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.

Hone Your Colonic Polyp Vocabulary with these two Tips

Find out how a pathology report can save your claim.

Remember that not all patients who present to the office with colon polyps will be diagnosed with colon cancer. This is the second-leading cause of cancer-related deaths in the United States and normally starts as small, benign adenomatous lump, and becomes cancerous overtime.

Colon cancer (colorectal cancer as it is regularly called) is a cancer which starts in the large bowel portion of the gastrointestinal (GI) system. Since it comes in many forms and symptoms, coding the definitive diagnosis might be risky. Safeguard your practice's deserved dollars with these three tips:

1. Do not go looking for 'benign', 'malignant'

Irrespective of whether or not you are dealing with a full-blown colorectal cancer, you should be looking at the different terms used to describe benign or malignant colonic polyps. Some of these cover:

Adenomas including tubular adenomas and tubulovillous adenomas

Hyperplastic polyps

Inflammatory polyps

Familial adenomatous polyposis, a rare hereditary disorder that causes hundreds of polyps in the lining of the colon starting in the teenage years. If this is not treated, the patient becomes high risk to develop colon cancer.

Hereditary nonpolyposis colorectal cancer, a hereditary disorder that leads to an increased risk of developing colon cancer.

However first, you have to achieve the task of determining, without a doubt if a polyp is benign or malignant. If you think you'd find the clues in the pathology report (PR), think again. Normally, the PR will not use the term 'benign" or 'malignant'. But then it'll use a description that points to the usual behavior of the polyp. It is up to you to interpret those descriptions into benign or malignant.

Key: Experts tell you that you always wait for the pathology report to come back before deciding on a particular ICD-9. Even the gastroenterologists, themselves normally defer to the pathology report prior to making a recommendation.

2. Check with ICD-9 Neoplasm table

The ICD-9 codes Alphabetic Index to Diseases (Volume 2) features a neoplasm table where you can choose a definitive diagnosis code for a polyp. All diagnosis codes for neoplastic polyps -- and some non-neoplastic polyps -- will come from this table. Consider three things when choosing the right polyp code:

a) Body part. For malignant primary neoplastic polyps in the colon, you should look for the specific site of the colon which the doctor should mention in the procedure report.(I'e., traverse, sigmoid, ascending and descending).

For all other behaviors, the code descriptions make a general reference to the colon, large intestine or for that matter digestive system.

b) Behavior. In particular, behavior refers to the polyp's capacity to spread. If the polyp happens to be benign, it's noncancerous; of it is malignant, it's cancerous. A polyp can also be defined as 'uncertain' (235.2, Neoplasm of uncertain behavior of stomach, intestines and rectum) if its behavior is unpredictable and requires further investigation. On the contrary, an unspecified polyp (239.0, Neoplasm of unspecified nature of digestive system) needs to be determined further by lab tests.

c) Malignant polyp's nature. Further, you'd classify a malignant polyp into primary, secondary or in situ. A primary malignant colonic polyp (153.0-154.0) is one where the colon is the original site of the cancer. Secondary (197.5, Secondary malignant neoplasm of large intestine and rectum) means the cancer has metastasized from another site to the colon. An in situ malignant colonic polyp (230.3-230.4) is one where the cancer is remains confined to the colon.   Source URL  :- http://www.supercoder.com/coding-newsletters/my-gastroenterology-coding-alert/diagnosis-coding-2-tips-to-hone-your-colonic-polyp-vocabulary-106130-article

Four Question to Guide your Ucler Reporting

Ask yourself few questions about the excision and debridement services, you will have an easier time selecting the right code.

When your dermatologist carries out a decubitus ulcer excision or debridement, you will have to choose from about 25 possible codes. If you ask yourself the following four questions about the excision and debridement services, you will have an easier time selecting the right code.

Was the wound closed? If yes, by what method?

In some instances, the dermatologist may debride the ulcer and allow the wound to stay open to heal.

On the other hand, the dermatologist may excise the ulcer, clear all infection, and close the wound.

The difference: You shouldn’t distinguish debridement from excision by the ulcer’s removal but, rather, by what the documentation specifies. For instance, documentation for an ulcer removal may read, “The skin was cut in elliptical fashion around the lesion, and the dermatologist excised and sent the lesion to pathology. The dermatolgist closed the wound with 4-0 sutures in a layered fashion (or packed open to drain and heal by secondary intention)." It’s difficult to tell the difference sometimes (both methods are ways of clearing infection); as such you should determine your coding on what the dermatologist describes in the documentation.

Where was the ulcer?

With the nine ICD-9 codes for decubitus ulcers (707.00-707.09), you may have many codes to select from, specific to the ulcer’s location on the body:

707.00 -- Pressure ulcer; unspecified site

707.01 -- elbow

707.02 -- upper back

707.03 -- lower back

707.04 -- hip

707.05 -- buttock

707.06 -- ankle

707.07 -- heel

707.09 -- other site.

How deep was the debridement?

You can report debridement (11040-11044) based on three different skin levels, which are partial thickness, full thickness or subcutaneous – or as deep as muscle or even bone. For instance, 11044 (Debridement; skin, subcutaneous tissue, muscle, and bone) describes a debridement that involves chipping off pieces of diseased bone to help rid the wound of infection.

A partial thickness debridement includes the epidermis and part of the dermis; however some dermal cells are left. The physician normally carries out these procedures using a scalpel or scissors, depending on the situation.

Besides the ulcer, was anything else excised?

In some cases, with coccygeal pressure sores the dermatologist may remove the coccyx to do away with irritation and prevent the ulcer from recurring. The dermatologist may also excise bony prominences as a pressure sore at the same time.

Was anything else excised besides the ulcer?

In some instances, with coccygeal pressure sores the dermatologist may remove the coccyx to eliminate irritation and prevent the ulcer from recurring. The dermatologist may also excise bony prominences at the same time as a pressure sore.

Source URL :- http://www.supercoder.com/coding-newsletters/my-dermatology-coding-alert/ulcer-treatments-70700-70709-basics-4-questions-guide-your-ulcer-reporting-article

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).

Source URL :- http://www.supercoder.com/coding-newsletters/my-ophthalmology-coding-alert/reader-questions-report-cosmetic-ptosis-repair-separately-15819-article

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.