414.4 Lets You Get Precise About Calcified Coronary Lesions

But 425.1 will take along instant denials

Don’t think that your ICD-9 2012 update lists final till you’ve studied these late additions for coronary atherosclerosis and hypertrophic cardiomyopathy.

Even though coders get information about ICD-9 changes each summer in CMS’s suggested Inpatient PPS rule, those specific changes aren’t the last word for updates. The codes below got effective Oct. 1, 2011.

414.4 Helps Identify Coronary Lesions

ICD-9 2012 adds 414.4 (Coronary atherosclerosis due to calcified coronary lesion).

The goal was to be able to differentiate a calcified lesion from other ischemic lesions. Calcified lesions are different as lipid rich plaque (414.3, Coronary atherosclerosis due to lipid rich plaque) as well as chronic total occlusions (414.2, Chronic total occlusion of coronary artery). And 414.8 (Other specified forms of chronic ischemic heart disease) is too common to identify the nature of the lesion.

Calcified lesions can be identified both by x-ray during coronary angiography along with intravascular ultrasound, and might be more challenging to treat than further coronary lesions. In case the physician is unable to cross the calcified lesion, he might have to stop the treatment and the patient may then need medical management or an extra invasive procedure.

Term tip: The code definition maintains calcified coronary lesion, however a note with the code explains that it is suitable when the physician documents coronary atherosclerosis owing to severely calcified coronary lesion.

"Severely" is a significant part of the diagnosis. However coders may not find the term "severely" in the documentation.

One more instruction with 414.4 informs you that you should code first coronary atherosclerosis (414.00-414.07). Consequently your first-listed code must specify the atherosclerosis (for instance 414.01, Coronary atherosclerosis of native coronary artery). After that report 414.4 in case the physician documents the situation is linked to a calcified coronary lesion.

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425.1 Now Necessitates a 5th Digit

ICD-9 2012 offers novel coding selections for hypertrophic cardiomyopathy.

Reason: Hypertrophic cardiomyopathy can have two planes of demonstration, obstructive or nonobstructive. Whether or not it is obstructive can influence the requirement for dissimilar medical or surgical treatments.

2011: In ICD9 2011 , 425.1 was a binding code defined as "Hypertrophic obstructive cardiomyopathy." In case you required reporting nonobstructive hypertrophic cardiomyopathy, you reported 425.4 (Other primary cardiomyopathies).

2012: The update reviews 425.1 (now defined as Hypertrophic cardiomyopathy) so that it is no longer a valid code -- you should add a fifth digit for it to be valid:

425.11, Hypertrophic obstructive cardiomyopathy Hypertrophic subaortic stenosis (idiopathic)

425.18, further hypertrophic cardiomyopathy Nonobstructive hypertrophic cardiomyopathy.

The changes offer you one code meant for hypertrophic obstructive (425.11) and then the other code meant for other hypertrophic, containing nonobstructive (425.18). To follow with the changes to the 425.1x range, ICD-9 erases the terms "hypertrophic" and "nonobstructive" from under 425.4.

Ace Your HTN Coding

Keep these strategies on assumptions, renal disease, and heart disease within reach.

Hypertension (HTN) is rising -- possibly a third of the U.S. population is at present affected. That implies that if your HTN coding skills aren’t top notch, a lot of your claims are at danger of errors.

For a compliant coding, apply these rules based on the ICD-9 official guidelines and know what ICD-9 codes you should choose.

1: ICD-9 Has a Hypertension Table; Use It

Coding HTN diagnoses can be challenging, however the Hypertension Table, listed in the ICD-9 index entry "Hypertension," helps streamline your search.

The table demonstrates not just the basic 401.x (Essential hypertension) ICD-9 codes, but also the ICD-9 codes for situations owing to or linked with HTN. Furthermore, the table helps explain when your code choices differ for malignant, benign, or unspecified conditions. After you’ve found the code in the index, don’t forget to check it in the tabular list.

2: Documentation Determines 401.x 4th Digit

ICD-9 official guidelines propose an important rule for compliant HTN coding. While reporting ICD-9 codes from 401.x, you should select a fourth digit to complete the code: "malignant (.0), benign (.1), or unspecified (.9). You should not use either .0 malignant or .1 benign without medical record documentation supporting such a designation.

3: ‘Hypertensive’ Supports 402.x Use

When a patient is going through HTN and heart disease, knowing whether the HTN resulted in the heart condition is vital to proper coding.

Look to find whether the patient has a situation defined under heart disease ICD-9 codes 425.8, 429.0-429.3, 429.8, and 429.9, official guidelines maintain. Moreover scrutinize the documentation for a stated or implied underlying relationship to HTN (for example, "due to HTN" or "hypertensive heart disease"). You should never suppose that the HTN resulted in the heart disease.

4: Assume HTN and CKD Are Connected

In direct contrast to the rules for coding HTN as well as heart disease, ICD-9 does assume a fundamental relationship between HTN and chronic kidney disease (CKD).

Translation: In case documentation demonstrates that a patient has HTN and a condition that falls under 585.x (Chronic renal failure) or 587 (Renal sclerosis unspecified), then you must report a code from 403.x (Hypertensive renal disease), even though there’s no sign that one lead to the other. You also should report the pertinent 585.x code to specify the CKD stage.

5: Unclutter Coding for Hypertensive Heart and CKD

A particular code from 404.xx (Hypertensive heart and renal disease) specifies that the patient has hypertensive heart disease along with hypertensive CKD. You again should presume a relationship between the HTN and CKD.

Crucial: When the patient is going through hypertensive heart disease and CKD, you must select a code from 404.xx. You must not report 402.x (hypertensive heart disease) along with 403.x (hypertensive CKD).

Radiofrequency Ablation Treatment: Vanish Your Coding Woes

Unlisted code 42299 is your only choice for LAUP.

Radiofrequency ablation (RFA) of the turbinates might be the procedure of choice for few physicians, however one on-going concern remains for a lot of ENT practices: “What CPT codes should I select for radiofrequency ablation techniques for turbinates, meant for the palate (UPPP), as well as for the tongue base?" Remember: Radiofrequency devices have two key purposes. Physicians might use them to ablate tissue or as actual cutting tools (e.g., for tonsillectomy). You must select CPT codes based on the exact way that your physician used the device.

1. Go For 41530 For RFA, Base Of Tongue


You could report 41530 (Submucosal ablation of the tongue base, radiofrequency, one or more sites, per session) in case your otolaryngologist treats OSA. This CPT® substituted 0088T (Submucosal radiofrequency tissue volume reduction of tongue base, one or more sites, per session [i.e., for treatment of obstructive sleep apnea syndrome]) in 2009. ICD-9 327.23 (Obstructive sleep apnea) along with at least one of the following listed secondary CPT codes (529.8, Other specified conditions of the tongue or 750.15, Macroglossia) are the only covered diagnoses for 41530. Ensure that these CPT codes are included in your claim, and should be documented in the medical record.

2. Laser-Assisted Uvulopalatoplasty Belongs To 42299 Alone

As far as RFA of the palate, uvula is concerned, you must use 42299 (Unlisted procedure, palate, uvula). CPT guidelines state that no other CPT® code fits suitably to define RFA of the palate or uvula, as well as debunk the option of using the uvulopalatopharyngoplasty code 42145 (Palatopharyngoplasty [e.g., uvulopalatopharyngoplasty, uvulopharyngoplasty]) appended by modifier 52 (Reduced services). You cannot go ahead and use 42145 (or 42145-52) as this code signifies an excisional removal of the uvula and palate, as well as the laser ablation (or reduction in size) does not meet the rules for an excisional removal as needed for 42145. Moreover, CMS has specified that they do not think through a LAUP or a RFA of the uvula or palate standards of care and take them experimental.

3. RFA Of Inferior Turbinates: 30801 For Surface Layer; 30802 For Intramural Soft Tissue

You should deliberate over the exact nature of the procedure while coding RFA of the inferior turbinates. For example, 30802 (Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method [e.g., electrocautery, radiofrequency ablation, or tissue volume reduction]; intramural [i.e., submucosal]) defines the ablation or cauterization of the deeper mucosal soft tissue, whereas 30801 (… superficial) relates to the ablation or cauterization including only the surface layer of the mucosa.

ICD-9 to ICD-10 Conversion: Get Ready or Face Fines

Improve your ICD-10 coding know-how.

Denials aren't the lone thing you have to dread if your practice doesn't implement ICD-10 by the Oct. 1, 2013 deadline. You could be slapped with fines, too, according to CMS.

Here are some FAQs that will surely help you ramp up your ICD-9 to ICD-10 conversion for your practice.

Get ready for Medicare and Other Payers

CMS has no plan of delaying the implementation of ICD-10 further than the Oct. 1, 2013, date. Though, not all entities are ready for the conversion.

Question 1: Just the entities covered by HIPAA need to make the transition form ICD-9 to ICD-10 -- does that imply that workers' compensation insurers will carry on using ICD-9, even after the remaining industry transitions to ICD-10 on Oct. 1, 2013?

Answer: The answer to that is vague, however CMS has heard murmurs that workers' comp. insurers will shift form ICD-9 to ICD-10.

Question 2: How about Medicaid?

Answer: CMS presented rankings for state Medicaid preparation. Remember that state Medicaid programs are at greater peril for not meeting the ICD-10 implementation date, whereas 21 states are at moderate danger. Fifteen states are at little risk, and four states have informed CMS where they stand in the process.

Question 3: What are the penalties fixed for entities that come under HIPAA who wish not to use ICD-10 codes as of Oct. 1, 2013?

Answer: Your claims will be denied -- and you technically could face fines as use of the ICD-10 codes comes under the HIPAA transaction code set regulations.

Denials: From a practical perspective, as of service dates of Oct. 1, 2013, if you don't use ICD-10 codes, most probably your claims will be returned and will be asked to transition from ICD-9 to ICD-10.

Fines: The penalties are the similar penalties that any HIPAA entity would be subject to. Most of you are acquainted with the ongoing HIPAA transaction codeset penalty that calls for a maximum of $25,000 per covered entity per year, but the HITECH legislation of last year in fact increased those transaction and codeset penalties, and they can be as high as $1.5 million per entity every year.

Carry on With Codesets and Coverage

Your ophthalmology practice can't get ready for the ICD-9 to ICD-10 transition all alone. Study the following questions to see how others' preparations can help or hinder you.

Question 4: The Medicare local coverage decisions (LCDs) presently list the payable ICD-9 codes that agree to all Medicare-payable procedures. Will contractors issue updated LCDs to the public before the Oct. 1, 2013 implementation date to demonstrate the payable ICD-10 codes for the procedures?

Answer: The answer to is unclear. The LCDs will be translated as they will need to be translated, however, as it relates to having them accessible to the public prior to the implementation date, that is not yet sure, as everyone is working fast and furious on all of ICD-10 implementation efforts.

The above ICD-9 to ICD-10 information is brought to you by SuperCoder.com. Log on to www.supercoder.com for more expert Medical Billing and coding guidance, news and information. 

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745.4 Goes with Q21.0 to Explain VSD

Even one-to-one matches can surprise you -- check the index for clearness.

When the conversion of ICD-9 to ICD-10 takes place in 2013, one lesson you'll need to keep in mind is that inclusion lists may vary between the two code sets. That implies that ICD- 9 and ICD-10 codes that seem to be twins might not apply to the same list of diagnoses.

Case in point: ICD-9 2011 code 745.4 (Ventricular septal defect) as well as ICD-10 2011 code Q21.0 (Ventricular septal defect) have the same code definition. Both reference ventricular septal defect (VSD), which includes no less than one hole in the wall separating the ventricles of the heart. In the process of conversion of ICD-9 to ICD-10, you will find that regardless of the similarity in the code definitions, the inclusion lists for these codes are not the same.

ICD-9 coding rules: Code 745.4 has an inclusion note informing you that the code is suitable for Eisenmenger's defect or complex, Gerbode defect, interventricular septal defect, left ventricular-right atrial communication, or Roger's Disease.

ICD-10 changes: The inclusion list under Q21.0 shows only Roger's disease.As you will find differences in which diagnoses come under similar ICD-9 and ICD-10 codes, the fundamental principle of checking both the index and the tabular list will be essential for proper ICD-10 coding.

For instance, if you search for Eisenmenger's defect (which falls under 745.4), you'll find that ICD-10 codes this particular defect to Q21.8 (Other congenital malformations of cardiac septa). And in another instance of what's different, Eisenmenger's complex (which also falls under 745.4) is as an alternative coded to I27.89 (Other specified pulmonary heart diseases) under ICD-10.

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Documentation: In case the patient has one of the named defects (for instance, those listed in the ICD-9 inclusion list), documentation of that definite name will let you check the index to be assured that you have the most suitable ICD-10 code.

You'll also require documentation to take account of whether the VSD is congenital (existing at or before birth), because of myocardial infarction, or or else acquired (a reaction to environmental influences). In the conversion of ICD-9 to ICD-10, you will experience that ICD-10 directs you away from Q21.0 in case the patient has an acquired septal defect (I51.0, Cardiac septal defect, acquired) or a VSD as a current complication of an acute myocardial infarction (I23.2, Ventricular septal defect as current complication following acute myocardial infarction).

Bonus tip: ICD-9 also has an exclusion list in 745.4, so you know not to use the code for common atrioventricular canal type (coded to 745.69, Other endocardial cushion defects) or single ventricle (coded to 745.3, Common ventricle) defects. In the conversion of ICD-9 to ICD-10, you will see that ICD-10 does not have an excludes list for Q21.0, but those diagnoses still are coded in another place: Q21.2 (Atrioventricular septal defect) is applicable to the common atrioventricular canal and Q20.4 (Double inlet ventricle) is applicable to the single or common ventricle diagnosis.

CCI Edits 2011 Prohibit Use of 45300 with Codes Meant For Therapeutic Anoscopy, Manipulation

Know what bundles you can still bill together using modifier 59.

Important changes to the gastroenterology practice involve a veto on proctosigmoidoscopy as well as therapeutic anoscopy procedures, among other modifications. Check out what you are supposed to do with the following tips.

Background: CCI Edits 2011 carry 2,343 new edit pairs and 224 deletions, comparatively fewer than earlier edits. A lot of edits come from the musculoskeletal code range. Though, bundles also affect the Surgery/Digestive System section of the CPT® manual.

Don't Ignore Your 45300 Bundles

CCI edits 2011 allocates a modifier indicator of “0," and implements a series of edits for:

46615 (Anoscopy; with ablation of tumor[s], polyp[s], or further lesion[s] not agreeable to removal by hot biopsy forceps, bipolar cautery or snare technique) as well as 45300 (Proctosigmoidoscopy, rigid; diagnostic, including or excluding collection of specimen[s] by brushing or washing [separate procedure])

46614 (including control of bleeding [for instance, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) as well as 45300

46612 (including removal of multiple tumors, polyps, or further lesions by hot biopsy forceps, bipolar cautery or snare technique) as well as 45300

46611 (including removal of single tumor, polyp, or further lesion by snare technique) as well as 45300

46610 (including removal of single tumor, polyp, or further lesion by hot biopsy forceps or bipolar cautery) as well as 45300

46608 (including removal of foreign body) as well as 45300

46606 (including biopsy, single or multiple) as well as 45300

46604 (including dilation [for instance balloon, guide wire, bougie]) as well as 45300.

These changes mainly say that the code meant for therapeutic anoscopy procedures should not be used along with the base code meant for proctosigmoidoscopy (rigid sigmoidoscopy). The accurate code would be from the family of proctosigmoidoscopy codes 453xx.

You are not supposed to use these codes together in any situation and in case you do, the higher value code will certainly be denied.

In the same way, a different series of edits including 45300 shows up in CCI edits 2011 as follows:

46220 (Excision of single external papilla or tag, anus) as well as 45300

46080 (Sphincterotomy, anal, division of sphincter [separate procedure]) as well as 45300

46040 (Incision and drainage of ischiorectal and/or perirectal abscess [separate procedure]) as well as 45300

45915 (Removal of fecal impaction or foreign body [separate procedure] under anesthesia) as well as 45300

45910 (Dilation of rectal stricture [separate procedure] under anesthesia except local) as well as 45300

45905 (Dilation of anal sphincter [separate procedure] under anesthesia except local) as well as 45300

45900 (Reduction of procidentia [separate procedure] under anesthesia) as well as 45300.

CCI edits 2011 maintain that the proctosigmoidoscopy code (in column 2) is incorporated in the column 1 code and cannot be used together in any situation. Yet again, in case you still used these codes together in your claim, the payer is expected to deny the higher value code.

HCPCS Codes 2011: G0431, G0434 Include Medicare Drug Screens

CMS scrubs out G0430 and won't pay for 80100, 80101, 80104.

Forget all you considered you knew about reporting drug screen tests to Medicare. With new, revised, and deleted codes for 2011, chances are you won't report your lab's drug testing the same way this year. Read on for an expert HCPCS codes insight.

Questions abound: Fast on the heels of 2010 HCPCS code changes and CMS's surprising 2011 HCPCS codes reversals, many lab coders and billers are puzzled.

Let our experts break down the problems – as well as solutions -- to make sure you get all the pay you deserve for Medicare drug screening tests.

'Complexity' Leads Your Choice

In case your lab carries out drug screening meant for single or multiple drug classes by the means of any lab method except chromatography, you have a couple of HCPCS codes choices to report your work for Medicare beneficiaries in 2011:

G0431 (revised) – i.e. Drug screen, qualitative; multiple drug classes as a result of high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter

G0434 (new) -- i.e. Drug screen, not including chromatographic; any number of drug classes, with CLIA waived test or moderate complexity test, per patient encounter.

It seems that you should select between these HCPCS codes based on the CLIA complexity categorization of the definite lab test you're using
You must report only one unit of G0431 or G0434 per patient encounter, despite of the figure of drug classes you distinguish.

The Clinical Laboratory Fee Schedule (CLFS) has priced G0431 at five times G0434 (national limit amount $102.33 versus $20.47).

Chromatography Gets Mixed Signals

Regardless of pricing 80100 on the CLFS, the Medicare Physician Fee Schedule (PFS) registers 80100 (Drug screen, qualitative; multiple drug classes chromatographic method, each procedure) by means of an "I" (invalid) code status indicator. That implies that the code is invalid for Medicare Purposes. Medicare uses a different code for reporting of, and payment for, these services

On the contrary, when Medicare pays for a code on the CLFS, you'll find the code that is listed on the PFS with status indicator "X". That implies that the code may be paid on a dissimilar fee schedule, like the CLFS, as the code signifies a service that is not in the statutory definition of 'physician services.

Best guess: It appears like Medicare desires labs to use G0431 for chromatography in place of using 80100

Problem: Even though the G0431 definition could include chromatography -- a high complexity test -- the code necessitates "multiple drug classes," which the lab may not always carry out. However you couldn't use G0434 as it states "except chromatographic."

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