Supercoder’s Code Connect featuring CPT Assistant to help you overcome denials with ease

Take the guesswork out of your coding and billing and overcome denials with the AMA punch – all conveniently packaged in Supercoder’s Code Connect featuring CPT Assistant

With a commitment to help medical coders by providing coding information and resources, SuperCoder.com offers a valuable resource – Code Connect – that will help coders plug all the loopholes to reduce errors and file clean and compliant claims. This tool not only allows users to save time but also work efficiently and effectively. 

“All the AMA's CPT® Assistantreference articles that help to overcome denials can be easily accessed on your desktop. Coders can simply enter a CPT® code and instantly connect with all of the CPT® Assistant articles that the AMA has published on the code since 1990,” said Jen Godreau, Director of Development & Operations, SuperCoder, giving out details about this unique tool. 

Having the ultimate guidance of the AMA, coders can easily understand codes and appropriately use them to file correct claims. Moreover, coders can simultaneously search CPT® Assistant 2012 & 1990-2011 Archives that will save time thereby maximizing efficiency. Authentic coding information, CPT code related information, articles from the AMA and monthly news and update makes this resource a must-have for all.

“This comprehensive CPT assistant tool will significantly boost efficiencies and reduce risks and has been priced reasonably at $199.95 with an amazing 10% discount throughout the month of November,” concludes Godreau.

To take advantage of this incredible offer just visit our webpage at code-connectand use the coupon code EXTRA10. Stay ahead of competition with definitive guidance from the AMA to understand codes better and get timely updates on your fingertips. With this valuable resource you can overcome all odds and code and bill correctly and efficiently to ensure a smooth sailing for your practice.

About SuperCoder.com

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Modifier –PD One of the Biggest Changes of CPT 2012

2012’s biggest change did not come in the form of the addition or deletion of a CPT code, but rather initiation of a modifier. 

The CPT 2012 manual brought several CPT procedure codes and modifier changes. But on top of all the changes, the big news was inception of modifier PD. It was introduced to designate services furnished to a Medicare beneficiary in the three days prior to an inpatient admission in a facility wholly owned or wholly operated by the hospital. This is inclusive of the physician practices that self-designate ownership interest, as well as enable payment at the facility rate and identify that the service is subject to the three day payment window. 

The existing as well as new patient definitions in the Evaluation and  Management (E/M) guidelines was revised to add further clarifications to the words “ specialties” and “subspecialties”. According to this revision, even if the physician is of the same specialty, differences between the subspecialty would require a significant new patient work-up and would be considered a new visit, say for instance cardiologist vs. electrophysiologist.

CPT codes 2012 lookupfor some specialties: 

CPT codes for Integumentary services related to surgery

There have been extensive changes for Integumentary services including the deletion of 24 codes, revision of six codes and the addition of eight new codes. The Skin Replacement codes (15271-15278) subheading was revised drastically. New skin replacement guidelines were added to state that skin replacement surgery now consists of the surgical preparation and topical placement of an autograft, which includes cultured tissue autograft, or skin substitute homograft, allograft and xenograft. 

CPT procedure codesfor Musculoskeletal services related to surgery

Two new codes for the treatment of Dupuytren's Contracture were added to the Musculoskeletal section of CPT 2012 which are code 20527 for the injection of an enzyme, such as collagenase, into the contracture and code 26341 is the follow up code for the manipulation of the Dupuytren Cord POST ENZYME injection. This code is to be used for subsequent visit(s) post the initial injection.

The phrase "bone biopsy included when performed" has been added to all vertebroplasty codes to be consistent with the kyphoplasty codes. You cannot report a separate bone biopsy in addition to a vertebroplasty. It’s not acceptable anymore. 

CPT codes cardiology (for Cardiovascular services related to surgery)

CPT code 71090, insertion pacemaker, fluoroscopy, radiological supervision and interpretation was assessed and found to be used in combination with Pacemaker/ICD procedures more than 75% of the time and as such as has been deleted. If fluoroscopic guidance is used for diagnostic lead evaluation minus lead insertion, coders need to use 76000, fluoroscopy up to 1 hour physician time.

CPT codes for Digestive system services related to surgery

CPT codes 49080 and 49081 (abdominal paracentesis) have made way for codes 49082-abdominal paracentesis without imaging guidance, 49083-WITH imaging guidance, and 49084-Peritoneal lavage with imaging guidance.

This is just a glimpse of few of the CPT code and verbiage changes that was incorporated this year and that had a say in your practice’s coding.

Everything your Ob-Gyn Practice Needs to Know about PQRS and eRx

If your Ob-Gyn practice is not taking part in both the PQRS and eRx programs, you could be facing penalties and missing out on hard-earned money. 

And even if you’re participating, you need to be well-versed with the latest updates. You can avoid the adjustments and take advantage of the incentives the CMS provides for e-Prescribing if you have sound understanding of eRx Incentive Program, hardship exemptions and payment adjustment exclusions, how to submit a hardship exemption request, and other aspects of e-prescribing!

At present, only about one in five health care professionals who can participate in the PQRS do so. Even though participation in both the programs is non-compulsory, providers who are able to take part in these programs but opt not to, will receive payment reductions from Medicare in the coming years.

To ensure your payments don’t get slashed, you can tune in to a FREE webinar on The Ins and Outs of Physician Quality Reporting and E-Prescribing for Ob-Gyn by coding expert, Melanie Witt, RN, CPC, COBGC, MA.

This 60-minute webinar will help you clear all your E-prescribing doubts. In the webinar, you’ll

·         Find out where you can get the latest updates and information on the programs to ensure successful participation.

·         Figure out which reporting period and data submission method is best for your practice as CMS offers more than one method 

·         The claim examples in the webinar will make everything easier for you

·         Learn which quality measures you can quickly adopt for easy reporting every time

·         Learn why getting into the habit of reporting quality measures now may enhance your practice’s value to commercial payers as they are eyeing the agency’s progress with PQRS and E-Rx programs

All this and a thousand other e-prescribing tips for no cost at all. Visit this link to register for this FREE webinar. http://www.supercoder.com/exclusives/webinars

Learn How to Code Nitroglycerin Injections and Brace Rx Management Documentation

Use 37202 for Nitroglycerin Injections

Question: Can you charge for nitroglycerin injections x 2 when carrying out a right posterior tibial angioplasty as well as right peroneal angioplasty? If so, which codes do you use for the full service?

Answer: You are not supposed to separately code nitroglycerin injections in catheter services for accurate CPT coding. The injections are a normal part of the procedure and must not be reported with their own codes.

Caution: Some coders wish to report 37202 (Transcatheter therapy, infusion other than for thrombolysis, any type [e.g., spasmolytic, vasoconstrictive]) for these nitroglycerin bolus injections. However, you must reserve 37202 for "prolonged infusions into peripheral arteries," as per CPT® Assistant (April 1998).

For the right posterior tibial and right peroneal angioplasty CPT coding, you should report 37228 (Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty) for one vessel and +37232 (Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty [List separately in addition to code for primary procedure]) for the second vessel.

For CPT coding purposes, CPT® counts the posterior tibial as well as the peroneal as separate vessels in the same vascular territory. So you may report every single intervention in this case separately.

Strengthen Rx Management Documentation

Question: Is there a specific code for writing a prescription?

Answer: As per CPT coding , writing prescriptions are a part of an E/M service. This is just part of the cost of seeing patients, much similar to office supplies. There is no particular code that payers will reimburse for writing a prescription.

Note: In case you review the Table of Risk in the 1995 or year 1997 E/M Documentation Guidelines, you'll see "Prescription drug management" designated as "Moderate" level of risk under "Management Options Selected." This is how prescription drug management can affect your E/M level.

Best possible practice is for the provider to document prescription's actual management. For instance, in case the cardiologist renews a cholesterol-related prescription, the plan of care may maintain that the patient has been bearing the present dosage well and it is keeping her numbers where they are required to be, therefore the physician is now renewing the prescription. As another instance, the physician may state that she's selecting a specific cardiovascular drug as it is safer in combination with the patient's diabetes medication.

Medical Coding and Billing Tip: ICD-9 includes V68.1 (Issue of repeat prescriptions), however you shouldn't report V68.1 with an E/M code in case the only cause the patient comes in is to pick up a prescription. Without face-to-face time and an actual evaluation and management service, you must not bill an E/M code.

Carefully Read Your Botox Treatment Report

HCPCS Code J0585

Don't oversee 5 documentation essentials -- including sites and number of units.

While a dermatologist treats blepharospasm (the uncontrollable contracting of eyelid muscles) with Botox, grab one of those J codes and combine it with a chemodenervation procedure. As long as you get the coding process going smoothly -- which means submitting the right documentation and reporting the right combination of codes -- you'll avoiding your medical coding and billing challenges easily.

For such a distinct application of ophthalmic reconstructive surgery, you must use 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) along with J0585 (Injection, onabotulinumtoxinA, 1 unit). Bill J0585 per total units used, not per eye.

Reporting HCPCS code J0585 or J0587 (Injection, rimabotulinumtoxinB, 100 units) has not been a reimbursement hassle, as long as you bill them properly with the drug being paid. More to the point, a lot of practices around the country have used them successfully without any trouble.

Draw the line: Append modifier JW (Drug amount discarded/not administered to any patient) to HCPCS Code J0585 to specify wasted Botox supply. Though, do not use it for claims billing while the drug code description already includes the amount administered and the amount wasted.

Learn Guidelines to Your Advantage

You must peruse your physician's chart note, which must involve:

• a diagnosis that essentially supports medical necessity, and
• a notation that the patient has been unresponsive to conventional techniques (such as medication and physical therapy) of controlling and/or treating spastic circumstances.

Good idea: In addition, physician must not miss some vital details in the documentation, particularly:

• Number of injections: Keep in mind that every injection site for spasms may need multiple units of botulinum.
• Injection sites and units injected at each site: The payer will reimburse for simply one injection code per site irrespective of the number of needle passes made into the site (being defined as a single contiguous body part -- for instance, the eyelid or elbow -- excluding when the procedure is bilateral). Correct documentation of multiple or complex injections can support and warrant additional reimbursement.
• Amount of medication wastage; and
• Results/response to the injections.

Your dermatologist's documentation is important, even at the E/M visit level. As far as the visit goes, you can make up a form, questionnaire-type flow sheet. It hinges on the cosmetic procedure as to what sorts of questions you wish to ask. We have dissimilar medical coding and billing questions for Botox versus laser versus surgery procedures. Always keep in mind your ABN in case reporting cosmetic procedures on Medicare patients.

These references must guide your practice to a accurate accounting of what takes place in the procedure, and consequently help you with medical coding and billing the procedure.

Watch Your Number of Treatments

Treatments may be continued lest any two consecutive treatments with the correct or maximum dose failed to produce a satisfactory clinical response. It is usually not considered medically necessary to give botulinum toxin type A injections for spastic or excess muscular contraction conditions more regularly than every 90 days.

Know What Modifiers You Must Select In This Turb-Post-Op OV Scenario

Question: A patient who is coming back for follow-up after unilateral endoscopic maxillary antrostomy with tissue removal and turbinectomy complains of a cough and fever. The otolaryngologist assesses and manages the problem and also carries out endoscopic sinus debridement on the patient. What modifiers do you need to report the encounter?

Answer: As the unrelated office visit as well as a staged debridement (planned staging for the endoscopic maxillary antrostomy) took place during the turbinectomy's 90-day global period, you will be required to use modifiers 24 (Unrelated evaluation and management service by the same physician during a postoperative period) with the EM service and modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) with the debridement. To show the E/M is a important and separate service from the debridement, you will also use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

Generally, you would not charge an E/M service that takes place within an active postoperative period. But as the otolaryngologist carries out the E/M service for a problem that is unrelated to the turbinectomy you must bill the office visit appended with modifier 24 for accurate medical coding and billing.

You must also use modifier 58 with the debridement code (31237, Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]). Modifier 58 specifies that the otolaryngologist carries out a procedure -- debridement -- that is a planned staged procedure related to the therapy and healing to attain the desired results from the maxillary antrostomy.

The scenario's same-day service and procedure necessitate modifier 25 as 31237 is a minor procedure, which has a built in mini EM service. You would usually include a minor related E/M service with the debridement. But as the otolaryngologist in your example carries out an important and separate service from the debridement, you must also report the office visit (9921X, Office or other outpatient visit for the evaluation and management of an established patient …) appended with modifier 25.

Medical Coding and Billing Tip: Although the patient requires debridement because of sinus surgery, the antrostomy does not make global surgery modifiers necessary. Functional endoscopic sinus surgery (FESS) codes involving 31267 contain zero global days. Once a non zero global day surgery (such as 90 days) is carried out with the zero global day FESS surgery, that entire surgical encounter gets the longer global attached to it for the total time the longer global exists (such as the full 90 days).

Your ICD-9 coding must demonstrate the office visit's separate nature from the debridement as well as the turbinectomy. Different diagnoses will tell the insurer that the otolaryngologist assessed and managed a significant and separate problem from the day's procedure (31237) and that the problem is not related to the active postoperative period created by the turbinectomy. The debridement also must only have the maxillary sinusitis (473.0) associated with it, as it is staged to the 31267 and not linked to the the turbinectomy.

Here's how: You must link the definitive acute diagnosis, for instance upper respiratory infection (465.9, Acute upper respiratory infections of multiple or unspecified sites; unspecified site), to the E/M code. For the debridement, use the suitable sinus surgery diagnoses, for instance chronic maxillary sinusitis (473.0).

The claim could read:
CPT codes ICD-9 codes
9921X-24-25 465.9
31237-58 473.0


ICD-10: When your diagnosis coding system changes in 2013, you will use J32.0 (Chronic maxillary sinusitis) instead of 473.0. Instead of ICD-9 coding option 465.9, you'll report J06.9 (Acute upper respiratory infection, unspecified).

CPT 17110: Destruction of Molluscum Contagiosum or Plantar Warts and Plasma Ablation

CPT 17110

Code for Destruction of Molluscum Contagiosum or Plantar Warts

Question: What code is used to bill for destruction of molluscum contagiosum or plantar warts?

You can use CPT codes 17110 and 17111 for destruction of common or plantar warts. The codes 17110 and 17111 have been revised to co destruction of benign lesions other than skin tags or cutaneous vascular lesions. Coders are no longer supposed to use CPT codes 17000 and 17003 for destruction of warts or molluscum contagiosum, as these codes now do not include destruction of benign lesions.

In case the physician destroys one to fourteen warts (or molluscum), then you code CPT 17110. Keep in mind that you should only code 17100 once, even if the physician has destroyed fourteen lesions.

In case the physician destroys fifteen or more warts (or molluscum), then you should code17111. Even in case the physician destroys thirty-five warts, it is suitable to only use the code 17111 a single time.

Formal definitions of the codes are as follows:

• CPT 17110 – (Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions; up to 14 lesions)
• CPT 17111 – (15 or more lesions)

CPT 17110 Definition Includes Plasma Ablation, Too

Question: Your gastroenterologist treats a patient who has a gastrostomy tube. The op note specifies that the patient has "some issues with granulation tissue at the stomal site that gets irritated and bleeds." The physician carried out"argon plasma photoablation of granulation tissue at stomal site." Can you use CPT 17110 even though its descriptor says nothing about plasma ablation?

Answer: Certainly. You should use 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions) for the procedure. Link that to a diagnosis of 701.5 (Other abnormal granulation tissue).

Even though CPT 17110 doesn't specifically mention plasma ablation, the wording doesn't discard it completely, either. Gastroenterologists generally use argon plasma coagulation -- jet of ionized gas -- to treat bleeding inside the body.