Improve Your Common ED Airway Procedure Accuracy

Seconds count with airway tube insertions, however take a few minutes to learn these significant tips.

A recurrent presenting problem in the emergency department is a patient having trouble breathing owing to pulmonary disease, injury, or swelling of the throat tissues. You would normally report these encounters as high level ED visits or critical care due to the nature of the presenting problem; however you may also be able to report a procedure code in case it is correctly documented. Read on for advice on correctly documenting to support your airway services procedure medical coding.

1. Define Reason for Airway

The most general airway related procedure in the ED setting is endotracheal intubation where the patient has a compromised airway that requires stabilization.

Sample scenario: You should look for documentation describing tube placement similar to the following medical coding example:

A 24 year old female is brought in by her boyfriend from a picnic in a neighbouring park. Her face depicts signs of increasing swelling and she complains of having trouble breathing as if her throat is closing. She then reports a history of reactions to bee stings that have intensified in severity since she was a child. She is unclear that she was actually stung, but the boyfriend reports that there were bees present in the area and that they were seated near a large flower garden.

The emergency physician then orders an epinephrine injection, and as the patient had established increasing respiratory distress, places a tube down her throat to maintain her airway. After obtaining that limited history due to her breathing issues, an examination shows no other indication for the allergic reaction and he finds a likely sting site on the back of her neck. The patient reacts well to the epinephrine and then the swelling starts to subside after 40 minutes once she is admitted to the hospital. The physician afterwards documents 32 minutes of critical care time outside of distinctly billable procedures and then gives a diagnosis of anaphylaxis because of the bee sting.

On the claim, you would report the following for error-free medical coding:

99291 {Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes}

31500 {Intubation, endotracheal, emergency) for the tube placement}

989.5 {Toxic effect of other substances, chiefly non-medicinal as to source, venom}

E905.3 {Venomous animals and plants as the cause of poisoning and toxic reactions, hornets, wasps, and bees}

Medical Coding Tip: Apply the modifier 25 to 99291 to demonstrate that the intubation is distinct from the critical care services.

2. Critical Care? Scan for Time Details

You must keep in mind that in case the patient was reported as critical care, you should back out the time spent providing other procedures, for instance intubation, from your entire patient care time. A lot of payers require a statement in the documentation to that effect. Fortunately, most emergency physicians can place a tube rather rapidly.

ICD-9 Coding: Welcome the New Year with a Reminder of Alcohol Related Diagnoses

Ensure that you choose the accurate diagnosis code when alcohol is a factor of an ED visit

The New Year is approaching and with it comes an upsurge in alcohol-related presentations to the ED. Even though a lot of presenting problems are injuries or illnesses to which alcohol was a reason, it may be worth reviewing the numerous alcohol-related diagnoses that are available and when are they applicable in the ED setting. Read this article to know what ICD-9 codes apply for stress-free medical coding.

Take a look at some common patient types:

1. Patients who are brought in as they are impaired

It is not unusual for a highly intoxicated person to be brought to the ED by concerned friends, parents, or law enforcement officers as the patient seems to be unresponsive or dangerously intoxicated.

First let’s consider the patient, for whom no other diagnosis is probable, has come under medical care owing to the maladaptive effect of a drug on which he is not reliant on, and that he has taken on his own initiative to the damage of his health or social functioning, for instance a New Year’s Eve or a Super Bowl party. In this case, the patient has no history of alcohol dependency, but seems to have considerably exceeded his limit on this occasion.

ICD-9 codes that might apply are as following:

1. 305.0 (Nondependent alcohol abuse)
2. 305.00 (Nondependent alcohol abuse, unspecified drinking behaviour)
3. 305.01 (Nondependent alcohol abuse, continuous drinking behaviour)
4. 305.02 (Nondependent alcohol abuse, episodic drinking behaviour)
5. 305.03 (Nondependent alcohol abuse, in remission)

2. Patients whose condition is caused by long time alcohol abuse

The other end of the range is the long time alcohol abuser whose medical problems are directly credited to that history. Probable presentations involve hallucinations, seizures or delirium tremens. These patients may or may not be impaired at the time of their visit.

Frequently seen ED presentations can be reported with the following diagnosis ICD-9 codes:

291 (Alcohol induced mental disorders)

291.0 (Alcohol withdrawl delirium)

291.1 (Alcohol induced persisting amnestic disorder)

291.2 (Alcohol-induced persisting dementia)

291.3 (Alcohol-induced psychotic disorder with hallucinations)

291.4 (Idiosyncratic alcohol intoxication)

291.5 (Alcoholic-induced psychotic disorder with delusions)

291.8 (Other specified alcohol-induced mental disorders)

291.81 (Alcohol withdrawl)

291.9 (Unspecified alcohol-induced mental disorders)

Is it time for an Intervention? Deliberate behavior change intervention ICD-9 codes

Occasionally the trip to the ED for an alcohol-related injury turns into a chance for a screening and intervention to occur. Consider the patient who fell down the stairs because they were intoxicated or when alcohol appears to have contributed to MVA related injuries. Even though a busy ED is not the best place for this service, check the chart documentation to find if there is support for reporting the following ICD-9 codes:

99408 {Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes (Do not report services of less than 15 minutes with 99408}

99409 {greater than 30}

For further details on this and for other medical coding updates, sign up  http://www.supercoder.com/.

Perfect Your Fibroid Claims By Knowing These Removal Methods

Reporting uterine fibroid removals can be hard if you do not know the way the ob-gyn used to take care of the growth. Read this article and learn about each method of fibroid treatment, so you will be ready for whatever your ob-gyn chooses to carry out.

Medical Coding Method 1: Count Hysterectomy As Most Common Procedure

Hysterectomy is when the ob-gyn does away with the uterus completely. Even though this is the most common approach, it is used only when the fibroids are producing problems, for nstance abdominal pain or heavy bleeding. In case the uterus is not removed, there are chances are that the fibroids will reappear. When you execute the CPT lookup, the code assignment will hinge on on the type and extent of the hysterectomy.

Coding example: As the patient is older than 50 years and has multiple fibroids, your ob-gyn carries out a total abdominal hysterectomy (58150, Total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]). You would not code the fibroid removal distinctly if the ob-gyn is eliminating the uterus.

Medical Coding Method 2: Hem in Your Hysteroscopy Choices

Fibroids can also be treated using the hysteroscopic procedure. Hysteroscopic submucous resection gets rid of a portion of the protruding fibroid and preserves fertility.

The procedure needs “the close monitoring of distention media, electrosurgical devices, along with a patient’s anatomy to circumvent perforating the uterus. Ob-gyns normally carry out this straightforward approach for intracavitary (submucosal) fibroids.

Medical Coding Method 3: Master These Myomectomy Codes

Myomectomy (58140-58146, 58545-58546) is one more choice for fibroid treatment. A myomectomy is the removal of uterine fibroids only, which preserves fertility.

Example 1: The ob-gyn sees a 32-year-old patient who has never given birth to a child but wishes to. She goes through heavy menses with anemia.

On examination, the physician finds a 15-cm uterus with manifold fibroids that distort the endometrium. As the patient wants to have children, she chooses to have a myomectomy, which the ob-gyn carries out by the means of an laparoscopic approach. The pathology report shows six intramural myomas.

For this case, when you execute the CPT lookup, you must report 58545 (Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 g or less and/or removal of surface myomas).

Medical Coding Method 4: Make Use of UAE Option

You may see additional uterine fibroid embolization or uterine artery embolization (UAE) procedures. UAE is a nonsurgical, minimally invasive procedure that will shrink the fibroids by cutting off the blood supply.

The ob-gyn inserts a catheter through an artery in the leg to the arteries in the uterus. The physician then inserts tiny particles of plastic or gelatin through the arteries to cease the blood flow inside the fibroids. Devoid of blood flow, the fibroids shrink or may even disappear over time.

In case this method is followed, once you do the CPT lookup, you’ll report using 37210 (Uterine fibroid embolization [UFE, embolization of the uterine arteries to treat uterine fibroids, leiomyomata], percutaneous approach inclusive of vascular access, vessel selection, embolization, and all radiological supervision and interpretation, intraprocedural roadmapping, and image guidance necessary to complete the procedure).

For further details on this and for other medical coding updates, sign up  http://www.supercoder.com/.

Hone Your Neuroendoscopy Coding Skills With These Easy Steps

You should ever use these codes for open surgery and endoscopy together.

In case your neurosurgeon carries out neuroendoscopy services during cranial procedures, you must never report the service with open procedures or else you might end up missing on reimbursement opportunities. Read this article to side-step errors in medical coding.

Codes to remember: While reporting the neuroendoscopy procedures, you will require choosing from the CPT codes 62161 (Neuroendoscopy, intracranial; with dissection of adhesions, fenestration of septum pellucidum or intraventricular cysts [including placement, replacement or removal of ventricular catheter]) – 62165 (Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or trans-sphenoidal approach) and the add-on code + 62160 (Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage [list separately in addition to code for primary procedure]).

1. Segregate Endoscopy from Open Codes

The surgeon may adopt either of the two choices to treat the problem, but he will never use both of them at the same time. He may either insert an endoscope to treat the underlying condition or may adopt an open approach for instance the affected area is surgically opened up to address the pathology. Neuroendoscopy CPT codes are definitive and independent. So, you cannot report neuroendoscopy codes with codes for parallel open procedures.

Example: In case your neurosurgeon undertakes an open approach to obliterate a supratentorial tumor which is not a meningioma, you would report 61510 (Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma). On the other hand if he adopts a neuroendoscopic procedure to accomplish the excision of the tumor, you would report 62164(Neuroendoscopy, intracranial; with excision of brain tumor, including placement of external ventricular catheter for drainage). This includes placement of a ventricular catheter for drainage.

Cautionary tip: You must be cautious to not report the codes for open and neuroendoscopic stand-alone procedures at the same time. Remember that you cannot report 61510 and 62164 together. The reason being that in one session, the surgeon can adopt either approach but not both to address the underlying pathology.

Exception: If your surgeon provides a detailed explanation of an accompanying procedure in the operative note, you can report 62160. CPT® allows this add-on code to be reported with primary procedure CPT codes like 62220, 62223, 62225 and 62230. CPT® made the neuroendoscopy codes to stand apart from open procedures, again, with the exception of 62160.

2. Beware the Bundles

You must never report a twist drill, cranial burr hole, or trephine along with the neuroendoscope code; NCCI bundles these access CPT codes with the endoscopy itself. The burr hole is assumed or included in the neuroendoscopy code(s), as you can’t do the neuroendoscopy excluding a burr hole, however you can do a burr hole excluding neuroendoscopy. In case twist drill, cranial burr, or trephine are carried out at the same time neuroendoscopy is, you would report only neuroendoscopy

CPT® 2012 Clarifications: Pediatric Hospital Rounds Will Be Stress-free to Code

Distinguish the common types of pediatric hospital visits and you'll be on the road to correct medical coding.

Though most pediatricians assess newborn inpatients as part of their fixed weekly work, some practices struggle with how to code such services. However once you break it down into the below listed most common categories of inpatient E/M rounds, you could be sending claims out the door sooner and more competently. Read this article for correct medical coding and know what CPT codes apply in this situation.

Check NICU Changes for CPT 2012

Two of the most severe types of infant hospital visits include time with intensive care or critical care. In both of such cases, the pediatrician has to go above and beyond what's needed when seeing a healthy newborn--and coding such visits can be a challenge.

The issue of level of care delivered is not specific to the site of service. Though, neonatal critical and intensive care services are normally provided in a NICU.

Intensive care: Assume that a baby is tachypneic with a fever as a newborn and is worked up and is getting treatment for sepsis. The pediatrician gives a neonatal intensive level of care, carrying out daily intensive care services. In these situations you'll report a code from the 99477-99480 series of CPT codes.

Critical care: After the pediatrician examines a patient for more austere issues—for instance organ system failure or serious respiratory distress--he might decide that the patient is in need of critical care, which you'll code using the 99468-99469 series of CPT codes. In a lot of cases, critical care would be administered by a neonatologist.

Changes for CPT 2012: Earlier, in case a patient was transferred from neonatal intensive to critical care--or vice versa--the coding rules were blurred. But, CPT 2012 clarifies that issue with parenthetical notes to guide you in making the correct CPT codes decision.

What CPT® now makes clear is that in case an infant recovers after the initial day and is transferred to a lower level of care, the transferring physician does not report a per-day intensive care service. In its place, the transferring doctor will report a code from the subsequent hospital care section (99231-99233) of CPT®. The receiving physician will report subsequent intensive care (99478-99480) or subsequent hospital care (99231-99233) as suitable based on the condition of the neonate or child.

In case the physician provides intensive care services but then the patient becomes critically ill and then is transferred to a dissimilar physician, the transferring physician reports either the critical hourly care service (99291-99292) or the daily intensive care service carried out , but not both.

Welcome Car Seat Testing Codes Effective Jan. 1

Plus: You'll find explanation on developmental testing codes 96110-96111.

Previous year, coders got a good dose of updates--and confusion--with the inclusion of numerous new vaccine administration codes. CPT 2012 goes lenient on pediatric practices with a few modifications to the code set which will generate the necessity for updates, but not overhauls. Read this article for stress-free and accurate medical coding.

At the top of the list this year, you'll find the following new CPT codes for car seat testing:

94780 – (Car seat/bed testing for airway integrity, neonate, with continual nursing observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with interpretation and report; 60 minutes)

+94781 – {...each additional full 30 minutes (List separately in addition to code for primary procedure)}

The car seat testing services will mainly be done in facility settings; however will be valued with facility and non-facility payment amounts. These tests are usually essential before premature or at-risk babies (with conditions such as heart disease or congenital malformations) are discharged home from NICU settings.

There are occasions where follow-up testing may be indicated. "This would normally be provided in a neonatal follow-up clinic, however could be carried out in the office setting, in case the setup is complete to offer all the necessities for the code. As more services shift to the medical home, this could happen more in the future. Having the CPT codes and the anticipated relative value payments should facilitate the process.

For More Information :- http://isupercoder.blogspot.in/2011/12/welcome-car-seat-testing-codes.html

Developmental 'Testing' Modifies to 'Screening'

New CPT codes are always great to find in CPT®, however occasionally you'll find changes that make significant explanations to present codes. Such is the case with existing developmental testing CPT codes 96110-96111. The new descriptors for these codes are listed below:

96110 – (Developmental screening, with interpretation and report, per standardized instrument form)

96111 – (Developmental testing, (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments), with interpretation and report)

Medical Coding Tip: Take Note of Vaccine Revisions

Last year, in pediatric medical coding, CPT® threw many practices for a loop with the adding of several new vaccine administration codes, which most payers finally began processing efficiently within the last few months. Luckily, such a main overhaul has not taken place this year. Instead, CPT® makes slight adjustments to how you'll report your vaccines for accurate medical coding.

For instance: CPT® will change meningococcal conjugate vaccine code 90644 to get rid of mention of "Hib-MenCY-TT." In its place, the new code descriptor reads "Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine (Hib-MenCY), 4-dose schedule, when administered to children 2-15 months of age, for intramuscular use.

CCI Edits 17.3: 32422, 71010 Bundle -- And More -- Enhance Your Pulmonary Coding Options

Immunotherapy code Q2043 is anot an area of concern for pulmonologists, and should be an oncology issue.

The most recent Correct Coding Initiative (CCI) edits bundle chest radiologic guidance along with numerous procedures on the lungs and pleura, and even though CCI edits 17.3 assemble immunotherapy code Q2043 with lots of ventilation and gas procedures, you must not worry -- here's why. Read this article for accurate medical coding.

Establish Chest X-ray Distinctness From Thoracentesis To Ignore Bundle

For the newest CCI edits version, you must keep an eye on bundled chest x-rays as well as chest tube procedures. Particularly, both 71010 (Radiologic examination, chest; single view, frontal) along with71020 (Radiologic examination, chest, 2 views, frontal and lateral) become parts of:

32422 – {Thoracentesis with insertion of tube, includes water seal (e.g., for pneumothorax), when performed (separate procedure)}

32550 – {Insertion of indwelling tunneled pleural catheter with cuff}

32551 – {Tube thoracostomy, includes water seal (e.g., for abscess, hemothorax, empyema), when performed (separate procedure)}

93503 – {Insertion and placement of flow directed catheter (e.g., Swan-Ganz) for monitoring purposes.}

CCI edits mention the motive for the bundle as wrongly using column two code with column one code. These CCI edits have a modifier indicator of "1", consequently you may overrule the edits with a modifier (i.e., modifier 59, Distinct procedural service) on the column 2 code when the services are different.

Example: A patient with COPD (490-496) gets admitted with shortness of breath (786.05) along with chest pain (786.5), deteriorating with inspiration. A chest x-ray (71010) prove pneumothorax (512.x) and the patient must go through thoracentesis with insertion of tube (32422) to get rid of the excess air and let the lung re-expansion. In this sceanrio, you would report 32422, 71010-59 to point out that the chest x-ray was different from the thoracentesis.

For More Info :- http://www.supercoder.com/coding-newsletters/my-pulmonology-coding-alert/cci-edits-173-32422-71010-bundle-and-more-improve-your-pulmonary-coding-options-this-quarter-108569-article

Take note: Pulmonary specific guidelines preside over the abovementioned Column 1 codes. For example when coding 32422, you must consider a dissimilar radiologic guidance code for catheter placement/confirmation (e.g., 76942, 77002, 77012), which more precisely reflects the service description, method as well as service time linked with the procedural guidance provided.

The similar guidelines are applicable to 32550-32551. In other words, you must consider code 75989 (Radiological guidance [i.e., fluoroscopy, ultrasound, or computed tomography], for percutaneous drainage [e.g., abscess, specimen collection], with placement of catheter, radiological supervision and interpretation) to signify radiologic guidance for catheter placement/confirmation.

Medical Coding Tip: Remember that you must use 71010 and 71020 simply for radiologic examination of the chest, and not to assist or substantiate needle placement.

Discover Site-Specific Bx Codes and Net $78 or More

Enhance claims accuracy by side-stepping these common biopsy coding difficulties.

In case you automatically assign 11100 when your dermatologist lays down the biopsy site, you could be losing deserved pay. Read this article to know what ICD-9 codes and CPT codes apply to this situation and ensure medical coding accuracy.

Site-specific codes increase medical coding accuracy. Besides, they pay more than the most extensively used code, 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion).

Don't Miss More Pay for More Work

Site-specific biopsy codes inform the payer that the dermatologist carried out a biopsy at a specific site, instead of a generic integumentary based biopsy (11000). A site-specific biopsy code also signifies a more complex procedure than 11000 does.

Result: The dermatologist is worthy more pay for the gretaer level of complexity of these site-specific procedures. Your practice is missing income and accuracy in medical coding in case your dermatologists ignore these site specific codes, which is easy to do as dermatology practices depend on on the integumentary segment of the CPT® manual.

Example 1: A patient comes to your practice with a papular lesion of the lip. Once the dermatologist examines the patient, he decides that he must carry out a biopsy.

In this scenario, you must report 40490 (Biopsy of lip) in place of of 11100. Provided that the dermatologist notes the site-specific biopsy within the documentation, you must get nearly $78 more for the procedure on the patient's lip than in case you had reported 11100 as this biopsy needed more work from the dermatologist.

Don't miss: For accurate medical coding, ensure that the biopsy is of the lip, not the skin surrounding.

Example 2: A patient with a pigmented lesion that is of the nail bed presents to your practice. The dermatologist doubts trauma but feels he should carry out a nail bed biopsy to rule out melanoma.

Your initially thought in coding this scenario could be to bill 11100. However, you should bill 11755 (Biopsy of nail unit [e.g., plate, bed, matrix, hyponychium, proximal and lateral nail folds] [separate procedure]).

Code 11755 is more precise and also pays around $25 more than code 11100 (3.81 non-facility RVUs x $33.9764 = $129.45).

For More Information :-  http://www.supercoder.com/  

Report Multiple Biopsies for Separate Sites

While your dermatologist carries out multiple biopsies, you require a tool to unravel the claim's payment. You must clarify the conditions to the payer by the means of modifiers.

Wait for Path Report to Choose Dx

ICD-9 Codes and CPT Codes: You must always wait until the pathology report comes back to select the appropriate codes to report, although this will not always affect the CPT codes you will wind up selecting.

Reason: The biopsy specimen's pathology will affect the ICD-9 codes you report, but most CPT codes are not based on the specimen's outcomes. There are a few CPT codes which are connected to definite diagnoses (for instance, excision of benign and malignant lesions).

Tact Your EKG Interpretation Claims With This Can't Miss Documentation Guidance

Does your chart include the needed elements to stand up under audit?

In case you're getting repeat denials when your ED physician reads electrocardiograms [EKG], it's time to ask yourself some serious questions, comprising whether the documentation meets Medicare's definition of interpretation and whether the notes clearly classify which ED provider did the reading and reason behind the EKG was ordered. Read this article to ensure accurate medical coding.

Reality: One of the most commonly reported non-E/M services in the emergency department is for EKG interpretation; unfortunately, if you execute CPT Lookup, you will find that these CPT codes also fall under the most commonly contested services as well.

E/M link: A review of a formerly interpreted EKG has value in E/M code Medical Decision Making, but in a totally diverse way from being distinctly billable.

Watch Out for Rhythm Report Reason

CPT Lookup: The CPT® book includes two CPT codes defining interpretation as well as report of diagnostic cardiographs or the tracings of heart rhythms.

93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only)

93042 (Rhythm ECG, 1-3 leads; interpretation and report only)

In the case of the 93042 code, you would not report it when the ED physician just reviews the telemetry monitor strips taken from a monitoring system. The needed definite order for 93042 must be supported by a diagnosis or symptom as the starting event. For supporting medical necessity for the service, clinical information representing the need to assessing for the presence or absence of an arrhythmia, cardiac ischemia, or further cardiovascular problem must exist within the medical record.

In the ED, the physician would not normally report the global CPT codes 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) or 93040 (Rhythm ECG, 1-3 leads; with interpretation and report) as the physician does not usually own the EKG machine nor employ the staff who in fact administers the test.

Code choice aside, some payers reject to reimburse for diagnostic interpretations in the ED setting, stating they are bundled into the E/M service and counted in the amount and difficulty of data reviewed component of medical decision making.

CPT Lookup Tip: EKG services must be distinctly reimbursed except there was simply a "review" of the tracing delivered rather than the CPT® defined independently distinctly identifiable signed written report. CPT® is quite specific in the E/M services guidelines that the actual presentation and/or interpretation of diagnostic tests/studies ordered in a patient encounter are not involved in the levels of E/M services. Physician presentation of diagnostic tests/studies for which definite CPT codes ( Source "http://www.supercoder.com/cpt-codes/" )are available may be reported distinctly, as well as the suitable E/M code if correctly documented.

HCPCS Codes May Spell Respite for Undefined CPT® Services

Even though pediatricians aren't accustomed of using HCPCS codes, the level-two S codes provide potential medical coding and reimbursement for services that CPT does not outline. Once a pediatrician offers a service that CPT does not define, follow the following listed three steps to use HCPCS level-two S codes to resolve the reimbursement hitch.

1. Know Who Admits S Codes

Blue Cross/Blue Shield (BCBS) established the S codes for reporting drugs, supplies and services. You must use these HCPCS codes at that time when no CPT code is present, when the HCPCS code is more precise, or when the third-party payer necessitates it. The codes are entirely for use with private payers. Medicare does not admit them.

In case an S code correctly describes the service provided, make certain the carrier will accept it. You must read material for instance newsletters and carriers' local medical review policies to stay well-informed. It's also significant to evaluate the HCPCS codes in the insurance fee or payment schedule. In case the code is not listed, it's generally not payable.

2. Watch Out for Common Areas of Use

Coders regularly have problems billing for suture removal delivered by a different physician. As far as these services are concerned, you must consider using a HCPCS code.

To bill for suture removal by a physician except the physician who initially closed the wound, you should bill S0630 (Removal of sutures by a physician other than the physician who originally closed the wound) to BCBS of Michigan. To all other carriers, we report a problem-oriented E/M code (99201-99215), and link ICD-9 code V58.3 (Attention to surgical dressings and sutures) with it.

Use the similar diagnosis medical coding for HCPCS codes as you would for the CPT code. There is no dissimilarity.

3. Generate a System of Payer-Appropriate Codes

Using the codes that individual insurers identify can help get claims paid on the first try. On the other hand, keeping track of the numerous codes to use for each carrier can pose a logistical nightmare. To solve this logistical problem, design an encounter form to help your pediatricians and billers keep the codes straight. Group the CPT or HCPCS code by the major insurance companies. Under the category of suture removal by dissimilar physician, the biller chooses from the following:

ALL OTHER INSURANCE

99201-99215 - Sick visit office code (V58.3).

Provided that you did the research described in step 2 and made a chart of your findings (step 3), carriers should not reject your claims. In case you have to appeal, you must send copies of the HCPCS book to prove that the code is not a deleted or an obsolete code.

For Further details and More Information  sign up  http://www.supercoder.com/

Medicare Slip-Ups: Providers Underbilled More Than $1 Billion to Medicare in the Previous Year

CERT results disclose $34.3 billion in inappropriate Medicare payments--$1.1 billion of which was underpaid.

In case your practice's collections rate was off by 10.5 percent, you'd be in big worry, right? In fact, that's the 2010 Medicare Fee-for-Service improper payment rate, and your MAC might come looking for money you still owe to them. Read this article and guarantee accurate medical coding.

CMS's novel Comprehensive Error Rate Testing (CERT) results, which were out in November, explain that practices in fact made fewer errors in 2010 than in the preceding year. Maximum of the errors were revealed as overpayments—implying that CMS recognized $33.2 billion that went out to Medicare providers in mistake, and there are chances that MACs will be asking for much of that money back, if they haven't by now. Furthermore, CMS noted that it still owes $1.1 billion to providers who were underpaid in 2010.

To generate the CERT report, CMS revised 30,965 Part B claims, together with claims from Part A and DME, as per the "Medicare Fee-for-Service 2010 Improper Payment Report." Auditors then pored over the claims to decide which had no documentation, inadequate documentation, incorrect medical coding, or was a medically unnecessary service.

Documentation: Part B practices were the complete worst of the provider types as far as documentation was concerned, with a 2.1 percent error rate in the "insufficient documentation" category, greater than both Part A and DME providers.

Warning: In case a reviewer reviews your claim and discovers only a listing of the CPT® and ICD-9 codes that you reported, you have not proven medical necessity for the service, or even established that you in reality saw the patient. In these circumstances, the MAC could request the whole payment back.

Incorrect medical coding: Part B providers also rated the maximum among incorrect medical coding errors, with a 0.8 percent error rate, which topped the Part A and DME rates. Once more, not all of these errors reflected overpayments to practices--in few cases, doctors in reality shorted themselves by coding erroneously.

Avoid These Top 5 Physician Documentation Errors To Ensure Accurate Medical Coding

CMS found that physicians inappropriately billed $6.22 billion in claims that were later found to have inadequate documentation. In case you want to evade that type of error--which will lead to inaccurate medical coding--check out the top five errors:

1. No signature. Medicare needs that the author of a note validates it with a handwritten or electronic signature, however found that $1.3 billion worth of claims in reality had no signature at all.

2. Several errors. CMS noted that it inappropriately paid $1.1 billion on claims that had numerous dissimilar types of documentation errors.

3. Documentation does not go with code billed. "If it wasn't documented, it wasn't done." Medicare reviewers wholeheartedly agree with this sentiment, and said that physicians may have billed a particular code to the MAC, however the documentation didn't support it, causing $0.9 billion in errors in this category.

4. Effective physician order missing. Many services need a physician order. CMS discovered that the order was absent in $0.7 billion worth of claims.

5. Illegible identifier. In case a physician's signature is illegible or missing, CMS will give the provider an opportunity to attest to his signature. But, if the doctor does not return the attestation, the practice has to return the money it collected for the visit. CMS discovered $0.7 billion worth of errors in this category in 2010.

HCPCS Codes 2012: Novel HCPCS Code Will Get You $32,000 x 3 – Only If You Bill It Appropriately

HCPCS Codes 2012: Novel HCPCS Code Will Get You $32,000 x 3 – Only If You Bill It Appropriately

In case your urologist carries out a novel treatment carried out for asymptomatic or minimally symptomatic metastatic castrate resistant carcinoma of the prostate by means of the drug Provenge or drug Sipuleucel-T, pay attention to new HCPCS codes 2012.
HCPCS Codes 2012, Medical Coding, Hcpcs Codes

Include correct primary and secondary diagnosis codes to guarantee payment.

In case your urologist carries out a novel treatment carried out for asymptomatic or minimally symptomatic metastatic castrate resistant (hormone refractory) carcinoma of the prostate by means of the drug Provenge or drug Sipuleucel-T, pay attention to new HCPCS codes 2012. Read this article to safeguard your payment and accurate medical coding.

Get to Know the Procedure

Medicare permits a patient one treatment with Provenge in their lifespan, which involves three distinct infusions within a two week period,

Blood is taken from the patient and then it is exposed to prostate cancer cells, preparing the patient's white blood cells to attack the cancer cells when reinfused into the patient. This also stimulates a recruitment of added white blood cells to put an end to the tumor. Provenge is the first in a new class of therapy that is intended to activate a patient's individual antigen-presenting cells to stimulate an immune response against prostate cancer.

Report the New Code 3 Times For Full Treatment

From the HCPCS codes 2012, the code for this particular procedure is Q2043 (Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion). This code signifies the anti-neoplastic treatment for this specific type of tumor.

You must keep in mind that the code descriptor states "per infusion," implying that in case the patient gets three infusions throughout the two-week treatment period, you must report HCPCS code Q2043 three distinct times. You bill this once for every single infusion, and Medicare will reimburse you $32,000 per infusion. The purchased price for the drug is approximately $30,189 per treatment. Medicare will reimburse this cost and above a six percent increase/profit.

Don't miss: While you report Q2043, from the HCPCS codes 2012, for this particular cancer treatment, keep in mind that this HCPCS code covers all additional preparatory procedures, for instance the collection of cells from the patient, the preparation as well as transportation of the cells to a specialized lab, and then the infusion itself.

Support Claim With Appropriate Diagnostic Codes

While reporting HCPCS code Q2043, the diagnosis codes should include 185 (Malignant neoplasm of prostate) as the primary diagnosis and no less than one metastatic diagnostic code as the secondary diagnosis, Potential secondary diagnostic codes involve the following:

196.1 – (Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes)

196.2 – ( intra-abdominal lymph nodes)

196.5 – ( lymph nodes of inguinal region and lower limb)

196.6 – ( intrapelvic lymph nodes)

196.8 – ( lymph nodes of multiple sites)

197.0 – ( Secondary malignant neoplasm of lung)

198.1 – ( other urinary organs)

198.5 – ( bone and bone marrow)

198.7 – ( adrenal gland)

198.82 –( genital organs.)

New CCI Edits Inverse 'No-Go' Status of Injections With Some Vascular Procedures

New CCI Edits Inverse 'No-Go' Status of Injections With Some Vascular Procedures

The newest edition of Correct Coding Initiative (CCI) edits holds some pleasant revelations for neurology and pain management coders.

CCI Edit, Medical Coding

Go to 'deleted edits' section for updates to paravertebral facet joint injections.

The newest edition of Correct Coding Initiative (CCI) edits holds some pleasant revelations for neurology and pain management coders. In place of being burdened with added CCI edits that limit your claims filing, most pairs linked to neurology or pain management in fact fall under the "deleted edits" category. Read this article for accurate medical coding.

As far as the terminated pairs are concerned, 218 were retroactively ended back to the last quarter release and one back to January 1, 2010. This simply implies that, in case you were denied payment owing to these edit pairs in the past, you would probably be able to resubmit the claim for payment at this time.

Medical Coding Tip: Verify Deletions for Injection/ Vascular Procedure Bundles

Terminated bundles have influence on three groups of procedures carried out by neurologists or pain management specialists: therapeutic or diagnostic injections, paravertebral facet joint injections (with either image or ultrasound guidance), as well as somatic nerve injections.

The affected diagnostic or therapeutic injection codes involve the following:

96372 – i.e. Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); along with subcutaneous or intramuscular

96374 -- i.e.Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); along with intravenous push, single or initial substance/drug

96375 -- i.e.Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); every additional sequential intravenous push of a novel substance/drug (List separately in addition to code for primary procedure)

A couple of Category III codes also come into the "deleted pairs" group:

0213T – {Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level}

0216T – {Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level.}

Furthermore, preceding CCI edits bundled the bulk of somatic nerve injections 64400-+64484 (Injection, anesthetic agent …) as well as paravertebral facet joint injections 64490-+64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT] …) into an extensive range of intra-arterial as well as venous procedures. As per new CCI edits, those bundles are deleted. .

Example: Previous CCI edits listed the listed injections as constituents of vascular procedures for instance 36000 (Introduction of needle or intracatheter, vein), 36410 (Venipuncture, age 3 years or older, necessitating physician's skill [separate procedure], for diagnostic or therapeutic purposes [not to be used for routine venipuncture]), as well as 36425 (Venipuncture, cutdown; age 1 or over). For error-free medical coding, You must verify your claims after Oct. 1 to double-check whether some of the preceding bundles might now be permitted, and if you can refile claims owing to retroactive changes.

Article Source :- http://www.supercoder.com/coding-newsletters/my-neurology-coding-alert/cci-update-new-cci-edits-reverse-no-go-status-of-injections-with-some-vascular-procedures-108436-article

285.3 vs. 284.89: Documentation of 'Aplastic' Can Lead to Accurate Coding

Know which condition is more probable to be caused by chemotherapy.

Patients with cancer might develop anemia from numerous cases. Here are some clues to help you identify the source and keep your medical coding compliant.

This article digs into proper anemia medical coding, looking at ICD-9 codes for anemia caused by treatment and at how guidelines are expected to change when ICD-10 use becomes mandatory in 2013.

Reassess Documentation Before You Assign 284.89

When documentation shows that antineoplastic chemotherapy caused a patient's anemia, you need to consider two ICD-9 codes:

285.3 (Antineoplastic chemotherapy induced anemia)

284.89 (Other specified aplastic anemias, due to drugs)

The main dissimilarity between the two is that 284.89 mentions "aplastic" anemia. Aplasia implies that the bone marrow is wiped,as per Coding Clinic for ICD-9-CM (2009, vol. 26, no. 4).

Antineoplastic chemotherapy induced anemia is not generally an aplastic process. The anemia is likely to be short term, however it might range from mild to severe. Thus 285.3 may be applicable to your patient's claims more often than 284.89, however you must let documentation direct your choice. Before you assign 284.89, ensure that the documentation shows the anemia is aplastic and due to drugs.

Expect a Shake-Up When ICD-10 Begins

Paying close attention to diagnosis coding guidelines will become even more vital as you get ready to use ICD-10 in place of ICD-9. To be specific, the ICD-10 2011 guidelines for anemia coding are different from those you know for ICD-9.

Example 1: A patient comes for treatment of just anemia. The physician documents that the patient's neoplasm caused the anemia to develop.

In ICD-9 2012 guidelines, your first-listed code must report the anemia (285.22). The correct malignancy code(s) must follow (ICD-9, Section I.C.2.c.1).

In case you were instead applying ICD-10 2011 guidelines, you would report the malignancy code first and then the anemia code, D63.0 (Anemia in neoplastic disease) (ICD-10, Section I.C.2.c.1).

Example 2: Another patient comes for treatment of just anemia. For this patient, the physician documents that the anemia is because of chemotherapy or immunotherapy.

Using ICD-9 guidelines, your first-listed code must denote anemia (such as 285.3). You smust report the neoplasm as an added code (ICD-9, Section I.C.2.c.2).

On the other hand, the 2011 ICD-10 guidelines ask you to use an adverse effect code as your first-listed code. Your anemia and neoplasm codes must follow that (ICD-10, Section I.C.2.c.2).

Remember: The guidelines given above reflect ICD-10 2011 guidelines. When ICD-10 goes into effect on Oct. 1, 2013, you will apply the official ICD-10 coding guidelines in effect for the pertinent date of service.

Source Code :- http://www.supercoder.com/coding-newsletters/my-oncology-hematology-coding-alert/part-2-diagnosis-coding-2853-vs-28489-documentation-of-aplastic-can-help-steer-your-coding-107679-article

Fungal Sinusitis: 2 Guaranteed Medical Coding Formulas That Work

The two areas you must focus on should be manifestation and kind of fungus.

Though unusual, some sinus infections are caused by fungus. When the otolaryngologist makes a diagnosis that a patient is infected with fungal sinusitis, a lone code will not be your easy way out. Read this article and learn from the experts what ICD-9 codes you must select in such a case for accurate medical coding.

In its place, you should depend on a grouping of ICD-9 codes, and a careful examination of the physician's notes for manifestations.

Scenario: A patient visits and reports to the office with the complain of severe headaches, loss of appetite as well as postnasal discharge into the throat. An ENT then diagnoses the patient with fungal sinusitis confirmed on culture. She then also writes down that a chronic ethmoidal kind of sinusitis owing to aspergillosis troubles the patient.

In case you check the ICD-9 codes manual for a code for fungal sinusitis, you would be directed to 117.9 (Other and unspecified mycoses). However a single code may not correctly describe the patient's condition. Here's what you should do:

1. List Manifestation As Primary Diagnosis

The first instruction for category 110-118 (Mycoses) directs you to use added code to classify manifestation. Mycoses pertain to any disease caused by fungi. In the scenario specified above, the ENT classifies the fungi as aspergillosis, and further the condition as chronic ethmoidal sinusitis. The specific fungi will not be identified until a culture is taken and sent to pathology for identification. You would use 117.9 while waiting for the definite fungi to be identified.

When you have this information, then you must go on by reporting the appropriate sinusitis code for sinus membrane lining inflammation. As far as chronic sinusitis is concerned, you would report 473.x, choosing the fifth-digit code based on where the sinusitis takes place. Keep in mind that you should pick the code 461.x for acute sinusitis.

In case of ethmoidal chronic sinusitis, you must report ICD-9 code 473.2 (Chronic sinusitis; ethmoidal). This is a situation that attacks the ethmoid sinuses, which are situated within the human skull between the eye sockets and above the nose.

2. Don't Leave Out Underlying Fungal Infection Code

Once you've coded the manifestation, after that you must report the ICD-9 code that best characterizes the fungal infection. Some types of mycoses consist of dermatophytosis (110), candidiasis (112), as well as blastomycotic infection (116). The fungus aspergillus (117.3, Aspergillosis) is found in compost heaps, air vents or airborne dust. Inhaling it may lead to ethmoidal sinusitis owing to aspergillosis.

On your claim, you must write down 117.3 as diagnosis 1 and 473.2 as diagnosis 2, specifically in Box 21 of the CMS-1500 form.

ICD-9 Quick fact: The condition produced by fungus aspergillus is generally marked by inflammatory granulomatous lesions in the skin, ear, orbit, nasal sinuses, lungs, and occasionally in the bones and meninges.

Source URL :- http://isupercoder.blogspot.in/2011/12/fungal-sinusitis-2-guaranteed-medical.html 

J9043 Leads the Pack of Novel Chemotherapy Codes for 2012

The 2012 examples demonstrate which novel drug code you're likely to pair with a push admin code.

HCPCS has three all new J9xxx codes offered for 2012 dates of service. If you run HCPCS code search, you will find that Jevtana, Halaven, and Yervoy all of these now have definite codes you can report when your practice supplies those drugs. Read this article for accurate HCPCS medical coding.

How to prepare? Ensure that you update your charge master, electronic dictionaries, as well as charge slips to reflect any code and/or unit changes. In case drug unit calculations are carried out electronically, make certain that those fields are current in the charge master or electronic billing system so the quantity is appropriately reflected in billing.

Smart move: The code changes are effective Jan. 1, 2012, so complete your updates along with education before that date to exclude errors

J9043 Applies to New Prostate Cancer Treatment

Cabazitaxel will get a definite code for 2012: J9043, Injection, cabazitaxel, 1 mg. If you run a HCPCS code search, you will find that there was no exclusive HCPCS code to report cabazitaxel in 2011.

The brand name you'll see related with this anti-cancer medication is Jevtana. Physicians order it, normally together with daily oral prednisone, for treating metastatic prostate cancer that has progressed despite previous treatments, with docetaxel (J9171, Injection, docetaxel, 1 mg).

2012 example: Thirty minutes after the patient takes oral pre-medications (antihistamine, corticosteroid, and H2 antagonist), staff governs 47.25 mg of Jevtana via 1-hour infusion. You must report 48 units of J9043 for the Jevtana supply as well as 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the administration.

Expect to Pair J9179 With IV Push Code

In case your practice provides Halaven injections, take note of novel code J9179 (Injection, eribulin mesylate, 0.1 mg). If you run a HCPCS code search, you will find that Eribulin mesylate also did not have an exclusive code in 2011.

Physicians might order eribulin mesylate (sold as Halaven) to treat locally advanced or metastatic breast cancer in patients who have previously received at least two chemotherapeutic regimens, with an anthracycline and a taxane.

2012 example: Staff gives 2.41 mg of Halaven by a 4-minute IV push. You must report the supply with 25 units of J9179, and report the administration by the means of 96409 (Chemotherapy administration; intravenous, push technique, single or initial substance/drug).

Source URL :- http://www.supercoder.com/coding-newsletters/my-oncology-hematology-coding-alert/hcpcs-update-j9043-leads-the-pack-of-new-chemotherapy-codes-for-2012-109227-109227-article 

HCPCS Says Yes to J9228 for Yervoy

You'll also have a novel 2012 CPT code for ipilimumab, which is sold as Yervoy: J9228, Injection, ipilimumab, 1 mg. If you run a HCPCS code search, you will find that it did not offer a distinct code for ipilimumab in 2011.

2012 example: Staff gives 210.93 mg of Yervoy via a 90-minute IV infusion. You must report 211 units of J9228 for the drug. For the administration you must report 96413, which covers the first hour plus up to an additional 30 minutes of administration time, a total of 90 minutes. (CPT® requires at least 31 additional minutes to report +96415, ... each additional hour [List separately in addition to code for primary procedure], so you should not report +96415 in this example which involves a 90-minute infusion).

Avoid Radiology Codes For Rectal Drug Supervision

ICD-9 564.0x should define constipation, but keep in mind to report comorbid conditions, too.

Not every enema is an imaging procedure. Occasionally the gastroenterologist will choose to administer an enema for treating constipation. The challenge that you face in such cases is whether you should cover the enema tubing in an E/M or bill it as a separate procedure. Take help of the following situation -- with the bonus tips -- to help you with accurate ICD-9 coding.

Scenario: Our nursing staff carried out an enema for an elderly gentleman because of severe constipation post an office visit with his physician. The patient already has history of encopresis as well as constipation. What code options do you have?

Avoid Imaging Services 74283, 74270

Seeing the word 'enema' can at times mislead you to consider 74283 (Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction [e.g., meconium ileus]), however, you must stop right there.

Why: You should not report medical CPT®74283 because this code wouldn't be appropriate for this particular scenario. Medical CPT® 74283 comes under the "Diagnostic Radiology (Diagnostic Imaging) Procedures of the Gastrointestinal Tract" section of your manual, and is classified as a radiology service. You would then use 74283 for imaging enhancement (e.g., barium enema), which has nothing to do with what we consider as a therapeutic enema in the physician's office.

Nor is 74270 (Radiologic examination, colon; contrast [example, barium enema, with or without KUB]) the appropriate medical CPT® code.

Source URL :- http://www.supercoder.com/coding-newsletters/my-gastroenterology-coding-alert/enema-administration-case-analysis-skip-radiology-codes-for-rectal-drug-supervision-108424-article

Incorporate Therapeutic Enema Into Your E/M

Enema administration may also be carried out therapeutically to relieve intussusceptions or intestinal obstructions. Once the provider injects liquid through the anal canal, fluid soaks and then loosens hardened waste matter lying in the patient's colon.

Enema carried out for removal of impacted feces is not reported distinctly and is included when an E/M code is reported.

Since this is the case with the given scenario, you would likely use any of the E/M established outpatient visit medical CPT codes 99213-99215 to describe the E/M and the rest of the procedure -- including the administration of enema.

There is also an additional code for E/M visits for prolonged service time that does not need direct patient face-to-face contact.

Someone might also consider that they can bill 99358 (Prolonged evaluation and management service before and/or after direct [face-to-face] patient care; first hour) or +99359 (Prolonged evaluation and management service before and/or after direct [face-to-face] patient care; each additional 30 minutes [List separately in addition to code for prolonged physician service]). Though, Medicare contractors will not pay (nor can providers bill the patient) for these prolonged services medical CPT codes. These are Medicare covered services and reimbursement is included in the payment for other billable E/M services.

Append correct dx: As for the appropriate ICD-9 code, you must report 564.00 (Unspecified constipation) as the primary diagnosis, and then 789.0x (Abdominal pain) as secondary diagnosis to define pain from the stomach or another of the patient's comorbid situations.

V Codes Might Hold the Answers to Complex Anesthesia Situations

Don't be reluctant of submitting the similar V code as surgeons.

In case you ignore the V code section of ICD-9 for the reason that you are unsure whether the choices are applicable to anesthesia claims, it's time to take a closer look. V codes provide added information and specificity, which can help get a claim paid. Read this article for expert guidance on accurate medical coding.

Remember Both MDs Can Report V's

The surgeon as well as anesthesiologist can both submit the similar V code for a patient's chief diagnosis or to help clarify the patient's medical history.

Example: Your anesthesiologist might be involved with prophylactic removal of a patient's ovary. Both physicians could report V50.42 (Prophylactic organ removal; ovary). If applies, you could also include V16.41 (Family history of malignant neoplasm; ovary).

Watch for Chart Clues

Anesthesia coders from time to time trust on V codes in diverse ways from other specialties. Information that you find in the anesthesia provider's notes can point you to V codes that might go disregarded.

Example: ICD-9 expanded the body mass index (BMI) choices in 2011 to show higher BMIs with five novel ICD-9 codes (V85.41-V85.45). Patients with a high BMI can result in additional work for an anesthesiologist in the procedure, so including BMI ICD-9 codes in your claim can help validate your provider's service.

Tip: You must think ahead for possible V code usage, even during the pre-operative anesthesia assessment. BMI has become a significant health tool. There are those who are of the belief that BMI should be an eighth option while counting important signs for the ‘constitutional' bullet in the E/M physical exam, specifically in bariatrics and orthopedics/sports medicine.

Double Check Guidelines

Payers can have dissimilar guidelines as regards their use or acceptance of V codes.

For instance: Aetna policies permit V58.64 (Long term [current] use of non-steroidal anti-inflammatories [NSAID]) as a possible diagnosis supporting trigger point injections or radiofrequency facet denervation in case certain criteria are fulfilled. Code V58.64 is not listed as a feasible option, though, for back pain treatments for example percutaneous lumbar discectomy or facet joint injections.

Tip: You must check your payer's policies prior to submitting claims with V codes. Experts also commend that you must, from time to time, review the ICD-9-CM Official Guidelines for Coding and Reporting since it never hurts to remind yourself of medical coding basics.

A lot of of the Medicare Administrative Contractors [MACs] propose free ICD-9 coding as well as refresher courses. You can earn AAPC credits and learn more about how you should report any of the ICD-9 codes appropriately.

Avoid 'Uncertain Behavior' Confusion With Expert Tips on 238.2 Use

You should wait for the path report to avoid payer scrutiny.

In case you always use diagnosis code 238.2 (Neoplasm of uncertain behavior of skin) while you're reporting 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) for a biopsy procedure your physician carries out, you're jeopardizing your practice. The key to knowing when ou should use the "uncertain behavior" diagnosis code is knowing what that code descriptor actually means. Follow these expert tips to ensure you're choosing the accurate code, after medical procedure codes lookup, for all your 11100 claims.

Wait For Pathology Before Selecting a Code

When your physician conducts a biopsy you must always wait until the pathology report gets back to you to select the appropriate diagnosis and procedure codes to report after medical procedure codes lookup -- even though this will not always have an impact on the CPT billing codes you will wind up choosing.

Reason: The biopsy specimen's pathology will influence the ICD-9 code you report, however maximum CPT procedure codes are not based on the specimen's results. There are a few CPT codes which are related to particular diagnoses (for instance, excision of benign and malignant lesions), but generally CPT is about what you did; whereas ICD-9 is about the result or the reason for it.

Identify the Meaning Behind 'Uncertain' Codes

Once you report 238.2 as the diagnosis, post medical procedure codes lookup , for a biopsy procedure, you're telling the payer that the pathologist stated in his path report that he was unclear regarding the morphology of the lesion.

Uncertain behavior doesn't imply that the coder is unclear or that the physician considers the lesion looks suspicious but it might be benign. Uncertain behavior actually means that a specimen has been examined by a pathologists and also that the cells are of mixed types.

Source URL :- http://www.supercoder.com/coding-newsletters/my-general-surgery-coding-alert/diagnosis-coding-primer-eliminate-uncertain-behavior-confusion-with-expert-tips-on-2382-use-102930-article

How it works: Uncertain behavior diagnoses are suitable for specimens recognized as hyperplastic (hyperplasia) or precancerous. In case you submit a claim with 238.2 as a diagnosis prior to you have the pathology report back, you might have in fact communicated to the insurer that the patient has a disease process that he doesn't really have or may have but has not yet been established.

Example: Your physician finds an irregular lesion on patient's face. The color and shape troubles him and he doubts the lesion may be malignant, however does not want to completely do away with it owing to its size and location unless it is essential. Thus, he simply takes a biopsy of the skin and subcutaneous tissue (11100) and sends the sample to pathology. On pathological evaluation the pathologist cannot decide if the cells from the lesion are malignant or benign, thus, he allocates the diagnosis of "uncertain behavior." In this case, after medical procedure codes lookup, you would validly report 238.2 as the diagnosis code after getting the pathology report.

Get Ready For These Key Changes in Observation and Prolonged Services Codes

And look into new guidance on wound, burn and ultrasound services that could have an impact on your revenue.

ED coders turn to E/M section of the 2012 CPT® manual for most of the related changes and additions. But beware: Most of these are slight references to time in related E/M codes for medical billing, frequently concealed in preambles along with parenthetical references that are likely to miss.

Read on for guidance on recognizing the ED changes that could have an impact on your claims, come Jan. 1.

Notice Revised Definitions of New and Established Patients

2012 brings new wording to the New and Established Patient section in the E/M services guidelines in the front of the CPT® book.

Although the new language does not influence the 9928xemergency department E/M codes for medical billing directly, more and more groups are being tasked with increasing their services outside the Emergency Department. As ED groups grow in their search for another revenue streams and the healthcare delivery system evolves towards larger integration, a lot of groups are staffing different urgent care clinics where the dissimilarity between new and established patient status will play a significant role in determining code selection and subsequent reimbursement.

For More Info :- http://www.supercoder.com/coding-newsletters/my-emergency-medicine-coding-alert/cpt-2012-update-prepare-for-these-key-changes-in-observation-and-prolonged-services-codes-108862-article

Note New ED Time Tip Included for 2012

You must search for new "Coding Tips" advice in the CPT E/M section on the significance of time as a factor in making your E/M code selections. "This is not new information but serves as a reminder that the inclusion of time is there to assist physicians in selecting the appropriate codes for medical billing and that the listed times are averages and consequently represent a range of times that may be higher or lower, depending on clinical circumstances.

Key: The ED coding tip repeats that time is not an aspect in choosing ED E/M codes for medical billing.

Use Prolonged Services Codes With Initial Observation

These typical time add-ons to the initial observation codes come into play with novel language relating to the prolonged services codes for medical billing . The preamble to the prolonged services section includes novel language explaining direct patient contact as face-to-face, involving additional non-face-to-face services on the patient's floor or unit of the hospital during the same session. Therefore, the term "face-to face" no longer has a place in the title of the prolonged services code preambles.

More importantly, code +99356 (Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service; first hour [List separately in addition to code for inpatient Evaluation and Management service]) has a parenthetical list of related code ranges that now involve the initial admit to observation codes.

Factors That Affect Reimbursement for Wart Removal

There are few distinct factors that influence your wart removal coding, and each element has a noteworthy bearing on payment. Warts are generally benign growths and, as removal is frequently viewed as a routine procedure, family practices at times assign the similar sets of codes without considering ways to capitalize on their reimbursement. The following listed questions may help coders as they assess documentation and choose which codes are most useful to assign.

1. What is the technique of removal?

Warts are nearly always removed by destruction, described in the CPT 17000 series of codes. Techniques of treatment contain cryosurgery, laser, chemical treatment as well as electrosurgery. Occasionally, in case the physician doubts that a wart-like growth might be something but a wart, the lesion may be excised and biopsied. You will find the excision codes listed in the 11000 segment of CPT and these are assigned as per the technique used, the location of the excision and, in few cases, the number of warts removed.

Family practice coders must note that in case warts and further lesions are removed from diverse sites, destruction and excision codes can be further billed on the similar date of service. For instance, in case a physician excises a growth on a patient's arm, however destroys a series of warts on the patient's foot, you can report codes from both the CPT 17000 series and the CPT 11000 series.

2. What sort of wart has been removed?

The physician should document the definite type of wart being removed as that determination could have a considerable impact on reimbursement.

As CPT 17110 (destruction by any method of flat warts, molluscum contagiosum, or milia; up to 14 lesions) as well as CPT 17111 (… 15 or more lesions) in detail mention flat warts in their descriptions, a lot of practices automatically allocate them for all wart removal. Though, three other codes, CPT 17000 (destruction by any method, including laser, with or without surgical curettement, all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions, including local anesthesia; first lesion), 17003 (… second through 14 lesions, each [list separately in addition to code for first lesion]) and 17004 (… 15 or more lesions), may be allocated for common as well as plantar wart removal – and may lead to maximized reimbursement in case multiple lesions are destroyed.

3. What is the number of warts that have been removed?

The figure of warts removed may have a considerable impact on the codes assigned – and the payment. This is mainly the case when reporting the destruction of common or plantar warts, is different from flat warts.

The flat wart destruction codes, which are, 17110 and 17111, define removal of multiple warts. That means the coders would assign 17110 once once the physician does away with one to 14 warts. In case more than 14 flat warts are destroyed, coders would allocate 17111 once.

Though, CPT permits destruction codes for several common or plantar warts to be assigned several times. Code 17000 would be given for the first wart and additional code 17003 would be assigned for every following wart removed up to 14. That means that in case the patient who presented with eight plantar warts, coders will then report CPT 17000 once and 17003 seven times.

  
Article Source :- http://www.supercoder.com/coding-newsletters/my-family-practice-coding-alert/six-factors-affect-reimbursement-for-wart-removal-article 

CPT 2012: Improve Your Medicine, Cardiothoracic Surgery Reporting

Part with diagnostic thoracoscopy code 32602 in favor of new codes 32607-32609.

Don't forget to check for deleted codes for CPT while preparing to use your CPT® 2012 manual, not just novel codes as well as revised descriptors. Next year's set of procedure codes will involve new additions for coding certain common medicine/pulmonary procedures. Simultaneously, you will be missing the resistance to airflow determination code, and also a few additional familiar pulmonary procedures.

Gauge Potential Opportunities With Brand New Medicine Codes

You and your pulmonologists should pay special attention to the subsequent novel codes for CPT in the medicine/pulmonary section of CPT® 2012 manual:

94726 -- i.e. Plethysmography meant for determination of lung volumes and, when carried out, airway resistance

94727 -- i.e. Gas dilution or washout meant for determination of lung volumes and, when carried out, distribution of ventilation as well as closing volumes

94728 -- i.e. Airway resistance by means of impulse oscillometry

+94729 – i.e. Diffusing capacity (e.g., carbon monoxide, membrane) (List separately in addition to code for primary procedure)

94780 -- i.e. Car seat/bed testing for airway integrity, neonate, with incessant nursing observation and incessant recording of pulse oximetry, heart rate along with respiratory rate, including interpretation as well as report; 60 minutes

+94781 -- i.e. …every added full 30 minutes (List separately in addition to code for primary procedure).

Certain of these codes for CPT were formulated in an effort to try to adapt to existing practice and elucidate earlier confusion while reporting PFTs. One instance is plethysmography. Earlier options for reporting this particular service was 93720 (Plethysmography, total body; with interpretation and report) or 94360 (Determination of resistance to airflow, oscillatory or plethysmographic methods). Effective Jan. 1 a noval code will now reflect the more correct testing method.

2012 will introduce 18 noval cardiothoracic surgery codes for CPT . These codes for CPT include:

32096 – i.e. Thoracotomy, including diagnostic biopsy(ies) of lung infiltrate(s) (e.g., wedge, incisional), unilateral

32097 -- i.e. Thoracotomy, including diagnostic biopsy(ies) of lung nodule(s) or mass(es) (e.g., wedge, incisional), unilateral

32098 -- i.e. Thoracotomy, including diagnostic biopsy(ies) of pleura

32505 -- i.e. Thoracotomy, including therapeutic wedge resection (e.g., mass, nodule), initial

+32506 -- i.e.... including therapeutic wedge resection (e.g., mass or nodule), each additional resection, ipsilateral (List separately in addition to code for primary procedure)

+32507 -- i.e. ... including diagnostic wedge resection followed by anatomic lung resection (List separately in addition to code for primary procedure)

32607 -- i.e. Thoracoscopy; including diagnostic biopsy(ies) of lung infiltrate(s) (e.g., wedge, incisional), unilateral

32608 -- i.e.... including diagnostic biopsy(ies) of lung nodule(s) of mass(es) (e.g., wedge, incisional), unilateral

32609 -- i.e.... including biopsy(ies) of pleura

32666 -- i.e.... including therapeutic wedge resection (e.g., mass, nodule), initial unilateral

+32667 -- i.e.... including therapeutic wedge resection (e.g., mass or nodule), each additional resection, ipsilateral (List separately in addition to code for primary procedure)

+32668 -- ... including diagnostic wedge resection with subsequent anatomic lung resection (List separately in addition to code for primary procedure)

32669 -- ... including removal of a single lung section (segmentectomy)

32670 -- ... including elimination of two lobes (bilobectomy)

32671 -- ... including removal of lung (pneumonectomy)

32672 -- ... including resection-plication for emphysematous lung (bullous or non-bullous) meant for lung volume reduction (LVRS), unilateral involves any pleural procedure, when carried out

32673 -- ... including resection of thymus, could be unilateral or bilateral

+32674 -- ... including mediastinal as well as regional lymphadenectomy (List separately in addition to code for primary procedure).

The codes are cardiothoracic surgery codes. It looks as if they [CPT®] have expanded all of these series to involve more detail, and more precisely capture the amount of effort related to unilateral vs bilateral services along with procedures including multiple (ipsilateral) biopsies.

CPT® 2012: 33227-33229 Transform Pacemaker Battery Change Coding

Celebrate an easierr way to report lone electrode repair in a dual-chamber system.

Each CPT® update brings an enormous overhaul of a diverse cardiology coding area, and 2012 will definitely be no exception. Starting January 1, you’ll report pacemaker as well as pacing cardioverter-defibrillator surgical services in a completely different way.

To help ease the task of acing these changes, here is the big picture view of the new codes for CPT.

Complete System: 33206-33208 and 33249 Get a Makeover

Pacemaker and pacing cardioverter-defibrillator codes for CPT are in the limelight in 2012, and the updates start with codes for comprehensive systems.

CPT® will include the following bold, italicized text to the definitions of 33206-33208: "Insertion of new or replacement of permanent pacemaker with transvenous electrode(s) ..."

For a pacing cardioverter-defibrillator, 33249 modifies as follows:

2011: Insertion or repositioning of electrode lead(s) for single or dual chamber pacing cardioverter-defibrillator as well as insertion of pulse generator

2012: Insertion or replacement of permanent pacing cardioverter-defibrillator system including transvenous lead(s), single or dual chamber.

Electrode Repair Receives a Needed Update

When you require to code electrode repair, you’ll select between these revised codes for CPT:

33218, i.e. Repair of single transvenous electrode, along woth permanent pacemaker or pacing cardioverter-defibrillator

33220, i.e. Repair of 2 transvenous electrodes meant for permanent pacemaker or pacing cardioverter-defibrillator.

Helpful: The change solves confusion over how you should code repair of a single electrode in a dual-chamber system. In 2011, the code definitions propose no clear solution as 33218 references repair of one electrode in a single-chamber system and 33220 refers to repair of two electrodes in a dual-chamber system.

For More Information :- http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/cpt-2012-33227-33229-revolutionize-pacemaker-battery-change-coding-108778-article

2 Codes No Longer Required for Battery Change

In 2012, coding for removing as well as replacing a pulse generator at a single session will turn very different. This service is frequently called a battery change. In 2011, you report a single code for the removal and then a second code for inserting the new pulse generator. In 2012, you’ll report a single code that captures both the removal and the insertion.

The following listed new Codes for CPT will define pacemaker pulse generator removal with replacement:

33227, i.e. Removal of permanent pacemaker pulse generator including replacement of pacemaker pulse generator; single lead system

33228, i.e.... dual lead system

33229, i.e.... multiple lead system.

CPT similarly adds codes to explain the replacement of a pacing cardioverter-defibrillator pulse generator:

33262, i.e. Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator; single lead system

33263, i.e. ... dual lead system

33264, i.e. ... multiple lead system.