Coding Tips: Unravel Your Photodynamic Therapy Claims With This Add-on Code Advice

Capture all facets of therapy to maximize reimbursements.

While your pulmonologist makes use of photodynamic therapy (PDT) to treat a patient with cancer, you are required to report all important components of the therapy that involves infusion, bronchoscopy along with the laser activation. Read on for some refresher tips to confront photodynamic therapy reporting with confidence and ascertain your CPT codes and ICD-9 codes.

Capture All Aspects of the Infusion

The first step to photodynamic therapy is the intravenous infusion of Photofrin (Porfimer), which could be carried out by your pulmonologist or by a nurse under the supervision of your pulmonologist. In case it is carried out in the hospital, no charge can be made. In case it is carried out in the office, a charge can be made although carried out by a nurse since she will be supervised by the pulmonologist.

The infusion of Photofrin must take about 10-15 minutes. In case the infusion lasts less than 30 minutes, you must use CPT code 96374 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; intravenous push, single or initial substance/drug). In case the infusion lasts over 30 minutes, you must use CPT code 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour)."

Besides the infusion, you will be required to report the J code for Photofrin. You will then report this with J9600 (Injection, porfimer sodium, 75 mg).

Note Timelines for Next Procedure

Prior to the infusion of Photofrin, the patient comes back to your pulmonologist's office after a period of 48 hours. This time gap is offered to facilitate selective absorption of the Photofrin by the cancerous cells for the reason that your pulmonologist can clearly detect it to destroy it. Your pulmonologist will then undertake a bronchoscopy to detect the areas that need to be treated with the laser in order to destroy the cancerous cells. As this procedure is carried out to destroy the tumor using laser therapy, you have to report the procedure with CPT code 31641 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with destruction of tumor or relief of stenosis by any method other than excision [e.g., laser therapy, cryotherapy]).

Example: Use this scenario to guide your coding:

A 66 year old patient with bronchogenic carcinoma experiences photodynamic therapy through bronchoscopy 48 hours prior to receiving a 15 minute IV infusion of Photofrin. The photodynamic therapy continues for 55 minutes. The photodynamic therapy should be coded with CPT 96570 , 96571x2 in addition to 31641. The ICD-9 code would be 162.9 for bronchogenic carcinoma. The infusion of Photofrin would be coded 96374 on the earlier day of the infusion along with 162.9.

Note: In case your pulmonologist carries out the laser activation for less than 23 minutes after initiation, then you are required to append modifier 52 (Reduced services) to CPT code 96570.

Accurate ICD-9 Codes for Follow-up and 368.10 Now Joins Palmetto LCD ICD-9 Choices

Read these two scenarios and see what ICD-9 codes apply.

410.31 or 410.32 applies to Follow-Up?

Question: The patient is there in the hospital for a 410.31, and after that is discharged. The patient is arranged to be seen in the office again for a follow-up visit. Concerning this follow-up visit, which is certainly less than 8 weeks from the myocardial infarction, is it suitable to use the fifth digit of "2" on the MI (410.32), or would you still use ICD-9 code 410.31?

Answer: You must use 410.32 (Acute myocardial infarction of inferoposterior wall; subsequent episode of care) for this particular follow-up visit. ICD-9 notes with the 410.xx fifth digit selections state that you must use fifth-digit 2 to specify an episode of care succeeding the initial episode when the patient is admitted for additional observation, evaluation or for treating a myocardial infarction that has been offered initial treatment, but is still less than 8 weeks old."

You must report 410.31 (Acute myocardial infarction of inferoposterior wall; initial episode of care) only in the initial episode of care. The fifth digit "1" is applicable until the patient is discharged, irrespective of where the cardiologist offers the care. Notes in the ICD-9 manual explain that you use "1" for the initial episode of care, irrespective of the number of times a patient may be transferred in the initial episode of care."

In case documentation doesn't mention the episode of care (initial or subsequent), you must use fifth digit "0" (Episode of care unspecified).

In case the patient returns more than eight weeks post infarction, you must use 414.8 (Other specified forms of chronic ischemic heart disease). Notes with this code agree it is suitable for any condition classifiable to 410 defined as chronic, or presenting with symptoms post 8 weeks from date of infarction."

368.10 Joins Palmetto LCD ICD-9 Options

Question: You see a notice that your LCD for Noninvasive Vascular Testing (L31712) was reviewed. How has it changed?

Answer: The Palmetto GBA local coverage determination (LCD) you talk about has had two revisions since September. Both add ICD-9 codes backing up coverage for a variety of services.

For example: The revision adds ICD-9 codes 454.8 (Varicose veins of lower extremities with other complications) and 586 (Renal failure unspecified) to the list of ICD9 codes supporting these particular procedure codes:

• 93965 (Noninvasive physiologic studies of extremity veins, complete bilateral study (e.g., Doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography)
• 93970 (Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study
• 93971 (Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study)

Test Yourself: Can You Ascertain the Conditions for 'Additional Work Up' and 'Moderate' Decision Making?

Read the following scenario and determines which way you'd code.

Simply because of the fact that you code for your physician's E/M services each day doesn't imply they're always easy to resolve. Check out this real-life medical billing and coding scenario and decide how you would code it

The family physician examines an established patient for a new problem. The documentation is: Diagnosis: abdominal pain. Patient does not wish to work up today. Suspect ovarian cyst. In case pain persists tomorrow, she will call and plan pelvic u/s or CT hinging on sx at that time. Patient agrees, does not want pain pills. She will take ibuprofen."

How would you code this particular medical billing and coding encounter?

Answer: This situation signifies moderate medical decision-making. You have an undiagnosed, novel problem with an indefinite prognosis.

At first look, you might think this is just a small problem as the provider didn't push for testing and was okay with the patient going home to take over-the-counter ibuprofen. However as there was no conclusive diagnosis, and the option of testing, you must consider this a 'new' problem even without a work up.

Another problem with no diagnosis backs moderate complexity medical decision making both in terms of the diagnosis as well as management options and in terms of the danger involved. As the level of medical decision making involved depends on meeting two of the three medical decision making elements (i.e. diagnosis and management options; amount and complexity of data reviewed; and risk), this medical billing and coding documentation seems to support a moderate level, although the amount and complexity of data reviewed is minimal or none.

Code check: E/M code 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity) maintains "medical decision making of moderate complexity," however that should neverbe your automatic code choice. In case this instance were on your desk, you would require verifying that the physician also reached the level of "detailed" history or exam prior to you could submit 99214.

Medical Billing and Coding Tip: In case you can't support a comprehensive history or exam to go with the moderate level of decision-making, you'll be required to drop back to 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making). Based on the documentation, you can conclude at least a problem-focused history. Include diagnosis 789.0x (Abdominal pain).

Units of Service: +96367: Annoying Frequency Edit Is on the Way Out

Medical Billing and Coding

Plus: Permitted Anzemet units take a dive. Here's the reason.

In case you're dealing with denials for consecutive therapeutic infusions or anti-nausea medications, don't overlook these two Medicare-related updates to ensure accurate medical billing and coding.

1. Determine How to Handle +96367 Claims

You're in good company in case you've been deliberating why you're facing denials for greater than three units of +96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion of a new drug/ substance, up to 1 hour [List separately in addition to code for primary procedure]).

The reason is a medically unlikely edit (MUE) of 3 for the code, effective Jan. 1, 2012. An MUE is a frequency edit that is applicable to Medicare claims via the Correct Coding Initiative (CCI).

Good news: CCI edit will change the MUE for +96367, announced the Community Oncology Alliance (COA) on its website.

The increased MUE is good news; however the change won't take place until April 1. That implies that you should decide how to handle claims for more than 3 units of +96367 till the change is effective. The practices may go for either of the following medical billing and coding practice:
For further details on this and for other medical coding updates, sign up  http://www.supercoder.com/

(1) Hold applicable claims until April 1 when payers will apply the augmented MUE (because the change is retroactive to Jan. 1, the new MUE will apply to dates of service going back to that time).

(2) Send in claims at this time, and overcome the MUE edit, which is checked against each line independently, by reporting +96367 x3 on one line and after that +96367-59 (Distinct procedural service) with up to an additional 3 units on a second line.

2. FDA Move Affects Anzemet Allowed Units

Medical Billing and Coding Update: CMS is decreasing the allowed units for intravenous and intramuscular Anzemet, long used to avoid nausea and vomiting in patients getting chemotherapy.

Reason: The Food and Drug Administration (FDA) took a closer look at Anzemet's ability to cause heart rhythm problems. Based on the results, the FDA decided to add a contraindication to Anzemet's prescribing information mentioning that the injection form of Anzemet (dolasetron mesylate) must no longer be used to check nausea and vomiting associated with cancer chemotherapy (CINV) in pediatric as well as adult patients.

Medical Billing and Coding Update : The change affects code J1260 (Injection, dolasetron mesylate, 10 mg). The number of allowed units was not involved in the announcement, and you won't find J codes published in CMS's MUE table.

Don't miss: The FDA main that physicians might still order an Anzemet injection for preventing and treating postoperative nausea as well as vomiting as lower doses used are less likely to influence the electrical activity of the heart and leads to abnormal heart rhythms.

ICD-10-CM: V10.05 Switches Places With Z85.030 for Personal History of Colon Neoplasm

ICD-9 Codes

Have you heard the latest news about the new code set's implementation date?

The ICD-10-CM implementation date has been publicly postponed and is no longer Oct. 1, 2013, as per a Feb. 16 statement released from the Dept. of Health and Human Services (HHS). Even though a new date hasn't been declared yet, you can take benefit of the extra time to make certain your practice has all of its arrangements in place for the new medical billing and coding along with the documentation requirements. Stay with your training with this look at how ICD-9 codes for history of malignant colon neoplasm are expected to change when ICD-10 hits.


With ICD-9-CM, you currently code personal history of colorectal cancer with ICD-9 code V10.05 (Personal history of malignant neoplasm of large intestine).


ICD-10-CM difference: The ICD-10-CM code set involves Z85.038 (Personal history of other malignant neoplasm of large intestine) in place of V10.05. Bearing the same descriptor, excluding the word "other" that is added in ICD-10-CM, you must regard Z85.038 the same way you do the ICD-9 code V10.05. The code definition for Z85.038 involves "other" to differentiate it from Z85.030 (Personal history of malignant carcinoid tumor of large intestine).

Documentation: As per ICD-10-CM, Z85.038 applies to conditions classifiable to code range C18 (Malignant neoplasm of colon), which includes:

• C18.0 (Malignant neoplasm of cecum)
• C18.1 (Malignant neoplasm of appendix)
• C18.2 (Malignant neoplasm of ascending colon)
• C18.3 (Malignant neoplasm of hepatic flexure)
• C18.4 (Malignant neoplasm of transverse colon)
• C18.5 (Malignant neoplasm of splenic flexure)
• C18.6 (Malignant neoplasm of descending colon)
• C18.7 (Malignant neoplasm of sigmoid colon)
• C18.8 (Malignant neoplasm of overlapping sites of colon)
• C18.9 (Malignant neoplasm of colon, unspecified)

Coding tips: ICD-9-CM official guidelines state that you must use history ICD-9 codes (such as V10.05) after a primary malignancy has been earlier excised or eradicated from its site and there is no additional treatment directed to that site and there is no indication of any prevailing primary malignancy.


ICD-10-CM official guidelines offer the same instruction for codes demonstrating history of malignant neoplasm.


Furthermore, a note with the Z85.- range maintains that code first any follow-up examination prior to treatment of malignant neoplasm (Z08)." Code Z08 (Encounter for follow-up examination after completed treatment for malignant neoplasm) involves medical surveillance following completed treatment.


Medical Billing and Coding Tip: Once ICD-10-CM goes into effect, you must apply the code set and official guidelines in effect for the date of service reported.

IOLs: V2632 Is Just the Beginning – Go to V2787 and V2788 for Multifocal IOLs

Medical Billing

Also: Anticipating extra pay for new-technology intraocular lenses? Read this medical billing and coding article first.

Cataract surgeries are a routine part of a lot of ophthalmologic surgery practices, and intraocular lens (IOL) insertion is a routine part of a lot of cataract surgeries. However a new generation of multifocal IOLs is altering the routine -- both for the surgeon as well as the coder. To get reimbursement, you'll need to keep your HCPCS manual handy. This expert medical billing and coding article will tell you how.

Background: Next to cataract surgery, in which the surgeon gets rid of the patient's natural lens, Medicare will pay for the insertion of a novel standard (monofocal) IOL. In case the surgery takes place in the office, you must assign HCPCS code V2632 (Posterior chamber intraocular lens) to cover the cost of the standard IOL.

For More About  IOLs :- http://www.supercoder.com/coding-newsletters/my-ophthalmology-coding-alert/iols-v2632-is-just-the-start-look-to-v2787-and-v2788-for-multifocal-iols-110579-article

Exception: Code V2632 does not cover the added cost of a multifocal IOL, which not only replaces the natural lens however also corrects refractive errors – for instance an astigmatism-correcting (A-C, also known as "toric") or presbyopia-correcting (P-C) IOL.

P-C IOLs go further than the function of a standard IOL by correcting presbyopia, the incapability to focus on near objects. An A-C IOL fixes astigmatism, an irregular curvature of the cornea.

Medical Billing and Coding Update: Turn to HCPCS Codes for Full Payment

Patients may be given the non-covered lens as well as physicians are recommended to counsel the patient that the cost will be their accountability. Collect the cost up-front or have the patient sign a financial responsibility agreement. Although Medicare will not pay for the additional cost of an A-C or P-C IOL, it is a correct medical billing and coding practice to bill the patient for the dissimilarity, using two HCPCS codes:

A-C IOLs: You must report V2787 (Astigmatism correcting function of intraocular lens). Medicare recognizes these as A-C IOLs:

• AcrySof Toric IOL
• AcrySof IQ Toric IOL
• Silicone 1P Toric IOL.

P-C IOLs: Report V2788 (Presbyopia correcting function of intraocular lens) Medicare recognizes these P-C IOLs:

• AcrySof ReSTOR
• AcrySof IQ ReSTOR
• Crystalens
• ReZoom
• Tecnis Multifocal Acrylic Intraocular Lens
• Tecnis Multifocal 1-Piece Intraocular Lens
• Tecnis Silicone Intraocular Lens.

No More New Technology IOL Reimbursement

Remember, you should not confuse A-C and P-C IOLs with novel technology IOLs (NTIOLs) to make certain that you achieve medical billing and coding accuracy. NTIOLs are a different category of IOLs that reduce corneal spherical aberrations. Medicare identifies them as having definite clinical advantages as well as dominance over existing IOLs with regard to lesser risk of postoperative complication or trauma, enhanced postoperative recovery, lesser induced astigmatism, enhanced postoperative visual acuity, more stable postoperative vision, or other similar clinical advantages.

CCI Policy Manual Limits Coverage for Procedure + Imaging

CCI Edits

Besides, get acquainted with endoscopic and bone marrow limitations.

Keeping pace with Correct Coding Initiative (CCI) quarterly updates to the edit-pair lists will merely get you so far in Medicare billing compliance. You also require studying guidance that CMS lists in the National Correct Coding Initiative Policy Manual, the latest being a Jan. 2012 update that could have noteworthy impact on your general surgery medical billing and coding.

We've got the lowdown on a few significant changes that are sure to affect the way you code your services.

Background: Every year, CMS updates the Policy Manual, which proposes rationale for several CCI edits, plus describing acceptable scenarios for overriding some edit pairs.

Bundle Imaging Into These Services

When it comes to emergency endotracheal intubation procedures (31500), Swan-Ganz catheter insertions (93503), plus chest tube insertions (32422, 32550, 32551), your surgeon is most probably used to carrying out a post-procedural x-ray to determine that the tubes are in the correct position. Still, as CMS considers that imaging to be normally associated with the procedure, the CCI edits have included the imaging payment into the RVUs for the insertions.

A chest radiologic examination CPT® code (e.g., 71010, 71020) must not be reported distinctly for this radiologic examination.

That's not all: The Policy Manual talks about other imaging restrictions, for instance not reporting +76937 (Ultrasound guidance for vascular access ...) in addition to 36147 (Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/ fistula) …). Likewise CMS says you must not distinctly report operative angiograms or venograms carried out as part of percutaneous interventional vascular procedures using diagnostic codes (such as 75820,Venography, extremity, unilateral, radiological supervision and interpretation).

Watch Bone Marrow Boundaries

While a surgeon performs a bone marrow aspiration and biopsy for the same patient on the same day, the Policy Manualupdate has so much to say about how you report those particular services:

• When the surgeon carries out bone marrow aspiration alone, the appropriate CPT code 2012 is 38220 (Bone marrow; aspiration only).
• When the physician carries out bone marrow biopsy alone, the suitable code is 38221 (Bone marrow; biopsy, needle or trocar).
• When the physician carries out bone marrow aspiration and biopsy at distinct sites or separate patient encounters, you may report CPT code 2012 38220 and 38221 together.

When the physician carries out bone marrow aspiration as well as biopsy at the similar site through the same skin incision, you must not report 38220 along with 38221. As an alternative, you must report 38221 and G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service) to Medicare payers.

CCI Edits Update: The Policy Manual also maintains that you must not list CPT code 2012 38220 with a spinal osteotomy, vertebral fracture repair, spinal arthrodesis, spinal fusion, laminectomy, spinal decompression, or vertebral corpectomy CPT code in case the bone marrow aspiration is obtained from the surgical field.

Modifier 78: Case Study: Reason Decides Correct Modifier for Metatarsal Excision

Read this expert medical billing and coding advice before allocating a code for multi-step procedures.

When a patient comes with a severe infection, you have to deal with numerous treatment steps -- and numerous potential complications for your coding. Test your medical billing and coding know-how by reviewing this scenario and determining the accurate modifiers when three distinct surgeries are required.

Scenario: An established patient who has peripheral neuropathy comes with a severe foot infection. During the evaluation and management, the podiatrist accomplishes a problem-focused exam and history to conclude that immediate incision and drainage is required (28003, Incision and drainage below fascia, with or without tendon sheath involvement, foot; multiple areas). He then concludes to wait for the infection to recede to see if any further procedure is needed.

Four days later, the podiatrist determines that he needs to further excise bone from the second and third metatarsals (28122, Partial excision [craterization, saucerization, sequestrectomy, or diaphysectomy] bone [e.g., osteomyelitis or bossing]; tarsal or metatarsal bone, except talus or calcaneus). The wound is left open for one week to drain the infection before the podiatrist performs a secondary closure (13160, Secondary closure of a surgical wound or dehiscence, extensive or complicated).

Your task: Decide what modifiers will get to the bottom of payment for these procedures.

Medical Billing and Coding Expert Advice: Don’t Forget Your E/M

Prior to deciding on correct modifiers for the excision as well as secondary closure, you want to make certain you’ve covered all your bases coding the initial patient encounter.

In case you just reported 99212 for the E/M accompanied by 28003 for the I&D, you’d be asking for a denial. You should append modifier 57 (Decision for surgery) to the E/M code to let your carrier know that the visit encompassed a separately identifiable service, and not merely a pre-op screening.

Remember to check your global for accurate medical billing and coding: In case the podiatrist carried out an I&D for merely one bursal space (28002), the 10-day global period of that procedure would lead you into appending modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). On the other hand, the 90-day global of 28003 ascertains it as a major surgery, necessitating modifier 57.

Medical Billing and Coding Tip : The 57 modifier is also applicable to E/M codes done the day before the major procedure. This is correct on condition that that the E&M code is important and distinctly identifiable.

For More Information :- http://www.supercoder.com/coding-newsletters/my-podiatry-coding-alert/modifier-78-case-study-reason-determines-correct-modifier-for-metatarsal-excision-110630-article 

CPT® 2012 Update: New and Revised Diagnostic Thoracoscopy Codes For Appropriate Reporting

Changes necessitate more specificity.

CPT® 2012 brought a load of changes to the way you report thoracoscopy. Besides including the term "VATS" (video-assisted thoracic surgery) to the thoracoscopy section descriptor, CPT has also introduced three new CPT codes 2012 to denote diagnostic thoracoscopy while phasing out the older codes.

For More about CPT® 2012 Update :- http://www.supercoder.com/cpt-codes/

Check out our advice that follows on accurately reporting diagnostic thoracoscopy this year.

Attention! Lung Biopsy Will Now be More Specific

Your options for coding thoracoscopies with a diagnostic biopsy expand in 2012. Now, as an alternative of 32602 (Thoracoscopy, diagnostic [separate procedure]; lungs and pleural space, with biopsy), you will need to report thoracoscopy with biopsy using the newly created CPT codes 2012:

• 32607 – (Thoracoscopy; with diagnostic biopsy[ies] of lung infiltrate[s] {e.g., wedge, incisional), unilateral)
• 32608 – (Thoracoscopy; with diagnostic biopsy[ies] of lung nodule[s] or mass[es] [e.g., wedge, incisional], unilateral)
• 32609 – (Thoracoscopy; with biopsy[ies] of pleura)

Benefits: This CPT® 2012 change has distinguished the three biopsy procedures with three separate CPT codes 2012. Consequently, now you can differentiate thoracoscopy with biopsy that includes an area of the lung with lung infiltrates, nodules or masses and the pleura with distinct codes.

In place of using a single code to signify multiple kinds of biopsy in a generalized area (lungs and pleural space) as earlier done with CPT® 32602, CPT® 2012 recognizes the varying efforts related with location along with the kind of tissue you are sampling.

The changes are also helpful in getting specific reimbursement for the procedures as the relative value units (RVUs) are dissimilar for the three CPT codes 2012 as follows: 32607 (~$316, 9.29 total RVUs); 32608 (~$388, 11.41 total RVUs); and 32609 (~$268, 7.89 total RVUs).

Coding Tips: Check the documentation to see if the biopsy involves an area of the lung with lung infiltrates, nodules, masses or the pleura to help arrive at the right thoracoscopy code. Also note that CPT® guidelines state that you can report CPT codes 32607 or 32608 only once for one lung.

Note This Diagnostic Thoracoscopy Excluding Biopsy Revision

CPT® 2012 changes the descriptor to 32601 (Thoracoscopy, diagnostic [separate procedure]; lungs, pericardial sac, mediastinal or pleural space, without biopsy) to cover all aspects of diagnostic thoracoscopy (without biopsy). The earlier descriptor to 32601 did not cover diagnostic thoracoscopy (without biopsy) with respect to the pericardial sac and the mediastinal space.

With this particular change, CPT® now has eliminated codes that used to cover diagnostic thoracoscopy (without biopsy) with respect to the pericardial sac as well as the mediastinal space. So, in place of CPT codes 32603 (Thoracoscopy, diagnostic [separate procedure]; pericardial sac, without biopsy) and 32605 (Thoracoscopy, diagnostic [separate procedure]; mediastinal space, without biopsy), you will just have to report 32601.

Coding Tips: Master Occipital Nerve Injection Claims With These Strategies

Hint: Follow site of needle insertion to select the accurate code.

While your physician treats a patient for occipital nerve pain, you'll require knowing what your physician does to treat it and where precisely your physician inserts the needle for correct claims. Read on for more medical billing and coding tips on how to ascertain which nerve your physician treats and the services delivered to reach at the right codes.

Build up Your Occipital Anatomy Basics

You will come across three different sets of occipital nerves in the body, thus you'll need to know that which one in particular your physician is treating. You report separate codes for procedures on each nerve.

Coding connection: To get to the accurate code, you must know the origin of the nerves, the structures these nerves supply and their distribution, and also what are the common complaints owing to involvement of these nerves in any pathology.

Identify nerve pathology: One common condition stemming from the involvement of the GON that you will frequently get to report is the occipital neuralgia. You report ICD-9 code 723.8 (Other syndromes affecting cervical region) for occipital neuralgia.

Note: When ICD-10 goes into effect, you'll report M53.82 (Other specified dorsopathies, cervical region) for occipital neuralgia.

Select Right Codes for Specific Nerves

In case of occipital neuralgia, your physician will carry out a block in an office setting excluding any radiologic guidance. You should code this as CPT code 64405 (Injection, anesthetic agent; greater occipital nerve). In case the physician diagnoses LON involvement, your physician may carry out a block for the LON excluding radiological assistance. You then report CPT code 64450 (Injection, anesthetic agent; other peripheral nerve or branch).

There is no specific CPT code for LON block procedure. CPT includes only a limited number of codes for injecting specific peripheral nerves. In case one is not specified, like LON, then CPT code 64450 is applied

You face the real challenge when your physician carries out a block for the TON.

Best code for TON: You may report CPT code 64490 (Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level) for the procedure on the TON.

Medical Billing and Coding Tip: The TON is neither anatomically nor functionally identical with the GON. Look sensibly in the procedure notes what necessitated the physician to carry out the block and where the needle was inserted for the procedure. Your physician may carry out the block on either of the occipital nerves to either diagnose or treat the patient's headache. Your physician will record the medical history and do a clinical examination to limit the choice to block a specific occipital nerve.

Molecular Pathology: 83890-83914: Keep On Piling in 2012

Notice payer guidance for novel MoPath codes -- some might surprise you.

With Medicare payment for 101 CPT codes 2012 meant for molecular pathology codes (81200-81048) hanging in the wind, does that mean you mustn't use the codes? That depends.

One thing is clear – a lot of payers will continue accepting the molecular diagnostics "stacking codes" (83890-83914,Molecular diagnostics …) this year. Despite AMA instruction to use the stacking codes merely for services not defined by new Tier 1 or Tier 2 codes, CMS's failure to price the new CPT codes 2012 keeps 83890-83914 in the spotlight.

CMS to Labs: Usage of Both Code Families

You're used to billing molecular diagnostics with stacking CPT codes 83890-83914, and that doesn't change in 2012 for most payers.

Use novel codes, too: Medicare desires that, besides the stacking codes, labs furthermore list the novel single CPT code that would be eventually used for payment purposes in case the CPT codes 2012 were active. CMS also demands that your Medicare claims reveal a charge for the new CPT code, although the Medicare acceptable for the new molecular pathology procedure CPT codes 2012 is $0.00.

Here's why: The Physician Fee Schedule lists molecular pathology CPT codes 81200-81408 with procedure status indicator "B" (Bundled Code Payments for covered services are always bundled into payment for other services not specified…).

However these services would traditionally be allocated a procedure status indicator of "I" (Not Valid for Medicare purposes Medicare uses another code for the reporting of, and the payment for these services), assigning these particular CPT codes a procedure status of B will permit CMS to collect claims information significant to assessing eventual pricing of these novel molecular pathology CPT codes 2012.

Opportunity: Even though Medicare doesn't need labs to list novel molecular pathology CPT codes 2012, doing so gives you an opportunity to provide pricing information that could impact the subsequent payment for these services.

Do this: You can make available pricing input meant for molecular pathology tests that your lab carries out by implementing the following listed steps and safeguards:

• Have the Medicare transmittal along with your compliance documents.
• Report the applicable 81200-81408 CPT code and price it as per the amount you believe signifies its fair market value, identifying that the amount may be different than the sum of the prices you've given to the stacking CPT codes.
• For the reason that CMS doesn't offer a modifier or any other mechanism to specify that the molecular pathology CPT code (from the range 81200-81408) on your claim is non-payable, you must observe all such claims to confirm that your Medicare contractor rejects the charge submitted with the novel CPT code 2012.

ICD-10 Update: Look for Precise Etiology While Determing Acute Bronchitis Dx

Single ICD-9 code transforms to ten codes in ICD-10.

While reporting acute bronchitis, you will need to have a closer look at the documentation to check for the etiology of acute bronchitis as this will carry weight when ICD-10 goes into effect. Here's how the reporting while selecting ICD-9 codes when ICD-10 hits.

ICD-9: There is only one ICD-9 code for acute bronchitis in ICD-9 irrespective of the etiology of the condition. At present, you will report acute bronchitis with ICD-9 code 466.0 (Acute bronchitis)

ICD-10 difference: When ICD-9 changes to ICD-10, you will transform your acute bronchitis coding from ICD-9 code 466.x to J20.x. Remember the expanded ten codes under J20.x that define the etiology of the condition in greater detail, including:

• J20.0 (Acute bronchitis due to Mycoplasma pneumoniae)
• J20.1 (Acute bronchitis due to Hemophilus influenzae)
• J20.2 (Acute bronchitis due to streptococcus)
• J20.3 (Acute bronchitis due to coxsackievirus)
• J20.4 (Acute bronchitis due to parainfluenza virus)
• J20.5 (Acute bronchitis due to respiratory syncytial virus)
• J20.6 (Acute bronchitis due to rhinovirus)
• J20.7 (Acute bronchitis due to echovirus)
• J20.8 (Acute bronchitis due to other specified organisms)
• J20.9 (Acute bronchitis, unspecified)

Medical Billing and Coding Documentation Tip: With ICD-10 Codes , you will need to concentrate more on the cause of the acute bronchitis, so check the encounter notes for these details. If the documentation does not identify the etiology of the acute bronchitis, then you will have to report J20.9. Be sure not to assign a definitive cause unless the physician confirms and documents the causal organism. Just as while selecting ICD-9 codes, do not assign a diagnosis if the physician references a causal organism as "suspected," "probable" or "possible."

For More About ICD-10 :- http://www.supercoder.com/icd-10/

Your pulmonologist will frequently diagnose a case of acute bronchitis by means of the signs and symptoms that the patient is going through. Some of the common signs and symptoms that will you will witness in the documentation will involve fever (R50.9, Fever unspecified), malaise (R53.81, Other malaise), nasal congestion, wheezing (R06.2, Wheezing) and dry or suppurative, persistent cough (R05, Cough).

As most of the instances of acute bronchitis are of viral origin and are self-limiting, the management will merely include treatment of symptoms that the patient is experiencing. In case there is significant amount of sputum formation, then your pulmonologist might be doubtful of a lower respiratory tract infection (such as pneumonia) and order further tests for instance a chest x-ray to rule out or confirm the condition.

Your pulmonologist might order a sputum culture to determine the etiology of the condition. This will often be vital in case your pulmonologist disbelieves a bacterial origin that will require treatment with antibiotics. In case your pulmonologist has ordered a histopathological study, the etiology of the condition stated in the documentation will help define the suitable code that you can report for the case of acute bronchitis to ensure accurate medical billing and coding.

ICD-10: 'Other Anomalies' Code 748.3 Will Expand to More Exact 'Other' Codes

Tip: You should be cautious while submitting probable diagnoses.

In case you use ICD-9 code 748.3 for your entire 'other' congenital abnormalities of the trachea as well as bronchi for conditions that are not otherwise stated in ICD-9, then you must be prepared to come across more specific 'other' codes in ICD-10. Most of them concentrate on the anatomical areas. Follow this expert medical billing and coding advice and know what codes you must report when ICD-9 to ICD-10 transition takes place.

Also mentioned as congenital deformities of the upper airway, the existing ICD-9 code includes:

• laryngomalacia – (a form of congenital laryngeal stridor characterized by flaccidity of the supraglottic structures);
• laryngeal cyst – (a mucus-filled dilatation of the laryngeal saccule which may distort the aryepiglottic fold, the false cord or the laryngeal ventricle_;
• laryngocoele – (an air-filled dilatation of the ventricular sinus of Morgagni);
• laryngeal web or glottis;
• Cri-du-chat syndrome;
• vocal cord paralysis;
• subglottic stenosis;
• subglottic haemangioma; and
• laryngotracheal cleft.

Abnormalities of the trachea as well as bronchi consist of agenesis, stenosis, tracheomalacia, vascular compression, vascular ring, bronchial bifurcations, as well as anterior/posterior compression.

Right now, in case a patient suffers from any of the conditions earlier enumerated, the ENT would probably diagnose her with "other congenital anomalies of larynx trachea and bronchus" which you would report with ICD-9 code 748.3 (Other congenital anomalies of larynx trachea and bronchus).

ICD-10 Change: When ICD-9 transitions to ICD-10 on Oct. 1, 2013, ICD-9 code 748.3 will expand into five more specific diagnosis codes:

• Q31.1 – (Congenital subglottic stenosis)
• Q31.3 – (Laryngocele)
• Q31.8 – (Other congenital malformations of larynx)
• Q32.1 – (Other congenital malformations of trachea)
• Q32.4 – (Other congenital malformations of bronchus)

This is an instance of why coders need to re-acquaint themselves with their anatomy and pathophysiology in preparation for the ICD-10 implementation.

Documentation: Keep in mind that you must code only the confirmed diagnoses. Besides, remember that you should not code "suspected," "rule out" or "probable" diagnoses. You may report codes that describe signs and symptoms, as opposed to diagnoses, when the ENT has not established a related definitive diagnosis.

Coder tips: Two of the commonly used CPT codes that an ENT would link to Q31.1, Q31.3, Q31.8, Q32.1, or Q32.4 are 31770 (Bronchoplasty; graft repair) and 31775 (Bronchoplasty; excision stenosis and anastomosis). A bronchoplasty is carried out with either graft repair or excision of a stenosis with anastomosis.

2012 Guideline Addition Explains When Post-Op Pain Management Is Suitable

Remember: Remember modifier 59 helps you

You must have been occupied with new as well as revised procedure or diagnosis codes, however don't forget the coding guidelines that are associated with CPT®, HCPCS, or other sources. Instance: The 2012 Correct Coding Initiative (CCI) coding guidelines include vital information about reporting post-operative pain management that your anesthesia providers will require knowing. Read on this expert medical billing and coding article for details on what CPT codes apply.

Check Timing and Clarify Purpose

Medicare global surgery rules specify that the surgeon performing the procedure is responsible for post-op pain management and should not report the care separate from the surgery. The rules change, however, when the surgeon asks the anesthesiologist or pain management specialist to handle the patient's post-op treatment.

Before asking for an anesthesiologist's help, the actual or postoperative pain should be severe enough to need treatments beyond the experience of the operating physician, as per CCI guidelines. For instance, the surgeon might request that the anesthesiologist place an epidural or nerve block to treat the patient's post-op pain.

Remember: The anesthesiologist might choose to place the epidural before, during, or after the surgery. You can only code the service, however, if the line for the epidural or nerve block is not also used for anesthesia administration during surgery. If it is, you should only report the appropriate anesthesia CPT code for the surgery and not separately code for post-op management.

After you can legitimately report the post-op management, look at following CPT codes as options:

• CPT code 62310 or 62311 ( Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid …)
• CPT code 62318 or 62319 – (Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid …)
• CPT code 64400-64530 – (Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic procedures on the extracranial nerves, peripheral nerves, and autonomic nervous system)

Append modifier 59 (Distinct procedural service) to specify that the anesthesiologist placed the nerve block or epidural for post-op management in place of intraoperative anesthesia. Remind the anesthesiologist to involve a procedure note in the patient's record documenting the block's purpose.

Medical Billing and Coding Tip: Watch Details of Post-Global Help

The surgeon might from time to time demand pain management services after the postoperative anesthesia care period ends. You can certainly code for this situation without thinking much about the fact that the care might be misconstrued as part of the surgical anesthesia. Though, CCI guidelines make clear that you still must append modifier 59 to the correct code for pain management services.

Enhance Your Practice's Bottom Line with These Easy-to-Implement Strategies

Medical Billing

The bonus: You'll help meet your patients' changing payment needs, too.

Each dollar counts in your practice and finding ways to enhance your medical billing and collections -- and then your practice's bottom line -- is vital. Discovering new, innovative ways to meet your patients' medical billing/payment needs and taking up new technologies will guarantee your practice getting every dollar it deserves.

With patients assuming greater percentage accountability for their medical bills, there has never been a more significant time for practices to evaluate the ways they use to process and collect payments.

Start with These 12 Ideas

Take a look at this rundown of medical billing and payment ideas that may help your practice enhance customer service and increase the bottom line. Then, implement the ones that work in your practice and watch your A/R improve.

All practices must consider adopting at least one of these 12 payment and medical billing ideas this year:

1. Convenience Fees: Think of either a 'No Fee to Biller' model by means of pre-set uniform convenience fees which is collected by your processor to retain 100 percent of your billable amounts, or a 'Biller Keeps the Fee' model to generate a new revenue stream and predict the positive impact to your medical billing and collections.

2. Account Verification: Confirm the correctness of the customer's account information and likeliness of positive pay prior to establishing recurring payment plans to evade costly and time consuming setups or frequent returned payments.

3. Virtual Agents: Allow computer-based algorithms handle payment options on succeeding account balances leaving agents as well as customer service reps free for further tasks.

4. ACH: Receive payments via ACH and decrease your processing fees increasing customer satisfaction through providing more competent cash management capabilities compared to traditional paper payments.

5. Cash Payments: Aid your underbanked customers make payments and settle debts by taking electronic cash payments – besides eliminate the risk of managing cash at your locations.

6. E-Billing (EBPP): Decrease your medical billing 's paper and postage costs by introducing e-billing and payment processing so customers can have their bills and pay online while also decreasing your Days Sales Outstanding (DSO) and operational costs.

7. Text payments: Customers appreciate this emerging technology. It offers a convenient option for busy mobile-savvy people; they can get bill reminders and authorize payment by text message.

8. PURLs for Personalized Payments: It is evident that one-time-use personalized URLs inspire electronic payments from paper statements and invoices, thus customers can quickly pay online however disregarding the need to create a profile or you must log into a public online payment portal.

9. Check 21: Substituting electronic images of checks simply means faster access to check payments and greater productivity than physically transporting paper checks in your medical billing procedure . Check 21 empowers non-standard paper checks for instance business checks to be converted to electronic images for processing.

For More Information :-

Medical Billing

Concentrate on the level of wound repair to maximize your reimbursement.

A lot of clinical scenarios do not need dermatologists to carry out debridement as a distinct service from wound closure. Though, recognizing the times when it is essential can help your practice get the full reimbursement it is worthy of. Follow the expert medical billing and coding advice given below and know what CPT codes apply.

In case you're considering reporting debridement distinctly from a wound closure, ensure that your dermatologist's notes clearly document that the wound was contaminated and needed instrumentation and saline or other substances to cleanse and debride the wound. You would require doing a sharp removal to use the debridement code.

Don't miss: In case you report a debridement code, for instance 11040 (Debridement; skin, partial thickness), along with your wound closure CPT codes, append modifier 59 (Distinct procedural service) to the debridement code. This tells the payer that you recognize that debridement is mostly bundled into wound repair, however that clinical circumstances needed the dermatologist to carry out debridement as a separate service.

1. Watch Out for Wound Repair With the Debridement

CPT® specifies that you might also report debridement CPT codes independently of repair CPT codes once the dermatologist gets rid of large amounts of devitalized or contaminated tissue or once the dermatologist carries out debridement without immediate primary repair of a wound.

The dermatologist might clean debris from the wound excluding repairing the wound as it was not deep enough to need repair or the dermatologist delayed the repair because of an extenuating circumstance.

For instance: The dermatologist may not have sufficient time to repair the wound at that particular time, or the patient may present with a more important skin condition that needs medical attention first. In such an instance, you can bill debridement for full, distinct payment minus a wound repair code.

Even though dermatologists most commonly clean a wound instantly before they repair it, you wouldn't report a debridement code separately. Don't miss: The debridement procedure may also require a repair procedure that will affect your medical billing report.

2. Don't Oversee Intermediate Wound Closure for Your Extensive Debridements

In case the dermatologist carries out a simple repair with nominal amounts of debridement, for example, you must only report a simple repair code (12001-12021). In case that same wound requires extensive cleaning or removal of particulate matter, you may, as an alternative, report an intermediate repair code (12031-12057).

Money opportunity: There is an important difference in payment between simple plus intermediate repair CPT codes . Reporting code 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) will reimburse you about $93.60, whereas 12031 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.5 cm or less) may pay $235.20.

Bust 4 Myths to Ace Tracheotomy Claims

Medical Billing

Be cautious of separate-procedure status of planned tracheostomy.

In case you're making assumptions about how should you report tracheostomy procedures, you could be costing your practice a lot of money. To make certain this won't happen to you; let our medical billing coding experts guide you through these four steps to ace tracheostomy coding.

Myth #1: A Planned Trach is No Dissimilar than an Emergency One.

CPT makes a major distinction between "planned" and "emergency" tracheostomy, and thus you must decide which of these conditions best defines the procedure when choosing CPT codes. So what's the difference?

In an emergency procedure, the patient is immediately endangered if the physician doesn't carry out the procedure. In other words, the airway is so compromised that the patient is already obstructed or may obstruct at any moment.

Use common sense: Simply because the ENT sees a patient and decides to carry out a tracheostomy that same day doesn't imply you have an emergency. Rather, an emergency tracheostomy must take place due to an immediate, life-threatening situation.

You must report such emergency procedures using one of two CPT codes:

• 31603 –(Tracheostomy, emergency procedure; transtracheal)
• 31605 – (…cricothyroid membrane)

These two procedures are different according to the location at which the surgeon carries out her incision.

Myth #2: All Trach Codes Have a Zero-Day Global Period.

In case the ENT uses skin flaps to make a more permanent stoma (opening) -- for instance for patients going through multiple sclerosis, amyotrophic lateral sclerosis (ALS) or further chronic conditions that cause breathing difficulties -- you must turn to 31610 (Tracheostomy, fenestration procedure with skin flaps).

Medical Billing & Coding Tip: At times physicians will use the terms "Bjork flap" or "inferior tracheal flap" to define skin flaps used in this kind of tracheostomy.

Global concerns: CPT Code 31610 is the lone tracheostomy procedure to include a 90-day global period. All added trach procedures have a zero-day global period.

Myth #3: Always Report Trach Code, Even if It's An Incidental Procedure.

As CPT describes all planned tracheostomies as "separate procedures," you must ensure that any trach the ENT offers is not essential to a more extensive procedure. In case the trach is incidental (that is, performed as a part of another procedure), you may not report it distinctly.

Example: In case the ENT carries out tracheostomy during laryngectomy (31360-31390) or large glossectomies (41140-41145), you may not report the tracheostomy separately. Reasonably, payment for the trach is included in the fee for the added extensive procedure, of which it is a part.

Myth #4: Patient's Age Doesn't Matter.

In case a planned tracheostomy occurs on a patient who is less than 24 months old, you should report CPT code 31601 (… under two years) rather than 31600,

Be aware: The "separate procedure" limitations apply to 31601 just as they do 31600. Consequently, for children under 2 years old, you must not report CPT code 31601 in case the tracheostomy is a part of an added extensive procedure.

Improve Your Hyperplasia Diagnosis Coding Skills Before Oct. 2013 Hits

You won't find one-to-one matches for all your existing ICD-9 codes.

In case a pathology report comes back along with a hyperplasia diagnosis, then there are five possible ICD-9 codes you can report. On the other hand, in ICD-10, you'll only have three choices.

Hyperplasia defined: When hyperplasia takes place, this means the patient has a rise in the number of cells. In the instance of endometrial hyperplasia, this implies that the cells have multiplied in the endometrium, or the inner lining of the uterus.

An endometrial intraepithelial neoplasm is essentially a precancerous lesion in the endometrium that makes the uterine lining more prone to endometroid endometrial adenocarcinoma.

ICD-9-CM Codes: Here are the ICD-9 codes that apply:

621.30 (Endometrial hyperplasia, unspecified)

621.31 (Simple endometrial hyperplasia without atypia)

621.32 (Complex endometrial hyperplasia without atypia)

621.33 (Endometrial hyperplasia with atypia)

621.35 (Endometrial intraepithelial neoplasia [EIN])

ICD-10-CM Codes:

N85.00 (Endometrial hyperplasia, unspecified)

N85.01 (Benign endometrial hyperplasia)

N85.02 (Endometrial intraepithelial neoplasm [EIN])

ICD-10 Change: In the incident of 621.30 and 621.31, you have a one-to-one relationship between your ICD-9 codes and ICD-10 counterparts (N85.00 and N85.01 respectively). Though, ICD-10 rolls 621.32, 621.33, and 621.35 into N85.02.

Documentation: Additional terms for N85.00 contain "hyperplasia (adenomatous) (cystic) (glandular) of endometrium" and "hyperplastic endometritis." A note listed beneath N85.01 includes "endometrial hyperplasia (complex) (simple) excluding atypia. Furthermore, another note under N85.02 is "endometrial hyperplasia with atypia."

Watch out: Assume the provider doubts hyperplasia. He identifies and documents "endometrial thickening" in an ultrasound examination. What diagnosis should you report? JSimply because the provider documents endometrial thickening does not imply that the patient actually has endometrial hyperplasia. A lot of coders make this mistake. You must not code this as hyperplasia as physicians don't always take the thickening of the uterus "abnormal;" in fact; it's simply a monthly "ramp up" for all women. For ICD10, this condition has been referred to R93.8 (Abnormal findings on diagnostic imaging of other specified body structures). You will discover this in the index by searching the term "thickening, endometrium.

Medical Billing and Coding Tips: You should not report hyperplasia until the provider has executed a biopsy, and you have a pathology report that confirms this condition.

ICD-9-CM to ICD-10-CM Transition Update: You have an Excludes1 note in the N85.-- classification, you'll see an Excludes1 note that prevents you from reporting these codes with endometriosis (N80.-), inflammatory diseases of uterus (N71-), noninflammatory disorders of cervix, excluding malposition (N86-N88), polyp of corpus uteri (N84.0), plus uterine prolapse (N81-).

You'll also discover another Excludes1 note under N85.02 preventing you from reporting this particular code with malignant neoplasm of endometrium (with endometrial intraepithelial neoplasia [EIN]) (C54.1).

For More :- http://www.supercoder.com/coding-newsletters/my-ob-gyn-coding-alert/icd-10-hone-your-hyperplasia-diagnosis-coding-skills-before-oct-2013-hits-109988-article

Consolidated Billing: Ensure Payment for Your NF Services With These 3 Simple Steps

Defining whether a patient is in a Part A or Part B stay is vital to proper reimbursement.

A lot of practices deal with a patient who is staying in a nursing facility at certain point. When that time comes and your physician sees a nursing facility patient in your office, your task is collecting appropriate reimbursement for those services. Read this expert medical billing article for more.

The challenge: A patient's nursing facility NF status -- whether the patient is in a Part A-covered stay or a Part B-covered stay -- defines how you are supposed to carry out medical billing for your physician's services, and in case you're not following consolidated billing rules you'll continue to lose part of your fees.

Good news: If you follow these steps, you'll ensure proper medical billing and payment every time.

1. Know Consolidated Billing and How It Affects Your Practice

Prior to you can start billing for services your physician carries out for nursing facility patients, you are required to figure out what consolidated billing really is and how does it affect your medical billing process.

How it works: Medicare's 'consolidated billing' is essentially a payment methodology that reimburses nursing facilities in a lump sum payment for entire facility services the patient may require in the course of a Part A nursing facility stay. Besides paying for the bed and using services the patient receives, the payment moreover covers other 'facility-type' services the patient may require to receive. The lump sum payment rate remains the same whether the patient gets these additional services or not.

Here's why it matters: As Medicare Part A normally covers nursing facility patients as well as consolidated billing rules apply, you can only report definite services to Medicare. When patient visits your office, in case the patient is in a covered Part A stay, the facility is accountable for the payment for the technical component services.

2. Check the Patient's Status

In order to ensure accurate medical billing and collect for nursing facility patient services is to in fact contact the facility to confirm whether the patient is in a Part A or Part B stay. In case he is not covered by Part A, you might bill your Part B carrier for the entire services you offer.

However in case his nursing home stay is covered by Part A, you are about to enter the world of consolidated billing. This really should start, not during medical billing, however with appointment scheduling.

3. Leave the Professional Part to Medicare

For services including both a technical and a professional component that your physician carries out for a nursing facility patient in your office, you must report only the professional component – for instance the written interpretation of an x-ray -- to your Medicare carrier/MAC.

Medical Billing Update: For a lot of the medications your physician may administer to a nursing home patient in a Part A stay, Medicare Part B will not reimburse you in the normal manner.

Laparoscopy Coding: 50544: Let 3 Scenarios Direct Your UPJ Obstruction Coding

Don't lose out on additional procedures as well as services for which you deserve reimbursement.

Laparoscopic procedures are becoming more usual in urology practices as well as pyeloplasty procedures are certainly no exception. Don't let this new surgical technique have adverse effect on your medical coding and cost your practice money. Take a look at three common clinical scenarios in coding pyeloplasty procedures to correctly apply ICD-9 and CPT codes.

Look for Bundles Involving Laparoscopic Pyeloplasty

Scenario 1: Your urologist carries out a laparoscopic pyeloplasty which is meant for a UPJ obstruction. He also executes a preoperative cystoscopic examination as well as retrograde pyelogram and keeps a double J stent.

First: In this case you must bill first for the highest paying service, the laparoscopic pyeloplasty (50544, Laparoscopy ,surgical, pyeloplasty) as your primary procedure code. The suitable ICD-9 diagnosis code is 753.21 (Congenital obstruction of ureteropelvic junction).

Then you must bill for the insertion of the JJ stent by means of 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]). Append modifier 51 (Multiple procedures) in case your payer needs that modifier for multiple procedures performed during the same session and assign ICD-9 codes 591 (Hydronephrosis) and V07.8 (Other specified prophylactic or treatment measure).

For More Information :- http://www.supercoder.com/coding-newsletters/my-urology-coding-alert/laparoscopy-coding-50544-let-3-scenarios-guide-your-upj-obstruction-coding-article

Add All Renal Procedure Codes When Carried Out

Scenario 2: Your urologist carries out a renal endoscopy through a formerly placed established nephrostomy site, gets rid of a small renal pelvic stone, replaces the nephrostomy tube, and carries out a nephrostogram revealing a ureteropelvic junction obstruction. He then chooses to execute a laparoscopic pyeloplasty meant for a UPJ obstruction.

Start the same way: Similar to the first scenario, you'll first report 50544 for the laparoscopic pyeloplasty as that code again carries the highest relative value units (RVUs). Again, you'll use 753.21 as the ICD-9 diagnosis code.

Next, you must report 50561 (Renal endoscopy through established nephrostomy or pyelostomy, including or excluding irrigation, installation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus) for the renal endoscopy with stone removal. Append modifier 51, if required.

ICD-9 and CPT Coding Tip: You can moreover bill the removal and replacement of the nephrostomy tube with 50398 (Change of nephrostomy or pyelostomy tube). Attach 51, if your payer requires that modifier. Assign ICD-9 diagnosis code 591 to 50398.

Confront Vessel Excision With 50544

Your urologist executes a laparoscopic pyeloplasty for a patient with a UPJ obstruction. He also carries out an excision of crossing venous vessels. Prior to the procedure he also executes a preoperative cystoscopic examination and retrograde pyelogram and then he places a double J stent.

ICD-9 and CPT Coding Tip: Stick with 50544: Similar to the last two scenarios, you'll report the laparoscopic pyeloplasty as the primary procedure by means of 50544 with ICD-9 diagnosis code 753.21.

After that you must report 55550 (Laparoscopy, surgical, with ligation of spermatic veins for varicocele) for the excision of crossingvenous vessels. Attach 51 if required. You'll assign ICD-9 diagnosis code 747.62 (Renal vessel anomaly) for this diagnosis.