Making assumptions about automatically applying 22 will land you in OIG hot water.
If you overuse modifier 22 (Increased procedural services) you'll wind up facing scrutiny -- or worse -- from your payers or even the Office of Inspector General (OIG). But if you avoid the modifier entirely, you're likely missing out on reimbursement your physician deserves.
How it works: When a procedure requires significant additional time or effort that falls outside the range of services described by a particular CPT code -- and no other CPT code better describes the work involved in the procedure" you should look to modifier 22. Modifier 22 represents those extenuating circumstances that don't merit the use of an additional or alternative CPT code but instead raise the reimbursement for a given procedure.
Take a look at these three myths -- and the realities -- to ensure you don't fall victim to the modifier 22 catch-22.
Myth #1: Morbid Obesity Means Automatic 22
While morbid obesity is sometimes an appropriate reason to use modifier 22, it's not appropriate to assume that just because the patient is morbidly obese you can append modifier 22.
"Modifier 22 is about extra procedural work and, although morbid obesity might lead to extra work, it is not enough in itself," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle.
"Unless time is significant or the intensity of the procedure is increased due to the obesity, then modifier 22 should not be appended," warns Maggie Mac, CPC, CEMC, CHC, CMM, ICCE, director of best practices -- network operations at Mount Sinai Hospital in New York City.
There are some scenarios where you usually be considering whether modifier 22 is appropriate -- such as reoperations, unusual body habitus (obesity, unusually thin, tall, short, etc.), altered anatomy (congenital or due to trauma or previous surgery), and very extensive injury or disease -- but do not automatically append modifier 22 without the documentation to back it up. You'll only be able to append modifier 22 when a procedure requires substantially greater additional time or effort because of the patient's obesity.
Check the notes: To support appending the modifier, your physician should document how the patient's obesity increased the complexity of that particular case. CPT specifically recommends that surgeons document the reason for the additional effort, such as "increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required."
Article source :- http://www.supercoder.com/coding-newsletters/my-practice-management-alert/coding-corner-overcome-modifier-22-mishaps-with-3-mythbusters-article
Thursday, June 30, 2011
Tuesday, June 28, 2011
ICD-10 Preparation: Not Planning to Transition to ICD-10 as of Oct. 1, 2013? You Might Be Liable to Face Millions in Fines, CMS Reps Say
Plus: CMS officials are considering how to handle dates of service that span the pre- and post-ICD-10 implementation dates.
If you think the ICD-10 codes won't apply to your Medicare claims as of Oct. 1, 2013, CMS has news for you--not only will your claims be denied if you continue to submit ICD-9 codes to Medicare after that date, but you could face fines. CMS representatives shed light on this and several other issues during the agency's May 18 "ICD-10 National Provider Teleconference," and we've broken down the five FAQs that best apply to Part B practices.
Question 1: How will CMS handle claims that span from before Oct. 1, 2013 through dates after Oct. 1, 2013? Should the practitioner use ICD-9 or ICD-10 codes for these claims?
Answer: CMS is mulling how to handle this situation, but hasn't yet arrived at a firm decision. "We are getting very close to finalizing our decision for all claim types, including professional claims, supplier claims, and the various types of institutional claims," said CMS's Sarah Shirey-Losso during the call. "Some claims will continue to use the discharge date, some will use the ‘from' date, and some may be required to be split," she said.
Stay tuned: CMS is currently working on a final decision, which the agency will issue in a "Change Request" document this summer.
Date of service issue: If, however, you submit a claim for a single date of service, you'll submit ICD-9 codes for dates of service through Sept. 30, 2013, and ICD-10 codes for dates of service Oct. 1, 2013 and thereafter. For instance: If you send in a claim on Oct. 15, 2013, but the date of service is Sept. 1, 2013, you'll still use ICD-9 codes.
Question 2: Will workers' compensation insurers still use ICD-9, even after the rest of the industry transitions to ICD-10 after Oct. 1, 2013?
Answer: The answer to that is unclear, but CMS has heard murmurs that workers' comp. insurers will switch over to ICD-10.
"We've heard anecdotally that even though they're not required to transition to ICD-10, that many of them are planning to, just because it's more practical to do so and they see that it's the way the rest of the industry is going," said CMS's Denise Buenning, MsM, during the call.
What about Medicaid? You can rest assured that Medicaid insurers will be transitioning to ICD-10 as of the Oct. 1, 2013 date, Buenning said. CMS is working with Medicaid administrators to ensure that they are compliant by the implementation date, she noted.
Article Source :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/icd-10-preparation-not-planning-to-transition-to-icd-10-as-of-oct-1-2013-you-might-be-liable-to-face-millions-in-fines-cms-reps-say-106761-article
If you think the ICD-10 codes won't apply to your Medicare claims as of Oct. 1, 2013, CMS has news for you--not only will your claims be denied if you continue to submit ICD-9 codes to Medicare after that date, but you could face fines. CMS representatives shed light on this and several other issues during the agency's May 18 "ICD-10 National Provider Teleconference," and we've broken down the five FAQs that best apply to Part B practices.
Question 1: How will CMS handle claims that span from before Oct. 1, 2013 through dates after Oct. 1, 2013? Should the practitioner use ICD-9 or ICD-10 codes for these claims?
Answer: CMS is mulling how to handle this situation, but hasn't yet arrived at a firm decision. "We are getting very close to finalizing our decision for all claim types, including professional claims, supplier claims, and the various types of institutional claims," said CMS's Sarah Shirey-Losso during the call. "Some claims will continue to use the discharge date, some will use the ‘from' date, and some may be required to be split," she said.
Stay tuned: CMS is currently working on a final decision, which the agency will issue in a "Change Request" document this summer.
Date of service issue: If, however, you submit a claim for a single date of service, you'll submit ICD-9 codes for dates of service through Sept. 30, 2013, and ICD-10 codes for dates of service Oct. 1, 2013 and thereafter. For instance: If you send in a claim on Oct. 15, 2013, but the date of service is Sept. 1, 2013, you'll still use ICD-9 codes.
Question 2: Will workers' compensation insurers still use ICD-9, even after the rest of the industry transitions to ICD-10 after Oct. 1, 2013?
Answer: The answer to that is unclear, but CMS has heard murmurs that workers' comp. insurers will switch over to ICD-10.
"We've heard anecdotally that even though they're not required to transition to ICD-10, that many of them are planning to, just because it's more practical to do so and they see that it's the way the rest of the industry is going," said CMS's Denise Buenning, MsM, during the call.
What about Medicaid? You can rest assured that Medicaid insurers will be transitioning to ICD-10 as of the Oct. 1, 2013 date, Buenning said. CMS is working with Medicaid administrators to ensure that they are compliant by the implementation date, she noted.
Article Source :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/icd-10-preparation-not-planning-to-transition-to-icd-10-as-of-oct-1-2013-you-might-be-liable-to-face-millions-in-fines-cms-reps-say-106761-article
Tuesday, June 14, 2011
Be Well-Versed With the Multiple Scope Rule
Here are four medical coding strategies every ortho coder needs to know.
If your orthopedist carries out several procedures during a knee arthroscopy on the same patient on the same day, you will need to understand the multiple-scope rule to figure out which procedures you can claim in reality and get paid for.
Exception: Remember that the multiple-scope rule applies mainly to shoulder and knee procedures in the orthopedic practice. However it also affects those of the elbow, wrist and hip. On the other hand, it doesn't apply to ankle or metacarpophalangeal (MCP) arthroscopy, and it does not impact arthroscopically aided procedures. What's more, some surgical knee arthroscopies are excluded from the family -- specifically, 29866-29868.
Here are some sure success medical coding tips:
For scope families, look to CPT
Prior to worrying about how to apply the multiple-endoscopy rule, you must first know why and when it applies. The multiple-endoscopy rule is Medicare's method to avoid double payment (or more) for inclusive services by paying back only a portion of any scope carried out at the same time as another scope of the same basic type.
Here's how the rule functions: CPT divides groups of similar codes into so-called families. The first code describes the basic procedure. Following the base code, CPT lists any variants that go beyond the base code. For instance take this partial code family: 29805, 29806, 29807, and 29819.
Always include the 'base' procedure
Let the say that the doctor has carried out a diagnostic shoulder arthroscopy (29805) plus shoulder arthroscopy for repair of SLAP lesion (29807). How does the multiple-scope rule apply here?
Bear in mind: Family codes always include the work involved in the base code and a surgical scope always includes the diagnostic scope of the same type. As such, you would only code 29807 in this case.
And what about diagnostic shoulder arthroscopy followed by arthroscopic limited debridement? Again, you should code only the more extensive procedure – in this instance 29822.
If there is no base procedure, you should bill both scopes
If the surgeon carries out two scopes in the same family, neither of which happens to be the base procedure, you should report both codes. Therefore, if your orthopedist carries out shoulder arthroscopy with foreign-body removal (29819) followed by shoulder arthroscopy for thorough synovectomy, you'd go for both 29819 and 29821.
Keep a watch on your reimbursement
Medicare will shell out money for the entire fee schedule amount only for the highest-valued scope in a given code family during the same operative session. Medicare carriers will pay any additional scopes in the same family by subtracting the value of the base scope in that family and paying the difference.
If your orthopedist carries out several procedures during a knee arthroscopy on the same patient on the same day, you will need to understand the multiple-scope rule to figure out which procedures you can claim in reality and get paid for.
Exception: Remember that the multiple-scope rule applies mainly to shoulder and knee procedures in the orthopedic practice. However it also affects those of the elbow, wrist and hip. On the other hand, it doesn't apply to ankle or metacarpophalangeal (MCP) arthroscopy, and it does not impact arthroscopically aided procedures. What's more, some surgical knee arthroscopies are excluded from the family -- specifically, 29866-29868.
Here are some sure success medical coding tips:
For scope families, look to CPT
Prior to worrying about how to apply the multiple-endoscopy rule, you must first know why and when it applies. The multiple-endoscopy rule is Medicare's method to avoid double payment (or more) for inclusive services by paying back only a portion of any scope carried out at the same time as another scope of the same basic type.
Here's how the rule functions: CPT divides groups of similar codes into so-called families. The first code describes the basic procedure. Following the base code, CPT lists any variants that go beyond the base code. For instance take this partial code family: 29805, 29806, 29807, and 29819.
Always include the 'base' procedure
Let the say that the doctor has carried out a diagnostic shoulder arthroscopy (29805) plus shoulder arthroscopy for repair of SLAP lesion (29807). How does the multiple-scope rule apply here?
Bear in mind: Family codes always include the work involved in the base code and a surgical scope always includes the diagnostic scope of the same type. As such, you would only code 29807 in this case.
And what about diagnostic shoulder arthroscopy followed by arthroscopic limited debridement? Again, you should code only the more extensive procedure – in this instance 29822.
If there is no base procedure, you should bill both scopes
If the surgeon carries out two scopes in the same family, neither of which happens to be the base procedure, you should report both codes. Therefore, if your orthopedist carries out shoulder arthroscopy with foreign-body removal (29819) followed by shoulder arthroscopy for thorough synovectomy, you'd go for both 29819 and 29821.
Keep a watch on your reimbursement
Medicare will shell out money for the entire fee schedule amount only for the highest-valued scope in a given code family during the same operative session. Medicare carriers will pay any additional scopes in the same family by subtracting the value of the base scope in that family and paying the difference.
Which Nerve Conduction Study Code Is Right for you?
Selecting the proper code to describe your nerve conduction test can prove to be a demanding proposition; but that need not be the case if you learn three important areas:
Here are some steps to boost your medical coding and billing know how and to make the proper choice every time.
Physicians make use of nerve conduction studies (NCS) to assess the function and electrical conduction of motor and sensory nerves in the body. CPT provides you with three options when you face nerve conduction studies coding: 95900, 95903, and 95904.
First step: Review carefully the physician's documentation for the individual nerves stimulated. Bear in mind that you can report only one unit of service of the corresponding NCS code when the neurologist carries out a diagnostic study on the same nerve at multiple sites.
Use codes 95900, 95903, and 95904 by "each nerve and ensure you follow this guide and are not reporting multiple units of service for NCS testing at multiple sites on the same nerve as "separate nerves".
Go for 95900, 95903 and/or 95904 only once when the provider stimulates or records multiple sites on the same nerve. Code 95903 includes both the F-wave study and the underlying motor nerve conduction study. As per NCCI edits, you cannot bill both 95900 and 95903 for motor NCS testing on the same nerve. CCI takes the Column 2 code, 95900 as a component of the more comprehensive Column 1 code 95903.
You should know when to add modifiers
While coding nerve conduction studies, modifiers can certainly come in handy especially when the doctor tests different nerves or nerve braches or carries out different diagnostic NCS.
Here's an example: The physician carries out a motor NCS without F-wave on the right motor ulnar nerve to the abductor digit minimi (ADM) muscles. During the same procedure, he also carries out a motor nerve conduction study with F-wave on the right radial motor nerve to the extensor digitorum communis (EDC) muscle.
You should report 95900 for the first motor NCS and 95903 for the second owing to the fact that the doctor carried out the diagnostic studies on different nerves. Add modifier 59 to the 95900 code to indicate that the physician performed a separate motor NCS on a different nerve.
You should establish medical necessity
The patient's signs and/or symptoms or a confirmed diagnosis support medical necessity while ordering a diagnostic procedure. The doctor must document the information in the order and note for the procedure. Information aiding medical necessity should also be in the professional interpretation report for the diagnostic study.
Caution: NCS studies look for underlying conditions or injuries that could cause compromised nerve function. Owing to this, numbness, tingling, weakness, and loss of sensation are all symptoms that can help support medical necessity for the diagnostic study, particularly when the final interpretation points to normal NCS.
For further details on this and for other medical coding and billing updates, sign up for a one-stop medical coding guide like Supercoder.
For More Info :- http://www.supercoder.com/coding-newsletters/my-neurology-coding-alert/know-which-nerve-conduction-study-code-is-right-for-you-article
Here are some steps to boost your medical coding and billing know how and to make the proper choice every time.
Physicians make use of nerve conduction studies (NCS) to assess the function and electrical conduction of motor and sensory nerves in the body. CPT provides you with three options when you face nerve conduction studies coding: 95900, 95903, and 95904.
First step: Review carefully the physician's documentation for the individual nerves stimulated. Bear in mind that you can report only one unit of service of the corresponding NCS code when the neurologist carries out a diagnostic study on the same nerve at multiple sites.
Use codes 95900, 95903, and 95904 by "each nerve and ensure you follow this guide and are not reporting multiple units of service for NCS testing at multiple sites on the same nerve as "separate nerves".
Go for 95900, 95903 and/or 95904 only once when the provider stimulates or records multiple sites on the same nerve. Code 95903 includes both the F-wave study and the underlying motor nerve conduction study. As per NCCI edits, you cannot bill both 95900 and 95903 for motor NCS testing on the same nerve. CCI takes the Column 2 code, 95900 as a component of the more comprehensive Column 1 code 95903.
You should know when to add modifiers
While coding nerve conduction studies, modifiers can certainly come in handy especially when the doctor tests different nerves or nerve braches or carries out different diagnostic NCS.
Here's an example: The physician carries out a motor NCS without F-wave on the right motor ulnar nerve to the abductor digit minimi (ADM) muscles. During the same procedure, he also carries out a motor nerve conduction study with F-wave on the right radial motor nerve to the extensor digitorum communis (EDC) muscle.
You should report 95900 for the first motor NCS and 95903 for the second owing to the fact that the doctor carried out the diagnostic studies on different nerves. Add modifier 59 to the 95900 code to indicate that the physician performed a separate motor NCS on a different nerve.
You should establish medical necessity
The patient's signs and/or symptoms or a confirmed diagnosis support medical necessity while ordering a diagnostic procedure. The doctor must document the information in the order and note for the procedure. Information aiding medical necessity should also be in the professional interpretation report for the diagnostic study.
Caution: NCS studies look for underlying conditions or injuries that could cause compromised nerve function. Owing to this, numbness, tingling, weakness, and loss of sensation are all symptoms that can help support medical necessity for the diagnostic study, particularly when the final interpretation points to normal NCS.
For further details on this and for other medical coding and billing updates, sign up for a one-stop medical coding guide like Supercoder.
For More Info :- http://www.supercoder.com/coding-newsletters/my-neurology-coding-alert/know-which-nerve-conduction-study-code-is-right-for-you-article
Monday, June 13, 2011
Know Your Cirrhosis Diagnosis Options
Staying tuned to specialty coding libraries will help you stand in good stead as far as cirrhosis diagnosis options and other coding know how is concerned.
Here's a scenario: According to medical records, your gastroenterologist treats a patient for "cirrhosis likely secondary to alcohol dependency complicated by varices with GI bleeding." In this situation, what cirrhosis diagnosis code should you report?
Well, none between alchoholic cirrhosis (571.2) and 571.5 could describe the condition more properly. Depending on what (if any) procedures the doctor carried out during this encounter, you should code it with gastrointestinal bleeding as the diagnosis (578.9, Hemorrhage of gastrointestinal tract, unspecified).
You should think about 456.20 as an option in the name of specificity. According to a note in the description of this code in the ICD-9 manual, you must code the underlying cause (either cirrhosis of the liver or portal hypertension) as the primary diagnosis, which forces you to select between alcoholic and non-alcoholic cirrhosis.
Reminder: Don't code for suspect, rule-out or probable diagnoses. In this instance, the gastroenterologist isn't sure this is alcoholic cirrhosis; as such you shouldn't code it as such. This practice protects the patient as well. If it turns out that it's not alcoholic cirrhosis, you have incorrectly labeled the patient as alcohol-dependent with his insurance company.
For further details on this and for other specialty-specific articles to assist your coding, sign up for a one-stop medical coding guide like Supercoder. Such a site comes with a Specialty Coding Library to assist you in your everyday coding. The library will help you get every dollar your practice deserves. A lot of people rely on this specialty library which offers 12 monthly issues of the Specialty Coding Alert of your choice, reader questions answered by experts, CPC moderated forums, 14 Specialty-specific SuperCoder Survival Guides, and you just name it.
Whether it's a powerful code reference tool, a real-time claims auditor to help you reduce denials or step-by-step guidance from CPC certified experts, we've got you covered. Some of our products like Physician Coding Bundle, Ambulatory Surgery Center (ASC) Authority, etc provide you with just the ammunition you need to get instant success.
Here's a scenario: According to medical records, your gastroenterologist treats a patient for "cirrhosis likely secondary to alcohol dependency complicated by varices with GI bleeding." In this situation, what cirrhosis diagnosis code should you report?
Well, none between alchoholic cirrhosis (571.2) and 571.5 could describe the condition more properly. Depending on what (if any) procedures the doctor carried out during this encounter, you should code it with gastrointestinal bleeding as the diagnosis (578.9, Hemorrhage of gastrointestinal tract, unspecified).
You should think about 456.20 as an option in the name of specificity. According to a note in the description of this code in the ICD-9 manual, you must code the underlying cause (either cirrhosis of the liver or portal hypertension) as the primary diagnosis, which forces you to select between alcoholic and non-alcoholic cirrhosis.
Reminder: Don't code for suspect, rule-out or probable diagnoses. In this instance, the gastroenterologist isn't sure this is alcoholic cirrhosis; as such you shouldn't code it as such. This practice protects the patient as well. If it turns out that it's not alcoholic cirrhosis, you have incorrectly labeled the patient as alcohol-dependent with his insurance company.
For further details on this and for other specialty-specific articles to assist your coding, sign up for a one-stop medical coding guide like Supercoder. Such a site comes with a Specialty Coding Library to assist you in your everyday coding. The library will help you get every dollar your practice deserves. A lot of people rely on this specialty library which offers 12 monthly issues of the Specialty Coding Alert of your choice, reader questions answered by experts, CPC moderated forums, 14 Specialty-specific SuperCoder Survival Guides, and you just name it.
Whether it's a powerful code reference tool, a real-time claims auditor to help you reduce denials or step-by-step guidance from CPC certified experts, we've got you covered. Some of our products like Physician Coding Bundle, Ambulatory Surgery Center (ASC) Authority, etc provide you with just the ammunition you need to get instant success.
Code the More Complex Procedure With 69610-RT
In a particular situation, a physician assessed the patient's right ear and cleared the canal of all cerumen. The tympanic membrane was visualized, which had retained a tube. He removed a tube in the anterior superior aspect of the eardrum with a Rosen needle while ciprodex was applied. Post this, a paper patch was placed in an overlay technique and positioned using the operative microscope. After this, the physician went to the left ear and got rid of some dry debris. He also got rid of an extruded tube. There wasn't any perforation in situ; he debrided the canal and applied Ciprodex. As such, how do you report this?
Well, first of all you need to code the more complex procedure with 69610-RT.
Call off these choices: You can't code for the binocular microscope since it's a separate procedure and inclusive minus any other ear procedure carried out. Likewise, the removal of impacted cerumen is also a separate procedure, and insurers take it as inclusive with any other ear procedure. What's more, if the physician carried out this service in the operating room, you can't code 69990 because even though the physician used the operating microscope, coding 69990 requires the use of microsurgical technique. These procedures show no proof of microsurgery.
Next, you should code 69424-59-LT if the doctor carried out this procedure in the operating room under general anesthesia. If the doctor carried out this service under local anesthesia in the OR or in the office, you can code it 92504-59-LT for the use of the binocular microscope as you won't find any code for tube removal when the physician does not use general anesthesia.
Typically, if an otologic procedure requires a transcanal or endaural approach with incision of the tympanic membrane and access through the middle ear, you shouldn't report it separately. But then your physician carried out these services on two ears and should be paid for them as separate procedures. Your claim should look like this: 69610-RT, 69424-59-LT or 92504-59-LT depending on the type of anesthesia the physician used.
For further details on this and for other physician medical billing and coding tips, sign up for a one-stop medical coding guide like Supercoder. Such a site comes stocked with a physician coder's Powerpack that offers powerful physician medical billing and coding tools to provide you everything you need for denial-proof claims. It comes with codesets and tools, specialty coding library, SuperScrubber for physicians, CPT Assistant, and the like.
Well, first of all you need to code the more complex procedure with 69610-RT.
Call off these choices: You can't code for the binocular microscope since it's a separate procedure and inclusive minus any other ear procedure carried out. Likewise, the removal of impacted cerumen is also a separate procedure, and insurers take it as inclusive with any other ear procedure. What's more, if the physician carried out this service in the operating room, you can't code 69990 because even though the physician used the operating microscope, coding 69990 requires the use of microsurgical technique. These procedures show no proof of microsurgery.
Next, you should code 69424-59-LT if the doctor carried out this procedure in the operating room under general anesthesia. If the doctor carried out this service under local anesthesia in the OR or in the office, you can code it 92504-59-LT for the use of the binocular microscope as you won't find any code for tube removal when the physician does not use general anesthesia.
Typically, if an otologic procedure requires a transcanal or endaural approach with incision of the tympanic membrane and access through the middle ear, you shouldn't report it separately. But then your physician carried out these services on two ears and should be paid for them as separate procedures. Your claim should look like this: 69610-RT, 69424-59-LT or 92504-59-LT depending on the type of anesthesia the physician used.
For further details on this and for other physician medical billing and coding tips, sign up for a one-stop medical coding guide like Supercoder. Such a site comes stocked with a physician coder's Powerpack that offers powerful physician medical billing and coding tools to provide you everything you need for denial-proof claims. It comes with codesets and tools, specialty coding library, SuperScrubber for physicians, CPT Assistant, and the like.
Thursday, June 9, 2011
Hyaluronic Acid Injections: 'Count Correctly' to get your Rightful Reimbursements
For some time, Hyaluronate injections have had its own J code. However it has been changed from 'unspecified' to its own assigned code, back to 'unspecified' and then back to an assigned HCPCS code. Now that all hyaluronate injections fall under the same code, here are three medical coding tips to remember and help you calculate the right way.
Validate the type of medication
Physicians make use of hyaluronate injections to lessen the patient's pain owing to osteoarthritis of the knee. The medications achieve the same purpose and you report both types of injections with J7325. Correct coding depends on the medication used and the number of units you report. Synvisc-One is a one-shot injection equaling 6 cc of the medication. The patient sees your physician once for the full injection, which you report as 48 units of J7325 (2 cc = 16 g, so 6 cc = 48 mg). Physicians administer the other forms of hyaluronate as a series of injections instead of one shot at a single patient visit. Watch the dosage amounts closely so that you will report the correct number of J7325 units for each administration.
Chart note: Owing to the difference in calculations and unit reporting, the doctor must clearly document the medication used and number of units administered. Medication reimbursement can be low; as such wrong or unclear documentation could mean the difference between some payment versus virtually none. Some providers give patients a prescription for hyaluronate (depending on the insurer) and ask them to get the medication and return to the physician's office for the injection.
Injection: Code J7325 represents the medication only; as such you still need to report the injection procedure. Submit 20610; take a look at the diagnosis code. Medicare will only pay for hyaluronate injections to treat osteoarthritis of the knee. You have several diagnosis choices; as such be sure one of these applies to help smooth your claims processing: 715.16, 715.26, 715.36, and 715.96.
Anatomy note: Your 'additional digit' choices for the 715. xx code family do not include a specific option for knee. While selecting the best anatomic choice, take the knee part of the lower leg in place of pelvic region and thigh.
Figure out whether evaluation & management and modifiers apply
Some visits for hyaluronate injections qualify for an evaluation & management code or modifiers; however others do not. If the patient comes to your office specifically for a scheduled Synvisc-One injection, you will only report the injection code. However, if the physician completes another service during the visit, an E/M code might apply.
For more on this and for other medical coding articles to assist your orthopedic coding, sign up for a one-stop medical coding guide like Supercoder.
Validate the type of medication
Physicians make use of hyaluronate injections to lessen the patient's pain owing to osteoarthritis of the knee. The medications achieve the same purpose and you report both types of injections with J7325. Correct coding depends on the medication used and the number of units you report. Synvisc-One is a one-shot injection equaling 6 cc of the medication. The patient sees your physician once for the full injection, which you report as 48 units of J7325 (2 cc = 16 g, so 6 cc = 48 mg). Physicians administer the other forms of hyaluronate as a series of injections instead of one shot at a single patient visit. Watch the dosage amounts closely so that you will report the correct number of J7325 units for each administration.
Chart note: Owing to the difference in calculations and unit reporting, the doctor must clearly document the medication used and number of units administered. Medication reimbursement can be low; as such wrong or unclear documentation could mean the difference between some payment versus virtually none. Some providers give patients a prescription for hyaluronate (depending on the insurer) and ask them to get the medication and return to the physician's office for the injection.
Injection: Code J7325 represents the medication only; as such you still need to report the injection procedure. Submit 20610; take a look at the diagnosis code. Medicare will only pay for hyaluronate injections to treat osteoarthritis of the knee. You have several diagnosis choices; as such be sure one of these applies to help smooth your claims processing: 715.16, 715.26, 715.36, and 715.96.
Anatomy note: Your 'additional digit' choices for the 715. xx code family do not include a specific option for knee. While selecting the best anatomic choice, take the knee part of the lower leg in place of pelvic region and thigh.
Figure out whether evaluation & management and modifiers apply
Some visits for hyaluronate injections qualify for an evaluation & management code or modifiers; however others do not. If the patient comes to your office specifically for a scheduled Synvisc-One injection, you will only report the injection code. However, if the physician completes another service during the visit, an E/M code might apply.
For more on this and for other medical coding articles to assist your orthopedic coding, sign up for a one-stop medical coding guide like Supercoder.
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