Apply These Added Tips for EEG Reporting Success

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

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

Identify Any Digital Analysis

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

Time the Physician Attendance

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

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

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

Beware Hidden Bundles

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

Distinguish Routine Polysomnography

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

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

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

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

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

Establish Chest X-ray Distinctness From Thoracentesis To Ignore Bundle

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

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

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

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

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

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

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

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

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

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

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

CCI 17.3 Adds 1,380 New Edit Pairs, Deletes 835 Pairs

The latest CCI edits (17.3) that went into effect on October 1 this year, has added 1,380 new edit pairs. So if you try to report X-rays with some chest procedures, you may be in for a disaster. Here's what to watch out for:

Some of the just-in edit pairs you will want to keep an eye on bundle chest X-rays into chest tube procedures. Since these edits have a modifier indicator of 1, you may override the edits with a modifier on the column 2 code when the services are distinct.

Closer look at overriding edits

In some clinical circumstances you can override – and not ignore – CCI edits and get separate payment for bundled codes. You should first check the "modifier indicator" to figure out if you can bill services separately; first check the 'modifier indicator'.

How it functions: All edits comprise code pairs that are arranged in two columns. Codes that are listed in Column 2 are not payable if carried out on the same day on the same patient by the same provider as the code listed in Column 1; unless the edits permit the use of a modifier associated with CCI.

A "0" indicator means that you can't unbundle the two codes under any circumstances. However, an indicator of "1" means that you may use a modifier to override the edit if the clinical circumstances warrant separate payment.

The most widespread modifiers that Part B practices use to override an edit pair are 25 when used with an associated E/M code or modifier 59 when two non-E/M services are carried out and no other modifier is there to report the two separate and distinct services.

Documentation: Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury not ordinarily encountered or carried out on the same day by the same individual.

This time CCI deletes 835 pairs; a large number of those eliminate edits with vascular introduction and injection procedures in column 1. As a matter of fact, more than 10 percent of deletions involved edits with a column 1 code of 36147.

Among the deleted codes, you will particularly want to pay attention to the deletion of edits with a modifier indicator of 0.

CCI 17.1: Get on Top of These Three Key Highlights for Cardiology This Quarter

Take a look at these major pointers to comply with the just-in cardiology-related edits, including cardiac catheterization, radiological supervision and interpretation, cardiac rehabilitation, and more.

Avoid denials by remembering 93454-93461 are diagnostic

Just-in edits will prevent you from reporting heart catheter/angiography codes 93454- 93461 (column 2) with the following cardiovascular therapeutic services and procedures (column 1):

92975, 92980, 92982, 92995

Take away: In column 1, the 929xx codes describe coronary therapies. You shouldn't use the 934xx diagnostic codes in column 2 to report catheter placement and coronary angiography performed as an integral part of the therapeutic column 1 services.

Opportunity: The edits have a modifier indicator of 1; as such you may override them with a proper modifier when the procedures are distinct. If you report both codes in the edit pair and do not add a modifier to the column 2 code, Medicare will reimburse you for only the column 1 code.

The AMA, via CPT Assistant (April 2005), indicates that you may report a true diagnostic catheterization apart from the therapeutic procedures described by 92980 and 92982:These two distinct procedures, therefore, should be reported separately when carried out at the same session or on the same day at a different session."

When the cardiologist does carry out a distinct 93454-93461 diagnostic service on the same date as a cardiovascular therapeutic service, you should append modifier 59 (Distinct procedural service) to the diagnostic code. You may also require to add modifier 51 (Multiple procedures).

Modifier 59 identifies the procedure as being a distinct procedural service while modifier 51 identifies multiple procedures were performed during the same session. Even though CPT identifies many codes as modifier 51 exempt, 93454-93461 are not currently exempt. But then, Medicare and other payers may tell you not to use modifier 51 since they'll apply the multiple procedure rule themselves.

Hints: You should also add modifier 26 (Professional component) to 93454-93461 when you need to indicate you're reporting only the professional component of the service. The Medicare physician fee schedule shows different PC and TC for these codes.

Follow S&I instructions to stay compliant

Like many other existing edits, a large number of the just-in cardiology-related edits help keep your coding in line with CPT guidelines for using radiology codes with procedure codes.

Example 1: Code 0236T includes radiological supervision and interpretation (S&I) in its definition. As such, you should not be surprised to know that the latest CCI bundles radiology codes 75600-75630 (Aortography … radiological supervision and interpretation) into 0236T.

Example 2: Now CCI bundles 75600-75774 and 75810-75891 into 37205. But then this should not restrict your coding since a CPT instruction with 37205 tells you that the proper code for S&I related to 37205 is 75960.

Good move: To stay away from denials, check code definitions, CPT guidelines, and CCI edits prior to reporting an S&I code with a procedure code – both to ensure you report the proper S&I code for the procedure and to be sure you comply with CCI edits.

Watch for blood draw, pulmonary services, EEG and others

In the latest CCI, it bundles many of the same column 2 codes into the following column 1 codes:

93660, 93724, 93797-93798

While the column two codes in the edits are not entirely identical for each of the column 1 codes above, there is a definite pattern. Here's a sampling of the column 2 codes:

364xx, 366xx, 37202, 43752, 94xxx, 958xx, 95955

Bottom line: Before you report a tilt table exam, an antitachycardia-pacemaker analysis, or outpatient cardiac rehab code, take a look at the CCI edits to verify that you haven't included one of the many bundled codes on your claim.

CCI Edits 16.3: Include Wound Repair In Free-Flap Grafts or Risk Denials

The latest CCI edits 16.3 that went into effect on October 1 this year creates a coding bundle naming simple wound repair codes 12001-12007 and 12041-12047 as intrinsic components of 15756, 15757, 15758.

What does this mean? In the above pairings, CCI lists the wound repair codes as column 2 codes, which means they are considered components of the comprehensive codes (15756-15758) under Column 1.

Do not miss: These bundles have a modifier indicator of one; as such you may use a modifier like 59 to override the edit if the clinical circumstances merit separate reimbursement like a separate encounter on the same date, a separate anatomical site or a separate indication.

Catch this debridement/site prep bundle

The latest CCI edits (Source "http://www.supercoder.com/coding-tools/cci-edits-checker/") addresses another aspect of your skin graft coding with a new edit bundling 11040 as a component of 15002. This edit indicates that Medicare considers debridement to be an essential component of site prep procedures. But CCI has also marked these bundles with modifier indicator 1 so you may report 11040 along with 15002 or 15004 under appropriate clinical circumstances with an appropriate modifier.

New edits target hematoma, nail repair

From October 1, CPT code 11740 includes 11730. As with other CCI edits, these bundles are marked with modifier indicator '1', allowing separate reporting if clinically necessary, with the right modifier appended to the component (column 2) code.

These would not be used together on the same site. They would have to be carried out on different nails.

Modifier 51 or 59? Choose Carefully

The physician controlled a patient's hemorrhage (30901) and removed a benign lesion from patient's temple (17110) during the same encounter. How should you go about this situation – report modifier 51 or 59?

As per coding rules, you should append modifier 51 (Multiple procedures) only when the doctor completes multiple procedures during the same encounter, and to add modifier 59 (Distinct procedural service) only when the two procedures you want to submit are not usually submitted together but are proper under the circumstances. Often modifier 59 is used to code pairs that have an active bundling edit through the correct coding initiative (CCI). Present CCI edits don't bundle codes 30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method) and 17110 (Destruction [example laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions).

You will most likely find different opinions on whether to add modifier 51 or 59. Some medical coders go for modifier 51 since most payers will process the encounter as a multiple surgical reduction irrespective of whether you include the modifier or not. Other medical coders recommend modifier 59 since reporting 51 could set you up for one of three undesirable (or at least aggravating outcomes); the payer does not bring down the payment correctly; the payer denies the entire claim; or the payer requests additional documentation prior to considering payment. Of the two modifiers, most probably modifier 51 is most appropriate in this example.

Source URL :- http://www.supercoder.com/coding-newsletters/my-family-practice-coding-alert/reader-questions-choose-carefully-between-modifiers-51-and-59-article

Tip you can follow: Whichever modifier you choose, add it to the lowest relative value units – (RVUs) -- in this instance, code 30901 with 2.82 relative value units.

What's more, double-check the code you are submitting for the lesion removal. As noted, the code you indicated (17110) is for destruction of a lesion by one of various methods. If the doctor removed the lesion through excision, you'll need to use a code from the series of codes for excision of benign skin lesions, 11400-11446.

Seven Key Billing Practices to Get the Payments You Deserve

When your practice is feeling pinched, it is important to ensure that you are not forgetting to bill for everything your practitioner performs and documents.

It's known to all that Medicare coding rules are tough and challenging; and sometimes it's difficult to gather which services you can bill rightfully. However if you remember these seven key billing practices, you will be collecting all of the pay you rightfully deserve.

Bear modifier 50 in mind: Many procedures are inherently unilateral and you will not get full reimbursement for bilateral versions of those procedures unless you add modifier 50 (Bilateral procedure).

Be careful: Often medical coders forget the modifier 50, and if your doctor performs and documents a bilateral procedure for one of those services, see to it that you submit your claim for a bilateral service.

Gather copays at the visit: You will save yourself time and money later on if you calculate copays following a patient's service and collect that money before they leave your office.

Bear in mind: If it is not a copay, you can gather it before the patient sees the doctor. Just because a doctor plans to carry out a service does not mean he will perform and document it properly. As such, it is a good idea to gather after the patient has already seen the practitioner.

Some coders are of the opinion that if the correct coding initiative (CCI) forbids billing two codes on the same date, that is the end of the story. However in fact, you may be missing out on some legitimate cases where CCI allows you to use a modifier like 59 (Distinct procedural service) to override an edit.

Always scan the CCI edits ( Source "" ) for the procedures you carried out to see which code pairs a modifier can override. You should of course only use the modifier 59 when the services are separate, distinct, and medically necessary, and the doctor has thoroughly documented the distinct nature of both services.

Keep a watch for supervision and interpretation: You need two codes – the S&I code plus a surgical code for many invasive/ diagnostic radiology codes. Regularly, coders forget to add the surgical code, moreso on the outpatient hospital claims.

For instance: You may keep in mind to report CT guided needle biopsy code 77012; however leave out the associated site-specific percutaneous needle biopsy code.

When you feel you've been wronged, appeal: As many practices fear being labeled "troublemakers" or even worse yet, non-compliant with the FCA's regulations, they accept Medicare payers at their word and this is not always a good idea.

If your MAC denies your claim or requests a refund, investigate the issue before you take the payer's word for it. You should make an appeal any time you feel your payer has denied your claim wrongly or erroneously requested a refund.

Ensure you have up to date coding guidelines

In some practices, coders have not updated their CPT, ICD-9-CM, or HCPCS coding manuals in years as they do not think that changes are enacted often enough to warrant purchasing new books. But then outdated codes can lead to claim rejections. What's more, the modifiers, coding rules, and parenthetical notes also change from year to year, and it is tough to understand which regulations apply if you do not have present resources. If you use a computer-based program for these resources, you can normally get all the updates through there; however paper manuals should be annually replaced.

Join outpatient E/M with initial hospital care record for same-day admits

If you witness a patient in your office and then perform initial inpatient care for the same patient on the same date, you should report one E/M code only.

When the doctor provides both services on the same date, combine the work documented in the office with the work documented in the hospital to figure out the proper level of initial inpatient care (99221-99223).

Easy Guidelines - Profit $16 from 94664

One thing you should remember while reporting for inhaler demo/ evaluation is the type of service the provider is using; however do not stop with just that. When coding for inhaler services, documentation requirements and qualifying modifiers are just as important.

When you are confused why some payers would deny reimbursement for some inhaler claims, here are some ideas that could guide you to a better understanding of how inhaler service codes work out.

Your ticket to diskus demo pay: 94664

If the nurse or medical assistant taught someone to use an Advair Diskus (Advair Diskus is an “aerosol generator) -- or any other diskus, you should code 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).

Bundle dose in teaching session

The patient may administer medication dose during the teaching session. Both services (treatment + teaching) are bundled into one CPT: 94640; as such you should not report them separately.

Here's why: The administration was carried out as part of the demonstration/evaluation.

Separate education? End it with modifier 59

During an outpatient visit, an asthmatic patient is wheezing and having breathing problems; this requires one or more bronchodilator treatments for intervention: 493.01; 493.02; 493.21, or 493.22. Prior to the visit, the patient did not use his MDI device, nebulizer and the like properly; therefore after the treatment, he was given an education about the use of these devices.

Report it: First, report 94640 (adding modifier 76, Repeat procedure or service by same physician, to separate line items of 94640 for multiple treatments) apart from the proper E/M code minus a modifier, unless the payer needs modifier 25 with the E/M. Then code 94664 with modifier 59 (Distinct procedural service), as the patient required additional instruction for his daily maintenance medication.

This is dissimilar from the medication provided for immediate intervention – 94640.

To put it briefly: If the patient required separate education after receiving an inhalation treatment on the same day, you'd bill both services (treatment plus education) adding modifier 59 to 94664.

Logic: The CCI places a level one edit on 94640 as well as 94664. Therefore, Medicare and payers that follow CCI edits may need modifier 59 on the component code (94664) to indicate that the teaching is a distinct procedure service from the inhalation treatment. It's important that the teaching was not part of the treatment for the patient, which would be one parallel encounter – teaching while treating.

Easy $16 with the aid of medical necessity support

If payers wouldn't pay your 94664 claim, you would need to support it with documentation indicating medical necessity to reimburse about $16 national rate (0.47 RVUs multiplied by 2011 conversion factor of 33.9764). For example, in the plan of treatment portion of the written record you might need to state that the patient needs a teaching session on the use of his MDI, diskus, nebulizer, and the like. What's more, do not forget to note why the session is required.

Source URL :-

Use 45990 for Rectal Exam with Anesthesia

In a particular case, the surgeon used a bivalve, suctioned the old blood from where a hemorrhoid had necrosed and fallen off; however the large vessel underneath was continuing to bleed (all done under anesthesia). After this he sutured the bleeding site. If you fail to find a proper CPT code for this, what should you do in this situation?

Well, the procedure described above is a rectal exam under anesthesia (45990, Anorectal exam, surgical, requiring anesthesia [general, spinal, or epidural], diagnostic). According to CCI edits, you shouldn’t report 45990 in conjunction with 45300-45327 (Proctosigmoidoscopy), 46600 (Anoscopy; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]), 57410 (Pelvic examination under anesthesia), and 99170 (Anogenital examination with colposcopic magnification in childhood for suspected trauma).

Physician responsibility: Anorerctal exam is primarily done by placing the patient in left lateral decubitus position. This exam is chiefly done to study anal fissures, anal fistula, anal mass and hemorrhoids. The patient is provided general, spinal or epidural anesthesia and the physician carries out a diagnostic digital rectal exam by inserting a lubricated gloved index finger after relaxation of anal sphincter mainly to examine the perineal area. An ansoscope is inserted into the rectum to visualize the anal canal and distal rectum. Soon after removing the anoscope, a rigid proctosigmoidoscope is inserted to the anus to visualize sigmoid colon and rectal lumen.

Source URL :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/reader-questions-consider-45990-for-rectal-exam-with-anesthesia-article

For Modifier Details, Explore CCI, Fee Schedule

Scenario: In your day to day coding, you may sometimes get denials that appear to be related to bundling issues; however you may not find the two-day code pair in the CCI edits. How can you find out which is the column 2 code so that you can put the modifier on the correct code?

If you cannot find the codes listed in the Correct Coding Initiative (CCI) edit tables, then they are not bundled under that system. See to it that you check both the mutually exclusive and non-mutually exclusive edit tables.

If your code pair is not bundled under correct coding initiative, then you would not need a CCI modifier such as 25 (Significant, separately identifiable E&M service by the same physician on the same day of the procedure or other service), 57 (Decision for surgery), or 59 (Distinct procedural service), to override the edit pair.

You need to tread carefully: Just because a code does not have a bundle in correct coding initiative does not mean a modifier is out of the picture. While you will not need a CCI modifier to override the edit, you might need a payment modifier.

You can get Medicare's other allowed modifiers for any given CPT code in the Medicare Physician Fee Schedule (MPFS)(http://www.supercoder.com/coding-tools/fee-schedules). Columns Y-AC indicate if a modifier such as 50 (Bilateral procedure), and the like, applies. For more on this, sign up for a medical coding guide like Supercoder, which comes with a fee schedule tool to help you in your coding job.

FAQS to Help You Choose the Right Code

Do you know how to bill your claim when a patient presents to your office for a capsule study and the capsule gets lodged in his stomach?

If you have a good sense of what anatomy the capsule study evaluates, it could save you from a possible coding disaster. It is not enough that you know the two CPTs (91110 and 91111) to use for this study.

Here are some answers to frequently asked questions (FAQs) which will help you in choosing the right code:

How would you code a repeat procedure with 91110?

Now and then, your gastroenterologist would use a capsule study to image the intraluminal esophagus all the way through the ileum and reaching the colon. Here, you should report 91110 (Gastrointestinal tract imaging, intraluminal [example, capsule endoscopy], esophagus through ileum, with physician interpretation and report).

For instance: Patient comes in for a capsule endoscopy; however the capsule gets stuck and visuals can't be seen past the stomach. The gastroenterologist ends up repeating the procedure to see if she can see the small and large intestine.

Report it: Initially you would code 91110 and then add modifier 53 (Discontinued procedure) to indicate that the doctor repeated the procedure. If the physician makes up his mind not to repeat the procedure, you should go for modifier 52 (Reduced Services) to mirror that the capsule imaged the patient's anatomy until it became lodged in the food.

Medical coding tip: If you think about repeating a capsule study owing to technical problems, it's a good idea to pre-authorize payment for the second study with the carrier. You may be required to provide records of the incomplete study.

According to CPT 91110's descriptor, the evaluation is from the esophagus to the ileum. The only time this won't be true is when the gastroenterologist places the pill cam endoscopically for the study. Once again in this case, you should use modifier 52 to 91110.

What does 'SB' (small bowel) and 'ESO' mean on PillCam Labels?

Imagine that the gastroenterologist limits her study to the patient's esophagus only – without going further down the stomach, duodenum, jejunum and ileum. Here, you should go for the other capsule study code: 91111 (Gastrointestinal tract imaging, intraluminal [example., capsule endoscopy], esophagus with physician interpretation and report).

Notice that the physician would use two different types of wireless capsules when performing 91110 and 91111, respectively. PillCam SB is designed specifically to visualize the esophagus, stomach, duodenum, jejunum, and ileum. It has one camera and a battery that can last up to eight hours. In contrast, PillCam ESO covers the esophagus. It has cameras at both ends of the capsules and takes very rapid images; however the battery lasts only for a short while.

Tread cautiously: Do not dare to report 91110 and 91111 together as the work required in 91111 is already included in 91110, according to CCI edits. As some payers consider PillCam ESO “investigational, and will not cover the procedure, you would be safe checking your payer's policies first prior to submitting your claim.

Where PC and TC matter

In many areas, hospital endoscopy suites purchase the capsules, and hospitals own the equipment used to view the capsule video. If the physician provides only the professional portion of the procedure ( i.e interpretation and report of the results) , you should use modifier 26 (PC) to the CPT Codes. Do not worry about adding any modifiers if the physician purchases the capsule and owns the computer video equipment. In that case the physician provides both the PC and TC of the procedure.

Advice: Ensure you maintain proper clinical and billing records in case the payer elects to audit claims.

96446 Joins CCI Edits 17.0 along With Many Others

Last month saw new CPT codes and CCI physician edits from CMS for those codes. The latest CCI edits have 19,822 new edit pairs which have been added while 9,778 have been terminated, for a net gain of 10,044 new edit pairs.

The main CCI edits you want to be sure to watch for are those related to new code 96446.

Note where 96446 falls (Col. 1/Col. 2) for non-mutually exclusive (NME edits)

The 96446 NME edits are largely what you'd expect based on other chemotherapy code edits – bundles with E/M, anesthesia, venipuncture and other vascular procedures, for instance. You want to be sure to watch which is the column 1 code and which is the column 2 code for these bundles.

For example: CCI places E/M codes 99217-99239 in the column 1 position and 96446 in the column 2 position. On the contrary, CCI places 96446 in the column 1 position and E/M codes 99201-99215 in the column 2 position.

Remember that if you report both codes in an NME edit pair without a modifier, Medicare (as well as payers who adopt these edits) will deny the column 2 code and pay you only for the column 1 code.

79200 edit reminds you to check ME edits as well

CCI Edit also created an ME edit for 96446. ME procedures cannot reasonably be performed at the same anatomic site or patient encounter. The edit places 96446 in column 1 and in column 2 is 79200. This edit also has a modifier indicator of 1; as such you may override the edit with a modifier when clinically appropriate, such as in the case of distinct separately identifiable encounters.

Count Post-Op Brace Fitting and Education Separate?

Is it feasible that my physician bill for a fitting and education of a brace during the postoperative period for an anterior cruciate ligament (ACL) surgery? I found 97760, but can I use this separately or is it considered a part of the ACL surgery's global period?

Answer: The CCI edits do not bundle 97760 (Orthotic[s] management and training [including assessent and fitting when not otherwise reported], upper extremity[s], lower extremity[s] and/or trunk, each 15 minutes) into any of the ACL repair codes, for instance, 27407 (Repair, primary, torn ligament and/or capsule, knee; cruciate). However, this does not automatically mean you can report 97760 in the situation outlined in the question above.

As per the December 2005 CPT Assistant, 97760 includes the provider's time associated with determining the proper orthotic design in relation to the patient's skin integrity, sensibility and healing of tissues with or without surgical repair.(for example static versus dynamic, pre-fabricated versus custom designed, choice of materials such as thermoplastic, pulleys, and elastic tendon). The code also includes the fitting of the orthotic, training in use, care and wearing time of the orthotic, and brief instructions in exercises that are to be carried out while the orthotic is in place."

When settling on whether to report 97760, examine your physician's documentation to ensure he has noted each of these decision-making processes. Most national and local Medicare coverage determinations note that physical therapists report this code most often and this service should take no longer than 30 minutes. As a result, you might run into frequency edits if you attempt to report more than two units of 97760.

Article  Source :- http://www.supercoder.com/coding-newsletters/my-orthopedic-coding-alert/you-be-the-coder-97760-count-post-op-brace-fitting-and-education-separate-article 

CCI Edits - Codes You Shouldn't Pair

Sometimes you might not be able to find your two-code pair in the CCI edits. How would you know which code would be considered as column 1 code and which would be considered as column 2 code in order to put your modifier on the proper code?

If the codes are not listed, the codes are not bundled under the CCI (Correct Coding Initiative ) edit pairs. For that reason, most likely you would need a CCI modifier such as 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), 57 (Decision for surgery), or 59 (Distinct procedural service), to override the edit when required.

A private payer could have a black box edit, though. You need to check with a rep for a recommendation. To add to it, the CCI manual and CPT guidelines may offer broad instructions on types of services that normally should not be reported together. You should also be sure you check both non-mutually exclusive and mutually exclusive CCI edits.

But remember that just because a code does not have a bundle in CCI does not mean a modifier is out of the picture. Even if you do not need a CCI modifier to override an edit, you might need a payment modifier for a code.

You can get Medicare's other allowed modifiers for any CPT code that is in the Medicare Physician Fee Schedule (MPFS). Columns Y-AC point to whether certain modifiers such as modifier 50 apply.

Article source :-  http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/reader-questions-look-beyond-cci-for-codes-you-shouldnt-pair-article

CCI 17.0 Takes Aim at Just-In Vaccine Administration Codes

The latest CCI edits (17.0) that went into effect on January 1 this year include 19,822 new active pairs and 9.778 code pair deletions. Many of the new code pair additions involve CPT codes that debuted on January 1, with CCI now halting payment if you report certain procedures together.

For example, you will find vaccine administration codes 90471 and 90473 bundled into new vaccine administration code 90460 and no modifier can separate these edits. This edit prevents mixing and matching the new immunization administration codes with the old, established immunization administration codes when delivering multiple vaccines at the same visit.

What's more, CCI bundles the new new subsequent observation care codes 99224-99226 into inpatient neonatal and pediatric critical care codes 99468-99476.

Good news on the modifier front

Not all news coming out of the latest CCI edits is bad. With effect from January 1, you will be able to use a modifier (such as 59, Distinct procedural service) to separate the edit bundling wound care management codes 97597-97602 into the just-revised debridement codes 11042-11044. Earlier, if your pediatrician performed both procedures on the same DOS, you could not collect for both no matter what; however now you'll be able to if your documentation demonstrates the separate and distinct nature of the services and you use the proper modifier.

Swapped pairs: To add to it, CCI did an about-face on several edits this round. Previously, if you reported 94660 or 94662 with an outpatient E/M code (99201-99215), CCI would reimburse you for the pressure ventilation and deny the E/M service. But then CCI version 17.0 now makes the E/M service the primary code, and the pressure ventilation code will be denied if you report the services together. These edits cannot be separated by any modifier.

In CCI 17.0, Anesthesia Overrides Bronchoscopy

The latest CCI edits (CCI 17.0) that went into effect on January 1 this year clarifies that typical anesthesia includes services described by new catheter and tube placement codes. Read on for more on this:

Just-in codes appear in Non-mutually exclusive pairs
Non-mutually exclusive edits apply to services that a doctor may carry out during the same care session but that are not billable together. The reason is one of the codes (the component code) is included in the services represented by the second (comprehensive) code of the pairing. You can bill individual components if the doctor doesn't carry out the entire comprehensive procedure. However if the doctor carries out the entire (comprehensive) procedure, you should bill the comprehensive code in place of the individual parts or components.

The latest CCI includes non-mutually exclusive edits for virtually every anesthesia code when carried out with various new CPT codes. Coding for the anesthesia procedure overrides the following codes when the doctor provides both services during the same session:

0251T -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), initial lobe

0253T -- Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach, into the suprachoroidal space

31634 -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, with assessment of air leak, with administration of occlusive substance [example, fibrin glue], if performed

43753 -- Gastric intubation and aspiration(s) therapeutic, necessitating physician's skill (example., for gastrointestinal hemorrhage), including lavage if performed

43754 -- Gastric intubation and aspiration, diagnostic; single specimen (example., acid analysis).

The same edits apply to anesthesia during three catheter and coronary angiography procedures:

93451 -- Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when carried out

93456 -- Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization

93457 -- Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization.

Exceptions: Each edit pair carries a modifier indicator of "1,"which means you can sometimes bypass the edit by filing the right modifier. See to it that you have enough supporting documentation to justify payment for both codes before filing with a modifier, say for instance 59 (Distinct procedural service).

Forget subsequent care with anesthesia

This time CPT introduces three new codes for subsequent observation care (99224-99226, Subsequent observation care, per day, for the evaluation and management of a patient …). The latest CCI edits clarify that standard anesthesia care includes services represented by 99224-99226. These edits carry a modifier indicator of "0", meaning you cannot report the services with a modifier to try and be paid for both codes. If you submit both codes on the same claim, you will get an automatic denial.

Article Source :-  http://isupercoder.blogspot.in/2011/01/in-cci-170-anesthesia-overrides.html

Going to Report E/M & OB Service Together?

CCI 17.0 brings 698,042 new edits. But that does not mean you need to push the panic button as most of the edits affecting your ob-gyn claims won't be tough to apply to your daily coding practice.

For example, if you are already comfortable with bundles that exist for 57155, then you are ready for the new bundles added to the new code 57156. They're the same.

Break the rest of the edits into two categories: fluoroscopy edits and E/M edits.

Consider four fluro codes as included in Gyn procedure

Your claims could face problems if you attempt to bill a fluroscopic code in addition to just about everything in the gynecology section in the CPT manual.

CCI 17.0 particularly highlights the following four fluoroscopic codes: 76000, 76001, 77001, 77002. Essentially, CCI 17.0 bundles 76000, 76001, and 77001 into some codes and only 77001 and 77002 into others.

Break down these Evaluation/Management edits

With a broad brush stroke, the latest CCI edits bundles E/M services into all delivery and delivery plus postpartum care codes. These edits carry a modifier indicator of "1", which means you can separate these bundles with a modifier so long as you can show these encounters are separately identifiable. Remember, these delivery and delivery plus postpartum care codes already include admission, subsequent hospital care, discharge, and postpartum care under CPT guidelines.

But then what's new is that you should now include observation care, which hasn't been a part of routine ob care in the past. What's more, you should include the nursing facility care, rest home care, and home care visits – which make no sense for ob patients anyway.

Antepartum care only codes 59425 Antepartum care only; 4-6 visits) and 59426 (7 or more visits) didn't escape CCI 17.0's notice. These codes now include 99201-99215 (Office or other outpatient visit ...). What's more, you can separate these edits with a modifier; but again be sure to include documentation to show payers how these services are separately identifiable. These bundles apply to the same date of service; as such, it's unlikely that you'd bill antepartum care and a separate E/M code on the same DOS unoless the E/M service was not related to pregnancy.

In the end, observation care (99217-99220, Initial observation care, per day, for the E/M of a patient …) is now part of 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)…

Anesthesia Overrides Bronchoscopy in CCI Edits 17.0

The latest Correct Coding Initiative edits (CCI 17.0), which went into effect on January 1, 2011 clarifies that typical anesthesia includes services described by new catheter and tube placement codes. Just-in codes appear in non-mutually exclusive pairs Non-mutually exclusive edits apply to services that a doctor might carry out during the same care session but that are not billable together. This is because one of the codes (the component code) is included in the services represented by the second (comprehensive) code of the pairing. You can bill individual components if the doctor doesn't carry out the entire comprehensive procedure. However, if the doctor carries out the entire (comprehensive) procedure, you should bill the comprehensive code in place of the individual parts or components.

The latest CCI edits include non-mutually exclusive edits for almost every anesthesia code when carried out with several just-in CPT codes. Coding for the anesthesia procedure overrides the following codes when the doctor provides both services during the same session.

0251T -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when carried out; with removal of bronchial valve(s), initial lobe

0253T -- Insertion of anterior segment aqueous drainage device, minus extraocular reservoir; internal approach, into the suprachoroidal space

31634 -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when carried out; with balloon occlusion, with assessment of air leak, with administration of occlusive substance [example fibrin glue], if carried out

43753 -- Gastric intubation and aspiration(s) therapeutic, necessitating physician's skill (example for gastrointestinal hemorrhage), including lavage if performed

43754 -- Gastric intubation and aspiration, diagnostic; single specimen (example acid analysis).
The same edits apply to anesthesia during three catheter and coronary angiography procedures:

93451 -- Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed

93456 -- Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization

93457 -- Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization.
There are exceptions: Each edit pair carries a modifier indicator of “1", which means you can sometimes bypass the edit by filing your claim with a proper modifier. Ensure you have enough supporting documentation to justify payment for both codes prior to filing with a modifier such as 59 (Distinct procedural service).
Forget subsequent care with anesthesia
CPT 2012 codes brings in three just-in codes for subsequent observation care (99224-99226, Subsequent observation care, per day, for the E/M of a patient …). CCI 17.0 clarifies that standard anesthesia care includes services represented by 99224-99226. These edits carry a modifier indicator of “0", which means you cannot go for the services with a modifier to try and be paid for both codes. If you submit both codes on the same claim, you'll get an automatic denial. Source URL :- http://www.supercoder.com/coding-newsletters/my-anesthesia-coding-alert/cci-170-anesthesia-overrides-bronchoscopy-in-newest-edits-article