Hyaluronic Acid Injections: 'Count Correctly' to get your Rightful Reimbursements

For some time, Hyaluronate injections have had its own J code. However it has been changed from 'unspecified' to its own assigned code, back to 'unspecified' and then back to an assigned HCPCS code. Now that all hyaluronate injections fall under the same code, here are three medical coding tips to remember and help you calculate the right way.

Validate the type of medication

Physicians make use of hyaluronate injections to lessen the patient's pain owing to osteoarthritis of the knee. The medications achieve the same purpose and you report both types of injections with J7325. Correct coding depends on the medication used and the number of units you report. Synvisc-One is a one-shot injection equaling 6 cc of the medication. The patient sees your physician once for the full injection, which you report as 48 units of J7325 (2 cc = 16 g, so 6 cc = 48 mg). Physicians administer the other forms of hyaluronate as a series of injections instead of one shot at a single patient visit. Watch the dosage amounts closely so that you will report the correct number of J7325 units for each administration.

Chart note: Owing to the difference in calculations and unit reporting, the doctor must clearly document the medication used and number of units administered. Medication reimbursement can be low; as such wrong or unclear documentation could mean the difference between some payment versus virtually none. Some providers give patients a prescription for hyaluronate (depending on the insurer) and ask them to get the medication and return to the physician's office for the injection.

Injection: Code J7325 represents the medication only; as such you still need to report the injection procedure. Submit 20610; take a look at the diagnosis code. Medicare will only pay for hyaluronate injections to treat osteoarthritis of the knee. You have several diagnosis choices; as such be sure one of these applies to help smooth your claims processing: 715.16, 715.26, 715.36, and 715.96.

Anatomy note: Your 'additional digit' choices for the 715. xx code family do not include a specific option for knee. While selecting the best anatomic choice, take the knee part of the lower leg in place of pelvic region and thigh.

Figure out whether evaluation & management and modifiers apply

Some visits for hyaluronate injections qualify for an evaluation & management code or modifiers; however others do not. If the patient comes to your office specifically for a scheduled Synvisc-One injection, you will only report the injection code. However, if the physician completes another service during the visit, an E/M code might apply.

For more on this and for other medical coding articles to assist your orthopedic coding, sign up for a one-stop medical coding guide like Supercoder.

CPT 2011 Freshens Up Your IP Catheter Coding Choices

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

Just-in code 49418 begins the IP catheter code changes

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

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

Rectify the codes listed in 49419's line note

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

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

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

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

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

Among other code changes, focus on 49422

Other changes pertaining to IP catheter coding include the following:

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

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

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

2011 Conversion Factor Will Stand at $33.9764

Recently, President Obama may have locked in a zero percent adjustment to your Medicare Part B payments, however that does not mean your ortho practice should be calculating your fees using last year's rates. As a matter of fact, the 2011 conversion factor is slightly lower this year than what you were collecting last year, according to an 'Emergency update' to the 2011 Fee Schedule that CMS issued on Dec. 30.

However the good news is that your payments should not drop.

Your 2011 conversion factor will stand at $33.9764, a net reduction of 7.86 percent from the 2010 conversion factor of 36.8729.

The Medicare and Medicaid Extenders Act of 2010, which was signed into law on December 15, established a payment update for 2011 of zero percent. In order to cover the cost of the legislation, Medicare has to modify provisions in the proposed 2011 Medicare Physician Fee Schedule final rule, which altered some of the RVUs, as well as the conversion factor. But then as the conversion factor went down, most of the RVUs went up, ensuring that you should not notice any payment woes over the changes.

Article source :- http://isupercoder.blogspot.in/2011/02/2011-conversion-factor-will-stand-at.html

For example, the RVUs for outpatient E/M code 99212 will change from the 2010 rate of 1.08 to a higher rate of 1.22 this year. Multiplied by the conversion factors for their respective years, the payment for 99212 this year will still be higher than it was last year, despite this year's low conversion factor (2010 payment was around $39.82 compared to the 2011 payment of approximately $41.45).

Three ways to add an Additional $293 in Minor Procedure Pay

You could be missing out on opportunities to capture higher-paying procedure codes if you are overlooking reporting these splinting and foreign body removal codes.

Procedure 1: Gather $38 for sport injury splinting

Pee-wee football has started up and with it the chance you will see an increased number of patients with jammed fingers. For a non-angulated finger, the pediatrician might fix the sprain, splint the finger and send the patient home.

For the finger splint application, you could report 29130, which contains 1.02 RVUs, using the Resource Based Relative Value Scale. Even though global fracture care codes include the initial cast or application, you may use the casting and splinting codes in addition to an appropriate E/M code with modifier 25 when you don't report a fracture treatment code.

Do not miss: For the history, exam, and medical decision making that led to the decision to splint the finger, you'd report a significant separate E/M service appended with modifier 25. As you are not reporting a global fracture care code, you may also code the x-ray.

Procedure 2: Use tapping procedure code to add on $38

If a toe is broken, the pediatrician might buddy tape it to the adjacent toe and refer the patient to an orthopedist. For the buddy tapping, you could code 29550 (Strapping toes). The Medicare Physician Fee Schedule, which many payers adopt, assigns the code 1.04 RVUs. Report the history, examination and medical decision making preceding the decision to buddy tape the toe with 99201-99215 appended with modifier 25.

For the x-ray, go for 73600.

Procedure 3: Capture $227 on splinter removal

Removing a splinter from a patient's foot can net you around $227. For example, a pediatrician removes a 3 mm wooden splinter from a child's foot. Rather than including the work in an E/M code, you can use 28190, which has 6.15 RVUs.

Tip: Prior to using 28190, check that the documentation includes two details. The code need excising or opening to remove the foreign body. You have to say how and what you removed. Proper documentation could read: “1 mm incision made with X, removed splinter. This entry meets 28190's requirements of incision and removal.

Source URL :- http://www.supercoder.com/coding-newsletters/my-pediatric-coding-alert/revenue-boosting-procedures-29130-29550-28190-3-ways-you-can-add-an-additional-293-in-minor-procedure-pay-article