2012 ICD- 9-CM Codes: Get Four Options for Non-Melanoma Malignant Neoplasm of the Lip

Plus, new codes will make cancer classification easier.

The proposed changes to 2012 ICD-9 codes is out; approved by the ICD-9-CM Coordination and Maintenance Committee, the new, revised and invalid codes were published in the Federal Register on May 5, 2011. After the new codes go into effect on October 1 this year, CMS will add ICD-9 codes on an emergency basis as it gears up to switch over the diagnosis coding system to ICD-10.

Expanded ICD-9 diagnosis code sets: As per the changes, from October 1 this year, dermatology coders will be able to report the location of carcinomas and other neoplasms of the skin more accurately. This time they include an expansion of the 173.x (Other malignant neoplasm of skin) series. Each code in that series will get a list of fifth digits that'll provide specifications on whether the malignant neoplasm is basal cell, squamous cell, or unspecified.

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ICD 9 codes 2011: Right now dermatology coders use 173.0 for any non-melanoma malignant neoplasm of the lip. This will become an invalid code once ICD-9 2012 codes go into effect.

ICD-9 codes 2012: When the ICD-9 2012 goes into effect, coders can choose from four options - 173.00, 173.01, 173.02 and 173.09.

New codes will make cancer classification easier: Normally, majority of skin cancers are either basal or squamous cell, neither of which are reportable conditions to central cancer registries. Due to the difficulty in distinguishing reportable skin cancers from non-reportable skin cancers, the facilities are transmitting skin cancers to central registries. This puts an additional burden on central registries and also ends up in the transmission of confidential patient information on patients whose information shouldn't be reported. The expansion of the category of 173 codes will allow for the differentiation of reportable and non-reportable skin cancer.

ICD-10 codes: We're not sure whether there'll be expanded skin neoplasm codes when coders update their diagnosis codes in 2013 with the new code set. Presently, ICD-10 is likely to include C44.0-C44.9, a code series that does not have the specificity as the soon-to-go-into-effect ICD-9 2012 codes.

HCPCS Level II Codes G0440-G0441 Can be Used for Either Apligraf or Dermagraft

Two G codes - G0440-G0441 - to report your surgeon's work this year.

This year you can turn to two G codes - G0440, G0441 - when your surgeon applies a tissue-cultured skin or dermal substitute for Medicare patients with lower extremity ulcers owing to venous statis or diabetes. This is a welcome change from using the CPT codes for the service, which depend on the type of skin or dermal substitute as follows:

Apligraf -- 15340-+15341

Dermagraft -- 15360-+15361 or 15365-+15366
For most non-Medicare payers, you should continue to use the 15300-series codes.

Cause of concern: General surgeons, podiatrists, plastic surgeons and wound care specialists were worried that Apligraf had a 90-day global period in comparison to Dermagraft, which had a 30-day global period. This lead to a lot of confusion as it caused providers to use one product over another to get financial advantage. But with the new G codes around, not anymore.

Codes G0440-G0441 to the rescue: Codes G0440-G0441 can be used for either Apligraf or Dermagraft. These HCPCS medical codes ( Source "http://www.supercoder.com/hcpcs-codes/" )have a 0 global days and include the site preparation and debridement services.

The just-in codes together with a 0-day global billing period will do away with unequal financial incentives in the selection of products for the treatment of chronic wounds as well as help ensure that physicians make their treatment decisions based solely on clinical advantage.

The road ahead: The Centers for Medicare & Medicaid is working on valuing G0440 and G0441 this year to pave the way for CPT 2012 to offer category III codes to replace the temporary G codes.

Reimbursement Roundup: Modifier PT Helps Your Practice Capture Screening-Turned-Diagnostic Colonoscopy Pay

New modifier became effective Jan. 1 -- here's how you'll report it.

The question of how to code a screening colonoscopy that becomes diagnostic during the course of the procedure -- and whether the patient's deductible applies -- has long puzzled some practices, but a new Medicare modifier solves that problem. Learn how modifier PT (CRC screening test converted to diagnostic test or other procedure) can solve your colonoscopy reimbursement woes.

Get to Know Modifier PT Basics

Effective Jan. 1, Medicare carriers accept new modifier PT to explain when your physician starts a screening colonoscopy that then becomes a diagnostic procedure.

"This tells the MAC contractor that the service started as a screening procedure (e.g. G0105 [Colorectal cancer screening; colonoscopy on individual at high risk], G0121 [Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk]) but an abnormality was found and the procedure became diagnostic or therapeutic," says Joel V. Brill, MD, AGAF, CHCQM, American Gastroenterological Association, AMA/Specialty Society Relative Value Update Committee (RUC) Advisory Committee Member.

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When appended to your procedure code, "the modifier will indicate to Medicare to waive the deductible for a diagnostic procedure," says Christine Ross, CPC, with Digestive Healthcare Center in Hillsborough, N.J.

Why the change? Practices needed a way to tell MACs that their procedures started out as screening services but changed to diagnostic but didn't want patients subjected to deductibles for these services. "The Affordable Care Act waives the Part B deductible for colorectal cancer screening tests that become diagnostic," CMS noted in MLN Matters article MM7012, which announced the new modifier PT (www.cms.gov/MLNMattersArticles/downloads/MM7012.pdf).

Avoid Reporting G Code With Modifier PT

Once the physician indicates that the screening procedure has turned diagnostic, you'll bill only the diagnostic colonoscopy code, and not the screening code (G0104-G0106, G0120-G0121). Not only is this correct coding, but it's also the only way you can use modifier PT.

The MLN Matters article notes that modifier PT should only be appended to a CPT code in the surgical range of 10000 to 69999. Therefore, you should not append modifier PT to a G code, says Brill, who represents the American Gastroenterological Association on the CPT Editorial Panel.

Under ICD-10-CM, Obstructive Sleep Apnea Gets a New Code - G47.33

As the October 1, 2013 ICD-10 deadline approaches, it's very important that you have a sound ICD-10 coding know how. If you are an otolaryngology coder, here are some ICD-10 guidelines that'll stand you in good stead.

Obstructive sleep apnea: Snoring, restless sleep, etc are manifestations of sleep-disordered breathing. The main disorders that may need surgical intervention are snoring and obstructive sleep apnea (OSA). In obstructive sleep apnea, pauses in breathing (more than 10 seconds at a time) take place because the airway becomes narrowed, blocked or floppy. This disorder may differ in severity and is normally associated with other physiologic problems.

Ways to diagnose OSA? An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck, many a time using a fiberoptic scope. Under ICD-9-CM code set, if the patient was diagnosed with obstructive sleep apnea, you would go for 327.23 (obstructive sleep apnea –adult – pediatric).

Transition from ICD-9 to ICD-10 codes : However, after the transition to ICD-10 on October 1, 2013, you would not report 327.23 for OSA as 327.23 becomes G47.33. This change will offer no difference; as a matter of fact, the descriptor of the new code is a carbon copy depiction of the previous code set's 327.23.

Documentation: While diagnosing a sleep disorder like obstructive sleep apnea, a physician may have the patient fill out a questionnaire to get information on wake-sleep patterns. Blood tests may also be ordered to rule out other conditions. If the physician suspects a sleep disorder, the patient would most probably undergo a polysomnography to record breathing and brain and muscle during sleep. Depending on the specific type of disorder, treatment will be provided.

Medical Billing: PMFSH Tips to help you Stay Away From Denials

If you're not billing higher level evaluation & management services because your physician glosses over a patient's PMFSH, you could be missing out on your reimbursements.

Here are some medical billing tips to ensure your physician is capturing and you are recognizing every history component the patient points out:

First, find out the PMFSH level – none, pertinent and complete

For medical coding and billing ( Source "http://www.supercoder.com") purposes, the history part of an evaluation & management service needs these three elements – history of present illness (HPI), review of systems (ROS), and past medical, family and social history (PMFSH). As such, the PMFSH helps determine patient history level, which has a huge impact on the evaluation & management level you report. Not knowing the PMFSH level will mean you'll not be able to decide which level of evaluation & management code you should report on the claim.

Second, zoom in on a code based on the PMFSH Element Requirement

After you determine the level of PMFSH contained in your physician's documentation, you can see which codes that history element supports.

Note of caution: If your physician doesn't document any PMFSH elements, you can only reach an extended problem-focused level of history; this means the highest codes you will be able to report are a level-two new patient code or a three-level established patient code. In order to get a level-four and level five new patient visits and level-five established patient visits, it's essential to have an all-encompassing level of history.

Third, do not neglect these areas

As per evaluation & management guidelines, if a patient's past medical, family and social history has not changed since a prior visit, your physician need not document the information once more. However, it's important that he documents that he reviewed the prior information in order to ensure it's up to date and also note in the present encounter's documentation on the date and place of the initial prior acquisition of the PMFSH. In fact if you neglect any of these criteria, some payers will give no PMFSH credit.

Part B Revenue Booster: Say Goodbye to X-Ray Denials With These Simple Tips

Palmetto providers: Add this 'history of' code to the list of covered conditions.

If you provide X-ray services, consider this: A chest X-ray's global fee is only $25 or so. Multiply that $25 by the number of services you perform, however, and you'll quickly see how getting these claims right is important to your practice's financial health.

Below, you'll find essential information for 71010 (Radiologic examination, chest; single view, frontal) and 71020 (Radiologic examination, chest, 2 views, frontal and lateral), including example services, typical supporting diagnosis codes, and advice on avoiding the most common causes of audit-related denials.

A tip to start: Codes 71010 and 71020 have separate professional and technical components under the Medicare physician fee schedule. So if you're reporting only the professional service, you should append modifier 26 (Professional component). To report the technical component only, append TC (Technical component). If you're reporting the global service (both professional and technical components), you shouldn't append modifier 26 or TC.

Boost Your X-Ray Skills by Understanding Views

The key element distinguishing 71010 from 71020 is that the first represents a single "frontal" view and the second represents two views, "frontal and lateral."

71010: The documentation for a 71010 service may refer to an "AP view," says Alice Wonderchek, CPC, billing and coding specialist with Ohio-based Radisphere National Radiology Group. AP stands for anteriorposterior, meaning the X-rays pass from the anterior (front) to the posterior (back) of the patient.

You also may see reference to a "PA view" (posterioranterior), in which the X-rays pass from the back to the front of the patient. The AP view can be more difficult to interpret than a PA view because of quality issues andthe way the heart appears enlarged on an AP view. As a result, the PA view usually is preferred over the AP view.

You typically will see an AP view when the patient cannot stand for the imaging service. As a result, another term you'll often see connected to 71010 services is "portable," meaning the tech takes the X-ray using a portable machine. You may see this particularly for services performed at bedside, Wonderchek says.

Example: A patient exhibits decreased breath sounds and low oxygen levels. The physician orders a portable AP chest X-ray to be performed at the patient's bedside. You should report 71010 for the single-view X-ray.

71020: You may see a 71020 service referred to as a "PA & Lat," Wonderchek says. The abbreviation refers to the PA (posterior-anterior) view and the Lat (lateral) view. Lateral means "side." Generally, the tech will take a left lateral X-ray, meaning the patient's left side is closer to the film than the right side is. But the physician may ask for a right lateral X-ray instead.

Example: A patient with a history of lung cancer presents complaining of fever and shortness of breath. Her physician orders PA and lateral X-ray imaging. This service merits code 71020.

Whittle Down the List of Likely Diagnoses

Physicians order chest X-rays for a wide variety of reasons. The potential exam findings also add up to a long list. Consequently, there are many ICD-9 codes that may apply to a chest X-ray claim.

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Pediatric Coding: Be Well-Versed With Prolonged Service Code

When you are thinking about prolonged service codes 99358-99359 for your evaluation and management (E/M) services, you'll come face to face with yet another common pediatric coding challenge. Since last year, you have been able to count indirect prolonged service time that takes place around the date of the E/M service.

As per the previous definition (year 2009 and before), the non-face-to-face service had to be the day of the evaluation and management visit. But then since the first day of last year, you simply have to prove that the time was 'related' to the evaluation & management service.

Word of caution: Prolonged service codes 99358 and +99359 still have to relate to an E/M service that involves patient contact.

As per the revised notes, the prolonged service must related to a service or patient where direct patient care has taken place or will occur and relate to ongoing patient management. According to CPT, there are no timeframe on the time that can elapse between the primary service and the prolonged prior to and after direct patient care service.

If you are tending to a complex child, the loosening of the prolonged non-face-to-face service codes has been a great help. You can assess the patient's chart and make phone calls prior to and after seeing the patient and count that time. You need a minimum of 30 minutes to bill the first hour of prolonged non-face-to-face care.

What if you are using electronic billing? If so, you may miss the opportunity to add 'related' prolonged service tomes to your claims. With electronic billing, the encounter is sent directly to the front office and the bill is sent out then and there.

What you need to do: You have to work with the practice management staff to ensure that you are holding the claim until all of the extra work related to the E/M visit is done and you are holding the claim until all of the additional work related to that E/M visit is finished and documented.