Medical Coding: Medicare will no longer pay you money for 90658 with effect from January 1, 2011.
The new year brings changes to flu vaccines and counseling codes.
Your vaccine coding in 2011 will be on its toes, thanks to changes in codes and administration reporting. Two more updates every family physician should know involve new Q codes for some Medicare flu vaccines and expanded ages for adolescent vaccine counseling.
Nix 90658 for Medicare patients
CMS has come up with New HCPCS codes and payment allowances to replace 90658. Medicare will no longer pay you money for 90658 with effect from January 1, 2011. As such, select from the new codes instead, based on the specific product: Q2035, Q2036, Q2037, Q2038, Q2039.
Timing: Codes Q2035-Q2039 went into effect on October 1, 2010. When filing claims for DOS from October 1 until December 31, 2010: bill Medicare immediately with 90658, or hold the claim until January 1, 2011 and file with the proper Q code.
Explanation: Medicare pays for influenza vaccine based on 95 percent of the average wholesale price. The products normally classifiable to 90658 have widely varying AWPs. If Medicare continued paying for all of them under a single code, they could be overpaying some and underpaying others, relatively.
Consequence: Medicare assigns different Q codes to each individual product starting January 1, 2011 to account for variances in manufacturing prices. "This should actually ensure that physicians are paid well for products that might have significant differences.
Report 90460, +90461 through age 18
You will be able to use medicine series vaccine administration with counseling codes on older patients and when a nurse provides the counseling, thanks to CPT 2011.
As counseling for adolescents can involve as much as counseling on vaccine for younger children, the American Academy of Pediatrics recommended that the age limitation on the vaccine administration with counseling codes be raised. New codes extend vaccine administration with counseling to patients through 18 years of age.
Benefit from RN/LPN counseling and still get the reimbursements
Busy practices will be excited at being able to use their registered nurses (RN) or licensed practicing nurses (LPN) to capture the higher RVUs some private payers associate with the vaccine administration with counseling codes. The just-in vaccine administation code with counseling code descriptor expands who can provide the vaccine counseling described in the deleted immunization administration with vaccine counseling codes (90465-90468). CPT 2010 vaccine administration with counseling codes 90465-90468 limited the counselor role to a doctor and, subject to state scope of practice laws, nurse practitioner (NP) or physician assistant (PA).
Final say: Remember the just-in administration codes 90460 and 90461 are per vaccine/toxoid component. That means if your doctor provides counseling and administration for a combination, you will report 90460 for the first component and 90461 for each additional component. In the MMR example, you would use 90460 once and 90461 twice. Before 2011, you'd report only a single vaccine administration code for a combination vaccine, irresespective of the number of components in the vaccine.
Thursday, December 16, 2010
Cisplatin, Cyclophosphamide, and Vincristine Most Affected
HCPCS 2011 code-set has a number of deletions, streamling your drug coding choices. Most affected are cisplatin, cyclophosphamide, and vincristine.
The just-released HCPCS 2011 code-set has a number of deletions, streamling your drug coding choices. Among the most affected are cisplatin, cyclophosphamide, and vincristine.
The good news is that this change should simplify billing, more so if the system your practice or facility uses like Pyxis or Lynx, limits you to a single code and billable unit for a drug.
Watch out: These HCPCS (http://www.supercoder.com/hcpcs-codes) changes have a positive side, however there are always considerations that'll arise. For instance, if your practice uses different sizes, you'll need to be alert for the different and specific national drug code (NDC) numbers for the agent dispensed to the patient when you send a claim to a payer who needs NDC information.
For cisplatin, stick to J9060
Cisplatin, ordered particularly for patients with metastatic testicular or ovarian neoplasms, or advanced bladder cancers, is one of the many agents impacted by the HCPCS 2011 shake-up.
Revision work: HCPCS 2011 will make a small wording revision to J9060.
2010: J9060 -- Injection, cisplatin, powder or solution, per 10 mg
2011: J9060 -- Injection, cisplatin, powder or solution, 10 mg.
Code J9062 (Cisplatin, 50 mg) will no longer be available for use in the new year. You should go for J9060 to report cisplatin, brand name Platinol, when supplied for 2011 dates of service.
For cyclophosphamide, J9070 comes out on top
At 1 unit per 100 mg, J9070 (Cyclophosphamide, 100 mg) won the role of the single option for coding cyclophosphamide injection supply.
J9080-J9097 go to the chopping block in 2011.
Vincristine Codes J9375 and J9380 feature in deleted list
Oncologists may order vincristine (Vincasar PFS) for patients with leukemia, Hodgkin's disease, non-Hodgkin's lymphoma, soft-tissue tumors, and neuroblastoma, among others. You will be reporting vincristine per milligram in the new year.
The just-released HCPCS 2011 code-set has a number of deletions, streamling your drug coding choices. Among the most affected are cisplatin, cyclophosphamide, and vincristine.
The good news is that this change should simplify billing, more so if the system your practice or facility uses like Pyxis or Lynx, limits you to a single code and billable unit for a drug.
Watch out: These HCPCS (http://www.supercoder.com/hcpcs-codes) changes have a positive side, however there are always considerations that'll arise. For instance, if your practice uses different sizes, you'll need to be alert for the different and specific national drug code (NDC) numbers for the agent dispensed to the patient when you send a claim to a payer who needs NDC information.
For cisplatin, stick to J9060
Cisplatin, ordered particularly for patients with metastatic testicular or ovarian neoplasms, or advanced bladder cancers, is one of the many agents impacted by the HCPCS 2011 shake-up.
Revision work: HCPCS 2011 will make a small wording revision to J9060.
Code J9062 (Cisplatin, 50 mg) will no longer be available for use in the new year. You should go for J9060 to report cisplatin, brand name Platinol, when supplied for 2011 dates of service.
For cyclophosphamide, J9070 comes out on top
At 1 unit per 100 mg, J9070 (Cyclophosphamide, 100 mg) won the role of the single option for coding cyclophosphamide injection supply.
J9080-J9097 go to the chopping block in 2011.
Vincristine Codes J9375 and J9380 feature in deleted list
Oncologists may order vincristine (Vincasar PFS) for patients with leukemia, Hodgkin's disease, non-Hodgkin's lymphoma, soft-tissue tumors, and neuroblastoma, among others. You will be reporting vincristine per milligram in the new year.
Steps to Pave the Way to Audit-Hardy Coding
ICD-9 coding: 6 steps to pave the way to audit-hardy coding. But remember what not to do.
An ICD-9 coding policy can keep your claims flowing smoothly; however you cannot just set it up and forget about it. Here's how to establish a policy that'll remain current and help you avoid headaches when auditors come calling.
Step 1: The first building block of a well-designed coding policy is to indicate that you adhere to the ICD-9-CM official guidelines for coding and reporting. If you don't stay up to date with these standard rules, you could be in for trouble.
For details: The official guidelines are updated each year and are normally available shortly after the annual ICD-9 updates go public.
If you keep up on the rules in the official guidelines, you will not have to worry about being blindsided by any across-the-board ICD-9 coding changes.
Step 2: Establish your coding process, including who does the coding and how you make corrections.
Step 3: Describe how your coding staff will stay up to date and keep up their coding competencies. Staying on top of changes can be especially vital, whether to the official guidelines, payer requirements or the transition to ICD-10.
Important issue: Right sequencing is always a concern for medical coders. Selecting the most proper diagnosis helps ensure not only that your practice gets its proper payments but that your coding will stand up under scrutiny from auditors. The assessing clinician and the expert coder must work together to ensure the ICD 9 codes are listed as per the seriousness of the patient's condition.
Step 4: Documenting 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 spot on before your mistakes are traced in a costly audit from a ZPIC, RAC, or one of the other auditing entities.
Step 5: Weigh the accuracy of your dermatology coders. Paired with auditing, establishing an accuracy rate for your coders can help set the bar for your commitment for precise coding. If you want your coders to maintain a 95 percent accuracy rate with their coding, include this information in your policy.
Step 6: Keep polices up to date. Do not let your coding policy sit on the shelf and grow dusty. Ensure the effort to check your policy periodically to make sure it's up to date.
Mistake: Do not write policies that attempt to address how you are going to code each particular diagnosis. General policies that address the methods you use to keep your coding spot on are more useful and workable.
Source URL :- http://www.supercoder.com/coding-newsletters/my-ophthalmology-coding-alert/diagnosis-coding-6-steps-pave-the-way-to-audit-hardy-coding-104080-article
Follow up: If you get downcoded in an audit related to your diagnosis codes, gear up to ask for a redetermination. If your coding is supported by clear clinical documentation and you have followed the proper guidance, be prepared to write an appeal stating why the coding is right and quote official guidance in that appeal.
Auditors are not necessarily coders and may not be aware of the rules that govern the practice of coding. Quoting specific sections of the official coding guidelines helps to show that you are knowledgeable and have coded right.
An ICD-9 coding policy can keep your claims flowing smoothly; however you cannot just set it up and forget about it. Here's how to establish a policy that'll remain current and help you avoid headaches when auditors come calling.
Step 1: The first building block of a well-designed coding policy is to indicate that you adhere to the ICD-9-CM official guidelines for coding and reporting. If you don't stay up to date with these standard rules, you could be in for trouble.
For details: The official guidelines are updated each year and are normally available shortly after the annual ICD-9 updates go public.
If you keep up on the rules in the official guidelines, you will not have to worry about being blindsided by any across-the-board ICD-9 coding changes.
Step 2: Establish your coding process, including who does the coding and how you make corrections.
Step 3: Describe how your coding staff will stay up to date and keep up their coding competencies. Staying on top of changes can be especially vital, whether to the official guidelines, payer requirements or the transition to ICD-10.
Important issue: Right sequencing is always a concern for medical coders. Selecting the most proper diagnosis helps ensure not only that your practice gets its proper payments but that your coding will stand up under scrutiny from auditors. The assessing clinician and the expert coder must work together to ensure the ICD 9 codes are listed as per the seriousness of the patient's condition.
Step 4: Documenting 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 spot on before your mistakes are traced in a costly audit from a ZPIC, RAC, or one of the other auditing entities.
Step 5: Weigh the accuracy of your dermatology coders. Paired with auditing, establishing an accuracy rate for your coders can help set the bar for your commitment for precise coding. If you want your coders to maintain a 95 percent accuracy rate with their coding, include this information in your policy.
Step 6: Keep polices up to date. Do not let your coding policy sit on the shelf and grow dusty. Ensure the effort to check your policy periodically to make sure it's up to date.
Mistake: Do not write policies that attempt to address how you are going to code each particular diagnosis. General policies that address the methods you use to keep your coding spot on are more useful and workable.
Source URL :- http://www.supercoder.com/coding-newsletters/my-ophthalmology-coding-alert/diagnosis-coding-6-steps-pave-the-way-to-audit-hardy-coding-104080-article
Follow up: If you get downcoded in an audit related to your diagnosis codes, gear up to ask for a redetermination. If your coding is supported by clear clinical documentation and you have followed the proper guidance, be prepared to write an appeal stating why the coding is right and quote official guidance in that appeal.
Auditors are not necessarily coders and may not be aware of the rules that govern the practice of coding. Quoting specific sections of the official coding guidelines helps to show that you are knowledgeable and have coded right.
Wednesday, December 15, 2010
Question and Answers to Help Code Unna Boot Application
Medically necessary Unna boots, not applied as post-op dressings make use of the CPT 29580
Find out why E/M and strapping cannot go together as separate codes
Are you aware that CCI bundles Unna boot application to many other complete surgeries (for instance tendon sheath injections, joint aspiration/injection, and the like)? If you are confused about this and many other questions about coding Unna boot application, the following questions and answers should throw some light.
Question 1: What's the purpose of Unna Boot?
Answer: The New York Medicare carrier National Government Services LCD L6979 Unna boot as a dressing used to treat varicose ulcers of the lower extremities, which are owing to increased venous pressure, venous insufficiency or capillary dysfunction. It comprises a bandage impregnated with a gelatin, zinc oxide, and glycerin paste that the provider layers on the leg ulcer until the bandage becomes rigid.
According to the LCD, the resulting pressure and bacteriostatic properties aid in healing.
Question 2: Do you get the payments for the supplies with Unna Boot?
Answer: You should not think about Unna boots applied as dressings a separately reimbursable service apart from surgical procedure.
As per CCI, payment for surgical dressings applied by the doctor during his/her encounter with the patient is included in the fee schedule payment for the doctor's service.
Medically necessary Unna boots, not applied as post-op dressings make use of the CPT 29580 (Strapping; Unna boot). Just like that, you should never code for any supplies. Payers include the cost of all Unna boot bandages, straps and paste in their payment for 29580.
But then you should report change in dressings every few days, while the patient is in Unna boot, with 29580, which has a global period of zero days.
Question 3: Can I bill an Evaluation/Management with 29580?
Answer: You may report an Unna boot application with 29580 apart from the proper E/M code only under this situation: The boot application is provided as an initial service with no expectation that the doctor who rendered only the original care will carry out another treatment or procedure.
To put it in other words, if the patient has a new or different complaint that requires a separate and significant E/M service, you may bill a proper E/M code. Do not forget to append with modifier 25.
Reminder: You'd need to attach a separate diagnosis to the E/M service to further distinguish it from the inherent E/M service included in the Unna boot application.
Question 4: What if Doc carried out a debridement also?
Answer: Debridement before applying the Unna boot is a typical procedure that podiatrist performs. You can report debridement during the same session as 29580 only if the services apply to separate anatomical areas (separate feet).
Fact: CCI has bundled column-2 code 29580 into column-1 codes 11040-11044 as a standard of medical/surgical practice. The modifier indicator of 1 allows you to report both procedures separately using modifier 59. For instance, the physician carries out a debridement on the patient's right foot and applies an Unna boot to the left foot.
Question 5: What ICD-9 codes should you use with 29580?
Answer: Depending on the payer, 29580 links to diseases like varicose veins of lower extremities (454.0-454.2) and lower limb ulcers, except decubitus (707.10, 707.12-707.19). Some payers will take additional diagnoses, such as atherosclerosis of extremity with ulceration (440.23) or sprains and strains of the ankle and foot (845.00-845.19). Like always, you should report the diagnosis as per your physician's documentation.
Do: Ensure you check with your payer on current policy or update for the different diagnoses.
Find out why E/M and strapping cannot go together as separate codes
Are you aware that CCI bundles Unna boot application to many other complete surgeries (for instance tendon sheath injections, joint aspiration/injection, and the like)? If you are confused about this and many other questions about coding Unna boot application, the following questions and answers should throw some light.
Question 1: What's the purpose of Unna Boot?
Answer: The New York Medicare carrier National Government Services LCD L6979 Unna boot as a dressing used to treat varicose ulcers of the lower extremities, which are owing to increased venous pressure, venous insufficiency or capillary dysfunction. It comprises a bandage impregnated with a gelatin, zinc oxide, and glycerin paste that the provider layers on the leg ulcer until the bandage becomes rigid.
According to the LCD, the resulting pressure and bacteriostatic properties aid in healing.
Question 2: Do you get the payments for the supplies with Unna Boot?
Answer: You should not think about Unna boots applied as dressings a separately reimbursable service apart from surgical procedure.
As per CCI, payment for surgical dressings applied by the doctor during his/her encounter with the patient is included in the fee schedule payment for the doctor's service.
Medically necessary Unna boots, not applied as post-op dressings make use of the CPT 29580 (Strapping; Unna boot). Just like that, you should never code for any supplies. Payers include the cost of all Unna boot bandages, straps and paste in their payment for 29580.
But then you should report change in dressings every few days, while the patient is in Unna boot, with 29580, which has a global period of zero days.
Question 3: Can I bill an Evaluation/Management with 29580?
Answer: You may report an Unna boot application with 29580 apart from the proper E/M code only under this situation: The boot application is provided as an initial service with no expectation that the doctor who rendered only the original care will carry out another treatment or procedure.
To put it in other words, if the patient has a new or different complaint that requires a separate and significant E/M service, you may bill a proper E/M code. Do not forget to append with modifier 25.
Reminder: You'd need to attach a separate diagnosis to the E/M service to further distinguish it from the inherent E/M service included in the Unna boot application.
Question 4: What if Doc carried out a debridement also?
Answer: Debridement before applying the Unna boot is a typical procedure that podiatrist performs. You can report debridement during the same session as 29580 only if the services apply to separate anatomical areas (separate feet).
Fact: CCI has bundled column-2 code 29580 into column-1 codes 11040-11044 as a standard of medical/surgical practice. The modifier indicator of 1 allows you to report both procedures separately using modifier 59. For instance, the physician carries out a debridement on the patient's right foot and applies an Unna boot to the left foot.
Question 5: What ICD-9 codes should you use with 29580?
Answer: Depending on the payer, 29580 links to diseases like varicose veins of lower extremities (454.0-454.2) and lower limb ulcers, except decubitus (707.10, 707.12-707.19). Some payers will take additional diagnoses, such as atherosclerosis of extremity with ulceration (440.23) or sprains and strains of the ankle and foot (845.00-845.19). Like always, you should report the diagnosis as per your physician's documentation.
Do: Ensure you check with your payer on current policy or update for the different diagnoses.
Tuesday, December 14, 2010
Choose 43255 for control-of-bleeding situations
43255 is a good choice for control-of-bleeding situations
When coding for excessive blood loss, modifier 22 may not be that ally you are looking for. The answer may lie on more proper CPTs such as 43255 and critical care codes. Take cue from these two scenarios:
Think about endoscopy with injection as option
First Scenario: The doctor injects epinephrine into a duodenal ulcer to control active bleeding during endoscopy with biopsy.
Code it: Earlier, you may opt to use 43239 appended with modifier 22 if the physician required significant effort to control the patient's bleeding.
However, the option would need you to submit additional paper documentation to support your modifier 22 claim. In place of submitting yourself to potential hassles, you can accurately describe the session by reporting 43239 for the biopsy and 43255 for the control of bleeding provided that the bleeding was not caused by the biopsy.
As evident from 43255's descriptor, this procedure describes control of bleeding by any method, including injection.
Requirement: On your claim, you should append modifier 59 to 43255, and then report 43239. Omitting the modifier would give payers the feeling that the biopsy (or physician) caused the bleeding and bundle 43255 into 43239.
Extraordinary bleeding will require critical care coding
Second scenario: When the gastroenterologist is about to carry out an upper GI endoscopy, the patient experiences gastrointestinal bleeding so severe that the physician must suspend the endoscopy and spend 40 minutes lavaging blood from gastro-intestinal tract before continuing.
Code it: Here, the critical code 99291 is your best choice.
Here's why? If the gastroenterologist caused the bleeding, you can't bill for the control of bleeding procedure. You should call on control-of- bleeding codes only when treatment is required to control bleeding that takes place spontaneously or as a consequence of traumatic injury (noniatrogenic), and not as a result of another type of operative intervention," states CPT Assistant.
Remember, the time spent at the bedside carrying out services including lavage of gastric blood is not included in the performance of a subsequent endoscopic procedure and is not part of the E&M service that might be carried out on the same day.
Nevertheless, you should not report a critical care code carelessly for an excessive bleeding situation that's not out of the ordinary. Additional time for emergency bedside services less that 30 minutes does not count as billable critical care service. For prolonged critical care services, the doctor should specifically note the amount of time in his notes.
When coding for excessive blood loss, modifier 22 may not be that ally you are looking for. The answer may lie on more proper CPTs such as 43255 and critical care codes. Take cue from these two scenarios:
Think about endoscopy with injection as option
First Scenario: The doctor injects epinephrine into a duodenal ulcer to control active bleeding during endoscopy with biopsy.
Code it: Earlier, you may opt to use 43239 appended with modifier 22 if the physician required significant effort to control the patient's bleeding.
However, the option would need you to submit additional paper documentation to support your modifier 22 claim. In place of submitting yourself to potential hassles, you can accurately describe the session by reporting 43239 for the biopsy and 43255 for the control of bleeding provided that the bleeding was not caused by the biopsy.
As evident from 43255's descriptor, this procedure describes control of bleeding by any method, including injection.
Requirement: On your claim, you should append modifier 59 to 43255, and then report 43239. Omitting the modifier would give payers the feeling that the biopsy (or physician) caused the bleeding and bundle 43255 into 43239.
Extraordinary bleeding will require critical care coding
Second scenario: When the gastroenterologist is about to carry out an upper GI endoscopy, the patient experiences gastrointestinal bleeding so severe that the physician must suspend the endoscopy and spend 40 minutes lavaging blood from gastro-intestinal tract before continuing.
Code it: Here, the critical code 99291 is your best choice.
Here's why? If the gastroenterologist caused the bleeding, you can't bill for the control of bleeding procedure. You should call on control-of- bleeding codes only when treatment is required to control bleeding that takes place spontaneously or as a consequence of traumatic injury (noniatrogenic), and not as a result of another type of operative intervention," states CPT Assistant.
Remember, the time spent at the bedside carrying out services including lavage of gastric blood is not included in the performance of a subsequent endoscopic procedure and is not part of the E&M service that might be carried out on the same day.
Nevertheless, you should not report a critical care code carelessly for an excessive bleeding situation that's not out of the ordinary. Additional time for emergency bedside services less that 30 minutes does not count as billable critical care service. For prolonged critical care services, the doctor should specifically note the amount of time in his notes.
Thursday, December 9, 2010
22551, 22552 Boost Your Arthrodesis Accuracy
CPT 2011 will come up with 200 plus new codes. 22551, 22552 Boost Your Arthrodesis Accuracy
Additional neurostimulator and arthrodesis codes are two of the plusses in the new and revised codes your orthopedic practice will have in the coming year.
As a matter of fact, CPT will come up with 200 plus new codes in 2011 and revise over 90 codes to help keep your coding more specific than ever, spanning a number of specialties, from dermatology to orthopedics to cardiology and beyond.
Make room for extra arthrodesis specificity
Beginning January 1, you'll be required to report arthrodesis procedures that include discectomy, osteophytectomy and spinal cord decompression with two new bundled codes:
22551
22552
Code 22552 is an add-on code; as such, you would report it with 22551 to reflect any additional interspace the neurosurgeon treats below C2. Earlier, this bundled procedure would have been reported as 63075, for the discectomy,osteophytectomy and spinal cord/nerve decompression and 22554-51. This is one of several code pairs which were used together more than 90 percent of the time, prompting CMS to request a bundled code from CPT.
Add more neurostimulator codes
Beginning January 1, you will be able to describe more fully tibial and cranial neurostimulator services with four new codes:
64566, 64568, 64569, 64570
And if your neurosurgeon carries out chemodenervation, you will have a new code to report for work on the salivary glands: 64611
Watch halo, allograft, and vertebral fracture revisions
Do not let code descriptor changes trip you up when you turn to 20664 for halo application as the latest revision removes the phrase “requiring general anesthesia:"
20664 (Revised)
Add-on allograft codes 20930 and 20931 received changes, which will be for the coming year:
20930 (Revised), 20931 (Revised)
The development of many bone graft extenders including demineralized bone matrix and bone morphogenic protein led to frequent questions regarding the right coding for these materials.
The revision of 20930 places these materials in the same category as other non-structural bone extenders that aren't obtained directly from the patient being treated.
Closed vertebral facture code 22315 now omits the phrase “with or without anesthesia": 22315 (Revised).
And code 22851 for application of intervertebral biomechanical devices deletes “threaded bone dowels" from the definition:22851 (Revised).
The rationale: The production of machined allografts led to frequent questions regarding the proper coding for placing these materials. As the machined allografts are bone allograft materials, the right code to describe their use was 20931. But the example of threaded bone dowel in code 22851 led to confusion that prompted removal of this example from 22851, which was intended to describe placement of structural devices composed of non-bony prosthetic material.
Source URL :- http://isupercoder.blogspot.in/2010/12/22551-22552-boost-your-arthrodesis.html
Additional neurostimulator and arthrodesis codes are two of the plusses in the new and revised codes your orthopedic practice will have in the coming year.
As a matter of fact, CPT will come up with 200 plus new codes in 2011 and revise over 90 codes to help keep your coding more specific than ever, spanning a number of specialties, from dermatology to orthopedics to cardiology and beyond.
Make room for extra arthrodesis specificity
Beginning January 1, you'll be required to report arthrodesis procedures that include discectomy, osteophytectomy and spinal cord decompression with two new bundled codes:
Code 22552 is an add-on code; as such, you would report it with 22551 to reflect any additional interspace the neurosurgeon treats below C2. Earlier, this bundled procedure would have been reported as 63075, for the discectomy,osteophytectomy and spinal cord/nerve decompression and 22554-51. This is one of several code pairs which were used together more than 90 percent of the time, prompting CMS to request a bundled code from CPT.
Add more neurostimulator codes
Beginning January 1, you will be able to describe more fully tibial and cranial neurostimulator services with four new codes:
64566, 64568, 64569, 64570
And if your neurosurgeon carries out chemodenervation, you will have a new code to report for work on the salivary glands: 64611
Watch halo, allograft, and vertebral fracture revisions
Do not let code descriptor changes trip you up when you turn to 20664 for halo application as the latest revision removes the phrase “requiring general anesthesia:"
20664 (Revised)
Add-on allograft codes 20930 and 20931 received changes, which will be for the coming year:
20930 (Revised), 20931 (Revised)
The development of many bone graft extenders including demineralized bone matrix and bone morphogenic protein led to frequent questions regarding the right coding for these materials.
The revision of 20930 places these materials in the same category as other non-structural bone extenders that aren't obtained directly from the patient being treated.
Closed vertebral facture code 22315 now omits the phrase “with or without anesthesia": 22315 (Revised).
And code 22851 for application of intervertebral biomechanical devices deletes “threaded bone dowels" from the definition:22851 (Revised).
The rationale: The production of machined allografts led to frequent questions regarding the proper coding for placing these materials. As the machined allografts are bone allograft materials, the right code to describe their use was 20931. But the example of threaded bone dowel in code 22851 led to confusion that prompted removal of this example from 22851, which was intended to describe placement of structural devices composed of non-bony prosthetic material.
Source URL :- http://isupercoder.blogspot.in/2010/12/22551-22552-boost-your-arthrodesis.html
Wednesday, December 8, 2010
Comparison of 2010 and 2011 definitions for 93922-93924
CPT 2011 revises the definitions for 93922-93924. Look how the 2010 and 2011 definitions compare for 93922-93924.
If you have been longing for more details in your noninvasive physiologic code definitions, your wish will be fulfilled in 2011.
CPT 2011 revises the definitions for 93922-93924. Take a look at how the 2010 and 2011 definitions compare for 93922-93924.
93922: Watch changes to number of levels
When looking at the 93922 definitions, notice that the 2010 version refers to ‘single level, while the 2011 version offers several examples that refer to "1-2 levels":
This year: 93922 -- Noninvasive physiologic studies of upper or lower extremity arteries, single level, bilateral (example, ankle/brachial indices, Doppler waveform analysis, volume plethysmography, transcutaneous oxygen tension measurement).
In the coming year: 93922 -- Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (example, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with transcutaneous oxygen tension measurements at 1-2 levels).
93923: Number of levels are the key change once again
One of the changes to watch for 93923 is the switch from "multiple levels" in this year to "3 or more levels" in the coming year:
This year: 93923 -- Noninvasive physiologic studies of upper or lower extremity arteries, multiple levels or with provocative functional maneuvers, complete bilateral study (example, segmental blood pressure measurements, segmental Doppler waveform analysis, segmental volume plethysmography, segmental transcutaneous oxygen tension measurements, measurements with postural provocative tests, measurements with reactive hyperemia)
In the coming year: 93923 -- Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, three or more levels (example for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/ dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional Doppler waveform recording and analysis, at three or more levels, or ankle/ brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental volume plethysmography at three or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at three or more level(s), or single level study with provocative functional maneuvers (example, measurements with postural provocative tests, or measurements with reactive hyperemia).
93924: Improve your understanding of this service
The change to 93924 is the addition of a lot more detail to explain what CPT intends the code to describe:
This year: 93924 -- Non-invasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, complete bilateral study.
In the coming year: 93924 -- Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, (i.e., bidirectional Doppler waveform or volume plethysmography recording and analysis at rest with ankle/ brachial indices immediately after and at timed intervals following performance of a standardized protocol on a motorized treadmill plus recording of time of onset of claudication or other symptoms, maximal walking time, and time to recovery) complete bilateral study.
If you have been longing for more details in your noninvasive physiologic code definitions, your wish will be fulfilled in 2011.
CPT 2011 revises the definitions for 93922-93924. Take a look at how the 2010 and 2011 definitions compare for 93922-93924.
93922: Watch changes to number of levels
When looking at the 93922 definitions, notice that the 2010 version refers to ‘single level, while the 2011 version offers several examples that refer to "1-2 levels":
This year: 93922 -- Noninvasive physiologic studies of upper or lower extremity arteries, single level, bilateral (example, ankle/brachial indices, Doppler waveform analysis, volume plethysmography, transcutaneous oxygen tension measurement).
In the coming year: 93922 -- Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (example, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with transcutaneous oxygen tension measurements at 1-2 levels).
93923: Number of levels are the key change once again
One of the changes to watch for 93923 is the switch from "multiple levels" in this year to "3 or more levels" in the coming year:
This year: 93923 -- Noninvasive physiologic studies of upper or lower extremity arteries, multiple levels or with provocative functional maneuvers, complete bilateral study (example, segmental blood pressure measurements, segmental Doppler waveform analysis, segmental volume plethysmography, segmental transcutaneous oxygen tension measurements, measurements with postural provocative tests, measurements with reactive hyperemia)
In the coming year: 93923 -- Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, three or more levels (example for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/ dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional Doppler waveform recording and analysis, at three or more levels, or ankle/ brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental volume plethysmography at three or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at three or more level(s), or single level study with provocative functional maneuvers (example, measurements with postural provocative tests, or measurements with reactive hyperemia).
93924: Improve your understanding of this service
The change to 93924 is the addition of a lot more detail to explain what CPT intends the code to describe:
This year: 93924 -- Non-invasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, complete bilateral study.
In the coming year: 93924 -- Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, (i.e., bidirectional Doppler waveform or volume plethysmography recording and analysis at rest with ankle/ brachial indices immediately after and at timed intervals following performance of a standardized protocol on a motorized treadmill plus recording of time of onset of claudication or other symptoms, maximal walking time, and time to recovery) complete bilateral study.
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