Are you aware of the difference between 'diagnostic' and 'therapeutic' injections or nerve blocks? And how does the provider decide which to do?
Physicians use diagnostic nerve blocks to figure out the sources of the patient's pain. These blocks normally contain an anesthetic with a known duration of relief. Therapeutic nerve blocks cover local anesthetic to control acute pain, once the doctor corroborates the source and cause of discomfort. Most CPT section headings for injection or nerve block codes mention 'diagnostic or therapeutic'. Often the codes cover for both situations, meaning you could most likely report the same code for both diagnostic and therapeutic injections, based on the type of block and administration site.
Source URL :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/reader-questions-distinguish-diagnostic-from-therapeutic-nerve-block-103751-article
Here's an example:
A provider might inject an anesthetic and a steroid into a facet joint or a peripheral nerve to figure out whether that's the source of the patient's pain. A nerve block might be both diagnostic and therapeutic in that situation. However payers may want to know whether the block is diagnostic or therapeutic. Specifying such can be a criterion of coverage. Teach your physicians on the importance of documenting whether the patient gets a diagnostic or therapeutic block.
Bear in mind: Take a look at whether you may report radiological guidance separately or whether it is included. For instance, you shouldn't report imaging guidance with a code like 64490. According to the code definition, "with image guidance" and CPT guidelines before the code tell you that fluoroscopy and CPT guidance as well as contrast injections are included in 64490.
Showing posts with label CPT guidelines. Show all posts
Showing posts with label CPT guidelines. Show all posts
Tuesday, May 31, 2011
Thursday, April 28, 2011
Avoid Leaving Split Antepartum Care Dollars On The Table
If you ob-gyn's providing only one-two visits, here's what you should submit.
When it comes to coding split antepartum visits, do not shortchange your practice. Depending on the number of visits your ob-gyn provides, you'll report either an evaluation & management visit or one unit of an antepartum visit code. Take this challenge and see how you fare:
Question 1: Establish antepartum care definition
According to CPT, antepartum care is inclusive of monthly visits up to 28 weeks gestation, bi-weekly visits up to 36 weeks gestation, and weekly visits until delivery.
Answer is true. Ob services include obtaining the patient's history, carrying out a physical exam, recording vital statistics, and doing other examinations required to provide safe and proper care for the mother and fetus.
Question 2: Splitting visits mean no global is it?
When you split out antepartum care for a patient halfway through her pregnancy, you should totally throw out global ob package codes.
Answer is true.
When your obstetrician shares routine maternity care with a doctor outside a group practice owing to transferring into or out of your practice, you'll have to get rid of the following global codes: 59400, 59510, 59610 and 59618.
Don't break the package just because a maternal fetal specialist also tends to the patient for a few visits during pregnancy owing to complication.
Question 3: Depend on evaluation & management code for this number of visits
If the patient had a total of one to three antepartum visits, report the proper level of evaluation & management service for each visit when the DOS that the visit took place and the diagnosis for why the patient was seen.
The answer is true. This is correct as per the American Congress of Obstetricians and Gynecologists (ACOG) and CPT guidelines.
For instance, if the physician sees an ob patient a couple of times prior to moving to a different area, you would use the proper E/M code (99201-99215) for each visit with V22.0 or V22.1.
Question 4: Be careful of your antepartum visits
If the ob-gyn tends to the patient four to six times prior to leaving his care, you'll report 59425 for each instance the ob-gyn sees the patient.
The answer is false. You should use 59425 one time only. Since this code represents the total work involved with all the visits, you should submit it only once with '1' in the units box of the CMS-1500 claim form. What's more, be sure to include the 'to' and 'from' dates during which the services took place. Enter the first prenatal visit in box 15 and enter only the last visit the patient was seen for prenatal care in box 25a.
When it comes to coding split antepartum visits, do not shortchange your practice. Depending on the number of visits your ob-gyn provides, you'll report either an evaluation & management visit or one unit of an antepartum visit code. Take this challenge and see how you fare:
Question 1: Establish antepartum care definition
According to CPT, antepartum care is inclusive of monthly visits up to 28 weeks gestation, bi-weekly visits up to 36 weeks gestation, and weekly visits until delivery.
Answer is true. Ob services include obtaining the patient's history, carrying out a physical exam, recording vital statistics, and doing other examinations required to provide safe and proper care for the mother and fetus.
Question 2: Splitting visits mean no global is it?
When you split out antepartum care for a patient halfway through her pregnancy, you should totally throw out global ob package codes.
Answer is true.
When your obstetrician shares routine maternity care with a doctor outside a group practice owing to transferring into or out of your practice, you'll have to get rid of the following global codes: 59400, 59510, 59610 and 59618.
Don't break the package just because a maternal fetal specialist also tends to the patient for a few visits during pregnancy owing to complication.
Question 3: Depend on evaluation & management code for this number of visits
If the patient had a total of one to three antepartum visits, report the proper level of evaluation & management service for each visit when the DOS that the visit took place and the diagnosis for why the patient was seen.
The answer is true. This is correct as per the American Congress of Obstetricians and Gynecologists (ACOG) and CPT guidelines.
For instance, if the physician sees an ob patient a couple of times prior to moving to a different area, you would use the proper E/M code (99201-99215) for each visit with V22.0 or V22.1.
Question 4: Be careful of your antepartum visits
If the ob-gyn tends to the patient four to six times prior to leaving his care, you'll report 59425 for each instance the ob-gyn sees the patient.
The answer is false. You should use 59425 one time only. Since this code represents the total work involved with all the visits, you should submit it only once with '1' in the units box of the CMS-1500 claim form. What's more, be sure to include the 'to' and 'from' dates during which the services took place. Enter the first prenatal visit in box 15 and enter only the last visit the patient was seen for prenatal care in box 25a.
Wednesday, April 20, 2011
37228-+37235: Four Steps to get TP trunk Services Pay
With a new section for endovascular revascularization in this year's CPT, you'll need to ensure your practice is up to date while billing for tibial/peroneal revascularization services.
Remember initial/additional designation
CPT 2011 divides the just-in codes by initial or additional vessel -- each including angioplasty in the same vessel, when the surgeon performs it -- as here:
Initial vessel: The first four codes apply to the initial tibial or peroneal vessel treated in a single leg:
CPT 2011 divides the just-in codes by initial or additional vessel -- each including angioplasty in the same vessel, when the surgeon performs it -- as here:
Initial vessel: The first four codes apply to the initial tibial or peroneal vessel treated in a single leg:
Angioplasty: 37228
Atherectomy (and angioplasty): 37229
Stent (and angioplasty): 37230
Stent and atherectomy (and angioplasty): 37231
Additional vessel: Report the remaining four add-on codes to report services on each additional ipsilateral (same side) vessel treated in the tibial/peroneal territory:
Additional vessel: Report the remaining four add-on codes to report services on each additional ipsilateral (same side) vessel treated in the tibial/peroneal territory:
Angioplasty: +37232
Atherectomy (and angioplasty): +37233
Stent (and angioplasty): +37234
Stent and atherectomy (and angioplasty): +37235
Revascularization general rule: You should report the one code that represents the most intensive service performed in a single lower extremity vessel. All lesser services in that vessel are included in that one code.
Count vessels carefully – more so for TP Trunk
The just-in revascularization codes (37220-+37235) apply to different "territories." Each territory has its own specific set of guidelines. Codes 37228-+37235 come under the tibial/peroneal vascular territory.
The tibial/peroneal arteries include anterior tibial (AT), posterior tibial (PT) and peroneal. This means the just-in codes relate to three vessels in each leg for the tibial/peroneal territory. Since you may report one code per vessel, you may use one initial code and up to two add-on codes per leg (for a total of three vessels). The three-vessel approach is somewhat similar to the iliac territory; however differs from the femoral/popliteal territory, which counts as a single vessel for coding.
Master coding for two legs or two territories
The just-in revascularization codes are unilateral, which means they apply to a service on a single side of the body. CPT indicates that if the doctor treats the identical territory in both legs at the same session, you should add modifier 59 (Distinct procedural service) to show both legs are involved.
However, watch out for payers' modifier preferences. Some may prefer you to use modifier 50, modifiers RT and LT or some combination of modifiers for procedures on both legs.
On the contrary, If the surgeon treats more than one territory in the same leg, you should report multiple codes, says CPT.
Consider included services
According to CPT guidelines, the endovascular revascularization codes include these services: accessing and catheterizing the vessel, crossing the lesion, any radiological supervision or embolic protection, arteriotomy closure, and imaging of the completed intervention.
Extras: If the doctor caries out mechanical thrombectomy (such as 37184-+37185, primary, or +37186, secondary), thrombolysis (such as 37201, 75896), or both to restore blood flow to the occluded area, according to CPT, you may report those services separately.
Article Source :- http://www.supercoder.com/coding-newsletters/my-general-surgery-coding-alert/cpt-2011-37228-37235-4-steps-garner-tp-trunk-services-pay-article
Revascularization general rule: You should report the one code that represents the most intensive service performed in a single lower extremity vessel. All lesser services in that vessel are included in that one code.
Count vessels carefully – more so for TP Trunk
The just-in revascularization codes (37220-+37235) apply to different "territories." Each territory has its own specific set of guidelines. Codes 37228-+37235 come under the tibial/peroneal vascular territory.
The tibial/peroneal arteries include anterior tibial (AT), posterior tibial (PT) and peroneal. This means the just-in codes relate to three vessels in each leg for the tibial/peroneal territory. Since you may report one code per vessel, you may use one initial code and up to two add-on codes per leg (for a total of three vessels). The three-vessel approach is somewhat similar to the iliac territory; however differs from the femoral/popliteal territory, which counts as a single vessel for coding.
Master coding for two legs or two territories
The just-in revascularization codes are unilateral, which means they apply to a service on a single side of the body. CPT indicates that if the doctor treats the identical territory in both legs at the same session, you should add modifier 59 (Distinct procedural service) to show both legs are involved.
However, watch out for payers' modifier preferences. Some may prefer you to use modifier 50, modifiers RT and LT or some combination of modifiers for procedures on both legs.
On the contrary, If the surgeon treats more than one territory in the same leg, you should report multiple codes, says CPT.
Consider included services
According to CPT guidelines, the endovascular revascularization codes include these services: accessing and catheterizing the vessel, crossing the lesion, any radiological supervision or embolic protection, arteriotomy closure, and imaging of the completed intervention.
Extras: If the doctor caries out mechanical thrombectomy (such as 37184-+37185, primary, or +37186, secondary), thrombolysis (such as 37201, 75896), or both to restore blood flow to the occluded area, according to CPT, you may report those services separately.
Article Source :- http://www.supercoder.com/coding-newsletters/my-general-surgery-coding-alert/cpt-2011-37228-37235-4-steps-garner-tp-trunk-services-pay-article
Monday, April 18, 2011
CCI 17.1: Get on Top of These Three Key Highlights for Cardiology This Quarter
Take a look at these major pointers to comply with the just-in cardiology-related edits, including cardiac catheterization, radiological supervision and interpretation, cardiac rehabilitation, and more.
Avoid denials by remembering 93454-93461 are diagnostic
Just-in edits will prevent you from reporting heart catheter/angiography codes 93454- 93461 (column 2) with the following cardiovascular therapeutic services and procedures (column 1):
92975, 92980, 92982, 92995
Take away: In column 1, the 929xx codes describe coronary therapies. You shouldn't use the 934xx diagnostic codes in column 2 to report catheter placement and coronary angiography performed as an integral part of the therapeutic column 1 services.
Opportunity: The edits have a modifier indicator of 1; as such you may override them with a proper modifier when the procedures are distinct. If you report both codes in the edit pair and do not add a modifier to the column 2 code, Medicare will reimburse you for only the column 1 code.
The AMA, via CPT Assistant (April 2005), indicates that you may report a true diagnostic catheterization apart from the therapeutic procedures described by 92980 and 92982:These two distinct procedures, therefore, should be reported separately when carried out at the same session or on the same day at a different session."
When the cardiologist does carry out a distinct 93454-93461 diagnostic service on the same date as a cardiovascular therapeutic service, you should append modifier 59 (Distinct procedural service) to the diagnostic code. You may also require to add modifier 51 (Multiple procedures).
Modifier 59 identifies the procedure as being a distinct procedural service while modifier 51 identifies multiple procedures were performed during the same session. Even though CPT identifies many codes as modifier 51 exempt, 93454-93461 are not currently exempt. But then, Medicare and other payers may tell you not to use modifier 51 since they'll apply the multiple procedure rule themselves.
Hints: You should also add modifier 26 (Professional component) to 93454-93461 when you need to indicate you're reporting only the professional component of the service. The Medicare physician fee schedule shows different PC and TC for these codes.
Follow S&I instructions to stay compliant
Like many other existing edits, a large number of the just-in cardiology-related edits help keep your coding in line with CPT guidelines for using radiology codes with procedure codes.
Example 1: Code 0236T includes radiological supervision and interpretation (S&I) in its definition. As such, you should not be surprised to know that the latest CCI bundles radiology codes 75600-75630 (Aortography … radiological supervision and interpretation) into 0236T.
Example 2: Now CCI bundles 75600-75774 and 75810-75891 into 37205. But then this should not restrict your coding since a CPT instruction with 37205 tells you that the proper code for S&I related to 37205 is 75960.
Good move: To stay away from denials, check code definitions, CPT guidelines, and CCI edits prior to reporting an S&I code with a procedure code – both to ensure you report the proper S&I code for the procedure and to be sure you comply with CCI edits.
Just-in edits will prevent you from reporting heart catheter/angiography codes 93454- 93461 (column 2) with the following cardiovascular therapeutic services and procedures (column 1):
92975, 92980, 92982, 92995
Take away: In column 1, the 929xx codes describe coronary therapies. You shouldn't use the 934xx diagnostic codes in column 2 to report catheter placement and coronary angiography performed as an integral part of the therapeutic column 1 services.
Opportunity: The edits have a modifier indicator of 1; as such you may override them with a proper modifier when the procedures are distinct. If you report both codes in the edit pair and do not add a modifier to the column 2 code, Medicare will reimburse you for only the column 1 code.
The AMA, via CPT Assistant (April 2005), indicates that you may report a true diagnostic catheterization apart from the therapeutic procedures described by 92980 and 92982:These two distinct procedures, therefore, should be reported separately when carried out at the same session or on the same day at a different session."
When the cardiologist does carry out a distinct 93454-93461 diagnostic service on the same date as a cardiovascular therapeutic service, you should append modifier 59 (Distinct procedural service) to the diagnostic code. You may also require to add modifier 51 (Multiple procedures).
Modifier 59 identifies the procedure as being a distinct procedural service while modifier 51 identifies multiple procedures were performed during the same session. Even though CPT identifies many codes as modifier 51 exempt, 93454-93461 are not currently exempt. But then, Medicare and other payers may tell you not to use modifier 51 since they'll apply the multiple procedure rule themselves.
Hints: You should also add modifier 26 (Professional component) to 93454-93461 when you need to indicate you're reporting only the professional component of the service. The Medicare physician fee schedule shows different PC and TC for these codes.
Like many other existing edits, a large number of the just-in cardiology-related edits help keep your coding in line with CPT guidelines for using radiology codes with procedure codes.
Example 1: Code 0236T includes radiological supervision and interpretation (S&I) in its definition. As such, you should not be surprised to know that the latest CCI bundles radiology codes 75600-75630 (Aortography … radiological supervision and interpretation) into 0236T.
Example 2: Now CCI bundles 75600-75774 and 75810-75891 into 37205. But then this should not restrict your coding since a CPT instruction with 37205 tells you that the proper code for S&I related to 37205 is 75960.
Good move: To stay away from denials, check code definitions, CPT guidelines, and CCI edits prior to reporting an S&I code with a procedure code – both to ensure you report the proper S&I code for the procedure and to be sure you comply with CCI edits.
Watch for blood draw, pulmonary services, EEG and others
In the latest CCI, it bundles many of the same column 2 codes into the following column 1 codes:
93660, 93724, 93797-93798
While the column two codes in the edits are not entirely identical for each of the column 1 codes above, there is a definite pattern. Here's a sampling of the column 2 codes:
364xx, 366xx, 37202, 43752, 94xxx, 958xx, 95955
Bottom line: Before you report a tilt table exam, an antitachycardia-pacemaker analysis, or outpatient cardiac rehab code, take a look at the CCI edits to verify that you haven't included one of the many bundled codes on your claim.
In the latest CCI, it bundles many of the same column 2 codes into the following column 1 codes:
93660, 93724, 93797-93798
While the column two codes in the edits are not entirely identical for each of the column 1 codes above, there is a definite pattern. Here's a sampling of the column 2 codes:
364xx, 366xx, 37202, 43752, 94xxx, 958xx, 95955
Bottom line: Before you report a tilt table exam, an antitachycardia-pacemaker analysis, or outpatient cardiac rehab code, take a look at the CCI edits to verify that you haven't included one of the many bundled codes on your claim.
Tuesday, March 8, 2011
CPT 2011: Femoral/Popliteal Coding Options
This time CPT 2011 adds new codes for lower extremity endovascular revascularization covering angioplasty, atherectomy, and stenting.
Here we'll take a look at the femoral/popliteal codes 37224-37227.
Master the single code approach for fem/pop coding
Remember that all of the codes include angioplasty in the same vessel when that service is carried out:
Angioplasty: 37224 -- Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal angioplasty
Atherectomy (and angioplasty): 37225 -- … with atherectomy, covers angioplasty within the same vessel, when carried out
Stent (& angioplasty): 37226 -- … with transluminal stent placement(s), covers angioplasty within the same vessel, when carried out
Stent & atherectomy (and angioplasty): 37227 -- … with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when carried out.
Note: Usually, the rule for 37224-37227 is that you should report the one code that represents the most intensive service carried out in a single lower extremity vessel.
Example: When the radiologist carries out a stent placement, atherectomy, and angioplasty in the left popliteal vessel, you should report 37227 only. That code includes stent placement, atherectomy, and angioplasty. In this scenario, you shouldn't report 37224 (angioplasty), 37225 (atherectomy), or 37226 (stent placement) separately or in addition to 37227.
Take a look at the change from component coding
According to CPT guidelines, in addition to the intervention carried out, the codes include:
Accessing the vessel
Selectively catheterizing the vessel
Crossing the lesion
Radiological supervision and interpretation for the intervention carried out
Any embolic protection used
Closure of arteriotomy (incision in the artery)
Here we'll take a look at the femoral/popliteal codes 37224-37227.
Master the single code approach for fem/pop coding
Remember that all of the codes include angioplasty in the same vessel when that service is carried out:
Note: Usually, the rule for 37224-37227 is that you should report the one code that represents the most intensive service carried out in a single lower extremity vessel.
Example: When the radiologist carries out a stent placement, atherectomy, and angioplasty in the left popliteal vessel, you should report 37227 only. That code includes stent placement, atherectomy, and angioplasty. In this scenario, you shouldn't report 37224 (angioplasty), 37225 (atherectomy), or 37226 (stent placement) separately or in addition to 37227.
Take a look at the change from component coding
According to CPT guidelines, in addition to the intervention carried out, the codes include:
Imaging carried out to document the intervention was completed.
To avoid denials, apply this territory rule
The just-in codes 37220-+37235 apply to different territories. Every territory has its own specific set of guidelines. Codes 37224-37227 come under the femoral/popliteal vascular territory.
Important rule: According to CPT, the entire femoral/popliteal territory in 1 lower extremity is considered a single vessel for CPT reporting.
Source URL :- http://www.supercoder.com/coding-newsletters/my-radiology-coding-alert/cpt-2011-37224-37227-revolutionize-your-femoralpopliteal-coding-options-article
Consequently, you should report a single code even if the radiologist carried out various interventions for various lesions in the popliteal artery and in the common, deep, and superficial femoral arteries in the same leg at the same session.
In situations such as these, you should use the code for the most complex service.
To avoid denials, apply this territory rule
The just-in codes 37220-+37235 apply to different territories. Every territory has its own specific set of guidelines. Codes 37224-37227 come under the femoral/popliteal vascular territory.
Important rule: According to CPT, the entire femoral/popliteal territory in 1 lower extremity is considered a single vessel for CPT reporting.
Source URL :- http://www.supercoder.com/coding-newsletters/my-radiology-coding-alert/cpt-2011-37224-37227-revolutionize-your-femoralpopliteal-coding-options-article
Consequently, you should report a single code even if the radiologist carried out various interventions for various lesions in the popliteal artery and in the common, deep, and superficial femoral arteries in the same leg at the same session.
In situations such as these, you should use the code for the most complex service.
Wednesday, January 26, 2011
Going to Report E/M & OB Service Together?
CCI 17.0 brings 698,042 new edits. But that does not mean you need to push the panic button as most of the edits affecting your ob-gyn claims won't be tough to apply to your daily coding practice.
For example, if you are already comfortable with bundles that exist for 57155, then you are ready for the new bundles added to the new code 57156. They're the same.
Break the rest of the edits into two categories: fluoroscopy edits and E/M edits.
Consider four fluro codes as included in Gyn procedure
Your claims could face problems if you attempt to bill a fluroscopic code in addition to just about everything in the gynecology section in the CPT manual.
CCI 17.0 particularly highlights the following four fluoroscopic codes: 76000, 76001, 77001, 77002. Essentially, CCI 17.0 bundles 76000, 76001, and 77001 into some codes and only 77001 and 77002 into others.
Break down these Evaluation/Management edits
With a broad brush stroke, the latest CCI edits bundles E/M services into all delivery and delivery plus postpartum care codes. These edits carry a modifier indicator of "1", which means you can separate these bundles with a modifier so long as you can show these encounters are separately identifiable. Remember, these delivery and delivery plus postpartum care codes already include admission, subsequent hospital care, discharge, and postpartum care under CPT guidelines.
But then what's new is that you should now include observation care, which hasn't been a part of routine ob care in the past. What's more, you should include the nursing facility care, rest home care, and home care visits – which make no sense for ob patients anyway.
Antepartum care only codes 59425 Antepartum care only; 4-6 visits) and 59426 (7 or more visits) didn't escape CCI 17.0's notice. These codes now include 99201-99215 (Office or other outpatient visit ...). What's more, you can separate these edits with a modifier; but again be sure to include documentation to show payers how these services are separately identifiable. These bundles apply to the same date of service; as such, it's unlikely that you'd bill antepartum care and a separate E/M code on the same DOS unoless the E/M service was not related to pregnancy.
In the end, observation care (99217-99220, Initial observation care, per day, for the E/M of a patient …) is now part of G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) and Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory)…
Break the rest of the edits into two categories: fluoroscopy edits and E/M edits.
Consider four fluro codes as included in Gyn procedure
Your claims could face problems if you attempt to bill a fluroscopic code in addition to just about everything in the gynecology section in the CPT manual.
CCI 17.0 particularly highlights the following four fluoroscopic codes: 76000, 76001, 77001, 77002. Essentially, CCI 17.0 bundles 76000, 76001, and 77001 into some codes and only 77001 and 77002 into others.
Break down these Evaluation/Management edits
With a broad brush stroke, the latest CCI edits bundles E/M services into all delivery and delivery plus postpartum care codes. These edits carry a modifier indicator of "1", which means you can separate these bundles with a modifier so long as you can show these encounters are separately identifiable. Remember, these delivery and delivery plus postpartum care codes already include admission, subsequent hospital care, discharge, and postpartum care under CPT guidelines.
But then what's new is that you should now include observation care, which hasn't been a part of routine ob care in the past. What's more, you should include the nursing facility care, rest home care, and home care visits – which make no sense for ob patients anyway.
Antepartum care only codes 59425 Antepartum care only; 4-6 visits) and 59426 (7 or more visits) didn't escape CCI 17.0's notice. These codes now include 99201-99215 (Office or other outpatient visit ...). What's more, you can separate these edits with a modifier; but again be sure to include documentation to show payers how these services are separately identifiable. These bundles apply to the same date of service; as such, it's unlikely that you'd bill antepartum care and a separate E/M code on the same DOS unoless the E/M service was not related to pregnancy.
In the end, observation care (99217-99220, Initial observation care, per day, for the E/M of a patient …) is now part of G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) and Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory)…
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