Archive by Author
How Do I Code a 2-Sided Nosebleed?
Posted on 19. Jan, 2010 by sanjay.aikat.
Heads up: 2 nosebleed codes are not the answer.
Question: A patient reports to the ED after sustaining injuries during a soccer match; she was hit in the face with a ball, her nose is bleeding, and her right eye is blackened. The physician is not able to stop the bleeding with ice or pressure, so she performs repeated and extensive cautery using a silver nitrate stick on both nostrils. The bleeding relents, and the physician orders an x-ray to ensure that the patient’s nose is not broken.
Results are negative. Notes indicate a level-four E/M. Can I report 30903 x 2, since the physician stopped bleeding in both nostrils? No, you’ll report this under bilateral procedure guidelines. On the claim, report the following:
Answer: No, you’ll report this under bilateral procedure guidelines. On the claim, report the following:
Continue Reading
Second Surgery Coding: Tips for Modifier 58, 78 Success
Posted on 19. Jan, 2010 by sanjay.aikat.
Don’t let ‘unplanned’ lead to ‘unpaid.’
The next time a patient takes an extra trip to the operating room, don’t let the added service throw your coding off track. Keep these tips in mind to know when to assign modifier 78 – or something else.
Check for Surprise Versus Planned
Two modifiers pertain to follow-up trips to the OR, but knowing the basic difference helps you choose the right one:
• Modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) represents an expected return to the OR. This could be because the original surgery normally is performed during multiple sessions or the follow-up is more extensive than the original procedure. “The patient’s condition dictates the additional service or the service was planned prior to the original surgery,” explains Linda Parks, office manager for Herrin Family Medicine in Lilburn, Ga. You can also report modifier 58 for non-OR sessions, such as planned therapy following surgery.
Continue Reading
Cataract Surgery Coding Skill Builder
Posted on 19. Jan, 2010 by sanjay.aikat.
Determine ‘planned or unplanned’ before separately coding vitrectomy.
With several possible surgical treatments for cataract procedures, which you probably code more often than any other surgery, there’s a lot of room for error – with over $890 at stake for complex cataract procedures in 2009.
Use these tricky scenarios as a guide through some of the most problematic cataract coding situations:
Document Necessity for Planned Vitrectomy
Scenario: During the course of a cataract removal, the vitreous collapses and the ophthalmologist finds it necessary to perform a vitrectomy.
Problem: Can you code separately for the vitrectomy?
Read more to learn solution …
Continue Reading
Winter Laceration Repair: How Do I Code For Dermabond?
Posted on 17. Jan, 2010 by sanjay.aikat.
Warning: Your coding will vary depending on who’s getting the claim
Question: A 60-year-old patient reports to the ED with a bandaged left hand. The patient says she was cleaning out the blades of her snow blower and cut her left index finger; the wound is wrapped in gauze, but it is reddening with blood. During an expanded problem focused history and exam, the physician undresses the wound, applies pressure and ice to stop the bleeding, and cleans it using Betadine. During the E/M service, the physician notes a laceration to the index finger but no signs of infection. Using Dermabond, the physician closes a 2.7 cm laceration on the patient’s finger. How should I code this encounter?
Answer…
Continue Reading
What Diagnosis Code Do I Use for a Fern Test?
Posted on 01. Dec, 2009 by sanjay.aikat.
Ob-Gyn Coding Tip: Scan for leukorrhea signs when fluid is present.
Question: My physician performs a fern test on a patient, trying to rule out rupture of membranes. What diagnosis code applies?
Answer: If the test result proves positive, then you should report 658.13 (Premature rupture of membranes with antepartum condition or complications). Otherwise, use V89.01 (Suspected problem with amniotic cavity and membrane not found), provided the patient showed no verifiable signs or symptoms.
Supplement: If the physician found fluid, but the patient did not rupture her membranes and was not in labor, report 623.5 (Leukorrhea, not specified as infective) as secondary diagnosis to the primary diagnosis 648.93 (Other current conditions classifiable elsewhere, but complicating pregnancy; antepartum condition or complication).
Keep in mind: If the patient is at her term, you will not likely be reimbursed extra to rule out labor.
Red flag: Coding for a fern test (Q0114) must indicate that the physician — not the lab — actually performed this Clinical Laboratory Improvement Amendments (CLIA) waived procedure.
© Ob-Gyn Coding Alert. Download your 2 FREE sample issues here.
Continue Reading
Celebrate CT Colonography’s 2010 Move to Category I
Posted on 01. Dec, 2009 by sanjay.aikat.
But don’t assume the new codes will yield improved fees.
Virtual colonoscopy coverage may be a mixed bag, but the AMA showed some confidence in the service by moving its codes from temporary Category III status to full-fledged Category I in 2010.
The switch from Category III to Category I does offer some hope of better reimbursement in the future, says Rhonda Townley, CPC, with University Radiology in Knoxville, Tenn. But don’t make assumptions.
For example, you should continue to check and follow coverage policies for Medicare beneficiaries, she warns. Medicare’s current policy is noncoverage, as announced in its “Decision Memo for Screening Computed Tomography Colonography (CTC) for Colorectal Cancer” (CAG-00396N).
Watch Contrast Use for Diagnostic Test
The details: CPT 2010 deletes 0066T (Computed tomographic [CT] colonography [i.e., virtual colonoscopy]; screening) and 0067T (… diagnostic). But in their place, you’ll have the following 3 codes:
• 74261 — Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material
Continue Reading
CPT 2010 Update: Laboratory & Pathology Coding
Posted on 29. Nov, 2009 by sanjay.aikat.
Stop using general codes for analyte-specific tests. Here’s why.
You have 15 new codes scattered throughout the pathology/laboratory CPT chapter, so we’ll help you jump start your 2010 claims with this how-to inventory. “From chemistry to surgical pathology, you’ll find new codes in CPT 2010 that you need to know,” says Peggy Slagle, CPC, billingcompliance coordinator at the University of Nebraska Medical Center in Omaha.
Chemistry changes — CPT 2010 has three new chemistry codes
• 83987 — pH; exhaled breath condensate
• 84145 — Procalcitonin (PCT)
• 84431 — Thromboxane metabolite (s), including thromboxane if performed, urine.
In addition to the new pH code (83987), CPT 2010 revises pH code 83986 to change “except blood” to “not otherwise specified.” “The change clarifies what has been proper coding all along — that you should not use 83986 for urine pH, because existing urinalysis codes 81000-81003 describe that test, says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.
Focus on immunology: Three new immunology codes give your lab more specific means to report certain tests, as follows:
Continue Reading
Test Yourself: ICD-9 2010 for Ob-Gyn Coders
Posted on 29. Nov, 2009 by sanjay.aikat.
Is your ob-gyn practice using the new codes correctly? 3 quick questions say for sure.
This year, ICD-9 2010 brought new hyperplasia, mammogram, and fertility preservation codes. In some cases, these codes simply expanded on existing options, and it’sup to you to spot when you should report the new versus old alternatives. Dig in to these three scenarios to see if you can choose the proper code for services performed on or after Oct. 1.
Scenario 1: Pick Apart New Puerperal Options Your ob-gyn documents “a puerperal infection,” a bacterial illness following childbirth. How would you report this?
A. 670.0 — Major puerperal infection
B. 670.1x [0,2,4] — Puerperal endometritis
C. 670.2x [0,2,4] — Puerperal sepsis
D. 670.3x [0,2,4] — Puerperal septic thrombophlebitis
E. 670.8x [0,2,4] — Other major puerperal infection
Scenario 2: Don’t Overlook 671 Category Notes You’re reporting a code from the 671 (Venous complications in pregnancy and the puerperium) category, but you need to provide what additional information? Select one of the following options:
Continue Reading
Can a Sleep Study Code Describe an Awake Test?
Posted on 29. Nov, 2009 by sanjay.aikat.
Question: A sleep study was ordered for a patient diagnosed with hypersomnolence. The neurologistincluded a multiple wake test in the sleep study. What CPT code should I use for the multiple wake test?
Answer: You should use 95805 (Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness). Code 95805 is the only sleep study code (95803-95811) that mentionswakefulness testing. Check if you need a modifier on 95805.
Sleep services codes (95805-95811) include recording, interpretation, and report. For cases when the neurologist does only the interpretation, use modifier 26 (Professional component) on the sleep study code.
All sleep studies must have a minimum of six hours. If the sleep study does not last that long, append modifier 52 (Reduced services) to your code.
The multiple wake test measures the patient’s ability to stay awake during a time when she is normally awake. During the wakefulness test the physician or technologist records the time it takes the patient to fall asleep during a course of four to five 20-minute nap opportunities provided during the testing period in the sleep lab.
The patient does not need to be asleep during the tests.
© Neurology Coding & Reimbursement. Download your 2 free sample issues here.
Continue Reading
Surgical Coding Mysteries: The Case of the Separate Mesh
Posted on 22. Nov, 2009 by sanjay.aikat.
Beware Separate Mesh Removal
Question: The surgeon performed the following: Made 10 cm supraumbilical transverse incision with 15-blade scalpel carried down through subcutaneous tissue using Bovie. Used combination electrocautery and blunted dissection to isolate area of scar tissue on patient’s right side. Noted sutures from previous umbilical hernia repair and mesh from right-lower abdominal hernia repair.
Excised mesh and surrounding scar tissue to level of fascia using combination Bovie and blunt dissection. Closed with 30 Vicrylc and interrupted nylons. Can we bill separately for abdominal exploration (49000), mesh removal (+11008), and scar revision (13101) based on this operative note?
Answer: No, you should not code three separate procedures. You should report 22999 (Unlisted procedure, abdomen, musculoskeletal system) alone for the service described by this operative note.
Here’s why: You should not list +11008 (Removal of prosthetic material or mesh, abdominal wall for infection [e.g., for chronic or recurrent mesh infection or necrotizing soft tissue infection] [List separately in addition to code for primary procedure]) because there is no indication of a post-op infection or a more extensive debridement for necrotizing soft tissue infection.
Although you are correct that complex repair codes such as 13101 (Repair, complex, trunk; 2.6 cm to 7.5 cm) describe scar revision, you should not use that code in this case. The service you describe goes deeper than the skin, and the surgeon does not document the length of repair or closure in layers as required for complex repair codes.
You cannot bill 49000 (Exploratory laparotomy, exploratory deliotomy with or without biopsy[s] [separate procedure]) because the surgeon did notperform a laparotomy — he did not document entering the abdomen, only working to the fascia level. The correct service is a foreign body removal from the abdominal wall. Although there are a number of codes that describe foreign body…
Continue Reading
Loading ...Visit SuperCoder For:
