10060 Won’t Wash for Some I&Ds

Posted on 14. Jan, 2010 by Editor.

Careful: A pilonidal cyst I&D is a separate animal.

Question: A patient presents to the ED reporting pain in her spine. During the exam portion of a level-three E/M, the physician discovers that the painful area is red, and slightly warm to the touch. The patient also has a low-grade fever that she says she noticed about two days ago. The physician makes a shallow incision with a scalpel at the base of the patient’s spine and drains the pus from the area. I reported 10060 and received a denial. Why?

Answer: You chose a standard incision and drainage (I&D) code when you should have opted for a pilonidal cyst I&D code. When you re-submit the claim, report the following: (more…)

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How Do I Bill For Follow-Up Visits After the Global?

Posted on 12. Jan, 2010 by Editor.

Tip: Make sure the ICD-9 coding & documentation support follow-up visits after the global.

Question: Code 19101 has a 10-day global period, which means you cannot bill an E/M for anything related to that procedure within that time frame. If the patient continues to have follow-up visits outside the global period, should we then report the appropriate E/M level?

Example: Patient has an open breast biopsy on June 15, so the global period goes through June 25. The patient then has additional follow-up visits on June 26, July 3, and July 10. What is the most appropriate way to bill for the three follow-up visits that the surgeon provides outside the global period? Does modifier 24 apply?

Answer … (more…)

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Radiology Coding Challenge: Why is Medicare Denying a 38792, 78195 Claim

Posted on 10. Jan, 2010 by Editor.

Tip: Discover true meaning of 38792 note

Question: The physician performed a sentinel node injection with lymphoscintigraphy. A note with 38792 states to report 78195 for imaging. So why did Medicare deny a claim that included both codes?

Answer: You should report 78195 (Lymphatic and lymph nodes imaging) for this service and leave 38792 (Injection procedure; for identification of sentinel node) off the claim. The Correct Coding Initiative (CCI) edits consider 38792 and 78195 to be mutually exclusive.

Helpful: CPT Assistant (December 1999) explains that imaging code 78195 includes the injection: “The injection of radioactive tracer is included in the lymphoscintigraphy procedure performed at the same session and is not reported separately. Therefore, it is inappropriate to report 38792 when lymphoscintigraphy is performed.” (more…)

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Radiology Coding Challenge: Total Spine MRI Without Contrast

Posted on 05. Jan, 2010 by Editor.

Question: Which CPT code should I use for a total spine MRI without contrast?

Answer: You won’t find a single CPT code that describes a “total spine” MRI, but you may report a code for each region the radiologist examines:

• 72141 — Magnetic resonance (e.g., proton) imaging, spinal canal and contents, cervical; without contrast material

• 72146 — Magnetic resonance (e.g., proton) imaging, spinal canal and contents, thoracic; without contrast material

• 72148 — Magnetic resonance (e.g., proton) imaging, spinal canal and contents, lumbar; without contrast material.

Support: Reporting all three spine regions (cervical, thoracic, lumbar) is appropriate when the radiologist performs and interprets an MRI of all three regions, according to the July/August 2003 issue of The ACR’s Radiology Coding Source. The ACR recommends that the radiologist dictate separate reports for each separate region studied.

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How Do I Code An Arthroscopic To Open Ankle Surgery?

Posted on 04. Jan, 2010 by Editor.

Question: Our surgeon attempted to remove a loose body in the ankle arthroscopically, but it was too large so he had to perform an open removal. Do I bill only for the open procedure, or include the arthroscopic attempt as a discontinued procedure?

Answer: Because your surgeon completed the procedure as an open case, you’ll report only 27620 (Arthrotomy, ankle, with joint exploration, with or without biopsy, with or without removal of loose or foreign body) Include V64.43 (Arthroscopic surgical procedure converted to open procedure) as a secondary diagnosis.

Arthroscopic answer: If the physician had completed the procedure arthroscopically, you would submit 29894 (Arthroscopy, ankle, [tibiotalar and fibulotalar joints], surgical; with removal of loose body or foreign body) instead.

© Orthopedic Coding Alert. Download your 2 FREE sample issues here.

Orthopedic Coders: Do you understand the new consult coding rules? Get clear answers from our 2010 orthopedic coding audio update on January 7th.

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How Do I Code Genetic Counseling By A Physician

Posted on 21. Dec, 2009 by Editor.

Limit 96040 to Trained Counselor

Question: May we report 96040 if our physician is performing genetic counseling?

Answer: You should report 96040 (Medical genetics and genetic counseling services, each 30 minutes face-toface with patient/family) only for a trained genetic counselor’s services. (Currently, the American Board of Genetic Counselors [ABMG] certifies genetic counselors in the US and Canada.) Don’t use 96040 for genetic counseling by a physician or nonphysician who is not a genetic counselor.

Although nothing precludes a physician from also being a genetic counselor, CPT states that if a physician provides genetic counseling to an individual, choose the appropriate E/M code. If the physician counsels a patient without symptoms or an established disease, CPT points you instead to 99401-99402 (Preventive medicine counseling …). (more…)

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Urology Reimbursement: Coding for MESA, TESA

Posted on 17. Dec, 2009 by Editor.

Question: Could you please give me the most current coding guidelines for the MESA and TESA procedures? The last I was aware, we were to use unlisted procedure codes. Is that still correct?

Answer: You should still use unlisted procedure codes to report microsurgical epididymal sperm aspiration (MESA) and testicular sperm aspiration (TESA, sometimes called TESE for testicular sperm extraction).

There are no Category I procedure codes for these procedures. For MESA, however, there is an S code: S4028 (Microsurgical epididymal sperm aspiration).

Bad news: Unfortunately, not all payers, including Medicare, will pay for S4028. S codes, found in the HCPCS manual, are temporary national codes for which Medicare will not reimburse you. You may typically report S codes to some private payers and Medicaid, but doublecheck the rules for your particular state and payer.

For payers that do not recognize S codes, you should report the unlisted procedure code, 55899 (Unlisted procedure, male genital system), for MESA. You should also use this unlisted code for all payers when reporting TESA/TESE.

Charge the patient: Many payers will not pay for male infertility diagnostic procedures or treatments, including MESA and TESA/TESE diagnostic procedures. Check with the patient’s insurance before the urologist performs the infertility service, and remember to request and obtain precertification from the payer before the procedure. You should also obtain a signed advance beneficiary notice (ABN) from the patient if you expect the payer to deny payment.

Remember: ABNs help patients decide whether they want to proceed with a service even though they may have to pay for it. A signed ABN helps ensure that your office will receive payment directly from the patient if a carrier refuses to pay. Without a valid ABN, you cannot hold a Medicare beneficiary responsible for the denied charges.

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Thursday on AUDIO: Dr. Ferragamo’s 2010 Coding & Reimbursement Update.

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Surgical Coding: Scar Revision on Previous Mastectomy Site

Posted on 15. Dec, 2009 by Editor.

Tip: Find mastectomy scar revision in wound repair

Question: Our surgeon performed a scar revision on the site of a previous mastectomy. The procedure involved excising a 16.5 cm curved scar before performing a layered closure. How should we code this?

Answer: You should use complex wound repair codes for the scar revision procedure that you describe. Specifically, you should use the trunk codes 13101 (Repair,complex, trunk; 2.6 cm to 7.5 cm) and +13102 (… each additional 5 cm or less [List separately in addition to code for primary procedure]).

Measure repair: Whether straight, curved, angular, or stellate, the operative report should note the length of the repair. Because your report stated 16.5 cm, you should report 13101 for the first 7.5cm and +13102 x 2 for the additional 9 cm.

You should not code separately for the scar excision. When the surgeon removes the scar, he creates the “defect” that he then repairs. The scar excision plus the layered closure justifies selecting the complex wound repair codes rather than intermediate wound repair.

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2010 General Surgery Coding Update. An audio class with Terri Brame, MBA, CPC-GENSG, CPC-H, CPC-I.

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Coding Keloid Scar Removal

Posted on 12. Dec, 2009 by Editor.

Watch out: Avoid this unlisted code.

Question: Is removal of a keloid scar considered an unlisted procedure? What is the right code?

Answer: Use 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular lesions; up to 14 lesions) with diagnosis 701.4 (Keloid scar). 17110 and 7111 (… 15 or more lesions) are now used for destruction of common or plantar warts.

Rewind: In 2007, these codes were revised to include destruction of benign lesions other than skin tags or cutaneous vascular lesions. (more…)

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