How to Code Cosmetic Ptosis Repair

Having issue how to code Cosmetic Ptosis repair. For more on this and all 2011 CPT updates visit a medical coding guide like Supercoder.

There is this Medicare patient of ours who'll be having a leva to resection on his right eye for ptosis. The ophthalmologist wants to do this as a bilateral procedure; however the patient's left eye is a non-seeing eye. As the operation on the right side may be medically necessary, but the left side would likely be considered cosmetic, how should I go about coding this surgery?

Well, you should report each side of the bilateral procedure on a separate line, appending modifiers LT (left side) and RT (Right side), linking each side to the appropriate diagnosis code explaining the necessity for the surgery.

In this situation, one side will be medically necessary, while the other will be cosmetic – the procedure will not benefit the vision on the non-seeing eye.

Here's what you need to do: Before the surgery, have the patient sign an advance beneficiary notice of non-coverage (ABN) prior to surgery, stating that he's aware that Medicare will not cover the procedure carried out on the left eye. Ensure your ABN is in layman's terms and specifies the specific reasons for non-coverage. (you shouldn't use CPT Code, ICD 9 codes on the ABN form).

You must also specify the estimated cost of the service on the ABN. The original signed ABN indicating the patients decision ( be sure the patient has chosen one of the options) to accept financial responsibility, is maintained by the practice and a fully executed copy must be provided to the patient. Append modifier (Waiver of liability statement on file) to the procedure done on the non-seeing eye to indicate that the patient was informed before and has selected the option to be responsible for the non-covered service and unpaid amount.

For instance: The patient has congenital ptosis (743.61), and his left eye is non-seeing. The ophthalmologist carries out levator resection (67904, Repair of blepharoptosis; [tarso] levator resection or advancement, external approach) bilaterally. Code as follows:

Line 1: 67904-RT linked to 743.61

Line 2: 67904-LT-GA linked to V50.1 (Elective surgery for purposes other than remedying health states; other plastic surgery for unacceptable cosmetic appearance).

If your documentation shows that the procedure was medically necessary on the right side, Medicare will reimburse the full amount for 67904-RT. The cosmetic diagnosis linked to 67904-LT-GA will prompt the carrier to deny the specific service due to the diagnosis and non-coverage of cosmetic services, and the explanation of benefits (EOB) received by the patient will confirm that the patient is responsible for payment.

Orthopedic Coding: Additional Neurostimulator & Arthrodesis Codes

Your orthopedic practice will enjoy the additional neurostimulator and arthrodesis codes as far as the new and revised CPT codes for your orthopedic practice in 2011 is concerned.

This time your orthopedic practice will enjoy the additional neurostimulator and arthrodesis codes as far as the new and revised CPT codes for your orthopedic practice in 2011 is concerned. You'll be required to report arthrodesis procedures that include discectomy, osteophytectomy and spinal cord decompression with two just-in bundled codes: 22551, 22552.

Since 22552 is an add-on code, you would report it with 22551 to reflect any additional interspace the neurosurgeon treats below C2. Prior to this, bundled procedure would have been reported as 63075 for the discectomy, osteophytectomy and spinal cord/nerve decompression and 22554-51 for the arthrodesis. This is one of several code pairs which were used together more than 90 percent of the time, leading CMS to request a bundled code from CPT.

Now you'll be able to describe fully tibial and cranial neurostimulator services with four new codes: 64566, 64568, 64569 and 64570. And if your neurosurgeon carries out chemodenervation, you'll have a new code to code for work on the salivary glands: 64611.

This year don't let code descriptor changes trip you up when you turn to 20664 for halo application, as the revision this time does away with the phrase "requiring general anesthesia:" 20664 (Revised). Add-on allograft codes 20930 and 20931 received changes, which will be for 2011: 20930 (Revised) and 20931 (Revised).

The development of many bone graft extenders including demineralized bone matrix and bone morphogenic protein led to frequent questions regarding the appropriate coding for these materials. The revision of 20930 places these materials in the same category as other non-structural bone extenders that are not obtained directly from the patient being tended to." Closed vertebral facture code 22315 now deletes the phrase with or without anesthesia: 22315 (Revised) and code 22851.

Pacing Systems: +33225 Confusion? Here is the Solution

CPT 33206

Mark this LV-lead modification in your manual.

Some biventricular upgrade cases have been frustrating for medical coders, but there's good news.

Looking for the accurate code combination is much easier now that the AMA has published an official rectification to the main CPT codes you might report with +33225 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator [including upgrade to dual chamber system and pocket revision] [List separately in addition to code for primary procedure]).

Add Gen Change Codes to Primary Options

The corrections document for AMA's CPT® 2012 manual reviews the parenthetical instruction following +33225. The revision adds four CPT codes to the list of possible primary codes for +33225:

• 33228 (Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system
• 33229 (multiple lead system)
• 33263 (Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator pulse generator; dual lead system)
• 33264 (multiple lead system)

Keep in mind that because +33225 is an add-on code, you should report it in addition to a primary code. You may never report +33225 without an accurate primary code.

Review These Upgrade Cases for Denials

The addition of CPT codes 33228, 33229, 33262, and 33264 to the list of primary codes resolves an issue many coders have faced as the codes became effective in January.

Affected cases are upgrades from a single- or dual-lead pacemaker or implantable cardioverter-defibrillator system to a biventricular (BiV) system. Specifically, the cases involve the physician placing the left ventricle lead (+33225), altering the pulse generator, and connecting earlier placed lead(s) to the new battery.

For instance, assume the physician does away with an existing single pacer generator, inserts a BiV pacer generator, connects the present right ventricle (RV) lead, and implants and connects a new left ventricle (LV) lead. The 2012 coding guidelines originally published didn't propose clear guidance on how to code this scenario.

The problem: The logical assumption is that you must report +33225 with the applicable generator change code when a case includes LV lead placement (+33225) and generator change (such as 33228, 33229, 33263, or 33264). However, CPT® did not list the novel generator change codes as acceptable primary codes for +33225.

Result: When practices attempted to report the generator change CPT codes along with +33225, they received denials.

Practices were left trying to find a different coding option. Some coders wondered if at all they could code the LV lead placement (+33225), a new system insertion (such as 33206-33208, Insertion of new or replacement of permanent pacemaker with transvenous electrode[s] …), and possibly battery removal (such as 33233, Removal of permanent pacemaker pulse generator only). This is technically inappropriate from a coding perspective as there was an LV lead added, however no RA or RV lead changed. The new system codes need lead insertion or replacement, so CPT 33206 -33208 would not be appropriate here.

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

Capture all facets of therapy to maximize reimbursements.

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

Capture All Aspects of the Infusion

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

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

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

Note Timelines for Next Procedure

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

Example: Use this scenario to guide your coding:

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

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

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

Changes necessitate more specificity.

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

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

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

Attention! Lung Biopsy Will Now be More Specific

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

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

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

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

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

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

Note This Diagnostic Thoracoscopy Excluding Biopsy Revision

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

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

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

Tip: You should be cautious while submitting probable diagnoses.

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

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

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

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

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

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

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

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

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

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

2012 Update: 96360-96549: Start Using These Guideline Revisions

These instruction changes intend to answer common infusion admin questions.

At first look, the CPT® 2012 manual appears to present a completely revamped set of infusion administration guidelines. However if you're confused about what exactly is new, you aren't alone. This expert medical coding insight will give you a rundown on these guidelines and related CPT codes.

Good news: The guideline revisions fall more under the category of "clarification" than under the category of "change". For instance, it offers clarified language about when hydration can be billed and how dates of service in an overnight outpatient hospital stay for observation must be reported. Thus the 2012 guidelines bring better direction supporting what practices must have been doing all along.

Watch for Supported Office/Outpatient E/M Visit

The revised guidelines add details on which E/M codes you may report in addition to the infusion administration CPT codes.

From the 2011 guidelines, you by now know that your physician may report an important, distinctly identifiable E/M service in addition to the infusion service code by appending modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.

The 2012 guidelines go a step further by affirming in case a separately identifiable E/M is executed, you must report a distinct "office or other outpatient" E/M service. To emphasize the point further, the guidelines list the possible office/outpatient CPT codes:

99201-99215 (Office or other outpatient visit )

99241-99245 (Office consultation )

99354-99355 (Prolonged service in the office or other outpatient setting …)

In a distinctive case, a physician reporting an E/M plus infusion admin for the same patient will be carrying out both in the office setting. This is for the reason that physicians should not submit claims for most infusions performed in a facility. As the guidelines state, infusion admin CPT codes 96360-96379, 96402, 96409-96425, 96521-96523 are not aimed to be reported by the physician in the facility setting.

Review When 2 Initial Codes Are OK

The 2012 guidelines go into more detail than the 2011 guidelines did on the meanings of initial, sequential, and concurrent when used in the infusion code definitions. The guidelines also propose practical information on how to apply the CPT codes.

Similar to the 2011 guidelines, the 2012 CPT guidelines state that while administering multiple infusions, you must report only one "initial" service CPT code. (CPT® 2012 adds "for a given date.") The exception under both 2011 and 2012 guidelines is that you may report more than one initial CPT code if protocol needs use of two distinct IV sites.

Increase Pay Up for Allergy Immunotherapy Billing for Each Service Delivered

Accurate code reporting for allergy immunotherapy depends on understanding that physicians are to bill merely for the component codes, i.e., the injection-only CPT codes (95115 and 95117) and/or the codes representing antigens and their preparation (CPT 95144-95170). Physicians providing both services must bill for both in order to ensure accurate medical coding.

The CPT outlines immunotherapy (desensitization, hyposensitization) as the parenteral administration of allergenic extracts by means of antigens at periodic intervals, generally on an increasing dosage scale to a dosage which essentially is maintained as maintenance therapy. Understanding the dissimilarities between the following listed CPT codes is important to obtaining correct reimbursement for these codes:

CPT 95115-95117 (professional services for allergen immunotherapy excluding provision of allergenic extracts; single injection; as well as two or more injections,

respectively)

CPT 95144 (professional services for the supervision and provision of antigens for allergen immunotherapy, single or multiple antigens, single-dose vials [specify number of vials])

The office visit is a distinct procedure. The patient comes in originally for the office visit [99212-99215] along with scratch test. After that the serum is made [CPT 95144]. Then the patient visits the allergist again or takes the serum to their general practitioner and continues getting the shots though frequently they are required to get them [95115 or 95117).

How to Bill in Case an Outside Entity Creates the Antigen

Several allergists have the antigen created in a different place, for instance a pharmaceutical company. In these cases, the antigen preparation is taken as a part of the patients prescription program or patient's medication benefit. This is particularly true with managed care plans.

While you report 95165 (professional services for the supervision and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) sometimes that will go to a dissimilar carrier. Blue Cross is infamous for that. You must find out which carrier the patients pharmacy program is with. The antigen is taken as a part of the prescription program, or patient's medication benefit. Remember that carriers will think through the antigen creation a preauthorized procedure. This implies that that you must be aware of your time limits for dosage administrations.

Also keep in mind that 95165 must be reported while you are using both 95115 (or 95117) and CPT 95144.

CPT 95144 (single dose vials of antigen) must be billed only in case the physician who makes the antigen is creating it to be injected by certain other entity.

While billing CPT 95144-95170, physicians must state the number of doses delivered in the units field. CPT Code 95165 signifies multiple-dose vials. A particular dose, in 95165, is the total amount of antigen to be administered to a patient during one treatment session. Physicians should specify the number of doses delivered in the full session.

For More Information :- http://www.supercoder.com/coding-newsletters/my-pulmonology-coding-alert/maximize-pay-up-for-allergy-immunotherapy-billing-for-each-service-rendered-article

CCI 18.0 Update: Include Compression Therapy in Numerous Skin Graft Codes

Watch out for different sessions or sites before you try to break these bundles.

If your dermatologist is carrying out venous compressions to treat ulcers, you might already be aware about novel procedure codes 29582-29584 (Application of multi-layer compression system…), introduced in CPT® 2012. At present you are required to know how that code is affected by the latest round of Correct Coding Initiative (CCI) edits to ensure error free medical coding.

CCI edits 2012 introduces 15,530 new edit pairs. As per CCI edits 2012, 29582-29584 are taken as an intrinsic part of these skin graft codes:

15050 – (Pinch graft, single or multiple, to cover small ulcer, tip of digit, or other minimal open area (except on face), up to defect size 2 cm diameter)

15100 – (Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050))

15110 – (Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children)

15115 – (Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children)

15120 – (Split-thickness autogr`aft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050))

15130 – (Dermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children)

15135 – (Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children)

15150 – (Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less)

15155 – (Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less)

15200 – (Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less)

15220 – (Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less)

15240 – (Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less)

15260 – (Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less)

15271-15278 – (Application of skin substitute graft …)

As per CCI edits 2012, besides, CPT code 29582 (Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed) is bundled into:

10060-10061 -- Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia…)

10140 – (Incision and drainage of hematoma, seroma or fluid collection)

10160 – (Puncture aspiration of abscess, hematoma, bulla, or cyst)

11000 – (Debridement of extensive eczematous or infected skin; up to 10% of body surface)

11042 – (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less)

Check Bundles for Novel Skin Substitute Codes
CCI edits 2012 also presents a number of code edits affecting the new skin substitute graft codes, 15271-15278 (Application of skin substitute graft ...). According to CCI edits 2012, the following listed procedures are taken as an intrinsic part of all of the skin substitute graft applications:

11000 – (Debridement of extensive eczematous or infected skin; up to 10% of body surface)

11042 – (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less)

12001-12007 – (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet))

12020-12021 – (Treatment of superficial wound dehiscence)

12031-12037 – (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet))

13120-13121 – (Repair, complex, scalp, arms, and/or legs)

16020-16030 – (Dressings and/or debridement of partial-thickness burns, initial or subsequent)

CCI 18.0: 87389: Choose Just 1 HIV Test Code or Face Denials

Update bundles meant for cytology, special stains.

Just as you're beginning to use CPT® 2012 changes in your laboratory, the latest edition of Medicare's Correct Coding Initiative (CCI) limits how you can use some of those CPT codes.

Remember: You cannot just go ahead and add a modifier (such as 59, Distinct procedural service) any time you wish to separate a code bundle, you'd have to validate it with the physician's documentation that denotes the distinct nature of the service, like a separate site or session.

87389 Stands Alone

With ample of HIV lab tests available, only one CPT code explains a single-result test for antigens and antibodies. That code was added in CPT 2012: 87389 (HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result).

Source URL :-

On the other hand, other HIV CPT codes describe a test for one or the other -- HIV antibodies or HIV antigens. Other HIV-1 and HIV-2 antigen and antibody test CPT codes are as follows:

Antibody tests:

86701 – (Antibody; HIV-1)

86702 – ( HIV-2)

86703 – ( HIV-1 and HIV-2 single result)

Antigen tests:

87390 – (Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; HIV-1)

87391 – ( HIV-2)

87534 – (Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, direct probe technique)

87535 – ( HIV-1, amplified probe technique)

87536 – ( HIV-1, quantification)

87357 – ( HIV-2, direct probe technique)

87358 – (HIV-2, amplified probe technique)

87359 – ( HIV-2, quantification)

CMS bundles some of these tests with CPT code 87389 in the latest CCI update. Specially, new edit pairs restrict billing 87389 with the combined HIV-1/HIV-2 antibody test (86703) and HIV-1 antigen tests 87535, 87536 and 87390. The "0" modifier indicator for most of these code bundles means that you should not override the edit pair under any circumstance.

Here's why: Because 87389 indicates both the HIV-1 antigen status and the HIV-1/HIV-2 antibody status of the patient, additionally reporting individual tests for the same indicators would be inappropriate.

More: CCI Edit 18.0 also bundles CPT code 87389 with some services that might be part of the prep steps for that assay: 87147 (Culture, typing; immunologic method, other than immunofluoresence [e.g., agglutination grouping], per antiserum) and 87253 (Virus isolation; tissue culture, additional studies or definitive identification [e.g., hemabsorption, neutralization, immunofluoresence stain], each isolate). These bundles include a modifier indicator of "1," implying that you can override the edit pair, when suitable.

In case the virus isolation or culture typing is not part of 87389, however you carry it out for a different test on the similar day as the combined HIV test, you can then use modifier 59 to override the edit pair.

CPT®2012 Update: Tips Help You Master Bone Biopsies With Vertebroplasties

Discover the levels for primary procedure as well as biopsy.

Read in the procedure note in case your surgeon carried put a bone biopsy while doing the vertebroplasty. In case the vertebroplasty and biopsy are at the same level, you are not supposed to report any additional bone biopsy codes for CPT. Look at examples below to brace your vertebroplasty reporting for error free medical coding.

Note the Change in Code Descriptor(s)

The CPT codes for vertebroplasty include a definite revision in the code descriptors which clearly states that you must include the bone biopsy when one is carried out. The revisions in code descriptors listedbelow:

22520 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; thoracic)

22521 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; lumbar)

+22522 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; each additional thoracic or lumbar vertebral body [List separately in addition to code for primary procedure])

The revision in these codes for CPT includes bone biopsy included when carried out.

The descriptor clearly describes that the bone biopsy is included when your surgeon does one.

Do Not Look To Additional Codes for Bone Biopsy

While you report vertebroplasty in 2012, you will not report an additional bone biopsy CPT code 20225 (Biopsy, bone, trocar, or needle; deep [eg, vertebral body, femur]) in case your surgeon carres out the biopsy at the similar spinal level as the primary procedure. This is due to the removal of bone tissue is inclusive in the vertebroplasty procedure and does not require additional procedure when the same is carried out to retrieve the tissue for a biopsy. Henceforth, you do not report the bone biopsy your surgeon performs at the same level as the vertebroplasty.

When your surgeon does the vertebroplasty and bone biopsy at different levels, you report the biopsy separately with modifier 59 (Distinct procedural service). Ensure your surgeon documents the unrelated nature and distinct locations of the two procedures.

Location Guides Your Choice of Codes

The CPT codes of SuperCoder.com  for vertebroplasty identify the location as lumbar or thoracic in the descriptor. The spinal location determines the CPT code you select. You choose a code to define the primary level where your surgeon carried out the procedure. You report CPT code 22520 for vertebroplasty at levels T1-T12 or 22521 for levels L1-L5. While the procedure spans to another level in the same location, you must also report CPT code +22522 in addition to 22520 or 22521.

Reporting 64405 for Third Occipital Nerve Blocks? Think Again

Also, learn what CPT codes you must choose for blocking lesser occipital nerve

Physiatrists who administer third occipital nerve blocks must not automatically assume that 64405* (Injection, anesthetic agent; greater occipital nerve) is the most suitable CPT code. Most medical coding consultants recommend reporting 64470-22 in place of 64405 to more precisely define these types of blocks.

Occipital Nerves Differ

When a physician specifies on the charge ticket that he or she carried out an occipital nerve block, your instinct might tell you to assign CPT code 64405. However 64405 is not at all times the most correct code. Physiatrists administer injections to the third occipital nerve to help diagnose and treat dissimilar forms of headache and neck pain.

The 'third occipital nerve' is not anatomically identical with the greater occipital nerve. Physicians use both injections to diagnose and/or treat some forms of headache. However coding hinge more on the anatomical structure and the procedure location than the patient's symptoms or diagnosis.

The body contains three diverse sets of occipital nerves: the greater occipital, the lesser occipital, and the third occipital nerve (also referred to as the “least occipital nerve"). By reviewing the physiatrist's documentation, you can identify which nerve he or she blocked and assign the correct code for the procedure.

The greater occipital nerve originates from the dorsal ramus of the C2 spinal nerve. It has movement (motor) functions that innervate in the posterior neck muscles and sensory functions for the skin of the posterior surface of the scalp. Physicians often inject the greater occipital nerve to diagnose and treat occipital neuralgia (723.8, other syndromes affecting cervical region). You should report CPT code 64405 for this procedure.

The lesser occipital nerve also originates from the C2 spinal nerve, but its source is the ventral ramus. It has only sensory functions that innervate the skin behind the ear. The CPT code for blocking lesser occipital nerve is 64450* (Injection, anesthetic agent; other peripheral nerve or branch).

The third occipital nerve (TON) is certainly the superficial medial branch of the C3 spinal nerve's dorsal ramus. The TON, like the greater occipital nerve, has both motor and sensory functions. It innervates some of the neck muscles and the C2-3 facet joint. Pain stemming from this joint can be referred to the occiput and even as far as the frontal region and orbit.

Source Code :-

Pinpoint the Correct Code

A physiatrist may inject all three occipital nerves to help diagnose or treat chronic headaches. The practitioner selects the suitable occipital nerve injection based on the patient's medical history along with the condition (for example, a history of neck trauma such as whiplash [847.0, Sprains and strains of other and unspecified parts of back; neck], tender neck points [723.1, Other disorders of cervical region; cervicalgia], description and quality of headache, etc.).

CPT® 2012 Update: Streamline Your PFT Reporting

CPT® simplifies reporting by combining two codes into one.

Have you ever struggled with distinguishing between pulmonary function tests for instance carbon monoxide diffusing capacity (DLCO) and membrane diffusion capacity (DMCO)? In case your answer to this is yes, then you’ll be happy to hear that effective Jan.1, 2012, CPT® has reduced your burden by combining these two CPT codes into a single code.

Read on for more on this change and how to adjust your reporting of these tests.

Note Advantages of Single Add-on Code

Before the changes initiated in 2012, you were required to report carbon monoxide diffusing capacity and membrane diffusion capacity using dissimilar CPT codes. This necessitated complex understanding of the procedures as well as knowing the difference between the two codes.

There was rumour that the codes were being reported erroneously since the increase in utilization for 94725 was recognized as 14% more than that of 94720 over a six year time period. Given the limited clinical indications and use for 94725, this surge seemed irrational.

The old CPT codes (prior to Jan, 1, 2012) that have now been deleted include the following:

94720 – (Carbon monoxide diffusing capacity [e.g., single breath, steady state])

94725 – (Membrane diffusion capacity)

Under CPT® 2012, you will be required to report these procedures under a single code:

+94729 – (Diffusing capacity [e.g., carbon monoxide, membrane][List separately in addition to code for primary procedure])

Benefit: This CPT 2012 ( Source "http://www.supercoder.com/cpt-codes/") change has made the job stress-free as there is no need to go into the procedure details to know whether it is a test for carbon monoxide diffusing capacity or membrane diffusion capacity. Both are now reported with single CPT code +94729. The reimbursement and relative value units for the new code (~$53, 1.57 total RVUs) are like 94720.

CPT Code Lookup Tip: As a lot of providers consider DLCO and DMCO to be a routine part of PFTs, they have now been collected together as an add-on code, and cannot be reported on its own. You should therefore report CPT code +94729 together with other pulmonary function tests, for instance:

94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation)

94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration)

94070 (Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents [eg, antigen[s], cold air, methacholine]) 94375 (Respiratory flow volume loop)

94726 (Plethysmography for determination of lung volumes and, when performed, airway resistance)

94727 (Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes)

94728 (Airway resistance by impulse oscillometry)

Abdominal Aortography Interp Might Be Payable With Heart Cath

Plus, know what CPT codes you must pick for aortography, abdominal, by serialography and more

Added payment may be gained for any abdominal aortography carried out during the same session for example a left heart cath with aortography of the aortic root however only if documentation specifies that the intent of the abdominal aortography was the treatment of a dissimilar problem. This expert medical coding article gives you CPT code lookup tips and more.

Procedure notes thus need to document clearly and accurately (by including, for example, a second diagnosis) that the additional aortography was separate from the heart cath.

When a left heart cath is done, aortography as well as the more distinctive angiography of the left coronary chambers as well as the coronary arteries may be carried out to get images of the aortic root (where the aorta joins the heart). For this particular procedure, once you execute CPT code lookup, 93544 (injection procedure during cardiac catheterization; for aortography) is reported with 93556 (imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; pulmonary angiography, aortography and/or selective coronary angiography including venous bypass grafts and arterial conduits [whether native or used in bypass]).

Any images gained from injections in the ascending aorta (the first section of the aorta, defined as the section from the left ventricle to the arch, or bend) are encompassed in CPT codes 93544/93556. 93544 includes positioning the catheter in the ascending aorta which is above the aortic valve. It does not, though, describe abdominal aortography.

Abdominal aortography may be carried out following a heart cath. For instance, the cardiologist may have trouble passing a guidewire plus catheter from the access site (the femoral artery) to the aorta as the patient has tortuous arteries (defined as twisted and full of turns).

In case the coronary problem needs urgent attention, the cardiologist may carry out the heart cath first. When the catheter is being removed via the aorta, another injection is done to image the abdominal aorta or other arteries (such as the renal, iliac and femoral arteries).

Abdominal aortography and heart cath may as well be carried out simultaneously in case the patient has a supplementary problem (such as hip pain or leg cramps) that the cardiologist wants to evaluate at the same time.

SourceURL:- http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/abdominal-aortography-interp-may-be-payable-with-heart-cath-article  

CPT Code Lookup tip: Even though aortography of the aortic root (or elsewhere in the ascending aorta) has already been carried out, and reported using CPT codes 93544/93556, the supervision as well as interpretation of the abdominal aortogram (which reflects the manipulation of the catheter as well as the interpretation of the images) must be distinctly payable using either 75625 (aortography, abdominal, by serialography, radiological supervision and interpretation) if only the aorta is imaged, or CPT code 75630 (… plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation) in case images of the iliac and/or femoral arteries are also gained.

Anesthesia CPT Codes For Subclavian Central Venous Catheter

To put it simply, venous catheterization is a technique to access veins. A central venous access catheter or device is used to deliver medications, intravenous fluids or get blood samples. Central venous access catheters as well as central venous access devices (VADs) are two diverse methods of venous catheterization. The correct procedural coding of central venous catheters and central venous devices (CVD) is to a certain extent difficult for many coders.

This is in part owing to the terms used by physicians when defining the catheters and devices inserted. Several physicians use the term "vascular access device" to mean any kind of central venous catheterization without providing sufficient information as to the exact type inserted, whether it is a non-tunneled or it is tunneled central venous catheter or the insertion of a tunneled, implantable, either partially or totally, central VAD. Similarly, the physician may not always document in case the insertion site is central or peripheral. This lack of exact documentation for the procedures leads to confusion and frustration on the part of the coder.

There are two sorts of VADs: one entirely implanted and the other partially implanted. Both types of VADs are intended to offer repeated access to the vascular system devoid of the trauma or complications of multiple veni-punctures.

CPT has distinct codes for non-tunneled and tunneled central venous access procedures. Consequently, the initial words to concentrate on while coding the insertion of central venous access procedures are "non-tunneled" and "tunneled." The subsequent key word is catheter or device. The non-tunneled central venous access catheter might have either the central or peripheral placement, with a dissimilar set of codes assigned as per the insertion site, central or peripheral, plus according to the age of the patient. Non-tunneled, centrally placed venous access catheters as well as non-tunneled peripherally inserted central venous catheters will not be having a port or pump.

The codes are as following: 36555 (insertion of non-tunneled centrally inserted central venous catheter, under 5 years of age), as well as code 36556 meant for age 5 years or older. The insertion of a non-tunneled, peripherally inserted central venous catheter, or PICC, is also broken down by age. The codes are 36568 (insertion of a non-tunneled peripherally inserted central venous catheter, without subcutaneous port or pump, under 5 years of age), and 36569 for age 5 years or older.

CPT has codes meant for the insertion of tunneled central VADs, they could be catheters or devices, along with for peripherally inserted central VADs. The tunneled central venous catheter codes are allocated on the basis of age. The code meant for the insertion of a tunneled centrally inserted central venous catheter, without a subcutaneous port or pump, under 5 years of age is 36557, and code 36558 for age 5 years or older.

For further details on this and for other medical coding updates, sign up  http://www.supercoder.com/.

Paravertebral Facet Joint Nerve Destruction: Deleted, Replaced, Reduced Codes In 2012

CPT code series, from CPT 64622 to CPT 64627, is replaced with CPT code series 64633-64636

Since paravertebral facet joint nerve destructions emerge to see a small reimbursement increase in 2012 as compared to 2011, both physicians and ambulatory surgery centers may take a hit in reimbursement when carrying out these injections. Read this expert medical coding insight n how these CPT codes changes affect your reimbursement.

Effective Jan. 1, 2012, paravertebral facet joint nerve destructions will no longer be reported per nerve. As an alternative, four novel codes have been established to echo the work and anatomical site involved when carrying out these destructions. Remember before 2012, the injection was reported per nerve at a single vertebral level. CPT 2012 requires that the injection will be reported per facet joint. As per the AMA, It is vital to note the number of nerves injected for a single facet joint does not influence code selection

Out with the old (deleted):

CPT code series, from CPT 64622 to CPT 64627, is deleted in 2012.

In with the new (replaced):

CPT code series, from CPT 64622 to CPT 64627, is replaced with CPT code series 64633-64636:

64633 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint (new code in 2012))

+64634 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure) (new code in 2012))

64635 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint (new code in 2012))

+64636 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure) (new code in 2012))

It may not seem to be a reduction until we report the facet joint in spite of of the number of nerves destroyed. Let's compare:

In 2011: A patient goes through a radiofrequency nerve destruction of two medial branch nerves L3 and L4 innervating the symptomatic lumbar facet joint. Reimbursement contemplation is based upon the following listed CPT code selections:

64622 — ($495.72 (approximate 2012 ASC reimbursement))

64623 — ($294.00 (approximate 2012 ASC reimbursement))

In 2012: A patient goes through a radiofrequency nerve destruction of two medial branch nerves L3 and L4 innervating the symptomatic lumbar facet joint. Reimbursement consideration is based upon the following listed CPT code selection:

64635 — ($516.47 (approximate 2012 ASC reimbursement))

CPT 2012 Coding tips:

Image guidance and localization are essential for the performance of paravertebral facet joint nerve destruction by means of neurolytic agent explained by CPT codes 64633 -64636.

You must not report 64633-64636 in combination with 77003 or 77012). Both CPT 77003 and/or 77012 are considered inclusive to the injection procedure in 2012. In case CT or fluoroscopic imaging is not used/documented, report unlisted CPT code 64999.

In case both facet joints at the same vertebral level are treated, then CPT 64633 or 64635 should be reported with modifier -50 appended pending carrier reporting necessities for bilateral procedures (-50 versus RT/LT versus units).

CPT 2012: 38230 and 38231 Will Need Knowledge of Bone Marrow Donor

Change to global days offers new possibility for E/M reporting.

Get ready to track down some donor details before coding bone marrow harvesting. CPT 2012 needs to know.

Concerning 2011 dates of service, in case someone had asked, "Does coding for bone marrow harvesting differ based on whether the patient donates the cells or whether another person donates the cells?" the answer would have been, "No."

However a code revision and a code adding in CPT 2012 change that answer to "Yes," effective Jan. 1, 2012.

Consider this revision of 38230:

CPT 2011: 38230, Bone marrow harvesting for transplantation

CPT 2012: 38230, Bone marrow harvesting for transplantation; allogeneic.

As 38230 is specific to allogeneic harvest in CPT 2012, CPT® similarly created a code for autologous harvest: 38232, Bone marrow harvesting for transplantation; autologous.

Match the CPT Codes to the Procedures

To apply the CPT codes correctly, keep in mind that "auto" means "self" and "allo" means "other."

For bone marrow transplant medical coding, "autologous" specifies the cells are from the same individual.

Thus autologous means a single patient donates the cells (38232) and then receives those cells back at a later date and through a distinctly reportable service (38241, Bone marrow or blood-derived peripheral stem cell transplantation; autologous).

Allogeneic means the cells are from someone other than the patient. The technical definition of allogeneic is "genetically different but from the same species. For allogeneic harvesting (38230), the donor may be either related or unrelated to the patient. Later, when the patient receives the cells donated from a different individual, you should report 38240 (Bone marrow or blood-derived peripheral stem cell transplantation; allogeneic) for the transplant.

Straight from the source: Medicare addresses stem cell transplantation in Claims Processing Manual 100-04, chapter 3, section 90.3. (“Stem cell transplantation is a process in which stem cells are harvested from either a patient's or donor's bone marrow or peripheral blood for intravenous infusion. Autologous stem cell transplants must be used to effect hematopoietic reconstitution following severely myelotoxic doses of chemotherapy and/or radiotherapy used to treat various malignancies. Allogeneic stem cell transplant may also be used to restore function in recipients having an inherited or acquired deficiency or defect. Bone marrow and peripheral blood stem cell transplantation is a process which includes mobilization, harvesting, and transplant of bone marrow or peripheral blood stem cells and the administration of high dose chemotherapy or radiotherapy prior to the actual transplant".)

Capture New Opportunity to Code Follow-Up

Wording changes aren't just the only news you require to know for stem cell harvest coding. The number of global days has a revision for CPT 2012, as well.

In 2011, Medicare gave 38230 a 10-day global period. That meant that E/M services on the day of the procedure and during the 10-day postoperative period normally weren't payable when the visit was related to the outcome of the procedure, as defined by the global surgical package rules.

As per the 2012 Medicare Physician Fee Schedule (Final, in comment period), CPT codes 38230 and 38232 have a global period of 000 for 2012. Reason: "These services rarely require overnight hospitalization and physician follow-up in the days following the procedure."

For More Information :-

Provider Requirement: 90460-90461 Show Significance of 'Qualified Health Care Professional' Definition

For accurate claims, distinguish these professionals from 'clinical staff.'

The definition of "other qualified health care professional" didn't make it into the CPT 2012 manual, but you are required to know and apply this definition all the same. Read this expert medical coding insight to learn more.

The AMA lists the definition as part of the "CPT 2012 Errata" on its website. The definition is as follows: (A 'physician or other qualified health care professional' is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service. These professionals are distinct from 'clinical staff.' A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service. Other policies may also affect who may report specified services.)

Understand Practical Application of the Definition

The definition was in answer to questions at 2011 Symposium related to CPT codes 90460-90461 [Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional …] counseling requirements and helps to clarify healthcare professionals as different from clinical staff.

Key: RNs and LPNs aren't included in the definition as they cannot individually report the professional services that they provide. RNs and LPNs fit the CPT® definition of "clinical staff," as their professional services are typically reported under a physician or other qualified health care professional's identification number (e.g., under Medicare's "incident to" rule). This implies that when certain CPT codes refer to 'other qualified health care professionals' they are not including RNs and LPNs.

Example: Immunization administration CPT codes 90460-90461 denote "counseling by physician or other qualified health care professional." Consequently, counseling by an RN or LPN would not qualify to meet the requirements of these codes.

More information: Understand that this concept is not new. Shortly after the effective date of the 90460 and 90461 CPT codes, CPT® Assistant (March 2011) explained the "other qualified health care professional" concept. As 90460-90461 replaced 90465-90468 (Immunization administration younger than 8 years … when the physician counsels the patient/family …), which by definition needed face-to-face counseling by a physician, the "other qualified healthcare professional" in 90460-90461 was intended to be a billing provider for example a PA or NP.

The CPT Assistant article mentions that the addition of 'qualified health care professional' echoes the recognition that frequently registered nurse practitioners and physician assistants carry out and report these services, however it should not be taken to mean that other types of office clinical staff may deliver the counseling.

CPT 2012: 37191-37193: Banish Unlisted Codes From Your IVC Filter Claims

Get ready for new renal catheter placement codes, too.

Surgical codes that define the whole package are becoming the norm, and CPT® 2012 continues the trend. Inferior vena cava (IVC) filter procedures and renal angiography have new 2012 CPT codes that combine surgical and imaging services into one neat bundle.

Clarify Your IVC Filter Options

Get ready for an all new way to report IVC filter services, outlining the service as insertion, repositioning, or retrieval:

37191 – (Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed)

37192 – (Repositioning of intravascular vena cava filter ...)

37193 – (Retrieval (removal) of intravascular vena cava filter ....)

Old way: In 2011, you reported IVC filter placement with 36010 (Introduction of catheter, superior or inferior vena cava for catheterization), 37620 (Interruption, partial or complete, of inferior vena cava by suture, ligation, plication, clip, extravascular, intravascular [umbrella device]), and 75940 (Percutaneous placement of IVC filter, radiological supervision and interpretation). As 37191 includes all of these elements, CPT® 2012 deletes the IVC-specific codes 37620 and 75940.

Clarify retrieval: Coding IVC filter removal wasn't as clear in 2011 as it is now. Prior to creation of 37193, payers may have demanded unlisted procedure codes or transcatheter retrieval codes 75961 (Transcatheter retrieval, percutaneous, of intravascular foreign body [e.g., fractured venous or arterial catheter], radiological supervision and interpretation) and 37203 (Transcatheter retrieval, percutaneous, of intravascular foreign body [e.g., fractured venous or arterial catheter) to describe the service. 2012 CPT updates clarify that you must not report 37193 alongside 75961 and 37203.

Replace Your Old Renal Catheter Placement Codes

Renal angiography sports four new 2012 CPT codes effective Jan. 1, 2012. Key elements differentiating the codes include whether the service is first order or it is higher, and whether the service is unilateral or bilateral:

36251 – (Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral)

36252 – (... bilateral)

36253 – (Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral)

36254 – (... bilateral.

Tip: When reporting the new renal 2012 CPT codes, do not report 36254 with 36252.

You also must not report 36253 with 36251 when carried out on the same renal/kidney. The accessory renal arteries only has an impact on medical coding if the catheter placement is in a second or higher order position

Don't miss: The addition of these 2012 CPT codes means you'll no longer use a code from 36245-+36248 (Selective catheter placement, arterial system...) to report the catheterization. And because imaging services are included in the new 2012 CPT codes, CPT® deletes 75722-75724 (Angiography, renal ...).

Imaging: 72114 and 72120 Get View Requirement Modifications in 2012

Start the documentation education now to ease possible 72114 audits.

Where view requirements are concerned, CPT® giveth, and CPT® taketh away for two spine X-ray 2012 CPT codes.

Ensure your medical coding practice applies these key code updates, effective for services on or after January 1.

2012 CPT Codes: Plan Ahead for Tougher 72114 Requirements

To report 72114 for a lumbosacral spine X-ray carried out in 2012, you must fulfil a new requirement for a "minimum of 6 views":

2011: (72114, Radiologic examination, spine, lumbosacral; complete, including bending views)

2012: (72114, Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views)

The above code from the 2012 CPT codes will be applicable to six or more views however the 2011 definition of 72114 did not include any definite number of views.

Potential problem: Some physicians now document complete including bending views, instead of stating the number of views.

Solution: This change is going to necessitate physician education to make certain coders are given adequate information to support this code. Stating the exact number of views has always been a documentation best practice, however this 2012 CPT update makes documenting those views an absolute must.

Alert your physicians and techs to the new prerequisite, and ask for documentation of the number of views, as well as the type of views, so you can support use of 72114.

Example: The radiologist's note documents performance and interpretation of the following listed views:

AP (anteroposterior)

Lateral

Flexion

Extension

LPO (left posterior oblique)

RPO (right posterior oblique)

Left bending view

Right bending view.

As the documentation meets the minimum of six views and comprises of bending views, you should choose 72114. (Reminder: Because the code covers a "minimum of 6 views, you should not report any views beyond the first six with a separate code. A single unit of 72114 will cover all of the lumbosacral spine X-ray views.)

2102 CPT Update: 2 Views Will Now Suffice for 72120

In case you're unhappy about the new minimum view requirement for 72114, you may be cheered by the change to 72120. CPT 2012 actually decreases the required number of views for 72120 from "minimum of 4" to "2 or 3":

2011: (72120, Radiologic examination, spine, lumbosacral, bending views only, minimum of 4 views)

2012: (72120, Radiologic examination, spine, lumbosacral, bending views only, 2 or 3 views)

This change is in line with existing practice as physicians normally don't need four views to capture what they need to see. Every time bending views are ordered, they are almost assured to require/order at least two views. As far as 2012 CPT codes are concerned, meeting the necessities of 72120 will be much easier.