Tips to Ensure a Successful CABG Coding

Here are some tips to ensure a pain-free CABG (coronary artery bypass graft) coding:

You should make it a point to examine the code choices. During CABG procedures, there are three CPT codes for anesthesia: 00562, 00566, and 00567.

The associated base units differ as per the procedure.

You should watch for pump documentation. The first question you need to answer when coding anesthesia during CABG is whether the anesthesiologist used a pump oxygenator during the procedure.

An 'off pump' case takes place when the surgeon operates on the patient's still-beating heart. The physician is required to document 'off pump' before you can report the codes with higher base unit values. It can be worth approximately $85 more for an average Medicare case; however see to it that your anesthesiologist has earned it before you code it.

And just as in any other type of procedure, the key to reimbursement is documentation.

You shouldn't always add qualifying circumstances

Some payers let coders report "qualifying circumstances" codes that explain aspects of the patient's situation that complicated the anesthesiologist's work. Three of these codes - 99100, 99116, and 99135 – might apply to cardiovascular cases.

You shouldn't include these codes with all CABG procedures. Often, Hypothermia is included in the anesthesia code and shouldn't be reported separately in those cases.

You should look for notes that add units

Documentation can sometimes justify extra base units; as such you should read your anesthesiologist's notes and the operative report carefully.

For instance, if the surgeon sews a graft during an off-pump procedure, the anesthesiologist is due one additional unit owing to the increased risk. Also, you can shift from 18 base units with 00567 to 20 base units with 00562 if the CABG procedure includes another heart procedure like valve placement or if the patient is having a re-do CABG more than one month after an original CABG surgery.

To get the full picture, you need to look at the operative note along with the anesthesia record to get the complete picture. If something is mentioned in the surgical note that counts as documentation, you can use in your anesthesia coding.

CPT codes: Technique Drives Your Code Selection

When our GI saw a patient for endoscopic biopsy, the patient's mucosa was normal except for internal hemorrhoids and a raised sessile diminutive polyp in the sigmoid colon that was ablated through hot biopsy forceps. In this situation, what CPT codes should be used to describe this procedure?

Be it cold biopsy forceps, hot biopsy forceps or snare technique normally it's the technique that drives your code selection.

Normally the technique should drive your code selection. But then it's possible to ablate a polyp or lesion not amenable to removal with many different devices including all of the above techniques in addition to argon plasma coagulation, gold probe bipolar cautery, and other methods. The answer to this question depends on whether any of the diminutive polyp was removed for pathology analysis.

Removing a specimen means you should code the hot biopsy using 45384, which describes a procedure wherein the physician uses bipolar forceps to both remove and cauterize a polyp simultaneously. You would also use this code when the physician uses either monopolar hot biopsy forceps or bipolar cautery forceps. But then if the polyp was not amenable to removal then you should code using 45383.

Note: The instrument utilized in a colonoscopy is a flexible, thin tube with a video camera and light at the end called a colonoscope. Oftentimes the physician passes other instruments (say for instance biopsy forceps) through the colonoscope to carry out procedures such as tissue biopsy and polypectomy. Many other CPT codes pertain to colonoscopy procedures apart from 45384.

Here are a number of factors you should think about while coding for colonoscopy:

During the diagnostic colonoscopy was another procedure(s) carried out. If it was carried out what was the procedure (s) and what was the technique used. Also consider whether the lesion was removed for pathology analysis as well as what instruments were used.

CPT Codes for Skin Replacement and Skin Substitute Grafts

Revised CPT instruction clarifies coding.

Although the codes and rules for reporting skin replacement and skin substitutes are not new, ever since 2011 CPT codes added a couple of new introductory sections it certainly looks clearer. Read on and take some lessons on ways to report skin replacement and skin substitute grafts:

When you shouldn't use these codes

There are over 50 codes that describe the various surgical steps and types of skin replacement/substitute procedures in the range 15002 - +15431.

So questions may arise whether you should report the proper codes from this range every time your surgeon makes use of a skin replacement or skin substitute to heal a wound. Well, in this case you shouldn't code a skin replacement or skin substitute application if the surgeon just applies skin replacement/substitute to the wound, even if he makes it stable by dressing.

Instead here's what you should do: You should use these codes only when the skin substitute/graft is anchored using the surgeon's option of fixation. Say for instance it might include adhesives, sutures, or staples.

You should look for documentation of fixation in the op note before you make use of any skin replacement or skin substitute codes.

Be familiar with what ‘application' services include

Many a time surgeons carry out skin replacement or skin substitute grafts post other surgical treatment for distressing wounds, burn eschar, or necrotizing infection. When the surgeon applies and fixes skin or a skin substitute you will need to understand which services you should and should not code in apart from the proper graft code.

You should include dressing: As per CPT instruction, when you report a skin or skin substitute graft, you should not code routine dressing supplies separately. Supplies like A6453 are included in the skin application charge.

2012 CPT Code Changes for Clinical Lab Codes

CPT 2012 brings new codes for HIV Antigen and NMPP22 – check them out.

On January 1 next year, 2011 CPT codes will be replaced by new codes. So if your lab runs a single-result test for HIV-1 antigens and HIV-1/HIV-2 antibodies, you will have a new code to report the service next year. This is one of the two new CPT codes that made an entry at the annual CMS laboratory public meeting for pricing new test codes for payment on the clinical laboratory fee schedule.

Even though there are no new codes on the horizon, this year's meeting featured much discussion about drug test coding.

Two new clinical lab test codes in CPT 2012

This time, CPT 2012 codes will bring these two clinical lab test codes: 863XX, 873XX. Both these codes will provide more specific reporting for newer tests you may have added to your menu recently.

Drug Testing Leads ‘Reconsideration'

Apart from pricing recommendations for the new codes, Centers for Medicare & Medicaid (CMS) heard public comments for reconsideration requests for these 2011 CPT codes : G0434, G0435, 83861, 86481 and 87906.

Drug screen

Many commentators suggested changing G0434 to cover only CLIA waived tests, while coding up with a new code for moderate complexity tests priced at four times G0434. The present grouping under G0434 comes down hard on clinical labs that carry out these tests while using instrumented moderate complexity systems. The moderate complexity instruments come with some clinical advantages - say for instance higher specificity that commentators said shouldn't be discouraged by coding and reimbursement.

Pricing Proposal & Comment

The agency received industry input during the July 18, 2011, public meeting for the new codes. It'll post final payment determinations on the same Website in October 2011.

Even though payment method for codes can be either crosswalk or gap-fill, almost all presenters at the public meeting recommended crosswalks for the just-in codes.