This year (2011), see to it that you stay away from frequency trap.
Think of a situation where your general surgeon carries out a procedure on a patient who is scheduled and prepared for a total colonoscopy. During the procedure, the physician finds out that owing to unforseen circumstance, he cannot advance the colonoscope beyond the splenic flexure. How should you go about this situation?
Here's what you need to do
You should use the colonoscopy code 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) with the proper modifier -- but then which modifier?
Disparate instructions lead to a lot of confusion
For the incomplete colonoscopy scenario, previous editions of CPT instructed you to use modifier 52 (reduced services) to 45378. On the other hand, the Center for Medicare and Medicaid (CMS) instructed you to go for modifier 53 (Discontinued procedure).
Rationale: The agency advised that you use modifier 53 in order to overcome a frequency edit trap. If after coding 45378-52, you had to go back and do a colonoscopy that you coded 45378, you would not get the payments because of the frequency edits.
Here's what you should know
CPT 2011 changes the text note so that it now instructs providers to report an incomplete colonoscopy with modifier 53 and the proper documentation.
Thursday, February 3, 2011
Wednesday, February 2, 2011
Gear Up With K Codes for Gerd In 2013
When coding for a motility manometric study that discovers esophageal reflux, you would most probably opt for 530.81 (Diseases of esophagus; other specified disorders of esophagus; esophageal reflux) to describe a diagnosis for the test claim.
As we all know, ICD-9 becomes ICD-10 in a couple of years' time (2013). When that happens, you will have to shift to coding either K21.0 (Gastro-esophageal reflux disease with esophagitis) or K21.9 (Gastro-esophageal reflux disease with no esophagitis) for the diagnosis.
ICD difference: When ICD-10 goes into effect on October 1, 2013, 530.81 will expand into two codes K21.0 and K21.9. The ICD-10 code specifically defines gastro-esophageal reflux disease (GERD) and indicates the presence or nonpresence of esophagitis.
Physician documentation: Notice the difference between K21.0 and K21.9, which depends on whether the test revealed that the patient has esophagitis. You should be on the lookout for any mention of this in the notes of your physician.
But then, remember that esophagitis is a visible or histologic finding that cannot be concluded without an endoscopic exam. You might be able to select other appropriate codes from ICD-10 for patients that have had endoscopy.
Tips for medical coders: In ICD-9 codes, GERD is coded 530.81, but in ICD-10 more details are called for. The user needs more information such as whether the GERD is with or without esophagitis.
ICD difference: When ICD-10 goes into effect on October 1, 2013, 530.81 will expand into two codes K21.0 and K21.9. The ICD-10 code specifically defines gastro-esophageal reflux disease (GERD) and indicates the presence or nonpresence of esophagitis.
Physician documentation: Notice the difference between K21.0 and K21.9, which depends on whether the test revealed that the patient has esophagitis. You should be on the lookout for any mention of this in the notes of your physician.
But then, remember that esophagitis is a visible or histologic finding that cannot be concluded without an endoscopic exam. You might be able to select other appropriate codes from ICD-10 for patients that have had endoscopy.
Tips for medical coders: In ICD-9 codes, GERD is coded 530.81, but in ICD-10 more details are called for. The user needs more information such as whether the GERD is with or without esophagitis.
96446 Joins CCI Edits 17.0 along With Many Others
Last month saw new CPT codes and CCI physician edits from CMS for those codes. The latest CCI edits have 19,822 new edit pairs which have been added while 9,778 have been terminated, for a net gain of 10,044 new edit pairs.
The main CCI edits you want to be sure to watch for are those related to new code 96446.
Note where 96446 falls (Col. 1/Col. 2) for non-mutually exclusive (NME edits)
The 96446 NME edits are largely what you'd expect based on other chemotherapy code edits – bundles with E/M, anesthesia, venipuncture and other vascular procedures, for instance. You want to be sure to watch which is the column 1 code and which is the column 2 code for these bundles.
For example: CCI places E/M codes 99217-99239 in the column 1 position and 96446 in the column 2 position. On the contrary, CCI places 96446 in the column 1 position and E/M codes 99201-99215 in the column 2 position.
Remember that if you report both codes in an NME edit pair without a modifier, Medicare (as well as payers who adopt these edits) will deny the column 2 code and pay you only for the column 1 code.
79200 edit reminds you to check ME edits as well
CCI Edit also created an ME edit for 96446. ME procedures cannot reasonably be performed at the same anatomic site or patient encounter. The edit places 96446 in column 1 and in column 2 is 79200. This edit also has a modifier indicator of 1; as such you may override the edit with a modifier when clinically appropriate, such as in the case of distinct separately identifiable encounters.
Note where 96446 falls (Col. 1/Col. 2) for non-mutually exclusive (NME edits)
The 96446 NME edits are largely what you'd expect based on other chemotherapy code edits – bundles with E/M, anesthesia, venipuncture and other vascular procedures, for instance. You want to be sure to watch which is the column 1 code and which is the column 2 code for these bundles.
For example: CCI places E/M codes 99217-99239 in the column 1 position and 96446 in the column 2 position. On the contrary, CCI places 96446 in the column 1 position and E/M codes 99201-99215 in the column 2 position.
Remember that if you report both codes in an NME edit pair without a modifier, Medicare (as well as payers who adopt these edits) will deny the column 2 code and pay you only for the column 1 code.
79200 edit reminds you to check ME edits as well
CCI Edit also created an ME edit for 96446. ME procedures cannot reasonably be performed at the same anatomic site or patient encounter. The edit places 96446 in column 1 and in column 2 is 79200. This edit also has a modifier indicator of 1; as such you may override the edit with a modifier when clinically appropriate, such as in the case of distinct separately identifiable encounters.
Modifier 62: Ease Your Multi-Provider Coding Confusion
When you come face-to-face with multi-provider situation, the last thing you would want is to mess up your coding by assigning the wrong modifier(s). As such, you really need to know how to assign the proper modifiers.
Here's a scenario: A 70-year-old female patient who presents with COPD and coronary artery disease, status post myocardial infarction (CAD s/p MI) has a 28 mm of inner diameter thoracic aortic aneurysm. Imaging studies indicate the aneurysm to be descending. The cardiologist teams up with a thoracic surgeon and decides to perform an open operative repair with graft replacement of the diseased segment.
The key in a multi-provider scenario is to treat each physician's work as a separate activity. But then, deciding when to report a case as co-surgery, assistant surgery -- or something else -- has more to it than meets the eye. Here are some expert advice:
Modifier 62, 81, 82
In this situation, a modifier is at hand; but then, more importantly you should be able to tell what role each modifier plays so that your procedure codes blend well together. Take a look at these common modifiers used in multi-provider situations:
The key in a multi-provider scenario is to treat each physician's work as a separate activity. But then, deciding when to report a case as co-surgery, assistant surgery -- or something else -- has more to it than meets the eye. Here are some expert advice:
Modifier 62, 81, 82
In this situation, a modifier is at hand; but then, more importantly you should be able to tell what role each modifier plays so that your procedure codes blend well together. Take a look at these common modifiers used in multi-provider situations:
Modifier 62 (Two surgeons). Use this modifier to each surgeon's procedure when the physicians perform distinct, separate portions of the same procedure. Also called co-surgery, modifier 62 applies when the skill of two surgeons (normally of different skills) is called for in the management of a special surgical procedure.
Opt between modifier 80 (Assistant surgeon), modifier 81 (minimum assistant surgeon), and modifier 82 (Assistant surgeon [when qualified resident surgeon not available]) when one surgeon aids the other with multiple portions of the case rather than completing his work independently. What to look for? Ensure your physician indicates in his documentation that he is working with an assistant surgeon, what the assistant surgeon did, and why he or she was used during the case.
When you report a nonphysician practitioner's (NPP's) involvement to Medicare, attach modifier AS (Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery).
But remember that not all payers recognize modifier AS. You should verify the proper way to report the NPP's service before completing your claim.
Stay away from the modifier 51 trap
When you are coding for multiple procedures during the same operative session, it is easy to fall into the lure of using modifier 51 (Multiple procedures). However you could end up in the gutters if you are not careful enough.
Here's why: Modifier 51 tells you that a surgeon was present carrying out multiple procedures. If a surgeon is not present physically for multiple procedures in a surgical case, it is not proper to indicate that he was busy using modifier 51.
Two surgeons require two echo claims
In the given scenario, both surgeons should bill 33880. (Then, you'd use 441.2 (Thoracic aneurysm without mention of rupture) with 33880 to describe the condition. Finally, you should use modifier 62 to 33880 to show that two surgeons performed the repair.
Catch: You do not use modifier 62 if the physicians are not reporting the same CPT code(source"http://www.supercoder.com/cpt-codes"). If each doctor can represent his work with a separate CPT code, leave out modifier 62. Ensure both surgeons send a claim with the same code and modifier declared or you would end up throwing away about $4,000 in reimbursements (56.62 RVUs multiplied by 2011 conversion factor of 33.9764; $1,923.74 for each surgeon).
But remember that not all payers recognize modifier AS. You should verify the proper way to report the NPP's service before completing your claim.
Stay away from the modifier 51 trap
When you are coding for multiple procedures during the same operative session, it is easy to fall into the lure of using modifier 51 (Multiple procedures). However you could end up in the gutters if you are not careful enough.
Here's why: Modifier 51 tells you that a surgeon was present carrying out multiple procedures. If a surgeon is not present physically for multiple procedures in a surgical case, it is not proper to indicate that he was busy using modifier 51.
Two surgeons require two echo claims
In the given scenario, both surgeons should bill 33880. (Then, you'd use 441.2 (Thoracic aneurysm without mention of rupture) with 33880 to describe the condition. Finally, you should use modifier 62 to 33880 to show that two surgeons performed the repair.
Catch: You do not use modifier 62 if the physicians are not reporting the same CPT code(source"http://www.supercoder.com/cpt-codes"). If each doctor can represent his work with a separate CPT code, leave out modifier 62. Ensure both surgeons send a claim with the same code and modifier declared or you would end up throwing away about $4,000 in reimbursements (56.62 RVUs multiplied by 2011 conversion factor of 33.9764; $1,923.74 for each surgeon).
Tuesday, February 1, 2011
2011 Conversion Factor Will Stand at $33.9764
Recently, President Obama may have locked in a zero percent adjustment to your Medicare Part B payments, however that does not mean your ortho practice should be calculating your fees using last year's rates. As a matter of fact, the 2011 conversion factor is slightly lower this year than what you were collecting last year, according to an 'Emergency update' to the 2011 Fee Schedule that CMS issued on Dec. 30.
However the good news is that your payments should not drop.
Your 2011 conversion factor will stand at $33.9764, a net reduction of 7.86 percent from the 2010 conversion factor of 36.8729.
The Medicare and Medicaid Extenders Act of 2010, which was signed into law on December 15, established a payment update for 2011 of zero percent. In order to cover the cost of the legislation, Medicare has to modify provisions in the proposed 2011 Medicare Physician Fee Schedule final rule, which altered some of the RVUs, as well as the conversion factor. But then as the conversion factor went down, most of the RVUs went up, ensuring that you should not notice any payment woes over the changes.
Article source :- http://isupercoder.blogspot.in/2011/02/2011-conversion-factor-will-stand-at.html
For example, the RVUs for outpatient E/M code 99212 will change from the 2010 rate of 1.08 to a higher rate of 1.22 this year. Multiplied by the conversion factors for their respective years, the payment for 99212 this year will still be higher than it was last year, despite this year's low conversion factor (2010 payment was around $39.82 compared to the 2011 payment of approximately $41.45).
However the good news is that your payments should not drop.
Your 2011 conversion factor will stand at $33.9764, a net reduction of 7.86 percent from the 2010 conversion factor of 36.8729.
The Medicare and Medicaid Extenders Act of 2010, which was signed into law on December 15, established a payment update for 2011 of zero percent. In order to cover the cost of the legislation, Medicare has to modify provisions in the proposed 2011 Medicare Physician Fee Schedule final rule, which altered some of the RVUs, as well as the conversion factor. But then as the conversion factor went down, most of the RVUs went up, ensuring that you should not notice any payment woes over the changes.
Article source :- http://isupercoder.blogspot.in/2011/02/2011-conversion-factor-will-stand-at.html
For example, the RVUs for outpatient E/M code 99212 will change from the 2010 rate of 1.08 to a higher rate of 1.22 this year. Multiplied by the conversion factors for their respective years, the payment for 99212 this year will still be higher than it was last year, despite this year's low conversion factor (2010 payment was around $39.82 compared to the 2011 payment of approximately $41.45).
Count Post-Op Brace Fitting and Education Separate?
Is it feasible that my physician bill for a fitting and education of a brace during the postoperative period for an anterior cruciate ligament (ACL) surgery? I found 97760, but can I use this separately or is it considered a part of the ACL surgery's global period?
Answer: The CCI edits do not bundle 97760 (Orthotic[s] management and training [including assessent and fitting when not otherwise reported], upper extremity[s], lower extremity[s] and/or trunk, each 15 minutes) into any of the ACL repair codes, for instance, 27407 (Repair, primary, torn ligament and/or capsule, knee; cruciate). However, this does not automatically mean you can report 97760 in the situation outlined in the question above.
As per the December 2005 CPT Assistant, 97760 includes the provider's time associated with determining the proper orthotic design in relation to the patient's skin integrity, sensibility and healing of tissues with or without surgical repair.(for example static versus dynamic, pre-fabricated versus custom designed, choice of materials such as thermoplastic, pulleys, and elastic tendon). The code also includes the fitting of the orthotic, training in use, care and wearing time of the orthotic, and brief instructions in exercises that are to be carried out while the orthotic is in place."
When settling on whether to report 97760, examine your physician's documentation to ensure he has noted each of these decision-making processes. Most national and local Medicare coverage determinations note that physical therapists report this code most often and this service should take no longer than 30 minutes. As a result, you might run into frequency edits if you attempt to report more than two units of 97760.
Article Source :- http://www.supercoder.com/coding-newsletters/my-orthopedic-coding-alert/you-be-the-coder-97760-count-post-op-brace-fitting-and-education-separate-article
Answer: The CCI edits do not bundle 97760 (Orthotic[s] management and training [including assessent and fitting when not otherwise reported], upper extremity[s], lower extremity[s] and/or trunk, each 15 minutes) into any of the ACL repair codes, for instance, 27407 (Repair, primary, torn ligament and/or capsule, knee; cruciate). However, this does not automatically mean you can report 97760 in the situation outlined in the question above.
As per the December 2005 CPT Assistant, 97760 includes the provider's time associated with determining the proper orthotic design in relation to the patient's skin integrity, sensibility and healing of tissues with or without surgical repair.(for example static versus dynamic, pre-fabricated versus custom designed, choice of materials such as thermoplastic, pulleys, and elastic tendon). The code also includes the fitting of the orthotic, training in use, care and wearing time of the orthotic, and brief instructions in exercises that are to be carried out while the orthotic is in place."
When settling on whether to report 97760, examine your physician's documentation to ensure he has noted each of these decision-making processes. Most national and local Medicare coverage determinations note that physical therapists report this code most often and this service should take no longer than 30 minutes. As a result, you might run into frequency edits if you attempt to report more than two units of 97760.
Article Source :- http://www.supercoder.com/coding-newsletters/my-orthopedic-coding-alert/you-be-the-coder-97760-count-post-op-brace-fitting-and-education-separate-article
Post ICD-10, Osteoarthritis Will Require Heightened Documentation
In 2013, as we all know, ICD-9 will become ICD-10. After this, you'll not always have a simple one-to-one relationship between old codes and the new ones. often, you will have more options that may need tweaking the way your doctor documents a service and a coder reports it.
Read on for some common osteoarthrosis diagnoses that will help you find out what you will report post October 1, 2013.
Normally a patient with osteoarthritis might start with his primary care physician, who then refers him to a rheumatologist. The rheumatologist has been tending to the patient with conservative measures such as NSAIDS (nonsteroidal anti-inflammatory drugs). Owing to increasing symptoms, now poorly controlled by the use of NSAIDS, the rheumatologist requests an orthopedic consultation. He diagnoses osteoarthrosis(715.xx-716. xx) and these codes specify location, primary, or secondary.
ICD-10 difference: For these codes, you should look at the following:
M15 (Polyosteoarthritis)
M16 (Osteoarthritis of hip)
M17 (Osteorthritis of knee)
M18 (Osteoarthritis of first carpometacarpal joint)
Read on for some common osteoarthrosis diagnoses that will help you find out what you will report post October 1, 2013.
Normally a patient with osteoarthritis might start with his primary care physician, who then refers him to a rheumatologist. The rheumatologist has been tending to the patient with conservative measures such as NSAIDS (nonsteroidal anti-inflammatory drugs). Owing to increasing symptoms, now poorly controlled by the use of NSAIDS, the rheumatologist requests an orthopedic consultation. He diagnoses osteoarthrosis(715.xx-716. xx) and these codes specify location, primary, or secondary.
ICD-10 difference: For these codes, you should look at the following:
M19 (Other and unspecified osteoarthritis).
Just like ICD-9 codes, these codes are broken down into location, primary and secondary. However they also sometimes specify unilateral, bilateral and post-traumatic indications.
Documentation: In order to submit the most detailed diagnosis, the orthopedic physician will need to maintain osteoarthrosis documentation but expand it to unilateral, bilateral, and/or post-traumatic specification. Some important terms are "oestoarthritis," "arthritis," "athrosis," "DJD," "arhtorpathy," "post traumatic arthritis," and "traumatic arthritis."
Tips for coders: See how codes M19.01--M19.93 entail unspecified locations. Now ICD-10 code(http://www.supercoder.com/coding-newsletters/icd-10-coding-alert)
does not group unspecified locations alongside the specific locations for each type (as in, the familiar .9 code in most ICD-9 codes categories). You'll find them at the end of the code grouping (M19.90--"M19.93) for each specific type but in an unspecified location.
That apart, traumatic osteoarthritis is now more appropriately indexed and described as post-traumatic osteoarthritis, the true condition.
Just like ICD-9 codes, these codes are broken down into location, primary and secondary. However they also sometimes specify unilateral, bilateral and post-traumatic indications.
Documentation: In order to submit the most detailed diagnosis, the orthopedic physician will need to maintain osteoarthrosis documentation but expand it to unilateral, bilateral, and/or post-traumatic specification. Some important terms are "oestoarthritis," "arthritis," "athrosis," "DJD," "arhtorpathy," "post traumatic arthritis," and "traumatic arthritis."
Tips for coders: See how codes M19.01--M19.93 entail unspecified locations. Now ICD-10 code(http://www.supercoder.com/coding-newsletters/icd-10-coding-alert)
does not group unspecified locations alongside the specific locations for each type (as in, the familiar .9 code in most ICD-9 codes categories). You'll find them at the end of the code grouping (M19.90--"M19.93) for each specific type but in an unspecified location.
That apart, traumatic osteoarthritis is now more appropriately indexed and described as post-traumatic osteoarthritis, the true condition.
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