CPT 2011 Codes Help Solve Your 'Middle Day' Code Dilemma

While reporting the middle day observations, this year you have new options to choose from. If you want to find out how CPT additions will have a say on your orthopedist's observation care services, read on and find out:

New codes bring clarity with them. Before the start of this year, coding for the 'middle days' of an observation service was a pain in the neck. Even though, it's not the norm, there are situation where a patient is admitted to observation and remains in that status for three or more days. The E/M section of CPT 2011 addresses these middle days with new codes. The three codes that parallel the hospital subsequent care series in terms of component requirements and time frames are 99224, 99225 and 99226.

There has been some confusion on ways to report the middle day for those cases when an observation period transcends three calendar days. The new CPT codes

99224-99226 stamp out insurer variances. There has been some uncertainty about how to report the middle day for those cases when an observation period transcends three calendar days. The new codes however solve the problem.

Prior guidance for these 'extended' observation and middle day observation stays created some confusion and led to different policies such as the Spring 1993 edition of CPT Assistant, which instructed coders to “use the unlisted evaluation and management service code to report these services."

However, when setting policy on 'middle day' observation coding, payers often took their own path. They would often call for 99499; but then some carriers preferred 99231-99233 or 99211-99215. Technically speaking, observation codes are outpatient codes.

But be ready for disappointing reimbursement. Physicians and coders who were excited about the new subsequent care observation codes will not be too happy when they hear the accepted payments for these codes. The Relative Value Update Committee had compared this year's codes 99224-99226 for subsequent observation care to subsequent hospital care and had requested the same work value. However, the Center for Medicare disagreed with the proposal.

You should focus this time clarification in your CPT 2011 manual. All that fine green print on time in your evaluation & management CPT 2011 manual comes down to one thing: you can round to the closest time code. However that advice from CPT is quite opposed to Medicare's threshold time guideline. This year's CPT tells you that you can use the code closest to the documented time. This advice is nothing new. In choosing time, the doctor must have spent a time closest to the chosen code, according to CPT Assistant, Aug 2004.

For further CPT details and for other information relating to CPT Assistant, sign up for a one-stop medical coding guide like Supercoder. This site comes with a CPT Assistant Code Connect for just $199.95 to help your understanding. In fact, the site offers 20 years of CPT Assistant articles and reader questions linked to every applicable CPT code.  Source URL :- http://www.supercoder.com/coding-newsletters/my-orthopedic-coding-alert/cpt-2011-99224-99225-99226-solve-middle-day-code-dilemma-103938-article

Use Medicine Series Vaccine Administration with Counseling Codes On Older Patients

By now, we all are aware that CMS has created HCPCS codes (Q2035, Q2036, Q2037, Q2038, and Q2039) and payment allowances to replace 90658. Apart from this, you will be able to use medicine series vaccine administration with counseling codes on older patients and when a nurse provides the counseling, thanks to CPT 2011. Since counseling for adolescents can involve as much time as counseling on vaccines for younger children, the American Academy of Pediatrics suggested that the age limitation on the vaccine administration with counseling codes be raised. Just-in codes extend vaccine administration with counseling to patients through 18 years of age.

Busy practices will be excited at being able to use their registered nurses (RN) or licensed practicing nurses (LPN) to capture the higher RVU some private payers associate with the vaccine administration with counseling. The just-in vaccine administration with counseling code descriptor expands who can provide the vaccine counseling described in the deleted immunization administration with vaccine counseling codes (90465-90468). Last year's CPT vaccine administration with counseling codes 90465-90468 limited the counselor role to a physician and, subject to state scope of practice laws, nurse practitioner or physician assistant.

The just-in administration with counseling code extend the counseling opportunity to any "qualified health care professional" practicing within his/her state described scope of practice. An RP, LPN or medical technician could provide the counseling and the practice could still use the vaccine administration along with counseling code.

On a concluding note, you should remember the just-in administration codes - 90460 and 90461 are per vaccine/toxoid component. This means that if your doctor provides counseling and administration for a combination vaccine such as MMR, you will report 90460 for the first component and 90461 for each additional component. In the MMR example, you'd code 90460 once and 90461 twice. You'd report only a single vaccine administration code for a combination vaccine irrespective of the number of components prior to this year.

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CPT 2011 Brings Two New Codes for Diabetic Foot Ulcer Treatment

CPT Codes 76881

This year, CPT comes with two new codes to report diabetic foot ulcer treatment involving tissue cultured skin substitutes to the lower extremity - G0440-G0441. You will have to use temporary G codes when reporting diabetic foot ulcer treatment involving tissue cultured skin substitutes to the lower extremity for a Medicare beneficiary in 2011.

CPT introduced G0440 and G0441 to put an end to the confusion providers put forth the different global periods for two tissue cultured skin substitute codes.

This year, for your ultrasound coding, you can bid 76880 good bye as CPT 2011 deletes this code. In its place, you can use two new CPT 76881 and 76882. A complete procedure (76881) includes real time scans of a specific joint that covers examination of the muscles, tendons, joint, other soft-tissue structures, and any identifiable aberration. A limited study (76882) involves examining the extremity where a specific anatomic structure such as a tendon or muscle is evaluated. You'd also report 76882 to assess a soft-tissue mass that may be present in an extremity where knowledge of its cystic or solid characteristics is called for.

Bear in mind: When the podiatrist carries out spectral and color Doppler evaluation of the extremities, you should use the proper code (93925-93926, 93930-93931, 93970 or 93971) in association with 76881 or 76882. In the meantime, CPT 2011 revises and revalues codes for non-invasive physiologic studies of the upper or lower extremity arteries: 93922, 93923, and 93924.

This year you'll find 93922-93924's code descriptors clearly differentiating between a limited study and a complete bilateral study, with additional instructions on how to report these codes properly.

Now you will never have to worry about choosing between a debridement code and an active wound code. This year's CPT revises debridement code guidelines to clarify the confusion. Depth is the only documentation item you require to figure out the correct code. Active wound care, which has a 0 day global period, refers to active wound care of the skin, dermis, or epidermis. For deeper wound care, you should go for debridement codes in the appropriate location.

Say for instance codes 11040 and 11041 have been axed. The parenthetical note under the codes' deletion says, for debridement of skin, that is, epidermis and/or dermis only, go for 97597 and 97598."

For further details on this and for other CPT 2011 coding guidelines, sign up for a one-stop medical coding guide like Supercoder.

CPT Changes Pediatric Critical Transport Code Bundles This Year

This year CPT brought a whole new crop of bundles with pediatric critical care and transport services. As a matter of fact, CPT went retro with pediatric critical care transport codes 99466-99467, reverting the bundles back to the 2007 rules.

CPT 2011 has changed which services are bundled into critical care codes 99291-99292 based on whether a facility or professional reports the services. In addition, CPT has returned the list of services bundled into 99466-99467 to the bundles that were in effect as of 2007.

This year, the following services are included when carried out during the pediatric patient transport by the physician providing critical care and may not be reported separately: Routine monitoring evaluations, interpretation of cardiac output measurements (93562), Chest x-rays (71010-71020), Pulse oximetry (94760-94762), Blood gases and information data stored in computers (for instance, ECGs, blood pressures, hematologic data - 99090), Gastric intubation (43752-43753), Temporary transcutaneous pacing (92953), Ventilatory management (94002-94003, 94660-94662), Vascular access procedures (36000, 36400-36406, 36415, 36591, and 3660

Critical care: In the present year, pediatricians from your practice will still face the following services as being bundled into critical care: interpretations of cardiac output measurements, chest xrays, pulse oximetry, blood gases, information data stored in computers, gastric intubation, temporary transcutaneous pacing, vent management, and vascular access. But then, facilities will be able to report these services separately from critical care and will not face the bundles.

Bear in mind: This means that you can report the critical care code ( Source "http://www.supercoder.com")only, even if the facility is reporting the critical care codes in addition to the separate x-rays, intubation, and other services separately.

You should not report new observation care codes with other E/M service. CPT 2011 adds 99224-99226 as far as coding subsequent observation care is concerned. Even though confusion surrounded these codes when CPT first debuted, recently some rules have come to light on how you can report them.

When to bill: Subsequent observation care starts after the initial observation care DOS.

In addition, you should not report subsequent observation care on the same date as initial observation care codes (99218-99220), nor can you report observation services on the same date as office or emergency department services. What's more, you cannot report the new subsequent observation codes on the same date as observation care discharge (99217).

CPT 2011 Freshens Up Your IP Catheter Coding Choices

For intraperitoneal (IP) catheter coding, confusing terms such as 'temporary' and 'permanent' are archaic now. Read on and find out how CPT 2011 freshens up your options:

Just-in code 49418 begins the IP catheter code changes

Defined as a 'complete' procedure, you will find multiple services covered by the just-in code 49418. Medicare assigned this code a 0-day global period, meaning Medicare does not bundle visits on subsequent days into the procedure payment.

Tread carefully: Medicare's national fee schedule () prices for 49418 vary considerably based on whether you are reporting a facility service ($234.78) or non-facility service ($1,519.08). This is a difference of more than $1,200; therefore you should make it a point to watch your place of service code.

Rectify the codes listed in 49419's line note

On the whole, changes demonstrate the 'coding lag' that occurs in keeping up with advances in new surgical procedures. As a matter of fact, the addition of 49418 is part of a larger reworking of tunneled intraperitoneal (IP) catheter codes to bring them in sequence with present practice. To begin with, CPT revises 49419:

Last year: 49419-- Insertion of intraperitoneal cannula or catheter, with subcutaneous reservoir, permanent (that is., totally implantable)

This year: 49419 -- Insertion of tunneled intraperitoneal catheter, with subcutaneous port (that is totally implantable).

Why: By referencing subcutaneous port, the code language reflects the present technology. What's more, CPT removed the term "cannula" since physicians normally carry out these procedures using a catheter only.

According to AMA's published errata, you will need to rectify the CPT manual note following 49419. The note should read as here: (changes underlined): "49420 has been deleted." In order to report open placement of a tunneled peritoneal catheter for dialysis, code 49421. Whereas to report open or percutaneous peritoneal drainage or lavage, see 49020, 49021, 49040, 49041, 49080, 49081, as proper. To report percutaneous insertion of a tunneled peritoneal catheter minus subcutaneous port, go for 49418.

Among other code changes, focus on 49422

Other changes pertaining to IP catheter coding include the following:

According to the Symposium presentation, these changes are part of an endeavor to 'clean up' codes that overlapped and caused confusion. For instance, the terms temporary and permanent (used last year) caused confusion over whether they referred to placement or to device itself. What's more, CPT 2011 added the term 'tunneled' to acknowledge the subcutaneous channel in which the doctor places the catheter.

Deletion: See to it that you catch CPT 2011 deleted 49420. The additions and revisions of other, more specific codes made 49420 obsolete.

Instruction: You should not miss the note with 49422. This code is only for removal of a tunneled catheter. If the doctor removes a non-tunneled IP catheter, CPT guides you to report the proper E/M code.

Cpt 2011: IP Catheter Code Changes

For intraperitoneal (IP) catheter coding, confusing terms such as 'temporary' and 'permanent' are a thing of the past. Here's how CPT 2011 freshened up your options:

New code 49418 begins the IP catheter code changes

Defined as a 'complete' procedure, you will find multiple services covered by new code 49418 (Insertion of tunneled intraperitoneal catheter [example dialysis, intraperitoneal chemotherapy instillation, management of ascites], complete procedure, including imaging guidance, catheter placement, contrast injection when carried out, and radiological supervision and interpretation, percutaneous).

Medicare assigned this just-in code a 0-day global period, which means Medicare does not bundle visits on subsequent days into the procedure payment.

Progress carefully: Medicare's national fee schedule prices for 49418 differ significantly based on whether you're reporting a facility service ($234.78) or non-facility service ($1,519.08). That is a difference of more than $1,200; as such be sure to watch your place of service code.

Rectify the codes listed in 49419's line note

Overall, changes show the 'coding lag' that occurs in keeping up with advances in new surgical procedures. In fact, the addition of 49418 is part of a larger reworking of tunneled intraperitoneal (IP) catheter codes to bring them in line with present practice. To begin with, CPT revises 49419:

2010: 49419

2011: 49419

Here's why: By referencing subcutaneous port, the code language reflects present technology.

What's more, CPT removed the term 'cannula' as doctors commonly carry out these procedures using a catheter only.

According to AMA's published errata: You will require correcting the CPT manual note following 49419. The note should read as follows: 49420 has made an exit. To report open placement of a tunneled peritoneal catheter for dialysis, report 49421. To report open or percutaneous peritoneal drainage or lavage, take a look at 49020, 49021, 49040, 49041, 49080, 49081 as proper. To report percutaneous insertion of a tunneled peritoneal catheter without subcutaneous port, go for 49418.

Among other code changes, focus on 49422 note

Other changes related to IP catheter coding include the following:

According to the symposium, these changes are part of an attempt to 'clean up' codes that overlapped and caused confusion. For instance, the terms temporary and permanent (used last year), caused confusion over whether they referred to placement or to the device itself. That apart, CPT 2011 added the term 'tunneled' to acknowledge the subcutaneous channel in which the physician places the catheter.

Exit: See to it that you catch that this year's CPT deleted 49420. The revisions and additions of other, more specific codes made 49420 obsolete.

Vital instruction: Do not miss the note with 49422. This code is for removal of a tunneled catheter only. If the physician removes a non-tunneled IP catheter, CPT guides you to use the proper E/M code.

Source URL :- http://www.supercoder.com/coding-newsletters/my-radiology-coding-alert/cpt-2011-49418-49422-changes-bring-ip-catheter-coding-up-to-date-article

Debridement Code or an Active Code? CPT Comes to Your Rescue

As you enter 2011, as a dermatology coder, you have a lot of CPT changes to adapt to. So for instance you may be confused about when to select a debridement code and when to go for an active wound code. CPT 2011 comes to your rescue with revised debridement code guidelines that show you how to select between the two code groups.
Depth is the only documentation item you need to figure out the correct code. Active wound care has a 0 day global period and is for active wound care of the skin, dermis or epidermis. For deeper wound care, make use of debridement codes in the proper location.

For instance: Codes 11040 and 11041 have made an exit. The parenthetical note under the codes' deletion says, "For debridement of skin, that is., epidermis and/or dermis only, see 97597, 97598."

The codes are then revised to reflect the change. For example, 11042 removes "Skin, and" and adds after subcutaneous tissue "includes epidermis and dermis, if carried out."

Code 97597's revision involves "mainly rewording to elucidate how active wound care is separate from integumentary wound care.

This time CPT includes guidelines that indicate two requirements for active wound care management. These guidelines train eyes on:

Intent: "Active wound care procedures are carried out to remove devitalized and/or necrotic tissue and promote healing."

For more on this and for all CPT code updates affecting your dermatology practice, sign up for a medical coding guide like Supercoder.

Hint: For deeper wound care, reserve debridement codes
We provide you simple, instant connection to official code descriptors & guidelines and other tools for 2010 CPT code, HCPCS lookup that help coders and billers to excel in the work they do every day.

Article Source :- http://isupercoder.blogspot.in/2011/01/debridement-code-or-active-code-cpt.html

CPT 2011 Asks for CMS re-Examination of Time as Averages or Thresholds

CPT 2011: The doctor must have spent a time closest to the chosen code, according to CPT Assistant

All that fine green print on time in your E/M CPT 2011 manual comes down to one thing: you can round to the closest time code. However, that advice from CPT contradicts Medicare's threshold time guideline.

CPT treats times as averages

CPT 2011 indicates that you can use the code closest to the documented time. That piece of advice is nothing new. In choosing time, the doctor must have spent a time closest to the chosen code, according to CPT Assistant, Aug. 2004.

Your documented time must be equal to or cross the average time given to bill that level. For a 35-minutes spent on a medically necessary counseling-dominated visit is a 99214, according to CPT you could report 99215.

Medicare has considered times thresholds

Medicare has always considered the times indicated in CPT's code descriptors to represent minimums. The doctor would choose the lower code (for example 99214… physicians typically spend 25 minutes face-to-face with the patient and/or family …) unless the time was greater or equal to the higher-level code's required time (such as 40 minutes for 99215).

Will Medicare alter its position?

When questioned on whether Medicare would change the allotments from thresholds to averages at the CPT® and RBRVS 2011 Annual Symposium, medical directors were hesitant to give a definitive answer. "I do not want to say one way either 'yes' or 'no' at this juncture," said E/M expert Deborah Patterson, MD, clinical medical director for Trailblazer Health Enterprises, LLC in Dallas.

For more on CPT 2011 , sign up for a medical coding guide like Supercoder!

Axe 90658 for Medicare Patients In Favor Of Just-In Q Codes

Medical Coding: Medicare will no longer pay you money for 90658 with effect from January 1, 2011.

The new year brings changes to flu vaccines and counseling codes.

Your vaccine coding in 2011 will be on its toes, thanks to changes in codes and administration reporting. Two more updates every family physician should know involve new Q codes for some Medicare flu vaccines and expanded ages for adolescent vaccine counseling.

Nix 90658 for Medicare patients

CMS has come up with New HCPCS codes and payment allowances to replace 90658. Medicare will no longer pay you money for 90658 with effect from January 1, 2011. As such, select from the new codes instead, based on the specific product: Q2035, Q2036, Q2037, Q2038, Q2039.

Timing: Codes Q2035-Q2039 went into effect on October 1, 2010. When filing claims for DOS from October 1 until December 31, 2010: bill Medicare immediately with 90658, or hold the claim until January 1, 2011 and file with the proper Q code.

Explanation: Medicare pays for influenza vaccine based on 95 percent of the average wholesale price. The products normally classifiable to 90658 have widely varying AWPs. If Medicare continued paying for all of them under a single code, they could be overpaying some and underpaying others, relatively.

Consequence: Medicare assigns different Q codes to each individual product starting January 1, 2011 to account for variances in manufacturing prices. "This should actually ensure that physicians are paid well for products that might have significant differences.

Report 90460, +90461 through age 18

You will be able to use medicine series vaccine administration with counseling codes on older patients and when a nurse provides the counseling, thanks to CPT 2011.

As counseling for adolescents can involve as much as counseling on vaccine for younger children, the American Academy of Pediatrics recommended that the age limitation on the vaccine administration with counseling codes be raised. New codes extend vaccine administration with counseling to patients through 18 years of age.

Benefit from RN/LPN counseling and still get the reimbursements

Busy practices will be excited at being able to use their registered nurses (RN) or licensed practicing nurses (LPN) to capture the higher RVUs some private payers associate with the vaccine administration with counseling codes. The just-in vaccine administation code with counseling code descriptor expands who can provide the vaccine counseling described in the deleted immunization administration with vaccine counseling codes (90465-90468). CPT 2010 vaccine administration with counseling codes 90465-90468 limited the counselor role to a doctor and, subject to state scope of practice laws, nurse practitioner (NP) or physician assistant (PA).

Final say: Remember the just-in administration codes 90460 and 90461 are per vaccine/toxoid component. That means if your doctor provides counseling and administration for a combination, you will report 90460 for the first component and 90461 for each additional component. In the MMR example, you would use 90460 once and 90461 twice. Before 2011, you'd report only a single vaccine administration code for a combination vaccine, irresespective of the number of components in the vaccine.

Comparison of 2010 and 2011 definitions for 93922-93924

CPT 2011 revises the definitions for 93922-93924. Look how the 2010 and 2011 definitions compare for 93922-93924.

If you have been longing for more details in your noninvasive physiologic code definitions, your wish will be fulfilled in 2011.

CPT 2011 revises the definitions for 93922-93924. Take a look at how the 2010 and 2011 definitions compare for 93922-93924.

93922: Watch changes to number of levels

When looking at the 93922 definitions, notice that the 2010 version refers to ‘single level, while the 2011 version offers several examples that refer to "1-2 levels":

This year: 93922 -- Noninvasive physiologic studies of upper or lower extremity arteries, single level, bilateral (example, ankle/brachial indices, Doppler waveform analysis, volume plethysmography, transcutaneous oxygen tension measurement).

In the coming year: 93922 -- Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (example, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with transcutaneous oxygen tension measurements at 1-2 levels).

93923: Number of levels are the key change once again

One of the changes to watch for 93923 is the switch from "multiple levels" in this year to "3 or more levels" in the coming year:

This year: 93923 -- Noninvasive physiologic studies of upper or lower extremity arteries, multiple levels or with provocative functional maneuvers, complete bilateral study (example, segmental blood pressure measurements, segmental Doppler waveform analysis, segmental volume plethysmography, segmental transcutaneous oxygen tension measurements, measurements with postural provocative tests, measurements with reactive hyperemia)

In the coming year: 93923 -- Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, three or more levels (example for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/ dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional Doppler waveform recording and analysis, at three or more levels, or ankle/ brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental volume plethysmography at three or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at three or more level(s), or single level study with provocative functional maneuvers (example, measurements with postural provocative tests, or measurements with reactive hyperemia).

93924: Improve your understanding of this service

The change to 93924 is the addition of a lot more detail to explain what CPT intends the code to describe:

This year: 93924 -- Non-invasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, complete bilateral study.

In the coming year: 93924 -- Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, (i.e., bidirectional Doppler waveform or volume plethysmography recording and analysis at rest with ankle/ brachial indices immediately after and at timed intervals following performance of a standardized protocol on a motorized treadmill plus recording of time of onset of claudication or other symptoms, maximal walking time, and time to recovery) complete bilateral study.

CPT 2010 adds More Options to Your Vaccine Administration Coding

Earlier Editions of CPT include vaccine administration codes (90465-90468) for children younger than eight years of age. Now CPT 2011adding more options to your Vaccine Administration.

As winter sets in, CPT 2011 will bring some welcome additions to your observation care and vaccine administration coding options. These vaccine administration codes are expected to help boost physicians' bottomlines.

Earlier editions of CPT included vaccine administration codes (90465-90468) for children younger than eight years of age when the physician counseled the patient/family. This time, CPT introduces two administration codes that expand the concept to include adolescents and teens and does away with the distinction based on route administration:

90460 -- Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component

90461 -- each additional vaccine/toxoid component (List separately in addition to code for primary procedure).
You could find yourself relying frequently on 90460 and 90461 if your physician often provides counseling with vaccinations for patients 18 or under. Perhaps part of the supposed need for these codes was the increasing prevalence of multicomponent vaccines. The physician needs to counsel regarding each component; but the coding did not distinguish that higher amount of counseling from counseling for a single component. The switch allows physicians to get credit for each component on which they counsel, and not the number of shots given.

Note: Components drive vaccine descriptors

The new immunization administration codes this time are based on the number of components in the vaccine.

Get a sneak peek on these vaccine administration codes as well the entire CPT code list (http://www.supercoder.com/cpt-codes) for the coming year by signing up for a medical coding guide like Supercoder!