Ensure you clear every ER/PR coding snag with these steps.
CPT codesets, CPT codes, Medical Coding
The adage to 'always report the most specifc CPT code' could ensnare your estrogen receptor (ER) and progesterone receptor (PR) coding for breast cases. Here our experts help you sort out the difference between specific analyte and specific method to ensure you select the right code every time.
Reserve 84233 and 84234 for assays
If you are searching for specific codes when a surgical pathology report references estrogen and/or progesterone receptor testing, you should not miss 84233 and 84234. However are those always the correct choice?
The 84233 and 84234 definitions create a confusion for medical coders reporting ER/PR tests. The question is whether you must report 84233/84234 as the definitions specify ER/PR, or if you can in its place report a generic immunohistochemistry code such as 88342 for certain ER/PR testing.
Codes 84233 and 84234 describe laboratory tests for estrogen and progesterone receptors that use a biochemical ligand-binding assay method like dextran-coated charcoal assay. However most labs evaluate ER/PR using immunohistochemistry as clinical studies have consistently shown the superiority of immunohistochemistry over biochemical assay methods for ER/PR testing.
Watch out for immunohistochemistry (IHC)
When the lab method involves immunohistochemistry for tissue specimens like evaluating breast tumors for ER and PR status, you should look to the following codes to describe the service: 88342, 88360, 88361.
Although these code definitions are 'generic' in the sense that they do not specifically identify estrogen or progesterone receptors, you should report them for an ER or PR (or any other) immunohistochemistry antibody strain.
Differentiate qualitative/quantitative codes
Choosing among 88342, 88360, or 88361 calls for knowing whether the immunohistochemistry analysis is qualitative or quantitative and whether quantification uses computer-assisted technology or “manual" counting, including visual approximation. You might choose to go for any of these three codes for ER, PR, Her- 2/neu, Ki-67, or any of various other IHC analyses
Count antibodies
You should report one unit of the right code for each antibody stain, irrespective of which antibody you are coding.
Wednesday, September 29, 2010
Watch HCPCS Codes to Clinch Clean
Codes you report should reflect the services and drugs provided and documented. Do not guess every case will merit the same HCPCS codes.
HCPCS codesets, hcpcs codes, Medical Coding
The Stanford V regimen covers seven basic drugs; however the patient won't be getting all of those drugs each treatment day. In order to keep your coding straight, take advantage of this outline of what to expect.
Remember: The codes you report should reflect the services and drugs provided and documented. Do not guess every case will merit the same HCPCS codes.
Background: The aim in developing the Stanford V regimen for Hodgkin's lymphoma was to provide chemotherapy regimen that received high remission rates with fewer side effects than ABVD like pulmonary damage and sterility.
Depending on the stage of the disease, the patient may have radiation therapy as well.
Day 1: Watch for Mechlorethamine, Doxorubicin, and Vinblastine on the first day of the treatment cycle, the patient normally receives three of the drugs in the regimen.
Day 8: Check for Vincristine and Bleomycin
Staff normally adminsters two of the regimen's drugs on day 8.
Day 15: Add Etoposide to Doxorubicin and Vinblastine
The normal day 15 routine is similar to day 1; however it is not exactly the same. The patient again gets doxorubicin (J9000) and vinblastine (J9360), however does not receive mechlorethamine.
In its place, intravenous etoposide, a DNA toxin, is used.
Day 16: Repeat etoposide infusion
On day 16, the patient gets one more etoposide (J9181) infusion.
Day 22: Expect same as day 8
The drugs administered on day 22 are the same as day 8, with the patient receiving short infusions of vincristine (J9370, J9375, J9380) and bleomycin (J9040).
Everyday: Pay attention to P.O. Prednisone
Article source:-http://www.supercoder.com/coding-newsletters/my-oncology-hematology-coding-alert/infusion-coding-part-1-watch-hcpcs-to-clinch-clean-article
HCPCS codesets, hcpcs codes, Medical Coding
The Stanford V regimen covers seven basic drugs; however the patient won't be getting all of those drugs each treatment day. In order to keep your coding straight, take advantage of this outline of what to expect.
Remember: The codes you report should reflect the services and drugs provided and documented. Do not guess every case will merit the same HCPCS codes.
Background: The aim in developing the Stanford V regimen for Hodgkin's lymphoma was to provide chemotherapy regimen that received high remission rates with fewer side effects than ABVD like pulmonary damage and sterility.
Depending on the stage of the disease, the patient may have radiation therapy as well.
Day 1: Watch for Mechlorethamine, Doxorubicin, and Vinblastine on the first day of the treatment cycle, the patient normally receives three of the drugs in the regimen.
Day 8: Check for Vincristine and Bleomycin
Staff normally adminsters two of the regimen's drugs on day 8.
Day 15: Add Etoposide to Doxorubicin and Vinblastine
The normal day 15 routine is similar to day 1; however it is not exactly the same. The patient again gets doxorubicin (J9000) and vinblastine (J9360), however does not receive mechlorethamine.
In its place, intravenous etoposide, a DNA toxin, is used.
Day 16: Repeat etoposide infusion
On day 16, the patient gets one more etoposide (J9181) infusion.
Day 22: Expect same as day 8
The drugs administered on day 22 are the same as day 8, with the patient receiving short infusions of vincristine (J9370, J9375, J9380) and bleomycin (J9040).
Everyday: Pay attention to P.O. Prednisone
Article source:-http://www.supercoder.com/coding-newsletters/my-oncology-hematology-coding-alert/infusion-coding-part-1-watch-hcpcs-to-clinch-clean-article
Tuesday, September 28, 2010
Coding for Cocaine Poisoning
ICD 9 codes 2011 go into effect on October 1, you can expect to see 970.81 available for when you need to report cocaine poisoning.
ICD 9 Codes 2011, medical coding
What do you do when the emergency department (ED) calls your cardiologist to care for a patient with cocaine poisoning? From October 1, 2010, a new code changes what you should report.
When ICD 9 codes 2011 go into effect on October 1, you can expect to see 970.81 available for when you need to report cocaine poisoning.
Get on top of this critical care scenario
Patients with cocaine poisoning can be very complex, extremely sick and are potential critical care cases.
Here's an example: A 22-year-old patient comes with acute chest pain and hypertension. History reveals that he inhaled four lines of cocaine within the past hour and has been abusing cocaine for the past year. The doctor carries out and documents a comprehensive history and exam.
Diagnostics include a cardiac panel and drug screen and an ECG, reveals ST elevation in the anterior leads. Lab work shows elevated CPK (creatine phosphokinase) and troponin. The doctor treats the patient with intravenous Valium and starts him on a nitroglycerin drip. The doctor then admits the patient to the critical care unit with anterior wall ST segment elevation myocardial infarction (STEMI) due to cocaine poisoning and hypertension. The doctor reports 45 minutes of critical care time.
Solution: You should report the following for this encounter: 99291, 970.81, 401.9
Check it out: For additional information on cardiology-related codes expected to go into effect October 1 and other ICD 9 codes 2011, sign up for a one-stop medical coding website. Such a site comes stocked with official guidelines and descriptors for ICD 9 codes. So sign up for one today!
Article Source :- http://www.supercoder.com/coding-newsletters/my-internal-medicine-coding-alert/icd-9-update-cocaine-poisoning-add-97081-to-your-coding-options-103141-article
ICD 9 Codes 2011, medical coding
What do you do when the emergency department (ED) calls your cardiologist to care for a patient with cocaine poisoning? From October 1, 2010, a new code changes what you should report.
When ICD 9 codes 2011 go into effect on October 1, you can expect to see 970.81 available for when you need to report cocaine poisoning.
Get on top of this critical care scenario
Patients with cocaine poisoning can be very complex, extremely sick and are potential critical care cases.
Here's an example: A 22-year-old patient comes with acute chest pain and hypertension. History reveals that he inhaled four lines of cocaine within the past hour and has been abusing cocaine for the past year. The doctor carries out and documents a comprehensive history and exam.
Diagnostics include a cardiac panel and drug screen and an ECG, reveals ST elevation in the anterior leads. Lab work shows elevated CPK (creatine phosphokinase) and troponin. The doctor treats the patient with intravenous Valium and starts him on a nitroglycerin drip. The doctor then admits the patient to the critical care unit with anterior wall ST segment elevation myocardial infarction (STEMI) due to cocaine poisoning and hypertension. The doctor reports 45 minutes of critical care time.
Solution: You should report the following for this encounter: 99291, 970.81, 401.9
Check it out: For additional information on cardiology-related codes expected to go into effect October 1 and other ICD 9 codes 2011, sign up for a one-stop medical coding website. Such a site comes stocked with official guidelines and descriptors for ICD 9 codes. So sign up for one today!
Article Source :- http://www.supercoder.com/coding-newsletters/my-internal-medicine-coding-alert/icd-9-update-cocaine-poisoning-add-97081-to-your-coding-options-103141-article
Make Smooth Transition from ICD 9 to ICD 10
Having issue while upgrade medical coding from ICD 9 to ICD 10. Use ICD 10 Bridge tool make smooth transition.
ICD 9 to ICD 10, ICD-10 bridge, ICD-9 codes, ICD 10 codes
2013 is still to come, but it's certainly not too early to start your ICD-10 preparations. Here are three things to keep in mind while making the change from ICD 9 to ICD 10.
Do not stall preparation as you expect a delay
Today isn't too early to gear up for the ICD 9 to ICD 10 transition. The more familiar you are with the changes, the easier the transition will be. You shouln't begin your intensive, in-depth ICD-10 training until six to nine months before implementation, but you can gear up in other ways now.
Get your physicians ready now
Presently, CMS publishes about 14,000 ICD-9 codes, however there'll be over 69,000 ICD-10 codes. These codes will make it possible for you to provide greater detail in describing diagnoses and procedures. As because ICD 10 codes will often be more detailed and specific than the ICD-9 codes you and your ophthalmologist are used to, you may need to encourage your doctor to begin being more detailed in his documentation.
Begin by speaking with your physicians now about improving their clinical documentation detail which will be the most important aspect for them and should be started before the change.
Reach out to vendors to ensure readiness
You should be involved when practices communicate with information system vendors about their plans for the new code set implementation.
You will need to work with your software vendors before time to confirm that no issues will exist with claims submissions using ICD-10. First you should check whether your vendors are ready for the transition to the new 5010 form, which is making way for the ICD-10 code set.
For more tips on ways to make the ICD 9 to ICD 10 transition, sign up for a one-stop medical coding update. Such a site comes stocked with an ICD-10 bridge to make the transition much easier!
ICD 9 to ICD 10, ICD-10 bridge, ICD-9 codes, ICD 10 codes
2013 is still to come, but it's certainly not too early to start your ICD-10 preparations. Here are three things to keep in mind while making the change from ICD 9 to ICD 10.
Do not stall preparation as you expect a delay
Today isn't too early to gear up for the ICD 9 to ICD 10 transition. The more familiar you are with the changes, the easier the transition will be. You shouln't begin your intensive, in-depth ICD-10 training until six to nine months before implementation, but you can gear up in other ways now.
Get your physicians ready now
Presently, CMS publishes about 14,000 ICD-9 codes, however there'll be over 69,000 ICD-10 codes. These codes will make it possible for you to provide greater detail in describing diagnoses and procedures. As because ICD 10 codes will often be more detailed and specific than the ICD-9 codes you and your ophthalmologist are used to, you may need to encourage your doctor to begin being more detailed in his documentation.
Begin by speaking with your physicians now about improving their clinical documentation detail which will be the most important aspect for them and should be started before the change.
Reach out to vendors to ensure readiness
You should be involved when practices communicate with information system vendors about their plans for the new code set implementation.
You will need to work with your software vendors before time to confirm that no issues will exist with claims submissions using ICD-10. First you should check whether your vendors are ready for the transition to the new 5010 form, which is making way for the ICD-10 code set.
For more tips on ways to make the ICD 9 to ICD 10 transition, sign up for a one-stop medical coding update. Such a site comes stocked with an ICD-10 bridge to make the transition much easier!
Monday, September 27, 2010
More Documentation Requirements add to Physician Burden
More Documentation Requirements add to Physician Burden
Medical Coders need to look on Medical coding because more documentation is requirements add to physician burden.
Medical Coding, Code lookup
Home health agencies will have less control over new doctor-related payment condition. Agencies are hoping for some big changes to one troublesome provision in the 2011 proposed payment rule – the face-to-face doctor encounter requirement.
The mandate for the face-to-face encounter was in the Patient Protection and Affordable Care Act health care reform law enacted this year. However, the CMS version of the requirement is more stricter than the law calls for.
For instance: The proposed rule also requires that the encounter be for the primary reason home care services are required and that doctors furnish 'unprecedented' physician documentation about the encounter and why the patient meets homebound criteria.
According to industry experts, the proposed face-to-face encounter requirement is riddled with problems for home health agencies. To start with, agencies have very little influence over whether their patients make it to a physician for a visit.
It is absolutely not proper to place a requirement on home health providers for which they have no control whatsoever, as a consultant puts it. “How is the staff of the home health provider supposed to ensure that the patient goes to the physician and that the physician documents right in her office records?"
One can make appointments for patients; however we cannot ensure they keep them; that their transportation is unfailing, that they feel well enough to make the trip. In fact, there are many reasons that patients fail to see the doctor despite the best efforts of the home care staff to make it happen.
For more on this, sign up for a one-stop medical coding website. Such a site comes with a code lookup tool that will help you in your coding.
Medical Coders need to look on Medical coding because more documentation is requirements add to physician burden.
Medical Coding, Code lookup
Home health agencies will have less control over new doctor-related payment condition. Agencies are hoping for some big changes to one troublesome provision in the 2011 proposed payment rule – the face-to-face doctor encounter requirement.
The mandate for the face-to-face encounter was in the Patient Protection and Affordable Care Act health care reform law enacted this year. However, the CMS version of the requirement is more stricter than the law calls for.
For instance: The proposed rule also requires that the encounter be for the primary reason home care services are required and that doctors furnish 'unprecedented' physician documentation about the encounter and why the patient meets homebound criteria.
According to industry experts, the proposed face-to-face encounter requirement is riddled with problems for home health agencies. To start with, agencies have very little influence over whether their patients make it to a physician for a visit.
It is absolutely not proper to place a requirement on home health providers for which they have no control whatsoever, as a consultant puts it. “How is the staff of the home health provider supposed to ensure that the patient goes to the physician and that the physician documents right in her office records?"
One can make appointments for patients; however we cannot ensure they keep them; that their transportation is unfailing, that they feel well enough to make the trip. In fact, there are many reasons that patients fail to see the doctor despite the best efforts of the home care staff to make it happen.
For more on this, sign up for a one-stop medical coding website. Such a site comes with a code lookup tool that will help you in your coding.
Coding & Billing: Clarify 'Present & Immediately Available'
'Physically present and available' can be one of the most difficult factors to determine when confirming medical direction.
Coding & billing, coding updates, coding updates
'Physically present and available' can be one of the most difficult factors to determine when confirming medical direction. You should keep these guides in mind when deciding whether your anesthesiologist's claim still merits medical direction modifiers QY or QK.
Think about individual circumstances
Vague medical direction rules like 'remains physically present and available for immediate diagnosis and treatment of emergencies' allow for individual interpretation.
Defining 'immediately available' accurately is more than looking at the hospital's blueprints to see how far your physician walks down the hall. Interpretation also takes each situation into account. For instance, the anesthesiologist needs to be more easily available to help during an emergency when he is medically directing an aneurysm repair versus a hernia repair.
Think about these three factors when trying to determine what qualifies as 'physically present and available' in your hospital.
OR Size:
Service location:
Patient condition:
Key determinant: Think how quickly the anesthesiologist could help the medically directed CRNA in the event of an emergency. If the anesthesiologist is away from the OR suite or outside the surgery department, is he 'immediately available' to return if required? If so, his work might still fit under the medical direction umbrella; if not, you might need to rethink his status.
Know how the factors impact coding & billing
The factors listed above will not change your code for the procedure itself, however can change the anesthesiologist's performance modifier and his reimbursement. If the anesthesiologist personally carries out a case, you know where he is for the entire procedure and report modifier AA with the procedure code. The carrier shells out money for the entire case.
Coding gets tougher when the anesthesiologist oversees other members of the team rather than personally performs cases. If he medically directs one CRNA, report modifier QY with the procedure code; if he directs from two to four anesthetists, report modifier QK instead. Doctors who medically direct cases split the procedure fee with the other anesthetist involved.
For more on this and other medical coding updates , sign up http://www.supercoder.com/.
Coding & billing, coding updates, coding updates
'Physically present and available' can be one of the most difficult factors to determine when confirming medical direction. You should keep these guides in mind when deciding whether your anesthesiologist's claim still merits medical direction modifiers QY or QK.
Think about individual circumstances
Vague medical direction rules like 'remains physically present and available for immediate diagnosis and treatment of emergencies' allow for individual interpretation.
Defining 'immediately available' accurately is more than looking at the hospital's blueprints to see how far your physician walks down the hall. Interpretation also takes each situation into account. For instance, the anesthesiologist needs to be more easily available to help during an emergency when he is medically directing an aneurysm repair versus a hernia repair.
Think about these three factors when trying to determine what qualifies as 'physically present and available' in your hospital.
OR Size:
Service location:
Patient condition:
Key determinant: Think how quickly the anesthesiologist could help the medically directed CRNA in the event of an emergency. If the anesthesiologist is away from the OR suite or outside the surgery department, is he 'immediately available' to return if required? If so, his work might still fit under the medical direction umbrella; if not, you might need to rethink his status.
Know how the factors impact coding & billing
The factors listed above will not change your code for the procedure itself, however can change the anesthesiologist's performance modifier and his reimbursement. If the anesthesiologist personally carries out a case, you know where he is for the entire procedure and report modifier AA with the procedure code. The carrier shells out money for the entire case.
Coding gets tougher when the anesthesiologist oversees other members of the team rather than personally performs cases. If he medically directs one CRNA, report modifier QY with the procedure code; if he directs from two to four anesthetists, report modifier QK instead. Doctors who medically direct cases split the procedure fee with the other anesthetist involved.
For more on this and other medical coding updates , sign up http://www.supercoder.com/.
Wednesday, September 22, 2010
CCI 16.3 to Reserve Edits Involving Vestibular Testing
Correct Coding Initiative (CCI) came down hard on practitioners who carry out vestibular testing; however a new correction.
CCI coding , CCI codes, CCI 16.3, 2010 CPT manual, Medical Coding
From october 1, you will be able to use a modifier to separate these services when they are carried out as distinct procedural services.
Earlier, the Correct Coding Initiative (CCI) came down hard on practitioners who carry out vestibular testing; however a new correction, with effect from October 1 this year should ease the restrictions and aid the otolaryngology practices that report these services.
The problem: Presently, CCI codes restrict practices from reporting 92541, 92542, 92544, and 92545 individually if three or less of the tests are carried out.
The solution: With effect from October 1, if two or three of these codes are reported for the same date of service (DOS) by the same provider for the same beneficiary, an NCCI-associated modifier may be used to bypass the NCCI edits.
Watch out for changes to vestibular testing descriptors
The root of the CCI problem started when the 2010 CPT manual was published, including new code 92540 and the subsequent codes following it, which make up the individual components of 92540. The clarification that resulted in the NCCI edits being lifted should be covered in the upcoming versions of the manual.
For the latest CCI codes(http://www.supercoder.com/coding-tools/cci-edits-checker/), sign up for a one-stop medical coding website. When you register yourself for one, you'll get the latest updates pertaining to these CCI codes. You'll also have access to a CCI coding tool that will offer you a fast solution to keep your claims compliant with NCCI. The tool will tell you if CCI bundles a code combination and if the edit allows a modifier.
CCI coding , CCI codes, CCI 16.3, 2010 CPT manual, Medical Coding
From october 1, you will be able to use a modifier to separate these services when they are carried out as distinct procedural services.
Earlier, the Correct Coding Initiative (CCI) came down hard on practitioners who carry out vestibular testing; however a new correction, with effect from October 1 this year should ease the restrictions and aid the otolaryngology practices that report these services.
The problem: Presently, CCI codes restrict practices from reporting 92541, 92542, 92544, and 92545 individually if three or less of the tests are carried out.
The solution: With effect from October 1, if two or three of these codes are reported for the same date of service (DOS) by the same provider for the same beneficiary, an NCCI-associated modifier may be used to bypass the NCCI edits.
Watch out for changes to vestibular testing descriptors
The root of the CCI problem started when the 2010 CPT manual was published, including new code 92540 and the subsequent codes following it, which make up the individual components of 92540. The clarification that resulted in the NCCI edits being lifted should be covered in the upcoming versions of the manual.
For the latest CCI codes(http://www.supercoder.com/coding-tools/cci-edits-checker/), sign up for a one-stop medical coding website. When you register yourself for one, you'll get the latest updates pertaining to these CCI codes. You'll also have access to a CCI coding tool that will offer you a fast solution to keep your claims compliant with NCCI. The tool will tell you if CCI bundles a code combination and if the edit allows a modifier.
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