-99233 - until the date of discharge. After the physician discharges the patient, you will submit the proper hospital discharge day code (99238 or 99239, Hospital discharge day management ).
Scenarios: After treating a patient in the office, our physician admitted her to the hospital later the same day. How should we go about this situation? Can we bill for the office visit and the first day of admission? Or do we just bill for the hospital stay?
Well, it all depends on whether your physician tends to the patient on the same day in the hospital.
Two face-to-face visits on the same date
If the physician tends to the patient in the hospital on the same day he saw her in the office, you are looking at two face-to-face visits on the same date. Go for only the proper initial hospital care code - (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ).
CPT coding guidelines ( Source "http://www.supercoder.com/cpt-codes/") lay down that all initial hospital care services that start in another place of location (say for instance the physician's office) should be combined and coded using the proper level of initial hospital care. As the 99221-99223 code will include the evaluation & management provided in the office, you will go for an initial hospital care code that includes the work done in both sites of the service.
Bill each encounter separately
However if your physician doesn't see the patient in the hospital until the next day, you should bill each encounter separately. Select the proper office visit code (99201-99205 or 99212-99215) for the visit on day one. After this add an initial hospital care code 99221-99223 for day two when the physician tends to the patient in the hospital for the first time.
Bear in mind: CPT uses initial hospital care codes to code the first hospital inpatient encounter by the admitting physician. Soon after that, you will report subsequent hospital care codes - 99231-99233 - until the date of discharge. After the physician discharges the patient, you will submit the proper hospital discharge day code (99238 or 99239, Hospital discharge day management ).
Wednesday, August 17, 2011
Medical Billing & Coding: Know How ERISA & PPACA Impact Your Practice
The Federal claims appeals regulations went into implementation on July 1. Here's an update on this and other medical billing and coding information relating to this change.
If you're not up to speed on the new law and honed your Employee Retirement Income Security Act (ERISA) know how, you could be taking your practice to a 'denial zone'. For the initiated, the Patient Protection and Affordable Care Act (PPACA) adopts existing ERISA claim regulation in total and adds on six to seven new standard requirements too.
The new appeals regs:
The just-in appeals regs will impact all your healthcare billing denials and appeals outside of Medicare and Medicaid; as such your billing department will need to be well-versed with them to get back their deserved payments.
The provider side of the healthcare industry does not focus enough on the new appeals regulation while the payer side of the industry talks about it all the time to ensure you don't get the payments.
Also bear in mind that PPACA is a Federal mandate and as such it's not optional.
Appeals options: Under PPACA, now there are both internal and external appeals options.
The good news is that for the internal appeals process, PPACA adopted ERISA claims regulations in their entirety and added six to seven new requirements as well. The law provides the just-in external appeals option by adoption the National Association of Insurance Commissioners (NAIC) external appeal model.
Note: As the practice or provider, you have no claim with the insurance company.
The appeal rights belong to the patient and not your practice; as such you need to get the patient's written permission to appeal a claim under ERISA. Under Federal Law, a provider or the representative of the provider can appeal an adverse benefit determination minus the written authorization by the member.
Under PPACA, if you have 'good assignment' from the patient, the healthcare provider will become a claimant during the appeals process.
PPACA requires one EOB format for the entire industry
A notable change is that PPACA requires explanation of benefits (EOBs) format for the entire industry. EOBs will be for initial denials called the adverse benefit determination, internal appeals denials (the final internal adverse benefit determination), and for external appeals denials (the final external adverse benefit determination).
Resource: For more information on the Federal claims appeals regulations, you can visit the labor department Website at http://www.dol.gov/ebsa/healthreform/.
If you're not up to speed on the new law and honed your Employee Retirement Income Security Act (ERISA) know how, you could be taking your practice to a 'denial zone'. For the initiated, the Patient Protection and Affordable Care Act (PPACA) adopts existing ERISA claim regulation in total and adds on six to seven new standard requirements too.
The new appeals regs:
The just-in appeals regs will impact all your healthcare billing denials and appeals outside of Medicare and Medicaid; as such your billing department will need to be well-versed with them to get back their deserved payments.
The provider side of the healthcare industry does not focus enough on the new appeals regulation while the payer side of the industry talks about it all the time to ensure you don't get the payments.
Also bear in mind that PPACA is a Federal mandate and as such it's not optional.
Appeals options: Under PPACA, now there are both internal and external appeals options.
The good news is that for the internal appeals process, PPACA adopted ERISA claims regulations in their entirety and added six to seven new requirements as well. The law provides the just-in external appeals option by adoption the National Association of Insurance Commissioners (NAIC) external appeal model.
Note: As the practice or provider, you have no claim with the insurance company.
The appeal rights belong to the patient and not your practice; as such you need to get the patient's written permission to appeal a claim under ERISA. Under Federal Law, a provider or the representative of the provider can appeal an adverse benefit determination minus the written authorization by the member.
Under PPACA, if you have 'good assignment' from the patient, the healthcare provider will become a claimant during the appeals process.
PPACA requires one EOB format for the entire industry
A notable change is that PPACA requires explanation of benefits (EOBs) format for the entire industry. EOBs will be for initial denials called the adverse benefit determination, internal appeals denials (the final internal adverse benefit determination), and for external appeals denials (the final external adverse benefit determination).
Resource: For more information on the Federal claims appeals regulations, you can visit the labor department Website at http://www.dol.gov/ebsa/healthreform/.
Tuesday, August 16, 2011
ICD-9-CM: 997.4 Makes Way for Four New Codes for Bariatric Procedures
Proposed ICD-9-CM code set for 2012 has changes for gastric band or bariatric procedures, pelvic circle fracture codes, skin cancer dx and more.
If the proposed ICD-9 CM codes become final, starting October 1 this year you will have four new codes to report complications of gastric band or bariatric procedures. This time you will get 539.xx and other new, invalid and revised codes that will have an impact on your general surgery practices.
Bariatric surgery or gastric band procedure: Presently, complications related to these are indexed to 997.4 as there is no secondary code to use. But all that is set to change on October 1, 2011 if the proposed codes - 539.01, 539.09, 539.81 and 539.89 - become final. When these codes go into effect, you can start reporting bariatric/gastric band complications with one of these four codes.
Note: ICD-9 adds an 'excludes' note to 997.4, and directs coders to these just-in codes.
These four codes come with a lot of advantages: The existing code 997.4 does not distinguish digestive system complications from bariatric or gastric band surgeries from complications owing to any other procedures or conditions. These new codes provide better data collection for bariatric and gastric band procedures.
Skin excision & ICD-9 2012: Apart from these changes, ICD-9 2012 proposed changes will expand 10 present codes to 40 new codes that you will have to use when your surgeon carries out a skin excision. Skin site distinguishes the 10 existing codes (173.0-173.9) that will become invalid.
Although the same site distinctions remain in the just-in codes, ICD-9 2012 adds a fifth digit to each four digit code to differentiate cancer type.
Here are four fifth digits to distinguish each site-specific four digit code based on neoplasm details:
If the proposed ICD-9 CM codes become final, starting October 1 this year you will have four new codes to report complications of gastric band or bariatric procedures. This time you will get 539.xx and other new, invalid and revised codes that will have an impact on your general surgery practices.
Bariatric surgery or gastric band procedure: Presently, complications related to these are indexed to 997.4 as there is no secondary code to use. But all that is set to change on October 1, 2011 if the proposed codes - 539.01, 539.09, 539.81 and 539.89 - become final. When these codes go into effect, you can start reporting bariatric/gastric band complications with one of these four codes.
Note: ICD-9 adds an 'excludes' note to 997.4, and directs coders to these just-in codes.
These four codes come with a lot of advantages: The existing code 997.4 does not distinguish digestive system complications from bariatric or gastric band surgeries from complications owing to any other procedures or conditions. These new codes provide better data collection for bariatric and gastric band procedures.
Skin excision & ICD-9 2012: Apart from these changes, ICD-9 2012 proposed changes will expand 10 present codes to 40 new codes that you will have to use when your surgeon carries out a skin excision. Skin site distinguishes the 10 existing codes (173.0-173.9) that will become invalid.
Although the same site distinctions remain in the just-in codes, ICD-9 2012 adds a fifth digit to each four digit code to differentiate cancer type.
Here are four fifth digits to distinguish each site-specific four digit code based on neoplasm details:
Pelvic circle fracture code search: Under ICD-9 2012 , there will be more precise coding choices as far as pelvic fracture codes are concerned. The just-in codes will be specific to 'without disruption: 808.44 and 808.54. These codes will offer choices to 'with disruption' codes 808.43 and 808.53.
For more details on the proposed ICD-9 code changes for 2012, sign up for a good coding resource like SuperCoder that provides you with fast online searches for this code set.
Friday, August 12, 2011
Burn Treatments: 16000-16030 May Not Tell Entire Burn Treatment Story
There's more to the procedures than dressing, debridement -- sometimes almost $900 more.
If you're reporting 16000-16036 codes, you might be forfeiting pay -- nearly $900 -- for separately reimbursable procedures, because procedures such as skin grafts are not included in these codes. Our coding experts offer these three tips for improving your burn treatment reimbursement.
Tip 1: Size Determines Anesthesia Code Choice
If the doctor only derides a burn, you should select an initial treatment code from the 16000-16030 series.
Here's why: Select 16000 (Initial treatment, first-degree burn, when no more than local treatment is required) when the physician tends to a first-degree burn only (burns affecting only the epidermis).
For more extensive burns, you must choose among codes 16020 (Dressings and/or debridement of partial-thickness burns, initial or subsequent; small [less than 5% total body surface area]), 16025 (… medium [e.g., whole face or whole extremity, or 5% to 10% total body surface area]), or 16030 (... large [e.g., more than 1 extremity, or greater than 10% total body surface area]).
Don't miss: To find the percentage of involved skin, use the “Rule of Nines," says Pamela Biffle, CPC, CPC-P, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas. According to the rule:
If you're reporting 16000-16036 codes, you might be forfeiting pay -- nearly $900 -- for separately reimbursable procedures, because procedures such as skin grafts are not included in these codes. Our coding experts offer these three tips for improving your burn treatment reimbursement.
Tip 1: Size Determines Anesthesia Code Choice
If the doctor only derides a burn, you should select an initial treatment code from the 16000-16030 series.
Here's why: Select 16000 (Initial treatment, first-degree burn, when no more than local treatment is required) when the physician tends to a first-degree burn only (burns affecting only the epidermis).
For more extensive burns, you must choose among codes 16020 (Dressings and/or debridement of partial-thickness burns, initial or subsequent; small [less than 5% total body surface area]), 16025 (… medium [e.g., whole face or whole extremity, or 5% to 10% total body surface area]), or 16030 (... large [e.g., more than 1 extremity, or greater than 10% total body surface area]).
Don't miss: To find the percentage of involved skin, use the “Rule of Nines," says Pamela Biffle, CPC, CPC-P, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas. According to the rule:
Select the treatment code based on that percentage, says Biffle.
One more thing: Make sure the dermatologist clearly states the size of the affected area(s) in the documentation to support any code selection.
Tip 2: Claim Skin Grafts When Applicable
Codes 16000-16036 describe treatment of the burn surface only, so you may report skin grafts if the physician performs them. You should select the appropriate skin graft code(s) from the 15040-15431 portion of CPT-- not doing so could undermine your reimbursement and cause your practice to lose well-deserved pay.
Example: The doctor treats a patient with third-degree burns on the left arm. He uses a free, full-thickness graft of 40 sq cm to close the wound.
Article Source :- http://www.supercoder.com/coding-newsletters/my-dermatology-coding-alert/burn-treatments-16000-16030-may-not-tell-entire-burn-treatment-story-107505-article
Tip 2: Claim Skin Grafts When Applicable
Codes 16000-16036 describe treatment of the burn surface only, so you may report skin grafts if the physician performs them. You should select the appropriate skin graft code(s) from the 15040-15431 portion of CPT-- not doing so could undermine your reimbursement and cause your practice to lose well-deserved pay.
Example: The doctor treats a patient with third-degree burns on the left arm. He uses a free, full-thickness graft of 40 sq cm to close the wound.
Article Source :- http://www.supercoder.com/coding-newsletters/my-dermatology-coding-alert/burn-treatments-16000-16030-may-not-tell-entire-burn-treatment-story-107505-article
Lowdown on Medicare Severity Diagnosis Related Groups (MS-DRG) Changes
Simple inpatient coding mistakes can weigh heavily on your hospitals – Here are some updates on DRG codes to help you stay informed and on the right reimbursement track.
DRGs are diagnosis-related group that classifies hospital cases into one of approximately 500 groups. These diagnosis related group codes are assigned by a 'grouper' program which is based on ICD diagnoses, procedures, age, discharge status and the like.
Recently, the CMS published the Federal Fiscal Year (FFY) 2012 Final Rule for Inpatient Prospective Payment System (IPPS) and the Long-term Care Hospital Prospective Payment System.
The implementation of the MS-DRG was needed to be done in a budget-neutral way. Since the time it came into being in FFY 2008, there have been documentation and coding changes made to the standardized amount to ensure the neutral stance of budget.
Very recently, the Centers for Medicare & Medicaid mandated a non-cumulative 2.9 % documentation and coding adjustment to get back overpayments occurring due to the conversion to the MS-DRG system. As made clear in the federal fiscal year 2011 IPPS Final rule, an additional - 2.9% adjustment is mandated statutorily for federal fiscal year 2012. But then since the FFY 2011 adjustment was non-cumulative, the net effect of the FFY 2012 adjustment comes with no change as compared to the FFY 2011 adjustment.
What's more, the agency finally rejected the proposed implementation of one more documentation and coding adjustment of -3.15% for FFY 2012.
In the proposed rule, the MS-DRG assignment for Percutaneous Mitral Valve Repair with Implant (MitraClip) also found mention.
ICD-10 & DRG codes: The proposed rule for FY 2012 doesn't provide comments regarding the ICD-10 MS –DRG. In fact, Version 28.0 of the ICD-10 MS-DRGs has been finalized and is available for public review on the CMS site.
For more DRG news and updates, sign up for a good online resource like SuperCoder. Such a site comes with a cutting edge tool - MS-DRG Master - that gives you the information on MS-DRG's allowed ICD-9-CM Volume 1 and 3 codes, LOS and payment weights in just one click.
Once you take the help of the MS-DRG Master, you will be able to correctly link ICD-9-CM Procedure Volume 3 codes to MS-DRG, identify all ICD-9-CM Diseases Volume 1 codes associated with a MS-DRG (Medicare System - Diagnostic Revenue Grouper) and lots more.
Sign up for one today and get all the tips and tricks to keep your inpatient coding on track.
DRGs are diagnosis-related group that classifies hospital cases into one of approximately 500 groups. These diagnosis related group codes are assigned by a 'grouper' program which is based on ICD diagnoses, procedures, age, discharge status and the like.
Recently, the CMS published the Federal Fiscal Year (FFY) 2012 Final Rule for Inpatient Prospective Payment System (IPPS) and the Long-term Care Hospital Prospective Payment System.
The implementation of the MS-DRG was needed to be done in a budget-neutral way. Since the time it came into being in FFY 2008, there have been documentation and coding changes made to the standardized amount to ensure the neutral stance of budget.
Very recently, the Centers for Medicare & Medicaid mandated a non-cumulative 2.9 % documentation and coding adjustment to get back overpayments occurring due to the conversion to the MS-DRG system. As made clear in the federal fiscal year 2011 IPPS Final rule, an additional - 2.9% adjustment is mandated statutorily for federal fiscal year 2012. But then since the FFY 2011 adjustment was non-cumulative, the net effect of the FFY 2012 adjustment comes with no change as compared to the FFY 2011 adjustment.
What's more, the agency finally rejected the proposed implementation of one more documentation and coding adjustment of -3.15% for FFY 2012.
In the proposed rule, the MS-DRG assignment for Percutaneous Mitral Valve Repair with Implant (MitraClip) also found mention.
ICD-10 & DRG codes: The proposed rule for FY 2012 doesn't provide comments regarding the ICD-10 MS –DRG. In fact, Version 28.0 of the ICD-10 MS-DRGs has been finalized and is available for public review on the CMS site.
For more DRG news and updates, sign up for a good online resource like SuperCoder. Such a site comes with a cutting edge tool - MS-DRG Master - that gives you the information on MS-DRG's allowed ICD-9-CM Volume 1 and 3 codes, LOS and payment weights in just one click.
Once you take the help of the MS-DRG Master, you will be able to correctly link ICD-9-CM Procedure Volume 3 codes to MS-DRG, identify all ICD-9-CM Diseases Volume 1 codes associated with a MS-DRG (Medicare System - Diagnostic Revenue Grouper) and lots more.
Sign up for one today and get all the tips and tricks to keep your inpatient coding on track.
Thursday, August 11, 2011
Diagnosis Coding Quiz: Are Your DX Coding Skills Up to Snuff? Take This Quick Quiz to Find Out
Hint: Coders shouldn't be interpreting test results to get quick diagnosis codes.
As your practice continues to prepare for the ICD-10 transition, it's important to still remain up-to-date on the ICD-9 coding rules, which remain in effect until Oct. 1, 2013. Read the following diagnosis coding questions submitted by our readers and check out our expert answers below.
Leave Diagnosing Patients to the Doctor
Question 1: If the physician hasn't indicated ECG results in his final diagnosis, should I code the findings? The doctor wrote a complete interpretation on the strip. He says "yes," because usually he has another diagnosis to justify the ECG.
Answer 1: The bottom line is if the test is positive, you should report the findings from the electrocardiogram (ECG) as the final diagnosis. If the test is negative, you should report the indications. For you to report positive findings from the ECG, the physician must document the findings as a final diagnosis. Choosing a diagnosis based on the patient's test results -- even when that diagnosis seems obvious-- is inappropriate and possibly fraudulent coding. CMS describes its guidelines for this issue in Transmittal AB-01-144 (Sept. 26, 2001) in which the agency states that a physician must confirm a diagnosis based on the test results.
This CMS transmittal goes on to say that if the test results are normal or nondiagnostic, you should code the signs or symptoms that prompted the test -- in other words, the indications. Similarly, the ICD-9 coding guidelines for diagnostic testing instruct you not to "interpret" what a study says, but rather to rely on the physician's stated diagnosis. If the ECG findings seem like an important component of the case -- and may play a role in substantiating the medical necessity for the visit-- you should query the physician regarding the diagnosis.
Heads up: Choose the CPT ECG code based on how much of the ECG service the physician's office provided. If the physician's office provided the entire service (both technical and professional components), assign 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report).
Code the technical component only as 93005 ( tracing only, withoutinterpretation and report). If the physician provided only the professional component, use 93010 ( interpretation and report only).
Don't Let Diabetes Dx Trip Up Your Claims
Question 2: Our physician treated a patient with diabetes, but he was actually seeing the patient to treat a complication of the diabetes, diabetic neuropathy. During his evaluation, the physician also noted that the patient had joint inflammation. Should we report the neuropathy complication only, or several of the ICD-9 codes?
Source URL :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/diagnosis-coding-quiz-are-your-dx-coding-skills-up-to-snuff-take-this-quick-quiz-to-find-out-107415-article
As your practice continues to prepare for the ICD-10 transition, it's important to still remain up-to-date on the ICD-9 coding rules, which remain in effect until Oct. 1, 2013. Read the following diagnosis coding questions submitted by our readers and check out our expert answers below.
Leave Diagnosing Patients to the Doctor
Question 1: If the physician hasn't indicated ECG results in his final diagnosis, should I code the findings? The doctor wrote a complete interpretation on the strip. He says "yes," because usually he has another diagnosis to justify the ECG.
Answer 1: The bottom line is if the test is positive, you should report the findings from the electrocardiogram (ECG) as the final diagnosis. If the test is negative, you should report the indications. For you to report positive findings from the ECG, the physician must document the findings as a final diagnosis. Choosing a diagnosis based on the patient's test results -- even when that diagnosis seems obvious-- is inappropriate and possibly fraudulent coding. CMS describes its guidelines for this issue in Transmittal AB-01-144 (Sept. 26, 2001) in which the agency states that a physician must confirm a diagnosis based on the test results.
This CMS transmittal goes on to say that if the test results are normal or nondiagnostic, you should code the signs or symptoms that prompted the test -- in other words, the indications. Similarly, the ICD-9 coding guidelines for diagnostic testing instruct you not to "interpret" what a study says, but rather to rely on the physician's stated diagnosis. If the ECG findings seem like an important component of the case -- and may play a role in substantiating the medical necessity for the visit-- you should query the physician regarding the diagnosis.
Heads up: Choose the CPT ECG code based on how much of the ECG service the physician's office provided. If the physician's office provided the entire service (both technical and professional components), assign 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report).
Code the technical component only as 93005 ( tracing only, withoutinterpretation and report). If the physician provided only the professional component, use 93010 ( interpretation and report only).
Don't Let Diabetes Dx Trip Up Your Claims
Question 2: Our physician treated a patient with diabetes, but he was actually seeing the patient to treat a complication of the diabetes, diabetic neuropathy. During his evaluation, the physician also noted that the patient had joint inflammation. Should we report the neuropathy complication only, or several of the ICD-9 codes?
Source URL :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/diagnosis-coding-quiz-are-your-dx-coding-skills-up-to-snuff-take-this-quick-quiz-to-find-out-107415-article
ICD-10 Updates: Combination Code for Coronary Atherosclerosis With Angina Pectoris
In a couple of years' time, when you start using ICD-10 codes, watch out for a combination code that covers more than one diagnosis.
For the uninitiated, atherosclerosis is a type of arteriosclerosis characterized by fatty plague deposits that restricts the blood flow through the arteries. Angina pectoris refers to chest pain or discomfort caused by coronary heart disease.
When you report coronary arteriosclerosis in ICD-10-CM, you will notice some differences from the present ICD-9-CM coding. As already mentioned, when you hop into the ICD-10 bandwagon, you should be ready for a combination code that covers more than one diagnosis:
ICD-10 combines your coding for native coronary atherosclerosis and angina pectoris.
Under ICD-9-CM, you use 414.01, coronary atherosclerosis of native coronary artery
Under ICD-10-CM , you will use I25.10, I25.110, I25.111, I25.118, and I25.119.
So what's different between the two code sets: The main change ICD-10 will bring is that they differ based on 'without' (I25.10) and "with" (I25.11-) angina pectoris.
ICD-10 rules, just like its predecessor ICD-9, indicate you should report an additional code (I25.82) if the patient also suffers from chronic total occlusion of a coronary artery. To add to it, if the patient has coronary atherosclerosis because of lipid rich plague, you should go for I25.83. For codes in the range for ischemic heart diseases (I20- I25), you should go for an additional code to identify presence of hypertension (I10-I15).
Clinicians should know that the presence of angina pectoris will alter your native coronary artery disease coding. While documenting, they should be specific about whether the angina pectoris is unstable, with documented spasm or for that matter another form. Documentation should also point to whether the patient has chronic hypertension, total coronary occlusion, and/or coronary atherosclerosis caused by lipid rich plaque.
Tips for coders: Modify coding tools; bear in mind that ICD-10 offers a combination code for coronary atherosclerosis with angina pectoris.
Source Code :- http://www.supercoder.com
For the uninitiated, atherosclerosis is a type of arteriosclerosis characterized by fatty plague deposits that restricts the blood flow through the arteries. Angina pectoris refers to chest pain or discomfort caused by coronary heart disease.
When you report coronary arteriosclerosis in ICD-10-CM, you will notice some differences from the present ICD-9-CM coding. As already mentioned, when you hop into the ICD-10 bandwagon, you should be ready for a combination code that covers more than one diagnosis:
ICD-10 combines your coding for native coronary atherosclerosis and angina pectoris.
Under ICD-9-CM, you use 414.01, coronary atherosclerosis of native coronary artery
Under ICD-10-CM , you will use I25.10, I25.110, I25.111, I25.118, and I25.119.
So what's different between the two code sets: The main change ICD-10 will bring is that they differ based on 'without' (I25.10) and "with" (I25.11-) angina pectoris.
ICD-10 rules, just like its predecessor ICD-9, indicate you should report an additional code (I25.82) if the patient also suffers from chronic total occlusion of a coronary artery. To add to it, if the patient has coronary atherosclerosis because of lipid rich plague, you should go for I25.83. For codes in the range for ischemic heart diseases (I20- I25), you should go for an additional code to identify presence of hypertension (I10-I15).
Clinicians should know that the presence of angina pectoris will alter your native coronary artery disease coding. While documenting, they should be specific about whether the angina pectoris is unstable, with documented spasm or for that matter another form. Documentation should also point to whether the patient has chronic hypertension, total coronary occlusion, and/or coronary atherosclerosis caused by lipid rich plaque.
Tips for coders: Modify coding tools; bear in mind that ICD-10 offers a combination code for coronary atherosclerosis with angina pectoris.
Source Code :- http://www.supercoder.com
Wednesday, August 10, 2011
ICD-9-CM codes: More Specificity for Neoplasm and Glaucoma Stages
Apart from new codes for acute respiratory failure and other complications after surgery, this time ICD-9-CM also brings five new V codes.
The ICD-9 Coordination and Maintenance Committee will implement a partial breeze of the ICD-9-CM and ICD-10 codes before transitioning to ICD-10. On October 1 this year, the last regular, annual updates to both ICD-10 and ICD-9-CM code sets will be made. As such, you need to brush up on the latest code choices now.
Now you will have more choices for lip neoplasm and glaucoma
This year, you need to pay special attention to expanded lip neoplasm and glaucoma choices in addition to new codes for acute respiratory failure and other complications after surgery. In other words, when ICD-9-CM codes go into effect, you will be able to locate some neoplasms and glaucoma stages more specifically:
Neoplasm codes 173.0-173.9 will take the exit path and be replaced by just-in fifth-digit choices 173.00-173.99 while glaucoma codes will expand to the fifth-digit level in order to differentiate the different stages. The just-in codes will be 365.70-365.74.
Fifth digit expansions to codes: This will help coders and physicians start thinking in terms of more detailed diagnoses.
Apart from this, you also need to get familiar with diagnosis changes for surgical procedures since anesthesiologists can find themselves covering all surgical areas. Just-in ICD 9 procedure codes (surgical) choices include:
539.01-538.89
629.31
726.13
518.81, 518.83, 518.84, 518.51
New codes: ICD-9 2012 ( Source "http://www.supercoder.com/icd9-codes/") will provide you with five V codes to help your physician better indicate conditions a patient might have as part of her personal or family medical history. The new options will include V12.21, V12.29, V12.55, V13.81 and V13.89.
Revised codes: As far as the revised codes are concerned, there are many migraine diagnoses listed. The descriptors are the same, but then the punctuation changes to some extent. Revised descriptors add a comma after the ‘so stated’ phrase in the fifth-digit ‘1’ subclassification descriptor for each type of migraine noted
The ICD-9 Coordination and Maintenance Committee will implement a partial breeze of the ICD-9-CM and ICD-10 codes before transitioning to ICD-10. On October 1 this year, the last regular, annual updates to both ICD-10 and ICD-9-CM code sets will be made. As such, you need to brush up on the latest code choices now.
Now you will have more choices for lip neoplasm and glaucoma
This year, you need to pay special attention to expanded lip neoplasm and glaucoma choices in addition to new codes for acute respiratory failure and other complications after surgery. In other words, when ICD-9-CM codes go into effect, you will be able to locate some neoplasms and glaucoma stages more specifically:
Neoplasm codes 173.0-173.9 will take the exit path and be replaced by just-in fifth-digit choices 173.00-173.99 while glaucoma codes will expand to the fifth-digit level in order to differentiate the different stages. The just-in codes will be 365.70-365.74.
Fifth digit expansions to codes: This will help coders and physicians start thinking in terms of more detailed diagnoses.
Apart from this, you also need to get familiar with diagnosis changes for surgical procedures since anesthesiologists can find themselves covering all surgical areas. Just-in ICD 9 procedure codes (surgical) choices include:
New codes: ICD-9 2012 ( Source "http://www.supercoder.com/icd9-codes/") will provide you with five V codes to help your physician better indicate conditions a patient might have as part of her personal or family medical history. The new options will include V12.21, V12.29, V12.55, V13.81 and V13.89.
Revised codes: As far as the revised codes are concerned, there are many migraine diagnoses listed. The descriptors are the same, but then the punctuation changes to some extent. Revised descriptors add a comma after the ‘so stated’ phrase in the fifth-digit ‘1’ subclassification descriptor for each type of migraine noted
Tuesday, August 9, 2011
Medicare fee schedule: CMS to expand the potentially misvalued code initiative
According to CMS, the total payments under the Medicare Physician Fee Schedule (MPFS) in CY 2012 will be $80 billion.
In an effort to ensure Medicare is paying appropriately for physician services and more closely managing the payment system, the agency is expanding the potentially misvalued code initiative, a July 1 CMS press release notes.
In 2011, the agency is focusing on the highest volume and dollar codes billed by physicians to find out whether these codes are overvalued and if E/M codes are undervalued. Prior to this, the agency targeted specific codes for review that may have impacted a few procedural specialties like cardiology, radiology or nuclear medicine however not taken a look at the highest expenditure codes across all specialties, the agency cites.
Strong efforts are required to assess fee schedule for Medicare ( Source "http://www.supercoder.com/coding-tools/fee-schedules") to see to it that it is paying right and ensuring that Medicare beneficiaries remain to have access to vital services, the release stresses. That aside, the agency is also proposing some changes in how it adjusts payment for geographic variation in the cost of practice.
Other changes in the proposed rule include:
The agency is also proposing to expand its multiple procedure payment reduction to the professional interpretation of advance imaging services to recognize the overlapping activities that go into valuing these services, the agency release cites.
The agency is also proposing criteria for a health risk assessment to be used with AWVs for which coverage began on January 1 this year under the affordable care act.
The agency will accept comments on the proposed rule until August 30 this year.
For more on this fee schedule update, click here
In an effort to ensure Medicare is paying appropriately for physician services and more closely managing the payment system, the agency is expanding the potentially misvalued code initiative, a July 1 CMS press release notes.
In 2011, the agency is focusing on the highest volume and dollar codes billed by physicians to find out whether these codes are overvalued and if E/M codes are undervalued. Prior to this, the agency targeted specific codes for review that may have impacted a few procedural specialties like cardiology, radiology or nuclear medicine however not taken a look at the highest expenditure codes across all specialties, the agency cites.
Strong efforts are required to assess fee schedule for Medicare ( Source "http://www.supercoder.com/coding-tools/fee-schedules") to see to it that it is paying right and ensuring that Medicare beneficiaries remain to have access to vital services, the release stresses. That aside, the agency is also proposing some changes in how it adjusts payment for geographic variation in the cost of practice.
Other changes in the proposed rule include:
The agency is also proposing to expand its multiple procedure payment reduction to the professional interpretation of advance imaging services to recognize the overlapping activities that go into valuing these services, the agency release cites.
The agency is also proposing criteria for a health risk assessment to be used with AWVs for which coverage began on January 1 this year under the affordable care act.
The agency will accept comments on the proposed rule until August 30 this year.
For more on this fee schedule update, click here
Monday, August 8, 2011
CPT Codes 2011: A Lowdown on Femoral Popliteal Service Codes
2011 has lots of changes as far as CPT codes and guidelines for your cardiology services are concerned. Here's a lowdown on this year's CPT codes that'll stand your cardiology coding in good stead.
Among the key changes, CPT 2011 has added new codes for lower extremity endovascular revascularization which includes angioplasty, atherectomy and stenting. This year's femoral/popliteal service codes include 37224 for angioplasty, 37225 for atherectomy (and angioplasty), 37226 for stent (and angioplasty) and 37227 for stent and atherectomy (and angioplasty).
Generally, for 37224-37227, you should go for one code that represents the most intensive service carried out in a single lower extremity vessel. Say for instance when the cardiologist carries out a stent placement, atherectomy, and angioplasty in the left popliteal vessel, you should use only 37227. This code includes stent placement, atherectomy, and angioplasty. In this situation, you shouldn't use the three codes 37224, 37225, or for that matter 37226 separately or in addition to 37227.
Territory rule:
This year's CPT codes - 37220-+37235- apply to different 'territories' and each territory has its own specific set of guidelines. The codes - 37224-37227 - fall under the femoral/popliteal vascular territory.
Important rule: According to CPT, the whole femoral/popliteal territory in 1 lower extremity is taken as a single vessel for CPT coding.
As such, you should go for a single code even if the cardiologist carried out various interventions for several lesions in the political artery and in the common, deep, and superficial femoral arteries in the same leg during the same session.
In situations like this, you should use the code for the most complex service. Say for instance if the cardiologist carries out angioplasty in the left popliteal artery and atherectomy in the left common femoral, you should go for atherectomy code 37225 only.
Remember: The codes are unilateral, which means they apply to a service on a single side of the body. According to CPT, if the physician treats the identical territory in both legs at the same session, you should go for modifier 59 (Distinct procedural service) to indicate both legs are involved.
Get information on CPT codes online by signing up for a reliable medical coding resource like SuperCoder.com.
Among the key changes, CPT 2011 has added new codes for lower extremity endovascular revascularization which includes angioplasty, atherectomy and stenting. This year's femoral/popliteal service codes include 37224 for angioplasty, 37225 for atherectomy (and angioplasty), 37226 for stent (and angioplasty) and 37227 for stent and atherectomy (and angioplasty).
Generally, for 37224-37227, you should go for one code that represents the most intensive service carried out in a single lower extremity vessel. Say for instance when the cardiologist carries out a stent placement, atherectomy, and angioplasty in the left popliteal vessel, you should use only 37227. This code includes stent placement, atherectomy, and angioplasty. In this situation, you shouldn't use the three codes 37224, 37225, or for that matter 37226 separately or in addition to 37227.
Territory rule:
This year's CPT codes - 37220-+37235- apply to different 'territories' and each territory has its own specific set of guidelines. The codes - 37224-37227 - fall under the femoral/popliteal vascular territory.
Important rule: According to CPT, the whole femoral/popliteal territory in 1 lower extremity is taken as a single vessel for CPT coding.
As such, you should go for a single code even if the cardiologist carried out various interventions for several lesions in the political artery and in the common, deep, and superficial femoral arteries in the same leg during the same session.
In situations like this, you should use the code for the most complex service. Say for instance if the cardiologist carries out angioplasty in the left popliteal artery and atherectomy in the left common femoral, you should go for atherectomy code 37225 only.
Remember: The codes are unilateral, which means they apply to a service on a single side of the body. According to CPT, if the physician treats the identical territory in both legs at the same session, you should go for modifier 59 (Distinct procedural service) to indicate both legs are involved.
Get information on CPT codes online by signing up for a reliable medical coding resource like SuperCoder.com.
Friday, August 5, 2011
2012 ICD- 9-CM Codes: Get Four Options for Non-Melanoma Malignant Neoplasm of the Lip
Plus, new codes will make cancer classification easier.
The proposed changes to 2012 ICD-9 codes is out; approved by the ICD-9-CM Coordination and Maintenance Committee, the new, revised and invalid codes were published in the Federal Register on May 5, 2011. After the new codes go into effect on October 1 this year, CMS will add ICD-9 codes on an emergency basis as it gears up to switch over the diagnosis coding system to ICD-10.
Expanded ICD-9 diagnosis code sets: As per the changes, from October 1 this year, dermatology coders will be able to report the location of carcinomas and other neoplasms of the skin more accurately. This time they include an expansion of the 173.x (Other malignant neoplasm of skin) series. Each code in that series will get a list of fifth digits that'll provide specifications on whether the malignant neoplasm is basal cell, squamous cell, or unspecified.
Source Code :- http://www.supercoder.com/icd9-codes/
ICD 9 codes 2011: Right now dermatology coders use 173.0 for any non-melanoma malignant neoplasm of the lip. This will become an invalid code once ICD-9 2012 codes go into effect.
ICD-9 codes 2012: When the ICD-9 2012 goes into effect, coders can choose from four options - 173.00, 173.01, 173.02 and 173.09.
New codes will make cancer classification easier: Normally, majority of skin cancers are either basal or squamous cell, neither of which are reportable conditions to central cancer registries. Due to the difficulty in distinguishing reportable skin cancers from non-reportable skin cancers, the facilities are transmitting skin cancers to central registries. This puts an additional burden on central registries and also ends up in the transmission of confidential patient information on patients whose information shouldn't be reported. The expansion of the category of 173 codes will allow for the differentiation of reportable and non-reportable skin cancer.
ICD-10 codes: We're not sure whether there'll be expanded skin neoplasm codes when coders update their diagnosis codes in 2013 with the new code set. Presently, ICD-10 is likely to include C44.0-C44.9, a code series that does not have the specificity as the soon-to-go-into-effect ICD-9 2012 codes.
The proposed changes to 2012 ICD-9 codes is out; approved by the ICD-9-CM Coordination and Maintenance Committee, the new, revised and invalid codes were published in the Federal Register on May 5, 2011. After the new codes go into effect on October 1 this year, CMS will add ICD-9 codes on an emergency basis as it gears up to switch over the diagnosis coding system to ICD-10.
Expanded ICD-9 diagnosis code sets: As per the changes, from October 1 this year, dermatology coders will be able to report the location of carcinomas and other neoplasms of the skin more accurately. This time they include an expansion of the 173.x (Other malignant neoplasm of skin) series. Each code in that series will get a list of fifth digits that'll provide specifications on whether the malignant neoplasm is basal cell, squamous cell, or unspecified.
Source Code :- http://www.supercoder.com/icd9-codes/
ICD 9 codes 2011: Right now dermatology coders use 173.0 for any non-melanoma malignant neoplasm of the lip. This will become an invalid code once ICD-9 2012 codes go into effect.
ICD-9 codes 2012: When the ICD-9 2012 goes into effect, coders can choose from four options - 173.00, 173.01, 173.02 and 173.09.
New codes will make cancer classification easier: Normally, majority of skin cancers are either basal or squamous cell, neither of which are reportable conditions to central cancer registries. Due to the difficulty in distinguishing reportable skin cancers from non-reportable skin cancers, the facilities are transmitting skin cancers to central registries. This puts an additional burden on central registries and also ends up in the transmission of confidential patient information on patients whose information shouldn't be reported. The expansion of the category of 173 codes will allow for the differentiation of reportable and non-reportable skin cancer.
ICD-10 codes: We're not sure whether there'll be expanded skin neoplasm codes when coders update their diagnosis codes in 2013 with the new code set. Presently, ICD-10 is likely to include C44.0-C44.9, a code series that does not have the specificity as the soon-to-go-into-effect ICD-9 2012 codes.
Thursday, August 4, 2011
HCPCS Level II Codes G0440-G0441 Can be Used for Either Apligraf or Dermagraft
Two G codes - G0440-G0441 - to report your surgeon's work this year.
This year you can turn to two G codes - G0440, G0441 - when your surgeon applies a tissue-cultured skin or dermal substitute for Medicare patients with lower extremity ulcers owing to venous statis or diabetes. This is a welcome change from using the CPT codes for the service, which depend on the type of skin or dermal substitute as follows:
This year you can turn to two G codes - G0440, G0441 - when your surgeon applies a tissue-cultured skin or dermal substitute for Medicare patients with lower extremity ulcers owing to venous statis or diabetes. This is a welcome change from using the CPT codes for the service, which depend on the type of skin or dermal substitute as follows:
For most non-Medicare payers, you should continue to use the 15300-series codes.
Cause of concern: General surgeons, podiatrists, plastic surgeons and wound care specialists were worried that Apligraf had a 90-day global period in comparison to Dermagraft, which had a 30-day global period. This lead to a lot of confusion as it caused providers to use one product over another to get financial advantage. But with the new G codes around, not anymore.
Codes G0440-G0441 to the rescue: Codes G0440-G0441 can be used for either Apligraf or Dermagraft. These HCPCS medical codes ( Source "http://www.supercoder.com/hcpcs-codes/" )have a 0 global days and include the site preparation and debridement services.
The just-in codes together with a 0-day global billing period will do away with unequal financial incentives in the selection of products for the treatment of chronic wounds as well as help ensure that physicians make their treatment decisions based solely on clinical advantage.
The road ahead: The Centers for Medicare & Medicaid is working on valuing G0440 and G0441 this year to pave the way for CPT 2012 to offer category III codes to replace the temporary G codes.
Wednesday, August 3, 2011
Reimbursement Roundup: Modifier PT Helps Your Practice Capture Screening-Turned-Diagnostic Colonoscopy Pay
New modifier became effective Jan. 1 -- here's how you'll report it.
The question of how to code a screening colonoscopy that becomes diagnostic during the course of the procedure -- and whether the patient's deductible applies -- has long puzzled some practices, but a new Medicare modifier solves that problem. Learn how modifier PT (CRC screening test converted to diagnostic test or other procedure) can solve your colonoscopy reimbursement woes.
Get to Know Modifier PT Basics
Effective Jan. 1, Medicare carriers accept new modifier PT to explain when your physician starts a screening colonoscopy that then becomes a diagnostic procedure.
"This tells the MAC contractor that the service started as a screening procedure (e.g. G0105 [Colorectal cancer screening; colonoscopy on individual at high risk], G0121 [Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk]) but an abnormality was found and the procedure became diagnostic or therapeutic," says Joel V. Brill, MD, AGAF, CHCQM, American Gastroenterological Association, AMA/Specialty Society Relative Value Update Committee (RUC) Advisory Committee Member.
Source URL :- http://www.supercoder.com/coding-newsletters/my-practice-management-alert/reimbursement-roundup-modifier-pt-helps-your-practice-capture-screening-turned-diagnostic-colonoscopy-pay-article
When appended to your procedure code, "the modifier will indicate to Medicare to waive the deductible for a diagnostic procedure," says Christine Ross, CPC, with Digestive Healthcare Center in Hillsborough, N.J.
Why the change? Practices needed a way to tell MACs that their procedures started out as screening services but changed to diagnostic but didn't want patients subjected to deductibles for these services. "The Affordable Care Act waives the Part B deductible for colorectal cancer screening tests that become diagnostic," CMS noted in MLN Matters article MM7012, which announced the new modifier PT (www.cms.gov/MLNMattersArticles/downloads/MM7012.pdf).
Avoid Reporting G Code With Modifier PT
Once the physician indicates that the screening procedure has turned diagnostic, you'll bill only the diagnostic colonoscopy code, and not the screening code (G0104-G0106, G0120-G0121). Not only is this correct coding, but it's also the only way you can use modifier PT.
The MLN Matters article notes that modifier PT should only be appended to a CPT code in the surgical range of 10000 to 69999. Therefore, you should not append modifier PT to a G code, says Brill, who represents the American Gastroenterological Association on the CPT Editorial Panel.
The question of how to code a screening colonoscopy that becomes diagnostic during the course of the procedure -- and whether the patient's deductible applies -- has long puzzled some practices, but a new Medicare modifier solves that problem. Learn how modifier PT (CRC screening test converted to diagnostic test or other procedure) can solve your colonoscopy reimbursement woes.
Get to Know Modifier PT Basics
Effective Jan. 1, Medicare carriers accept new modifier PT to explain when your physician starts a screening colonoscopy that then becomes a diagnostic procedure.
"This tells the MAC contractor that the service started as a screening procedure (e.g. G0105 [Colorectal cancer screening; colonoscopy on individual at high risk], G0121 [Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk]) but an abnormality was found and the procedure became diagnostic or therapeutic," says Joel V. Brill, MD, AGAF, CHCQM, American Gastroenterological Association, AMA/Specialty Society Relative Value Update Committee (RUC) Advisory Committee Member.
Source URL :- http://www.supercoder.com/coding-newsletters/my-practice-management-alert/reimbursement-roundup-modifier-pt-helps-your-practice-capture-screening-turned-diagnostic-colonoscopy-pay-article
When appended to your procedure code, "the modifier will indicate to Medicare to waive the deductible for a diagnostic procedure," says Christine Ross, CPC, with Digestive Healthcare Center in Hillsborough, N.J.
Why the change? Practices needed a way to tell MACs that their procedures started out as screening services but changed to diagnostic but didn't want patients subjected to deductibles for these services. "The Affordable Care Act waives the Part B deductible for colorectal cancer screening tests that become diagnostic," CMS noted in MLN Matters article MM7012, which announced the new modifier PT (www.cms.gov/MLNMattersArticles/downloads/MM7012.pdf).
Avoid Reporting G Code With Modifier PT
Once the physician indicates that the screening procedure has turned diagnostic, you'll bill only the diagnostic colonoscopy code, and not the screening code (G0104-G0106, G0120-G0121). Not only is this correct coding, but it's also the only way you can use modifier PT.
The MLN Matters article notes that modifier PT should only be appended to a CPT code in the surgical range of 10000 to 69999. Therefore, you should not append modifier PT to a G code, says Brill, who represents the American Gastroenterological Association on the CPT Editorial Panel.
Under ICD-10-CM, Obstructive Sleep Apnea Gets a New Code - G47.33
As the October 1, 2013 ICD-10 deadline approaches, it's very important that you have a sound ICD-10 coding know how. If you are an otolaryngology coder, here are some ICD-10 guidelines that'll stand you in good stead.
Obstructive sleep apnea: Snoring, restless sleep, etc are manifestations of sleep-disordered breathing. The main disorders that may need surgical intervention are snoring and obstructive sleep apnea (OSA). In obstructive sleep apnea, pauses in breathing (more than 10 seconds at a time) take place because the airway becomes narrowed, blocked or floppy. This disorder may differ in severity and is normally associated with other physiologic problems.
Ways to diagnose OSA? An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck, many a time using a fiberoptic scope. Under ICD-9-CM code set, if the patient was diagnosed with obstructive sleep apnea, you would go for 327.23 (obstructive sleep apnea –adult – pediatric).
Transition from ICD-9 to ICD-10 codes : However, after the transition to ICD-10 on October 1, 2013, you would not report 327.23 for OSA as 327.23 becomes G47.33. This change will offer no difference; as a matter of fact, the descriptor of the new code is a carbon copy depiction of the previous code set's 327.23.
Documentation: While diagnosing a sleep disorder like obstructive sleep apnea, a physician may have the patient fill out a questionnaire to get information on wake-sleep patterns. Blood tests may also be ordered to rule out other conditions. If the physician suspects a sleep disorder, the patient would most probably undergo a polysomnography to record breathing and brain and muscle during sleep. Depending on the specific type of disorder, treatment will be provided.
Obstructive sleep apnea: Snoring, restless sleep, etc are manifestations of sleep-disordered breathing. The main disorders that may need surgical intervention are snoring and obstructive sleep apnea (OSA). In obstructive sleep apnea, pauses in breathing (more than 10 seconds at a time) take place because the airway becomes narrowed, blocked or floppy. This disorder may differ in severity and is normally associated with other physiologic problems.
Ways to diagnose OSA? An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck, many a time using a fiberoptic scope. Under ICD-9-CM code set, if the patient was diagnosed with obstructive sleep apnea, you would go for 327.23 (obstructive sleep apnea –adult – pediatric).
Transition from ICD-9 to ICD-10 codes : However, after the transition to ICD-10 on October 1, 2013, you would not report 327.23 for OSA as 327.23 becomes G47.33. This change will offer no difference; as a matter of fact, the descriptor of the new code is a carbon copy depiction of the previous code set's 327.23.
Documentation: While diagnosing a sleep disorder like obstructive sleep apnea, a physician may have the patient fill out a questionnaire to get information on wake-sleep patterns. Blood tests may also be ordered to rule out other conditions. If the physician suspects a sleep disorder, the patient would most probably undergo a polysomnography to record breathing and brain and muscle during sleep. Depending on the specific type of disorder, treatment will be provided.
Tuesday, August 2, 2011
Medical Billing: PMFSH Tips to help you Stay Away From Denials
If you're not billing higher level evaluation & management services because your physician glosses over a patient's PMFSH, you could be missing out on your reimbursements.
Here are some medical billing tips to ensure your physician is capturing and you are recognizing every history component the patient points out:
First, find out the PMFSH level – none, pertinent and complete
For medical coding and billing ( Source "http://www.supercoder.com") purposes, the history part of an evaluation & management service needs these three elements – history of present illness (HPI), review of systems (ROS), and past medical, family and social history (PMFSH). As such, the PMFSH helps determine patient history level, which has a huge impact on the evaluation & management level you report. Not knowing the PMFSH level will mean you'll not be able to decide which level of evaluation & management code you should report on the claim.
Second, zoom in on a code based on the PMFSH Element Requirement
After you determine the level of PMFSH contained in your physician's documentation, you can see which codes that history element supports.
Note of caution: If your physician doesn't document any PMFSH elements, you can only reach an extended problem-focused level of history; this means the highest codes you will be able to report are a level-two new patient code or a three-level established patient code. In order to get a level-four and level five new patient visits and level-five established patient visits, it's essential to have an all-encompassing level of history.
Third, do not neglect these areas
As per evaluation & management guidelines, if a patient's past medical, family and social history has not changed since a prior visit, your physician need not document the information once more. However, it's important that he documents that he reviewed the prior information in order to ensure it's up to date and also note in the present encounter's documentation on the date and place of the initial prior acquisition of the PMFSH. In fact if you neglect any of these criteria, some payers will give no PMFSH credit.
Here are some medical billing tips to ensure your physician is capturing and you are recognizing every history component the patient points out:
First, find out the PMFSH level – none, pertinent and complete
For medical coding and billing ( Source "http://www.supercoder.com") purposes, the history part of an evaluation & management service needs these three elements – history of present illness (HPI), review of systems (ROS), and past medical, family and social history (PMFSH). As such, the PMFSH helps determine patient history level, which has a huge impact on the evaluation & management level you report. Not knowing the PMFSH level will mean you'll not be able to decide which level of evaluation & management code you should report on the claim.
Second, zoom in on a code based on the PMFSH Element Requirement
After you determine the level of PMFSH contained in your physician's documentation, you can see which codes that history element supports.
Note of caution: If your physician doesn't document any PMFSH elements, you can only reach an extended problem-focused level of history; this means the highest codes you will be able to report are a level-two new patient code or a three-level established patient code. In order to get a level-four and level five new patient visits and level-five established patient visits, it's essential to have an all-encompassing level of history.
Third, do not neglect these areas
As per evaluation & management guidelines, if a patient's past medical, family and social history has not changed since a prior visit, your physician need not document the information once more. However, it's important that he documents that he reviewed the prior information in order to ensure it's up to date and also note in the present encounter's documentation on the date and place of the initial prior acquisition of the PMFSH. In fact if you neglect any of these criteria, some payers will give no PMFSH credit.
Monday, August 1, 2011
Part B Revenue Booster: Say Goodbye to X-Ray Denials With These Simple Tips
Palmetto providers: Add this 'history of' code to the list of covered conditions.
If you provide X-ray services, consider this: A chest X-ray's global fee is only $25 or so. Multiply that $25 by the number of services you perform, however, and you'll quickly see how getting these claims right is important to your practice's financial health.
Below, you'll find essential information for 71010 (Radiologic examination, chest; single view, frontal) and 71020 (Radiologic examination, chest, 2 views, frontal and lateral), including example services, typical supporting diagnosis codes, and advice on avoiding the most common causes of audit-related denials.
A tip to start: Codes 71010 and 71020 have separate professional and technical components under the Medicare physician fee schedule. So if you're reporting only the professional service, you should append modifier 26 (Professional component). To report the technical component only, append TC (Technical component). If you're reporting the global service (both professional and technical components), you shouldn't append modifier 26 or TC.
Boost Your X-Ray Skills by Understanding Views
The key element distinguishing 71010 from 71020 is that the first represents a single "frontal" view and the second represents two views, "frontal and lateral."
71010: The documentation for a 71010 service may refer to an "AP view," says Alice Wonderchek, CPC, billing and coding specialist with Ohio-based Radisphere National Radiology Group. AP stands for anteriorposterior, meaning the X-rays pass from the anterior (front) to the posterior (back) of the patient.
You also may see reference to a "PA view" (posterioranterior), in which the X-rays pass from the back to the front of the patient. The AP view can be more difficult to interpret than a PA view because of quality issues andthe way the heart appears enlarged on an AP view. As a result, the PA view usually is preferred over the AP view.
You typically will see an AP view when the patient cannot stand for the imaging service. As a result, another term you'll often see connected to 71010 services is "portable," meaning the tech takes the X-ray using a portable machine. You may see this particularly for services performed at bedside, Wonderchek says.
Example: A patient exhibits decreased breath sounds and low oxygen levels. The physician orders a portable AP chest X-ray to be performed at the patient's bedside. You should report 71010 for the single-view X-ray.
71020: You may see a 71020 service referred to as a "PA & Lat," Wonderchek says. The abbreviation refers to the PA (posterior-anterior) view and the Lat (lateral) view. Lateral means "side." Generally, the tech will take a left lateral X-ray, meaning the patient's left side is closer to the film than the right side is. But the physician may ask for a right lateral X-ray instead.
Example: A patient with a history of lung cancer presents complaining of fever and shortness of breath. Her physician orders PA and lateral X-ray imaging. This service merits code 71020.
Whittle Down the List of Likely Diagnoses
Physicians order chest X-rays for a wide variety of reasons. The potential exam findings also add up to a long list. Consequently, there are many ICD-9 codes that may apply to a chest X-ray claim.
Article Source :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/part-b-revenue-booster-say-goodbye-to-x-ray-denials-with-these-simple-tips-107358-107358-article
If you provide X-ray services, consider this: A chest X-ray's global fee is only $25 or so. Multiply that $25 by the number of services you perform, however, and you'll quickly see how getting these claims right is important to your practice's financial health.
Below, you'll find essential information for 71010 (Radiologic examination, chest; single view, frontal) and 71020 (Radiologic examination, chest, 2 views, frontal and lateral), including example services, typical supporting diagnosis codes, and advice on avoiding the most common causes of audit-related denials.
A tip to start: Codes 71010 and 71020 have separate professional and technical components under the Medicare physician fee schedule. So if you're reporting only the professional service, you should append modifier 26 (Professional component). To report the technical component only, append TC (Technical component). If you're reporting the global service (both professional and technical components), you shouldn't append modifier 26 or TC.
Boost Your X-Ray Skills by Understanding Views
The key element distinguishing 71010 from 71020 is that the first represents a single "frontal" view and the second represents two views, "frontal and lateral."
71010: The documentation for a 71010 service may refer to an "AP view," says Alice Wonderchek, CPC, billing and coding specialist with Ohio-based Radisphere National Radiology Group. AP stands for anteriorposterior, meaning the X-rays pass from the anterior (front) to the posterior (back) of the patient.
You also may see reference to a "PA view" (posterioranterior), in which the X-rays pass from the back to the front of the patient. The AP view can be more difficult to interpret than a PA view because of quality issues andthe way the heart appears enlarged on an AP view. As a result, the PA view usually is preferred over the AP view.
You typically will see an AP view when the patient cannot stand for the imaging service. As a result, another term you'll often see connected to 71010 services is "portable," meaning the tech takes the X-ray using a portable machine. You may see this particularly for services performed at bedside, Wonderchek says.
Example: A patient exhibits decreased breath sounds and low oxygen levels. The physician orders a portable AP chest X-ray to be performed at the patient's bedside. You should report 71010 for the single-view X-ray.
71020: You may see a 71020 service referred to as a "PA & Lat," Wonderchek says. The abbreviation refers to the PA (posterior-anterior) view and the Lat (lateral) view. Lateral means "side." Generally, the tech will take a left lateral X-ray, meaning the patient's left side is closer to the film than the right side is. But the physician may ask for a right lateral X-ray instead.
Example: A patient with a history of lung cancer presents complaining of fever and shortness of breath. Her physician orders PA and lateral X-ray imaging. This service merits code 71020.
Whittle Down the List of Likely Diagnoses
Physicians order chest X-rays for a wide variety of reasons. The potential exam findings also add up to a long list. Consequently, there are many ICD-9 codes that may apply to a chest X-ray claim.
Article Source :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/part-b-revenue-booster-say-goodbye-to-x-ray-denials-with-these-simple-tips-107358-107358-article
Pediatric Coding: Be Well-Versed With Prolonged Service Code
When you are thinking about prolonged service codes 99358-99359 for your evaluation and management (E/M) services, you'll come face to face with yet another common pediatric coding challenge. Since last year, you have been able to count indirect prolonged service time that takes place around the date of the E/M service.
As per the previous definition (year 2009 and before), the non-face-to-face service had to be the day of the evaluation and management visit. But then since the first day of last year, you simply have to prove that the time was 'related' to the evaluation & management service.
Word of caution: Prolonged service codes 99358 and +99359 still have to relate to an E/M service that involves patient contact.
As per the revised notes, the prolonged service must related to a service or patient where direct patient care has taken place or will occur and relate to ongoing patient management. According to CPT, there are no timeframe on the time that can elapse between the primary service and the prolonged prior to and after direct patient care service.
If you are tending to a complex child, the loosening of the prolonged non-face-to-face service codes has been a great help. You can assess the patient's chart and make phone calls prior to and after seeing the patient and count that time. You need a minimum of 30 minutes to bill the first hour of prolonged non-face-to-face care.
What if you are using electronic billing? If so, you may miss the opportunity to add 'related' prolonged service tomes to your claims. With electronic billing, the encounter is sent directly to the front office and the bill is sent out then and there.
What you need to do: You have to work with the practice management staff to ensure that you are holding the claim until all of the extra work related to the E/M visit is done and you are holding the claim until all of the additional work related to that E/M visit is finished and documented.
As per the previous definition (year 2009 and before), the non-face-to-face service had to be the day of the evaluation and management visit. But then since the first day of last year, you simply have to prove that the time was 'related' to the evaluation & management service.
Word of caution: Prolonged service codes 99358 and +99359 still have to relate to an E/M service that involves patient contact.
As per the revised notes, the prolonged service must related to a service or patient where direct patient care has taken place or will occur and relate to ongoing patient management. According to CPT, there are no timeframe on the time that can elapse between the primary service and the prolonged prior to and after direct patient care service.
If you are tending to a complex child, the loosening of the prolonged non-face-to-face service codes has been a great help. You can assess the patient's chart and make phone calls prior to and after seeing the patient and count that time. You need a minimum of 30 minutes to bill the first hour of prolonged non-face-to-face care.
What if you are using electronic billing? If so, you may miss the opportunity to add 'related' prolonged service tomes to your claims. With electronic billing, the encounter is sent directly to the front office and the bill is sent out then and there.
What you need to do: You have to work with the practice management staff to ensure that you are holding the claim until all of the extra work related to the E/M visit is done and you are holding the claim until all of the additional work related to that E/M visit is finished and documented.
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