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Reader Question: Provider-Neutral Language Shouldn’t Impact Too Harshly
Posted on 11. Mar, 2013 by rpandit.
Question: Does our practice need to make any changes to our systems to accommodate the fact that CPT® 2013 changed so many descriptors from “physician” to “other qualified health care provider?”
Answer: The most widespread changes throughout CPT® 2013 — the switch to more inclusive or provider-neutral language — shouldn’t be difficult for physician practices to put into place.
“The concepts are pretty straightforward,” said Richard Duszak, Jr., MD, an AMA CPT® Editorial Panel member and practicing radiologist, during his presentation at the American Medical Association’s (AMA) annual CPT® and RBRVS Symposium, held Nov. 14-16 in Chicago. “There’s been an evolution in CPT® for how codes report services by non-physicians.”
Result: Hundreds of codes were revised for 2013 to include “provider neutral language.” Codes throughout the book have replaced designations of “physician” with “individual” or “qualified health care provider.”
Exception: A few codes retained the “physician” language, such as those related to skilled nursing facility admissions, because regulations require that a physician admit the patient.
“CPT® is not the turf police,” Duszak said. “We’re focusing on the services provided and recognize that sometimes professionals other than physicians are qualified to provide some services. As a nationally recognized reporting system, it’s important for CPT® to maintain provider neutrality.”
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Visual Fields: Don’t Pick Intermediate VF Code When Extended Code Is Justified
Posted on 11. Mar, 2013 by rpandit.
Choosing between 92082 or 92083 can be tricky – let our expert advice guide you.
Even small practices are likely to have a Humphrey visual field analyzer, yet many ophthalmologists don’t know the secrets for securing adequate reimbursement for these services — and they even go so far as to put themselves at risk for costly audits due to lack of documentation.
Stop Shortchanging Yourself With Intermediate Codes
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Expand Your Undescended, Retractile Testicle Diagnoses in 2014
Posted on 26. Feb, 2013 by rpandit.
Make sure your urologist gets specific in his documentation.
When your urologist performs an orchiopexy procedure, you’ll most likely use one of the following diagnosis codes along with the procedure code:
- 752.51 – Undescended testis (includes ectopic testicle)
- 752.52 – Retractile testis.
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Reader Question: Earn For Discontinued Procedures with Modifier 53
Posted on 26. Feb, 2013 by rpandit.
Question: Our neurologist was performing a trigeminal nerve block, 64400 (Injection, anesthetic agent; trigeminal nerve, any division or branch) when he aborted it due to the needle penetrating the oral cavity. Should this be billed to insurance as a discontinued procedure, with modifier 53 (Discontinued procedure) or not billed at all due to the error?
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Annual Wellness Visits: CMS Begins Recouping Overpayments Made for AWVs
Posted on 26. Feb, 2013 by rpandit.
When both the facility and the doctor bill for the same service, Medicare ends up double-paying.
You may have been overpaid for annual wellness visits without even knowing it, but your MAC could come calling for a refund soon, if a recent CMS Transmittal is any indication.
When CMS established the annual wellness visit (AWV) codes G0438 and G0439, the agency noted that it would accept claims from facilities furnishing the service, or from physicians performing it. Unfortunately, however, that information was misinterpreted by some providers, so when AWVs were performed by physicians in the facility setting, both the facility and the doctor submitted Medicare claims for the AWV, and both got paid.
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Diagnostic Tests: Hone How You Report Hemoccult Tests With This Expert Advice
Posted on 26. Feb, 2013 by rpandit.
Why, who, and where work hand-in-hand to point you to the right code.
If you want to keep the dollars flowing for in-office examination of fecal occult blood test (FOBT), you should focus on the difference between three hemoccult codes and their purpose.
Consider the following scenario:
A patient presented in the ob-gyn office complaining of diarrhea preceded by intestinal cramping, which lasted a couple of weeks. The patient is 60 years old and has no history of cancer in the family. She also didn’t feel nauseous at all. The physician took a stool sample to test for both parasites and blood. How should you tackle this?
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Z15 and V84 Trade Places in 2014 for Coding Neoplasm Genetic Susceptibility
Posted on 13. Feb, 2013 by rpandit.
Follow instructions to include code for current neoplasm and family history, too.
You can expect a direct crosswalk of a few ICD-9-CM codes to ICD-10-CM for reporting certain genetic susceptibility test results.
ICD-9-CM Codes:
- V84.01, Genetic susceptibility to malignant neoplasm of breast
- V84.02, Genetic susceptibility to malignant neoplasm of ovary
- V84.03, Genetic susceptibility to malignant neoplasm of prostate
- V84.04, Genetic susceptibility to malignant neoplasm of endometrium
- V84.09, Genetic susceptibility to other malignant neoplasm
ICD-10-CM Codes:
- Z15.01, Genetic susceptibility to malignant neoplasm of breast
- Z15.02, Genetic susceptibility to malignant neoplasm of ovary
- Z15.03, Genetic susceptibility to malignant neoplasm of prostate
- Z15.04, Genetic susceptibility to malignant neoplasm of endometrium
- Z15.09, Genetic susceptibility to other malignant neoplasm
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Dodge Denials with CPT↔ICD-9 CrossRef – Now Part of Coding Solutions!
Posted on 13. Feb, 2013 by rpandit.
Many SuperCoder.com subscribers asked for an ICD-9 to CPT® crosswalk and SuperCoder’s new CPT↔ICD-9 CrossRef fulfills that need with a standalone dual-entry tool plus CPT code suggestions on ICD-9 code details pages. Coders and billers can avoid the top denial reason by checking if an ICD-9 code matches the reported CPT® code and vise versa.
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Reader Question: Current Results Can Trump Previous HIV Positive Test
Posted on 13. Feb, 2013 by rpandit.
Question: A two-year-old child was admitted with pneumonia due to respiratory syncytial virus (RSV). The child’s history includes prematurity and being HIV positive. He was treated with Ribavarin and bronchodilators. All blood work was normal, and the HIV test was negative. What is the best way to code everything, especially with the different HIV test result?
Florida Subscriber
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CMS News: Update Your Revalidation Plan With New CMS Instruction
Posted on 13. Feb, 2013 by rpandit.
Kinder, gentler process forestalls ‘revocation.’
Don’t lose your ability to provide Medicare services by missing the boat on re-enrollment. Read on to see what you should do for your general surgery practice when that revalidation notice comes in the mail.
Good news: CMS has made improvements to the re-enrollment process, according to an Oct. 10 CMS National Provider Call with the agency’s Provider Enrollment Operations Group.
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