Document Now to Save Yourself Trouble Later on

If Medicare carries out an audit and figures out that your documentation is not in proper order, you could find yourself having to repay them for all the claims they find problems with.

Medicare only sees the front portion of the form when you send in a CMS-1500 form. What Medicare fails to see is what is on the other side of that form, which is your documentation. They presuppose that your document is right until they carry out an audit.

If Medicare carries out an audit and figures out that your documentation is not in proper order, you could find yourself having to repay them for all the claims they find problems with. That is the reason why it is vital to cautiously document the medical necessity of the visual field exam in the patient's medical record.

According to experts, one of the weak areas of optometrists is the "interpretation and report" portion of several codes. For instance code 92083 provides one example. As per your record of a visual field, "Informed patient test for OD showed small area we need to watch; have return in three months." In a postpayment audit, Medicare will not accept this billing. Here's why? Interpretation and report" needs assessment of both eyes.

Bear in mind: All three visual field codes have a TC and PC. When you bill 92083, you are telling Medicare you performed both the TC and the PC. It is better to have a form just for visual fields, apart from your regular notes.

This may sound excess, but remember that in case of an audit, such a form could save you money.

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493.2x: Your Physician's Notes are Your Best Bet Here

You should have the right information ready prior to referring to your ICD-9 coding manual to save yourself from trouble.

It always helps to have the right documentation in place. When a patient comes to the pulmonologist with asthma or bronchitis, and symptoms of chronic obstructive pulmonary disease, your physician's notes may be your best choice.

You should have the right information ready prior to referring to your ICD-9 coding manual to save yourself from trouble. Ensure the documentation supports the physician's diagnosis. After this, be on the lookout for any associated acute conditions. When you face the situation, ask these three important questions that can help you breathe easily through your lung diagnosis coding.

Check whether the patient has status asthmaticus or acute exacerbation before using 493.20

If a pulmonologist diagnosed a patient with both asthma and chronic obstructive pulmonary disease, go to the v493.x section of ICD-9 and choose from the three options: 493.20, 493.21, and 493.22. For some payers, 493.20 is default code. It is always better to check with your pulmonologist first to see if the patient has status asthmaticus or acute exacerbation before settling with 493.20.

Note of caution: A diagnosis of 'status asthmaticus' is the most acute presentation and takes precedence over any type of COPD; as such you should primarily list the most acute diagnosis addressed if the physician documents both findings. On the claim, you should report 493.21, and not 493.22 (an acute exacerbation). If status asthmaticus is documented by the provider with any type of COPD or with acute bronchitis, the status asthmaticus should be sequenced first. It supersedes any type of COPD including that with acute exacerbation or acute bronchitis.

Don't report 466.0 for obstructive chronic bronchitis

When your pulmonologist documents chronic obstructive bronchitis with an episode of acute bronchitis, you should code 491.22. You should not report 466.0 (Acute bronchitis) for the obstructive chronic bronchitis since this code fails to capture the patient complexity of an acute-on-chronic illness, as in 491.22.

Get thorough documentation from your pulmonologist

If you are coding COPD, full details are very important. The documentation should include a listing of signs, symptoms, and conditions. A mere entry of “shortness of breath and cough" may not just be enough. Since cardiopulmonary diseases manifest themselves in this fashion, these symptoms can represent a progression of chronic illness or other acute issues, either related or not related to the patient's chronic disease. As such, clinical evaluation, based on a detailed history, is of prime importance. In order to determine a new illness or a progressing/exacerbating chronic illness, the physician may order blood studies, along with radiographical and physiological evaluations. Just listing COPD as the diagnosis does not reflect the patient's present status. Including the signs, symptoms, or the exacerbation will aid in justifying the medical necessity of the studies ordered. The payer will better understand that these aren't routine surveillance studies.

Don't Trip Up Your Foot and Ankle Claims

Be aware of some of the more common foot procedures your family physician might face if you want to get the rightful reimbursements for your foot and ankle claims.

You need to be aware of some of the more common foot procedures your family physician might face if you want to get the rightful reimbursements for your foot and ankle claims.

You should have sound basic knowledge

Sudden impact or simple wear-and-tear can cause toe, foot and ankle problems. As such you need to be aware of the differences between these diagnoses or you may miss a subtle difference and report the wrong code.

One thing to bear in mind is that you might require modifiers to help differentiate work on different areas of the feet or for that matter toes. These modifiers include LT and RT, TA-T9 and sometimes 59 depending on the service your physician provides. These modifiers become all the more important if the FP carries out the same procedure on more than one foot or toe.

Be aware of the difference between Bunions and Hallux Valgus

A bunion is an enlargement of bone or tissue around the metatarsophalangeal (MTP) joint of the great toe. It's often caused by patients wearing shoes that are too narrow around the toe box and can cause pain and deformity of the toes.

Remember: A common mistaken belief is that "hallux valgus" and "bunion" refer to the same thing. Even though CPT code lists bunion procedure codes like 28290 as "hallux valgus corrections," doctors who carry out these are not necessarily correcting a hallux valgus, according to ICD-9 terminology. If you look up 735.0, the definition reads, "Angled displacement of the great toe, causing it to ride over or under other toes."

As such, you should not report 735.0 unless the patient has an angular deformity of the great toe. As per this definition, a person could have a bunion but not necessarily a hallux valgus deformity; however experts say that the above definition is not actually followed. Hallux valgus is simply a valgus deformity of the distal great toe and does not have to overlap for a physician to call it hallux valgus.

If the patient's great toe is not overlapping or impinging upon the second toe, but he still has an obvious bunion, take a look at 727.1; this code specifically says 'bunion' and the ICD-9 definition is "enlarged first metatarsal head due to inflamed bursa; results in laterally displaced great toe."

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See Which Audit Process You Need to Follow for Your Practice

Remember that the same audit process and timeline will not work for every practice to identify the needs of your practice.

Internal audits are a way to ensure you're on track and nothing has gone wrong. See to it that your pediatric practice conducts regular internal audits if you don't want to lose money and overlook billing mistakes that could result in missed billing opportunities.

But before starting your audits, you should explain to everyone in your practice why you should go for an internal audit and how an internal audit will benefit your practice.

Internal audit charts: Internal chart audits make it possible to find and fix coding mistakes and self report rather than letting the payer find them. If your staff members are not willing to participate, let them know that the point of the audit is to improve coding down the line.

Types of internal audits:

Prospective audit: Your practice assesses new claims before you file them. Such an audit helps you identify and rectify problems prior to sending the claim, which could mean you will discover improper coding or charges that would have been missed otherwise. However, remember that this kind of chart audit can delay billing.

Retrospective audit: Your practice takes a look at paid claims. On the other hand, this type of audit do not delay billing but causes your office to be proactive in finding problems before you submit the claim.

But remember that the same audit process and timeline won't work for every practice to identify your practice's needs.

What should be done: Your practice must determine for itself what types of audits your staff can reasonably compete and what effects on claim submission timing and cash flow your practice can handle.

You should remember that an audit is much more than coding; it involves documentation, coding, billing and data input, denials management and office process following policies and procedures.

Orthopedic Coding: Additional Neurostimulator & Arthrodesis Codes

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

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

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

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

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

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

Support Your Incident-to Claims or Face OIG Scrutiny This Year

Make certain your visit meets 4 criteria before filing an incident-to claim.

In case you don't know how to appropriately bill the services the non-physician practitioners (NPPs) in your office perform, it might cost you more than the 15 percent difference in reimbursement rates. Read this expert medical billing article and know what you require to keep you practice off the OIG hot list.

Reason: As part of its 2012 Work Plan, which came out last October, the HHS Office of Inspector General (OIG) plans to inspect incident to services.

Your best bet for evading OIG scrutiny is no to bill incident to lest you're assured you've met the requirements.

Know What Incident to Means

As most practices already know, under incident-to rules, qualified NPPs can treat definite patients and still bill the visit in the physician's National Provider Identifier (NPI), bringing in 100 percent of the assigned fee.

How it works: While an NPP provides a service to a Medicare patient incident-to the physician, you can report the service in the physician's NPI as long as all of the rules for incident-to services are taken care of. You will then charge the payer 100 percent of the service's fee.

Remember: In case you find the service does not meet incident-to medical billing requirements, you don't have to sacrifice payment completely in many cases. In case a Medicare credentialed NPP delivers the service, you can bill under his own NPI. In that case, you'll generally receive between 65 and 85 percent of the normal global fee found in the Medicare Physician Fee Schedule, depending on the type of NPP.

Medical Billing Tip: In case a member of your auxiliary staff, for instance a medical assistant (MA), offers a service when there is no direct supervision, you cannot bill for the service.

Get to Know OIG's Plans

The OIG aims to decide whether payment for incident to services displayed a higher error rate than non-incident to services. Incident-to medical billing services denote a program vulnerability in that they do not appear in claims data and can be recognized only by reviewing the medical record. They may also be exposed to overutilization and expose Medicare beneficiaries to care that fails to meet professional standards of quality.

"Incident-to' medical Coding billing is always something being examined by the Office of the Inspector General (OIG) simply by nature. The claims are sent in under the physician's name. The mid-level provider is ‘transparent' to this process. In case the carriers see more claims than usual coming in for the physician, that type of specialty, etc. they will wish to investigate to see if the patients are being seen suitably and thus being billed correctly.

A lot of the recent overpayment, audit, civil false claims act, and also criminal cases established by the federal and state agencies overseeing the Medicare and Medicaid programs include allegations of improper medical Billing for -- incident-toservices.

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Consolidated Billing: Solid Contract With Nursing Facilities to Ensures You Get Paid Every Time

Think of having a healthcare attorney assist with the process.

In order to get payment for the some of the technical components of the services your physician offers in the office for patients in nursing facilities, you may need to have a set contract with the facility. Read this expert medical billing article to learn more.

Collecting payment from the nursing facility for the technical component services your physician carries out – for instance medications, lab work, x-rays (the technical portion, not the interpretation), the technical share of EKGs, billable supplies, DME allotted from office, etc.-- can be your next task. Setting up a contract with each nursing facility you work with can help you circumvent consolidated medical billing and collection headaches down the road -- here's how.

Make the Contract Specific and Detailed

You'll wish to make the contract specific and identify the services, by means of CPT and HCPCS codes, your physicians can deliver to the facility's patients along with the negotiated fees for those procedures and services.

To ensure accurate medical billing, the contract must evidently indicate the nature of the relationship, compensation for the services to be delivered, the length of the contractual obligation, along with confidentiality and further compliance requirements.
The contract must also list your medical Coding billing information and involve a disclaimer mentioning that you anticipate payment for services rendered irrespective of the nursing facility's reimbursement status with the Medicare carrier. Deliver an executed copy of the contract to the facility, and you must keep one for your records.

Medical Billing Tip: Don't Price Gouge Simply Because You Can

You must consider charging the nursing facility merely for the reimbursement you could assume as per the Medicare Physician Fee Schedule, experts recommend. Just for the reason that you're not held to a set fee schedule doesn't mean you could set prices higher than you'd charge for other patients.

While you are not bound by Medicare's set fees for the services you bill directly to the nursing facility, you'll likely find yourself struggling to get additional dollars from the facility over and above the fee schedule amount. The effort won't be worth the time and effort, chiefly if you deal with several nursing facilities -- besides you risk having the facility choose to stop using your practice.

Good practice: Try using a contract and talking first to resolve any persistent payment problems with a nursing facility. As a last resort, however, you can report your problems to the local or regional overseer of nursing homes and request an investigation into their medical billing operations.

For More Information :- http://www.supercoder.com/coding-newsletters/my-practice-management-alert/consolidated-billing-set-up-a-solid-contract-with-nursing-facilities-to-ensure-you-get-paid-every-time-article

Thinking of Going Out of Network? Follow These 3 Tips to Ensure Success

Be honest with your patients to guarantee a smooth transition.

More and more providers are questioning whether moving to an out of network situation with a payer -- or multiple payers -- is best for their practice. Becoming out of network certainly has pros and cons that you'll wish to weigh sensibly before coming to a decision. Read this expert medical billing article for more.

If you're considering a move to becoming a non-contracted provider, follow these three steps to set your practice up for success.

1. Assess Your Existing Contracts and Patient Base

Before your practice starts talking about becoming out of network with a payer, you must review your contracts. There are specific key areas to pay attention to as you go through the contracts like:

• Enhanced groupers
• Implant thresholds
• Procedure rates versus case rates
• Silent PPOs
• Reduction of state mandated fee schedules
• Claims filing limitations
• Penalty for provider termination.

Medical Billing Tip: You also want to determine how going out of network will affect your patients and, as a result, patient perception and satisfaction. You can still see patients with the insurance even if you go out of network with a payer, but if the patient's plan does not have out of network benefits, you will need to determine how to transition their healthcare to a participating provider.

2. Reflect on Renegotiation of Your Existing Contract

In case you're having trouble with a certain payer, it may be worth doing some negotiating before you decide on going out of network.

In case reimbursement is too low, you can attempt to renegotiate your contract or get certain carve-outs so that the fee schedule is exceeding your costs. In case you think the contract is not satisfactory, schedule a meeting with your provider relations representative to talk over your needs and decide if negotiation is a possibility. You may also wish to focus on re-training members of your medical billing staff to check that they are medical billing correctly and collecting all the reimbursement your contract permits.

3. Inform Your Patients of Your Decision

In case your practice weighs the pros and cons and decides that going out of network is best, ensure to inform your patients and clarify the reasons for your decision.

Adjust your written financial policy to visibly state how patient out of pocket costs will be billed and what medical coding or collection practices will be implemented.

Make this written information available to your patients, and consider posting a notice in your waiting room as well.

Be ready to answer patients who call about their description of benefits. You must have a script that everyone on your medical billing staff follows so that the clarification and the general message stay consistent.

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CPT 2012: Don't Skip These Explanations About New Patients plus 'Qualified Healthcare Professional'

Learn how changes influence your use of 99201-99205, 99460-99461, and more.

Medical coding guidelines can at times seem puzzling when you're trying to decide whether to categorize a patient as new or established. For instance when an established patient comes to your practice to see a new physician, would you report a new patient office visit code?

CPT 2012 tries to clarify this question and one other E/M question: Who counts as a "qualified healthcare professional" to administer that vaccine or deliver prolonged service?

'New Patient' Classification Goes to a New Level

At present, CPT® indicates that a "new patient" refers to a patient who has not received any professional services, for instance an E/M or other face-to-face service, from the physician or another physician of the same specialty in the similar group practice in the past three years.

Clarification: CPT 2012 takes that definition a step further, by stating, "A new patient is one who has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years." The parts of the description that are novel for 2012 are underlined.

What it means: In case your practice employs several subspecialists, CPT® now clarifies that claims for patients who see dissimilar doctors with different subspecialties can be billed using a novel patient code (such as 99201-99205).

RN Doesn't Fit 'Other Qualified Healthcare Professional'

In case your payer follows CPT® rules, you can now eliminate registered nurses from the list of professionals who can administer vaccinations or offer prolonged services for patients.

At the demand of many physicians, CPT 2012 now describes the term "other qualified healthcare professional." Although this definition didn't make it into the 2012 manual, the AMA lists it as part of the "CPT 2012 Errata" on its Web site.

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

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

Prepare Yourself With Novel Codes To Report Neurolysis in 2012

While reporting the paravertebral facet joint nerve injections in 2012, you will no more be counting nerves that your surgeon targeted. Till now, you have been reporting injections for each nerve at a distinct vertebral level. Effective Jan. 1, you'll require adjusting your technique to look for the particular anatomical site involved along with the work that your surgeon did. Read this expert medical coding article for more on what changes does CPT 2012 brings for these injections in: what goes obsolete and what new comes in.

CPT 2012: Know the Deletions

Here are four CPT codes that will be deleted in 2012:

64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level)

+64623 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level [List separately in addition to code for primary procedure])

64626 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level)

+64627 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level [List separately in addition to code for primary procedure])

CPT 2102: Look at Novel Codes

You will find four new CPT codes in 2012. These include the following:

64633 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; cervical or thoracic, single facet joint)

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

64635 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single facet joint)

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

Don't Distinctly Report Image Guidance

When reporting neurolysis described by new CPT codes 64633-64636, ensure that your surgeon has used and documented the image guidance used to carry out the paravertebral facet joint nerve destruction. The CPT 2012 codes are inclusive of the image guidance, so you do not individually report the fluoroscopy or CT guidance used for the paravertebral nerve localization. Keep in mind that image guidance with either fluoroscopy or CT is both required and is bundled into the new CPT codes.
 

CPT 2012 Tip: You do not report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, subarachnoid, or sacroiliac joint], including neurolytic agent destruction) for fluoroscopic guidance and 77012 (Computed tomography guidance for needle placement [eg, biopsy, aspiration, injection, localization device], radiological supervision and interpretation) for CT guidance with 64633-64636.

33202-33211 Get Numerous Guidelines in 2012

Hint: Understanding RS&I coding is the important for denial prevention.

The enormous changes to CPT®'s pacemaker (PM) along with implantable cardioverter-defibrillator (ICD) section are challenging even to expert coders. You can streamline the switch by breaking the changes into convenient chunks and mastering one group before going to the next. This expert medical coding article will focus on changes to CPT codes 33202-33211.

Confirm Provider Before Reporting 33202-33203

When reviewing CPT codes 33202-33211 in the 2012 manual, the first change you'll find is a revision to the parenthetical note following 33202-33203 (Insertion of epicardial electrode[s] ...). Compare the 2011 and 2012 descriptions of the note:

2011: ("When epicardial lead placement is performed by the same physician at the same session as insertion of the generator, report 33202, 33203 in conjunction with 33212, 33213, as appropriate.")

2012: ("When epicardial lead placement is performed with insertion of the generator, report 33202, 33203 in conjunction with 33212, 33213, 33221, 33230, 33231, 33240.")

The major change to the instruction is the list of CPT codes you may report along with epicardial lead placement CPT codes 33202 and 33203. The longer list is the outcome of CPT® 2012 adding and revising a number of codes for the insertion of a PM pulse generator (33212, 33213, 33221) or the insertion of a pacing ICD pulse generator (33230, 33231, 33240).

33206-33208 Join Other Codes for Full Replacement

The subsequent change you'll notice for this code range is a revision to 33206-33208. CPT® 2012 includes the following bold text to the definitions: "Insertion of new or replacement of permanent pacemaker with transvenous electrode(s) ..."

What does not change: As in 2011, the codes vary based on the electrode location:

33207, ... ventricular

33208, ... atrial and ventricular.

Similarly just as in 2011, 33206-33208 comprise subcutaneous insertion of the pulse generator as well as a transvenous placement of electrode[s], as per a parenthetical note with the codes.

Scratch 71090 Off Your Medical Coding Aids

One code you may have noticed absent from the above discussion is 71090 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation). The reason behind that is in 2012, radiological supervision as well as interpretation associated with the pacemaker or pacing cardioverter-defibrillator procedure is included in 33206-33249, as per CPT® guidelines. In fact, 71090 is no longer in the list if valid CPT codes in 2012.

Example: In 2011, you would have reported dual lead pacemaker insertion in fluoroscopy by the means of CPT codes 33208 and 71090. In 2012, you'll report that similar service using only 33208.

The removal of fluoroscopy while placing devices is another instance of addition for routine services. Fluoro is required to place the PM or ICD so CPT® may have streamlined that it is a component part of the service and not distinctly billable.

Source URL :- http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/electrophysiology-33202-33211-get-bulked-up-guidelines-in-2012-109255-article 

Improve Your Common ED Airway Procedure Accuracy

Seconds count with airway tube insertions, however take a few minutes to learn these significant tips.

A recurrent presenting problem in the emergency department is a patient having trouble breathing owing to pulmonary disease, injury, or swelling of the throat tissues. You would normally report these encounters as high level ED visits or critical care due to the nature of the presenting problem; however you may also be able to report a procedure code in case it is correctly documented. Read on for advice on correctly documenting to support your airway services procedure medical coding.

1. Define Reason for Airway

The most general airway related procedure in the ED setting is endotracheal intubation where the patient has a compromised airway that requires stabilization.

Sample scenario: You should look for documentation describing tube placement similar to the following medical coding example:

A 24 year old female is brought in by her boyfriend from a picnic in a neighbouring park. Her face depicts signs of increasing swelling and she complains of having trouble breathing as if her throat is closing. She then reports a history of reactions to bee stings that have intensified in severity since she was a child. She is unclear that she was actually stung, but the boyfriend reports that there were bees present in the area and that they were seated near a large flower garden.

The emergency physician then orders an epinephrine injection, and as the patient had established increasing respiratory distress, places a tube down her throat to maintain her airway. After obtaining that limited history due to her breathing issues, an examination shows no other indication for the allergic reaction and he finds a likely sting site on the back of her neck. The patient reacts well to the epinephrine and then the swelling starts to subside after 40 minutes once she is admitted to the hospital. The physician afterwards documents 32 minutes of critical care time outside of distinctly billable procedures and then gives a diagnosis of anaphylaxis because of the bee sting.

On the claim, you would report the following for error-free medical coding:

99291 {Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes}

31500 {Intubation, endotracheal, emergency) for the tube placement}

989.5 {Toxic effect of other substances, chiefly non-medicinal as to source, venom}

E905.3 {Venomous animals and plants as the cause of poisoning and toxic reactions, hornets, wasps, and bees}

Medical Coding Tip: Apply the modifier 25 to 99291 to demonstrate that the intubation is distinct from the critical care services.

2. Critical Care? Scan for Time Details

You must keep in mind that in case the patient was reported as critical care, you should back out the time spent providing other procedures, for instance intubation, from your entire patient care time. A lot of payers require a statement in the documentation to that effect. Fortunately, most emergency physicians can place a tube rather rapidly.

ICD-9 Coding: Welcome the New Year with a Reminder of Alcohol Related Diagnoses

Ensure that you choose the accurate diagnosis code when alcohol is a factor of an ED visit

The New Year is approaching and with it comes an upsurge in alcohol-related presentations to the ED. Even though a lot of presenting problems are injuries or illnesses to which alcohol was a reason, it may be worth reviewing the numerous alcohol-related diagnoses that are available and when are they applicable in the ED setting. Read this article to know what ICD-9 codes apply for stress-free medical coding.

Take a look at some common patient types:

1. Patients who are brought in as they are impaired

It is not unusual for a highly intoxicated person to be brought to the ED by concerned friends, parents, or law enforcement officers as the patient seems to be unresponsive or dangerously intoxicated.

First let’s consider the patient, for whom no other diagnosis is probable, has come under medical care owing to the maladaptive effect of a drug on which he is not reliant on, and that he has taken on his own initiative to the damage of his health or social functioning, for instance a New Year’s Eve or a Super Bowl party. In this case, the patient has no history of alcohol dependency, but seems to have considerably exceeded his limit on this occasion.

ICD-9 codes that might apply are as following:

1. 305.0 (Nondependent alcohol abuse)
2. 305.00 (Nondependent alcohol abuse, unspecified drinking behaviour)
3. 305.01 (Nondependent alcohol abuse, continuous drinking behaviour)
4. 305.02 (Nondependent alcohol abuse, episodic drinking behaviour)
5. 305.03 (Nondependent alcohol abuse, in remission)

2. Patients whose condition is caused by long time alcohol abuse

The other end of the range is the long time alcohol abuser whose medical problems are directly credited to that history. Probable presentations involve hallucinations, seizures or delirium tremens. These patients may or may not be impaired at the time of their visit.

Frequently seen ED presentations can be reported with the following diagnosis ICD-9 codes:

291 (Alcohol induced mental disorders)

291.0 (Alcohol withdrawl delirium)

291.1 (Alcohol induced persisting amnestic disorder)

291.2 (Alcohol-induced persisting dementia)

291.3 (Alcohol-induced psychotic disorder with hallucinations)

291.4 (Idiosyncratic alcohol intoxication)

291.5 (Alcoholic-induced psychotic disorder with delusions)

291.8 (Other specified alcohol-induced mental disorders)

291.81 (Alcohol withdrawl)

291.9 (Unspecified alcohol-induced mental disorders)

Is it time for an Intervention? Deliberate behavior change intervention ICD-9 codes

Occasionally the trip to the ED for an alcohol-related injury turns into a chance for a screening and intervention to occur. Consider the patient who fell down the stairs because they were intoxicated or when alcohol appears to have contributed to MVA related injuries. Even though a busy ED is not the best place for this service, check the chart documentation to find if there is support for reporting the following ICD-9 codes:

99408 {Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes (Do not report services of less than 15 minutes with 99408}

99409 {greater than 30}

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Perfect Your Fibroid Claims By Knowing These Removal Methods

Reporting uterine fibroid removals can be hard if you do not know the way the ob-gyn used to take care of the growth. Read this article and learn about each method of fibroid treatment, so you will be ready for whatever your ob-gyn chooses to carry out.

Medical Coding Method 1: Count Hysterectomy As Most Common Procedure

Hysterectomy is when the ob-gyn does away with the uterus completely. Even though this is the most common approach, it is used only when the fibroids are producing problems, for nstance abdominal pain or heavy bleeding. In case the uterus is not removed, there are chances are that the fibroids will reappear. When you execute the CPT lookup, the code assignment will hinge on on the type and extent of the hysterectomy.

Coding example: As the patient is older than 50 years and has multiple fibroids, your ob-gyn carries out a total abdominal hysterectomy (58150, Total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]). You would not code the fibroid removal distinctly if the ob-gyn is eliminating the uterus.

Medical Coding Method 2: Hem in Your Hysteroscopy Choices

Fibroids can also be treated using the hysteroscopic procedure. Hysteroscopic submucous resection gets rid of a portion of the protruding fibroid and preserves fertility.

The procedure needs “the close monitoring of distention media, electrosurgical devices, along with a patient’s anatomy to circumvent perforating the uterus. Ob-gyns normally carry out this straightforward approach for intracavitary (submucosal) fibroids.

Medical Coding Method 3: Master These Myomectomy Codes

Myomectomy (58140-58146, 58545-58546) is one more choice for fibroid treatment. A myomectomy is the removal of uterine fibroids only, which preserves fertility.

Example 1: The ob-gyn sees a 32-year-old patient who has never given birth to a child but wishes to. She goes through heavy menses with anemia.

On examination, the physician finds a 15-cm uterus with manifold fibroids that distort the endometrium. As the patient wants to have children, she chooses to have a myomectomy, which the ob-gyn carries out by the means of an laparoscopic approach. The pathology report shows six intramural myomas.

For this case, when you execute the CPT lookup, you must report 58545 (Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 g or less and/or removal of surface myomas).

Medical Coding Method 4: Make Use of UAE Option

You may see additional uterine fibroid embolization or uterine artery embolization (UAE) procedures. UAE is a nonsurgical, minimally invasive procedure that will shrink the fibroids by cutting off the blood supply.

The ob-gyn inserts a catheter through an artery in the leg to the arteries in the uterus. The physician then inserts tiny particles of plastic or gelatin through the arteries to cease the blood flow inside the fibroids. Devoid of blood flow, the fibroids shrink or may even disappear over time.

In case this method is followed, once you do the CPT lookup, you’ll report using 37210 (Uterine fibroid embolization [UFE, embolization of the uterine arteries to treat uterine fibroids, leiomyomata], percutaneous approach inclusive of vascular access, vessel selection, embolization, and all radiological supervision and interpretation, intraprocedural roadmapping, and image guidance necessary to complete the procedure).

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Hone Your Neuroendoscopy Coding Skills With These Easy Steps

You should ever use these codes for open surgery and endoscopy together.

In case your neurosurgeon carries out neuroendoscopy services during cranial procedures, you must never report the service with open procedures or else you might end up missing on reimbursement opportunities. Read this article to side-step errors in medical coding.

Codes to remember: While reporting the neuroendoscopy procedures, you will require choosing from the CPT codes 62161 (Neuroendoscopy, intracranial; with dissection of adhesions, fenestration of septum pellucidum or intraventricular cysts [including placement, replacement or removal of ventricular catheter]) – 62165 (Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or trans-sphenoidal approach) and the add-on code + 62160 (Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage [list separately in addition to code for primary procedure]).

1. Segregate Endoscopy from Open Codes

The surgeon may adopt either of the two choices to treat the problem, but he will never use both of them at the same time. He may either insert an endoscope to treat the underlying condition or may adopt an open approach for instance the affected area is surgically opened up to address the pathology. Neuroendoscopy CPT codes are definitive and independent. So, you cannot report neuroendoscopy codes with codes for parallel open procedures.

Example: In case your neurosurgeon undertakes an open approach to obliterate a supratentorial tumor which is not a meningioma, you would report 61510 (Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma). On the other hand if he adopts a neuroendoscopic procedure to accomplish the excision of the tumor, you would report 62164(Neuroendoscopy, intracranial; with excision of brain tumor, including placement of external ventricular catheter for drainage). This includes placement of a ventricular catheter for drainage.

Cautionary tip: You must be cautious to not report the codes for open and neuroendoscopic stand-alone procedures at the same time. Remember that you cannot report 61510 and 62164 together. The reason being that in one session, the surgeon can adopt either approach but not both to address the underlying pathology.

Exception: If your surgeon provides a detailed explanation of an accompanying procedure in the operative note, you can report 62160. CPT® allows this add-on code to be reported with primary procedure CPT codes like 62220, 62223, 62225 and 62230. CPT® made the neuroendoscopy codes to stand apart from open procedures, again, with the exception of 62160.

2. Beware the Bundles

You must never report a twist drill, cranial burr hole, or trephine along with the neuroendoscope code; NCCI bundles these access CPT codes with the endoscopy itself. The burr hole is assumed or included in the neuroendoscopy code(s), as you can’t do the neuroendoscopy excluding a burr hole, however you can do a burr hole excluding neuroendoscopy. In case twist drill, cranial burr, or trephine are carried out at the same time neuroendoscopy is, you would report only neuroendoscopy

CPT® 2012 Clarifications: Pediatric Hospital Rounds Will Be Stress-free to Code

Distinguish the common types of pediatric hospital visits and you'll be on the road to correct medical coding.

Though most pediatricians assess newborn inpatients as part of their fixed weekly work, some practices struggle with how to code such services. However once you break it down into the below listed most common categories of inpatient E/M rounds, you could be sending claims out the door sooner and more competently. Read this article for correct medical coding and know what CPT codes apply in this situation.

Check NICU Changes for CPT 2012

Two of the most severe types of infant hospital visits include time with intensive care or critical care. In both of such cases, the pediatrician has to go above and beyond what's needed when seeing a healthy newborn--and coding such visits can be a challenge.

The issue of level of care delivered is not specific to the site of service. Though, neonatal critical and intensive care services are normally provided in a NICU.

Intensive care: Assume that a baby is tachypneic with a fever as a newborn and is worked up and is getting treatment for sepsis. The pediatrician gives a neonatal intensive level of care, carrying out daily intensive care services. In these situations you'll report a code from the 99477-99480 series of CPT codes.

Critical care: After the pediatrician examines a patient for more austere issues—for instance organ system failure or serious respiratory distress--he might decide that the patient is in need of critical care, which you'll code using the 99468-99469 series of CPT codes. In a lot of cases, critical care would be administered by a neonatologist.

Changes for CPT 2012: Earlier, in case a patient was transferred from neonatal intensive to critical care--or vice versa--the coding rules were blurred. But, CPT 2012 clarifies that issue with parenthetical notes to guide you in making the correct CPT codes decision.

What CPT® now makes clear is that in case an infant recovers after the initial day and is transferred to a lower level of care, the transferring physician does not report a per-day intensive care service. In its place, the transferring doctor will report a code from the subsequent hospital care section (99231-99233) of CPT®. The receiving physician will report subsequent intensive care (99478-99480) or subsequent hospital care (99231-99233) as suitable based on the condition of the neonate or child.

In case the physician provides intensive care services but then the patient becomes critically ill and then is transferred to a dissimilar physician, the transferring physician reports either the critical hourly care service (99291-99292) or the daily intensive care service carried out , but not both.

Welcome Car Seat Testing Codes Effective Jan. 1

Plus: You'll find explanation on developmental testing codes 96110-96111.

Previous year, coders got a good dose of updates--and confusion--with the inclusion of numerous new vaccine administration codes. CPT 2012 goes lenient on pediatric practices with a few modifications to the code set which will generate the necessity for updates, but not overhauls. Read this article for stress-free and accurate medical coding.

At the top of the list this year, you'll find the following new CPT codes for car seat testing:

94780 – (Car seat/bed testing for airway integrity, neonate, with continual nursing observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with interpretation and report; 60 minutes)

+94781 – {...each additional full 30 minutes (List separately in addition to code for primary procedure)}

The car seat testing services will mainly be done in facility settings; however will be valued with facility and non-facility payment amounts. These tests are usually essential before premature or at-risk babies (with conditions such as heart disease or congenital malformations) are discharged home from NICU settings.

There are occasions where follow-up testing may be indicated. "This would normally be provided in a neonatal follow-up clinic, however could be carried out in the office setting, in case the setup is complete to offer all the necessities for the code. As more services shift to the medical home, this could happen more in the future. Having the CPT codes and the anticipated relative value payments should facilitate the process.

For More Information :- http://isupercoder.blogspot.in/2011/12/welcome-car-seat-testing-codes.html

Developmental 'Testing' Modifies to 'Screening'

New CPT codes are always great to find in CPT®, however occasionally you'll find changes that make significant explanations to present codes. Such is the case with existing developmental testing CPT codes 96110-96111. The new descriptors for these codes are listed below:

96110 – (Developmental screening, with interpretation and report, per standardized instrument form)

96111 – (Developmental testing, (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments), with interpretation and report)

Medical Coding Tip: Take Note of Vaccine Revisions

Last year, in pediatric medical coding, CPT® threw many practices for a loop with the adding of several new vaccine administration codes, which most payers finally began processing efficiently within the last few months. Luckily, such a main overhaul has not taken place this year. Instead, CPT® makes slight adjustments to how you'll report your vaccines for accurate medical coding.

For instance: CPT® will change meningococcal conjugate vaccine code 90644 to get rid of mention of "Hib-MenCY-TT." In its place, the new code descriptor reads "Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine (Hib-MenCY), 4-dose schedule, when administered to children 2-15 months of age, for intramuscular use.

CCI Edits 17.3: 32422, 71010 Bundle -- And More -- Enhance Your Pulmonary Coding Options

Immunotherapy code Q2043 is anot an area of concern for pulmonologists, and should be an oncology issue.

The most recent Correct Coding Initiative (CCI) edits bundle chest radiologic guidance along with numerous procedures on the lungs and pleura, and even though CCI edits 17.3 assemble immunotherapy code Q2043 with lots of ventilation and gas procedures, you must not worry -- here's why. Read this article for accurate medical coding.

Establish Chest X-ray Distinctness From Thoracentesis To Ignore Bundle

For the newest CCI edits version, you must keep an eye on bundled chest x-rays as well as chest tube procedures. Particularly, both 71010 (Radiologic examination, chest; single view, frontal) along with71020 (Radiologic examination, chest, 2 views, frontal and lateral) become parts of:

32422 – {Thoracentesis with insertion of tube, includes water seal (e.g., for pneumothorax), when performed (separate procedure)}

32550 – {Insertion of indwelling tunneled pleural catheter with cuff}

32551 – {Tube thoracostomy, includes water seal (e.g., for abscess, hemothorax, empyema), when performed (separate procedure)}

93503 – {Insertion and placement of flow directed catheter (e.g., Swan-Ganz) for monitoring purposes.}

CCI edits mention the motive for the bundle as wrongly using column two code with column one code. These CCI edits have a modifier indicator of "1", consequently you may overrule the edits with a modifier (i.e., modifier 59, Distinct procedural service) on the column 2 code when the services are different.

Example: A patient with COPD (490-496) gets admitted with shortness of breath (786.05) along with chest pain (786.5), deteriorating with inspiration. A chest x-ray (71010) prove pneumothorax (512.x) and the patient must go through thoracentesis with insertion of tube (32422) to get rid of the excess air and let the lung re-expansion. In this sceanrio, you would report 32422, 71010-59 to point out that the chest x-ray was different from the thoracentesis.

For More Info :- http://www.supercoder.com/coding-newsletters/my-pulmonology-coding-alert/cci-edits-173-32422-71010-bundle-and-more-improve-your-pulmonary-coding-options-this-quarter-108569-article

Take note: Pulmonary specific guidelines preside over the abovementioned Column 1 codes. For example when coding 32422, you must consider a dissimilar radiologic guidance code for catheter placement/confirmation (e.g., 76942, 77002, 77012), which more precisely reflects the service description, method as well as service time linked with the procedural guidance provided.

The similar guidelines are applicable to 32550-32551. In other words, you must consider code 75989 (Radiological guidance [i.e., fluoroscopy, ultrasound, or computed tomography], for percutaneous drainage [e.g., abscess, specimen collection], with placement of catheter, radiological supervision and interpretation) to signify radiologic guidance for catheter placement/confirmation.

Medical Coding Tip: Remember that you must use 71010 and 71020 simply for radiologic examination of the chest, and not to assist or substantiate needle placement.

Discover Site-Specific Bx Codes and Net $78 or More

Enhance claims accuracy by side-stepping these common biopsy coding difficulties.

In case you automatically assign 11100 when your dermatologist lays down the biopsy site, you could be losing deserved pay. Read this article to know what ICD-9 codes and CPT codes apply to this situation and ensure medical coding accuracy.

Site-specific codes increase medical coding accuracy. Besides, they pay more than the most extensively used code, 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion).

Don't Miss More Pay for More Work

Site-specific biopsy codes inform the payer that the dermatologist carried out a biopsy at a specific site, instead of a generic integumentary based biopsy (11000). A site-specific biopsy code also signifies a more complex procedure than 11000 does.

Result: The dermatologist is worthy more pay for the gretaer level of complexity of these site-specific procedures. Your practice is missing income and accuracy in medical coding in case your dermatologists ignore these site specific codes, which is easy to do as dermatology practices depend on on the integumentary segment of the CPT® manual.

Example 1: A patient comes to your practice with a papular lesion of the lip. Once the dermatologist examines the patient, he decides that he must carry out a biopsy.

In this scenario, you must report 40490 (Biopsy of lip) in place of of 11100. Provided that the dermatologist notes the site-specific biopsy within the documentation, you must get nearly $78 more for the procedure on the patient's lip than in case you had reported 11100 as this biopsy needed more work from the dermatologist.

Don't miss: For accurate medical coding, ensure that the biopsy is of the lip, not the skin surrounding.

Example 2: A patient with a pigmented lesion that is of the nail bed presents to your practice. The dermatologist doubts trauma but feels he should carry out a nail bed biopsy to rule out melanoma.

Your initially thought in coding this scenario could be to bill 11100. However, you should bill 11755 (Biopsy of nail unit [e.g., plate, bed, matrix, hyponychium, proximal and lateral nail folds] [separate procedure]).

Code 11755 is more precise and also pays around $25 more than code 11100 (3.81 non-facility RVUs x $33.9764 = $129.45).

For More Information :-  http://www.supercoder.com/  

Report Multiple Biopsies for Separate Sites

While your dermatologist carries out multiple biopsies, you require a tool to unravel the claim's payment. You must clarify the conditions to the payer by the means of modifiers.

Wait for Path Report to Choose Dx

ICD-9 Codes and CPT Codes: You must always wait until the pathology report comes back to select the appropriate codes to report, although this will not always affect the CPT codes you will wind up selecting.

Reason: The biopsy specimen's pathology will affect the ICD-9 codes you report, but most CPT codes are not based on the specimen's outcomes. There are a few CPT codes which are connected to definite diagnoses (for instance, excision of benign and malignant lesions).

Tact Your EKG Interpretation Claims With This Can't Miss Documentation Guidance

Does your chart include the needed elements to stand up under audit?

In case you're getting repeat denials when your ED physician reads electrocardiograms [EKG], it's time to ask yourself some serious questions, comprising whether the documentation meets Medicare's definition of interpretation and whether the notes clearly classify which ED provider did the reading and reason behind the EKG was ordered. Read this article to ensure accurate medical coding.

Reality: One of the most commonly reported non-E/M services in the emergency department is for EKG interpretation; unfortunately, if you execute CPT Lookup, you will find that these CPT codes also fall under the most commonly contested services as well.

E/M link: A review of a formerly interpreted EKG has value in E/M code Medical Decision Making, but in a totally diverse way from being distinctly billable.

Watch Out for Rhythm Report Reason

CPT Lookup: The CPT® book includes two CPT codes defining interpretation as well as report of diagnostic cardiographs or the tracings of heart rhythms.

93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only)

93042 (Rhythm ECG, 1-3 leads; interpretation and report only)

In the case of the 93042 code, you would not report it when the ED physician just reviews the telemetry monitor strips taken from a monitoring system. The needed definite order for 93042 must be supported by a diagnosis or symptom as the starting event. For supporting medical necessity for the service, clinical information representing the need to assessing for the presence or absence of an arrhythmia, cardiac ischemia, or further cardiovascular problem must exist within the medical record.

In the ED, the physician would not normally report the global CPT codes 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) or 93040 (Rhythm ECG, 1-3 leads; with interpretation and report) as the physician does not usually own the EKG machine nor employ the staff who in fact administers the test.

Code choice aside, some payers reject to reimburse for diagnostic interpretations in the ED setting, stating they are bundled into the E/M service and counted in the amount and difficulty of data reviewed component of medical decision making.

CPT Lookup Tip: EKG services must be distinctly reimbursed except there was simply a "review" of the tracing delivered rather than the CPT® defined independently distinctly identifiable signed written report. CPT® is quite specific in the E/M services guidelines that the actual presentation and/or interpretation of diagnostic tests/studies ordered in a patient encounter are not involved in the levels of E/M services. Physician presentation of diagnostic tests/studies for which definite CPT codes ( Source "http://www.supercoder.com/cpt-codes/" )are available may be reported distinctly, as well as the suitable E/M code if correctly documented.