CPT Codes for Skin Replacement and Skin Substitute Grafts

Revised CPT instruction clarifies coding.

Although the codes and rules for reporting skin replacement and skin substitutes are not new, ever since 2011 CPT codes added a couple of new introductory sections it certainly looks clearer. Read on and take some lessons on ways to report skin replacement and skin substitute grafts:

When you shouldn't use these codes

There are over 50 codes that describe the various surgical steps and types of skin replacement/substitute procedures in the range 15002 - +15431.

So questions may arise whether you should report the proper codes from this range every time your surgeon makes use of a skin replacement or skin substitute to heal a wound. Well, in this case you shouldn't code a skin replacement or skin substitute application if the surgeon just applies skin replacement/substitute to the wound, even if he makes it stable by dressing.

Instead here's what you should do: You should use these codes only when the skin substitute/graft is anchored using the surgeon's option of fixation. Say for instance it might include adhesives, sutures, or staples.

You should look for documentation of fixation in the op note before you make use of any skin replacement or skin substitute codes.

Be familiar with what ‘application' services include

Many a time surgeons carry out skin replacement or skin substitute grafts post other surgical treatment for distressing wounds, burn eschar, or necrotizing infection. When the surgeon applies and fixes skin or a skin substitute you will need to understand which services you should and should not code in apart from the proper graft code.

You should include dressing: As per CPT instruction, when you report a skin or skin substitute graft, you should not code routine dressing supplies separately. Supplies like A6453 are included in the skin application charge.

Dermatology Coding Alert: Master Your Derm ASC Coding

Numerous changes affecting ASCs every year are enough to confuse you. Still, few aspects of ASC reimbursement continue to be the same. Read further to know how the ASC rules affect you and what dermatology codes you should choose in such a case. These expert tips will surely take you a step ahead in perfecting your dermatology medical billing and coding.

1. ASC-allowed services: Know where to find them. CMS has a very specific list of codes payable for ASCs, but if you don't know how to access the list, you could be losing your reimbursement.

You can download the most recent ASC-allowable codes from the CMS website. It includes both the current quarter as well as previous quarters in case you're battling older claims.

2. 'Same-day global' rule. Each procedure the ASC bills takes a "same-day" global period as the ASC is only reporting facility fees and not physician work services. This is applicable to the coder working for the ASC and not the physician who performed the service.

In case the physician returned the patient to the ASC the day after the initial surgery, the ASC coder is supposed to report the suitable control-of-bleeding code with no modifier. On the other hand, the surgeon's coder would report the bleeding-control code with modifier 78 appended because the physician's services follow the standard global rule.

The ASC coder should go by the "same-day" global rule, but the physician's coder should follow standard global period rules from the fee schedule.

3. You Can Avoid modifier SG. In the past, the ASC coder had to list modifier SG (ASC facility service) as the first modifier on the claim in case he billed Medicare for any service performed in the ASC. However, that all changed with the CMS Transmittal 1410, which stated that the SG modifier is no longer applicable for Medicare services for services on or after January 1, 2008.

4. Discontinued surgery modifiers may differ. ASC coders may sometimes use modifier 52 (Reduced services) but would not use modifier 53 (Discontinued procedure). Instead, insurers generally want ASC coders to call on modifiers 73 (Discontinued outpatient hospital/ASC procedure before administration of anesthesia) or 74 (Discontinued outpatient hospital/ASC procedure after the administration of anesthesia), as appropriate.

When the physician gets back to the ASC with the patient to perform the aborted procedure at a later date or time, the ASC will get full reimbursement for the completed procedure.

5. Keep in contact with the surgeon's coder. You could lose your reimbursements when the physician and the ASC report separate codes for the same procedure. Remember, the physician and ASC should report the same codes for each surgery, any coding differences should be fixed before the claim is submitted.

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Vitiligo Treatment : Know Whether to Apply 96900 or 96910

Avoid misrepresenting phototherapy services and know what dermatology codes apply

You need to examine your dermatologist's documentation to define what type of light, wavelength, and materials he used while providing phototherapy treatment to vitiligo /dychromia patients. Read this article to know what dermatology codes you should choose in such a case and how to overcome both E/M and multiequipment correct coding initiative (CCI) challenges.

In case you are charging for an office visit on the same day as phototherapy, the reimbursement might depend on the fact whether your physician's documentation includes a different diagnosis code. Experts maintain that the payers might reimburse at times if the doctor examines the patient for a different problem, hence with a different diagnosis code.

For patients having vitiligo (709.01), your dermatologist might use narrow band UVB phototherapy. The phototherapy is administered for two to three times per week for several months until the patient attains repigmentation of the skin. For this procedure, you need to pinpoint what types of phototherapy, UVA or UVB, the physician used as well as the varying wavelengths.

In case your dermatologist used tar or or petrolatum with the light treatment, you should code 96910 (Photochemotherapy; tar and ultraviolet B [Goeckerman treatment] or petrolatum and ultraviolet B). Through this procedure, the dermatologist runs ultraviolet B light, with dosages cautiously increased as the treatment develops, resulting in longer times spent under the light source.

You should report 96900 (Actinotherapy [ultraviolet light]) in case the patient applies the treatment herself.

Note: You should always check with your payer for their rules.

In case, your dermatolist prescribed psolarens combined with ultraviolet A (UVA) light therapy, you should use 96912 (Photochemotherapy; psoralens and ultraviolet A [PUVA]). If your dermatologist doesn't use tars, petrolatum or psolarens with the light treatment, the code that remains is 96900.

The difference: UVA phototherapy is generally given with a lightsensitizing tablet named psoralen (PUVA therapy). Occasionally a light-sensitizing cream or lotion having psoralen is used in localized skin areas (for instance feet [topical PUVA]). On the other hand, UVB phototherapy uses the sunburning part of the UV spectrum.

Don't take risks: If you code either 96910 or 96912 when your dermatologist uses merely a light source in the treatment or the patient applies a topical agent, you could be accused of misrepresentation of service. It could be a fraudulent claim under the Federal False Claims Act.

Want to get more tips like these to master dermatology medical billing and coding? Click here to read the entire article and to get access to our monthly Dermatology Coding Alert: Your practical adviser for ethically optimizing dermatology medical billing and coding, payment, and efficiency for dermatology practices

HCPCS Codes: Couple of Temporary G codes for the Current Year

This year there are a couple of temporary G codes that you need to use.

In a particular situation, your dermatologist applies a tissue-cultured skin or dermal substitute for Medicare patients with lower extremity ulcers owing to venous stasis or diabetes. If you are to report such a situation, you have a couple of temporary 'G' codes for the present year.

Be it Apligraf or Dermagraft, you should zero in on G0440 and G0441 to report your surgeon's work in the present year. This is a change from using the current CPT codes for the service, which depend on the type of skin or dermal substitutes which are: Apligraf -- 15340-+15341, Dermagraft -- 15360-+15361.

Note: For most non-Medicare payers you should continue to use the 15300-series codes.

Sometimes your surgeon may prefer one skin or dermal substitute product or the other for clinical reasons in particular cases. In such cases coverage quirks for the CPT codes can provide payment cracks that sway product choice.

Challenge: What was worrying for general surgeons, podiatrists, plastic surgeons and wound care specialists was that Apligraf had a 90-day global period in comparison to Dermagraft, which had a 30-day global period. This lead providers to use one product over another to get financial advantage.

What's more, 15340-+15341 include site preparation and debridement, when you can bill those services separately with 15360-+15366.

Utilized for either Apligraf or Dermagraft, codes G0440-G0441 have 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 along with ensuring that physicians make their treatment decisions based on clinical benefit only.

In the future: For new or revised codes pertaining to these services, look to CPT 2012.

ICD-9 2012: Perfect your HTN Coding

ICD-9 2012 codes go into effect on October 1 this year. Like other practices, your cardiology practice too will be impacted by this year's list of ICD-9 codes. And since Hypertension (HTN) is on the rise in the US, it's essential that your HTN coding is top-quality. Or else many of your claims will be in the danger zone.

Here are some rules to polish your HTN coding to perfection:

Utilize the Hypertension Table: This Hypertension Table simplifies your search and can be found under the ICD-9 index entry "Hypertension". It not only shows the basic 401.x (Essential hypertension) codes but also the codes for conditions owing to or associated with HTN. What's more, the table helps clarify when you code choices differ for malignant, benign or unspecified conditions.

Documentation & 401.x 4th Digit

Be it malignant (.0), benign (.1), or unspecified (.9), while reporting codes from 401.x, you must select a fourth digit to complete the code. You shouldn't use either 0 malignant or .1 benign unless medical record documentation supports such a designation.

'Hypertensive' aids 402.x Use

If a patient has both heart disease and HTN, knowing whether the HTN caused the heart condition is key to correct coding. See whether the patient has a condition described under heart disease codes 425.8, 429.0-429.3, 429.8, and 429.9. What's more, you should also check the documentation for a stated or implied causal relationship to HTN.

Think that HTN and chronic kidney disease are connected

ICD-9 codes presume a causal relationship between HTN and chronic kidney disease. If documentation shows a patient ahs HTN and a condition that falls under 585.x or 587, then you should report a code from 403.x even if there is no indication one lead to the other. You should also report the pertinent 585.x code to indicate the CKD stage.

Hypertensive Heart and CKD

A single code from 404.xx indicates the patient has both hypertensive heart disease and hypertensive CKD. You should once again assume a relationship between the HTN and CKD. When the patient suffers from hypertensive heart disease and CKD, you should select a code from 404.xx and not report 402.x (hypertensive heart disease) and 403.x (hypertensive CKD) together.

Head Diagnoses? Think 2 Codes

If the patient is diagnosed with hypertensive cerebrovascular disease, you should first go for the proper code from 430-438.x first and then report the proper hypertension code, 401.x-405.x.

Urology Coding Alert: Verify Your Group's Signature Compliance

Be careful of EMR signature pitfalls.

Including provider signatures is a basic documentation requirement for your patient charts as well as daily challenge. Here's how you can verify your group's signature compliance.

According to CMS documents, "Medicare needs a legible identifier for services that are provided/ordered." That "identifier", or signature, can be electronic or handwritten, as long as the provider fulfils certain criteria. Readable first and last names, a Readable first initial with last name, or even an unreadable signature over a printed or typed name are adequate and acceptable. Moreover, you're also covered in case the provider's signature is illegible but is on a page with further information classifying the signer (letterhead, addressograph, etc.).

Ensure that you include the provider's credentials. The credentials can be with the signature or they can also be identified elsewhere on the note.

Example: Pre-printed forms might list the physician's name and credentials anywhere: at the top, side, or end. All of these qualify as standard documentation as long as the coder or auditor is able to identify the provider's credentials.

You can also use a signature log to support your urologist's documentation. The log should cover each provider's printed or typed name and credentials as well as their signatures and initials. You can reference the signature log to verify a note that includes an otherwise unidentifiable signature.

Tip: You should update signature logs at least once a year. Make distinct logs by provider (physicians, CRNAs, AAs, residents, etc.) to make the tracking easier.

Remember: Stamped signatures don't meet the CMS requirements because anyone who has an access to the stamp, could use it. It doesn't validate that the billing provider was himself the author of the supporting documentation. You can, though, use a typed or printed block print name under the provider's signature to noticeably identify an illegible signature.

Don't Let EMRs Do All Your Work

Some coders -- or providers -- consider that electronic medical records (EMRs) do all the documentation work, but that's not essentially the case. Even electronic signatures must fulfil certain requirements.

Considerations: As your providers include EMR in their everyday care, you should double check the electronic signature's wording. It should say ‘Electronically signed by' or ‘Authenticated by' also include the date.

There are multiple ways of phrasing and formatting the electronic signature. You should verify that the format you're implementing is accepted by CMS.

Warning: Electronic signatures could be misused or abused. The safety of system and software products against unauthorized modifications should be ensured. Electronic capabilities should follow recognized standards and laws. You should consult your healthcare attorney and/or malpractice insurer to ensure compliance.

Urology Coding Alert : Avoid the Pressure of Choosing Physical Examination Levels

1995 vs. 1997 guidelines: Choose one per claim, but you should feel free to use either one for different claims.

Determining the Physical Examination Level


There are two sets of guidelines you should know before determining the level of the physical examination key element for your E/M coding: 1995 and 1997 medical guidelines.

Both sets of guidelines help you decide which of the following listed four levels of examinations your urologist accomplished during an E/M service:

problem-focused,

detailed,

expanded problem focused,

and comprehensive.

The level of exam is a key factor in determining which code you should report: 99201- 99205 (Office or other outpatient visit for the E/M of a new patient, which needs these 3 basic components …) for new patients or 99212-99215 (Office or other outpatient visit for the E/M of an established patient, which requires at least 2 of these 3 basic components …) for established patients.

1995 and 1997 Guidelines: What's the Difference

The most significant difference between these two sets of guidelines is the exam element.

1997: The 1997 guidelines involve specific physical exam elements that must be addressed in the documentation. If a physician addresses elements other than those specified in the guidelines, the physician will not essentially receive credit for that particular element in the level of service. Also, if the language relating to an exam element included in the documentation is different from the one in the guidelines, an auditor who has not had much clinical experience may reject the element from being credited in the level of service.

1995: The 1995 guidelines are comparatively less restrictive. They let the physician make any comment in any of the designated body areas and/or organ systems he examines. What the physician examines within the areas and systems and the language he or she chooses to document are eventually decided by the physician.

Which Guidelines Should You Use?

It is not required that you pick one set of guidelines and stick with them whenevr you code an E/M service. You can switch between 1995 and 1997 and choose whichever set of guidelines is most beneficial for each encounter.

Important: The key, however, is that, for a single encounter you should use either 1995 or 1997 guidelines. Keep in mind that the guidelines are only for the reporting of the physical examination. The remaining two key components, history and medical decision making, continue to be the same. It doesn't matter which physical examination guidelines you use.

Besides, practices should know if there are any special requirements of their contracts with their insurers.

So which guideline should you use? That also depends on your urologist and how does he document. Usually the 1995 documentation guidelines are going to be more beneficial for most practices. The reason being that they are more flexible and they also reflect the way most physicians were trained to document. However, some physicians may have been trained or may have developed decent documentation practices around the 1997 guidelines, and this may be beneficial to them.

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2012 CPT Code Changes for Clinical Lab Codes

CPT 2012 brings new codes for HIV Antigen and NMPP22 – check them out.

On January 1 next year, 2011 CPT codes will be replaced by new codes. So if your lab runs a single-result test for HIV-1 antigens and HIV-1/HIV-2 antibodies, you will have a new code to report the service next year. This is one of the two new CPT codes that made an entry at the annual CMS laboratory public meeting for pricing new test codes for payment on the clinical laboratory fee schedule.

Even though there are no new codes on the horizon, this year's meeting featured much discussion about drug test coding.

Two new clinical lab test codes in CPT 2012

This time, CPT 2012 codes will bring these two clinical lab test codes: 863XX, 873XX. Both these codes will provide more specific reporting for newer tests you may have added to your menu recently.

Drug Testing Leads ‘Reconsideration'

Apart from pricing recommendations for the new codes, Centers for Medicare & Medicaid (CMS) heard public comments for reconsideration requests for these 2011 CPT codes : G0434, G0435, 83861, 86481 and 87906.

Drug screen

Many commentators suggested changing G0434 to cover only CLIA waived tests, while coding up with a new code for moderate complexity tests priced at four times G0434. The present grouping under G0434 comes down hard on clinical labs that carry out these tests while using instrumented moderate complexity systems. The moderate complexity instruments come with some clinical advantages - say for instance higher specificity that commentators said shouldn't be discouraged by coding and reimbursement.

Pricing Proposal & Comment

The agency received industry input during the July 18, 2011, public meeting for the new codes. It'll post final payment determinations on the same Website in October 2011.

Even though payment method for codes can be either crosswalk or gap-fill, almost all presenters at the public meeting recommended crosswalks for the just-in codes.

CPT Coding for Sphenopalatine Artery Ligation

Endoscopic transnasal approach for ligation of the sphenopalatine artery may be the surgical technique of choice for control of a severe epistaxis when traditional treatment has met with failure. But the fact is there's no CPT code for this operative procedure.

Let us say a patient with coagulopathy has epistaxis which hasn't been controlled with nasal packing. The bleeding takes form from the posterior nasal cavity of the posterior ethmoid artery or a branch of the sphenopalatine artery. In order to put a check on the nose bleed, the otolaryngologist decides to carry out an endoscopic transnasal sphenopalatine artery ligation.

When you are left with a definitive CPT code to describe the procedure, you should look at other similar CPT codes, and try to work around it.

31238: You should upgrade Endoscopic Control of Nasal Hemorrhage with Modifier 22. You can report 31238 for endoscopic transnasal sphenopalatine artery ligation appended by modifier 22.

But even though 31238-22 is a practical and accurate coding choice, payer reimbursement may be lower than what surgeons feel is constant with the associated physician work: about $200.46.

31299: You may also choose to go for unlisted procedure code 31299. Some coders would actually recommend this option; however you should be careful of the mistakes. They need appeal with documentation explaining what was done.

Documentation requirements may prove to be difficult. Practices aren't sure about what charge to attach to the unlisted code. While declaring a charge benchmark, you should choose a reasonably close existing code and give justification for its use.

Some experts are of the opinion that an unlisted code when carrying out a procedure that has a CPT code for an open approach however doesn't have a CPT code for an endoscopic approach. Why? Because there's no way for the RUC to account for the relative units associated with this endoscopic approach when and if a new CPT is created for the endoscopic approach.

Tip: While submitting an unlisted code, make it a point to ask your physicians to include information at the top of the operative note explaining the procedure and listing a comparable procedure and code for setting payment.

Also, make a habit of attaching a detailed operative note to your claim since it'll be subjected to a strict medical review. What's more, a cover letter explaining in lay language what services were carried out and the justification for the charge submitted could help you escape potential denial or audit.

Bariatric Surgery Complications? ICD-9 2012 Brings Different Choices

2012 ICD-9 code changes go into effect in a week's time. Like other practices, your general surgery practices will also have to gear up for the changes.

On October 1, 2011, you'll have to bid goodbye to ICD 9 2011 Codes and welcome new changes. Your general surgery practices will need to be well-versed with four new codes to report complications of gastric band or bariatric procedures from October 1. Of these, you'll find 539.xx and other just-in, invalid and revised codes that'll have a say on your practice.

Bariatric surgery or gastric band procedure complications are presently indexed to 997.4. This is a situation where we simply index the complication to a generic code; and there are no secondary codes to use.

In a week's time, this'll change – you will have to start reporting bariatric/gastric band complications with one of these codes: 539.01, 539.09, 539.81, 539.89.

Directing coders to new codes, ICD-9 adds an 'excludes' note to 997.4. This code does not distinguish digestive system complications from bariatric or gastric band surgeries from complications resulting from any other procedures or conditions.

Benefit: These just-in codes allow better data collection for complications of bariatric and gastric band procedures.

That apart, ICD-9 2012 will also expand 10 current codes to 40 new codes that you will have to use when your surgeon carries out a skin excision.

Skin site makes a distinction between the 10 prevalent codes (173.0-173.9) that'll become invalid. One can notice the same site distinctions in the new codes, however the latest ICD-9 codes 2012 adds a fifth digit to each four digit code to differentiate cancer type. Say for instance basal cell or squamous cell carcinoma.

Put an end to your pelvic circle fracture code search

Hospital Coding Updates: An Insight on FY 2012 IPPS Rule

The final rule for FY 2012 will be effective in about a week's time.

Recently CMS issued a final rule that'll update Medicare payment policies and rates for hospitals in FY 2012, an August 1 CMS release notes. The rule will affect Medicare payments to general acute care hospitals and long-term care hospitals for inpatient stays, supports endeavors to promote ongoing improvements in hospital care that'll lead to better patient results while taking a look at long-term health care cost growth, the agency mentions.

According to CMS Administrator Donald M. Berwick, M.D, "The final rule continues a payment approach that encourages hospitals to adopt practices that reduce errors and prevent patients from acquiring new illnesses or injuries during a hospital stay."


The final rule makes changes to payment policies and rates for acute care hospitals paid under the Inpatient Prospective Payment System (IPPS); so also hospitals paid under Long Term Care hospital Prospective Payment System.


This rule also boosts the Hospital Inpatient Quality Reporting (IQR) Program by placing more emphasis on avoiding health care-associated infections in general acute care hospitals.

The final rule will be effective for discharges taking place on or after October 1, 2011.

Under the FY 2012 IPPS, the agency had proposed a year-over-year reduction of 0.5% in payments to acute care hospitals. But then the agency finalized a cut of 2.0%, a decrease from 2.9% in FY 2011. This translates to $1.13 billion more in hospital payments in financial year 2012 than what was received in the previous year.

For more hospital billing and coding updates, sign up for a good coding resource like SuperCoder. Such a site has all the essential tools and resources you need to put your inpatient coding on track. Its DRG coder helps you get all of the inpatient coding data and tools you need to boost your payments and help you walk the compliance line.

Version 28.0 of the ICD-10 MS-DRGs is Final

Inpatient coding woes? Well, there could be something amiss in your DRG process.

Every year thousands of dollars go down the drain because of poor Medicare Severity Diagnosis Related Groups Codes selection and under coding. One needs to understand the complete DRG process to figure out the ways to proper reimbursement. Spot on DRG assignment and auditing practices help you stay away from both up-coding and under-coding; in the process you'll save money and cut short the revenue cycle.

Changes to Medicare Severity Diagnosis Related Groups (MS-DRG)

Right from the time it was implemented in 2008, MS-DRG has witnessed documentation and coding adjustments made to the standardized amount to ensure budget neutrality. In FY 2011, Centers for Medicare and Medicaid mandated a non-cumulative 2.9% documentation and coding adjustments as part of a two-year process to get back overpayments ensuing from the conversion to the MS-DRG system.

As mentioned in the last IPPS Final Rule, an additional -2.9% adjustment is statutorily mandated for FY 2012. But then since the FY 2011 adjustment was non-cumulative, the net effect of the FFY 2012 adjustment resulted in no change as compared to the earlier adjustment.

In the end, the agency rejected the proposed implementation of another documentation and coding adjustment of 3.15 percent for FY 2012.

DRG codes & ICD-10 codes:

ICD-10 MS DRGs which are likely to go into effect in FY 2014 will be subject to notice and comment rulemaking. Meanwhile, the agency will provide extensive and detailed information on this activity by way of the ICD-9-CM Maintenance and Coordination Committee.

Version 28.0 of the ICD-10 MS-DRGs based on FY 2011 MS-DRGs is final and is available for public review on the CMS' website.

In the mean time the agency will continue to work with the public on the conversion and post drafts for updates. The final version of the ICD-10 MS-DRGs which will go into effect in FY 2014 will be subject to notice and comment rulemaking.

In the intervening time, the agency will provide extensive and detailed information on this activity through the ICD-9-CM Maintenance and Coordination Committee.

DRG Codes Lookup: For more MS-DGR updates, sign up for a good coding resource like SuperCoder. Such a site comes with Grouper-Procedure Code CrossRef, hospital coding datasets, average LOS look-up, MS-DRG to ICD-9-CM Vol. 1 CrossRef, a robust search engine, and more. Sign up today and see how it puts your inpatient coding on track.

ICD-9 codes: Preop exams? Don't overlook V codes

Here's an ICD coding scenario that'll help you in your work when you start using 2012 ICD-9 codes from October 1, 2011.

ICD-9 2012 changes will go into effect in a week's time. So are you geared up to tackle a diagnostic test that comes back minus a definitive diagnosis? You'll overcome these challenges when you make it a point to convey to payers exactly what you found.

Scenario: A patient who is schedule to undergo a gall bladder surgery presents for a pre-op evaluation. The GI lists the condition talking about the surgery as acute cholecystitis (575.0) and the underlying medical condition as diabetes (250.xx).

How would you handle this situation? Should you report the screening code here?

Many a time, a physician would order a diagnostic test without any signs and symptoms or perform a preop evaluation for the patient. If the main reason for the encounter is preop evaluation, you should first list a code from category V72.8 (Other specified examinations) to describe the preop evaluation. After this, you need to report a code for the condition prompting the surgery as an additional diagnosis (here 575.0). If you find out any condition during the screening, it should be reported as additional diagnosis.

V codes take center stage too

When a patient has no signs or symptoms and the gastroenterologist carries out a test solely for screening purposes, V codes will take the limelight. In this situation, you should ignore typical diagnosis codes and locate an appropriate “V" code to describe the test to the payer.

Note of caution: You should tread carefully while using V codes because there are many payers out there who will not pay for claims with only a V code as a diagnosis, with the exception of physicals or covered preventative health services; even then they'll only shell out money for one adult physical each year.

Screening codes: If the reason for the visit is specifically the screening exam, you should list the screening code first. However, you need to report the screening code as an additional code if the physician carries out the screening during an office visit for other health woes. Moreover, if the screening returns an abnormal result, then you should code those results as an additional diagnosis.

Medical Coding & Billing: Tips to Improve Your Appeals Process

A particular practice after ensuring it has not made any medical coding and billing entry error automatically appeals payer denials using a standard letter. However this wasn't working in getting them their payments. The question is: How can it boost its appeals process?

Well, before starting the appeal process, one needs to check the payer's policies first. Say for instance if the payer has a policy that bundles dipstick urinalysis (81002) into any evaluation & management services carried out on the same day and will not be reimbursed separately, one should not appeal these. Writing appeals takes up a lot of time. As such you wouldn't want to waste time on appeals you cannot win since already there is a specific policy in place.

What you should do:

Next time, you should follow the payer's appeal procedure just as it is. Many a time, the address to submit appeals is different from the claims address and some payers require you to send a special form with the appeal.

Being specific is the key:

In place of sending a generic appeal letter for every denial, you can customize your letter with the proper key words for each situation. Say for instance you submitted a claim for an evaluation and management service and injection on the same date. You added modifier 25 to the evaluation & management service code, however the payer still denied it.

Here's what you can do: Instead of sending a letter saying 'the claim was submitted correctly', send a letter that addresses the specific claim and the specific reason why modifier 25 was spot on. What's more, you should quote industry guidelines (say for instance CPT and/or CMS guidelines) and if likely the insurance company's own guidelines.

Appeal letter tips: Writing an appeals letter can take up a lot of your time. However you can save time by figuring out your most frequent denials and creating fill-up-the-gap appeal letters for each of these situations.

Say for instance you may find that you get many denials for bundling issues even when you use modifier 59 correctly. Most probably the letters you put together will begin and end basically the same. By creating a base template you can focus on filling in the details for each claim instead of writing each one from scrape.

Ophthalmology Coding Alert: Avoid Losing Level Four and Five E/Ms with These PFSH Tips

If the patient or a nurse documents the history, the job of your ophthalmologist's gets easier

You might be losing up to $69 per E/M, if your ophthalmologist glosses over a patient's past family and social history (PFSH).

As the top-level E/M codes need PFSH elements, accurately counting the number of PFSH items could result in more money.

For coding purposes, the history portion of an E/M service requires all three elements –

history of present illness (HPI),

review of systems (ROS),

and past family and social history (PFSH).

Thus, the PFSH helps define patient history level, which influences the E/M level you can report. Though, medical necessity for performing a comprehensive history must be marked in the patient progress notes. It may well be a standard of care to get a comprehensive history with new patients or patients who have not been seen for a year or more, but it is clear that a comprehensive history is not essential if the patient is being seen only days or weeks apart.
Altogether, there are following three levels of PFSH:

N/A

pertinent,

complete

Pertinent: You need an appropriate PFSH to reach a comprehensive level of history for the encounter. You need at least one specific item from any of the above listed three PFSH areas to attain the pertinent level. When the physician inquires only about one history area related to the main problem, this is a pertinent PFSH.
Complete: A complete PFSH includes at least one particular item from two of the three areas for the following E/M services' categories:

Established patient office/outpatient services

Emergency department services

Established patient domiciliary care

Established patient home care.

Remember that is not necessary to perform the PFSH for subsequent hospital visits or subsequent nursing facility care.
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ICD-10 Codes: You'll Have One-to-One Hyperplasia Equivalents, But Tread Carefully

Does 'Endometrial thickening' mean you should report these codes? Well, not necessarily.

The switch from ICD-9 to ICD-10 represents one of the most extensive impacts to a healthcare provider's business. So if the very thought of the dramatic increase in codes worries you, rest assured. You'll find simple one-to-one relationships between old and new codes.

That is also the case for hyperplasia; however you need to beware. You'll still need to carry over the same coding conventions.

Say for example your ob-gyn suspects hyperplasia. He traces and documents 'endometrial thickening' during an ultrasound examination; keeping this mind, what diagnosis should you report here?

Many coders all prey to this mistake

Just because your ob-gyn documents endometrial thickening doesn't mean the patient has endometrial hyperplasia. Many coders fall prey to this. (621.30 or 621.31).

ICD-10 Updates: Remember this snag. If you come face to face with the same situation in 2013, you shouldn't go for the straight forward hyperplasia equivalents N8500 (Endometrial hyperplasia, unspecified) and N8501 (Simple endometrial hyperplasia without atypia). These definitions are exactly the same.

ICD-10 Coding Tips: You should not be carried away by 'endometrial thickening'. Don't code this as hyperplasia because physicians do not always take the thickening of the uterus 'abnormal'; as a matter of fact, it is just a monthly ramp up for all women. You should not report hyperplasia until and unless the ob-gyn has carried out a biopsy and you have at hand a pathology report that corroborates this condition.

Way out: Since you have no code to describe the patient's condition, you should go for 793.5. Since endometrial thickening is a finding and not a diagnosis, you should locate the diagnosis code in the signs and symptoms section of ICD-0. If you look under thickened endometrium, this will take you to 793.5.

You will not see 'thickened endometrium' referenced at all; therefore you'd normally rely on the options given by one of the equivalent tables that have been produced based on the ICD-9 code 793.5.

Watch Out: If you look up the equivalent ICD-10 code for 793.5, you will find that the national Center for Health Statistics still lists R93.4; this is wrong as the uterus is not a urinary organ.

For more ICD-10 guidelines and updates, sign up for a one-stop medical coding guide like SuperCoder. Such a site comes with packed with all the information you need about ICD-10 to make a smooth transition.

Medical Billing Woes? Here're Five Ways to Ease the Pain of Billing Workers' Compensation

Not having relevant patient information before attending to the patient? Well your medical billing process could invite trouble.

Processing workers' compensation claim may give you a harrowing time. Here are some guidelines to stay clear of them all.

Issue: One of the key points of uncertainty is that, while workers' compensation is authorized with federal guidance, it's a state-run program. This is to say that each state comes with its own rules, fee schedule, and process. What's more, add in the fact that federal and railroad employees have their own workers' compensation (WC) programs and you might have a difficult time.

Here are five expert tips to help your practice toward clean WC claims:

Get all relevant claim info before the patient steps in:

Start your work on a WC claim even before the patient arrives at your office. When a patient calls to fix his first appointment for an injury that could have been on the job, say for instance sprained back, the first thing your staff members should ask is whether this injury was work related.

If so, you should gather as much relevant information as possible over the phone.

Train eyes on the state the claim originated from


Oftentimes a patient will sustain an injury in one state, however seek treatment in another. In instances such as these, you should follow the rules for the state in which the injury took place. Train eyes on where the claim was first filed. That state will have jurisdiction over the claim.

Do not depend just on the WC Fee Schedule


You do not require the WC carrier's fee schedule to bill claims. However you may want to since you may actually boost your revenue by following their fee schedule.

Be careful treating and billing other problems

While your physician can technically and legally tend to a patient for a worker's comp visit and other problems not related on the same day, you may find it easier in the long run to keep the visits separate. Remember that you will have to send claims to two different payers if the physician tends to the WC condition and an unrelated problem in the same visit – One claim will go to the WC carrier and the other to the patient's normal insurance.

Focus on special DME Regulations

If you provide DME, you may speed through a few extra hoops to ensure you get paid for those services as well as the office visit and treatment services or procedures.

Some carriers need prior authorization for DME. As such see to it that out have these pre-authorization before dispensing. Having the patient sign an ABN often turns out to be futile.

For more online medical coding billing information, sign up for a good Medical Coding resource like SuperCoder.com.

Tips to Help Physicians Switch to ICD-10

Jittery about using ICD-10 codes? Well, here are some tips for physicians that'll help them make a smooth transition to ICD-10.

It's practically not feasible to remember by heart all the codes that the ICD-10 code set contains. However you can take heart as switching to the new code set will not need practitioners to learn new code sets – in fact, most practitioners probably do not know ICD-9 codes by heart.

ICD-10 Tips for Physicians

In order to be all keyed up for ICD-10, physicians will need to take a look at the codes they use very often in their offices and come up with new job aids or superbills for those procedures. You will stand in good stead if you take a good look at the codes that you see most frequently in your practice. You can choose the top 30 diagnoses that they see and concentrate on knowing how to code those properly.


Here's what physicians need to do:

You should use your list of the top diagnoses that your practice sees to find the corresponding ICD-10 codes.

After this, see to it that coders are trained, that your claims are form 5010 compliant and that your claim submission system supplier is ICD-10 ready.

If you have an EMR or you plan to get one, see to it that it can handle ICD-10.

If you are beginning to bring an EMR, you should convert to ICD-10 first, and not bring one under ICD-9 and then convert.

You will not be able to glean ICD-10 codes from a physician's documentation if it is not thorough and detailed. Therefore physicians should take the opportunity to boost their documentation skills.

Note: The Centers for Medicare & Medicaid will very soon determine ways to process claims that span the ICD-10 implementation date.
For more ICD 10 coding tips, sign up for a good coding resource like SuperCoder. Such a site comes with an ICD-10 code lookup tool to help you in your coding.

863XX & 873XX are two new CPT Codes For linical Lab Test

As we get ready to enter the final quarter of this year, the talk that's taking center stage now is the CPT 2012 code changes.

Two new 2012 CPT codes made its debut at the annual CMS laboratory public meeting for pricing new test codes for payment on the clinical laboratory fee schedule (CLFS). One of them is if your lab runs a single-result test for HIV-1 antigens and HIV-1/HIV-2 antibodies, you'll have a new code to use in the coming year.

More on the horizon? Not really. This year there were five codes on the agency's 'reconsideration request' list. Even though this year's meeting featured much discussion about drug test coding there were no new codes on the horizon.

In the coming year, you can expect these two just-in clinical lab test codes (although numbering is yet to be determined). These codes will provide more specific reporting for newer tests you may have added to your menu.

863XX -- Nuclear Matrix Protein 22 (NMP22), qualitative

873XX -- HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result

Drug Testing
Apart from pricing recommendations for the just-in codes, the agency heard public comments for reconsideration requests for these CPT codes 2011: G0434, G0435, 86481

Drug screen: Many commentators suggested altering G0434 to include only CLIA waived tests while coming up with a new CPT code for moderate complexity tests priced at four times G0434. The present grouping under G0434 fines clinical labs that carry out these tests using instrumented moderate complexity systems. This instrument provides clinical advantages like higher specificity that commentators said shouldn't be disheartened by coding and reimbursement.

Pricing proposal

The agency received industry input during the July 18, 2011 public meeting for the new codes. You can get CMS's proposed payments at www.cms.gov/ClinicalLabFeeSched/ and you can make comments on the recommended pricing. The agency will post final payment determinations on the same website in October this year.

Almost everyone at the public meeting expressed their willingness for crosswalks for the new CPT codes.

The AMA proposed 101 new CPT 2012 codes for molecular assays in cancer, genetics and histocompatibility all right, however CMS will not consider setting prices for those codes on the CLFS in 2012 since they were not under consideration at the public meeting.

Crutches, Refractive Lenses and other Supplies? Be Well-versed with Modifiers

You will need to be spot on with modifiers when it comes to crutches, refractive lenses and other supplies. Read on for more information on HCPCS medical codes and modifiers relating to these:

When a patient leaves your office with crutches, you report E0110 to your MAC. However you find denials waiting for you instead. Don't be surprised as this is a common issue that practices face when dispensing equipment. So get yourself up on collecting for equipment by getting to know two important modifiers.

Modifier NU

When you give out crutches, your work is cut out for you from a billing standpoint – unless you know the correct modifiers to add to your claim. Crutches will more likely need an NU modifier and the codes for lower leg DME need a modifier KX and an RT or LT modifier in Massachusetts for Medicare. You only use the KX modifier if the patient meets the criteria set up by Medicare for the DME. But the tricky part is that those criteria can change from one state carrier to the next; as such you need to be sure to get your MAC's policy in writing.

Steps to follow: Check if there is an LCD. If it's there and the criteria are met, then the claim will need the KX modifier. After this check the fee schedule for the code. If it's on the fee schedule and there's a modifier listed, the claim will need to be billed with that modifier.

Modifier position

The modifier listed on the fee schedule must be listed in the first position. As such the claim would be billed as E0110-NU-KX. As a quick reference for accurate billing, you can keep handy the DMEPOS HCPCS codes 2011 for your jurisdiction, as well as the LCD and fee schedules.

Remember: Always review the chart note for spot on coding and correctly add the right modifiers, the documentation in the patient's chart must always support the services and modifiers billed.

KX

It's likely that you find the KX modifier handy for more than just splints and crutches. Say for instance if you are providing refractive lenses for cataract surgery patients, you will need to use KX as your go-to modifier in order to tell the payer that your physician ordered the lenses.

For more information on HCPCS codes online , sign up for a good Medical coding resource like SuperCoder. Such a site provides you with HCPCS code lookup tools to assist you in your coding.

G47.33 Replaces 327.23 Under ICD-10-CM

When ICD-10 codes go into effect, similar functioning code in the I-10 G Suffix replaces 327.23.

In order to diagnose obstructive sleep apnea (OSA), an otolaryngologist will provide a complete inspection of the nose, mouth, throat, palate and neck, many a time using a fiberoptic scope. Right now, you would code 327.23 for patients suffering from OSA.

Difference in ICD-10 coding: So now under ICD-9-CM code set, when a patient gets diagnosed with obstructive sleep apnea, you will go for 327.23. However after a couple of years, when ICD-10 goes into effect, this code will become G47.33. This change to ICD-10 will not offer any difference. As a matter of fact, G47.33's descriptor is a carbon copy depiction of ICD-9's 327.23.

While diagnosing a sleep disorder such as OSA, a physician may have the patient fill up a questionnaire in order to obtain information on patterns of wake-sleep. That apart, she may also order blood tests to rule out other conditions. If the physician suspects a sleep disorder, the patient would most likely go through a polysomnography to record breathing and brain and muscle during sleep. Treatment will depend on the specific type of disorder, and if there's an underlying cause.

ICD-10 tips: One of the ways an otolaryngologist can lessen this potentially life-threatening condition is with genioglossus advancement. This procedure involves the surgeon creating a small bone window in front of the lower jaw, and then pulls the tendons that fix the front of the tongue to the jaw forward onto a bone fragment. This leads to a larger airway between the back of the tongue and the throat, and results in easier breathing for obstructive sleep apnea patients.

You would code mandibular segmental osteotomy with genioglossus advancement with 21199 when carried out to treat obstructive sleep apnea.

For more ICD-10 updates and ICD-10 guidelines, sign up for a good Medical coding resource.

ICD-9 Coding: Changes for Hemophilia, LEMS, and Anaphylaxis & More

With less than a month to go for the proposed changes for ICD-9 2012 to go into effect, here's a rundown on the codes that'll have a say on your oncology and hematology claims.

This time, the list of proposed ICD-9 codes is fairly short; but even then quite a few of them apply to your oncology and hematology claims. Here's what you need to watch out for:

Bansal and Squamous Cell

The proposed changes to ICD-9 medical codes 2012 include an expansion of 173.x. Each code in that series will get fifth digit choices, which will provide further details of the skin neoplasm type. The revisions in the 173.xx skin cancer codes follow a pattern where:

The fifth digit "0" refers to an unspecified malignant neoplasm

"1" denotes basal cell cancer (BCC)

"2" refers to squamous cell carcinoma (SCC)

"9" describes "other" specified malignant neoplasm.

Better documentation need of the hour: You will need to improve documentation as it'll allow you to code these conditions more specifically starting October 2011. In fact, this will also stand you in good stead when you switch to ICD-10.

Own code for hemophilia

You should also plan for the soon-to-go-into-effect ICD-9 codes to expand current four-digit code 286.5 into a new range of 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.

These changes will allow for more specific identification. It'll also help track trials on the cause, self-correction, and pharmaceutical treatment of these disease types of hemophilia.

Three new codes related to LEMS

ICD-9 2012 is likely to add three new codes pertaining to Lambert-Eaton myasthenic syndrome (LEMS): 358.30, Lambert-Eaton syndrome, unspecified, 358.31, Lambert-Eaton syndrome in neoplastic disease, 358.39, Lambert-Eaton syndrome in other diseases classified elsewhere.

Right now, LEMs falls under 358.1. The code has an instruction to code first underlying disease. Say for instance, you may select the proper malignant neoplasm code from 140.0-208.9.

ICD-10 Codes: Be Selective while Reporting G89 Category Codes

When ICD-10 goes into effect in a couple of years' time, you need to learn to apply G89 category as it is the key to getting your pain diagnoses right.

Important ICD-10 coding tip: You should be selective in reporting the codes from the G89 category codes. If the definitive diagnosis is established, these codes are never assigned. The only exception happens to be when the reason for the encounter is pain control and not the management of the underlying condition.

You need to combine G89 with site-specific pain codes

You can report the G89 category code along with codes that identify the site of pain; the two codes can be sequenced as per the circumstances.

One-to-one match for several pain codes

The soon to go into effect coding system has a one-to-one match for various pain codes in the current code set. Here are the choices you will have post October 1, 2013.

ICD-9's 338.18 corresponds to G89.18 in ICD-10. Likewise, 338.28 corresponds to G89.28 in ICD-10. In these pairs, there's a change from 'postoperative' to 'postprocedure'. G89.18 covers both postoperative pain NOS as well as postprocedural pain NOS. The inclusion of postprocedure pain acknowledges those circumstances where a procedure, say for instance lumbar puncture or other percutaneous treatment leads to acute or chronic pain.

You should include psychological factors

We know pain is an emotional experience. As such there may be an accompanying psychological component which you should not miss out on. F45.42 which corresponds to 307.89 in ICD-9 is ICD-10 code for the psychological factors. See to it that you have supporting documents for the psychological factors. you have Excludes 1 and Excludes 2 information under G89 and the bottom of the Excludes 2 information urges you to report F45.42 for psychological factors. If you make use of the index and take a look under pain, you'll find psychogenic pain that'll guide you to the code.

Note: You should also use the index and then check the tabular for the right code.

Medical Billing: Say No to Forms 4010/4010A1 for Electronic Transactions from January 1

In a few months from now, (From January 1, 2012), you will bid goodbye to forms 4010/4010A1 for electronic transactions as you will no longer need fully functional form 5010 to comply with HIPAA electronic transaction standards. You won't be able to submit electronic transactions to Medicare if you do not have your problems worked out by that date.

Gear up now

Version 5010 lays out the technical electronic standards mandated for HIPAA transactions that includes claims, eligibility inquiries, remittance advice and payment data using ICD-10.

The present version (4010/4010A1) doesn't accommodate the ICD-10 code set. That is why CMS will need version 5010 for use by all HIPAA-covered entities as of January 1, 2012.

The agency began accepting 5010 forms from January 1 this year and the agency will require the form as of January 1, 2012. The ICD-10 codes will take effect on October 1, 2013 allowing for 5010 testing and implementation time.

Here are some common 5010 pitfalls you need to stay alert to

Under the new 5010 standards, the place of service address can't be a P.O box, it has to be a street address. The claim will be rejected if it is not a street address. How you fix the problem is up to you. The vendor does not have control of the provider master list.

Upgrade your software now: Now is your chance to research form 5010 problems and see if you need a software upgrade while there is time.

You should correct patient information too: Dig into your claim forms now to see to it that the beneficiary's information is spot on to the letter or you will face lots of denied claims on the just-in HIPAA 5010 forms. This is because CMS will deny claims with a beneficiary's name that does not perfectly match how it is listed on the Medicare ID card. What's more, you need to be sure you include suffixes such as Jr or Sr abbreviations along with the patient's last name. Also, the date of birth you put on the claim form must match with what the Social Security Administration has on file.

The agency will use various new codes on claims once the 5010 form goes into effect. And if you use a clearinghouse, you should discuss with them how they will convey these mistakes to you and how these changes will affect your practice.

67840 or 11440 - Which is the Right CPT CODE for Lesion Removals?

In a particular situation, your ophthalmologist takes off lesions from a patient's eyelids. While doing so, you may find yourself embroiled in a dilemma that you can solve only by assessing the physician's notes. You need to figure out whether the procedure is an integumentary procedure or an eyelid surgery procedure.

The answer determines whether you should turn over to codes 11440-11446 in your CPT manual or whether you should instead look at 67840. Your code selection depends on the number, location, type and size of the lesions. Take a look at these expert tips so that you make the right choice every time:

First step: You need to dig into your ophthalmologist's procedure documentation to figure out which code set you should go for. As a simple rule, you should go for 11440-11446 if the excision involves mainly skin.

To report 67840, see to it that the surgery involves more than the eyelid's skin. Say for instance, the procedure might involve lid margin, tarsus and/or palpebral conjunctiva.

Here's a CPT coding tip: Choose the proper lesion excision size code based on the report of the ophthalmologist. If the doctor does not measure the lesion before he cuts it out, he is bringing down the reimbursement in half.

Remember: Choosing the most appropriate CPT codes to describe the physician's work is the motivating factor behind your code assignment determination. As such, you should never base your code selection on reimbursement value.

Malignant in comparison to benign matters too

Step two: When your ophthalmology carries out an eyelid lesion excision that involves the eyelid mainly, you know you should go for the integumentary lesion excision codes.

The next question is which code in this section you should go for.

Well, for benign lesions, you should go for 11440-11446 while for malignant lesions you should turn to 11640-11646. Since a lesion's nature can be very deceptive based on the visual examination, you should always wait for the pathology report prior to billing the excision. Then choose your code based on the pathologic findings and the lesion size.

Bear in mind: You shouldn't use lesion excision and/or repair codes for skin tags. There are different codes for skin tag removal.

Multiple-lesion pitfalls to watch out for

Ophthalmologists will not always excise just one lesion at one go. As such you will face one more coding challenge when your physician does away with multiple lesions. Since 67840 is an excision code, which means you report it by the lid you can't report it with units – quite unlike the integumentary codes.

Medical Billing & Coding: Go for a Code Based on PMFSH Element Needs

Physician billing tips to save precious dollars for your practice.

Not billing higher level E/M services because your physician glosses over a patient's past medical, family, and social history (PMFSH)? Well, you could be missing out on up to $69 per E/M if you are not doing so.

In order to ensure you're recognizing every history component the patient mentions, you need to heed these three key things: Determine the level of MPFSH, select a code based on PMFSH Element Requirement and count unchanged PMFSH in current encounter.

After you determine the level of PMFSH your physician documentation contains, you can see which codes that history element supports. Let's zoom in on this aspect:

Watch out: If your physician doesn't document any PMFSH elements, you can see which codes that history element supports. This means the highest codes you will be able to report are a level-two new patient code (99202) or a level-three established patient code (99213). Reporting 99202 will fetch you $71.01, while 99213 will bring in $68.97.

Relevant past medical, family, and social history supports a detailed history level; with detailed history you can report a level-three new patient code (99203) and a level-four established patient code. You will take home $102.95 for 99203 and $102.27 for 99214.

In order to get to level-four and five new patient visits and level-five established patient visits, you need to have an all-encompassing level of history. For that, you must determine complete PMFSH in your physician's documentation. If you can get 99204 or 99205, you will take home $158.33 (4.66 RVUs) and $197.06 (5.8 RVUs), in that order. You can anticipate $137.60 (4.05 RVUs) for 99215 – as much as $69 more than if you are obliged to code 99213 as you did not have adequate PMFSH.

Remember: As established patient office visits need two of three vital components, a higher level service is still possible based on the service's examination and medical decision making (MDM) types. For an established patient, you may decide to leave history off and count only the exam and MDM and then you have the low history. As such, if you have a weak history, you may still get to the higher level evaluation & management.

ICD-10 Updates: A Burn May Be Corrosion Under the Soon-To-Go-Into Effect Code Set

The new diagnosis coding system will allow your surgeon to make a distinction.

When you start using ICD-10 in October 2013, reporting burns by body site/ ‘degree’ plus an additional code for total body surface area (TBSA) won’t change. However, reporting the cause of the burn will.

Changes ICD-10 will bring to burn source

In ICD-9, a burn is a burn; however under ICD-10, a burn may be a corrosion, which is a chemical burn and the new diagnosis coding system will allow your surgeon to make a distinction.

Here’s an Instance:

A patient has a second degree burn of the right thigh from accidentally spilling boiling water. Under the present code system, you would report the condition as 945.26 whereas under ICD-10, you need to list T24.211.

Now let us say you have the exact scenario, except the burn is from an accidental spill of a strong acid. With the present code system, you’d still go for 945.26. However, you’ll use T24.611- (Corrosion of second degree of right thigh) for ICD-10.

ICD-10 helps you zoom in on body site more specifically than the current code set. ICD-10 provides distinct codes for you to report bilateral body sites as right, left or unspecified.

Additional codes

Just like ICD-9, you will need to list a distinct ICD-10 code pointing to the extent of burns (or corrosions) using a unique TBSA code.

Say for instance in ICD-9, you would go for 948.10. But after 2013, you will have two TBSA choices based on the burn/corrosion distinction: T31.10, T32.10.

Corrosion codes in ICD-10: After 2013, not only do you have different corrosion codes in the soon-to-go-into effect ICD-10 code set , you also need to report a unique code to determine the cause of the chemical burn. ICD-10 provides this instruction: Code first: (T51-T65) to identify chemical and intent preceding the corrosion codes.

Medical Billing & Coding: AMA Report Shows 19.3 Percent Claims-Processing Error Rate

Here are some payer updates that will stand your medical coding & billing in good stead.

The findings of the American Medical Association’s (AMA) fourth annual National Health Insurer Report Card (NHIRC) do not paint a rosy picture. As per the association, commercial payers show an average claims processing error rate of 19.3 percent, notes an AMA press release. This is a two percent increase over last year.

Errors galore

According to the release, 20 percent error rate among health insurers talks of a great deal of incompetence that leads to a wastage of $17 billion annually.

Need of the hour

Keeping this huge inefficiency in mind, health insurers must put in more effort into paying claims correctly the first time to save money and bring down needless administrative tasks that take time and resources away from the patient, the release cites.

Payer rankings

As far as claims-processing accuracy is concerned, UnitedHealthcare was the only payer that showed a boost. The firm was ranked first in the list of seven leading commercial payers with an accuracy rate of 90.23 percent while Anthem Blue Cross Blue Shield figured in the bottom with an accuracy rate of 61.05 percent.

Legitimate pay may go unpaid by an insurer

What’s more, the report card also showed that you got no payment at all on around 23 percent of claims you submitted to commercial payers.

There are many reasons a rightful claim may go unpaid by an insurer, the release indicates. It may be denied, edited or deferred to patients. During February and March of this year, the most common reason insurers did not issue a payment was owing to deductible requirements that shift payment responsibility to patients until a dollar limit is surpassed.

Healthcare billing news: For many of the payers included in the report - Aetna, Anthem Blue Cross Blue Shield, Health Care Service Corporation and UnitedHealthcare - there were lower denial rates.

In addition, the report card indicates that Cigna and Humana cut their medical claims response time in half during the last four years.

Resource: More information is available at http://www.ama-assn.org/ama/pub/advocacy/topics/administrative-simplification-initiatives/national-health-insurer-report-card.page.

Fee Schedule: ABN changes? Stay Up to Date

CMS urges you to use the latest version of ABN with effect from November 1.

A couple of months back, the Centers for Medicare & Medicaid (CMS) released its proposed Medicare Physician Fee Schedule (MPFS) for year 2012. This 621-page document zooms in on how the agency configures its relative value unit (RVU) assignments.

Imaging pay will see further cuts if the proposed rule becomes final. Right now, 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 procedures by half.

The agency is proposing that next year, it'll not only slash the TC of subsequent radiological procedures by 50 percent, but will also bring down the PC by half. Total payment would be made for the PC and TC of the highest paid procedure and payment would be brought down by half for the PC and TC for every additional procedure provided to the same patient in the same session.

Note: Payment cuts to radiology procedures could be even more in 2013 and after.

Reaction to radiology cuts:

Professional societies raised their voices at CMS' radiology cuts. The AMA opposed a proposal to use significant cuts to Medicare payments for diagnostic imaging to offset the cost of a trade pack.

What's more, many radiologists noted that multiple interpretations of exams carried out on one patient are not less work-intensive than multiple interpretations of separate patients.

ABN deadline

The time to upgrade to a newer version of the ABN is a couple of months away - mandatory use of the new version starts on November 1, 2011.

Why the upgrade: The present ABN form had an expiration date on it, and as a rule forms are updated every three years based on provider comments.

ICD-9-CM Changes for Neoplasms & Glaucoma

With less than a month to go for ICD-9-CM 2012 codes to go into effect, now is the time to brush up on the latest coding options. This time, the spotlight's on expanded lip neoplasm and glaucoma options in addition to new codes for acute respiratory failure and other complications that result after surgery.

Now you will be able to pinpoint some stages more specifically.

While Neoplasm codes 173.0-173.9 will be axed and replaced by just-in fifth-digit choices - 173.00-173.99, Glaucoma codes expand to the fifth-digit level in order to differentiate the different stages. The just-in codes will be 365.70-365.74.

Since there will be much more spot on diagnosis choices when ICD-10 goes into effect in a couple of years time, these fifth digit expansions to codes will help coders and physicians start thinking in terms of more detailed diagnoses.

ICD 9 procedure codes for Gastric Band 

Source Code :- http://www.supercoder.com/coding-newsletters/my-anesthesia-coding-alert/correction-double-check-new-gastric-band-respiratory-failure-icd-9-codes-109162-article

Since anesthesiologists can find themselves absorbed in cases covering all surgical areas, you need to get acquainted with diagnosis changes for surgical procedures.

Get acquainted with just-in personal, family history choices

There are five new V codes that'll help your physician better indicate conditions a patient might have as part of her personal or family medical history. The just-in choices are:

Personal history of gestational diabetes - V12.21

Personal history of other endocrine, metabolic, and immunity disorders - V12.29

Personal history of pulmonary embolism - V12.55

Personal history of anaphylaxis - V13.81

Personal history of other specified diseases - V13.81

And as far as the revisions are concerned, when you go through the list of codes that have been revised, you'll find many migraine diagnosis listed. Although the descriptors are the same, the punctuation changes a little. Changed descriptors add a comma after the 'so stated' phrase in the fifth-digit '1' subclassification descriptor for each type of migraine mentioned.

Fee Schedule: There's a Distinct Difference Between XXX & 000 Global Periods

The classification XXX means that the service is completely free of global surgical bundling issues while the 000 indicator applies to the date of the procedure only.

The Centers for Medicare and Medicaid (CMS) has changed the global periods for both 51736 and 51741 from 000 to XXX in this year's January release of the Medicare Physician Fee Schedule. The agency drastically brought down the payment you get for both simple and complex uroflowmetry for this year. However in doing that they put the code in the category of 'global concept doesn't apply'.

Remember: The change to XXX applies to the global codes - 51736 and 51741 – as well as their Professional Component (PC) and Technical Component (TC). This means that whether you bill 51736/51741, 51736/51741-26 or 51736/51741-TC, there is no global period related with these flow rate size.

XXX versus 000

Even though both XXX and 000 global periods appear free of global bundling issues, you should know that there's a distinct difference between these two.

The classification XXX means that the service is completely free of global surgical bundling issues, and you can separately report services that your urologist carries out on the same day as the surgical procedure.

The value of this global period has always meant that the global concept does not apply to the procedure. Its value has always meant that the global concept does not apply to the procedure.

While the 000 indicator applies to the date of the procedure only. As such, Medicare will bundle all services that the physician carries out on that surgery date into codes with this indicator. On the other hand, 000 is for endoscopic procedures or minor procedures. If you have a code with a zero day global period make sure you include related pre operative and post operative care on the day of the procedure only.

Here's how other global periods function: Key surgical procedures covers a 90-day global period while lesser surgical procedures may include a global period of 10 days.

What you need to remember: The YYY global period to unlisted procedures only to unlisted-procedure codes and points to the fact that the payer is free to determine a global period for the procedure. The ZZZ designation denotes an add-on procedure for which the global period is covered in the primary procedure.

Here's what you should do: You should verify your payers' policies before you code your next claim. For more global-period information, go to the Medicare Fee schedule database available at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html?redirect=/PhysicianFeeSched/

ICD-9 2012 Brings more Specific Choices for Your Ob-Gyn Coding

As the nation celebrates 'Labor Day' in a few days from now, SuperCoder brings you a never-before coding offer - a gift card worth $25 to take your coding to a denial-free and maximum-profit zone.

If you're an ob-gyn coder, this year you'll run into more specific ICD-9 codes; this means you need to get on top of these changes that go into effect on October 1. And the Labor Day offer from SuperCoder couldn't have come at a more opportune time as it provides you with the code look-up tools and specialty advice you need for denial-proof coding.

New ICD-9 codes reflect early spontaneous labor with a planned cesarean delivery

You will choose from among these codes - 649.81 and 649.82 – when a patient was thinking about having the cesarean but went into labor early and had to have the cesarean early. This time round, there is also a new diagnosis to demonstrate a chemical or 'false' pregnancy post October; take a look at 631.0. What's more, if a patient has a blighted ovum or mole, you will go for 631.8.

996.39 will make an exit

From October 1 this year, you'll bid code 996.39 goodbye if the patient has an erosion or exposure of mesh material used during pelvic reconstruction surgery. In place of this, you'll have two more specific choices: 629.31, 629.32.

You need to treat new Hemorrhagic Disorder Codes as Secondary Dx

If a patient who's pregnant has antiphospholipid antibodies, you will have two new codes to use as secondary diagnoses. Note that your primary diagnosis would be from the coagulation defects category (649.3x). And if the patient simply had the antibody as a finding, here the secondary code would be the present code 795.79. If the condition happens to be with a hypercoaguable state, the secondary code would be the current code 289.81. But again if the patient has the antibody and has a present hemorrhagic disorder, you can use a new code - 286.53 – to report it.

To add to it all, ICD 9 also adds an 'Other' code to the 286.5x category - 286.59.

More V code choices

When your ob-gyn documents a patient's personal history, you'll have more V code choices: V12.21, V12.29, V23.42 and V23.87.

And the codes these V codes will be replacing are 631 and V12.2.