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ICD-10: 2 New H Codes To Take Place Of 366.16 in 2013
Posted on 17. Feb, 2011 by dchandhok.
When ICD-9 becomes ICD-10 in October 2013, the diagnosis codes you’re accustomed to reporting will no longer exist. Many diagnosis codes will include more details than their current counterparts, and some sub-codes of the same family will even move to different locations.
Consider two new commonly reported options for nuclear sclerosis, or nuclear cataract (366.16, Senile nuclear sclerosis).
ICD-10 difference: Diagnosis 366.16 will change to
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Modifiers 52 or 53? Prevent Denials By Making The Correct Choice
Posted on 17. Feb, 2011 by dchandhok.
If you mistake modifiers 52 and 53 as one or the other because they’re both used for incomplete procedures, you’ll end up losing your reimbursement. Remember these two have extremely distinctive functions.
Consider a situation when the gastroenterologist performs an esophagogastroduodenoscopy (EGD) to examine the lining of the esophagus, stomach, and upper duodenum of a patient as part of a GERD evaluation.
Suppose that while inserting the endoscope, the patient registers unstable vital signs. The gastroenterologist, then, decides it is not in the patient’s best interest to continue the procedure. You would report this on your claim using:
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Per New CMS Transmittal Modifier, All Claims With Modifier GZ Will Be Denied Immediately
Posted on 17. Feb, 2011 by dchandhok.
As per the latest CMS regulation, all claims with modifier GZ appended will be denied straight away. It is not unusual even in the best-run medical practices that the physician performs a noncovered service and doesn’t get an ABN signed.
If you should have had a patient sign an advance beneficiary notice (ABN) but failed to do so, you should append modifier GZ (Item or service expected to be denied as not reasonable and necessary) to the CPT code describing the noncovered service the physician provided. The advantage to reporting modifier GZ is
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Is Modifier 50 OK for Bilateral Radiology Exams?
Posted on 16. Feb, 2011 by dchandhok.
Question: Our physician x-rayed a patient’s symptomatic knee and ordered an x-ray of the other knee for comparative purposes. How should we report the comparison x-ray?
Answer: Report the appropriate radiology code on two separate lines of your claim, such as 73560 (Radiologic examination, knee; 1 or 2 views). Although you’re reporting x-rays of mirror-image body parts,
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GI Tract Reporting: When and When Not To Use 91110, 91111
Posted on 16. Feb, 2011 by dchandhok.
While you know for sure that you can report 91110 and 91111 for capsule study, but knowing just that is not enough to prevent your claims from being denied. We’ll tell you just when it is appropriate to report them and which modifiers to append.
Reporting a Repeat Procedure with 91110
Sometimes, your gastroenterologist would use a capsule study to image the intraluminal esophagus all the way through the ileum and reaching the colon. In this case, you should report
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Multi-Provider Coding: Modifier 62 Can Save You $4k
Posted on 15. Feb, 2011 by dchandhok.
When you come face-to-face with multi-provider situation, the last thing you would want is to mess up your coding by assigning the wrong modifier(s).
Imagine a 70-year-old female patient presenting with COPD and coronary artery disease, status post myocardial infarction (CAD s/p MI) having a 28 mm of inner diameter thoracic aortic aneurysm. Imaging studies indicate the aneurysm to be descending. The cardiologist, together with a thoracic surgeon, decides to perform an open operative repair with graft replacement of the diseased segment.
The main key in a multi-provider scenario is to treat
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Look Up New Observation Codes When Reporting ‘Middle Days’
Posted on 06. Feb, 2011 by dchandhok.
2011 brings a new coding option when reporting the middle day of observations that last longer than two days. Check out this expert advice on how CPT additions will affect your FP’s observation care services coding starting on Jan. 1, 2011.
Until this point, coding for the “middle days” of an observation service caused problems. Although not the norm, there are times when a physician admits a patient to observation and she remains in that status for three or more days. CPT 2011 addresses these middle days between admission and discharge by introducing three new E/M codes. The additions parallel the hospital subsequent care series in terms of
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Myomectomy Claims: Anatomical Location Is Your Key
Posted on 05. Feb, 2011 by dchandhok.
Deciding which myomectomy code you’ll report depends on three factors: the approach the ob-gyn uses, the number of myomas, and their weight. Here’s how to translate this information into the correct CPT code every time.
If your ob-gyn performs a hysterectomy, you won’t report the myomectomy separately.
When your ob-gyn performs a myomectomy, he is removing myomas or uterine fibroid tumors. Knowing what
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Therapy Progression Is Your Key to Correct Whiplash Coding
Posted on 05. Feb, 2011 by dchandhok.
Be on a look out for Scans, TPIs, and more
Though coding for whiplash diagnosis and treatment is pretty straightforward, you should still watch out situations when the patient’s symptoms persist despite conservative therapy and warrant more extensive treatment. You will miss your pay if you miss these diagnoses.
When a patient presents with whiplash symptoms, your pain management specialist will conduct a thorough exam and will often order neck x-rays to rule out fractures. On diagnoses of whiplash (847.0, Sprains and strains of other and unspecified parts of back; neck sprain), he typically will prescribe conservative treatment. Common options include physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants. Some patients may also
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Is 96413 + 96365 OK?
Posted on 04. Feb, 2011 by dchandhok.
Coding is all about applying standardized code sets to situations that don’t always qualify as “standard.” The good news is that authoritative coding resources sometimes address even those encounters you don’t handle on a daily basis. Test your skills with these two scenarios and see whether your responses match the official rules.
Challenge 1: Staff administers a non-chemotherapy therapeutic drug via one IV infusion site, and then following oncologist orders based on protocol, administers chemotherapy intravenously via a second IV site. Should you report the chemotherapy admin or the non-chemotherapy admin as the initial code?
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