Anesthesia CPT Codes For Subclavian Central Venous Catheter

To put it simply, venous catheterization is a technique to access veins. A central venous access catheter or device is used to deliver medications, intravenous fluids or get blood samples. Central venous access catheters as well as central venous access devices (VADs) are two diverse methods of venous catheterization. The correct procedural coding of central venous catheters and central venous devices (CVD) is to a certain extent difficult for many coders.

This is in part owing to the terms used by physicians when defining the catheters and devices inserted. Several physicians use the term "vascular access device" to mean any kind of central venous catheterization without providing sufficient information as to the exact type inserted, whether it is a non-tunneled or it is tunneled central venous catheter or the insertion of a tunneled, implantable, either partially or totally, central VAD. Similarly, the physician may not always document in case the insertion site is central or peripheral. This lack of exact documentation for the procedures leads to confusion and frustration on the part of the coder.

There are two sorts of VADs: one entirely implanted and the other partially implanted. Both types of VADs are intended to offer repeated access to the vascular system devoid of the trauma or complications of multiple veni-punctures.

CPT has distinct codes for non-tunneled and tunneled central venous access procedures. Consequently, the initial words to concentrate on while coding the insertion of central venous access procedures are "non-tunneled" and "tunneled." The subsequent key word is catheter or device. The non-tunneled central venous access catheter might have either the central or peripheral placement, with a dissimilar set of codes assigned as per the insertion site, central or peripheral, plus according to the age of the patient. Non-tunneled, centrally placed venous access catheters as well as non-tunneled peripherally inserted central venous catheters will not be having a port or pump.

The codes are as following: 36555 (insertion of non-tunneled centrally inserted central venous catheter, under 5 years of age), as well as code 36556 meant for age 5 years or older. The insertion of a non-tunneled, peripherally inserted central venous catheter, or PICC, is also broken down by age. The codes are 36568 (insertion of a non-tunneled peripherally inserted central venous catheter, without subcutaneous port or pump, under 5 years of age), and 36569 for age 5 years or older.

CPT has codes meant for the insertion of tunneled central VADs, they could be catheters or devices, along with for peripherally inserted central VADs. The tunneled central venous catheter codes are allocated on the basis of age. The code meant for the insertion of a tunneled centrally inserted central venous catheter, without a subcutaneous port or pump, under 5 years of age is 36557, and code 36558 for age 5 years or older.

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Paravertebral Facet Joint Nerve Destruction: Deleted, Replaced, Reduced Codes In 2012

CPT code series, from CPT 64622 to CPT 64627, is replaced with CPT code series 64633-64636

Since paravertebral facet joint nerve destructions emerge to see a small reimbursement increase in 2012 as compared to 2011, both physicians and ambulatory surgery centers may take a hit in reimbursement when carrying out these injections. Read this expert medical coding insight n how these CPT codes changes affect your reimbursement.

Effective Jan. 1, 2012, paravertebral facet joint nerve destructions will no longer be reported per nerve. As an alternative, four novel codes have been established to echo the work and anatomical site involved when carrying out these destructions. Remember before 2012, the injection was reported per nerve at a single vertebral level. CPT 2012 requires that the injection will be reported per facet joint. As per the AMA, It is vital to note the number of nerves injected for a single facet joint does not influence code selection

Out with the old (deleted):

CPT code series, from CPT 64622 to CPT 64627, is deleted in 2012.

In with the new (replaced):

CPT code series, from CPT 64622 to CPT 64627, is replaced with CPT code series 64633-64636:

64633 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint (new code in 2012))

+64634 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure) (new code in 2012))

64635 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint (new code in 2012))

+64636 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure) (new code in 2012))

It may not seem to be a reduction until we report the facet joint in spite of of the number of nerves destroyed. Let's compare:

In 2011: A patient goes through a radiofrequency nerve destruction of two medial branch nerves L3 and L4 innervating the symptomatic lumbar facet joint. Reimbursement contemplation is based upon the following listed CPT code selections:

64622 — ($495.72 (approximate 2012 ASC reimbursement))

64623 — ($294.00 (approximate 2012 ASC reimbursement))

In 2012: A patient goes through a radiofrequency nerve destruction of two medial branch nerves L3 and L4 innervating the symptomatic lumbar facet joint. Reimbursement consideration is based upon the following listed CPT code selection:

64635 — ($516.47 (approximate 2012 ASC reimbursement))

CPT 2012 Coding tips:

Image guidance and localization are essential for the performance of paravertebral facet joint nerve destruction by means of neurolytic agent explained by CPT codes 64633 -64636.

You must not report 64633-64636 in combination with 77003 or 77012). Both CPT 77003 and/or 77012 are considered inclusive to the injection procedure in 2012. In case CT or fluoroscopic imaging is not used/documented, report unlisted CPT code 64999.

In case both facet joints at the same vertebral level are treated, then CPT 64633 or 64635 should be reported with modifier -50 appended pending carrier reporting necessities for bilateral procedures (-50 versus RT/LT versus units).

Ondansetron Update: Q0162 Replaces Q0179 in 2012

Hit these resources on Medicare's oral anti-emetic policy.

In case your practice reports oral anti-emetics, ensure you're up on the latest ondansetron medical coding news or you could start facing denials.

This drug gota new HCPCS code, effective Jan. 1, 2012: Q0162 (Ondansetron 1 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen).

To make room for this novel code, HCPCS deleted Q0179 (Ondansetron hydrochloride 8 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen).

Bottom line: Reporting Q0179 for a 2012 date will bring an instantaneous denial. You must use HCPCS code Q0162 instead.

Zuplenz Factors Into Unit Change

Pay attention to how the HCPCS code change influences unit reporting. For 2011's Q0179, one unit represented 8 mg. In 2012, one unit of Q0162 represents only 1 mg.

The change permits for more precise reporting of the ondansetron oral soluble films sold as Zuplenz. The films are obtainable in 4 mg and 8 mg doses. Even though HCPCS codes specific to the oral films were requested, the novel code was created so that it could be allocated to any oral dose form available.

Brush Up on Oral Anti-Emetic Rules

Prior to reporting HCPCS code Q0162, take heed. There is a precise set of guidelines for oral anti-emetics to be considered payable by Medicare.

Smart idea: You must review Medicare's national resources on reporting oral anti-emetics.

Claims processing jurisdiction is one vital area covered in the MCPM. Practices must bill the oral anti-emetic to their Durable Medical Equipment Medicare Administrative Contractor (DME MAC). In contrast, you'd report an intravenous anti-emetic to your local carrier (Part B MAC).

Read on: For Medicare patients, you also must check for local coverage determinations (LCDs) that address coverage for oral anti-emetics by the suitable region's DME MAC.

The LCD may disclose specific modifiers you must use with the HCPCS code. For instance, modifier KX (Requirements specified in the medical policy have been met) may apply.

Moreover, to support oral anti-emetic coverage, the patient should be receiving what is considered to be a highly emetic chemotherapy agent, for instance Cisplatin or other drugs listed on the DME MAC's LCD," says Martin. (The MCPM provides a list of the chemotherapy agents that support necessity for the oral anti-emetic tri-pack of aprepitant [Emend], a 5-HT3 antagonist [such as ondansetron], and dexamethasone.)

Remember: Commercial insurances also may have entirely different payment policies for oral medications. Confirm the payer policy to see how or even if these would be paid under the patient's medical benefits.

Sorce URL :-

CPT 2012: 38230 and 38231 Will Need Knowledge of Bone Marrow Donor

Change to global days offers new possibility for E/M reporting.

Get ready to track down some donor details before coding bone marrow harvesting. CPT 2012 needs to know.

Concerning 2011 dates of service, in case someone had asked, "Does coding for bone marrow harvesting differ based on whether the patient donates the cells or whether another person donates the cells?" the answer would have been, "No."

However a code revision and a code adding in CPT 2012 change that answer to "Yes," effective Jan. 1, 2012.

Consider this revision of 38230:

CPT 2011: 38230, Bone marrow harvesting for transplantation

CPT 2012: 38230, Bone marrow harvesting for transplantation; allogeneic.

As 38230 is specific to allogeneic harvest in CPT 2012, CPT® similarly created a code for autologous harvest: 38232, Bone marrow harvesting for transplantation; autologous.

Match the CPT Codes to the Procedures

To apply the CPT codes correctly, keep in mind that "auto" means "self" and "allo" means "other."

For bone marrow transplant medical coding, "autologous" specifies the cells are from the same individual.

Thus autologous means a single patient donates the cells (38232) and then receives those cells back at a later date and through a distinctly reportable service (38241, Bone marrow or blood-derived peripheral stem cell transplantation; autologous).

Allogeneic means the cells are from someone other than the patient. The technical definition of allogeneic is "genetically different but from the same species. For allogeneic harvesting (38230), the donor may be either related or unrelated to the patient. Later, when the patient receives the cells donated from a different individual, you should report 38240 (Bone marrow or blood-derived peripheral stem cell transplantation; allogeneic) for the transplant.

Straight from the source: Medicare addresses stem cell transplantation in Claims Processing Manual 100-04, chapter 3, section 90.3. (“Stem cell transplantation is a process in which stem cells are harvested from either a patient's or donor's bone marrow or peripheral blood for intravenous infusion. Autologous stem cell transplants must be used to effect hematopoietic reconstitution following severely myelotoxic doses of chemotherapy and/or radiotherapy used to treat various malignancies. Allogeneic stem cell transplant may also be used to restore function in recipients having an inherited or acquired deficiency or defect. Bone marrow and peripheral blood stem cell transplantation is a process which includes mobilization, harvesting, and transplant of bone marrow or peripheral blood stem cells and the administration of high dose chemotherapy or radiotherapy prior to the actual transplant".)

Capture New Opportunity to Code Follow-Up

Wording changes aren't just the only news you require to know for stem cell harvest coding. The number of global days has a revision for CPT 2012, as well.

In 2011, Medicare gave 38230 a 10-day global period. That meant that E/M services on the day of the procedure and during the 10-day postoperative period normally weren't payable when the visit was related to the outcome of the procedure, as defined by the global surgical package rules.

As per the 2012 Medicare Physician Fee Schedule (Final, in comment period), CPT codes 38230 and 38232 have a global period of 000 for 2012. Reason: "These services rarely require overnight hospitalization and physician follow-up in the days following the procedure."

For More Information :-

HCPCS Update: J1561's New Look Discloses Trade Name and Admin Modifications

Plus: Check out more new HCPCS codes for pain and fracture prevention.

Modifications to acetaminophen, denosumab, and immune globulin coding are sure to keep you on your toes in 2012. Keep a close eye on the administration methods for Ofirmev and Gamunex-C, in particular. Read this expert medical coding article and know more about what HCPCS codes apply.

J0131: Add a New Acetaminophen Code

In 2012, there is an addition of a HCPCS code for acetaminophen administered by infusion: J0131 (Injection, acetaminophen, 10 mg). The brand name for this particluar injectable form is Ofirmev.

Physicians might order the drug for the management of mild to moderate pain; management of moderate to severe pain along with adjunctive opoid analgesics; and also for fever reduction in adults and children 2 years or older.

2012 example: Staff administers 1000 mg of Ofirmev over 15 minutes. You should report J0131 x 100 units (1000 mg administered divided by the 10 mg in the definition). For the administration, report 96374 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; intravenous push, single or initial substance/drug).

J0897: Prolia and Xgeva Get a Specific Code

As of Jan. 1, 2012, you'll be able to report denosumab with ease using new HCPCS code J0897 (Injection, denosumab, 1 mg). This antibody works by decreasing bone resorption and increasing bone density. Brand names for denosumab consist of Prolia and Xgeva.

Prolia is specified to increase bone mass in individuals at high fracture risk because of certain cancer therapies, especially in men getting androgen deprivation therapy to treat nonmetastatic prostate cancer as well as in women with breast cancer who receive adjuvant aromatase inhibitor therapy. According to the HCPCS agenda, Xgeva is intended for prevention of skeletal-related events (SREs) in patients with bone metastases from solid tumors. In 2011, denosumab didn't have a definite HCPCS code for practices to report, so they used J3590 (Unclassified biologics) on Medicare claims.

2012 example: Staff administers a 120 mg subcutaneous injection of Xgeva. You must report 120 units of J0897 for the supply and 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the injection.

J1557 and J1561: Watch IG Brand Names

Don't overslook two changes to immune globulin (IG) used to treat immunodeficiencies. Out of these HCPCS codes, one is a new code and one is a revision of an existing code.

New: Intravenous IG (IVIG) product Gammaplex gets its own individual code for 2012: J1557 (Injection, immune globulin, [Gammaplex], intravenous, non-lyophilized [e.g. liquid], 500 mg).

In 2011, your best option for Gammaplex was J1599 (Injection, immune globulin, intravenous, non-lyophilized [e.g. liquid], not otherwise specified, 500 mg). As per HCPCS agenda, the new HCPCS code ( source "http://www.supercoder.com/hcpcs-codes/") was requested as Gammaplex is different from other licensed IVIG products in numerous significant respects that can influence product tolerability and safety.

2012 example: Staff administers a 2-hour, 16,350 mg Gammaplex infusion. You must report 33 units of J1557. (Divide the 16,350 mg administered by the 500 mg in the definition to get 32.7. Round up to 33.) You must report 96365 for the first hour of administration. As far as the second hour is concerned, report +96366 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; each additional hour [List separately in addition to code for primary procedure]).

Provider Requirement: 90460-90461 Show Significance of 'Qualified Health Care Professional' Definition

For accurate claims, distinguish these professionals from 'clinical staff.'

The definition of "other qualified health care professional" didn't make it into the CPT 2012 manual, but you are required to know and apply this definition all the same. Read this expert medical coding insight to learn more.

The AMA lists the definition as part of the "CPT 2012 Errata" on its website. The definition is as follows: (A 'physician or other qualified health care professional' is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service. These professionals are distinct from 'clinical staff.' A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service. Other policies may also affect who may report specified services.)

Understand Practical Application of the Definition

The definition was in answer to questions at 2011 Symposium related to CPT codes 90460-90461 [Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional …] counseling requirements and helps to clarify healthcare professionals as different from clinical staff.

Key: RNs and LPNs aren't included in the definition as they cannot individually report the professional services that they provide. RNs and LPNs fit the CPT® definition of "clinical staff," as their professional services are typically reported under a physician or other qualified health care professional's identification number (e.g., under Medicare's "incident to" rule). This implies that when certain CPT codes refer to 'other qualified health care professionals' they are not including RNs and LPNs.

Example: Immunization administration CPT codes 90460-90461 denote "counseling by physician or other qualified health care professional." Consequently, counseling by an RN or LPN would not qualify to meet the requirements of these codes.

More information: Understand that this concept is not new. Shortly after the effective date of the 90460 and 90461 CPT codes, CPT® Assistant (March 2011) explained the "other qualified health care professional" concept. As 90460-90461 replaced 90465-90468 (Immunization administration younger than 8 years … when the physician counsels the patient/family …), which by definition needed face-to-face counseling by a physician, the "other qualified healthcare professional" in 90460-90461 was intended to be a billing provider for example a PA or NP.

The CPT Assistant article mentions that the addition of 'qualified health care professional' echoes the recognition that frequently registered nurse practitioners and physician assistants carry out and report these services, however it should not be taken to mean that other types of office clinical staff may deliver the counseling.

Compliance: Streamline Your ICD-10 Implementation Efforts

Part of your 2012 plan must include concentrating on your most common codes.

In spite of recent rumors, CMS has no intention of delaying the implementation of ICD-10 beyond the Oct. 1, 2013 date. That means every physician group should be taking steps toward the transition of ICD-9 coding to ICD-10 medical coding.

Know Penalties for Nonparticipation

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

Answer: Your claims will be denied -- and you technically could face fines since using the ICD-10 codes falls under the HIPAA transaction code set regulations.

From a practical viewpoint, as of service dates of Oct. 1, 2013, in case you still use ICD-9 codes and don't use ICD-10 codes, most probably your claims will be returned and will be asked to transition to ICD-10.

The penalties are the similar penalties that any HIPAA entity would be subject to. Most of you are acquainted with the ongoing HIPAA transaction code set penalty that calls for a maximum of $25,000 per covered entity per year, however the HITECH legislation of last year in fact upped those transaction and code set penalties, and they can be as much as $1.5 million per entity per year. So evidently it behooves everybody -- Medicare and Medicaid inclusive -- to ensure you are compliant with these ICD-10 codes by the Oct. 1, 2013 date.

LCD Updates Could Come Later

Question: The Medicare local coverage decisions (LCDs) presently list the payable ICD-9 codes that match up 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 that isn't that clear yet. The LCDs will be translated as they will need to be translated, [but] as it relates to having them accessible to the public before the implementation date, that is not certain yet, as CMS is working fast and furious on all of its ICD-10 implementation efforts.

Shape Down Your Code List

Question: What can your practice do to get ready for the ICD-10 conversion?

Answer: One thing you won't need to do is keep in mind a bunch of new codes. In fact, most practitioners perhaps don't know many ICD9 codes by heart, so they won't be expected to memorize ICD-10 codes either.

Strategy: You must use your list of the top diagnoses that your practice gets to find the corresponding ICD-10 codes , and you've got your cheat sheet. Then, make certain that your coders are trained, that your claims are form 5010 compliant, and that your claim submission system supplier is ICD-10-ready. Besides, in case you have an electronic medical record or you plan to get one, make sure it can handle ICD-10. In case you're starting to bring in an EMR, you want to convert to ICD-10 first, not bring one in under ICD9 coding and then convert.

CPT 2012: 37191-37193: Banish Unlisted Codes From Your IVC Filter Claims

Get ready for new renal catheter placement codes, too.

Surgical codes that define the whole package are becoming the norm, and CPT® 2012 continues the trend. Inferior vena cava (IVC) filter procedures and renal angiography have new 2012 CPT codes that combine surgical and imaging services into one neat bundle.

Clarify Your IVC Filter Options

Get ready for an all new way to report IVC filter services, outlining the service as insertion, repositioning, or retrieval:

37191 – (Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed)

37192 – (Repositioning of intravascular vena cava filter ...)

37193 – (Retrieval (removal) of intravascular vena cava filter ....)

Old way: In 2011, you reported IVC filter placement with 36010 (Introduction of catheter, superior or inferior vena cava for catheterization), 37620 (Interruption, partial or complete, of inferior vena cava by suture, ligation, plication, clip, extravascular, intravascular [umbrella device]), and 75940 (Percutaneous placement of IVC filter, radiological supervision and interpretation). As 37191 includes all of these elements, CPT® 2012 deletes the IVC-specific codes 37620 and 75940.

Clarify retrieval: Coding IVC filter removal wasn't as clear in 2011 as it is now. Prior to creation of 37193, payers may have demanded unlisted procedure codes or transcatheter retrieval codes 75961 (Transcatheter retrieval, percutaneous, of intravascular foreign body [e.g., fractured venous or arterial catheter], radiological supervision and interpretation) and 37203 (Transcatheter retrieval, percutaneous, of intravascular foreign body [e.g., fractured venous or arterial catheter) to describe the service. 2012 CPT updates clarify that you must not report 37193 alongside 75961 and 37203.

Replace Your Old Renal Catheter Placement Codes

Renal angiography sports four new 2012 CPT codes effective Jan. 1, 2012. Key elements differentiating the codes include whether the service is first order or it is higher, and whether the service is unilateral or bilateral:

36251 – (Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral)

36252 – (... bilateral)

36253 – (Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral)

36254 – (... bilateral.

Tip: When reporting the new renal 2012 CPT codes, do not report 36254 with 36252.

You also must not report 36253 with 36251 when carried out on the same renal/kidney. The accessory renal arteries only has an impact on medical coding if the catheter placement is in a second or higher order position

Don't miss: The addition of these 2012 CPT codes means you'll no longer use a code from 36245-+36248 (Selective catheter placement, arterial system...) to report the catheterization. And because imaging services are included in the new 2012 CPT codes, CPT® deletes 75722-75724 (Angiography, renal ...).

Imaging: 72114 and 72120 Get View Requirement Modifications in 2012

Start the documentation education now to ease possible 72114 audits.

Where view requirements are concerned, CPT® giveth, and CPT® taketh away for two spine X-ray 2012 CPT codes.

Ensure your medical coding practice applies these key code updates, effective for services on or after January 1.

2012 CPT Codes: Plan Ahead for Tougher 72114 Requirements

To report 72114 for a lumbosacral spine X-ray carried out in 2012, you must fulfil a new requirement for a "minimum of 6 views":

2011: (72114, Radiologic examination, spine, lumbosacral; complete, including bending views)

2012: (72114, Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views)

The above code from the 2012 CPT codes will be applicable to six or more views however the 2011 definition of 72114 did not include any definite number of views.

Potential problem: Some physicians now document complete including bending views, instead of stating the number of views.

Solution: This change is going to necessitate physician education to make certain coders are given adequate information to support this code. Stating the exact number of views has always been a documentation best practice, however this 2012 CPT update makes documenting those views an absolute must.

Alert your physicians and techs to the new prerequisite, and ask for documentation of the number of views, as well as the type of views, so you can support use of 72114.

Example: The radiologist's note documents performance and interpretation of the following listed views:

AP (anteroposterior)

Lateral

Flexion

Extension

LPO (left posterior oblique)

RPO (right posterior oblique)

Left bending view

Right bending view.

As the documentation meets the minimum of six views and comprises of bending views, you should choose 72114. (Reminder: Because the code covers a "minimum of 6 views, you should not report any views beyond the first six with a separate code. A single unit of 72114 will cover all of the lumbosacral spine X-ray views.)

2102 CPT Update: 2 Views Will Now Suffice for 72120

In case you're unhappy about the new minimum view requirement for 72114, you may be cheered by the change to 72120. CPT 2012 actually decreases the required number of views for 72120 from "minimum of 4" to "2 or 3":

2011: (72120, Radiologic examination, spine, lumbosacral, bending views only, minimum of 4 views)

2012: (72120, Radiologic examination, spine, lumbosacral, bending views only, 2 or 3 views)

This change is in line with existing practice as physicians normally don't need four views to capture what they need to see. Every time bending views are ordered, they are almost assured to require/order at least two views. As far as 2012 CPT codes are concerned, meeting the necessities of 72120 will be much easier.

PM Generator: 33221 Joins 33212 and 33213 for Just Battery Insertion

Keep your distance with these codes when patient presents to switch the old battery for a new one.

CPT® 2012 brings code changes, revised guidelines, as well as new definitions to the Pacemaker and Pacing Cardioverter-Defibrillator section. This expert medical coding article focuses on 2012 coding updates on pacemaker (PM) pulse generator insertion codes 33212, 33213, and 33221.

Get started: One significant change to remember is that radiological supervision and imaging is now encompassed in PM and pacing cardioverter-defibrillator codes 33206-33249.

2012 coding update: Get a Quick View of Revisions and Additions

CPT® 2012 reviews the definitions of 33212 and 33213 as shown below, effective Jan. 1, 2012:

CPT® 2012 furthermore adds a third code to this family:

33221, with existing multiple leads.

'Replacement' Removal Is Key Change

The 2012 CPT codes' first modification of note is the deletion of "or replacement" from the common portion of the definition shared by 33212, 33213, and (in 2012) 33221.

Removing "replacement" makes way for the addition of three novel 2012 CPT codes that you must use in 2012 when the physician removes a PM pulse generator (battery) and replaces the battery at the same session:

33227, Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system

33228, dual lead system

33229, multiple lead system.

Compare 2011 to 2012: As an instance of how these changes impact coding, recall that in 2011 you reported a single-chamber PM generator change using 2011 codes 33233 (Removal of permanent pacemaker pulse generator) for the removal of a battery and 33212 for replacing a battery at the same session. As far as 2012 CPT codes are concerned, you, as a replacement, must report 33227 to capture both the removal as well as the replacement.

Subsequently, in 2012, you'll report 33212, 33213, and 33221 only when a patient who already has electrodes (leads) in place presents simply for insertion of the PM pulse generator. You are no longer supposed to use 33212, 33213, or 33221 together with 33233 for a battery change. To further lay emphasis on this change, 33233 has a revised definition in 2012, adding the term "only" at the end: Removal of permanent pacemaker pulse generator only. This means that 33233 is a stand-alone code.

Helpful instruction: A parenthetical note with the 2012 CPT codes makes certain you understand that 33212, 33213, and 33221 are not suitable for replacement services: You must not report 33212, 33213, 33221 in combination with 33233 for removal and replacement of the pacemaker pulse generator. Use 33227-33229, as suitable, when pulse generator replacement is indicated.

For More Info :- http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/pm-generator-33221-joins-33212-and-33213-for-battery-insertion-only-109496-article

96110: Use This Tool to Combat Medicaid Denials for Developmental Screening

Even though CMS originally suspended RVUs for this code, you'll now find an update.

In case your Medicaid provider is sending back your developmental screening claims and marking them "denied," there's a powerful new tool that can help you combat those zero-reimbursement situations for error-free medical coding.

Issue Lies in Testing vs. Screening Difference

Although most yearly CPT manual updates have the potential to help your practice considerably, others can cut your income to a halt. Unfortunately, that's been the case for a lot of pediatric practices that have been thwarted by the latest adjustment to the developmental screening code 96110 (Developmental screening, with interpretation and report, per standardized instrument form).

Owing to the fact that this code was earlier referred to as a developmental "testing" code in the CPT manual, reimbursement was under no circumstances an issue for it. However, since a lot of Medicaid payers don't pay for "screening," some practices had to fight their payers for hours over the denial of these services. To control this issue, CMS released an "Informational Bulletin" on Dec. 28 that advises how to collect for these services.

As per the bulletin, a lot of State Medicaid agencies have developed fee schedules based upon Medicare billing codes and associated relative value units. Since Medicare does not pay for screening or preventive services…CMS changed the active status of code 96110 and did not take account of associated value units in the 2012 Medicare Resource Based Relative Value Scale physician fee schedule (PFS).

This change stemmed a lot of questions and potentially unintended consequences for other payers. CMS maintains that it wants to be clear that Medicaid and other private payers will be able to carry on using code 96110 although it is a statutorily non-covered service under Medicare. In addition, a lot of State Medicaid programs rely upon Medicare-published relative value units, including those related with code 96110 in the CPT manual.

Owing to this confusion, CMS announced that Medicare will update its 2012 Fee Schedule to signify the 2012 payment rate for 96110, which is 0.28 RVUs. The code will be noted status "N," demonstrating that code 96110 in the CPT manual is a non-covered service for Medicare payers. It must be recognized and covered by other payers, including Medicaid.

Source Code :- http://www.supercoder.com/coding-newsletters/my-pediatric-coding-alert/medicaid-96110-use-this-tool-to-fight-medicaid-denials-for-developmental-screening-109560-article 

Use CMS Letter as Your Appeal Tool

In case your Medicaid or private payer is following the original 2012 CMS directive to assign zero RVUs to 96110, you'll require to appeal any denials based on that wrong value assignment.

Along with your appeal letter, you must also include a copy of CMS's clarification, which evidently states the new RVUs for 96110.

E/M Coding: 99058: ‘Walk-in' Patients Only Won't Qualify You for This Emergency Code

Stress on the phrase "in addition to basic service."

Pediatricians don't always see patients during scheduled office a visit, which implies that you perhaps see walk-in patients almost every week. Even though some practices instantly stamp a 99058 code on all walk-in claims, you must avoid adding this code to your visit except you can prove that the patient's visit is truly emergent. Go through this expert medical coding article for learning more.

Office Emergency Points to 99058

While CPT code lookup, you must think "emergency" and "interruption" when considering whether to include 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service) on a claim.

It requires to really be an emergent or urgent problem that be applicable to to walk-ins in case they have a triage assessment and have a severe problem that needs to be worked up instantaneously and they are seen by a doctor as soon as possible; however, it doesn't apply in an unvarying way to walk-ins. Reviewers have seen 99058 linked to ICD9 codes for pharyngitis, upper respiratory infections, and different other conditions that are normally considered non-emergent.

CPT Code Lookup Tip: Cases that worth 99058 are urgent care situations that disturb the office schedule, for instance a child who is suffering from asthma and also going through active wheezing as well as shortness of breath (493.02, Extrinsic asthma; with [acute] exacerbation).The patient's parent could bring the child himself, or a different physician office could call saying the it is essential for the patient to be seen right away. You must ensure the pediatrician sufficiently documents the situation, however, prior to submitting 99058 -- payers want to know that the physician treated the patient for an emergent problem, disrupting their schedule.

Remember to Include E/M Codes

At first glimpse, when you execute CPT code lookup, 99058 seems complete enough to stand on its own. You must, however, always take a closer look and the phrase "in addition to basic service" is your hint that more codes are required.

Once you perform CPT code lookup, you will find that CPT doesn't designate the status with a plus sign, however the code technically is considered add-on. As a result, you can only report it in combination with the suitable E/M code.

Some payers, including Medicare, do not reimburse for the after-hours codes -- but others do. Reimbursement rates might not be high, but every little bit adds up. You can also use the fact that few payers are reimbursing you for this code to help negotiate for payment from non-paying insurers.

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Apply These Added Tips for EEG Reporting Success

Do not look at frequency and never overlook a hidden bundle.

Learn how to report the digital analysis and time the physician attendance. This article also review show to identify Correct Coding Initiative (CCI) bundling edits in the EEG codes. Read this expert medical coding article to further learn how to report EEG recording in situations like coma and polysomnography.

Identify Any Digital Analysis

For digital services, after CPT code lookup you turn to code 95957 (Digital analysis of electroencephalogram [EEG] [e.g., for epileptic spike analysis]). You, nonetheless, would not universally bill this particular code for digital recording of and/or use of an automated spike and seizure detector on a routine EEG, ambulatory EEG or video-EEG monitoring. You execute CPT code lookup and precisely report 95957 once your physician uses specialized digital services similar to three-dimensional (3D) dipole localization or alike techniques for the EEG recording. Digital analysis is frequently used for presurgical planning as epileptic spike onset must be localized. It would not be suitable to bill 95957 for source localization when the EEG is normal, i.e. no spikes to analyze.

Time the Physician Attendance

When your neurologist uses surface electrodes in the brain to provoke seizures and obtain a mapping, you should use your physician's attendance time, not the recording time, to determine the coding. In this case, after CPT code lookup, you would report 95961 (Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of physician attendance) for the first hour of physician attendance.

Following the CPT® 'passing the time requirement, you would append modifier 52 (Reduced services) with the 95961 CPT® code if the neurologist's physical attendance time is 30 minutes or less.

Once you execute CPT code lookup, you report +95962 (… each additional hour of physician attendance [List separately in addition to code for primary procedure]) along with the 95961 CPT code for every additional hour of physician attendance time.

Beware Hidden Bundles

An EEG might be bundled in some medical procedures and these may not indicate the EEG in code descriptors. An instance of such a procedure is the recording of circadian respiration in infants reported with 94772 (Circadian respiratory pattern recording [pediatric pneumogram], 12 to 24 hour continuous recording, infant). CPT® precisely mentions that "separate procedure codes for electromyograms, EEG, ECG, and recordings of respiration are excluded when 94772 is reported." "This parenthetical note is not payer specific, for instance Medicare's CCI edits. It applies to all payers that use CPT® codes to process their claims.

Distinguish Routine Polysomnography

Your neurologist may perform other diagnostic testing during the process of investigating the patient for the seizures, so you should know when to separately report the EEG testing.

Medicare's CCI edits bundle the extended EEG monitoring codes, 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes) and 95813 (Electroencephalogram [EEG] extended monitoring; greater than 1 hour), as components of the sleep staging investigation codes, 95808 (Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist)-95811 (Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist).

CCI Edits 18.0: Get Well-Versed with New Bundled Codes

Plus: 94150 'separate procedure' doesn't every time mean separate coding.

New codes aren't just the only things that affect your coding in 2012 -- you also need to cull through the most recent Correct Coding Initiative (CCI) edits to make certain you appropriately report multiple procedures. CCI edits 2012 went into effect Jan. 1, 2012, with substantial changes to how you should code familiar injection or incision/drainage procedures.

Report Injection Over Compression, Aspiration

CCI edits 2012 includes 15,530 new edit pairs. In case your physician manages trigger point, joint, or tendon injections, don't miss the CCI edits involving those procedures:

Trigger point injection codes 20552 and 20553 are the Column 1 codes with novel codes 29582 (Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed) and 29584 (… upper arm, forearm, hand, and fingers).

Joint injection codes 20600, 20605, and 20610 are the Column 1 codes with novel procedures 20527 (Injection, enzyme [e.g., collagenase], palmar fascial cord [i.e., Dupuytren's contracture]), 29582, 29583 (Application of multi-layer compression system; upper arm and forearm), and 29584.

Tendon injection procedures 20526 and 20527 are selected as the Column 1 code for more than 130 edit pairs. The coupled procedures range from abscess aspirations and therapeutic injections to cast applications, venipuncture, and anesthetic injections, to name a few. Search through the CCI edits to see which ones might apply to your providers.

Reminder: When CCI edits pair two codes together, you'll normally report the Column 1 code in place of the Column 2 code. The Column 1 code either signifies a procedure that involves the services of the Column 2 code, or denotes a procedure that "outweighs" the Column 2 code and should be reported alone.

I&D or Debridement Override Compression

A number of other CCI edits are also applicable to novel code 29582 (Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed). The compression system application is part of the service represented by incision/drainage or debridement codes for instance:

10060 – (Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single)

10061 – (… complicated or multiple)

10140 – (Incision and drainage of hematoma, seroma or fluid collection)

10160 – (Puncture aspiration of abscess, hematoma, bulla, or cyst)

11000 – (Debridement of extensive eczematous or infected skin; up to 10% of body surface.)

The CCI edits 2012 keep your medical coding consistent with CPT guidelines. Each edit pair carries a modifier indicator of "1," however, which implies that you might occasionally be able to sidestep the edit with a modifier and be paid for both services (such as modifier 59, Distinct procedural service).

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Are you aware of These CPT 93000 Requirements?

Experts disclose 4 secrets of component-ECG coding

Family physicians (FPs) don't always carry out the same electrocardiogram (ECG) service - the differences in where and what they provide decide your CPT 93000, 93005 or 93010 selection.

In case an in-office machine spits out the information, and then the FP issues a report, you must report the complete code CPT 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report), which certainly pays more than $26. However, determining which code to report when your practice doesn't deliver the tracing or interpret the results is more challenging.

You shouldn't fall into the trap of using modifiers -TC (Technical component) and -26 (Professional component) on CPT 93000. You should as an alternative report 93005 (… tracing only, without interpretation and report) for the technical component and 93010 (… interpretation and report only) for the professional service.

Why does CPT use 93000-93010 rather than modifiers -TC and -26 for ECG component coding? When CPT developed the ECG codes, many payers didn't recognize modifiers. To avoid insurers ignoring the modifiers and in turn rejecting claims for what would then appear as duplicate CPT 93000 billing, CPT assigned precise codes for the services. To decide when to use 93000-93010, medical coding experts mention four guidelines:

1. Bill 93005 for In-Office Procedure

In case your FP carries out an in-office ECG without interpreting the report, you must assign 93005 for the technical component. Code 93005 contains of the FP or his staff placing the 12 leads on the patient, carrying out the standardization process and taking the gel off the patient at the end of the ECG.

2. Use 93010 for Report Only

Occasionally the FP carries out the ECG in the hospital however still issues the report. In this case, you must bill 93010 for the professional component.

To get the $9 for carrying out the professional component, your FP needs to document that he interpreted the ECG's printout. As the technical component (93005) contains the machine's report, the FP should show that he did more than look at the printout.

Medicare and other carriers anticipate the FP to write report interpretations on the machine's 8 x 11 sheet or strip report. Appropriate documentation comprises stating why the doctor agrees or disagrees with the machine's description and signing and dating the report.

3. Assign 93000 for Procedure and Report

You must bill the global code CPT 93000 when your FP carries out the ECG and documents his findings. You will have no problems with Medicare and other insurers reimbursing you for ECGs, provided you follow these rules.

4. Employ Other-Physician Interpretations Options

A number of FPs do not feel contented reading the ECG reports and hire a cardiologist or internist to interpret the printout. In this case, each doctor must bill for his own role.

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Thyroid Coding: Learn When to Report Dissections Distinct From Thyroidectomy

Remember, "Functional," "selective," and "radical" denote the same procedure.

Believing you know thyroidectomy codes completely may set you up for disaster. You actually have to study the code descriptors and identify the terminology related with neck dissection to precisely code these procedures. Follow this expert medical coding advice and know what CPT codes you should select in this case.

Medical Coding Tip: While coding for thyroidectomy procedures (60240-60271), keep a close watch on the code descriptors. A lot of of them include all of the procedures that the otolaryngologist carried out, thus you won't have to report further codes for the auxiliary services.

Decide Whether to Report Dissections

Test yourself with the following example.

Assume your otolaryngologist does away with both thyroid lobes with the isthmus and pyramid lobe tissue. He furthermore classifies and excises all enlarged lymph nodes. The malignancy has not spread considerably, thus the otolaryngologist excises merely a few selection of lymph nodes. Accordingly, he carries out a thyroidectomy with restricted neck dissection. What CPT codes must you report, and should you report a distinct code for the dissection?

Answer 1: You must report only 60252 (Thyroidectomy, total or subtotal for malignancy; with limited neck dissection). You must not report a distinct code for the dissection. This code comprises reimbursement for the thyroidectomy as well as the limited dissection.

What in case the physician states in the operative note that she carried out a "central neck dissection?" What would you code in this particular situation?

Answer 2: A central neck dissection is alike the example above and signifies a limited neck dissection, not a radical neck nor a modified radical neck dissection. Consequently, in case it is stated that a central neck dissection is carried out with a total thyroidectomy, you would report 60252 (Thyroidectomy, total or subtotal for malignancy; with limited neck dissection).

Let's try a different example. Throughout a total thyroidectomy, an otolaryngologist dissects all the levels of lymph nodes and should sacrifice the spinal accessory nerve, jugular vein along with the sternocleidomastoid muscles to eliminate a malignant lymphatic chain. What CPT codes should you report, and should you report a distinct code for the dissection?

Answer 3: In the above case, you must report only the thyroidectomy along with radical neck dissection with 60254 (Thyroidectomy, total or subtotal for malignancy; with radical neck dissection). By definition, you must not distinctly report the radical neck dissection (38720, Cervical lymphadenectomy [complete]).

CPT, though, throws you a curve ball once your physician combines thyroidectomy along with modified radical neck dissection. None of the thyroidectomy CPT codes identify this combination, which you'll have to code out distinctly.

Prepare Yourself With Novel Codes To Report Neurolysis in 2012

Keep a count of joints, irrespective of the numbers of nerves.

While reporting the paravertebral facet joint nerve injections in 2012, you will no more be counting nerves that your surgeon targeted. You have up to now been reporting injections for every nerve at a single vertebral level. Effective Jan. 1, you'll require adjusting your method to look for the precise anatomical site involved and also the work that your surgeon did. Read on for more on what changes to expect for these injections in CPT 2012: what goes obsolete and what new comes in.

Know the CPT 2012 Deletions

Here are four CPT codes that will be deleted in CPT 2012:

64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level)

+64623 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level [List separately in addition to code for primary procedure])

64626 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level)

+64627 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level [List separately in addition to code for primary procedure])
Look at New Codes

You will find four novel CPT codes in CPT 2012. These include the following:

64633 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; cervical or thoracic, single facet joint)

+64634 (Destruction by neurolytic agent, paravertebral facet joint nerve [s], with imaging guidance [fluoroscopy or CT]; cervical or thoracic, each additional facet joint [List separately in addition to code for primary procedure])

64635 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single facet joint)

+64636 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, each additional facet joint [List separately in addition to code for primary procedure])
Don't Distinctly Report Image Guidance

While reporting neurolysis defined by new CPT codes 64633-64636, ensure that your surgeon has used and documented the image guidance used to carry out the paravertebral facet joint nerve destruction. The CPT codes for 2012 are inclusive of the image guidance, so you do not individually report the fluoroscopy or CT guidance used for the paravertebral nerve localization.

Medical Coding Tip: You are not supposed to 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) for fluoroscopic guidance and 77012 (Computed tomography guidance for needle placement [eg, biopsy, aspiration, injection, localization device], radiological supervision and interpretation) for CT guidance with 64633-64636.

G0105, 45378: Use This Coding Combination For Your High-Risk Patients

Irrespective of findings, stick to V10.05 to define condition.

Correctly reporting colorectal cancer screenings on patients at high risk for the disease can depend on fine points like allocating the right V code. Read this expert medical coding article and know what ICD-9 codes apply in this scenario.

Examine the following given scenario and the medical coding advice that follows to ace these claims -- and recover your deserved reimbursement for these services:

Scenario: A patient has a personal history of colon cancer, went through treatment for colon cancer six years before, however she is presently facing no symptoms. Her 2006 colonoscopy came out clear, as well as her recent one carried out about a month ago. You billed 45378 for the procedure, and then you selected V10.05, from the ICD-9 codes, for the diagnosis. Though, the patient called complaining you should've billed the procedure as routine as her last two colonoscopies were clean. How would you resolve this?

Choose G0105 Or 45378, But Get The History Diagnosis Right

In case you're billing Medicare, you smust report the procedure as a high risk screening with code G0105 (Colorectal cancer screening; colonoscopy on individual at high risk). Then, from ICD-9 codes, report V code V10.05 (Personal history of malignant neoplasm of large intestine) as the primary diagnosis.

Code V10.05 fits the bill for primary diagnosis as the patient presents to the office for a screening exam and not precisely for follow-up assessment of the cancer. In case the encounter's purpose is for cancer surveillance and follow-up at an interval close by the surgical treatment, you could, as an alternative, code V67.09 (Follow-up examination following other surgery) as your primary diagnosis. Though, keep in mind that this ICD-9 code is seldom used.

On the contrary, certain commercial carriers would need the code 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) with modifier 33 (Preventive services) appended to signify that the service was preventive, and the V code V10.05 as diagnosis.

Don't forget: From ICD-9 codes, you must list V10.05 as your primary diagnosis for both circumstances (Medicare and commercial payers), irrespective of the fact that the results were clear or not. Use this ICD-9 code if all treatment focused toward the cancer is complete and there are no symptoms of current disease . Don't make the error of reporting a cancer code (153.3, Malignant neoplasm of sigmoid colon) or the family history code (V16.0, Family history of malignant neoplasm of gastrointestinal tract).

Draw On Diplomacy To Confer With Patients

Complaints like this from patients on a screening colonoscopy are common in the gastroenterology practice. The best guidance is to talk it out with your patient, and make clear how their cancer history influences the medical coding.

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Ace Routine And Extended EEG Coding With These Pointers

Exact timing of EEG monitoring is crucial, frequency is not important.

While reporting EEG recording, the most vital factor is to time the procedure. In case your physician uses advanced methods, video and digital recordings; you may be faced with added medical coding challenges for these services. Read on to prepare yourself on how to accurately time the procedure along with code the routine, extended, and special monitoring.

Look For How Long the Diagnostic Study Continued

While reporting EEG, you must look for how long your neurologist took to perform the monitoring. Monitoring that lasts 20 to 40 minutes is taken as routine. You will report CPT codes for extended monitoring in case the procedure goes beyond 40 minutes in duration. For EEG recording that lasts 41 to 60 minutes, you must report 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes), and in case it lasts more than an hour, you would report 95813 (Electroencephalogram [EEG] extended monitoring; greater than 1 hour).

It is significant that your neurologist's report evidently documents the actual EEG recording time. Medical coding is based on the recording though it is underway and the neurologist or technician is collecting data. You do not involve the set-up and take-down time..

Exception: CPT® does not include EEG CPT codes 95824 (Electroencephalogram [EEG]; cerebral death evaluation only), 95827 (Electroencephalogram [EEG]; all night recording), and 95829 (Electrocorticogram at surgery [separate procedure]) from a time component as these are unique services rendered by the physician to monitor a certain pathological condition or diagnose one.

Important note: You can report CPT codes 95812 or 95813 instead of 95816 (Electroencephalogram [EEG]; including recording awake and drowsy), 95819 (… including recording awake and asleep) or 95822 (… recording in coma or sleep only), however you cannot report them together. There is a thin line between drowsy and asleep. You report 95819 when the patient in reality slept during the monitoring. In case the patient did not achieve sleep in a procedure that intended monitoring in sleep, you report 95816 as an alternative.

In case the neurology specialist carries out the global diagnostic service, i.e. owns the equipment, employs the technical staff as well as interprets the diagnostic findings, then the EEG code would be billed without any modifiers. On the other hand, you would append modifier 26 (Professional component) to the EEG CPT® code, in case your neurologist only carries out the professional interpretation of the diagnostic study.

Scan For Video and Channels in Extended Monitoring

For 24-hour EEG monitoring, you should assess CPT codes 95950 (Monitoring for identification and lateralization of cerebral seizure focus, electroencephalographic [e.g., 8 channel EEG] recording and interpretation, each 24 hours)-95953 (Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic [EEG] recording and interpretation, each 24 hours, unattended) or 95956 (Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, electroencephalographic [EEG] recording and interpretation, each 24 hours, attended by a technologist or nurse).

CPT 2012: Don't Skip These Explanations About New Patients plus 'Qualified Healthcare Professional'

Learn how changes influence your use of 99201-99205, 99460-99461, and more.

Medical coding guidelines can at times seem puzzling when you're trying to decide whether to categorize a patient as new or established. For instance when an established patient comes to your practice to see a new physician, would you report a new patient office visit code?

CPT 2012 tries to clarify this question and one other E/M question: Who counts as a "qualified healthcare professional" to administer that vaccine or deliver prolonged service?

'New Patient' Classification Goes to a New Level

At present, CPT® indicates that a "new patient" refers to a patient who has not received any professional services, for instance an E/M or other face-to-face service, from the physician or another physician of the same specialty in the similar group practice in the past three years.

Clarification: CPT 2012 takes that definition a step further, by stating, "A new patient is one who has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years." The parts of the description that are novel for 2012 are underlined.

What it means: In case your practice employs several subspecialists, CPT® now clarifies that claims for patients who see dissimilar doctors with different subspecialties can be billed using a novel patient code (such as 99201-99205).

RN Doesn't Fit 'Other Qualified Healthcare Professional'

In case your payer follows CPT® rules, you can now eliminate registered nurses from the list of professionals who can administer vaccinations or offer prolonged services for patients.

At the demand of many physicians, CPT 2012 now describes the term "other qualified healthcare professional." Although this definition didn't make it into the 2012 manual, the AMA lists it as part of the "CPT 2012 Errata" on its Web site.

The definition("A 'physician or other qualified health care professional' is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service. These professionals are distinct from 'clinical staff.' A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service. Other policies may also affect who may report specified services.)

Result: RNs and LPNs are excluded in the definition, as they cannot individually report the professional services that they offer. RNs and LPNs suit the CPT® definition of "clinical staff," as their professional services are normally reported under a physician or other qualified health care professional's identification number (e.g., under Medicare's "incident to" rule). This implies that when certain CPT codes refer to 'other qualified health care professionals' they are not including RNs and LPNs.

Prepare Yourself With Novel Codes To Report Neurolysis in 2012

While reporting the paravertebral facet joint nerve injections in 2012, you will no more be counting nerves that your surgeon targeted. Till now, you have been reporting injections for each nerve at a distinct vertebral level. Effective Jan. 1, you'll require adjusting your technique to look for the particular anatomical site involved along with the work that your surgeon did. Read this expert medical coding article for more on what changes does CPT 2012 brings for these injections in: what goes obsolete and what new comes in.

CPT 2012: Know the Deletions

Here are four CPT codes that will be deleted in 2012:

64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level)

+64623 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level [List separately in addition to code for primary procedure])

64626 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level)

+64627 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level [List separately in addition to code for primary procedure])

CPT 2102: Look at Novel Codes

You will find four new CPT codes in 2012. These include the following:

64633 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; cervical or thoracic, single facet joint)

+64634 (Destruction by neurolytic agent, paravertebral facet joint nerve [s], with imaging guidance [fluoroscopy or CT]; cervical or thoracic, each additional facet joint [List separately in addition to code for primary procedure])

64635 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single facet joint)

+64636 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, each additional facet joint [List separately in addition to code for primary procedure])

Don't Distinctly Report Image Guidance

When reporting neurolysis described by new CPT codes 64633-64636, ensure that your surgeon has used and documented the image guidance used to carry out the paravertebral facet joint nerve destruction. The CPT 2012 codes are inclusive of the image guidance, so you do not individually report the fluoroscopy or CT guidance used for the paravertebral nerve localization. Keep in mind that image guidance with either fluoroscopy or CT is both required and is bundled into the new CPT codes.
 

CPT 2012 Tip: You do not 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) for fluoroscopic guidance and 77012 (Computed tomography guidance for needle placement [eg, biopsy, aspiration, injection, localization device], radiological supervision and interpretation) for CT guidance with 64633-64636.

33202-33211 Get Numerous Guidelines in 2012

Hint: Understanding RS&I coding is the important for denial prevention.

The enormous changes to CPT®'s pacemaker (PM) along with implantable cardioverter-defibrillator (ICD) section are challenging even to expert coders. You can streamline the switch by breaking the changes into convenient chunks and mastering one group before going to the next. This expert medical coding article will focus on changes to CPT codes 33202-33211.

Confirm Provider Before Reporting 33202-33203

When reviewing CPT codes 33202-33211 in the 2012 manual, the first change you'll find is a revision to the parenthetical note following 33202-33203 (Insertion of epicardial electrode[s] ...). Compare the 2011 and 2012 descriptions of the note:

2011: ("When epicardial lead placement is performed by the same physician at the same session as insertion of the generator, report 33202, 33203 in conjunction with 33212, 33213, as appropriate.")

2012: ("When epicardial lead placement is performed with insertion of the generator, report 33202, 33203 in conjunction with 33212, 33213, 33221, 33230, 33231, 33240.")

The major change to the instruction is the list of CPT codes you may report along with epicardial lead placement CPT codes 33202 and 33203. The longer list is the outcome of CPT® 2012 adding and revising a number of codes for the insertion of a PM pulse generator (33212, 33213, 33221) or the insertion of a pacing ICD pulse generator (33230, 33231, 33240).

33206-33208 Join Other Codes for Full Replacement

The subsequent change you'll notice for this code range is a revision to 33206-33208. CPT® 2012 includes the following bold text to the definitions: "Insertion of new or replacement of permanent pacemaker with transvenous electrode(s) ..."

What does not change: As in 2011, the codes vary based on the electrode location:

33207, ... ventricular

33208, ... atrial and ventricular.

Similarly just as in 2011, 33206-33208 comprise subcutaneous insertion of the pulse generator as well as a transvenous placement of electrode[s], as per a parenthetical note with the codes.

Scratch 71090 Off Your Medical Coding Aids

One code you may have noticed absent from the above discussion is 71090 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation). The reason behind that is in 2012, radiological supervision as well as interpretation associated with the pacemaker or pacing cardioverter-defibrillator procedure is included in 33206-33249, as per CPT® guidelines. In fact, 71090 is no longer in the list if valid CPT codes in 2012.

Example: In 2011, you would have reported dual lead pacemaker insertion in fluoroscopy by the means of CPT codes 33208 and 71090. In 2012, you'll report that similar service using only 33208.

The removal of fluoroscopy while placing devices is another instance of addition for routine services. Fluoro is required to place the PM or ICD so CPT® may have streamlined that it is a component part of the service and not distinctly billable.

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CPT® 2012: You'll Get Closure With Novel Skin Repair Guidelines

Also, don't overlook separate debridement opportunity.

Feeling dazed by all the changes in the CPT 2012 integumentary section? Read this expert medical coding article to keep your skin repair claims clean and earn all the pay you deserve.

Note New Modifier Advice for Repairs

CPT 2012 proposes new introductory notes that offer guidance on how to report skin closures (12001-13160). Though the guidelines earlier advised the use of modifier 51 (Multiple procedures) when reporting dissimilar wound repair classifications together, that guidance is old news as of Jan. 1.

In black and white: The 2012 CPT® manual reads, "When more than one classification of wounds is repaired, list the more complicated as the primary procedure and the less complicated as the secondary procedure, using modifier 59."

What's "complicated? As CPT 2012 proposes simple, intermediate, and complex repairs, you'd think through the "simple" repair the minimum complicated, and the "complex" repair the maximum complicated. Consequently, in case the surgeon closes a leg wound with a simple repair for instance 12001(Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less) and an intermediate repair, for instance 12032 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm), you'll report the intermediate repair first, which should be followed by the simple repair with the modifier: 12032, 12001-59.

Know When Debridement is ‘Separate'

When surgeons carries out skin grafting, it's normal for coders to spend a lot of time and work trying to decide whether they can bill debridement distinctly, as a lot of physicians request.

Debridement is taken as a distinct procedure only when gross contamination needs a prolonged cleansing, when considerable amounts of devitalized or contaminated tissue are removed, or when debridement is performed separately without immediate primary closure.

CPT 2012 Tip: Your documentation must fully explain the surgeon's work cleansing the contamination and eliminating the devitalized tissue prior to you distinctly bill your insurer for debridement.

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Skin Substitute Coding Renovation Simplifies Processes

Even though you may have been surprised when you saw that CPT 2012 made enormous changes to the skin substitute coding section (15271-15278, Application of skin substitute graft …), you must know that the AMA's goal was to make your life stress-free, not more difficult,

For wounds that are lesser than 100 square centimeters, you'll follow one code structure – in case your wound is 100 square centimeters or greater, you'll follow a different code structure. It has been felt that about 80 percent of the wounds would fit into the ‘less than 100 sq. cm' description.