Have Comprehensive Knowledge of CPT, HCPCS, and ICD-9-CM

The interest in ICD-10-CM training is at a high level with most coders, which is not going to stop till October 1, 2013, implementation date. We are constantly seeing the drive for education careening to ICD-10-CM; however, but ICD-9-CM isn't supposed to be left behind.

Coders should be well-versed with their coding manuals. Remember, outpatient coding is not simply about CPT coding, but it is relatively about conceptualizing the whole picture in conjunction with CPT and ICD-9-CM codes. ICD-9-CM has a comprehensive listing of guidelines similar to the CPT manual. Interpreting ICD-9-CM knowledge prevents coders from fully understanding why diagnosis codes are used or sequenced in a specific way to produce complete claims. A coder must have a well-rounded knowledge of CPT, HCPCS, and ICD-9-CM. This will lead to fewer denials owing to ICD-9-CM mismatches with the CPT codes chosen.

The basics of ICD-9-CM should be well known; though, let's evaluate the important steps coders are required to take in order to correctly report the diagnosis for the following example.

A patient was admitted after developing severe diarrhea on day 50 following a living donor kidney transplant. A stool sample revealed a significant number of donor lymphocytes due to acute graft-vs.-host (GVH) disease. The physician diagnosed the patient with acute GVH disease.

First, find the main entry term; in this scenario, let's look at GVH disease. Keep in mind, conditions are expressed in the documentation as well as the index as nouns, adjectives, and eponyms. Numerous synonyms are also used for some circumstances, letting a coder to find the precise code through numerous lookup methods.

The next step is to look at the code found in the tabular section of the index to confirm correct code selection. Here, you will find the code 279.50. If you look under this code, it explains that in case this is a complication because of organ transplant not somewhere else classified, see Complications, transplant, organ. Although this is a complication arising from a kidney transplant, you will still necessitate reporting the GVH disease, so look at the tabular section for code 279.50, where you will get 279.51, which precisely reports the disease documented at the maximum specificity.

Prior to applying 279.51 to the claim, you need to carry out one additional step. Most coders overlook to look around the code to see in case there is any parenthetical information that may affect the coding. Possibly an added code is needed to report a manifestation or if the code comprises or not comprises a condition or disease. It may also have the instruction to code the underlying disease first.

This example requires the use of an ICD-9 information is brought to you by SuperCoder.com. Log on to www.supercoder.com for more accurate and profitable expert medical coding and billing advice.

ICD-9-CM: Master the Changes in Respiratory Conditions

Don't reports 488.12 until physician approves H1N1 influenza.

If you're intimidated by the thought of arranging through all the diagnostic coding modifications that went into effect on Oct. 1, 2011, you shouldn't worry more. Get the insider's info with this rundown on some of the novel respiratory system diagnosis codes.

Quick reference: You should always check the diagnoses index along with the tabular list for selection of the suitable codes to include on your encounter form.

New Novel Influenza Code Amendments

With this condition frequently developing new forms, ICD-9-CM has made modifications to new influenza codes for three years in line.

A novel subcategory 488.8 (Influenza owing to novel influenza A) along with related codes have been created in order to report Novel influenza A. They are:

488.81 -- Influenza because of identified novel influenza A virus including pneumonia

488.82 -- Influenza because of identified novel influenza A virus with added respiratory manifestations

488.89 -- Influenza because of identified novel influenza A virus with added manifestations.

Definition: Novel influenza comprises all human infections along with influenza A viruses which are novel or dissimilar from presently circulating human influenza viruses. These involve viruses which are subtyped as nonhuman in beginning, and those that cannot be subtyped with standard laboratory methods.

Providers frequently denote the 2009 pandemic influenza as 2009 H1N1 influenza instead of novel H1N1 influenza, consequently ICD-9-CM has reviewed the following listed codes, with earlier references to "novel" in their descriptors to change to "2009." The codes involve:

488.11 -- i.e. Influenza because of identified 2009 H1N1 influenza virus with pneumonia

488.12 -- i.e. Influenza because of identified 2009 H1N1 influenza virus with other respiratory manifestations

488.19 –- i.e. Influenza because of identified 2009 H1N1 influenza virus with other manifestations.

Change To 512.2 When You Report Postoperative Air Leaks

ICD-9-CM has applied revisions along with novel codes through Category 512 to distinguish air leaks from pneumothorax. This classification is currently labeled pneumothorax along with air leaks.

New code: You can at the present report postoperative air leaks with 512.2 (Postoperative air leak). You earlier reported this condition using code 512.1 (Iatrogenic pneumothorax), which was deceptive since a patient can go through a postoperative air leak devoid of significant air in the pleural space leading to pneumothorax. ICD-9-CM prevents reporting 512.1 or 512.2 without the physician documentation precisely specifies postoperative or owing to a procedure.

ICD-9-CM states that, though, patients might also have an insistent air leak which is not postoperative, for instance when a chest tube has been positioned for a spontaneous pneumothorax along with the lung re-expands however the air leak continues. Spontaneous pneumothorax might be primary or secondary and associated with numerous other conditions for instance cystic fibrosis, spontaneous rupture of the esophagus, lung cancer, etc.

Coding Nondefinitive Diagnoses Continue to be Your Prime Challenge

All you require is to report signs as well as symptoms when diagnostics come back normal.

You consider that you may have aced most ICD-9 challenges, however do you aware with how to manage a diagnostic test which comes back without a final diagnosis? Once you make sure to convey to payers precisely what you found, you'll come out of these challenges. Here are guaranteed ways how to do that and the related ICD-9-CM guidelines.

Follow 3 Rules for Normal Diagnostics Results

Scenario 1: The gastroenterologist refers a patient to a radiologist for an abdominal CT scan (74150-74170) with an indication of abdominal pain (789.0). The CT scan, when read by the GI, discloses the occurrence of an abscess. Both the radiologist -- while reporting for the technical part of the CT scan, along with the gastroenterologist -- when reporting for the professional component of the same test, must report a diagnosis which is "intra-abdominal abscess" (567.22, Peritoneal abscess).

Challenge: What are you supposed to do in case the diagnostics came out normal?

Beware of three different rules:

Rule 1: ICD-9-CM guidelines state that in case the diagnostic test did not deliver a conclusive diagnosis or came out normal consequences, you must code the sign and symptom that encouraged the treating physician to order the study. Roughly, in the preceding scenario, the CT scan results came back minus any abnormal findings, at that time you would report the symptom 789.0 (Abdominal pain) in place of 567.22.

Rule 2: In case the diagnostic test was normal, however the referring physician accounts a suspected (a.k.a. probable, suspected, questionable, rule out, or working) diagnosis, you must not code the referring diagnosis. In its place, you must report the presenting signs and symptoms, according to ICD-9-CM guidelines.

Rule 3: In case the patient is getting only diagnostic services in the outpatient visit, you would list first the condition that is the chief reason for the visit on the claim. According to ICD-9-CM guidelines, this code must be your primary diagnosis. After that, code for further diagnoses (such as chronic conditions) on the following lines.

Tackle This Chronic Condition Scenario

Scenario 2: A patient already diagnosed with liver cancer came to the gastroenterologist for esophageal varices. On the first line of your claim, you would list 456.1 (Esophageal varices without bleeding) for the presenting problem (varices), and after that report 155.0 (Malignant neoplasm of liver primary) meant for the chronic disease (hepatocellular carcinoma).

Challenge: Are you supposed to report the chronic condition?

ICD-9-CM guidelines maintain that you should not code the chronic condition in case it is not related to the primary reason for the visit. For example, the liver cancer patient in Example 2 comes with dyspepsia, you should code only 536.8 (Dyspepsia and other specified disorders of function of stomach), and never 155.0.

ICD-9-CM: Shifts in Respiratory Conditions

Don't report 488.12 except if the physician verifies H1N1 influenza. Learn what code should fit your claim.

In case you're intimidated by the thought of going through each and every diagnostic coding change that went into effect on Oct. 1, 2011, you should not worry any more. Grab the insider's information with this rundown on some of the new respiratory system diagnosis codes that have an effect on you.

Quick reference: You should always check equally the diagnoses index as well as the tabular list in order to select the correct codes to include on your encounter form.

Keep Up With Fresh Novel Influenza Code Amendments

With this condition repeatedly developing new forms, ICD-9-CM has made changes to new influenza codes for three years in a row. Changes to the novel influenza codes were suggested by the CDC National Center for Immunization and Respiratory Diseases (NCIR).

A novel subcategory 488.8 (Influenza due to novel influenza A) as well as related codes have been made to report Novel influenza A. They are:

488.81 -- Influenza owing to identified novel influenza A virus including pneumonia

488.82 -- Influenza owing to identified novel influenza A virus including other respiratory manifestations

488.89 -- Influenza owing to identified novel influenza A virus including other manifestations.

Definition: Novel influenza cover all human infections including influenza A viruses that are either new or unlike presently circulating human influenza viruses. These involve viruses subtyped as nonhuman in starting point, and those that cannot be subtyped by means of standard laboratory methods.

Providers frequently refer to the 2009 pandemic influenza as 2009 H1N1 influenza rather than novel H1N1 influenza, as a result ICD-9-CM has revised the following listed codes, with preceding references to "novel" in their descriptors to modify to "2009." The codes involve:

488.11 – i.e Influenza owing to identified 2009 H1N1 influenza virus including pneumonia

488.12 -- i.e Influenza owing to identified 2009 H1N1 influenza virus including other respiratory manifestations

488.19 -- i.e Influenza owing to identified 2009 H1N1 influenza virus including other manifestations.

Turn To 512.2 While Reporting Postoperative Air Leaks

ICD-9-CM has implemented revisions and novel codes made to Category 512 to distinguish air leaks from pneumothorax. This category is at the present labeled pneumothorax and air leaks.

New code: You are now allowed to report postoperative air leaks by means of 512.2 (Postoperative air leak). You before reported this particular situation using code 512.1 (Iatrogenic pneumothorax), which was confusing as a patient might go through a postoperative air leak with no significant air in the pleural space leading to pneumothorax. ICD-9-CM forbids reporting 512.1 or 512.2 except the physician documentation specially denotes postoperative or because of a procedure.

Lookout for Expanded Neoplasm, Personal History Codes That Govern 2012 ICD-9 Updates

Plus: Migraine revisions concentrate on punctuation addition, not descriptor change.

New and revised ICD-9 codes for 2012 went into effect October 1, which means it's time to brush up on the latest code options. You should pay special attention to expand your lip neoplasm as well as glaucoma choices, and more new ICD-9 codes for acute respiratory failure and further complications following surgery.

Expand Digits for Certain Neoplasm, Glaucoma Diagnoses

With ICD-9-CM 2012 going into effect, you are now able to determine some neoplasms and glaucoma stages more precisely:

Neoplasm codes i.e. 173.0-173.9 (Other malignant neoplasm of skin) are now deleted and replaced by new fifth-digit options 173.00-173.99.

Glaucoma codes now expand to the fifth-digit level so as to distinguish the different stages (unspecified, mild, moderate, severe, or indeterminate stage). The new codes are 365.70-365.74.

Reasoning: You'll have much more precise diagnosis options when ICD-10 goes into effect in October 2013. Adding fifthdigit expansions to ICD-9 codes like these now will help coders and physicians start considering in terms of more detailed diagnoses.

Watch for Gastric Band and Other Surgical Additions

As anesthesiologists can find themselves involved in cases encompassing all surgical areas, get acquainted with diagnosis changes for surgical procedures. New ICD-9-CM surgical procedure choices you'll want to check out include:

Infection or complications because of gastric band or bariatric procedures (539.01-538.89)

Erosion of implanted vaginal mesh as well as other prosthetic material near an organ or tissue (629.31)

Partial tear of rotator cuff (726.13)

Acute or chronic respiration failure, in normal conditions or following trauma and surgery (518.81, 518.83, 518.84, 518.51).

An anesthesiologist will report a wide range of diagnosis codes. Whatever someone can have done surgically and require anesthesia for, that's what anesthesiologists are required to know.

Get Familiar With New Personal, Family History Options

Five new V codes will aid your physician better specify conditions which could be a part of patient's personal or family medical history. Your new choices are:

V12.21 –- i.e. Personal history of gestational diabetes

V12.29 -- i.e. Personal history of further endocrine, metabolic, and immunity disorders

V12.55 -- i.e. Personal history of pulmonary embolism

V13.81 -- i.e. Personal history of anaphylaxis

V13.89 -- i.e. Personal history of other stated diseases.

Migraine Revisions Don't Mean Real Change

When you read through the list of revised ICD-9 codes , you'll see many migraine diagnoses listed (for instance 346.01, Migraine with aura, with intractable migraine, so stated, excluding mention of status migrainosus, and 346.11, Migraine without aura, with intractable migraine, so stated, without mention of status migrainosus). The descriptors themselves don't change, but the punctuation changes to some extent. Updated descriptors further add a comma following the "so stated" phrase in the fifth-digit "1" subclassification descriptor for every single type of migraine which is noted.

Source URL :- http://www.supercoder.com/coding-newsletters/my-anesthesia-coding-alert/2012-code-changes-watch-for-expanded-neoplasm-personal-history-codes-that-dominate-2012-icd-9-updates-107385-107385-107385-article

Version 28.0 of the ICD-10 MS-DRGs is Final

Inpatient coding woes? Well, there could be something amiss in your DRG process.

Every year thousands of dollars go down the drain because of poor Medicare Severity Diagnosis Related Groups Codes selection and under coding. One needs to understand the complete DRG process to figure out the ways to proper reimbursement. Spot on DRG assignment and auditing practices help you stay away from both up-coding and under-coding; in the process you'll save money and cut short the revenue cycle.

Changes to Medicare Severity Diagnosis Related Groups (MS-DRG)

Right from the time it was implemented in 2008, MS-DRG has witnessed documentation and coding adjustments made to the standardized amount to ensure budget neutrality. In FY 2011, Centers for Medicare and Medicaid mandated a non-cumulative 2.9% documentation and coding adjustments as part of a two-year process to get back overpayments ensuing from the conversion to the MS-DRG system.

As mentioned in the last IPPS Final Rule, an additional -2.9% adjustment is statutorily mandated for FY 2012. But then since the FY 2011 adjustment was non-cumulative, the net effect of the FFY 2012 adjustment resulted in no change as compared to the earlier adjustment.

In the end, the agency rejected the proposed implementation of another documentation and coding adjustment of 3.15 percent for FY 2012.

DRG codes & ICD-10 codes:

ICD-10 MS DRGs which are likely to go into effect in FY 2014 will be subject to notice and comment rulemaking. Meanwhile, the agency will provide extensive and detailed information on this activity by way of the ICD-9-CM Maintenance and Coordination Committee.

Version 28.0 of the ICD-10 MS-DRGs based on FY 2011 MS-DRGs is final and is available for public review on the CMS' website.

In the mean time the agency will continue to work with the public on the conversion and post drafts for updates. The final version of the ICD-10 MS-DRGs which will go into effect in FY 2014 will be subject to notice and comment rulemaking.

In the intervening time, the agency will provide extensive and detailed information on this activity through the ICD-9-CM Maintenance and Coordination Committee.

DRG Codes Lookup: For more MS-DGR updates, sign up for a good coding resource like SuperCoder. Such a site comes with Grouper-Procedure Code CrossRef, hospital coding datasets, average LOS look-up, MS-DRG to ICD-9-CM Vol. 1 CrossRef, a robust search engine, and more. Sign up today and see how it puts your inpatient coding on track.

ICD-9-CM Changes for Neoplasms & Glaucoma

With less than a month to go for ICD-9-CM 2012 codes to go into effect, now is the time to brush up on the latest coding options. This time, the spotlight's on expanded lip neoplasm and glaucoma options in addition to new codes for acute respiratory failure and other complications that result after surgery.

Now you will be able to pinpoint some stages more specifically.

While Neoplasm codes 173.0-173.9 will be axed and replaced by just-in fifth-digit choices - 173.00-173.99, Glaucoma codes expand to the fifth-digit level in order to differentiate the different stages. The just-in codes will be 365.70-365.74.

Since there will be much more spot on diagnosis choices when ICD-10 goes into effect in a couple of years time, these fifth digit expansions to codes will help coders and physicians start thinking in terms of more detailed diagnoses.

ICD 9 procedure codes for Gastric Band 

Source Code :- http://www.supercoder.com/coding-newsletters/my-anesthesia-coding-alert/correction-double-check-new-gastric-band-respiratory-failure-icd-9-codes-109162-article

Since anesthesiologists can find themselves absorbed in cases covering all surgical areas, you need to get acquainted with diagnosis changes for surgical procedures.

Get acquainted with just-in personal, family history choices

There are five new V codes that'll help your physician better indicate conditions a patient might have as part of her personal or family medical history. The just-in choices are:

Personal history of gestational diabetes - V12.21

Personal history of other endocrine, metabolic, and immunity disorders - V12.29

Personal history of pulmonary embolism - V12.55

Personal history of anaphylaxis - V13.81

Personal history of other specified diseases - V13.81

And as far as the revisions are concerned, when you go through the list of codes that have been revised, you'll find many migraine diagnosis listed. Although the descriptors are the same, the punctuation changes a little. Changed descriptors add a comma after the 'so stated' phrase in the fifth-digit '1' subclassification descriptor for each type of migraine mentioned.

ICD-10 Updates: Check Out New Options for Thyroid Disorders

While coding for thyroid disorders, here's what you need to keep in mind when ICD-10 goes into effect on October 1, 2013.

Although general rules of coding for both the code sets - ICD-10 and ICD-9 - will remain the same except for some subcategory variations, you need to stay up to date with these ICD 10 coding changes.

When it comes to thyroid disorders, here's how ICD-10 changes will have a say in your coding.

About thyroid gland: The thyroid gland is located in the front part of the neck; it produces the thyroid hormone which is important to normal metabolism. These disorders range from:

Hyperthyroidism: The thyroid gland becomes overactive here. It produces excess thyroid hormone and speeds up the body's metabolism. For hyperthyroidism, ICD-9 presently uses 242.

Hypothyroidism: On the other hand, here the thyroid gland becomes underactive. This happens if the thyroid does not produce enough hormones. ICD-9 currently uses 244 to report this.

In ICD-10-CM( Source "http://www.supercoder.com/icd-10/"), thyroid gland disorders are classified to these categories: E00 (Congenital iodine-deficiency syndrome), E01 (Iodine-deficiency related thyroid disorders and allied conditions), E02 (Subclinical iodine-deficiency hypothyroidism), E03 (Other hypothyroidism),E04 ( Other nontoxic goiter), E05 (Thyrotoxicosis [hyperthyroidism), E06 (Thyroiditis) and E07 ( Other disorders of thyroid).

Difference between the two code sets when it comes to coding for thyroid disorders:

Even though the coding rules related to thyroid diseases will be generally the same in ICD-10-CM as in the present code set, ICD-10-CM will classify some conditions to different chapters or different blocks. Say for instance ICD-9-CM's code for postsurgical hypothyroidism is 244.0, which is in the hypothyroidism category. In the new code system, you will not locate postsurgical hypothyroidism under category E03. In its place, you'll code it with E89.0, which is under category E89.

Tips for coders: A patient recently underwent surgery and radiation therapy for her thyroid cancer. The physician tends to this patient and carries out a level-two evaluation & management (E/M) and diagnoses her with hypothyroidism caused by the recent treatments. In this situation, you should opt for a more specific ICD-9 code than E03.9. When the patient has recently underwent thyroid surgery radiation therapy that caused the hypothyroidism, select the fourth digit based on the most recent factor affecting the hypothyroidism. For example , if the patient had surgery recently, choose E89.0. And if the radiation therapy was more recent, ICD-10 guidelines state that you would choose the same code.

ICD-9-CM: 997.4 Makes Way for Four New Codes for Bariatric Procedures

Proposed ICD-9-CM code set for 2012 has changes for gastric band or bariatric procedures, pelvic circle fracture codes, skin cancer dx and more.

If the proposed ICD-9 CM codes become final, starting October 1 this year you will have four new codes to report complications of gastric band or bariatric procedures. This time you will get 539.xx and other new, invalid and revised codes that will have an impact on your general surgery practices.

Bariatric surgery or gastric band procedure: Presently, complications related to these are indexed to 997.4 as there is no secondary code to use. But all that is set to change on October 1, 2011 if the proposed codes - 539.01, 539.09, 539.81 and 539.89 - become final. When these codes go into effect, you can start reporting bariatric/gastric band complications with one of these four codes.

Note: ICD-9 adds an 'excludes' note to 997.4, and directs coders to these just-in codes.

These four codes come with a lot of advantages: The existing code 997.4 does not distinguish digestive system complications from bariatric or gastric band surgeries from complications owing to any other procedures or conditions. These new codes provide better data collection for bariatric and gastric band procedures.

Skin excision & ICD-9 2012: Apart from these changes, ICD-9 2012 proposed changes will expand 10 present codes to 40 new codes that you will have to use when your surgeon carries out a skin excision. Skin site distinguishes the 10 existing codes (173.0-173.9) that will become invalid.

Although the same site distinctions remain in the just-in codes, ICD-9 2012 adds a fifth digit to each four digit code to differentiate cancer type.

Here are four fifth digits to distinguish each site-specific four digit code based on neoplasm details:

0 -- Unspecified malignant neoplasm of

1 -- Basal cell carcinoma of

2 -- Squamous cell carcinoma of

9 -- Other specified malignant neoplasm of

Pelvic circle fracture code search: Under ICD-9 2012 , there will be more precise coding choices as far as pelvic fracture codes are concerned. The just-in codes will be specific to 'without disruption: 808.44 and 808.54. These codes will offer choices to 'with disruption' codes 808.43 and 808.53.

For more details on the proposed ICD-9 code changes for 2012, sign up for a good coding resource like SuperCoder that provides you with fast online searches for this code set.

Lowdown on Medicare Severity Diagnosis Related Groups (MS-DRG) Changes

Simple inpatient coding mistakes can weigh heavily on your hospitals – Here are some updates on DRG codes to help you stay informed and on the right reimbursement track.

DRGs are diagnosis-related group that classifies hospital cases into one of approximately 500 groups. These diagnosis related group codes are assigned by a 'grouper' program which is based on ICD diagnoses, procedures, age, discharge status and the like.

Recently, the CMS published the Federal Fiscal Year (FFY) 2012 Final Rule for Inpatient Prospective Payment System (IPPS) and the Long-term Care Hospital Prospective Payment System.

The implementation of the MS-DRG was needed to be done in a budget-neutral way. Since the time it came into being in FFY 2008, there have been documentation and coding changes made to the standardized amount to ensure the neutral stance of budget.

Very recently, the Centers for Medicare & Medicaid mandated a non-cumulative 2.9 % documentation and coding adjustment to get back overpayments occurring due to the conversion to the MS-DRG system. As made clear in the federal fiscal year 2011 IPPS Final rule, an additional - 2.9% adjustment is mandated statutorily for federal fiscal year 2012. But then since the FFY 2011 adjustment was non-cumulative, the net effect of the FFY 2012 adjustment comes with no change as compared to the FFY 2011 adjustment.

What's more, the agency finally rejected the proposed implementation of one more documentation and coding adjustment of -3.15% for FFY 2012.

In the proposed rule, the MS-DRG assignment for Percutaneous Mitral Valve Repair with Implant (MitraClip) also found mention.

ICD-10 & DRG codes: The proposed rule for FY 2012 doesn't provide comments regarding the ICD-10 MS –DRG. In fact, Version 28.0 of the ICD-10 MS-DRGs has been finalized and is available for public review on the CMS site.

For more DRG news and updates, sign up for a good online resource like SuperCoder. Such a site comes with a cutting edge tool - MS-DRG Master - that gives you the information on MS-DRG's allowed ICD-9-CM Volume 1 and 3 codes, LOS and payment weights in just one click.

Once you take the help of the MS-DRG Master, you will be able to correctly link ICD-9-CM Procedure Volume 3 codes to MS-DRG, identify all ICD-9-CM Diseases Volume 1 codes associated with a MS-DRG (Medicare System - Diagnostic Revenue Grouper) and lots more.

Sign up for one today and get all the tips and tricks to keep your inpatient coding on track.

ICD-9-CM codes: More Specificity for Neoplasm and Glaucoma Stages

Apart from new codes for acute respiratory failure and other complications after surgery, this time ICD-9-CM also brings five new V codes.

The ICD-9 Coordination and Maintenance Committee will implement a partial breeze of the ICD-9-CM and ICD-10 codes before transitioning to ICD-10. On October 1 this year, the last regular, annual updates to both ICD-10 and ICD-9-CM code sets will be made. As such, you need to brush up on the latest code choices now.

Now you will have more choices for lip neoplasm and glaucoma

This year, you need to pay special attention to expanded lip neoplasm and glaucoma choices in addition to new codes for acute respiratory failure and other complications after surgery. In other words, when ICD-9-CM codes go into effect, you will be able to locate some neoplasms and glaucoma stages more specifically:

Neoplasm codes 173.0-173.9 will take the exit path and be replaced by just-in fifth-digit choices 173.00-173.99 while glaucoma codes will expand to the fifth-digit level in order to differentiate the different stages. The just-in codes will be 365.70-365.74.

Fifth digit expansions to codes: This will help coders and physicians start thinking in terms of more detailed diagnoses.

Apart from this, you also need to get familiar with diagnosis changes for surgical procedures since anesthesiologists can find themselves covering all surgical areas. Just-in ICD 9 procedure codes (surgical) choices include:

539.01-538.89

629.31

726.13

518.81, 518.83, 518.84, 518.51

New codes: ICD-9 2012 ( Source "http://www.supercoder.com/icd9-codes/") will provide you with five V codes to help your physician better indicate conditions a patient might have as part of her personal or family medical history. The new options will include V12.21, V12.29, V12.55, V13.81 and V13.89.


Revised codes: As far as the revised codes are concerned, there are many migraine diagnoses listed. The descriptors are the same, but then the punctuation changes to some extent. Revised descriptors add a comma after the ‘so stated’ phrase in the fifth-digit ‘1’ subclassification descriptor for each type of migraine noted

ICD-9 2012 Update: 173.0-173.9 Get Specific Next Year with New Fifth Digits

Expanded diagnosis code sets will allow coders to classify whether skin cancer is basal, squamous, or unspecified.

On October 1, dermatology coders will be able to more accurately report the location of carcinomas and other neoplasms of the skin.

The Centers for Medicare & Medicaid Service (CMS) has released its proposed changes to ICD-9 2012, and they include an expansion of the 173.x (Other malignant neoplasm of skin) series. Each code in that series will get a list of fifth digits that will specify whether the malignant neoplasm is basal cell, squamous cell, or unspecified.

Example: Now, dermatology coders would report 173.0 (Other malignant neoplasm of skin of lip) for any non-melanoma malignant neoplasm of the lip. But when ICD-9 2012 becomes effective on October 1, 2011, coders can choose from:

173.00 -- Unspecified malignant neoplasm of skin of lip

173.01 -- Basal cell carcinoma of skin of lip

173.02 -- Squamous cell carcinoma of skin of lip

173.09 -- Other specified malignant neoplasm of skin of lip. Additionally, in October, 173.0 will become an invalid diagnosis code.
The changes in the other skin cancer categories follow this pattern, with the fifth digit of "0" referring to an unspecified malignant neoplasm, "1" denoting a basal cell cancer, "2" referring to a squamous cell carcinoma," and "9" describing another specified malignant neoplasm.

The new, revised, and invalid codes have been approved by the by the ICD-9-CM Coordination and Maintenance Committee and were published in the Federal Register on May 5, 2011. After the new codes take effect on Oct. 1, CMS will only add new ICD-9 codes on an emergency basis as it prepares to switch over the diagnosis coding system to ICD-10.

Get Staff Up to Speed on Changes

With only a few months before implementation, the time to act is now, says Pamela Biffle, CPC, CPC-P, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas.

"Coders will have to maker sure their systems are updated with the new codes," she notes. "Training will have to be done for all the staff."

Good idea: "This is a great example of when to have a lunch and learn session for all providers and other clinical staff that may be assigning diagnosis codes," Biffle suggests. Source URL :-

CMS releases proposed changes to ICD-9 2012

Ensure your systems are updated with the just-in codes.

Recently, the Centers for Medicare and Medicaid Services (CMS) released its proposed changes to ICD-9-CM diagnosis codes 2012, which are effective for dates of service on or post October 1 this year. This time, as in previous years, there are hundreds of additions, changes and deletions. These codes are compulsory for all health insurance claims filed from October 1 this year till September 30, 2012.

These changes have been approved by the ICD-9-CM Coordination and Maintenance Committee and were published in the Federal Register on May 5, 2011.

Key: Post the October 1 deadline goes into effect, the agency will only add new ICD-9 codes on an emergency basis as it gears up to switch over the diagnosis coding system to ICD-10.

Good news for dermatology coders: If you're a dermatology coder, there's good news for you as you will be more spot on with the reporting of the location of carcinomas and other neoplasms of the skin.

Obsolete: When ICD 9 2011 codes go into effect, 173.0 will become an invalid diagnosis code.

This time, there is an expansion of the 173.x (Other malignant neoplasm of skin) series. In this series, each code will get a list of fifth digits that'll specify whether the malignant neoplasm is basal cell, squamous cell or unspecified.

Dermatology coders will now report 173.0 for any non-malanoma malignant neoplasm of the lip. When these codes go into effect, coders can take a pick from 173.00, 173.01, 173.02, and 173.09.

What you should do now?

With just a few months before implementation, now is the time to act. Get your systems updated today!

Be prepared for: Will there be any expanded skin neoplasm codes when coders update their diagnosis codes in 2013 with ICD-10? Well, it's not sure.

For the latest on ICD 9 2012 changes and for other medical coding updates, sign up for a good coding resource like Supercoder.

Seven Key Billing Practices to Get the Payments You Deserve

When your practice is feeling pinched, it is important to ensure that you are not forgetting to bill for everything your practitioner performs and documents.

It's known to all that Medicare coding rules are tough and challenging; and sometimes it's difficult to gather which services you can bill rightfully. However if you remember these seven key billing practices, you will be collecting all of the pay you rightfully deserve.

Bear modifier 50 in mind: Many procedures are inherently unilateral and you will not get full reimbursement for bilateral versions of those procedures unless you add modifier 50 (Bilateral procedure).

Be careful: Often medical coders forget the modifier 50, and if your doctor performs and documents a bilateral procedure for one of those services, see to it that you submit your claim for a bilateral service.

Gather copays at the visit: You will save yourself time and money later on if you calculate copays following a patient's service and collect that money before they leave your office.

Bear in mind: If it is not a copay, you can gather it before the patient sees the doctor. Just because a doctor plans to carry out a service does not mean he will perform and document it properly. As such, it is a good idea to gather after the patient has already seen the practitioner.

Some coders are of the opinion that if the correct coding initiative (CCI) forbids billing two codes on the same date, that is the end of the story. However in fact, you may be missing out on some legitimate cases where CCI allows you to use a modifier like 59 (Distinct procedural service) to override an edit.

Always scan the CCI edits ( Source "" ) for the procedures you carried out to see which code pairs a modifier can override. You should of course only use the modifier 59 when the services are separate, distinct, and medically necessary, and the doctor has thoroughly documented the distinct nature of both services.

Keep a watch for supervision and interpretation: You need two codes – the S&I code plus a surgical code for many invasive/ diagnostic radiology codes. Regularly, coders forget to add the surgical code, moreso on the outpatient hospital claims.

For instance: You may keep in mind to report CT guided needle biopsy code 77012; however leave out the associated site-specific percutaneous needle biopsy code.

When you feel you've been wronged, appeal: As many practices fear being labeled "troublemakers" or even worse yet, non-compliant with the FCA's regulations, they accept Medicare payers at their word and this is not always a good idea.

If your MAC denies your claim or requests a refund, investigate the issue before you take the payer's word for it. You should make an appeal any time you feel your payer has denied your claim wrongly or erroneously requested a refund.

Ensure you have up to date coding guidelines

In some practices, coders have not updated their CPT, ICD-9-CM, or HCPCS coding manuals in years as they do not think that changes are enacted often enough to warrant purchasing new books. But then outdated codes can lead to claim rejections. What's more, the modifiers, coding rules, and parenthetical notes also change from year to year, and it is tough to understand which regulations apply if you do not have present resources. If you use a computer-based program for these resources, you can normally get all the updates through there; however paper manuals should be annually replaced.

Join outpatient E/M with initial hospital care record for same-day admits

If you witness a patient in your office and then perform initial inpatient care for the same patient on the same date, you should report one E/M code only.

When the doctor provides both services on the same date, combine the work documented in the office with the work documented in the hospital to figure out the proper level of initial inpatient care (99221-99223).

Spot on Coding Does not Require An Overly-Detailed Coding Policy

Spot on coding does not require an overly-detailed coding policy. ICD-9 Coding policy can certainly help keep your claims.

An ICD-9 coding policy can certainly help keep your claims flowing smoothly, but then you cannot just set it up and sit back. Read on and know how to establish a policy that'll remain current and help you duck the the auditors when they come calling.

The first element of a well-designed coding policy is to point out that you adhere to the ICD-9-CM Official Guidelines for Coding and Reporting. If you do not stay tuned to these standard rules you may land in trouble.

Secondly, establish your coding process, including who does the coding and how you make corrections.

Third, describe how your coding staff will stay tuned and maintain their coding competencies. Keeping pace with the changes can be especially important, whether to the official guidelines, payer requirements or the ensuing transition to ICD-10.

Document your auditing process, including the percentage of charts you will audit for accuracy and how often you will conduct those audits. Internal auditing can help ensure your dermatology coding is accurate before your mistakes are found in a costly audit from a ZPIC, RAC, or one of the other auditing entities.

Gauge your dermatology coders' accuracy. Paired with auditing, establishing an accuracy rate for your medical coders can help set the bar for your commitment to accurate coding. If you need your coders to maintain a 95 percent accuracy rate with their coding, include this information in your policy.

Keep policies up to date. Do not let your coding policy sit on the shelf and grow dusty. Try to check your policy periodically to ensure it's current.

For more on this and other diagnosis coding tips, sign up for a medical coding guide like

http://www.supercoder.com/

FAQ to Boost Your Pain Management ICD-9 Coding

FAQ to boost your pain management ICD-9 coding

If you do not know how many diagnosis codes you can report, you could find yourself assigning the wrong code. Here's a question followed by the answer that'll help you get quick tips to help your pain management ICD-9 coding:

How many diagnosis codes are 'too many'?

Question: Our pain management specialist treated a patient with diabetes, however he was actually seeing the patient to treat a complication of the diabetic polyneuropathy. During his evaluation, the doctor also noted that the patient has shoulder joint inflammation. Should we use the neuropathy complication only or several ICD-9 codes to represent various conditions of the patient?

Answer: Normally, the primary diagnosis code that you list on your claim should represent the main reason for the encounter, or the condition with the highest risk of morbidity/mortality that the physician tends to during the visit. However, when you deal with a condition like diabetes, the situation changes.

Section 1.A.6 of the ICD-9-CM official

Guidelines for coding and reporting certain conditions have both an underlying etiology and multiple body system manifestations owing to the underlying etiology. For conditions such as this, the ICD-9-CM(http://www.supercoder.com/icd9-codes/) has a coding convention that requires that the underlying condition be sequenced first after the manifestation.

If a patient has more than one manifestation of diabetes, more than one code from category 250 may be used with as many manifestation codes as are needed to describe the patient's diabetic condition fully.

As such, you should first use 250.6x (Diabetes with neurological manifestations). Remember to add a fifth digit to reflect the patient's type of diabetes and status of control. Your secondary code should represent the specific pain manifestation being treated. In this case, you should report 357.2 (Polyneuropathy in diabetes) as the secondary diagnosis. As because your pain practitioner documented joint inflammation, you should also report the right code describing that condition (716.91, Arthropathy, unspecified; shoulder region).

Why so many codes: Even though many payers will link only the first, main diagnosis code that you list to support the provided service's medical necessity, reporting all the diagnoses that follow the HIPAA-mandated guidelines is compliant coding. As of July 2007, Medicare must accept up to eight diagnoses for each electronic claim reported. The additional diagnoses might indicate more complex presenting problems and can provide the help you might need for a higher-level E/M service.