ICD-9 Coding: Generalized Complaints for Blurry Vision Can Lead to Confusion

Having trouble getting to the proper ICD 9 diagnosis code for blurred vision? That should not be a problem if you know the reason behind the blurred vision.

A person complains of blurred vision and visits an eye-care specialist. But when a patient comes with hazy, generalized complaints, say for instance blurry vision, dry eyes, and the like – coders find it difficult to report these. ICD-9 codes that describe blurred vision specifically and similar diagnoses that relate to refractive error sometimes are not covered. So how do you go about this situation? Many coders use 368.8 (Visual disturbances; other specified visual disturbances).

The ICD-9 manual covers the note “blurred vision not otherwise specified" (NOS). This points to the fact that this is a good option for blurred vision. But then some carriers do not agree using the logic that there must be something leading to the blurriness and insisting you report the cause and not the symptom.

Rule for coders: You need to use the final diagnoses if a patient has a medical problem; however if the patient has only blurred vision, you should go for 368.8. Here’s an instance: A patient reports with a blurry vision and the ophthalmologist finds a cataract. Here you need to report cataract (366.xx) as the primary diagnosis and blurred vision (368.8) as the secondary diagnosis. This gets more confusing when the patient does not specifically complain of blurred vision and asks for a regular eye exam instead. Experts say that how you code depends on the insurance. If the patient visits for a routine vision exam and you know you are going to bill a vision insurance, report with a routine diagnostic code for refractive error [367.x]. But if the patient does not have a vision plan, then you may choose 368.8 to report it.

According to some coders, while billing with a symptom code like 368.8, their carrier also needs the use of V80.2. And in case you are have some confusion, ask the carrier for its written policy.

Dry-Eye Syndrome

The most common ICD-9 diagnosis code related to dry eye is 375.15. One more code would be 370.33. A word of caution though: Many believe they can report 375.15 and 370.21 interchangeably; however this is not true.

Medical Billing & Coding: Hardware is a Vital Cog in 5010 & ICD-10 Implementations

From January 1 next year, your practice will have to make the required changes or enhancements to your practice management system, EMR system and/or medical billing and coding. Keeping this in mind, you need to work with your vendors to ensure your healthcare billing and practice management systems are up and running for the conversions to 5010 and ICD-10.

Communication with vendors a vital cog

It's very important that you get in touch with outside vendors to ensure the success of your practice's transition to version 5010 and ICD-10.

One more key to success is to test early and that too often

You should make it a point to test transactions and claim submissions with your vendor, clearing house and payer prior to the 5010 version deadline next year and the ICD-10 deadline in 2013. This step is very important for you to make a smooth transition.

Don't wait too late to test as your task will be tougher if you detect a flaw in your system in the last minute.

How to go about it: Get in touch with your software vendors well ahead of time to ensure that no issues will be there as far as claims submissions using ICD-10 are concerned. First you need to find out whether your vendors are all geared up for the transition to the just-in 5010 format.

Hardware requirements for your practice

Hardware is a vital peg for the 5010 and ICD-10 implementations. As such you need to assess the hardware your practice or vendor use. Find out the present age of your practice's hardware, the dual-processing capability for the two code sets (ICD-9 and ICD-10), storage capacity, processing power, and the like.

Also, you will need to see to it that your system is able to handle alphanumeric codes, seven characters, code descriptions which are long, just-in edits based on age, sex, and more, separate data entry programs for dual processing.

Your system is very important to be able to process both the soon-to-go ICD-9 code set and the soon-to-come ICD-10 code set concurrently to allow for claims processing, reporting and analysis.

The time required for maintaining both ICD-9 and ICD-10 will depend on your individual practice's requirement.

Source URL :-  http://www.supercoder.com/icd-10/icd-10-bridge

You also need to see that your practice or vendor has a hardware that can handle the increased file and database storage you will need when the new code system goes into effect.

ICD-10 Updates: Report ‘Other’ and ‘Unspecified’ Hyperlipidemia Separately

ICD-10 offers a one-to-one code match with the previous code set for pure hypercholesterolemia, pure hyperglyceridemia, and mixed hyperlipidemia. Read on for a comparative study of how coding for the two code sets will affect you.

When ICD-10 goes into effect on October 1, 2013, there are good chances that high cholesterol will still be a hurdle for your patients. Take a look at how coding for this and similar diagnoses compares between the two code sets (ICD-9 and ICD-10).

ICD-9-CM codes include 272.0, 272.1, 272.2 and 272.4 while soon to go into effect ICD-10-CM codes include E78.0, E78.1, E78.2, E78.4, and E78.5.

ICD-10 coding changes

ICD-10 offers a one-to-one code match with ICD-9 for pure hypercholesterolemia (272.0, E78.0), pure hyperglyceridemia (272.1, E78.1), and mixed hyperlipidemia (272.2, E78.2). However where ICD-9 code offers one code for 'other and unspecified hyperlipidemia" (272.4), ICD-10 offers one code for 'other' E78.4) and a different code for “unspecified" (E78.5).

Don't change your clinicians' documentation from its present form

When it comes to clinicians' documentation you should not change it from its present form. All that you need to do as a coder to capture this already existing information is to format your superbill to capture the difference between 'other' and 'unspecified' hyperlipidemia. By 'others' it means the physician documented the type; however the new code set does not offer a code specific to the documented type. By 'Unspecified' it means that the physician didn't document the type of hyperlipidemia.

Differences between ICD-9 and ICD-10 codes for lipid metabolism disorders

Although the notes with the ICD-9 and ICD-10 codes for lipid metabolism disorders are very similar, there are a few differences though.

Example: Say for instance while 272.1 includes “hypertriglyceridemia, essential," E78.1 includes “elevated fasting triglycerides." Under E78.2, ICD-10 adds 'combined hyperlipidemia NOS', elevated cholesterol with elevated triglycerides NEC and “Hyperlipidemia, group C. Code E78.2 also has an Excludes1 note, asking you to code E78.4 for “familial combined hyperlipidemia" and E78.5 for “cerebrotendinous cholesterosis".

Bear in mind: When the new code system goes into effect on October 1, 2013, you should apply the code set and official guidelines in effect for the date of service (DOS) reported. (You can get more information here www.cdc.gov/nchs/icd/icd10cm.htm#10update.).

On-Call Services: Avoid On-Call Fraud Accusations with These FAQs

Beware: You can't capture ER coverage services with after-hours codes.

If you bill incorrectly when your physician covers for others -- or when another physician covers for your physician -- you could be setting yourself up for charges of fraud.

Don't stress: Remember just a few simple answers to the top three on-call medical billing questions, and you'll be ready to correctly file claims.

1. Which Physician Bills for the Services?

If your physician is on call and handling patient services for another physician, don't fall into the trap of letting the other physician bill for the services. Even though a patient sees a particular physician, that does not mean that physician can bill for any services related to that patient's care. When your physician provides a service, even while on call for another doctor, you should bill the services.

Check the NPI: Each doctor who sees a patient should bill for the appropriate services rendered, under his/ her own NPI (National Provider Identifier) number.

The key: Whoever sees the patient face to face and documents and signs his/her name should be the one billing for those services provided regardless of who the admitting surgeon is.

2. How Do You Report On-Call ER Services?

Often, physicians see patients in the emergency department while on call. Don't turn to the after-hours codes to bill for these services when the hospital pays your physician for on-call status.

Reasoning: If the hospital is already paying the physician to be the on-call physician in the emergency room (ER), you cannot double-bill for his services. You should bill the after-hours codes 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed [e.g., holidays, Saturday or Sunday], in addition to basic service) and 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service) only when your physician sees a patient in your office outside regular office hours andanother third party is not compensating him for his time.

Example: If your office closes at 5 p.m. but your physician sees a patient on an emergency basis at 7 p.m., report 99050 in addition to any other services provided. If your physician saw the patient in the emergency room at 7 p.m., you should not report 99050. Keep in mind: Not all insurers will pay you for the after-hours codes.

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Hospital Coding Scenarios to Help You Avoid Denials

Hospital coding and billing mistakes can cost your hospitals thousands of dollars. Here are a couple of hospital billing & coding scenarios to help your understanding and save you from unnecessary denials.

Scenarios: After treating a patient in the office, our physician admitted her to the hospital later the same day. How should we go about this situation? Can we bill for the office visit and the first day of admission? Or do we just bill for the hospital stay?

Well, it all depends on whether your physician tends to the patient on the same day in the hospital.

Two face-to-face visits on the same date

If the physician tends to the patient in the hospital on the same day he saw her in the office, you are looking at two face-to-face visits on the same date. Go for only the proper initial hospital care code - (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ).

CPT coding guidelines ( Source "http://www.supercoder.com/cpt-codes/") lay down that all initial hospital care services that start in another place of location (say for instance the physician's office) should be combined and coded using the proper level of initial hospital care. As the 99221-99223 code will include the evaluation & management provided in the office, you will go for an initial hospital care code that includes the work done in both sites of the service.

Bill each encounter separately

However if your physician doesn't see the patient in the hospital until the next day, you should bill each encounter separately. Select the proper office visit code (99201-99205 or 99212-99215) for the visit on day one. After this add an initial hospital care code 99221-99223 for day two when the physician tends to the patient in the hospital for the first time.

Bear in mind: CPT uses initial hospital care codes to code the first hospital inpatient encounter by the admitting physician. Soon after that, you will report subsequent hospital care codes - 99231-99233 - until the date of discharge. After the physician discharges the patient, you will submit the proper hospital discharge day code (99238 or 99239, Hospital discharge day management ).

Medical Billing & Coding: Know How ERISA & PPACA Impact Your Practice

The Federal claims appeals regulations went into implementation on July 1. Here's an update on this and other medical billing and coding information relating to this change.

If you're not up to speed on the new law and honed your Employee Retirement Income Security Act (ERISA) know how, you could be taking your practice to a 'denial zone'. For the initiated, the Patient Protection and Affordable Care Act (PPACA) adopts existing ERISA claim regulation in total and adds on six to seven new standard requirements too.

The new appeals regs:

The just-in appeals regs will impact all your healthcare billing denials and appeals outside of Medicare and Medicaid; as such your billing department will need to be well-versed with them to get back their deserved payments.

The provider side of the healthcare industry does not focus enough on the new appeals regulation while the payer side of the industry talks about it all the time to ensure you don't get the payments.

Also bear in mind that PPACA is a Federal mandate and as such it's not optional.

Appeals options: Under PPACA, now there are both internal and external appeals options.

The good news is that for the internal appeals process, PPACA adopted ERISA claims regulations in their entirety and added six to seven new requirements as well. The law provides the just-in external appeals option by adoption the National Association of Insurance Commissioners (NAIC) external appeal model.

Note: As the practice or provider, you have no claim with the insurance company.

The appeal rights belong to the patient and not your practice; as such you need to get the patient's written permission to appeal a claim under ERISA. Under Federal Law, a provider or the representative of the provider can appeal an adverse benefit determination minus the written authorization by the member.

Under PPACA, if you have 'good assignment' from the patient, the healthcare provider will become a claimant during the appeals process.

PPACA requires one EOB format for the entire industry

A notable change is that PPACA requires explanation of benefits (EOBs) format for the entire industry. EOBs will be for initial denials called the adverse benefit determination, internal appeals denials (the final internal adverse benefit determination), and for external appeals denials (the final external adverse benefit determination).

Resource: For more information on the Federal claims appeals regulations, you can visit the labor department Website at http://www.dol.gov/ebsa/healthreform/.

ICD-9-CM: 997.4 Makes Way for Four New Codes for Bariatric Procedures

Proposed ICD-9-CM code set for 2012 has changes for gastric band or bariatric procedures, pelvic circle fracture codes, skin cancer dx and more.

If the proposed ICD-9 CM codes become final, starting October 1 this year you will have four new codes to report complications of gastric band or bariatric procedures. This time you will get 539.xx and other new, invalid and revised codes that will have an impact on your general surgery practices.

Bariatric surgery or gastric band procedure: Presently, complications related to these are indexed to 997.4 as there is no secondary code to use. But all that is set to change on October 1, 2011 if the proposed codes - 539.01, 539.09, 539.81 and 539.89 - become final. When these codes go into effect, you can start reporting bariatric/gastric band complications with one of these four codes.

Note: ICD-9 adds an 'excludes' note to 997.4, and directs coders to these just-in codes.

These four codes come with a lot of advantages: The existing code 997.4 does not distinguish digestive system complications from bariatric or gastric band surgeries from complications owing to any other procedures or conditions. These new codes provide better data collection for bariatric and gastric band procedures.

Skin excision & ICD-9 2012: Apart from these changes, ICD-9 2012 proposed changes will expand 10 present codes to 40 new codes that you will have to use when your surgeon carries out a skin excision. Skin site distinguishes the 10 existing codes (173.0-173.9) that will become invalid.

Although the same site distinctions remain in the just-in codes, ICD-9 2012 adds a fifth digit to each four digit code to differentiate cancer type.

Here are four fifth digits to distinguish each site-specific four digit code based on neoplasm details:

0 -- Unspecified malignant neoplasm of

1 -- Basal cell carcinoma of

2 -- Squamous cell carcinoma of

9 -- Other specified malignant neoplasm of

Pelvic circle fracture code search: Under ICD-9 2012 , there will be more precise coding choices as far as pelvic fracture codes are concerned. The just-in codes will be specific to 'without disruption: 808.44 and 808.54. These codes will offer choices to 'with disruption' codes 808.43 and 808.53.

For more details on the proposed ICD-9 code changes for 2012, sign up for a good coding resource like SuperCoder that provides you with fast online searches for this code set.