Archive for 'Coding Challenge'
Cyst Expression: I&D or Excision?
Posted on 12. Aug, 2010 by jennifer.godreau.
Question: Documentation reads, “The cyst was excised after performing a central incision directly on the cyst. All the material was expressed, then cyst capsule was removed completely and excised completely. Packing was performed.” Should I code the procedure as an I&D or an excision?
Answer: You should look at the pathology report and any further excision description to reach the correct code set. “Excision is defined as full thickness [through the dermis] removal of a lesion …,” according to CPT’s Excision-Benign Lesions guidelines. The documentation you provided (more…)
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Medicare Repeat Pap Smears: Find Out If 99000 Is OK
Posted on 12. Aug, 2010 by jennifer.godreau.
Hint: Abnormal versus insufficient cells mean different diagnosis codes.
When a patient returns to your office for a repeat Pap smear, you’ve got to weigh your options of E/M and specimen handling codes, as well as diagnosis codes. Take this challenge to see how you fare and prevent payment from slipping through your fingers.
Question 1: When a patient comes in for a second Pap smear, what CPT code(s) should you apply and why? (more…)
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Protect Incident To Pay
Posted on 12. Aug, 2010 by jennifer.godreau.
Incident-to services are on auditors radar. To prevent paybacks, you’ve got to know when to use incident to – and capture full pay, and when to bill services directly – and lose the standard 15%. Test your incident to savvy with this question:
Question: Can an NP see a new patient in the office under incident to?
Answer: Check out the solution.
P.S. Got a coding stumper? The Coding Institute CPC staff provide fast, easy-to-understand answers – with a M-F 24-hour turnaround!
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RFA: 64622, 64623 Vs. 64640
Posted on 12. Aug, 2010 by jennifer.godreau.
With multiple ways to denervate the sensory nerve/nerve branches, pain management coders may argue about which 64xxx code is right. You’ve got to dig into the chart note to identify the method used. See if you’re up to the challenge with this Supercoder Forum Insight.
Question: A provider is doing RFA’s of the left L4, L5, S1, S2, S3 and SA. He is billing 64622 x 1 and 64623 x 4. The other pain provider states this is incorrect and that he should be billing 64640 for S1, S2, S3 and SA. Which coding is correct?
Answer: This is a complex coding issue because there are several different methods to denervate the sensory nerve/nerve branches that provide innervations from the SI joint. Because of this, the coding will depend somewhat on the method used. (more…)
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Medical Coders: Accepting a PFFS Plan is Your Choice
Posted on 18. Jun, 2010 by Editor.
Here are the pros and cons to help guide your decision.
Question: Our practice is considering accepting patients with PFFS plans. We’re heard that some patients are starting to have them, but we’re not sure whether we’re going to accept them or not. Are PFFS plans beneficial for us?
Answer: PFFS are Private Fee-for-Service plans, which are non-network plans. These plans let members receive care from any doctor or hospital that accepts the plan’s payment terms and conditions.
If your practice decides to accept these terms, you would (more…)
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Medical Coding: Ease Counseling Codes Acceptance With Distinct Dxs
Posted on 14. Jun, 2010 by Editor.
Study frequency guidelines before you bill for counseling services.
Question: A 60-year-old established Medicare patient with a confirmed diagnosis of vanishing lung (emphysema) reports to the family physician (FP) for a medication check and blood work; the patient is a moderate smoker. During the medication check and blood work, which took about 5 minutes, the patient tells the practice’s non-physician practitioner (NPP) “I think I’m ready to quit smoking; can you help?” The NPP spends the next 7 minutes providing smoking cessation counseling for the patient. Can I report a cessation code and an E/M?
Answer: Provided the patient meets Medicare’s requirements for cessation counseling, you can report the following:
- 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes or less are spent performing or supervising these services.) for the E/M
- 492.0 (Emphysema; emphysematous bleb) appended to (more…)
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Ophthalmology Coders: Does Old BB-Gun Injury Have Bearing on Coding?
Posted on 14. Jun, 2010 by Editor.
The reason your patient is visiting is key.
Question: We have a patient who came in for a routine eye exam, but reported retinal damage from a BB-gun incident six years ago. What would be the best way to code this? This is a new patient, and I do not have any old records.
Answer: Unless the BB-gun injury six years ago has something to do with why the patient is there, it may not have any bearing on your coding. The diagnosis code always depends on (more…)
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Anesthesia Coding: Find the Missing EGD Reimbursement Link
Posted on 07. Jun, 2010 by Editor.
Warning: Just including EGD diagnosis with your claim doesn’t guarantee reimbursement — here’s help.
Question: Our anesthesiologist provided anesthesia during an esophagogastroduodenoscopy (EGD) procedure, at the request of the attending physician. We coded the anesthesia portion with 00810. A note in the documentation mentions the request was due to the patient’s symptoms, but no other details were provided. The claim we submitted was denied, but we followed all of the other guidelines provided by the payer, including proof that the anesthesiologist administered Propofol. What did we do wrong?
Answer: One key to the denial might be found in the lack of coding for the patient’s condition. Your diagnosis code should indicate the co-existing medical condition that justifies your anesthesiologist’s involvement in the case, not the gastrointestinal condition leading to the endoscopy.
You may want to consult with your anesthesiologist to verify that the patient had a condition such as: (more…)
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Oncology Coding: Determine the Proper Adverse Reaction Code
Posted on 03. Jun, 2010 by Editor.
Remember to describe all the circumstances surrounding a push to get full reimbursement.
Question: If a non-Hodgkin’s lymphoma patient has an adverse reaction to Rituximab less than 15 minutes into the ordered hour-long infusion, should I report a push?
Answer: Experts suggest the most appropriate way to report a discontinued infusion is to append modifier 53 (Discontinued procedure) to the appropriate chemotherapy infusion code, such as 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug).
You should use modifier 53 when a physician stops a procedure “due to extenuating circumstances or those that threaten the well-being of the patient,” according to CPT.
Modifier 53 describes an unexpected problem, beyond the physician’s or patient’s control, that necessitates ending the procedure. The physician doesn’t elect to discontinue the procedure as much as he is forced to do so because of the circumstances.
Push: CPT guidelines include (more…)
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Medical Records: 5 Reasons Your EMR Transition Will Pay Off
Posted on 01. Jun, 2010 by Editor.
The hard work and hassle of ditching paper documentation is not in vain.
Question: Our office is weighing the pros and cons of transitioning to electronic medical records (EMRs). We know the process is a huge undertaking that often results in even lower productivity and more confusion. So, is making the change really worth it?
Answer: If you haven’t witnessed or lead a conversion from paper records to an electronic medical record (EMR) system, it’s easy to get overwhelmed by the potential downsides. But experts agree that yes, going electronic is worth it. Here are a few reasons why:
1. You Open More Cash Inlets. Many research studies pull their data via electronic records. So, if you can’t tune in to participate, opportunities for cash perks will fly by. “Grant money and incentive programs are available, for example, and they want data in the electronic form,” points out Francine Wheelock, PT, MPA, manager of clinical systems for MaineGeneral Health.
Just look at nationwide push for value-based purchasing and outcome data, and expect to go electronic if you want to be in the loop.
Stay alert: Last year, the federal government (more…)
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