Improve Your Endoscopy through Stoma Reporting with Useful Coding Tactics

Multiple endoscopy rules don’t apply when you report an endoscopy through stoma along with a flexible sigmoidoscopy.

Using colonoscopy code sets (45378 -- 45385) when your gastroenterologist performs a colonoscopy through a stoma is not correct. Instead, you will have to use another set of codes to correctly capture reporting for these procedures. We look at some helpful coding tactics that will help you correctly report these procedures:

Basic procedure      

                                                                 

If your gastroenterologist performs an endoscopic procedure through a stomal opening, your reporting will be based on the surgical procedure carried out previously when the stoma was created. If the initial procedure was a colectomy with an ileostomy, report an endoscopy through stoma using ileoscopy through the stoma codes (44380 -- 44382, Ileoscopy, through stoma...).

If your gastroenterologist performed a partial colectomy and a colostomy prior to this, you need to report an endoscopic procedure through stoma using colonoscopy through stoma codes (44388 -- 44397, Colonoscopy through stoma...). If the previous procedure involved the creation of an ileal pouch before it connects to the stomal opening, report an endoscopic procedure through stoma using 44385 – 44386.

All procedures are not listed through stoma

If you report an endoscopic procedure through a stoma, you’ll realize that there are not many codes that you can use to report all therapeutic procedures performed by your gastroenterologist. More specifically if you have to report an ileoscopy through stoma or an endoscopic evaluation of a small intestinal pouch. Your only reporting options are: 44380, 44382, 44383, 44385, 44386 

The code sets for colonoscopy through stoma are more detailed and include most of the procedures that your gastroenterologist might conduct through the stomal opening.

Exception: But there are some procedures such as dilation of the stoma using a bougie or a balloon during a colonoscopy through stoma that do not have specific procedural codes. 

What do you do when you have to report a procedure performed by your gastroenterologist that’s not covered under these codesets? To report the procedure, you will have to use an unlisted code 44799 (Unlisted procedure, intestine).

What about Sigmoidoscopy?

In many case, post a partial or a complete colectomy and stomal creation, your gastroenterologist may need to examine the rest of the lower intestinal structures to check for healing or recurrence of the condition for which initial procedures were performed. 

In such circumstances, your gastroenterologist may perform an endoscopy through the stoma as well as conduct a sigmoidoscopy through the rectum to check the distal intestinal structures. You can bill a flexible sigmoidoscopy with a colonoscopy through stoma. 

Why? The basis is that the two procedures have different entry points as well to visualize different components of the colon. As such when both procedures are performed, you can report them together.

Remember: Multiple endoscopy rules are not applicable when you report an endoscopy through stoma along with a flexible sigmoidoscopy. Expect complete pay for both procedures when you report both these procedures together. Also note that each payer may have their own policy regarding the two being billed together. So check with each payer prior to billing.

Coding and billing for colectomy and sigmoidoscopyand other services that your gastroenterologist performs everyday is not easy. That’s why you need a gastroenterology coding resource that simplifies your task and supports your goals for error-free, compliant and revenue-capturing coding and billing. You could try Gastroenterology Coder that assists correct coding and billing with a number of time-saving online tools and resources specific to gastroenterology.

Get Ahead on MPFS, MRI, and ABN Changes

Don't omit the proposal to expand the MPPR starting from technical to professional payment.

As if imaging practices didn't get sufficient bad news in 2011, CMS's payment proposals for 2012 show the situation could get even worse. Look out for the proposed fee schedule changes, as well as news for MRI and Advance Beneficiary Notices (ABNs). Read on for expert radiology medical coding information and take a step closer towards accurate and profitable radiology coding.

1. Concentrate on Possible Imaging Fee Cuts

CMS released its planned Medicare Physician Fee Schedule(MPFS) for 2012. The 621-page document proposes a look into how the agency organizes its relative value unit (RVU) assignments.

Imaging pay, hit rigid over the last years, will observe additional cuts in case the proposed rule is finalized. Presently, while you carry out numerous radiological procedures on the Multiple Procedure Payment Reduction (MPPR) list in a single session, Medicare decreases the technical component of the lower paid procedure(s) by 50 percent.

However Supercoder CMS wishes to further decrease those payments, noting in the proposal,

The cuts: CMS is suggesting that in 2012, it will not only reduce the technical component of radiological procedures by 50 percent, but also will slash the professional component by 50 percent. It also maintains that payment cuts to radiology procedures could be even more in 2013 and beyond.

Professional societies were fast to criticize CMS's radiology cuts. The AMA strongly opposes a proposal to use noteworthy cuts to Medicare payments for diagnostic imaging to balance the cost of a trade agreement.

Besides, various radiologists maintained that multiple interpretations of exams carried out on one patient aren't less tedious than multiple interpretations of distinct patients. The time, intensity, as well as the mental effort it takes to interpret an individual exam is comparatively persistent irrespective of whether the patients' exams are interpreted distinctly or at the similar session. Medicare must support such quality care and not constantly attempt to weaken it.

Coverage for MRI Update Is Now Official

CMS has offered decision memo in support of including MRI scans for patients with MRI-safe pacemakers. At the present that decision memo is declared official.

CMS is firm that the evidence is sufficient to determine that magnetic resonance imaging (MRI) develops health results for Medicare beneficiaries with implanted permanent pacemakers (PMs) while the PMs are used as per the FDA approved labeling for use in an MRI environment.

Use New ABN by Nov. 1

It might appear like just yesterday that you moved to the most recent version of the ABN, but it's in reality time to upgrade again to a newer version.

Want to know get more radiology coding expert advice like this? Click here to read the entire article and to get access to our monthly Radiology Coding Alert: Your practical adviser for ethically optimizing Radiology medical coding, payment and efficiency in radiology practices.

Read more to perfect your radiology medical coding:

Optimize Payment For Occupational Therapy With CPT 97530

You can use 97530 to report dynamic therapeutic activities in a one-on-one setting, in which the therapist examines and treats the patient's limbs and leads them in exercises to increase his/her strength, flexibility, etc.

What are therapeutic activities?

Therapeutic activities involve the use of such parameters as balance, strength, and range of motion, etc. for an improved everyday functionality, and these are advised to patients who require rehabilitative techniques. Through the use of graduated weights and using a series of movements (such as bending, lifting, carrying, reaching, catching, and overhead activities), therapeutic activities increase the body's flexibility, strength, and coordination. These can be specifically designed for a particular body part or they could work on improving the functioning of the entire body in a progressive manner.

Who can report 97530?

The code 97530 is intended for use only by trained occupational therapists, who design therapeutic activities; massage therapists are not eligible to report this code for their services.

Team therapy

Supercoder CMS says that when two or more therapists or therapy assistants work together as a "team" to treat a patient, you cannot bill separately for the same or different service provided at the same time to the same patient. Also, where a physical and occupational therapist both provide services to a patient at the same time, only one therapist can bill for the entire service or the PT and OT can divide the service units. For example, a PT and an OT work together for 30 minutes with one patient on transfer activities. The PT and OT could each bill one unit of 97530. Alternatively, the 2 units of 97530 could be billed by either the PT or the OT, but not both.

Coding confusion-97110 or 97530?

The similarities between CPT 97110 and CPT 97530 (both are time-based-billed per 15 units, focus on balance, strength, and range of motion, and need direct one-on-one contact by the provider) can lead to wrong code choice and a possible denial. Here's how you can pin down the appropriate code:

    Choose 97110 when the activity is performed to achieve only one of the following: strength, endurance, range of motion, or flexibility.

    Go for 97530 when the activity is performed to achieve multiple parameters and improved functional performance (e.g., lifting, pulling, and bending).

Revised PQRS Measures In Anesthesia Coding This Year

CPT code for the year 2014 doesn’t introduce any new category I codes in anaesthesia coding , but anaesthesia providers need to take care of the category II section. Here are some revisions that you need to incorporate in your practice:

              

·         Patient Transfers Gets Two New Codes

Two new codes, 0581F (Patient transferred directly from anesthetizing location to critical care unit) and 0582F (Patient not transferred directly from anesthetizing location to critical care unit) has been incorporated in the category II section that will help to describe how the patient has been transferred to the critical care unit from the treatment location. These codes will help to understand the condition of criticality of the patient upon transfer of care and is looked upon as a new PQRS measure in anaesthesia coding.

Although these codes were implemented in 2013, they are being incorporated in the PQRS anaesthesia measurement codes in CPT 2014.

·         Anaesthesia Measure 193 Changes With The Introduction Of Four New Codes

Four new codes 4553F, 4555F, 4559F, 4560F has been added to category II codes that is a change to the present PQRS measure 193 for anaesthesia. Now this can end up being a little confusing because currently you report performance measurement codes 4250F-4256F for postoperative temperature management. But, since these codes will be very much effective and in use in 2014, their similarity to the new codes that have been introduced, it can lead to errors and denials. So you need to be very cautious while reporting these codes.

Experts believe that only detailed clarification for these new codes will enable accurate reporting of these codes. Additionally, your staff should follow anaesthesia PQRS updates annually to steer clear of errors.

·         Take Note Of Hypothermia Code Changes

Two hypothermia codes in the category III section that were introduced in 2012 will now find a new place in category I this year.

Code 0260T will now be 99481 with the description total body systemic hypothermia in a crucially ill neonate per day and code 0261T will change to 99482 and will describe selective head hypothermia in a critically ill neonate per day. 

But there is a word of caution associated with these codes. Although these CPT codes represent controlled hypothermia they are not intended for anesthesia providers. Experts warn that for hypothermia only codes for qualifying circumstances are used until and unless it is there in the base value of the anaesthesia code. 

In case your provider uses hypothermia but it is not inherent to the anesthesia service, one can use 99116 in the claim. Using this particular code is safe and beneficial for your practice as it adds to your total five base units as the word demanded from your anaestheologist is also of a high level.

Although these changes are minor, one needs to be careful and stay updated with all the changes to keep your practice on track.