Burn Treatments: 16000-16030 May Not Tell Entire Burn Treatment Story

There's more to the procedures than dressing, debridement -- sometimes almost $900 more.

If you're reporting 16000-16036 codes, you might be forfeiting pay -- nearly $900 -- for separately reimbursable procedures, because procedures such as skin grafts are not included in these codes. Our coding experts offer these three tips for improving your burn treatment reimbursement.

Tip 1: Size Determines Anesthesia Code Choice

If the doctor only derides a burn, you should select an initial treatment code from the 16000-16030 series.

Here's why: Select 16000 (Initial treatment, first-degree burn, when no more than local treatment is required) when the physician tends to a first-degree burn only (burns affecting only the epidermis).

For more extensive burns, you must choose among codes 16020 (Dressings and/or debridement of partial-thickness burns, initial or subsequent; small [less than 5% total body surface area]), 16025 (… medium [e.g., whole face or whole extremity, or 5% to 10% total body surface area]), or 16030 (... large [e.g., more than 1 extremity, or greater than 10% total body surface area]).

Don't miss: To find the percentage of involved skin, use the “Rule of Nines," says Pamela Biffle, CPC, CPC-P, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas. According to the rule:

head and neck, the right arm, and the left arm each equal 9 percent

the back trunk, front trunk, left leg, and right leg each equal 18 percent (the front and back trunk are divided into upper and lower segments, and each leg is divided into back and front segments, each equaling 9 percent)

genitalia equals 1 percent.

Select the treatment code based on that percentage, says Biffle.

One more thing: Make sure the dermatologist clearly states the size of the affected area(s) in the documentation to support any code selection.

Tip 2: Claim Skin Grafts When Applicable

Codes 16000-16036 describe treatment of the burn surface only, so you may report skin grafts if the physician performs them. You should select the appropriate skin graft code(s) from the 15040-15431 portion of CPT-- not doing so could undermine your reimbursement and cause your practice to lose well-deserved pay.

Example: The doctor treats a patient with third-degree burns on the left arm. He uses a free, full-thickness graft of 40 sq cm to close the wound.

Article Source :- http://www.supercoder.com/coding-newsletters/my-dermatology-coding-alert/burn-treatments-16000-16030-may-not-tell-entire-burn-treatment-story-107505-article

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

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

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

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

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

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

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

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

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

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

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

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

Diagnosis Coding Quiz: Are Your DX Coding Skills Up to Snuff? Take This Quick Quiz to Find Out

Hint: Coders shouldn't be interpreting test results to get quick diagnosis codes.

As your practice continues to prepare for the ICD-10 transition, it's important to still remain up-to-date on the ICD-9 coding rules, which remain in effect until Oct. 1, 2013. Read the following diagnosis coding questions submitted by our readers and check out our expert answers below.

Leave Diagnosing Patients to the Doctor

Question 1: If the physician hasn't indicated ECG results in his final diagnosis, should I code the findings? The doctor wrote a complete interpretation on the strip. He says "yes," because usually he has another diagnosis to justify the ECG.

Answer 1: The bottom line is if the test is positive, you should report the findings from the electrocardiogram (ECG) as the final diagnosis. If the test is negative, you should report the indications. For you to report positive findings from the ECG, the physician must document the findings as a final diagnosis. Choosing a diagnosis based on the patient's test results -- even when that diagnosis seems obvious-- is inappropriate and possibly fraudulent coding. CMS describes its guidelines for this issue in Transmittal AB-01-144 (Sept. 26, 2001) in which the agency states that a physician must confirm a diagnosis based on the test results.

This CMS transmittal goes on to say that if the test results are normal or nondiagnostic, you should code the signs or symptoms that prompted the test -- in other words, the indications. Similarly, the ICD-9 coding guidelines for diagnostic testing instruct you not to "interpret" what a study says, but rather to rely on the physician's stated diagnosis. If the ECG findings seem like an important component of the case -- and may play a role in substantiating the medical necessity for the visit-- you should query the physician regarding the diagnosis.

Heads up: Choose the CPT ECG code based on how much of the ECG service the physician's office provided. If the physician's office provided the entire service (both technical and professional components), assign 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report).

Code the technical component only as 93005 ( tracing only, withoutinterpretation and report). If the physician provided only the professional component, use 93010 ( interpretation and report only).

Don't Let Diabetes Dx Trip Up Your Claims

Question 2: Our physician treated a patient with diabetes, but he was actually seeing the patient to treat a complication of the diabetes, diabetic neuropathy. During his evaluation, the physician also noted that the patient had joint inflammation. Should we report the neuropathy complication only, or several of the ICD-9 codes?

Source URL :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/diagnosis-coding-quiz-are-your-dx-coding-skills-up-to-snuff-take-this-quick-quiz-to-find-out-107415-article

ICD-10 Updates: Combination Code for Coronary Atherosclerosis With Angina Pectoris

In a couple of years' time, when you start using ICD-10 codes, watch out for a combination code that covers more than one diagnosis.

For the uninitiated, atherosclerosis is a type of arteriosclerosis characterized by fatty plague deposits that restricts the blood flow through the arteries. Angina pectoris refers to chest pain or discomfort caused by coronary heart disease.

When you report coronary arteriosclerosis in ICD-10-CM, you will notice some differences from the present ICD-9-CM coding. As already mentioned, when you hop into the ICD-10 bandwagon, you should be ready for a combination code that covers more than one diagnosis:

ICD-10 combines your coding for native coronary atherosclerosis and angina pectoris.

Under ICD-9-CM, you use 414.01, coronary atherosclerosis of native coronary artery

Under ICD-10-CM , you will use I25.10, I25.110, I25.111, I25.118, and I25.119.

So what's different between the two code sets: The main change ICD-10 will bring is that they differ based on 'without' (I25.10) and "with" (I25.11-) angina pectoris.

ICD-10 rules, just like its predecessor ICD-9, indicate you should report an additional code (I25.82) if the patient also suffers from chronic total occlusion of a coronary artery. To add to it, if the patient has coronary atherosclerosis because of lipid rich plague, you should go for I25.83. For codes in the range for ischemic heart diseases (I20- I25), you should go for an additional code to identify presence of hypertension (I10-I15).

Clinicians should know that the presence of angina pectoris will alter your native coronary artery disease coding. While documenting, they should be specific about whether the angina pectoris is unstable, with documented spasm or for that matter another form. Documentation should also point to whether the patient has chronic hypertension, total coronary occlusion, and/or coronary atherosclerosis caused by lipid rich plaque.

Tips for coders: Modify coding tools; bear in mind that ICD-10 offers a combination code for coronary atherosclerosis with angina pectoris.

Source Code :- http://www.supercoder.com

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

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

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

Now you will have more choices for lip neoplasm and glaucoma

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

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

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

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

539.01-538.89

629.31

726.13

518.81, 518.83, 518.84, 518.51

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


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

Medicare fee schedule: CMS to expand the potentially misvalued code initiative

According to CMS, the total payments under the Medicare Physician Fee Schedule (MPFS) in CY 2012 will be $80 billion.

In an effort to ensure Medicare is paying appropriately for physician services and more closely managing the payment system, the agency is expanding the potentially misvalued code initiative, a July 1 CMS press release notes.

In 2011, the agency is focusing on the highest volume and dollar codes billed by physicians to find out whether these codes are overvalued and if E/M codes are undervalued. Prior to this, the agency targeted specific codes for review that may have impacted a few procedural specialties like cardiology, radiology or nuclear medicine however not taken a look at the highest expenditure codes across all specialties, the agency cites.

Strong efforts are required to assess fee schedule for Medicare ( Source "http://www.supercoder.com/coding-tools/fee-schedules") to see to it that it is paying right and ensuring that Medicare beneficiaries remain to have access to vital services, the release stresses. That aside, the agency is also proposing some changes in how it adjusts payment for geographic variation in the cost of practice.

Other changes in the proposed rule include:

The agency is also proposing to expand its multiple procedure payment reduction to the professional interpretation of advance imaging services to recognize the overlapping activities that go into valuing these services, the agency release cites.

The agency is also proposing criteria for a health risk assessment to be used with AWVs for which coverage began on January 1 this year under the affordable care act.

The agency will accept comments on the proposed rule until August 30 this year.

For more on this fee schedule update, click here

CPT Codes 2011: A Lowdown on Femoral Popliteal Service Codes

2011 has lots of changes as far as CPT codes and guidelines for your cardiology services are concerned. Here's a lowdown on this year's CPT codes that'll stand your cardiology coding in good stead.

Among the key changes, CPT 2011 has added new codes for lower extremity endovascular revascularization which includes angioplasty, atherectomy and stenting. This year's femoral/popliteal service codes include 37224 for angioplasty, 37225 for atherectomy (and angioplasty), 37226 for stent (and angioplasty) and 37227 for stent and atherectomy (and angioplasty).

Generally, for 37224-37227, you should go for one code that represents the most intensive service carried out in a single lower extremity vessel. Say for instance when the cardiologist carries out a stent placement, atherectomy, and angioplasty in the left popliteal vessel, you should use only 37227. This code includes stent placement, atherectomy, and angioplasty. In this situation, you shouldn't use the three codes 37224, 37225, or for that matter 37226 separately or in addition to 37227.

Territory rule:

This year's CPT codes - 37220-+37235- apply to different 'territories' and each territory has its own specific set of guidelines. The codes - 37224-37227 - fall under the femoral/popliteal vascular territory.

Important rule: According to CPT, the whole femoral/popliteal territory in 1 lower extremity is taken as a single vessel for CPT coding.

As such, you should go for a single code even if the cardiologist carried out various interventions for several lesions in the political artery and in the common, deep, and superficial femoral arteries in the same leg during the same session.

In situations like this, you should use the code for the most complex service. Say for instance if the cardiologist carries out angioplasty in the left popliteal artery and atherectomy in the left common femoral, you should go for atherectomy code 37225 only.

Remember: The codes are unilateral, which means they apply to a service on a single side of the body. According to CPT, if the physician treats the identical territory in both legs at the same session, you should go for modifier 59 (Distinct procedural service) to indicate both legs are involved.

Get information on CPT codes online by signing up for a reliable medical coding resource like SuperCoder.com.