Procedure's Intent Decides Your 11100 Reimbursement

Know When You Should Use CPT 11100: Key to biopsy pay

In case you're puzzled about when you should report a biopsy and also when you should select an excision code, ask these simple questions to know when you are supposed to report CPT 11100 and avoid this common dermatology denial trap.

1. Why did the dermatologist do away with the skin abnormality?

When your dermatologist examines a patient who has a suspicious lesion, for instance a mole that transformed it's shape over time or has uneven borders, the dermatologist should remove that lesion.

Caution: Just for the reason that the dermatologist removed the lesion, he didn't essentially conduct a biopsy. Dermatologists send both excisions along with biopsies to pathology, but you must report a biopsy: CPT 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) only in case the dermatologist gets a diagnosis (for instance, 172.x, Malignant melanoma of skin) from the pathology report.

In case the dermatologist actually carried out an excision and did not performed a biopsy, you must report the procedure with an excision code (11400-11646)

2. What is the quantity of the lesion that the dermatologist removed?

The lesion's size or depth generally dictates the removal method. Dermatologists generally carry out superficial shaves to entirely remove lesions for instance surface moles. However in other occurrences, the dermatologist will carry out an excision to get a portion of a more serious lesion, for instance a cyst-like lesion underneath the skin's surface.

In this case, the dermatologist excises a part of the lesion and then sends the specimen to pathology. Then should you code an excision or a biopsy?

Answer: You must report a biopsy code as the dermatologist took only a portion of the lesion meant for a pathology diagnosis. Consequently, in this case, you must bill code CPT 11100 for a single lesion, and add-on code +11101 (… each separate/additional lesion [list separately in addition to code for primary procedure]) in case the dermatologist takes a sample from more than one lesion.

Don't miss: As add-on codes denote the procedures the physician carried out along with a primary service/procedure, you should never report them as individual codes or you will face denials.

Ensure that you look at CPT's parenthetical instructions, which generally inform you which procedure codes you can use along with the add-on code.

Extra: In case the documentation does not evidently state the specimen's size (for instance, the whole lesion or just a sampling), you can always wait for the particulars of the pathology report before you define which code to use: CPT 11100 or CPT 11400 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less).

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CPT® 2012 Contains Intradermal Flu Vaccine Option With 90654

Don't overlook revisions to other vaccine, E/M codes.

CPT® 2012 will go into effect in a few weeks, so you must prepare yourself now for new and revised choices associated with vaccine administration and prolonged E/M service to make sure your claims stay correct. Read this article for an ICD-9 and CPT 2012 expert insight for accurate claims and maximized ethical reimbursement.

Official Addition of 90654

CPT® 2012 adds a different option to your flu vaccine coding by adding 90654 (Influenza virus vaccine, split virus, preservative-free, for intradermal use). The inclusion expands on the code family 90655-90668 that at present addressed influenza vaccines.

A couple of factors separate 90654 from a lot of of the other flu vaccine codes:

Code 90654 is not age specific, while codes 90655-90658 do identify the patient's age (either 6 to 35 months of age, or age 3 years and older).

Code 90654 denotes an intradermal injection (administered to the dermal layer of skin), however additional codes (e.g. 90655-90658 and 90662) describe intramuscular injections (administered to muscle tissue) as well as intranasal administration (e.g. 90660).

ICD-9 and CPT Tip: Code 90654 signifies just the vaccine product. Include the fitting administration code (90460-90474) on your claim. In case your physician delivers a noteworthy, distinctly identifiable E/M service in the encounter for the vaccine, also report the suitable E/M code (99201-99205 for a new patient or 99211-99215 for an established patient).

Though 2012 will be the first time 90654 is covered in the CPT® book, the code has been present for more than a year.

Ace ICD-9 and CPT 2012: Note Extra Specificity of 90460-90461

A number of additional vaccine as well as vaccine administration codes go through revision for CPT® 2012. Revised codes involve (underline indicates change):

90460 -- Immunization administration over 18 years of age through any route of administration, including counseling by a physician or added qualified health care professional; first or only component of each vaccine or toxoidadministered.

+90461 -- ... every single additional vaccine or toxoid component which is administered (List separately in addition to code for primary procedure)

90581 -- Anthrax vaccine, meant for subcutaneous or intramuscular use

90644 -- Meningococcal conjugate vaccine, as well as serogroups C & Y along with Hemophilus influenza B vaccine (Hib-MenCY), a 4 dose schedule, while administered to children who are 2-15 months of age, for intramuscular use.

ICD-9 and CPT Expert Tip: CPT 2012 removes vaccine codes 90470 (H1N1 immunization administration [intramuscular, intranasal [including counseling when performed) and 90663 (Influenza virus vaccine, pandemic formulation, H1N1). These codes were possibly considered no longer required, particularly with the inclusion of codes 90664-90668 in 2011.

Source URL :- http://www.supercoder.com/coding-newsletters/my-family-practice-coding-alert/code-changes-cpt-2012-includes-intradermal-flu-vaccine-option-with-90654-108687-article

Use 11100/11101 for pathology specimens only

In case you're reporting biopsy codes CPT 11100 and CPT 11101 distinctly from excisions or additional biopsies, you're unknowingly going in the trap of denials and even a possible audit. In order to side-step these problems, you must use 11100/11101 when the surgeon gets a portion of a lesion for pathology only. Read the following article and know when you should use these biopsy skin add-on codes to ensure accurate claims.

Instructional notes make it clear that you must not report CPT 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) and +11101 (… each separate/additional lesion [list separately in addition to code for primary procedure]) along with excision or other biopsy codes,

Notes prior to the “Biopsy" portion of CPT say:

You should report CPT 11100 as well as CPT 11101 only when the physician gets hold of a specimen: For instance, the surgeon does away with a part of a patient's skin lesion (709.1, Vascular disorders of skin) and then sends the specimen to pathology. In that particular case, you would certainly use CPT 11100. You must then allocate add-on code 11101 in combination with 11100 when the surgeon conducts a biopsy of a second lesion. You may report one added unit of CPT 11101 for each additional biopsy the surgeon carries out.

Source URL :- http://www.supercoder.com/coding-newsletters/my-general-surgery-coding-alert/biopsy-and-excision-at-the-same-time-think-again-article

You can't report CPT 11100 and CPT 11101 when you bill for a different procedure, for instance an excision. For instance, assume that the surgeon get rid of a whole lesion and after that submits it to pathology, you must then use only 11400 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less). You are not supposed to use a biopsy code, as according to CPT, the biopsy is a component of 11400.

When the surgeon carries out a biopsy on a dissimilar site from the excision, you may separately assign CPT 11100 and CPT 11101. For instance, your surgeon does away with an all-inclusive benign lesion from a patient's arm, and also a part of a lesion on a patient's neck. As far as the arm lesion is concerned, use 11400, and as far as neck biopsy is concerned, report 11100-59 (Distinct procedural service). By means of appending modifier -59 to the second code, you specify that the biopsy took place at a distinct location from the lesion removal.

Have Comprehensive Knowledge of CPT, HCPCS, and ICD-9-CM

The interest in ICD-10-CM training is at a high level with most coders, which is not going to stop till October 1, 2013, implementation date. We are constantly seeing the drive for education careening to ICD-10-CM; however, but ICD-9-CM isn't supposed to be left behind.

Coders should be well-versed with their coding manuals. Remember, outpatient coding is not simply about CPT coding, but it is relatively about conceptualizing the whole picture in conjunction with CPT and ICD-9-CM codes. ICD-9-CM has a comprehensive listing of guidelines similar to the CPT manual. Interpreting ICD-9-CM knowledge prevents coders from fully understanding why diagnosis codes are used or sequenced in a specific way to produce complete claims. A coder must have a well-rounded knowledge of CPT, HCPCS, and ICD-9-CM. This will lead to fewer denials owing to ICD-9-CM mismatches with the CPT codes chosen.

The basics of ICD-9-CM should be well known; though, let's evaluate the important steps coders are required to take in order to correctly report the diagnosis for the following example.

A patient was admitted after developing severe diarrhea on day 50 following a living donor kidney transplant. A stool sample revealed a significant number of donor lymphocytes due to acute graft-vs.-host (GVH) disease. The physician diagnosed the patient with acute GVH disease.

First, find the main entry term; in this scenario, let's look at GVH disease. Keep in mind, conditions are expressed in the documentation as well as the index as nouns, adjectives, and eponyms. Numerous synonyms are also used for some circumstances, letting a coder to find the precise code through numerous lookup methods.

The next step is to look at the code found in the tabular section of the index to confirm correct code selection. Here, you will find the code 279.50. If you look under this code, it explains that in case this is a complication because of organ transplant not somewhere else classified, see Complications, transplant, organ. Although this is a complication arising from a kidney transplant, you will still necessitate reporting the GVH disease, so look at the tabular section for code 279.50, where you will get 279.51, which precisely reports the disease documented at the maximum specificity.

Prior to applying 279.51 to the claim, you need to carry out one additional step. Most coders overlook to look around the code to see in case there is any parenthetical information that may affect the coding. Possibly an added code is needed to report a manifestation or if the code comprises or not comprises a condition or disease. It may also have the instruction to code the underlying disease first.

This example requires the use of an ICD-9 information is brought to you by SuperCoder.com. Log on to www.supercoder.com for more accurate and profitable expert medical coding and billing advice.

CPT 2012: 62310, 62318 Revisions Help Simplify Your Single Shot vs. Indwelling Catheter Coding

Plus: Get ready for changes to 77003, too.

Though you won't report new or revised CPT® anesthesia codes until January 2012, get ready -- and your anesthesia providers -- at this time for revisions that can impact your everyday coding, for instance the rewording of two general epidural codes.

Observe the Descriptor Differences

The chief modifications are applicable to epidural codes 62310 along with 62318. The existing and upcoming descriptors are as follows:

The novel descriptors include several changes:

62310 specifies that it can be used for more than one single injection.

62310 no longer statesthe possible use for epidurography. Epidurography is a distinct procedure that doesn't need to be associated with this code.

The existing version of 62310 doesn't involve catheter administration, however the revised descriptor does. Physicians were placing catheters for single shots and trying to bill 62310 or 62311. The dissimilarity is that one pair of anesthesia codes is for constant or continuous bolus (62318/62319). The other is for a single distinct dose at a time (62310/62311), irrespective of catheter use.

The revised 62318 explains "indwelling" catheter and changes from "injection" to "injections".

Keep in mind: Anesthesia codes 62311 as well as 62319 now read "lumbar or sacral (caudal)" in place of "lumbar; sacral (caudal)."


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Don't Miss Fluoro and Nerve Destruction Changes

In case you occasionally report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, subarachnoid, or sacroiliac joint], including neurolytic agent destruction) in combination with diagnostic or therapeutic injections, make certain that you note the descriptor change, come January.

The novel descriptor will read "Fluoroscopic guidance and localization or needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid)."

Change: The code no longer covers guidance for sacroiliac joint injections or neurolytic agent destruction.

Replacements: Codes 64622-64627 for paravertebral facet joint nerve destruction have been deleted and replaced with following listed four novel anesthesia codes :

64633 – i.e. Destruction by means of neurolytic agent, paravertebral facet joint nerve(s) including imaging guidance (fluoroscopy or CT); cervical or thoracic, as well as single facet joint

64634 -- i.e.... cervical or thoracic, every additional facet joint (List separately in addition to code for primary procedure)

64635 -- i.e.... lumbar or sacral, as well as single facet joint

64636 -- i.e.... lumbar or sacral, every additional facet joint (List separately in addition to code for primary procedure).

ICD-9 Coding: 700 Basics: Simplify Corn and Callus Coding

Learn what to do when these lesser-known terms show up in your doctor's documentation?

For dermatologists who are treating the skin of a patient's foot, one of the most generally coded diagnoses is corns (and calluses). This particular condition has a slew of puzzling names that may be difficult to find -- or may not be present in your ICD-9 coding book -- and could quickly overturn your claims.

Decoding all of the corn and callus terminology can be particularly complex in case you work for numerous physicians and each one has his own particular way of naming the same thing, or in case you've lately started working at another practice. But you no longer have to be ignorant as far as a callus-related term is concerned.

Watch out: "Tylosis" could lead you down the erroneous coding path if you're not cautious. The ICD-9 index present in the front of the coding book presents numerous options, for instance 757.39 (Other specified amomalies of skin; other; includes accessory skin tags, congenital; congenital scar; epidermolysis bullosa; keratoderma [congenital]), and this is the incorrect path for a basic corn or callus. The best way you encounter this particular term present in the documentation is to ask the dermatologist to explain the condition.

ICD-10: Once ICD-9 changes to ICD-10 in October, 2013, code 700 become invalid. In its place, you would report ICD-10 code L84 (Corns and callosities).

Ace the Definitions

In case you're still uncertain about your dermatologist's everyday explanation of these general conditions, learning the definitions of "corn" and "callus" will help. Remember, a corn is a small, horny area of the skin produced by local pressure (e.g., a shoe or hosiery) irritating the tissue over a bony prominence.

Corns normally takes place on a toe, where they form "hard corns." (Between the toes, pressure can form a soft corn of macerated skin, which often yellows.)

Moreover, a callus is localized thickening and enlargement of the horny layer of the skin because of pressure or friction. Normally, calluses as well as corns can result in pain, and soft-tissue inflammation may take place around the base of the lesion.

Knowing these definitions is also supportive in case you plan to ask the dermatologist for explanation.

For instance: You're struggling with how you should code a patient diagnosis that defines a "keratosis" of the bottom of the great toe and the heel. You've learned the synonyms for corns/calluses and recall that this is one more name for a callus, however you notice that a different nearby code has the identical word in its descriptor: 701.1 (Keratoderma, acquired; Keratosis [blennorrhagica]).

For an error-free ICD-9 coding , you request the dermatologist for more particulars about the patient's condition so you can code it correctly, and he defines a basic thickening of the skin owing to bad shoes. After studying the definitions, now you know that it's just a callus and you can further code it as 700.

For More Information :- http://www.supercoder.com/coding-newsletters/my-dermatology-coding-alert/icd-9-coding-700-basics-take-the-rough-edge-off-corn-and-callus-coding-108680-article

Get Well-Versed With NCCI v17.1: The Version Includes Thousands of New Edits

The Centers for Medicare & Medicaid Services (CMS) has released the latest National Correct Coding Initiative (NCCI) update this year. Version 17.1 comprises more than 700,000 code pair edits. Amongst those NCCI edits, nearly 12,000 are new to Version 17.1. About 350 code pair edits have been removed, the majority of which are retroactive to earlier dates of service.

Retroactive code pair deletions may imply that you're entitled for payment on past claims, in case those claims were overruled based on the now-deleted code pair edits.

Version 17.1 is noteworthy for another reason: For the first time ever, Medicaid payers will have to observe NCCI edits. The Patient Protection and Affordable Care Act (H.R. 3590, section 65607) necessitates that state Medicaid programs must include NCCI methodologies into their claims processing systems.

The objective of NCCI is to stop payments when inappropriate code combinations (unbundling) are reported. NCCI comprises two types of NCCI edits: The first of these edits are essentially the bundling edits, named "column 1/column 2" or "correct coding" edits. Codes which are listed in column 2 generally are bundled to the code listed in column 1, which is essentially the "more extensive" procedure. For instance, "CPT® code 36000 Introduction of needle or intracatheter in a vein is essential to every nuclear medicine procedure necessitating injection of a radiopharmaceutical into a vein. CPT® code 36000 is not distinctly reportable with these sorts of nuclear medicine procedures. Though, CPT® code 36000 might be reported alone in case the lone service delivered is the inclusion of a needle into a vein, as per the Correct Coding Initiative Policy Manual.

The second kind of NCCI edits, named "mutually exclusive edits," defines code pairs that will not practically be conducted at the same session along with anatomic location for the similar patient. As per the Correct Coding Initiative Policy Manual clarifies, "An instance of a mutually exclusive condition is the repair of an organ that can be carried out by two dissimilar methods. Merely one method can be selected to repair the organ. A second instance is a service that can be reported either as an ‘initial' service or a ‘subsequent' service. With the exclusion of drug administration services, the initial service along with subsequent service should not be reported at the same patient encounter."

You'll certainly want to ensure that you always refer to the most current version of NCCI when checking for code bundles. CMS updates the NCCI each quarter and posts the broad list of NCCI edits as a free download. You also may buy a subscription to NCCI, in either an electronic or a paper format, from National Technical Information Service (NTIS).

ICD-9 2012: 173.xx Leads List of ICD-9 Updates

With the subsequent round of revisions, ICD-9 might provide a chance to report skin neoplasm types more precisely.

Though the complete list of suggested ICD-9 updates is fairly short, a number of these are applicable to your oncology and hematology claims. Here are the main proposals to watch for when the codes are finalized in the fall.

Get Precise About Basal and Squamous Cell

CMS's recommended changes to ICD-9 2012 comprise of an expansion of 173.x (Other malignant neoplasm of skin). Every code in that series will get novel fifth digit options, which will deliver added details of the skin neoplasm type.

The modifications in the 173.xx skin cancer codes have a pattern where the fifth digit of "0" discusses about an indefinite malignant neoplasm, "1" signifies basal cell cancer (BCC), "2" denotes squamous cell carcinoma (SCC), and "9" defines "other" definite malignant neoplasm. BCC and SCC are the two most general types of skin cancer.

The ICD-9 Coordination and Maintenance Committee extended the code series resulting from a request from the New York State Cancer Registry to help differentiate reportable skin cancers from non-reportable skin cancers, for instance BCC and SCC. The way these general neoplasms behave clinically is dissimilar enough that separating them would be beneficial.

Caution: The expansion implies that the four-digit 173.x codes become invalid in October as each code in the range will want a fifth digit to be complete. Getting ready for the new and revised ICD-9 code modifications needs you to create better documentation habits.

Not only will refining documentation let you code these situations more precisely, but it will also help prepare you for ICD-10's overall increase in documentation requirements

Acquired Hemophilia Gets Its Own Code

You also must plan for ICD-9 2012 to increase existing four-digit code 286.5 (Hemorrhagic disorder due to intrinsic circulating anticoagulants) into a novel range of five-digit codes:

286.52, i.e. Acquired hemophilia

286.53, i.e. Antiphospholipid antibody including hemorrhagic disorder

286.59, i.e. Added hemorrhagic disorder because of intrinsic circulating anticoagulants, antibodies, or inhibitors.

The changes agree to more precise identification and will help monitor "trials on the cause, self-correction, along with pharmaceutical treatment of these disease categories of haemophilia.

Terms you may see associated with 286.52 involve autoimmune hemophilia, autoimmune inhibitors to clotting factors, as well as secondary hemophilia. Code 286.53 might be used most frequently to report the hemorrhagic disorder with an antibody called lupus anticoagulant or systemic lupus erythematosus.

Source URL :- http://www.supercoder.com/coding-newsletters/my-oncology-hematology-coding-alert/icd-9-2012-173xx-leads-list-of-proposed-icd-9-updates-for-october-107223-article

Update Your Anaphylaxis Terminology

In case you require coding anaphylactic or serum reactions under ICD9 2012, ensure that you must check the index. A range of new codes will shift the options you may be used to.

Simplify CABG Coding With These Expert Tips

Surgeon's documentation also helps boost your coding accuracy.

While coding for anesthesia during coronary artery bypass graft (CABG) procedures, aspects like the patient's age and whether physicians' usage of specialized equipment while carrying out surgery can affect your reporting.

Do Examine the Code Choices

CPT® includes three anesthesia codes during CABG procedures:

00562 – i.e. Anesthesia carried out for procedures on heart, pericardial sac, along with great vessels of chest; including pump oxygenator, with age 1 year or older, meant for all non-coronary bypass procedures (for instance valve procedures) or for carrying out re-operation for coronary bypass more than 1 month after original operation

00566 -- i.e. Anesthesia carried out for direct coronary artery bypass grafting; excluding pump oxygenator

00567 -- i.e. Anesthesia for direct coronary artery bypass grafting; including pump oxygenator.

The associated base units differ according to the procedure. Code 00562 carries 20 base units, code 00566 carries 25 base units, and code 00567 carries 18 base units.

Do Watch for Pump Documentation

The first question you are required to answer when coding anesthesia during CABG is whether the anesthesiologist carried out the use of a pump oxygenator during the procedure.

Definitions: A case is deliberated "on pump" once the physician uses a pump oxygenator to stop the patient's heart and lungs during surgery. An "off pump" case takes place when the surgeon carries out the operation on the patient's still-beating heart.

The physician should document ‘off pump' prior to you can report the anesthesia codes that have higher base unit values. It can be worth almost $85 more for a normal Medicare case, but you must ensure that your anesthesiologist has rightfully earned it before you code it.

Don't Always Add Qualifying Circumstances

Some payers permit coders to report "qualifying circumstances" anesthesia codes that clarify features of the patient's situation that made the anesthesiologist's work complicated. Three of these anesthesia codes might apply to cardiovascular cases:

99100 – i.e. Anesthesia meant for patient of extreme age, for patients younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure)

99116 -- i.e. Anesthesia which is complicated by utilization of entire body hypothermia (List separately in addition to code for primary anesthesia procedure)

99135 -- i.e. Anesthesia which is complicated by utilization of controlled hypotension (List separately in addition to code for primary anesthesia procedure).

Don't automatically include these anesthesia codes with all CABG procedures.

Do Look for Notes That Add Units

Go through your anesthesiologist's notes and the operative report sensibly, as documentation can occasionally justify extra base units.

For instance, in case the surgeon sews a graft in an off -pump procedure, the anesthesiologist is due one additional unit owing to the increased risk. You can also shift from 18 base units with 00567 to 20 base units with 00562 in case the CABG procedure involves another heart procedure for instance valve placement or in case the patient is having a re-do CABG more than one month post an original CABG surgery.

ICD-9 to ICD-10 Conversion: Simplify Pain Dx: Get Confident on G89

Go for site specific codes and involve psychological factors.

You must be careful while reporting the codes that come from the G89 category. These particular codes are never allocated in case the definitive diagnosis is recognized. The lone exception is when the purpose for the encounter is mainly pain control and not the management of the original condition per se. See the examples listed below for neurosurgery applications you might face in the ICD-9 to ICD-10 conversion:

1) In case the neurosurgeon implants a neurostimulator for control of pain, you then report the pain code as the major or firstlisted diagnosis.

2) In case the patient comes to the neurosurgeon for management of pain post a displaced intervertebral disc, you report G89 code and the primary condition can be reported as an added diagnosis.

3) In case the patient reports to the neurosurgeon for spinal fusion, you, then, do not report the G89 category code. In its place, you report the chief diagnosis; like the spinal stenosis or a vertebral fracture.

G89 Should Be Combined with Site-Specific Pain Codes

When ICD-9 to ICD-10 transition takes place, you can use the G89 category code together with codes that explain the site of pain. You arrange the two codes according to the conditions.

Example: In case a patient withstands an acute neck injury in an accident and your neurosurgeon offers treatment for pain, you assign code G89.11 (Acute pain due to trauma) and you also report M54.2 (Cervicalgia) to explain the site of pain. Though, in case your neurosurgeon is treating the patient for a different reason, then you assign the G89 code only as a secondary diagnosis.

Note the One-To-One Match

ICD-10 includes a one-to-one match for numerous pain codes in ICD- 9. Below are the selections you will have once ICD-9 to ICD-10 transition goes into effect in October 2013.

Distinguish Postoperative vs. Postprocedure

In ICD-9, you have 338.18 (Other acute postoperative pain) which matches to G89.18 (Other acute postprocedural pain) in ICD-10. Likewise, 338.28 (Other chronic postoperative pain) matches up to G89.28 (Other chronic postprocedural pain) in ICD-10. There is a modification from ‘postoperative' to ‘postprocedure' in these pairs. G89.18 includes both postoperative pain NOS along with postprocedural pain NOS. The presence of postprocedure pain recognizes those conditions where a procedure for instance lumbar puncture or further percutaneous treatment leads to acute or chronic pain.

Involve Psychological Factors

Pain is essentially an emotional experience. There may be an additional psychological component which you are not supposed to miss. When ICD-9 to ICD-10 transition take place, the ICD-10 code for the psychological factors is F45.42 (Pain disorder with related psychological factors) which matches to 307.89 (Other, pain disorder related to psychological factors) in ICD-9. Ensure that you have backup documents for the psychological factors.

ICD-9-CM: Master the Changes in Respiratory Conditions

Don't reports 488.12 until physician approves H1N1 influenza.

If you're intimidated by the thought of arranging through all the diagnostic coding modifications that went into effect on Oct. 1, 2011, you shouldn't worry more. Get the insider's info with this rundown on some of the novel respiratory system diagnosis codes.

Quick reference: You should always check the diagnoses index along with the tabular list for selection of the suitable codes to include on your encounter form.

New Novel Influenza Code Amendments

With this condition frequently developing new forms, ICD-9-CM has made modifications to new influenza codes for three years in line.

A novel subcategory 488.8 (Influenza owing to novel influenza A) along with related codes have been created in order to report Novel influenza A. They are:

488.81 -- Influenza because of identified novel influenza A virus including pneumonia

488.82 -- Influenza because of identified novel influenza A virus with added respiratory manifestations

488.89 -- Influenza because of identified novel influenza A virus with added manifestations.

Definition: Novel influenza comprises all human infections along with influenza A viruses which are novel or dissimilar from presently circulating human influenza viruses. These involve viruses which are subtyped as nonhuman in beginning, and those that cannot be subtyped with standard laboratory methods.

Providers frequently denote the 2009 pandemic influenza as 2009 H1N1 influenza instead of novel H1N1 influenza, consequently ICD-9-CM has reviewed the following listed codes, with earlier references to "novel" in their descriptors to change to "2009." The codes involve:

488.11 -- i.e. Influenza because of identified 2009 H1N1 influenza virus with pneumonia

488.12 -- i.e. Influenza because of identified 2009 H1N1 influenza virus with other respiratory manifestations

488.19 –- i.e. Influenza because of identified 2009 H1N1 influenza virus with other manifestations.

Change To 512.2 When You Report Postoperative Air Leaks

ICD-9-CM has applied revisions along with novel codes through Category 512 to distinguish air leaks from pneumothorax. This classification is currently labeled pneumothorax along with air leaks.

New code: You can at the present report postoperative air leaks with 512.2 (Postoperative air leak). You earlier reported this condition using code 512.1 (Iatrogenic pneumothorax), which was deceptive since a patient can go through a postoperative air leak devoid of significant air in the pleural space leading to pneumothorax. ICD-9-CM prevents reporting 512.1 or 512.2 without the physician documentation precisely specifies postoperative or owing to a procedure.

ICD-9-CM states that, though, patients might also have an insistent air leak which is not postoperative, for instance when a chest tube has been positioned for a spontaneous pneumothorax along with the lung re-expands however the air leak continues. Spontaneous pneumothorax might be primary or secondary and associated with numerous other conditions for instance cystic fibrosis, spontaneous rupture of the esophagus, lung cancer, etc.

Flu, BMI, Jaw Pain Diagnosis Codes Are More Direct

Think through: Where do BMI codes exist in pulmonology?

Proficient billing is not only about getting your CPTs right. You are required to have an in-depth knowledge and use of modifiers as well as diagnosis codes prior to you can come full circle on competent billing and reimbursement.

While latest additions on influenza ICD-9 codes seem to be confusing, it's not what it seems to be. Catch up with these newest flu codes, together with some other pulmonology-related diagnosis codes with these beneficial tips.

Choose From 6 Extra Flu Codes

As the introduction of six new ICD-9 codes on influenza in October 2010, you should have been using the more detailed codes in the 488.0x (Influenza due to identified avian influenza virus) as well as 488.1x (Influenza due to identified novel H1N1 influenza virus) subcategories.

In case you used to satisfy yourself with the old code category 487 (Influenza) which didn't deliver the detail you required for more kinds of the flu, now you must be using six new ICD-9 codes growing from the 488.0 and 488.1 subcategories:

488.01: i.e. Influenza owing to identified avian influenza virus including pneumonia

488.02: i.e. Influenza owing to identified avian influenza virus including further respiratory manifestations

488.09: i.e. Influenza owing to identified avian influenza virus including further manifestations

488.11: Influenza owing to identified novel H1N1 influenza virus including pneumonia

488.12: i.e. Influenza owing to identified novel H1N1 influenza virus including further respiratory manifestations

488.19: i.e. Influenza owing to identified novel H1N1 influenza virus including further manifestations.

Remember: With 487.0 (Influenza with pneumonia), when you code 488.01 or 488.11, you should be using an added code to categorize the type of pneumonia (480.0-480.9, 481, 482.0-482.9, 483.0-483.8, 485)

Caveat: You must not use one of these new ICD9 codes except the cause of the pneumonia is established. Influenza symptoms may rest on which virus lead to the infection however regularly is alike those connected with seasonal influenza. Laboratory tests can be carried out to approve influenza infection. Prescription antiviral drugs confirmed for influenza (based on seasonal outbreak data) may be of some advantage in treating avian or H1N1 flu infection.

Search for Jaw Pain Codes

How are you presently addressing to report a patient's jaw pain? You must be coding 784.92 (Jaw pain) to define this symptom.

Jaw pain may be an indication of a pulmonary embolism (415.19), or additional conditions not related with TMJ. ICD-9 code 784.92 was created to categorize the patient, and validate the essential testing/evaluation for patients who come with this complaint.

For More Info :- http://www.supercoder.com/coding-newsletters/my-pulmonology-coding-alert/icd-9-coding-flu-bmi-jaw-pain-diagnosis-codes-become-more-straightforward-106140-article

Two Novel Paracentesis Codes For 2012

CPT obliterates intraperitoneal catheter insertion code.

Do you know what CPT changes will have an influence on your gastroenterology practice in 2012? Here's a clue: a couple of peritoneocentesis CPT codes will be absent in your CPT manual. You need to be ready to report new CPT codes as substitutes.

Substitute Old Peritoneocentesis CPT Codes With Three Novel Ones

The change will remove 49080 (Peritoneocentesis, abdominal paracentesis, or peritoneal lavage [diagnostic or therapeutic]; initial) along with 49081 (…subsequent), and will substitute them with three new CPT codes:

49082 –- i.e. Abdominal paracentesis (diagnostic or therapeutic); excluding imaging guidance

49083 -- i.e ....including imaging device

49084 -- i.e. Peritoneal lavage, including imaging guidance, when carried out.

When fluid between abdominal structures in the abdomen gathers, the physician may carry out abdominal paracentesis. CPT 49082 defines the procedure in which a needle is used to take away a sample of fluid or to drain fluid that has gathered. This procedure should be carried out excluding image guidance (49083 describes image-guided diagnosis or therapy).

CPT manual instructs not to report 49083 in combination with 76942, 77002, 77012, and 77021 because these radiologic codes define the possible imaging devices that your physician can use to help with assistance of the paracentesis needle and the services are involved within code 49083.

Meanwhile, a physician carries out 49084 to define the presence or absence of internal bleeding in the abdomen. Injury to the abdomen can be initiated by blunt forces as well as penetrating objects. The physician performs the test by inserting a long, flexible plastic tube in the abdomen over a small incision in line to the belly button. After that he places fluid into the abdominal cavity over the tube and does away with it through the tube for examination. The procedure may involve the use of image guidance.

Get ready For Category III Code 0288T

A novel Category III code on anoscopy will get introduced in 2012: 0288T (Anascopy with radio frequency delivery). This code defines an examination of the rectum wherein the physician inserts a small tube into the anus to screen, diagnose, and assess problems of the anus as well as anal canal. The physician then applies radio frequency energy delivery to close or ablate diverse abnormalities in the rectal area.

Revive Your Deleted Code List To Involve 78220-78223

Further gastroenterology-related CPT codes changes that will take place in 2012 involve the deletion of codes:

49420 – i.e. Inclusion of intraperitoneal cannula or insertion of catheter meant for drainage or dialysis; temporary

78220 -- i.e. Liver function study including hepatobiliary agents, along with serial images

78223 -- i.e. Hepatobiliary ductal system imaging, with gallbladder, including or excluding pharmacologic intervention, including or excluding quantitative measurement of gallbladder function

91012 -- i.e. Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study; including acid perfusion studies.

Coding Nondefinitive Diagnoses Continue to be Your Prime Challenge

All you require is to report signs as well as symptoms when diagnostics come back normal.

You consider that you may have aced most ICD-9 challenges, however do you aware with how to manage a diagnostic test which comes back without a final diagnosis? Once you make sure to convey to payers precisely what you found, you'll come out of these challenges. Here are guaranteed ways how to do that and the related ICD-9-CM guidelines.

Follow 3 Rules for Normal Diagnostics Results

Scenario 1: The gastroenterologist refers a patient to a radiologist for an abdominal CT scan (74150-74170) with an indication of abdominal pain (789.0). The CT scan, when read by the GI, discloses the occurrence of an abscess. Both the radiologist -- while reporting for the technical part of the CT scan, along with the gastroenterologist -- when reporting for the professional component of the same test, must report a diagnosis which is "intra-abdominal abscess" (567.22, Peritoneal abscess).

Challenge: What are you supposed to do in case the diagnostics came out normal?

Beware of three different rules:

Rule 1: ICD-9-CM guidelines state that in case the diagnostic test did not deliver a conclusive diagnosis or came out normal consequences, you must code the sign and symptom that encouraged the treating physician to order the study. Roughly, in the preceding scenario, the CT scan results came back minus any abnormal findings, at that time you would report the symptom 789.0 (Abdominal pain) in place of 567.22.

Rule 2: In case the diagnostic test was normal, however the referring physician accounts a suspected (a.k.a. probable, suspected, questionable, rule out, or working) diagnosis, you must not code the referring diagnosis. In its place, you must report the presenting signs and symptoms, according to ICD-9-CM guidelines.

Rule 3: In case the patient is getting only diagnostic services in the outpatient visit, you would list first the condition that is the chief reason for the visit on the claim. According to ICD-9-CM guidelines, this code must be your primary diagnosis. After that, code for further diagnoses (such as chronic conditions) on the following lines.

Tackle This Chronic Condition Scenario

Scenario 2: A patient already diagnosed with liver cancer came to the gastroenterologist for esophageal varices. On the first line of your claim, you would list 456.1 (Esophageal varices without bleeding) for the presenting problem (varices), and after that report 155.0 (Malignant neoplasm of liver primary) meant for the chronic disease (hepatocellular carcinoma).

Challenge: Are you supposed to report the chronic condition?

ICD-9-CM guidelines maintain that you should not code the chronic condition in case it is not related to the primary reason for the visit. For example, the liver cancer patient in Example 2 comes with dyspepsia, you should code only 536.8 (Dyspepsia and other specified disorders of function of stomach), and never 155.0.

414.4 Lets You Get Precise About Calcified Coronary Lesions

But 425.1 will take along instant denials

Don’t think that your ICD-9 2012 update lists final till you’ve studied these late additions for coronary atherosclerosis and hypertrophic cardiomyopathy.

Even though coders get information about ICD-9 changes each summer in CMS’s suggested Inpatient PPS rule, those specific changes aren’t the last word for updates. The codes below got effective Oct. 1, 2011.

414.4 Helps Identify Coronary Lesions

ICD-9 2012 adds 414.4 (Coronary atherosclerosis due to calcified coronary lesion).

The goal was to be able to differentiate a calcified lesion from other ischemic lesions. Calcified lesions are different as lipid rich plaque (414.3, Coronary atherosclerosis due to lipid rich plaque) as well as chronic total occlusions (414.2, Chronic total occlusion of coronary artery). And 414.8 (Other specified forms of chronic ischemic heart disease) is too common to identify the nature of the lesion.

Calcified lesions can be identified both by x-ray during coronary angiography along with intravascular ultrasound, and might be more challenging to treat than further coronary lesions. In case the physician is unable to cross the calcified lesion, he might have to stop the treatment and the patient may then need medical management or an extra invasive procedure.

Term tip: The code definition maintains calcified coronary lesion, however a note with the code explains that it is suitable when the physician documents coronary atherosclerosis owing to severely calcified coronary lesion.

"Severely" is a significant part of the diagnosis. However coders may not find the term "severely" in the documentation.

One more instruction with 414.4 informs you that you should code first coronary atherosclerosis (414.00-414.07). Consequently your first-listed code must specify the atherosclerosis (for instance 414.01, Coronary atherosclerosis of native coronary artery). After that report 414.4 in case the physician documents the situation is linked to a calcified coronary lesion.

Source Code :- http://www.supercoder.com/coding-newsletters/my-internal-medicine-coding-alert/icd-9-2012-4144-lets-you-get-specific-about-calcified-coronary-lesions-108506-article

425.1 Now Necessitates a 5th Digit

ICD-9 2012 offers novel coding selections for hypertrophic cardiomyopathy.

Reason: Hypertrophic cardiomyopathy can have two planes of demonstration, obstructive or nonobstructive. Whether or not it is obstructive can influence the requirement for dissimilar medical or surgical treatments.

2011: In ICD9 2011 , 425.1 was a binding code defined as "Hypertrophic obstructive cardiomyopathy." In case you required reporting nonobstructive hypertrophic cardiomyopathy, you reported 425.4 (Other primary cardiomyopathies).

2012: The update reviews 425.1 (now defined as Hypertrophic cardiomyopathy) so that it is no longer a valid code -- you should add a fifth digit for it to be valid:

425.11, Hypertrophic obstructive cardiomyopathy Hypertrophic subaortic stenosis (idiopathic)

425.18, further hypertrophic cardiomyopathy Nonobstructive hypertrophic cardiomyopathy.

The changes offer you one code meant for hypertrophic obstructive (425.11) and then the other code meant for other hypertrophic, containing nonobstructive (425.18). To follow with the changes to the 425.1x range, ICD-9 erases the terms "hypertrophic" and "nonobstructive" from under 425.4.

Ace Your HTN Coding

Keep these strategies on assumptions, renal disease, and heart disease within reach.

Hypertension (HTN) is rising -- possibly a third of the U.S. population is at present affected. That implies that if your HTN coding skills aren’t top notch, a lot of your claims are at danger of errors.

For a compliant coding, apply these rules based on the ICD-9 official guidelines and know what ICD-9 codes you should choose.

1: ICD-9 Has a Hypertension Table; Use It

Coding HTN diagnoses can be challenging, however the Hypertension Table, listed in the ICD-9 index entry "Hypertension," helps streamline your search.

The table demonstrates not just the basic 401.x (Essential hypertension) ICD-9 codes, but also the ICD-9 codes for situations owing to or linked with HTN. Furthermore, the table helps explain when your code choices differ for malignant, benign, or unspecified conditions. After you’ve found the code in the index, don’t forget to check it in the tabular list.

2: Documentation Determines 401.x 4th Digit

ICD-9 official guidelines propose an important rule for compliant HTN coding. While reporting ICD-9 codes from 401.x, you should select a fourth digit to complete the code: "malignant (.0), benign (.1), or unspecified (.9). You should not use either .0 malignant or .1 benign without medical record documentation supporting such a designation.

3: ‘Hypertensive’ Supports 402.x Use

When a patient is going through HTN and heart disease, knowing whether the HTN resulted in the heart condition is vital to proper coding.

Look to find whether the patient has a situation defined under heart disease ICD-9 codes 425.8, 429.0-429.3, 429.8, and 429.9, official guidelines maintain. Moreover scrutinize the documentation for a stated or implied underlying relationship to HTN (for example, "due to HTN" or "hypertensive heart disease"). You should never suppose that the HTN resulted in the heart disease.

4: Assume HTN and CKD Are Connected

In direct contrast to the rules for coding HTN as well as heart disease, ICD-9 does assume a fundamental relationship between HTN and chronic kidney disease (CKD).

Translation: In case documentation demonstrates that a patient has HTN and a condition that falls under 585.x (Chronic renal failure) or 587 (Renal sclerosis unspecified), then you must report a code from 403.x (Hypertensive renal disease), even though there’s no sign that one lead to the other. You also should report the pertinent 585.x code to specify the CKD stage.

5: Unclutter Coding for Hypertensive Heart and CKD

A particular code from 404.xx (Hypertensive heart and renal disease) specifies that the patient has hypertensive heart disease along with hypertensive CKD. You again should presume a relationship between the HTN and CKD.

Crucial: When the patient is going through hypertensive heart disease and CKD, you must select a code from 404.xx. You must not report 402.x (hypertensive heart disease) along with 403.x (hypertensive CKD).

Radiofrequency Ablation Treatment: Vanish Your Coding Woes

Unlisted code 42299 is your only choice for LAUP.

Radiofrequency ablation (RFA) of the turbinates might be the procedure of choice for few physicians, however one on-going concern remains for a lot of ENT practices: “What CPT codes should I select for radiofrequency ablation techniques for turbinates, meant for the palate (UPPP), as well as for the tongue base?" Remember: Radiofrequency devices have two key purposes. Physicians might use them to ablate tissue or as actual cutting tools (e.g., for tonsillectomy). You must select CPT codes based on the exact way that your physician used the device.

1. Go For 41530 For RFA, Base Of Tongue


You could report 41530 (Submucosal ablation of the tongue base, radiofrequency, one or more sites, per session) in case your otolaryngologist treats OSA. This CPT® substituted 0088T (Submucosal radiofrequency tissue volume reduction of tongue base, one or more sites, per session [i.e., for treatment of obstructive sleep apnea syndrome]) in 2009. ICD-9 327.23 (Obstructive sleep apnea) along with at least one of the following listed secondary CPT codes (529.8, Other specified conditions of the tongue or 750.15, Macroglossia) are the only covered diagnoses for 41530. Ensure that these CPT codes are included in your claim, and should be documented in the medical record.

2. Laser-Assisted Uvulopalatoplasty Belongs To 42299 Alone

As far as RFA of the palate, uvula is concerned, you must use 42299 (Unlisted procedure, palate, uvula). CPT guidelines state that no other CPT® code fits suitably to define RFA of the palate or uvula, as well as debunk the option of using the uvulopalatopharyngoplasty code 42145 (Palatopharyngoplasty [e.g., uvulopalatopharyngoplasty, uvulopharyngoplasty]) appended by modifier 52 (Reduced services). You cannot go ahead and use 42145 (or 42145-52) as this code signifies an excisional removal of the uvula and palate, as well as the laser ablation (or reduction in size) does not meet the rules for an excisional removal as needed for 42145. Moreover, CMS has specified that they do not think through a LAUP or a RFA of the uvula or palate standards of care and take them experimental.

3. RFA Of Inferior Turbinates: 30801 For Surface Layer; 30802 For Intramural Soft Tissue

You should deliberate over the exact nature of the procedure while coding RFA of the inferior turbinates. For example, 30802 (Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method [e.g., electrocautery, radiofrequency ablation, or tissue volume reduction]; intramural [i.e., submucosal]) defines the ablation or cauterization of the deeper mucosal soft tissue, whereas 30801 (… superficial) relates to the ablation or cauterization including only the surface layer of the mucosa.

ICD-9 to ICD-10 Conversion: Get Ready or Face Fines

Improve your ICD-10 coding know-how.

Denials aren't the lone thing you have to dread if your practice doesn't implement ICD-10 by the Oct. 1, 2013 deadline. You could be slapped with fines, too, according to CMS.

Here are some FAQs that will surely help you ramp up your ICD-9 to ICD-10 conversion for your practice.

Get ready for Medicare and Other Payers

CMS has no plan of delaying the implementation of ICD-10 further than the Oct. 1, 2013, date. Though, not all entities are ready for the conversion.

Question 1: Just the entities covered by HIPAA need to make the transition form ICD-9 to ICD-10 -- does that imply that workers' compensation insurers will carry on using ICD-9, even after the remaining industry transitions to ICD-10 on Oct. 1, 2013?

Answer: The answer to that is vague, however CMS has heard murmurs that workers' comp. insurers will shift form ICD-9 to ICD-10.

Question 2: How about Medicaid?

Answer: CMS presented rankings for state Medicaid preparation. Remember that state Medicaid programs are at greater peril for not meeting the ICD-10 implementation date, whereas 21 states are at moderate danger. Fifteen states are at little risk, and four states have informed CMS where they stand in the process.

Question 3: What are the penalties fixed for entities that come under HIPAA who wish not to use ICD-10 codes as of Oct. 1, 2013?

Answer: Your claims will be denied -- and you technically could face fines as use of the ICD-10 codes comes under the HIPAA transaction code set regulations.

Denials: From a practical perspective, as of service dates of Oct. 1, 2013, if you don't use ICD-10 codes, most probably your claims will be returned and will be asked to transition from ICD-9 to ICD-10.

Fines: The penalties are the similar penalties that any HIPAA entity would be subject to. Most of you are acquainted with the ongoing HIPAA transaction codeset penalty that calls for a maximum of $25,000 per covered entity per year, but the HITECH legislation of last year in fact increased those transaction and codeset penalties, and they can be as high as $1.5 million per entity every year.

Carry on With Codesets and Coverage

Your ophthalmology practice can't get ready for the ICD-9 to ICD-10 transition all alone. Study the following questions to see how others' preparations can help or hinder you.

Question 4: The Medicare local coverage decisions (LCDs) presently list the payable ICD-9 codes that agree to all Medicare-payable procedures. Will contractors issue updated LCDs to the public before the Oct. 1, 2013 implementation date to demonstrate the payable ICD-10 codes for the procedures?

Answer: The answer to is unclear. The LCDs will be translated as they will need to be translated, however, as it relates to having them accessible to the public prior to the implementation date, that is not yet sure, as everyone is working fast and furious on all of ICD-10 implementation efforts.

The above ICD-9 to ICD-10 information is brought to you by SuperCoder.com. Log on to www.supercoder.com for more expert Medical Billing and coding guidance, news and information. 

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745.4 Goes with Q21.0 to Explain VSD

Even one-to-one matches can surprise you -- check the index for clearness.

When the conversion of ICD-9 to ICD-10 takes place in 2013, one lesson you'll need to keep in mind is that inclusion lists may vary between the two code sets. That implies that ICD- 9 and ICD-10 codes that seem to be twins might not apply to the same list of diagnoses.

Case in point: ICD-9 2011 code 745.4 (Ventricular septal defect) as well as ICD-10 2011 code Q21.0 (Ventricular septal defect) have the same code definition. Both reference ventricular septal defect (VSD), which includes no less than one hole in the wall separating the ventricles of the heart. In the process of conversion of ICD-9 to ICD-10, you will find that regardless of the similarity in the code definitions, the inclusion lists for these codes are not the same.

ICD-9 coding rules: Code 745.4 has an inclusion note informing you that the code is suitable for Eisenmenger's defect or complex, Gerbode defect, interventricular septal defect, left ventricular-right atrial communication, or Roger's Disease.

ICD-10 changes: The inclusion list under Q21.0 shows only Roger's disease.As you will find differences in which diagnoses come under similar ICD-9 and ICD-10 codes, the fundamental principle of checking both the index and the tabular list will be essential for proper ICD-10 coding.

For instance, if you search for Eisenmenger's defect (which falls under 745.4), you'll find that ICD-10 codes this particular defect to Q21.8 (Other congenital malformations of cardiac septa). And in another instance of what's different, Eisenmenger's complex (which also falls under 745.4) is as an alternative coded to I27.89 (Other specified pulmonary heart diseases) under ICD-10.

Article Source :- http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/icd-10-7454-matches-to-q210-to-describe-vsd-107520-article

Documentation: In case the patient has one of the named defects (for instance, those listed in the ICD-9 inclusion list), documentation of that definite name will let you check the index to be assured that you have the most suitable ICD-10 code.

You'll also require documentation to take account of whether the VSD is congenital (existing at or before birth), because of myocardial infarction, or or else acquired (a reaction to environmental influences). In the conversion of ICD-9 to ICD-10, you will experience that ICD-10 directs you away from Q21.0 in case the patient has an acquired septal defect (I51.0, Cardiac septal defect, acquired) or a VSD as a current complication of an acute myocardial infarction (I23.2, Ventricular septal defect as current complication following acute myocardial infarction).

Bonus tip: ICD-9 also has an exclusion list in 745.4, so you know not to use the code for common atrioventricular canal type (coded to 745.69, Other endocardial cushion defects) or single ventricle (coded to 745.3, Common ventricle) defects. In the conversion of ICD-9 to ICD-10, you will see that ICD-10 does not have an excludes list for Q21.0, but those diagnoses still are coded in another place: Q21.2 (Atrioventricular septal defect) is applicable to the common atrioventricular canal and Q20.4 (Double inlet ventricle) is applicable to the single or common ventricle diagnosis.

CCI Edits 2011 Prohibit Use of 45300 with Codes Meant For Therapeutic Anoscopy, Manipulation

Know what bundles you can still bill together using modifier 59.

Important changes to the gastroenterology practice involve a veto on proctosigmoidoscopy as well as therapeutic anoscopy procedures, among other modifications. Check out what you are supposed to do with the following tips.

Background: CCI Edits 2011 carry 2,343 new edit pairs and 224 deletions, comparatively fewer than earlier edits. A lot of edits come from the musculoskeletal code range. Though, bundles also affect the Surgery/Digestive System section of the CPT® manual.

Don't Ignore Your 45300 Bundles

CCI edits 2011 allocates a modifier indicator of “0," and implements a series of edits for:

46615 (Anoscopy; with ablation of tumor[s], polyp[s], or further lesion[s] not agreeable to removal by hot biopsy forceps, bipolar cautery or snare technique) as well as 45300 (Proctosigmoidoscopy, rigid; diagnostic, including or excluding collection of specimen[s] by brushing or washing [separate procedure])

46614 (including control of bleeding [for instance, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) as well as 45300

46612 (including removal of multiple tumors, polyps, or further lesions by hot biopsy forceps, bipolar cautery or snare technique) as well as 45300

46611 (including removal of single tumor, polyp, or further lesion by snare technique) as well as 45300

46610 (including removal of single tumor, polyp, or further lesion by hot biopsy forceps or bipolar cautery) as well as 45300

46608 (including removal of foreign body) as well as 45300

46606 (including biopsy, single or multiple) as well as 45300

46604 (including dilation [for instance balloon, guide wire, bougie]) as well as 45300.

These changes mainly say that the code meant for therapeutic anoscopy procedures should not be used along with the base code meant for proctosigmoidoscopy (rigid sigmoidoscopy). The accurate code would be from the family of proctosigmoidoscopy codes 453xx.

You are not supposed to use these codes together in any situation and in case you do, the higher value code will certainly be denied.

In the same way, a different series of edits including 45300 shows up in CCI edits 2011 as follows:

46220 (Excision of single external papilla or tag, anus) as well as 45300

46080 (Sphincterotomy, anal, division of sphincter [separate procedure]) as well as 45300

46040 (Incision and drainage of ischiorectal and/or perirectal abscess [separate procedure]) as well as 45300

45915 (Removal of fecal impaction or foreign body [separate procedure] under anesthesia) as well as 45300

45910 (Dilation of rectal stricture [separate procedure] under anesthesia except local) as well as 45300

45905 (Dilation of anal sphincter [separate procedure] under anesthesia except local) as well as 45300

45900 (Reduction of procidentia [separate procedure] under anesthesia) as well as 45300.

CCI edits 2011 maintain that the proctosigmoidoscopy code (in column 2) is incorporated in the column 1 code and cannot be used together in any situation. Yet again, in case you still used these codes together in your claim, the payer is expected to deny the higher value code.

HCPCS Codes 2011: G0431, G0434 Include Medicare Drug Screens

CMS scrubs out G0430 and won't pay for 80100, 80101, 80104.

Forget all you considered you knew about reporting drug screen tests to Medicare. With new, revised, and deleted codes for 2011, chances are you won't report your lab's drug testing the same way this year. Read on for an expert HCPCS codes insight.

Questions abound: Fast on the heels of 2010 HCPCS code changes and CMS's surprising 2011 HCPCS codes reversals, many lab coders and billers are puzzled.

Let our experts break down the problems – as well as solutions -- to make sure you get all the pay you deserve for Medicare drug screening tests.

'Complexity' Leads Your Choice

In case your lab carries out drug screening meant for single or multiple drug classes by the means of any lab method except chromatography, you have a couple of HCPCS codes choices to report your work for Medicare beneficiaries in 2011:

G0431 (revised) – i.e. Drug screen, qualitative; multiple drug classes as a result of high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter

G0434 (new) -- i.e. Drug screen, not including chromatographic; any number of drug classes, with CLIA waived test or moderate complexity test, per patient encounter.

It seems that you should select between these HCPCS codes based on the CLIA complexity categorization of the definite lab test you're using
You must report only one unit of G0431 or G0434 per patient encounter, despite of the figure of drug classes you distinguish.

The Clinical Laboratory Fee Schedule (CLFS) has priced G0431 at five times G0434 (national limit amount $102.33 versus $20.47).

Chromatography Gets Mixed Signals

Regardless of pricing 80100 on the CLFS, the Medicare Physician Fee Schedule (PFS) registers 80100 (Drug screen, qualitative; multiple drug classes chromatographic method, each procedure) by means of an "I" (invalid) code status indicator. That implies that the code is invalid for Medicare Purposes. Medicare uses a different code for reporting of, and payment for, these services

On the contrary, when Medicare pays for a code on the CLFS, you'll find the code that is listed on the PFS with status indicator "X". That implies that the code may be paid on a dissimilar fee schedule, like the CLFS, as the code signifies a service that is not in the statutory definition of 'physician services.

Best guess: It appears like Medicare desires labs to use G0431 for chromatography in place of using 80100

Problem: Even though the G0431 definition could include chromatography -- a high complexity test -- the code necessitates "multiple drug classes," which the lab may not always carry out. However you couldn't use G0434 as it states "except chromatographic."

For More Info :- http://www.supercoder.com/coding-newsletters/my-pathology-lab-coding-alert/hcpcs-2011-g0431-g0434-encompass-medicare-drug-screens-article