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Reader Question: Document Donor Site to Code Advancement Flaps

Posted on 12. Feb, 2015 by .

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Question: Our surgeon closed a deep abdominal wall defect that was approximately 440 sq. cm. using 300 sq. cm. flaps on each side. Should I report just the repair, or can I separately code the advancement flaps?

FloridaSubscriber

Answer:

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E/M Coding: Can you Spot the Problem With This E/M Code Assignment?

Posted on 12. Feb, 2015 by .

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A thorough read is all it takes to identify the most glaring issue.

Sometimes, we’re so quick to review a physician’s documentation that we can gloss over important facts within the records, which can lead to assigning the wrong code. Read through the following documentation example and see if you can identify the problems with the physician’s code assignment.

Date of service: Dec. 8, 2014

Chief complaint: The patient presents today to assess the status of his left shoulder abscess, on which we performed an I&D on Dec. 1.

HPI: This 77-year-old male is improving with no further problems and there are no stitches that need to be removed. He is back to his normal activities of daily living and his urination and bowel movements are normal. He is not using pain medication and he reports that the incision is healing well.

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News Flash: Look Ahead to New Global Periods Coming Your Way in 2017

Posted on 12. Feb, 2015 by .

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Plus: If CMS prevails, you may get paid less for surgical procedures.

Global periods affect every provider’s coding, billing, and reimbursement, whatever the specialty and place of service might be. Figuring out when you can and can’t bill office visits for patients who have recently had a procedure performed may get easier, thanks to a proposed rule from CMS for the Medicare Physician Fee Schedule (PFS).

Read on for the scoop about CMS’s plan to eliminate global periods for surgical procedures and how the changes could affect your practice’s bottom line.

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ICD-10: Get to Know CMS’s ICD-10 Guideline Updates

Posted on 28. Jan, 2015 by .

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Some revisions may actually seem very familiar. 

Even though you still have another year before ICD-10 goes in to effect, that doesn’t mean CMS has stopped preparing for the new diagnosis coding system. In fact, the agency recently released a transmittal that should help you clarify some of the rules surrounding how you’ll report these codes when insurers start requiring them on Oct. 1, 2015.

Changes Match ICD-9 Guidelines

CMS issued Transmittal 3020 on Aug. 8, and it announces revisions to the official ICD-10 Coding Guidelines which put them more in line with the current ICD-9 rules. For example, CMS revised the ICD-10 regs to now say, “Do not code diagnoses documented as ‘probable,’ ‘suspected,’ ‘questionable,’ ‘rule out,’ or ‘working diagnosis’ or other similar terms indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reasons…

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Reader’s Question: Swine Flu Out of Pandemic Vaccine List

Posted on 28. Jan, 2015 by .

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Question: Our practice has been receiving queries for H1N1 vaccinations. What are our coding options and restrictions?

New Jersey Subscriber

Answer:

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Physician Notes: ‘No Show’ Physician Faces 5 Years in Prison Over $13 Million Scheme

Posted on 28. Jan, 2015 by .

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A Brooklyn, NY healthcare clinic was raking in cash over the past several years, despite the fact that investigators say its medical director wasn’t even on site to perform the services being billed to Medicare and Medicaid.

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Industry Notes: CMS Reveals ICD-10 Testing Dates

Posted on 28. Jan, 2015 by .

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Self-disclosure clause built in to nip fraud in the bud.

As promised, the Centers for Medicare & Medicaid Services (CMS) has finally revealed the dates of its latest ICD-10 testing opportunities. MLN Matters article MM8858, issued on Aug. 22, outlines the following date ranges when you can test out your ICD-10 claims:

  • Nov. 17 to 21, 2014
  • March 2 to 6, 2015
  • June 1 to 5, 2015

During these periods, trading partners will have access to MACs and CEDI for testing “with real-time help desk support,” the article says.

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Dermatology: Don’t Get Zapped When Radiation-Related Disorders Codes Change

Posted on 14. Jan, 2015 by .

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In 2015, look for debut of the L57.- codes.

In the Dermatology Coding Alert volume 10 number 10, we looked at how ICD-10 would change diagnosis coding for sunburn and other solar radiation-related skin conditions. This time, we’ll examine how your coding will change effective Oct. 1, 2015, for skin disorders caused by other sources of radiation.

ICD-10 contains a category of diagnoses relating to “Skin changes due to chronic exposure to nonionizing radiation,” which will map to ICD-9 codes that are now scattered among different sections. The new ICD-10 category, L57.-, consists of:

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Reader Question: Get Clarification on “Dilation” and 58100

Posted on 14. Jan, 2015 by .

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Question: The Feb. 2012 issue of the Ob-gyn Coding Alert has an example of CPT® 58100-endometrial sampling (biopsy) as: “…plastic catheter into the uterus and suctions out a small amount of the endometrial lining.” Dilation is bundled with 58100. If a provider does some cervical dilation along with an endometrial sampling, at what point do we change from coding a 58100, 58120-52 or 58120? I spoke with a provider who uses the plastic catheter suction device and states he does a 360 degree endometrial curettage, after dilating the cervix slightly and sounding the uterus. Another provider uses the same tool and states he does a 360 degree endometrial biopsy, after sounding the uterus and dilating the cervix as needed. Is there a clear CPT® guideline on what is considered a sampling/biopsy and what is considered a curettage? Both of these providers do this procedure with out anesthesia for menorrhagia. 

Iowa Subscriber…

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Physician Notes: CMS Clears up the Most Common ICD-10 Myths

Posted on 14. Jan, 2015 by .

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Plus: MACs to increase minimum dollar amounts for appeals in 2015

You’ve heard there won’t be an ICD-10 book that you can keep on your desk because the abundance of codes would make a book too thick—but is that tale true? Actually, no—it’s one of many ICD-10 myths that CMS hopes to dispel with its latest publication, called ICD-10-CM/PCS Myths and Facts.

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