Choose 20552 or 20553 — Not 20605 — for Trigger Points

Posted on 08. May, 2013 by rpandit.

Question: The physician administered trigger point injections to fingers 2-5 on both the patient’s hands. He coded the procedure as 20605 x 8, but I don’t think that’s correct. What should we report?
Massachusetts Subscriber

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Reader Question: Watch Details When Deciding Between Levels 4 and 5 E/M

Posted on 24. Apr, 2013 by rpandit.

Question: We have enough details for an encounter to reach these levels: 

·         HPI – detailed

·         ROS – complete

·         PFSH – complete

·         EXAM – 10 systems

·         MDM – moderate.

Is this documentation sufficient to support a Level 5 E/M code for an established patient?

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Reader Question: 995.94 Isn’t the Only Code for SIRS Case

Posted on 08. Apr, 2013 by rpandit.

Reader Question: 995.94 Isn’t the Only Code for SIRS Case

Question: The physician saw an inpatient with chronic lymphocytic leukemia who was admitted with tumor lysis syndrome due to chemotherapy and then developed SIRS related to the cancer and resulting in acute kidney failure and acute respiratory failure. How should I report these diagnoses?

Answer: For the tumor lysis syndrome, you should report 277.88 (Tumor lysis syndrome). Because the syndrome was secondary to chemotherapy, you also should report E933.1 (Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use).

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Reader Question: Know the Path Codes for Scar Examination

Posted on 28. Mar, 2013 by rpandit.

Question: When our pathologist examines scar tissue, or tissue with a diagnosis related to scarring, can we bill 88305 if the specimen difficulty warrants the charge? Is there any time that a scar should not be 88305?

Answer: Yes, you can sometimes bill a scar specimen as 88305, but some guidelines might clarify when you should and shouldn’t do so.

You might report your surgical pathologist’s exam of scar or “scar related” tissue using any of the following codes, depending on the circumstances:

88302 — Level II – Surgical pathology, gross and microscopic examination… plastic repair…

88304 — Level III – Surgical pathology, gross and microscopic examination… skin – cyst/tag/debridement or Soft tissue, debridement…

88305 — Level IV – Surgical pathology, gross and microscopic examination… Skin, other than cyst/tag/debridement/plastic repair….

The code choice depends on the circumstances of the case, including the tissue origin of the scar (skin or soft tissue) and the extent of the service. Look at the following tips to help you decide when a scar fits under each code:

88302: Use this when the scar originates in the skin, and the pathologist’s work essentially involves tissue from “plastic repair.” That means the scar is an incidental part of a plastic repair procedure, and the specimen shows no significant pathology.

88304: A scar that originates in soft tissue or skin could qualify for 88304 when the specimen is essentially equivalent to a debridement. A “simple scar” removed for pathologic diagnosis, not as an incidental part of plastic repair, would qualify for 88304.

88305: A more complex skin scar specimen, such as a keloid scar or a tumor excision/re-excision, qualifies for this surgical pathology level under the catch-all skin code “other than cyst/tag/debridement/plastic repair.

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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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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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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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Reader Question: Not All Pain is ‘Typical’

Posted on 23. Jan, 2013 by rpandit.

Question: What’s the diagnosis code for “atypical” chest pain?

Answer: The ICD-9 index points to 786.59 (Other chest pain) for atypical chest pain. This code applies for any sort of discomfort, pressure, or tightness in the chest if there’s no more specific code for the condition.

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Reader Question: New Year, New Insurance = New Verification

Posted on 08. Jan, 2013 by rpandit.

Question: How should I file a claim on a patient who has new coverage but has not received an insurance identification card yet?

Georgia Subscriber

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Reader Question: Earn For Redo Spinal Procedures

Posted on 24. Dec, 2012 by rpandit.

Question: How do we report the following?

1. Decompressive Laminectomies Total L3, partial L2-L4
2. Bilateral Forminotomy L2-3 and Redo L3-4
3. Only Dural Graft with PAM

Is it correct to report 63047 (Laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [e.g., spinal or lateral recess stenosis], single vertebral segment; lumbar)? How do we capture the bilateral foraminotomy?

Kansas Subscriber

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