Support Your Incident-to Claims or Face OIG Scrutiny This Year

Make certain your visit meets 4 criteria before filing an incident-to claim.

In case you don't know how to appropriately bill the services the non-physician practitioners (NPPs) in your office perform, it might cost you more than the 15 percent difference in reimbursement rates. Read this expert medical billing article and know what you require to keep you practice off the OIG hot list.

Reason: As part of its 2012 Work Plan, which came out last October, the HHS Office of Inspector General (OIG) plans to inspect incident to services.

Your best bet for evading OIG scrutiny is no to bill incident to lest you're assured you've met the requirements.

Know What Incident to Means

As most practices already know, under incident-to rules, qualified NPPs can treat definite patients and still bill the visit in the physician's National Provider Identifier (NPI), bringing in 100 percent of the assigned fee.

How it works: While an NPP provides a service to a Medicare patient incident-to the physician, you can report the service in the physician's NPI as long as all of the rules for incident-to services are taken care of. You will then charge the payer 100 percent of the service's fee.

Remember: In case you find the service does not meet incident-to medical billing requirements, you don't have to sacrifice payment completely in many cases. In case a Medicare credentialed NPP delivers the service, you can bill under his own NPI. In that case, you'll generally receive between 65 and 85 percent of the normal global fee found in the Medicare Physician Fee Schedule, depending on the type of NPP.

Medical Billing Tip: In case a member of your auxiliary staff, for instance a medical assistant (MA), offers a service when there is no direct supervision, you cannot bill for the service.

Get to Know OIG's Plans

The OIG aims to decide whether payment for incident to services displayed a higher error rate than non-incident to services. Incident-to medical billing services denote a program vulnerability in that they do not appear in claims data and can be recognized only by reviewing the medical record. They may also be exposed to overutilization and expose Medicare beneficiaries to care that fails to meet professional standards of quality.

"Incident-to' medical Coding billing is always something being examined by the Office of the Inspector General (OIG) simply by nature. The claims are sent in under the physician's name. The mid-level provider is ‘transparent' to this process. In case the carriers see more claims than usual coming in for the physician, that type of specialty, etc. they will wish to investigate to see if the patients are being seen suitably and thus being billed correctly.

A lot of the recent overpayment, audit, civil false claims act, and also criminal cases established by the federal and state agencies overseeing the Medicare and Medicaid programs include allegations of improper medical Billing for -- incident-toservices.

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Consolidated Billing: Solid Contract With Nursing Facilities to Ensures You Get Paid Every Time

Think of having a healthcare attorney assist with the process.

In order to get payment for the some of the technical components of the services your physician offers in the office for patients in nursing facilities, you may need to have a set contract with the facility. Read this expert medical billing article to learn more.

Collecting payment from the nursing facility for the technical component services your physician carries out – for instance medications, lab work, x-rays (the technical portion, not the interpretation), the technical share of EKGs, billable supplies, DME allotted from office, etc.-- can be your next task. Setting up a contract with each nursing facility you work with can help you circumvent consolidated medical billing and collection headaches down the road -- here's how.

Make the Contract Specific and Detailed

You'll wish to make the contract specific and identify the services, by means of CPT and HCPCS codes, your physicians can deliver to the facility's patients along with the negotiated fees for those procedures and services.

To ensure accurate medical billing, the contract must evidently indicate the nature of the relationship, compensation for the services to be delivered, the length of the contractual obligation, along with confidentiality and further compliance requirements.
The contract must also list your medical Coding billing information and involve a disclaimer mentioning that you anticipate payment for services rendered irrespective of the nursing facility's reimbursement status with the Medicare carrier. Deliver an executed copy of the contract to the facility, and you must keep one for your records.

Medical Billing Tip: Don't Price Gouge Simply Because You Can

You must consider charging the nursing facility merely for the reimbursement you could assume as per the Medicare Physician Fee Schedule, experts recommend. Just for the reason that you're not held to a set fee schedule doesn't mean you could set prices higher than you'd charge for other patients.

While you are not bound by Medicare's set fees for the services you bill directly to the nursing facility, you'll likely find yourself struggling to get additional dollars from the facility over and above the fee schedule amount. The effort won't be worth the time and effort, chiefly if you deal with several nursing facilities -- besides you risk having the facility choose to stop using your practice.

Good practice: Try using a contract and talking first to resolve any persistent payment problems with a nursing facility. As a last resort, however, you can report your problems to the local or regional overseer of nursing homes and request an investigation into their medical billing operations.

For More Information :- http://www.supercoder.com/coding-newsletters/my-practice-management-alert/consolidated-billing-set-up-a-solid-contract-with-nursing-facilities-to-ensure-you-get-paid-every-time-article

Match Diagnosis to Findings and Discover Dividing Line for ISH Codes

Question: An ob-gyn gave 3 cm sections of right and left fallopian tubes along with a surgical note demonstrating that he removed the tissue as part of a routine sterilization procedure. Your pathologist found indication of malignant neoplasm, though. What would be the correct ICD-9 and CPT codes for this case?

Answer: You must assign the diagnosis founded on the pathologist's findings rather than the surgical report. In place of using the ICD-9 code signifying that the surgeon submitted the fallopian tubes from a sterilization procedure (V25.2,Sterilization), you must use the code that specifies your pathologist's findings. In this case, you must list 183.2 (Malignant neoplasm of fallopian tube).

Here's why: The ICD-9-CM Official Guidelines for Coding and Reporting for both inpatients as well as outpatients state that you must code a definite or definitive diagnosis provided by a physician --in this situation, the pathologist.

ICD-9 and CPT Coding Tip: This case points at a significant consideration -- the diagnosis can have an effect on the pathology procedure code in some conditions. As the pathologist inspects the fallopian tubes for cancer, you must report the service as 88305 (Level IV- Surgical pathology, gross and microscopic examination, Fallopian tube, biopsy) in place of 88302 (Level II -- Surgical pathology, gross and microscopic examination, Fallopian tube, sterilization).

Discover Dividing Line for ISH Codes

Question: When your lab carries out ISH procedures, you have PhD scientists who provide the results of the test. You've been told that if your physician medical director evaluates a certain percentage of cases, that you can use the 88367 in place of 88271 codes. Is that correct, and if so, what is the required percentage of cases?

Answer: There is no standard percentage of physician (medical director) review that lets you to report in situ hybridization (ISH) performed by a PhD scientist by means of physician codes.

ICD-9 and CPT Coding Tip: Based on CMS and AMA direction for using the codes in question, you can go ahead and report 88365 (In situ hybridization [e.g., FISH], each probe) and 88367-88368 (Morphometric analysis, in situ hybridization [quantitative or semi-quantitative] each probe …) simply in case a physician (MD or DO) carries out the interpretation. In case a FISH test is carried out by a PhD without a pathologist interpretation, you should use codes from the series 88271-88275 (Molecular cytogenetics …).

Fee schedule hint: Medicare essentially pays for 88365-88368 on the physician fee schedule, however pays for 88271-88275 on the clinical lab fee schedule "http://www.supercoder.com/coding-tools/fee-schedules ". The payment schedules help differentiate physician services from lab services carried out without a direct physician diagnostic interpretation and medical decision making.

Discover Your Diagnostic Scope Coding Options to Safeguard Maximum Pay

Are you banking on 31575 for each of your diagnostic scope claim? You might be denying your practice up to $80 per claim, and in these times, you can't manage to miss a dime. In case you can spot these significant terms for 31231 or 92511, then you can improve your claim's bottom line. Read this expert medical coding article and know what ICD-9 and CPT codes apply.

You must grasp these scope fundamentals to ensure error-free claims.

ICD-9 and CPT Tip: Dismiss 92511 'Loser' Myth

In case you're like many ENT coders, you may not want to code 92511 (Nasopharyngoscopy with endoscope [separate procedure]) as you think it pays the minimum of the flexible scope codes. In reality, the code's total value is in between the lower-paying 31575 (Laryngoscopy, flexible fiberoptic; diagnostic) and the higher-paying 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]).

With the current Medicare Physician Fee Schedule's conversion factor of 34.0376, the codes' relative value units and payments in ascending order include:

Surprise: Even though 92511 pays $27.57 more than 31575, and 31231 pays $79.99 more than the laryngoscopy code, the Correct Coding Initiative takes 31575 as the all-inclusive code. Code 31575 includes 92511 as well as 31231.

Check for 31575 Medical Necessity

Trace how far a flexible scope goes to see in case you're in 31231, 92511 or 31575 territory. You must use 31231 for a scope of the nasal cavity and sinuses. 92511 denotes viewing the nasal cavity down the throat until the nasopharynx (the edge of the soft palate). Code 31575 is for a medically necessary scope that observes all the way down to the larynx.

Example: An ENT used topical lidocaine for anesthesia and executed flexible fiberoptic laryngoscopy through the right nostril. The procedure note specifies, "The nasopharynx, vallecula, epiglottis, sinuses as well as vocal cords were all visualized."

As the scope goes all the way into the larynx, 31575 might be accurate based on anatomy. You must use 31575 instead of 92511 only in case the note shows that scrutinizing this far was medically necessary. There has to be a main complaint and a history of a problem demanding viewing all the way down to the larynx.

In case, however, the ENT is simply looking for the condition of the nasopharynx, like for eustachian tube dysfunction (the eustachian tube terminate in the nasopharynx) or a mass in the nasopharynx, you would code 92511.

ICD-9 and CPT Expert Advice: Should You Make This 'Rigid' or 'Flexible' Distinction?

Even though you may think 31525 is meant for rigid laryngoscope and 31575 is for flexible laryngoscope -- end of story -- you need to keep in mind that the nasal exam (31231) may include a rigid scope. Consequently, you cannot assume a rigid scope is a laryngoscopy carried out under sedation.

ICD-9 and CPT Hint: ENTs do not execute rigid laryngoscopies in the office. Providers will schedule them for the OR on an outpatient basis. Thus, when the service is an office diagnostic procedure, a rigid scope simply means you should report a 31231.

ICD-10: 173.xx Specificity Absent in Translation to C44.xx

You'll shed the basal cell/squamous cell difference in 2013.

You'll hardly have time to get used to differentiating "other" malignant skin neoplasms, for instance basal cell as well as squamous cell carcinomas, using ICD-9 2012 changes when you'll drop the difference again in ICD-10 -- effective Oct. 1, 2013.

In place of distinguishing "other" skin cancer type with the fifth digit, ICD-10 codes will need a fifth digit for certain skin sites based on a difference between right, left, or unspecified.

40 Codes Shrink to 22

You just read in "173 and 041: Get Specific With Fifth Digits for Skin Cancer, E. coli" that ICD-9, 2012 creates 40 novel 173.xx codes.

Based on the existing proposed ICD-10 codes (source "http://www.supercoder.com/icd-10/"), you'll just have 22 codes to pick from in 2013, as you can see from the following list:

• C44.0 – (Malignant neoplasm of skin of lip)
• C44.10 – ( skin of unspecified eyelid, including canthus)
• C44.11 – (skin of right eyelid, including canthus)
• C44.12 – ( skin of left eyelid, including canthus)
• C44.20 – ( skin of unspecified ear and external auricular canal)
• C44.21 – ( skin of right ear and external auricular canal)
• C44.22 – (skin of left ear and external auricular canal)
• C44.30 – ( skin of unspecified part of face)
• C44.31 – (skin of nose)
• C44.32 – ( skin of other parts of face)
• C44.4 – ( skin of scalp and neck)
• C44.51 – ( anal skin)
• C44.52 – ( skin of breast)
• C44.59 – ( other part of trunk)
• C44.60 – ( skin of unspecified upper limb, including shoulder
• C44.61 – ( skin of right upper limb, including shoulder
• C44.62 – ( skin of left upper limb, including shoulder
• C44.70 – ( skin of unspecified lower limb, including hip
• C44.71 – ( skin of right lower limb, including hip
• C44.72 – ( skin of left lower limb, including hip
• C44.8 – ( overlapping sites of skin
• C44.9 – ( skin, unspecified.

Change focus: But beginning Oct. 1, 2013, you'll need to be cautious to extract information from the pathology report about the skin site, comprising right or left, for C44.xx.

Clarify Codes for Cancer Registry

One of the reasons for the expanded 173.xx codes is to help find cancers reportable to central cancer registries.

The huge majority of skin cancers are either basal or squamous cell, neither of which are reportable conditions to central cancer registries. The expansion of the codes that come under category 173 in ICD-9 2012 permits facilities to differentiate reportable as well as non-reportable skin cancers, which might diminish the problem of facilities reporting all skin cancers to central registries.

Problem: Under presently proposed ICD-10 codes , you'll no longer be able to use diagnosis codes to differentiate certain skin cancers that aren't reportable to central cancer registries.

2012 Physician Fee Schedule: Get Ready For ED E/M Coding Adjustments, Telehealth Coverage, and Other Changes

Look at these RVU changes to calculate your 2012 payments

In case you were anticipating a reprieve this year from the recession cost stresses on EDs, the word is that you can assume a complete decrease of 1.5 percent in this year's 2012 CMS payments. Read this medical coding article for how 2012 physician fee schedule breaks down and will influence your ED billing.

Look For Small ED E/M RVUs Decreases

As per the 2012 final rule, emergency medicine will go through a -1 percent update to complete RVU values in 2012. This is free of any change to the conversion factor.

The RVUs for ED E/M codes, the main factor in determining ED reimbursement, have only second decimal point adjustments chiefly owing to small changes in practice expense. Of note, the work RVUs have not altered for 2012 and remain steady at 2011 levels.

Anticipate More Pay for Initial, Subsequent Observation

The good news is that now you can look for huge RVU gains for initial and subsequent observation care services, even though the same day observation admit as well as discharge codes will remain close to the 2011 values.

2012 Physician Fee Schedule Update: Get Ready For Pay Upticks for These ED Procedures

The 2012 RVUs allocated to complex abscess drainage 10061 (Incision and drainage of abscess [e.g. carbuncle, suppurative hidradentits , cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; complicated or multiple) will increase by almost 9 percent and the CPR code 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest] will go through a 5 percent increase. The intermediate laceration codes had diverse results. Some of the code work RVUs were reduced slightly and a few of the intermediate code values were augmented.

Telehealth Coverage For ED Services Gets Approval

As per 2012 physician fee schedule, CMS has extended its telehealth site promotion to take in EDs, which implies that EDs are now qualified site for telehealth coverage. The ED was not taken as a qualified site of services earlier, but for 2012, Medicare is creating novel code descriptors for the telehealth codes. The definition is now being expanded further than inpatients and also includes the emergency department.

Ultrasounds take a hit: once those services are discounted under MPPR rules.

CMS has sustained its interest in bundling "like procedures" and imposing discounts when multiple services are delivered in a single setting. This discounting system, the Multiple Procedure Payment Reduction (MPPR), was earlier restricted to the facility or technical component of imaging. The program has now been expanded to involve the professional element of CTs, MRIs, and ultrasounds. In MPPR, subsequent studies will be discounted by 25 percent. The developed priced study will be paid at the full fee schedule and the second study will be paid at 75 percent of the physician fee schedule .

Whether it's a powerful code reference tool, a real-time claims auditor to help you reduce denials or step-by-step guidance from CPC certified experts, we've got you covered. Some of our unique products provide you the update information on ICD-9 Codes and HCPCS codes , the ammunition you need to get instant success.

Thinking of Going Out of Network? Follow These 3 Tips to Ensure Success

Be honest with your patients to guarantee a smooth transition.

More and more providers are questioning whether moving to an out of network situation with a payer -- or multiple payers -- is best for their practice. Becoming out of network certainly has pros and cons that you'll wish to weigh sensibly before coming to a decision. Read this expert medical billing article for more.

If you're considering a move to becoming a non-contracted provider, follow these three steps to set your practice up for success.

1. Assess Your Existing Contracts and Patient Base

Before your practice starts talking about becoming out of network with a payer, you must review your contracts. There are specific key areas to pay attention to as you go through the contracts like:

• Enhanced groupers
• Implant thresholds
• Procedure rates versus case rates
• Silent PPOs
• Reduction of state mandated fee schedules
• Claims filing limitations
• Penalty for provider termination.

Medical Billing Tip: You also want to determine how going out of network will affect your patients and, as a result, patient perception and satisfaction. You can still see patients with the insurance even if you go out of network with a payer, but if the patient's plan does not have out of network benefits, you will need to determine how to transition their healthcare to a participating provider.

2. Reflect on Renegotiation of Your Existing Contract

In case you're having trouble with a certain payer, it may be worth doing some negotiating before you decide on going out of network.

In case reimbursement is too low, you can attempt to renegotiate your contract or get certain carve-outs so that the fee schedule is exceeding your costs. In case you think the contract is not satisfactory, schedule a meeting with your provider relations representative to talk over your needs and decide if negotiation is a possibility. You may also wish to focus on re-training members of your medical billing staff to check that they are medical billing correctly and collecting all the reimbursement your contract permits.

3. Inform Your Patients of Your Decision

In case your practice weighs the pros and cons and decides that going out of network is best, ensure to inform your patients and clarify the reasons for your decision.

Adjust your written financial policy to visibly state how patient out of pocket costs will be billed and what medical coding or collection practices will be implemented.

Make this written information available to your patients, and consider posting a notice in your waiting room as well.

Be ready to answer patients who call about their description of benefits. You must have a script that everyone on your medical billing staff follows so that the clarification and the general message stay consistent.

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ICD-10 Coding: Target These Areas To Boost Your ED Diagnosis Coding Transition

From extreme epistasis to dolphin bites, specificity is all essential with ICD-10

Even though constant efforts are on the move to postpone this implementation, you must move forward supposing that the official startup on Oct. 1, 2013 will not be delayed. Read on for instructions on how ICD-10 will affect ED coding and tips for a smooth transition.

Review on Basic ICD-9, ICD-10 Differences

ICD-10-CM codes are the ones selected for use in documenting diagnoses. These codes are 3-7 characters long and over-all 68,000, whereas ICD-9-CM diagnosis codes are 3-5 digits long and number over 14,000. The ICD-10-PCS are essentially the procedure codes and these codes are alphanumeric, 7 characters long, and they are total about 87,000, while ICD-9-CM procedure codes are only 3-4 numbers in length and total about 4,000 codes.

The number of codes present in ICD-10 has increased considerably, and the reformatting of the number of characters per code and the demands for augmented code specificity need major planning, training, software/system upgrades/replacements. The move to ICD-10 impacts other medical coding and medical billing systems as well.

Get ED Physicians Ready for These Details

Even though the main impact with be on IT systems and medical coding professionals, the dramatic change in ICD-10 code descriptions will mean your physicians will require upgrading their documentation practices at all levels. Providers will be needed to look in a different way at how differential diagnoses, final diagnoses, operative notes, diagnostic interpretations and more are documented.

For a sneak peek at what's coming ED coding, compare these common ED diagnosis statements and the associated ICD-9 codes and ICD-10 codes:

Documentation pointer: You should not let the complexities of the new system challenge you. As so many conditions are pooled into one ICD-10 code where they were previously identified individually, you will see complex statements like those below bundled into one specific code:

Anatomy rules: Providers will be needed to provide a higher level of anatomical detail in notes and note conditions for instance "stabbing", "visible", "extreme" and a more definite and exact location of problem.

Coma Scale? Make certain you know it: Documentation of a Glasgow Coma Scale will be needed for coding a lot of neurologic complaints and will need that coders clearly comprehend how the Coma Score translates to conditions recognized for coding, (e.g. motor response, verbal response, eye opening). Expanding documentation "macros" as well as templates will be an important component of the transition to ICD-10 Codes

ICD-10 Update: J67.0 Changes Your Farmer's Lung Reporting in 2013

Use history as well as symptoms hand-in-hand to arrive at the correct diagnosis.

At present, in case your pulmonologist arrives at the diagnosis of farmer's lung, you are required to report it with the ICD-9 code 495.0 (Farmers' lung). When ICD-9 transforms to ICD-10 effective October 1, 2013, the ICD-10 code for farmers' lung will change to J67.0 (Farmer's lung). Though, the descriptor under ICD-10 will remain the same as in ICD-9. Read on for more on the condition and how to report it.

Clinical details: Hypersensitivity pneumonitis is also called extrinsic allergic alveolitis (EAA). EAA is a respiratory condition which is caused by a hypersensitivity reaction to inhaled extrinsic factors leading to inflammation in the alveoli of the lungs. This is an occupational hazard, and the classification of EAA is also decided on the grounds of the inhaled extrinsic factor.

One such sort of EAA is Farmer's lung. Farmer's lung is caused by inhalation of moldy hay particles or other agricultural dust particles contaminated by mold.

The inhalation of these particles will initially demonstrate type III hypersensitivity (immune-complex induced tissue injury) which results in inflammation of the alveoli. In case left unchecked or exposure constantly persists, it will lead to a chronic inflammatory condition.

ICD difference: Even though ICD-10 codes are aimed at improving the description of the diagnosis of diseases based on advancements in medical science, the descriptor for Farmers' lung remains unaffected under J67.0.

ICD-10 Medical Coding tips: Documentation of the signs as well as symptoms forms an integral part of the report while your pulmonologist considers the differential diagnoses of any kind of EAA.

A number of the commonly seen signs as well as symptoms that are essential to be reported and that you must look for in the note will include: fever (R50.9, Fever unspecified), fatigue (R53.83, Other fatigue), shortness of breath (R06.02, Shortness of breath), painful breathing (R07.1, Chest pain on breathing), anorexia (R63.0 and weight loss (R63.4, Abnormal weight loss).

However, in ICD-10 codes, to arrive at a definitive diagnosis of farmers' lung (or any other type of EAA), your pulmonologist will require a complete history, a thorough examination as well as the results of diagnostic tests, for instance bronchoscopy (31622 [Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure)], 31623 [….with brushing or protected brushings], 31624 […..with bronchial alveolar lavage], 31628 […. with transbronchial lung biopsy(s), single lobe]) as well as pulmonary function tests (94010 [Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation], 94727 [Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes], 94375 [Respiratory flow volume loop], +94729 [Diffusing capacity (e.g., carbon monoxide, membrane)(List separately in addition to code for primary procedure)]).

Whether it's a powerful code reference tool, a real-time claims auditor to help you reduce denials or step-by-step guidance from CPC certified experts, we've got you covered. Some of our unique products provide you the update information on ICD-9 Codes and HCPCS codes , the ammunition you need to get instant success.

2012 Update: 96360-96549: Start Using These Guideline Revisions

These instruction changes intend to answer common infusion admin questions.

At first look, the CPT® 2012 manual appears to present a completely revamped set of infusion administration guidelines. However if you're confused about what exactly is new, you aren't alone. This expert medical coding insight will give you a rundown on these guidelines and related CPT codes.

Good news: The guideline revisions fall more under the category of "clarification" than under the category of "change". For instance, it offers clarified language about when hydration can be billed and how dates of service in an overnight outpatient hospital stay for observation must be reported. Thus the 2012 guidelines bring better direction supporting what practices must have been doing all along.

Watch for Supported Office/Outpatient E/M Visit

The revised guidelines add details on which E/M codes you may report in addition to the infusion administration CPT codes.

From the 2011 guidelines, you by now know that your physician may report an important, distinctly identifiable E/M service in addition to the infusion service code by appending modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.

The 2012 guidelines go a step further by affirming in case a separately identifiable E/M is executed, you must report a distinct "office or other outpatient" E/M service. To emphasize the point further, the guidelines list the possible office/outpatient CPT codes:

99201-99215 (Office or other outpatient visit )

99241-99245 (Office consultation )

99354-99355 (Prolonged service in the office or other outpatient setting …)

In a distinctive case, a physician reporting an E/M plus infusion admin for the same patient will be carrying out both in the office setting. This is for the reason that physicians should not submit claims for most infusions performed in a facility. As the guidelines state, infusion admin CPT codes 96360-96379, 96402, 96409-96425, 96521-96523 are not aimed to be reported by the physician in the facility setting.

Review When 2 Initial Codes Are OK

The 2012 guidelines go into more detail than the 2011 guidelines did on the meanings of initial, sequential, and concurrent when used in the infusion code definitions. The guidelines also propose practical information on how to apply the CPT codes.

Similar to the 2011 guidelines, the 2012 CPT guidelines state that while administering multiple infusions, you must report only one "initial" service CPT code. (CPT® 2012 adds "for a given date.") The exception under both 2011 and 2012 guidelines is that you may report more than one initial CPT code if protocol needs use of two distinct IV sites.

Lead Repair: Master Electrode Repair Coding Conundrum

Learn how to code lead repair as well as battery change at same session.

Medical coding for electrode repair is slightly clearer in 2012.

In 2011, your electrode (lead) repair choices for a pacemaker (PM) or implantable cardioverter-defibrillator (ICD) involved these two CPT codes:

33218 (Repair of single transvenous electrode for a single chamber permanent pacemaker or single chamber pacing cardioverter-defibrillator)

33220 (Repair of 2 transvenous electrodes for a dual chamber permanent pacemaker or dual chamber pacing cardioverter-defibrillator)

Problem: As per the wording in the 2011 definitions, neither code appeared suitable for repair of a single lead in a dual-chamber system. Code 33218 denoted a single lead in a single-chamber system, as well as 33220 denoted repairing two leads in a dual-chamber system. At one point, AMA's Principles of CPT® Coding (fourth edition) suggested reporting 33220-52 (Reduced services) to signify repair of a single electrode in a dual-chamber device.

2012 solution: CPT 2012 revises the code definitions to refer only to the number of electrodes and not the number of chambers involved:

33218 (Repair of single transvenous electrode, permanent pacemaker or pacing cardioverter-defibrillator)

33220 (Repair of 2 transvenous electrodes, permanent pacemaker or pacing cardioverter-defibrillator)

Based on the above definitions, the suitable code for single-electrode repair when the date of service is on or after Jan. 1, 2012, appears to be 33218.

Battery Change + Lead Repair = Multiple Codes

Owing to changes elsewhere in the PM and ICD range of CPT®, the codes you'll pair with 33218 and 33220 for lead repair at the same session as a battery change have a new look.

A note with 33218 tells that when the physician repairs a single electrode for a PM or ICD at the similar session as pulse generator replacement, you must report 33218 with the correct code from:

33227-33229 (Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator…)

33262-33264 (Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator …)

Code 33220 has its own individual new note asking you to report repair of two transvenous electrodes and generator replacement at the similar session using 33220 in conjunction with the single suitable code from:

33228 (dual lead PM battery change)

33229 (multiple lead PM battery change)

33263 (dual lead ICD battery change)

33264 (multiple lead ICD battery change).

Problem: CCI edits 2012 shows edits bundling dual- and multiple-lead PM battery changes (33228-33229) with single lead repair CPT 33218. The edits have a modifier indicator of 0, so you may not override the edits. The edits as mentioned in CCI edits 2012 could cause reporting problems if the physician repairs a single lead at the same session as a battery change for a dual- or multiple-lead system.

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Increase Pay Up for Allergy Immunotherapy Billing for Each Service Delivered

Accurate code reporting for allergy immunotherapy depends on understanding that physicians are to bill merely for the component codes, i.e., the injection-only CPT codes (95115 and 95117) and/or the codes representing antigens and their preparation (CPT 95144-95170). Physicians providing both services must bill for both in order to ensure accurate medical coding.

The CPT outlines immunotherapy (desensitization, hyposensitization) as the parenteral administration of allergenic extracts by means of antigens at periodic intervals, generally on an increasing dosage scale to a dosage which essentially is maintained as maintenance therapy. Understanding the dissimilarities between the following listed CPT codes is important to obtaining correct reimbursement for these codes:

CPT 95115-95117 (professional services for allergen immunotherapy excluding provision of allergenic extracts; single injection; as well as two or more injections,

respectively)

CPT 95144 (professional services for the supervision and provision of antigens for allergen immunotherapy, single or multiple antigens, single-dose vials [specify number of vials])

The office visit is a distinct procedure. The patient comes in originally for the office visit [99212-99215] along with scratch test. After that the serum is made [CPT 95144]. Then the patient visits the allergist again or takes the serum to their general practitioner and continues getting the shots though frequently they are required to get them [95115 or 95117).

How to Bill in Case an Outside Entity Creates the Antigen

Several allergists have the antigen created in a different place, for instance a pharmaceutical company. In these cases, the antigen preparation is taken as a part of the patients prescription program or patient's medication benefit. This is particularly true with managed care plans.

While you report 95165 (professional services for the supervision and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) sometimes that will go to a dissimilar carrier. Blue Cross is infamous for that. You must find out which carrier the patients pharmacy program is with. The antigen is taken as a part of the prescription program, or patient's medication benefit. Remember that carriers will think through the antigen creation a preauthorized procedure. This implies that that you must be aware of your time limits for dosage administrations.

Also keep in mind that 95165 must be reported while you are using both 95115 (or 95117) and CPT 95144.

CPT 95144 (single dose vials of antigen) must be billed only in case the physician who makes the antigen is creating it to be injected by certain other entity.

While billing CPT 95144-95170, physicians must state the number of doses delivered in the units field. CPT Code 95165 signifies multiple-dose vials. A particular dose, in 95165, is the total amount of antigen to be administered to a patient during one treatment session. Physicians should specify the number of doses delivered in the full session.

For More Information :- http://www.supercoder.com/coding-newsletters/my-pulmonology-coding-alert/maximize-pay-up-for-allergy-immunotherapy-billing-for-each-service-rendered-article

CCI 18.0 Update: Include Compression Therapy in Numerous Skin Graft Codes

Watch out for different sessions or sites before you try to break these bundles.

If your dermatologist is carrying out venous compressions to treat ulcers, you might already be aware about novel procedure codes 29582-29584 (Application of multi-layer compression system…), introduced in CPT® 2012. At present you are required to know how that code is affected by the latest round of Correct Coding Initiative (CCI) edits to ensure error free medical coding.

CCI edits 2012 introduces 15,530 new edit pairs. As per CCI edits 2012, 29582-29584 are taken as an intrinsic part of these skin graft codes:

15050 – (Pinch graft, single or multiple, to cover small ulcer, tip of digit, or other minimal open area (except on face), up to defect size 2 cm diameter)

15100 – (Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050))

15110 – (Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children)

15115 – (Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children)

15120 – (Split-thickness autogr`aft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050))

15130 – (Dermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children)

15135 – (Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children)

15150 – (Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less)

15155 – (Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less)

15200 – (Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less)

15220 – (Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less)

15240 – (Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less)

15260 – (Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less)

15271-15278 – (Application of skin substitute graft …)

As per CCI edits 2012, besides, CPT code 29582 (Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed) is bundled into:

10060-10061 -- Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia…)

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)

11042 – (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less)

Check Bundles for Novel Skin Substitute Codes
CCI edits 2012 also presents a number of code edits affecting the new skin substitute graft codes, 15271-15278 (Application of skin substitute graft ...). According to CCI edits 2012, the following listed procedures are taken as an intrinsic part of all of the skin substitute graft applications:

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

11042 – (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less)

12001-12007 – (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet))

12020-12021 – (Treatment of superficial wound dehiscence)

12031-12037 – (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet))

13120-13121 – (Repair, complex, scalp, arms, and/or legs)

16020-16030 – (Dressings and/or debridement of partial-thickness burns, initial or subsequent)

CCI 18.0: 87389: Choose Just 1 HIV Test Code or Face Denials

Update bundles meant for cytology, special stains.

Just as you're beginning to use CPT® 2012 changes in your laboratory, the latest edition of Medicare's Correct Coding Initiative (CCI) limits how you can use some of those CPT codes.

Remember: You cannot just go ahead and add a modifier (such as 59, Distinct procedural service) any time you wish to separate a code bundle, you'd have to validate it with the physician's documentation that denotes the distinct nature of the service, like a separate site or session.

87389 Stands Alone

With ample of HIV lab tests available, only one CPT code explains a single-result test for antigens and antibodies. That code was added in CPT 2012: 87389 (HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result).

Source URL :-

On the other hand, other HIV CPT codes describe a test for one or the other -- HIV antibodies or HIV antigens. Other HIV-1 and HIV-2 antigen and antibody test CPT codes are as follows:

Antibody tests:

86701 – (Antibody; HIV-1)

86702 – ( HIV-2)

86703 – ( HIV-1 and HIV-2 single result)

Antigen tests:

87390 – (Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; HIV-1)

87391 – ( HIV-2)

87534 – (Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, direct probe technique)

87535 – ( HIV-1, amplified probe technique)

87536 – ( HIV-1, quantification)

87357 – ( HIV-2, direct probe technique)

87358 – (HIV-2, amplified probe technique)

87359 – ( HIV-2, quantification)

CMS bundles some of these tests with CPT code 87389 in the latest CCI update. Specially, new edit pairs restrict billing 87389 with the combined HIV-1/HIV-2 antibody test (86703) and HIV-1 antigen tests 87535, 87536 and 87390. The "0" modifier indicator for most of these code bundles means that you should not override the edit pair under any circumstance.

Here's why: Because 87389 indicates both the HIV-1 antigen status and the HIV-1/HIV-2 antibody status of the patient, additionally reporting individual tests for the same indicators would be inappropriate.

More: CCI Edit 18.0 also bundles CPT code 87389 with some services that might be part of the prep steps for that assay: 87147 (Culture, typing; immunologic method, other than immunofluoresence [e.g., agglutination grouping], per antiserum) and 87253 (Virus isolation; tissue culture, additional studies or definitive identification [e.g., hemabsorption, neutralization, immunofluoresence stain], each isolate). These bundles include a modifier indicator of "1," implying that you can override the edit pair, when suitable.

In case the virus isolation or culture typing is not part of 87389, however you carry it out for a different test on the similar day as the combined HIV test, you can then use modifier 59 to override the edit pair.

Here's What Documentation You Require to Report Twin Pregnancies in 2013

Regardless of unspecified codes, submit dx with the maximum level of specificity.

A twin pregnancy is described as one where the mother carries two foetuses. This may involve one placenta along with one amniotic sac, one placenta along with two amniotic sacs, or two placentae along with two amniotic sacs. Read this expert medical coding insight on how ICD-9 codes change in the ICD-10 transition.

In order to appropriately report twin pregnancies in ICD-10, then your provider needs to document the following:

twin pregnancy

specific trimester

number of placentae

number of amniotic sacs

ICD-9 Codes: Here is how you presently report twin pregnancies:

651.00 (i.e. Twin pregnancy, unspecified as to episode of care)

651.01 (i.e. Twin pregnancy delivered; or)

651.03 (i.e. Twin pregnancy antepartum condition or complication;

with V91.00, Twin gestation, unspecified number of placenta, unspecified number of amniotic sacs; or

with V91.01, Twin gestation, monochrionic/monamniotic (one placenta, one amniotic sac); or

with V91.02, Twin gestation, monochrionic/diamoniotic (one placenta, two amniotic sacs); or

with V91.03, Twin gestation, dichorionic/diamniotic (two placentae, two amniotic sacs); or

with V91.09, Twin gestation, unable to determine number placenta and number of amniotic sacs)

ICD-10-CM Codes: Here is how your diagnosis medical coding options will expand:

O30.001 (i.e. Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, first trimester)

O30.002 (i.e. Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, second trimester)

O30.003 (i.e. Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third trimester)

O30.009 (i.e. Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, unspecified trimester)

O30.011 (i.e. Twin pregnancy, monoamniotic/monochorionic, first trimester)

O30.012 (i.e. Twin pregnancy, monoamniotic/monochorionic, second trimester)

O30.013 (i.e. Twin pregnancy, monoamniotic/monochorionic, third trimester)

O30.019 (i.e. Twin pregnancy, monoamniotic/monochorionic, unspecified trimester)

O30.031 (i.e. Twin pregnancy, monochorionic/diamniotic, first trimester)

O30.032 (Twin pregnancy, monochorionic/diamniotic, second trimester)

O30.033 (i.e. Twin pregnancy, monochorionic/diamniotic, third trimester)

O30.039 (i.e. Twin pregnancy, monochorionic/diamniotic, unspecified trimester)

O30.041 (i.e. Twin pregnancy, dichorionic/diamniotic, first trimester)

O30.042 (i.e. Twin pregnancy, dichorionic/diamniotic, second trimester)

O30.043 (i.e. Twin pregnancy, dichorionic/diamniotic, third trimester)

O30.049 (i.e. Twin pregnancy, dichorionic/diamniotic, unspecified trimester)

O30.091 (i.e. Twin pregnancy, unable to determine number of placenta and number of amniotic sacs, first trimester)

O30.092 (i.e. Twin pregnancy, unable to determine number of placenta and number of amniotic sacs, second trimester)

O30.093 (i.e. Twin pregnancy, unable to determine number of placenta and number of amniotic sacs, third trimester)

O30.099 (i.e. Twin pregnancy, unable to determine number of placenta and number of amniotic sacs, unspecified trimester)

ICD-10-CM Change: Presently, you would usse ICD-9 codes 651.01 or 651.03 to report twins with a V91.0x identifying the number of amniotic sacs and placentae. In 2013, ICD-10-CM will combine these particular ICD9 codes into single options for twin pregnancy based on specific trimester as well as the number of placenta and amniotic sacs.

You do have unspecified trimester as well as unspecified number of placentae/amniotic sacs coding options, but you must always code to the maximum specificity. You also have a choice to report when the physician cannot define the placenta/amniotic sac status of the pregnancy, however the physician should document this fact in the record.

Catheter Coding: 36245-+36248: Determine Which Codes See a Global Period Change in 2012

Related revisions are currently in place for 36200.

In case you want evidence that annual CPT code updates go beyond definition revisions, look into these moderate sedation as well as global surgical package changes to 36200 and 36245-+36248.

1. Revision Sign Indicates Moderate Sedation Change

You'll find the following CPT codes on the list of revised codes for 2012:

36200 (Introduction of catheter, aorta)

36245 (Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family)

36246 (… initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family)

36247 ( … initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family)

+36248 ( … additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate))

A quick comparison of the 2011 and 2012 definitions of these CPT codes will show you that the wording remains the same. The revision is in the addition of the moderate sedation symbol to these CPT codes

The symbol means payers include moderate (or conscious) sedation as part of the fee for the procedure code. So the physician performing the catheter introduction or placement should not separately report 99143-+99145 (Moderate sedation services ...) for 36200 or 36245-+36248 services performed on or after Jan. 1, 2012.

Source URL :- http://www.supercoder.com/coding-newsletters/my-radiology-coding-alert/catheter-coding-36245-36248-discover-which-codes-see-a-global-period-change-in-2012-109796-article

2. Review the MPFS for Changes, Too

Prior to submitting a claim for these CPT codes for catheter introduction and placement in 2012, ensure you take into account changes to the global periods of CPT codes 36200, 36246, and 36247.

In 2011, the global period for each of these CPT codes was XXX. In 2012, 36200, 36246, and 36247 have a global period of 000.

Impact: The global period change means you must no longer independently report related E/M services executed on the same date as 36200, 36246, or 36247.

Here's why: In 2011, the CPT codes had the classification XXX. That classification means the service is free of global surgical bundling issues, and you can independently report services that your physician carries out on the similar date as the surgical procedure, for instance E/M services.

The XXX value means that the global concept is not applicable to the procedure

In 2012, the codes have a 000 indicator, which is applicable to the date of the procedure only. Medicare will bundle all related services that the physician carries out on that surgery date into codes with the 000 indicator.

CPT®2012 Update: Tips Help You Master Bone Biopsies With Vertebroplasties

Discover the levels for primary procedure as well as biopsy.

Read in the procedure note in case your surgeon carried put a bone biopsy while doing the vertebroplasty. In case the vertebroplasty and biopsy are at the same level, you are not supposed to report any additional bone biopsy codes for CPT. Look at examples below to brace your vertebroplasty reporting for error free medical coding.

Note the Change in Code Descriptor(s)

The CPT codes for vertebroplasty include a definite revision in the code descriptors which clearly states that you must include the bone biopsy when one is carried out. The revisions in code descriptors listedbelow:

22520 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; thoracic)

22521 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; lumbar)

+22522 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; each additional thoracic or lumbar vertebral body [List separately in addition to code for primary procedure])

The revision in these codes for CPT includes bone biopsy included when carried out.

The descriptor clearly describes that the bone biopsy is included when your surgeon does one.

Do Not Look To Additional Codes for Bone Biopsy

While you report vertebroplasty in 2012, you will not report an additional bone biopsy CPT code 20225 (Biopsy, bone, trocar, or needle; deep [eg, vertebral body, femur]) in case your surgeon carres out the biopsy at the similar spinal level as the primary procedure. This is due to the removal of bone tissue is inclusive in the vertebroplasty procedure and does not require additional procedure when the same is carried out to retrieve the tissue for a biopsy. Henceforth, you do not report the bone biopsy your surgeon performs at the same level as the vertebroplasty.

When your surgeon does the vertebroplasty and bone biopsy at different levels, you report the biopsy separately with modifier 59 (Distinct procedural service). Ensure your surgeon documents the unrelated nature and distinct locations of the two procedures.

Location Guides Your Choice of Codes

The CPT codes of SuperCoder.com  for vertebroplasty identify the location as lumbar or thoracic in the descriptor. The spinal location determines the CPT code you select. You choose a code to define the primary level where your surgeon carried out the procedure. You report CPT code 22520 for vertebroplasty at levels T1-T12 or 22521 for levels L1-L5. While the procedure spans to another level in the same location, you must also report CPT code +22522 in addition to 22520 or 22521.

High Risk Factors for Medicare Well Women Exams

Coding along with reimbursement for Medicare well-woman screening exams is certainly one of the major challenges in ob/gyn medical coding. You should know whether a patient meets Medicare's criteria for "high-risk" or "low-risk." This risk factor controls the regularity with which Medicare pays for well-woman care. Also, know what ICD-9 codes are applicable to this scenario.

Medicare sets parameters regarding when a patient is high-risk as well as worthy for annual well-woman exams, against when a patient is low-risk and eligible for well-woman exams simply once every two years. Even though the codes for the exam and also Pap smear collection are similar – G0101 (cervical or vaginal cancer screening; pelvic and clinical breast examination) and Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) – determining patient risk is crucial to proper reimbursement and accountable preventive care.

For More Information :- http://www.supercoder.com/coding-newsletters/my-ob-gyn-coding-alert/risk-factors-rule-well-woman-exams-article

Risk Codes plus Factors

While billing for Medicare well-woman care, you must use one of three ICD-9 codes:

V76.2 – (special screening for malignant neoplasms; cervix)

V76.49 – (special screening for malignant neoplasms; other sites)

V15.89 – (other specified personal history presenting hazards to health; other)

The ICD9 Codes V76.2 and V76.49, selected by Medicare for when the patient no longer has a uterus, are the "low-risk" codes, besides V15.89 is the "high-risk" code. As far as well-woman exam is concerned, high-risk indicates that because of family, personal/social or medical history the patient is then at higher risk for developing cervical or further gynecological cancers. It has no bearing on any other health problems the patient may have that are unconnected to her reproductive and sexual history.

There are very precise parameters that permit you to be high-risk and thus receive screening (not diagnostic) Paps, screening pelvic as well as breast exams every year paid by Medicare. Medicare rules have numerous factors that specify high risk:

V69.2 (high-risk sexual behaviour, Onset of sexual activity under 16 years of age)

V69.2 (Five or more sexual partners in a lifetime)

V13.8 (personal history of other specified diseases: History of sexually transmitted disease)

795.0 (abnormal Pap smear : Absence of three negative Pap smears)

V08 (asymptomatic HIV status, or 042, HIV : History of HIV)

Absence of any Pap smears in the previous seven years. No exact ICD-9 codes, occurs for this, but V15.89 may be adequate by itself. You may require to submit documentation with the claim

760.76 (DES affecting fetus via placenta or breast milk : Prenatal exposure to DES, commonly referred to as DES daughter).

These criteria are applicable to women who are no more of childbearing age. The risk status is determined mainly through the interview form the patient completes at the beginning of her treatment with the physician.

Resting on the risk status, the encounter with the patient is billed to Medicare as following:

G0101 (linked to V76.2/V76.49 or V15.89) or

Q0091 (linked to V76.2/V76.49 or V15.89)

Medicare Physician Fee Schedule 2012: Strut Your Practice for 27% Medicare Conversion Factor Cut

Could a reprieve be approaching?

It is the time for another round of stressed waiting to see if you'll get a vivid reduction in 2012 Medicare payments meant for your general surgical services. Keep in mind that the calendar year 2012 Medicare Physician Fee Schedule [PFS] conversion factor is $24.6712, as per the 2012 Medicare Physician Fee Schedule Final Rule, as printed in the Nov. 28 Federal Register -- and that could mean a huge cut in your pay.

Wait for Congressional Relief

The conversion factor (CF) sums to a dismal 27.4 percent cut compared to the existing rate of $33.9764. CMS recognizes that this enormous cut may not be set in stone, stating that while Congress has offered temporary relief from these reductions every year from 2003, a long-term solution is critical. It further says that it will carry on working with Congress to provide solution to this indefensible situation so doctors and beneficiaries no longer have to be concerned about the stability and adequacy of their Medicare Physician Fee Schedule payments.

Physician advocacy organizations were quick to criticize the cuts. Payments for Medicare physician services have dropped so far underneath upsurges in medical practice costs that there is certainly a 20 percent gap between Medicare payment updates and the cost of caring for seniors.

Even CMS officials consented that the 27.4 percent cut would be devastating, however remained positive that the government might cure the situation before the pay cuts take effect. This payment rate cut would have dismal consequences that must not be allowed to happen. CMS says that it needs a permanent SGR fix to resolve this problem once and for all. That is the reason why the President's Budget and his Plan for Economic Growth and Deficit Reduction call for permanent, fiscally responsible reform and why CMS is committed to working with the Congress to achieve a permanent and sustainable fix.

Recall 2011 fix: Last December, Congress voted to stave off a 25 percent cut to your Medicare pay. But that vote kept the cuts at bay only through December 31 of 2011. Effective January 1, 2012, your Medicare pay is set to drop again based on the new 2012 Medicare Physician Fee Schedule information, unless Congress interferes to reverse the cuts.

Temporary reprieve: On December 23, 2011, President Obama signed into law the "Temporary Payroll Tax Cut Continuation Act of 2011," which delays the proposed 27 percent cut for two months.

Botox Reimbursement for Achalasia and Anal Conditions Is Gaining Wider Recognition

Plus, know what is the botox protocol that Bluecross/Blue Shield follows

Reimbursement for the usage of Botulinum toxin type A, usually called Botox, to treat achalasia (530.0) is becoming more usual with Medicare carriers. A lot of carriers are also covering Botox injections meant for the treatment of anal fissures and anal spasms. Medical Coding differences among carriers for these three diagnoses continue to challenge gastroenterologists. Similarly, caution in billing for the drug is essential to avoid common mistakes that could result in lost reimbursement.

Botox Suitable Only After Others Fail

In nearly all cases, Botox injections for achalasia are the treatment of last resort. Reimbursement for Botox treatment naturally needs the gastroenterologist to present documentation that more conventional therapies have now been tried or that these therapies are certainly a risk to the patient. Common conventional therapies involve splitting the esophageal muscles, a surgical procedure named myotomy, along with balloon dilation, which carries the risk of complications for instance internal bleeding or esophageal perforation.

In a patient with achalasia, the sphincter at the lower end of the esophagus fails to appropriately relax and the esophagus distends over time. In advanced cases, the usual passage of food from the esophagus into the stomach becomes more and more difficult and the patient has trouble swallowing. Botox injections reduce the lower esophageal sphincter letting food to work its way through the digestive system.

Selective Coverage for Further Botox Therapies

Gastroenterologists also use Botox therapy for anal fissures (565.0) and anal spasms (564.6). Medicare coverage and reimbursement for these diagnoses is spotty, but seems to be increasing. AdministarFederal is one carrier in Indiana and Kentucky that includes the usage of Botox for anal fissures. CPT code 64640 (destruction by neurolytic agent; other peripheral nerve or branch) is required. New Jersey includes Botox injections for anal fissures and anal spasms. Both of these CPT codes are covered diagnoses while reporting 64640.

Though, CPT medical coding for these diagnoses differs, making it significant for gastroenterologists to know their own state's LMRP. For instance, Pennsylvania covers Botox therapy for anal spasm as well as anal fissure, however endorses the use of CPT code 20999 (unlisted procedure, musculoskeletal system, general) along with a description of the procedure performed. Tennessee also covers these two diagnoses but needs 90799. Virginia has delivered a draft LMRP for Botox that involves coverage for achalasia as well as anal fissure, however the draft does not include definite coding guidelines.

In ordee to inject Botox for anal fissures, a flexible sigmoidoscopy, colonoscopy or proctosigmoidoscopy is vital. The gastroenterologist must use the suitable base CPT code for the procedure (i.e., 45330 [sigmoidoscopy, flexible; diagnostic], 45378 [colonoscopy, flexible, proximal to splenic flexure; diagnostic] or 45300 [proctosigmoidoscopy, rigid; diagnostic]) and 90782 (therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) for administering the Botox.

Commercial carriers appear to be more accepting of Botox therapies meant for the diagnoses of anal fissure as well as anal spasm. For instance, Aetna's Botox policy bulletin specifies that the payer covers its usage for treating anal spasm and anal fissure. Blue Cross/Blue Shield of Tennessee as well as Blue Shield of California also cover Botox therapy meant for chronic anal fissure.

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Reporting 64405 for Third Occipital Nerve Blocks? Think Again

Also, learn what CPT codes you must choose for blocking lesser occipital nerve

Physiatrists who administer third occipital nerve blocks must not automatically assume that 64405* (Injection, anesthetic agent; greater occipital nerve) is the most suitable CPT code. Most medical coding consultants recommend reporting 64470-22 in place of 64405 to more precisely define these types of blocks.

Occipital Nerves Differ

When a physician specifies on the charge ticket that he or she carried out an occipital nerve block, your instinct might tell you to assign CPT code 64405. However 64405 is not at all times the most correct code. Physiatrists administer injections to the third occipital nerve to help diagnose and treat dissimilar forms of headache and neck pain.

The 'third occipital nerve' is not anatomically identical with the greater occipital nerve. Physicians use both injections to diagnose and/or treat some forms of headache. However coding hinge more on the anatomical structure and the procedure location than the patient's symptoms or diagnosis.

The body contains three diverse sets of occipital nerves: the greater occipital, the lesser occipital, and the third occipital nerve (also referred to as the “least occipital nerve"). By reviewing the physiatrist's documentation, you can identify which nerve he or she blocked and assign the correct code for the procedure.

The greater occipital nerve originates from the dorsal ramus of the C2 spinal nerve. It has movement (motor) functions that innervate in the posterior neck muscles and sensory functions for the skin of the posterior surface of the scalp. Physicians often inject the greater occipital nerve to diagnose and treat occipital neuralgia (723.8, other syndromes affecting cervical region). You should report CPT code 64405 for this procedure.

The lesser occipital nerve also originates from the C2 spinal nerve, but its source is the ventral ramus. It has only sensory functions that innervate the skin behind the ear. The CPT code for blocking lesser occipital nerve is 64450* (Injection, anesthetic agent; other peripheral nerve or branch).

The third occipital nerve (TON) is certainly the superficial medial branch of the C3 spinal nerve's dorsal ramus. The TON, like the greater occipital nerve, has both motor and sensory functions. It innervates some of the neck muscles and the C2-3 facet joint. Pain stemming from this joint can be referred to the occiput and even as far as the frontal region and orbit.

Source Code :-

Pinpoint the Correct Code

A physiatrist may inject all three occipital nerves to help diagnose or treat chronic headaches. The practitioner selects the suitable occipital nerve injection based on the patient's medical history along with the condition (for example, a history of neck trauma such as whiplash [847.0, Sprains and strains of other and unspecified parts of back; neck], tender neck points [723.1, Other disorders of cervical region; cervicalgia], description and quality of headache, etc.).

Recognize Key Words to Bill Successfully for Indirect Laryngoscopy Procedures

Indirect laryngoscopy is certainly the simplest of the three laryngoscopy types (indirect laryngoscopy, direct laryngoscopy, flexible laryngoscopy). Thus, the five procedures in this category do not include a scope and offer the least reimbursement. Relatively, they are used when the otolaryngologist observes the patient using mirrors to visualize the larynx, which could be either for diagnostic determinations or as a guide meant for biopsy, lesion or foreign body removal, or for vocal cord injection. Go through this expert medical coding article and learn what ICD9 codes as well as CPT codes apply to indirect laryngoscopy.

The easiest of these codes (diagnostic) frequently is used during a routine examination and must not be billed separately.

In case the mirror is used to check on a definite condition or symptom, though, it may be billed distinctly. For instance, a patient visits the doctor owing to an earache (381.01, acute serous otitis media) however also complains of a sore tongue. The otolaryngologist evaluates the tongue using the mirror and defines the patient has glossitis (529.0).

As the mirror exam is not related to the earache, 31505 can be billed distinctly. The suitable level evaluation and management (E/M) service would be coded with a -25 modifier (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) attached. Diagnosis code 381.01 would be connected to the E/M code, however the mirror exam would correspond to diagnosis code 529.0.

However, in case a patient suffering from hoarseness (784.49) already had received a flexible laryngoscopy (31575, laryngoscopy, flexible fiberoptic; diagnostic), and in the course of follow-up the otolaryngologist uses the mirror to examine how the patient is doing, no E/M may be billed. The otolaryngologist can charge, still, for the 31505.

Other services executed via indirect laryngoscopy are:

31510( laryngoscopy, indirect; with biopsy)

31511 (laryngoscopy, indirect; with removal of foreign body)

31512( laryngoscopy, indirect; with removal of lesion)

31513 (laryngoscopy, indirect; with vocal cord injection)

Though these diagnostic procedures must not be reported if carried out during the same session as a surgical endoscopy, they might be reported in case an open surgical procedure is accomplished. Furthermore, 31511 may be billed distinctly in case the procedure is carried out during critical care of a patient.

Note (Indirect laryngoscopy with vocal cord injection uses both mirrors and a laryngoscope. The mirrors are used to examine the larynx and visualize the injection, which is then performed by a laryngoscope.)

Key words Once an indirect laryngoscopy has been carried out, coders must look for these key words: indirect and mirror.

An indirect laryngoscopy must be coded 31505. Added words such as biopsy, removal of foreign body or lesion, as well as vocal cord injection must guide the coder to choose either 31510, 31511, 31512 or 31513, as suitable.

For More Information :- http://www.supercoder.com/coding-newsletters/my-otolaryngology-coding-alert/recognize-key-words-to-bill-effectively-for-laryngoscopy-procedures-article 

CPT® 2012 Update: Streamline Your PFT Reporting

CPT® simplifies reporting by combining two codes into one.

Have you ever struggled with distinguishing between pulmonary function tests for instance carbon monoxide diffusing capacity (DLCO) and membrane diffusion capacity (DMCO)? In case your answer to this is yes, then you’ll be happy to hear that effective Jan.1, 2012, CPT® has reduced your burden by combining these two CPT codes into a single code.

Read on for more on this change and how to adjust your reporting of these tests.

Note Advantages of Single Add-on Code

Before the changes initiated in 2012, you were required to report carbon monoxide diffusing capacity and membrane diffusion capacity using dissimilar CPT codes. This necessitated complex understanding of the procedures as well as knowing the difference between the two codes.

There was rumour that the codes were being reported erroneously since the increase in utilization for 94725 was recognized as 14% more than that of 94720 over a six year time period. Given the limited clinical indications and use for 94725, this surge seemed irrational.

The old CPT codes (prior to Jan, 1, 2012) that have now been deleted include the following:

94720 – (Carbon monoxide diffusing capacity [e.g., single breath, steady state])

94725 – (Membrane diffusion capacity)

Under CPT® 2012, you will be required to report these procedures under a single code:

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

Benefit: This CPT 2012 ( Source "http://www.supercoder.com/cpt-codes/") change has made the job stress-free as there is no need to go into the procedure details to know whether it is a test for carbon monoxide diffusing capacity or membrane diffusion capacity. Both are now reported with single CPT code +94729. The reimbursement and relative value units for the new code (~$53, 1.57 total RVUs) are like 94720.

CPT Code Lookup Tip: As a lot of providers consider DLCO and DMCO to be a routine part of PFTs, they have now been collected together as an add-on code, and cannot be reported on its own. You should therefore report CPT code +94729 together with other pulmonary function tests, for instance:

94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation)

94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration)

94070 (Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents [eg, antigen[s], cold air, methacholine]) 94375 (Respiratory flow volume loop)

94726 (Plethysmography for determination of lung volumes and, when performed, airway resistance)

94727 (Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes)

94728 (Airway resistance by impulse oscillometry)

Abdominal Aortography Interp Might Be Payable With Heart Cath

Plus, know what CPT codes you must pick for aortography, abdominal, by serialography and more

Added payment may be gained for any abdominal aortography carried out during the same session for example a left heart cath with aortography of the aortic root however only if documentation specifies that the intent of the abdominal aortography was the treatment of a dissimilar problem. This expert medical coding article gives you CPT code lookup tips and more.

Procedure notes thus need to document clearly and accurately (by including, for example, a second diagnosis) that the additional aortography was separate from the heart cath.

When a left heart cath is done, aortography as well as the more distinctive angiography of the left coronary chambers as well as the coronary arteries may be carried out to get images of the aortic root (where the aorta joins the heart). For this particular procedure, once you execute CPT code lookup, 93544 (injection procedure during cardiac catheterization; for aortography) is reported with 93556 (imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; pulmonary angiography, aortography and/or selective coronary angiography including venous bypass grafts and arterial conduits [whether native or used in bypass]).

Any images gained from injections in the ascending aorta (the first section of the aorta, defined as the section from the left ventricle to the arch, or bend) are encompassed in CPT codes 93544/93556. 93544 includes positioning the catheter in the ascending aorta which is above the aortic valve. It does not, though, describe abdominal aortography.

Abdominal aortography may be carried out following a heart cath. For instance, the cardiologist may have trouble passing a guidewire plus catheter from the access site (the femoral artery) to the aorta as the patient has tortuous arteries (defined as twisted and full of turns).

In case the coronary problem needs urgent attention, the cardiologist may carry out the heart cath first. When the catheter is being removed via the aorta, another injection is done to image the abdominal aorta or other arteries (such as the renal, iliac and femoral arteries).

Abdominal aortography and heart cath may as well be carried out simultaneously in case the patient has a supplementary problem (such as hip pain or leg cramps) that the cardiologist wants to evaluate at the same time.

SourceURL:- http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/abdominal-aortography-interp-may-be-payable-with-heart-cath-article  

CPT Code Lookup tip: Even though aortography of the aortic root (or elsewhere in the ascending aorta) has already been carried out, and reported using CPT codes 93544/93556, the supervision as well as interpretation of the abdominal aortogram (which reflects the manipulation of the catheter as well as the interpretation of the images) must be distinctly payable using either 75625 (aortography, abdominal, by serialography, radiological supervision and interpretation) if only the aorta is imaged, or CPT code 75630 (… plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation) in case images of the iliac and/or femoral arteries are also gained.