CPT 2012: 62310, 62318 Revisions Help Simplify Your Single Shot vs. Indwelling Catheter Coding

Plus: Get ready for changes to 77003, too.

Though you won't report new or revised CPT® anesthesia codes until January 2012, get ready -- and your anesthesia providers -- at this time for revisions that can impact your everyday coding, for instance the rewording of two general epidural codes.

Observe the Descriptor Differences

The chief modifications are applicable to epidural codes 62310 along with 62318. The existing and upcoming descriptors are as follows:

The novel descriptors include several changes:

62310 specifies that it can be used for more than one single injection.

62310 no longer statesthe possible use for epidurography. Epidurography is a distinct procedure that doesn't need to be associated with this code.

The existing version of 62310 doesn't involve catheter administration, however the revised descriptor does. Physicians were placing catheters for single shots and trying to bill 62310 or 62311. The dissimilarity is that one pair of anesthesia codes is for constant or continuous bolus (62318/62319). The other is for a single distinct dose at a time (62310/62311), irrespective of catheter use.

The revised 62318 explains "indwelling" catheter and changes from "injection" to "injections".

Keep in mind: Anesthesia codes 62311 as well as 62319 now read "lumbar or sacral (caudal)" in place of "lumbar; sacral (caudal)."


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Don't Miss Fluoro and Nerve Destruction Changes

In case you occasionally report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, subarachnoid, or sacroiliac joint], including neurolytic agent destruction) in combination with diagnostic or therapeutic injections, make certain that you note the descriptor change, come January.

The novel descriptor will read "Fluoroscopic guidance and localization or needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid)."

Change: The code no longer covers guidance for sacroiliac joint injections or neurolytic agent destruction.

Replacements: Codes 64622-64627 for paravertebral facet joint nerve destruction have been deleted and replaced with following listed four novel anesthesia codes :

64633 – i.e. Destruction by means of neurolytic agent, paravertebral facet joint nerve(s) including imaging guidance (fluoroscopy or CT); cervical or thoracic, as well as single facet joint

64634 -- i.e.... cervical or thoracic, every additional facet joint (List separately in addition to code for primary procedure)

64635 -- i.e.... lumbar or sacral, as well as single facet joint

64636 -- i.e.... lumbar or sacral, every additional facet joint (List separately in addition to code for primary procedure).

ICD-9 Coding: 700 Basics: Simplify Corn and Callus Coding

Learn what to do when these lesser-known terms show up in your doctor's documentation?

For dermatologists who are treating the skin of a patient's foot, one of the most generally coded diagnoses is corns (and calluses). This particular condition has a slew of puzzling names that may be difficult to find -- or may not be present in your ICD-9 coding book -- and could quickly overturn your claims.

Decoding all of the corn and callus terminology can be particularly complex in case you work for numerous physicians and each one has his own particular way of naming the same thing, or in case you've lately started working at another practice. But you no longer have to be ignorant as far as a callus-related term is concerned.

Watch out: "Tylosis" could lead you down the erroneous coding path if you're not cautious. The ICD-9 index present in the front of the coding book presents numerous options, for instance 757.39 (Other specified amomalies of skin; other; includes accessory skin tags, congenital; congenital scar; epidermolysis bullosa; keratoderma [congenital]), and this is the incorrect path for a basic corn or callus. The best way you encounter this particular term present in the documentation is to ask the dermatologist to explain the condition.

ICD-10: Once ICD-9 changes to ICD-10 in October, 2013, code 700 become invalid. In its place, you would report ICD-10 code L84 (Corns and callosities).

Ace the Definitions

In case you're still uncertain about your dermatologist's everyday explanation of these general conditions, learning the definitions of "corn" and "callus" will help. Remember, a corn is a small, horny area of the skin produced by local pressure (e.g., a shoe or hosiery) irritating the tissue over a bony prominence.

Corns normally takes place on a toe, where they form "hard corns." (Between the toes, pressure can form a soft corn of macerated skin, which often yellows.)

Moreover, a callus is localized thickening and enlargement of the horny layer of the skin because of pressure or friction. Normally, calluses as well as corns can result in pain, and soft-tissue inflammation may take place around the base of the lesion.

Knowing these definitions is also supportive in case you plan to ask the dermatologist for explanation.

For instance: You're struggling with how you should code a patient diagnosis that defines a "keratosis" of the bottom of the great toe and the heel. You've learned the synonyms for corns/calluses and recall that this is one more name for a callus, however you notice that a different nearby code has the identical word in its descriptor: 701.1 (Keratoderma, acquired; Keratosis [blennorrhagica]).

For an error-free ICD-9 coding , you request the dermatologist for more particulars about the patient's condition so you can code it correctly, and he defines a basic thickening of the skin owing to bad shoes. After studying the definitions, now you know that it's just a callus and you can further code it as 700.

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Get Well-Versed With NCCI v17.1: The Version Includes Thousands of New Edits

The Centers for Medicare & Medicaid Services (CMS) has released the latest National Correct Coding Initiative (NCCI) update this year. Version 17.1 comprises more than 700,000 code pair edits. Amongst those NCCI edits, nearly 12,000 are new to Version 17.1. About 350 code pair edits have been removed, the majority of which are retroactive to earlier dates of service.

Retroactive code pair deletions may imply that you're entitled for payment on past claims, in case those claims were overruled based on the now-deleted code pair edits.

Version 17.1 is noteworthy for another reason: For the first time ever, Medicaid payers will have to observe NCCI edits. The Patient Protection and Affordable Care Act (H.R. 3590, section 65607) necessitates that state Medicaid programs must include NCCI methodologies into their claims processing systems.

The objective of NCCI is to stop payments when inappropriate code combinations (unbundling) are reported. NCCI comprises two types of NCCI edits: The first of these edits are essentially the bundling edits, named "column 1/column 2" or "correct coding" edits. Codes which are listed in column 2 generally are bundled to the code listed in column 1, which is essentially the "more extensive" procedure. For instance, "CPT® code 36000 Introduction of needle or intracatheter in a vein is essential to every nuclear medicine procedure necessitating injection of a radiopharmaceutical into a vein. CPT® code 36000 is not distinctly reportable with these sorts of nuclear medicine procedures. Though, CPT® code 36000 might be reported alone in case the lone service delivered is the inclusion of a needle into a vein, as per the Correct Coding Initiative Policy Manual.

The second kind of NCCI edits, named "mutually exclusive edits," defines code pairs that will not practically be conducted at the same session along with anatomic location for the similar patient. As per the Correct Coding Initiative Policy Manual clarifies, "An instance of a mutually exclusive condition is the repair of an organ that can be carried out by two dissimilar methods. Merely one method can be selected to repair the organ. A second instance is a service that can be reported either as an ‘initial' service or a ‘subsequent' service. With the exclusion of drug administration services, the initial service along with subsequent service should not be reported at the same patient encounter."

You'll certainly want to ensure that you always refer to the most current version of NCCI when checking for code bundles. CMS updates the NCCI each quarter and posts the broad list of NCCI edits as a free download. You also may buy a subscription to NCCI, in either an electronic or a paper format, from National Technical Information Service (NTIS).

ICD-9 2012: 173.xx Leads List of ICD-9 Updates

With the subsequent round of revisions, ICD-9 might provide a chance to report skin neoplasm types more precisely.

Though the complete list of suggested ICD-9 updates is fairly short, a number of these are applicable to your oncology and hematology claims. Here are the main proposals to watch for when the codes are finalized in the fall.

Get Precise About Basal and Squamous Cell

CMS's recommended changes to ICD-9 2012 comprise of an expansion of 173.x (Other malignant neoplasm of skin). Every code in that series will get novel fifth digit options, which will deliver added details of the skin neoplasm type.

The modifications in the 173.xx skin cancer codes have a pattern where the fifth digit of "0" discusses about an indefinite malignant neoplasm, "1" signifies basal cell cancer (BCC), "2" denotes squamous cell carcinoma (SCC), and "9" defines "other" definite malignant neoplasm. BCC and SCC are the two most general types of skin cancer.

The ICD-9 Coordination and Maintenance Committee extended the code series resulting from a request from the New York State Cancer Registry to help differentiate reportable skin cancers from non-reportable skin cancers, for instance BCC and SCC. The way these general neoplasms behave clinically is dissimilar enough that separating them would be beneficial.

Caution: The expansion implies that the four-digit 173.x codes become invalid in October as each code in the range will want a fifth digit to be complete. Getting ready for the new and revised ICD-9 code modifications needs you to create better documentation habits.

Not only will refining documentation let you code these situations more precisely, but it will also help prepare you for ICD-10's overall increase in documentation requirements

Acquired Hemophilia Gets Its Own Code

You also must plan for ICD-9 2012 to increase existing four-digit code 286.5 (Hemorrhagic disorder due to intrinsic circulating anticoagulants) into a novel range of five-digit codes:

286.52, i.e. Acquired hemophilia

286.53, i.e. Antiphospholipid antibody including hemorrhagic disorder

286.59, i.e. Added hemorrhagic disorder because of intrinsic circulating anticoagulants, antibodies, or inhibitors.

The changes agree to more precise identification and will help monitor "trials on the cause, self-correction, along with pharmaceutical treatment of these disease categories of haemophilia.

Terms you may see associated with 286.52 involve autoimmune hemophilia, autoimmune inhibitors to clotting factors, as well as secondary hemophilia. Code 286.53 might be used most frequently to report the hemorrhagic disorder with an antibody called lupus anticoagulant or systemic lupus erythematosus.

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Update Your Anaphylaxis Terminology

In case you require coding anaphylactic or serum reactions under ICD9 2012, ensure that you must check the index. A range of new codes will shift the options you may be used to.

Simplify CABG Coding With These Expert Tips

Surgeon's documentation also helps boost your coding accuracy.

While coding for anesthesia during coronary artery bypass graft (CABG) procedures, aspects like the patient's age and whether physicians' usage of specialized equipment while carrying out surgery can affect your reporting.

Do Examine the Code Choices

CPT® includes three anesthesia codes during CABG procedures:

00562 – i.e. Anesthesia carried out for procedures on heart, pericardial sac, along with great vessels of chest; including pump oxygenator, with age 1 year or older, meant for all non-coronary bypass procedures (for instance valve procedures) or for carrying out re-operation for coronary bypass more than 1 month after original operation

00566 -- i.e. Anesthesia carried out for direct coronary artery bypass grafting; excluding pump oxygenator

00567 -- i.e. Anesthesia for direct coronary artery bypass grafting; including pump oxygenator.

The associated base units differ according to the procedure. Code 00562 carries 20 base units, code 00566 carries 25 base units, and code 00567 carries 18 base units.

Do Watch for Pump Documentation

The first question you are required to answer when coding anesthesia during CABG is whether the anesthesiologist carried out the use of a pump oxygenator during the procedure.

Definitions: A case is deliberated "on pump" once the physician uses a pump oxygenator to stop the patient's heart and lungs during surgery. An "off pump" case takes place when the surgeon carries out the operation on the patient's still-beating heart.

The physician should document ‘off pump' prior to you can report the anesthesia codes that have higher base unit values. It can be worth almost $85 more for a normal Medicare case, but you must ensure that your anesthesiologist has rightfully earned it before you code it.

Don't Always Add Qualifying Circumstances

Some payers permit coders to report "qualifying circumstances" anesthesia codes that clarify features of the patient's situation that made the anesthesiologist's work complicated. Three of these anesthesia codes might apply to cardiovascular cases:

99100 – i.e. Anesthesia meant for patient of extreme age, for patients younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure)

99116 -- i.e. Anesthesia which is complicated by utilization of entire body hypothermia (List separately in addition to code for primary anesthesia procedure)

99135 -- i.e. Anesthesia which is complicated by utilization of controlled hypotension (List separately in addition to code for primary anesthesia procedure).

Don't automatically include these anesthesia codes with all CABG procedures.

Do Look for Notes That Add Units

Go through your anesthesiologist's notes and the operative report sensibly, as documentation can occasionally justify extra base units.

For instance, in case the surgeon sews a graft in an off -pump procedure, the anesthesiologist is due one additional unit owing to the increased risk. You can also shift from 18 base units with 00567 to 20 base units with 00562 in case the CABG procedure involves another heart procedure for instance valve placement or in case the patient is having a re-do CABG more than one month post an original CABG surgery.

ICD-9 to ICD-10 Conversion: Simplify Pain Dx: Get Confident on G89

Go for site specific codes and involve psychological factors.

You must be careful while reporting the codes that come from the G89 category. These particular codes are never allocated in case the definitive diagnosis is recognized. The lone exception is when the purpose for the encounter is mainly pain control and not the management of the original condition per se. See the examples listed below for neurosurgery applications you might face in the ICD-9 to ICD-10 conversion:

1) In case the neurosurgeon implants a neurostimulator for control of pain, you then report the pain code as the major or firstlisted diagnosis.

2) In case the patient comes to the neurosurgeon for management of pain post a displaced intervertebral disc, you report G89 code and the primary condition can be reported as an added diagnosis.

3) In case the patient reports to the neurosurgeon for spinal fusion, you, then, do not report the G89 category code. In its place, you report the chief diagnosis; like the spinal stenosis or a vertebral fracture.

G89 Should Be Combined with Site-Specific Pain Codes

When ICD-9 to ICD-10 transition takes place, you can use the G89 category code together with codes that explain the site of pain. You arrange the two codes according to the conditions.

Example: In case a patient withstands an acute neck injury in an accident and your neurosurgeon offers treatment for pain, you assign code G89.11 (Acute pain due to trauma) and you also report M54.2 (Cervicalgia) to explain the site of pain. Though, in case your neurosurgeon is treating the patient for a different reason, then you assign the G89 code only as a secondary diagnosis.

Note the One-To-One Match

ICD-10 includes a one-to-one match for numerous pain codes in ICD- 9. Below are the selections you will have once ICD-9 to ICD-10 transition goes into effect in October 2013.

Distinguish Postoperative vs. Postprocedure

In ICD-9, you have 338.18 (Other acute postoperative pain) which matches to G89.18 (Other acute postprocedural pain) in ICD-10. Likewise, 338.28 (Other chronic postoperative pain) matches up to G89.28 (Other chronic postprocedural pain) in ICD-10. There is a modification from ‘postoperative' to ‘postprocedure' in these pairs. G89.18 includes both postoperative pain NOS along with postprocedural pain NOS. The presence of postprocedure pain recognizes those conditions where a procedure for instance lumbar puncture or further percutaneous treatment leads to acute or chronic pain.

Involve Psychological Factors

Pain is essentially an emotional experience. There may be an additional psychological component which you are not supposed to miss. When ICD-9 to ICD-10 transition take place, the ICD-10 code for the psychological factors is F45.42 (Pain disorder with related psychological factors) which matches to 307.89 (Other, pain disorder related to psychological factors) in ICD-9. Ensure that you have backup documents for the psychological factors.

ICD-9-CM: Master the Changes in Respiratory Conditions

Don't reports 488.12 until physician approves H1N1 influenza.

If you're intimidated by the thought of arranging through all the diagnostic coding modifications that went into effect on Oct. 1, 2011, you shouldn't worry more. Get the insider's info with this rundown on some of the novel respiratory system diagnosis codes.

Quick reference: You should always check the diagnoses index along with the tabular list for selection of the suitable codes to include on your encounter form.

New Novel Influenza Code Amendments

With this condition frequently developing new forms, ICD-9-CM has made modifications to new influenza codes for three years in line.

A novel subcategory 488.8 (Influenza owing to novel influenza A) along with related codes have been created in order to report Novel influenza A. They are:

488.81 -- Influenza because of identified novel influenza A virus including pneumonia

488.82 -- Influenza because of identified novel influenza A virus with added respiratory manifestations

488.89 -- Influenza because of identified novel influenza A virus with added manifestations.

Definition: Novel influenza comprises all human infections along with influenza A viruses which are novel or dissimilar from presently circulating human influenza viruses. These involve viruses which are subtyped as nonhuman in beginning, and those that cannot be subtyped with standard laboratory methods.

Providers frequently denote the 2009 pandemic influenza as 2009 H1N1 influenza instead of novel H1N1 influenza, consequently ICD-9-CM has reviewed the following listed codes, with earlier references to "novel" in their descriptors to change to "2009." The codes involve:

488.11 -- i.e. Influenza because of identified 2009 H1N1 influenza virus with pneumonia

488.12 -- i.e. Influenza because of identified 2009 H1N1 influenza virus with other respiratory manifestations

488.19 –- i.e. Influenza because of identified 2009 H1N1 influenza virus with other manifestations.

Change To 512.2 When You Report Postoperative Air Leaks

ICD-9-CM has applied revisions along with novel codes through Category 512 to distinguish air leaks from pneumothorax. This classification is currently labeled pneumothorax along with air leaks.

New code: You can at the present report postoperative air leaks with 512.2 (Postoperative air leak). You earlier reported this condition using code 512.1 (Iatrogenic pneumothorax), which was deceptive since a patient can go through a postoperative air leak devoid of significant air in the pleural space leading to pneumothorax. ICD-9-CM prevents reporting 512.1 or 512.2 without the physician documentation precisely specifies postoperative or owing to a procedure.

ICD-9-CM states that, though, patients might also have an insistent air leak which is not postoperative, for instance when a chest tube has been positioned for a spontaneous pneumothorax along with the lung re-expands however the air leak continues. Spontaneous pneumothorax might be primary or secondary and associated with numerous other conditions for instance cystic fibrosis, spontaneous rupture of the esophagus, lung cancer, etc.