Surgical Modifiers: Protect Yourself From Instant ‘PC’ Claim Denials

Posted on 19. Mar, 2010 by suzanne.leder.

Don’t let ‘wrong surgery’ modifier mistakes stall your reimbursement.

You use modifier TC for the technical component of a test. So logically, you should use modifier PC for the professional component, right? Wrong. But many coders are making that mistake and causing their practices unnecessary denial hassles. Here’s what you need to know.

Get ‘Wrong Surgery’ Modifiers Right

When practitioners perform erroneous surgeries, CMS requires the hospital outpatient department, ambulatory surgical center (ASC), physician, or other entity to append one of the following three modifiers to codes for services related to the erroneous procedure effective Jan. 15, 2009: (more…)

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Modifiers, not Math, Make Multi-Excision Claims Go

Posted on 15. Mar, 2010 by suzanne.leder.

Measuring total removal lengths is a no-no … here’s why.

Your ED physician removes a pair of benign lesions from the patient’s left thigh; you add the repair lengths and code based on those numbers. You’ve coded correctly … right?

Wrong: Many coders get tripped up by lesion removal codes, which are governed by different rules than lesion excision codes. Get the real lowdown on coding multiple lesion excisions right here, and you’ll get it right every time.

CPT, Experts Agree: Don’t Add Lengths

When your physician removes multiple lesions, “code for each individual lesion; this is not like laceration repairs, where you combine the length of all of the same body area/complexity wounds,” explains Sharon Richardson, RN, compliance officer at Emergency Groups’ Office in Arcadia, Calif. (more…)

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Learn the Ins and Outs of Add-on Codes to Ensure Payable Claims

Posted on 12. Mar, 2010 by suzanne.leder.

Knowing how to use add-on codes can net you up to $258 in additional reimbursement.

CPT is full of “add-on” codes, additions to minor and major surgical procedures as well as to E/M services. Fortunately for urology there are not many “add-on codes,” but that makes it essential for you to know the special rules that apply to these codes when you do have to use them. If you learn just a few main guidelines, you can gain the best possible reimbursement for your urologist’s procedures including all add-on codes.

Look for the ‘+’ Symbol

There’s an easy way to tell if a CPT code is designated as an add-on code… (more…)

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Want to Bill the Patient? Make Sure You Use Two ABN Modifiers

Posted on 10. Mar, 2010 by suzanne.leder.

A revised GA and new GX hope to clarify some of Medicare’s non-coverage policies.

At least one aspect of dealing with Advance Beneficiary Notice of Non-Coverage (ABN) forms is about to get a little simpler, thanks to two modifiers.

CMS is now giving you two HCPCS level 2 modifiers to distinguish between voluntary and required uses of liability codes, according to release CR6563.

Know when you need an ABN with this expert advice: (more…)

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Achieve Modifier 25 Success in Just 3 Easy Steps

Posted on 08. Mar, 2010 by suzanne.leder.

Understand ‘significant’ and ‘separate’ to earn a gold star.

Knowing when to report modifiers and choosing the best one for each situation can be an easy trip-up for coders. If you find yourself especially befuddled by modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), keep reading for real-world tips that will help you code confidently every time.

Starting point: Remember you can only consider reporting modifier 25 when coding an E/M service. If the procedures you’re reporting don’t fall under E/M services, check whether the encounter qualifies for modifier 59 (Distinct procedural service) instead. (more…)

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Think You Understand the New Consult Rules? Find Out Fast

Posted on 04. Mar, 2010 by suzanne.leder.

Check your 2010 consultation coding savvy.

Find out if you’re set to properly code your physician’s consultation services this year by tackling three problems and their solutions.

Check With Your MAC for Guidance

When your physician sees a Medicare inpatient and would have used an inpatient consultation code, this year you should report an initial hospital care code (99221-99223). If the E/M service and documentation do not meet the requirements of an initial inpatient hospital care code, however, your coding will now depend on your Medicare Administrative Contractor’s (MAC) or carrier’s policy.

Problem: The lowest initial hospital care code (99221) requires a detailed history and detailed exam. When your physician’s documentation does not reach this level, there is a question as to what CPT codes you should use. (more…)

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Stay in the Game With the Correct Ligament Repair, Reconstruction Codes

Posted on 02. Mar, 2010 by suzanne.leder.

Remember ligament repair abbreviations to simplify elbow ligament surgeries.

Baseball players are gearing up for the season, which means your orthopedist could see a sudden increase in elbow ligament injuries. If conservative therapies fail to help torn medial (841.1) or lateral (841.0) collateral ligament injuries, your surgeon might opt to perform a ligament repair or reconstruction. Follow our tips to distinguish between procedures, and you’ll hit a coding homerun.

Terms, Diagnosis Can Signal Correct Procedure

Because surgeons don’t always use the words “reconstruction” or “repair” in their operative reports, you might have difficulty choosing between elbow ligament surgery codes:

• 24343 — Repair lateral collateral ligament, elbow, with local tissue
• 24344 — Reconstruction lateral collateral ligament, elbow, with tendon graft (includes harvesting of graft)
• 24345 — Repair medial collateral ligament, elbow, with local tissue
• 24346 — Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft).

Tip: Look for words such as … (more…)

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Give Your Radiosurgery or Gamma Knife Surgery Coding a Check-Up

Posted on 28. Feb, 2010 by suzanne.leder.

Improve your reimbursement chances by applying modifier 58 in this situation.

When your surgeon targets the brain or spine with stereotactic radiosurgery (also called gamma knife surgery) to treat multiple lesions over multiple sessions, you need to know two crucial things: what stereotactic radiosurgery codes to use and how many units to include.

Take this three-question challenge to see whether you’ve got stereotactic radiosurgery intricacies down.

Hint: If you want to pass with flying colors, follow this expert advice: you’ll report “61796 through 61799 depending on simple or complex lesions and add a second code for additional lesion treatment,” says Nancy Chicolte, CPC, senior coding specialist for Johns Hopkins University’s Department of Neurosurgery in Baltimore.

Read 3 Statements, Then Choose True or False (more…)

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Get Paid for EM Visits: How Much ROS Documentation Is Enough?

Posted on 25. Feb, 2010 by suzanne.leder.

Caution: Keep enough paperwork on hand to back up EHR.

Transitioning to the world of Electronic Health Records (EHR) can make your coding easier on many levels, but don’t take it for granted. Physicians often fall short in their review of systems (ROS) documentation whether you use paper charts or rely on EHR, but you can help correct the deficiency.

Consider this situation and decide how you would handle it before reading on for our experts’ advice.

Try this Scenario: The pediatric practice uses EHR, and one physician has a sheet listing any concerns or problems that the patient fills out prior to her visit. The physician uses the sheet as his review of systems (ROS) for chart note documentation. He lists anything the patient marks as positive and then states “all others negative.” He discards the form the patient completed. (more…)

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Red Alert, Cardiology Coders: Expect EP Study + Ablation Denials Until April 1

Posted on 24. Feb, 2010 by suzanne.leder.

CMS won’t fix CCI blunder until version 16.1, to be released in the spring.

If your heart skipped a beat when you saw that January’s Correct Coding Initiative (CCI) edits bundled catheter ablations with electrophysiology (EP) studies, you weren’t alone.

Good news: CMS has decided to delete the edits retroactively because their addition was a mistake, according to the Heart Rhythm Society (HRS).

Snag: The deletion won’t happen until April 1. Here’s what you need to know. (more…)

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OIG Hit List: Perfect Your 38220, 38221, and G0364 Usage

Posted on 22. Feb, 2010 by suzanne.leder.

Don’t sweat reporting 38220-59 if you meet these Medicare-approved conditions.

If your oncologist takes both a bone marrow biopsy and a bone marrow aspiration, whether you’ll see Medicare reimbursement depends on the two guidelines below. But watch out: With OIG scrutiny and a HCPCS twist, these guidelines will put your coding savvy to the test.

Append 59 for Different Sites and Encounters

Because a bone marrow biopsy and a bone marrow aspiration can provide different diagnostic information for certain leukemia evaluations, taking both specimens from the same patient on the same day isn’t unusual, according to R.M. Stainton Jr., MD, president of Doctor’s Anatomic Pathology in Jonesboro, Ark.

Snag: Medicare and some other payers use the Correct Coding Initiative (CCI) edits to restrict how you bill for “sequenced” surgical procedures through the same incision. For biopsy and aspiration, CCI bundles the following codes: (more…)

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E/M Coding: Don’t Sell Yourself Short on Problem Sports Exams

Posted on 19. Feb, 2010 by suzanne.leder.

Tip: Time-based E/M might be in line when managing diabetes, asthma, ADHD.

Overlooking time as the key factor on a camp or sports exam in which the patient has a problem could cut $30 per claim.

Opportunity: An office visit (99201-99215, Office or Other Outpatient Services) using time as the key factor might be appropriate, but keep in mind that lowballing time-based E/M codes because of poor documentation can be a revenue-loser for many practices, says Jennifer Godreau, who’s presenting a free webinar next week to help coders tackle trouble-spots.

Watch for Chronic Conditions (more…)

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Coding Compliance: OIG Targets Transforaminal Epidural Injections

Posted on 17. Feb, 2010 by suzanne.leder.

Verify that you’re counting injections and levels correctly to keep claims clean.

The Office of Inspector General (OIG) Work Plan for 2010 includes a closer look at Medicare payments for transforaminal epidural injections. The Work Plan specifically states, “We will review Medicare claims to determine the appropriateness of Medicare Part B payments for transforaminal epidural injections.”

Stay out of the OIG crosshairs by ensuring that your pain management specialist documents each procedure thoroughly. Follow these steps to count levels and assign the appropriate codes correctly.

1. Understand What ‘Transforaminal’ Means

Physicians often administer transforaminal epidurals laterally through the selected neuroforamen under fluoroscopy, says Joanne Mehmert, CPC, CCS-P, president of Joanne Mehmert and Associates in Kansas City, Mo. Once there, the physician performs an injection at the nerve root area to help relieve the patient’s pain. The medication goes into the anterior epidural space, “bathing” a specific spinal nerve as it exits the spinal cord.

CPT includes four codes to represent transforaminal epidural injections, which you choose between based on the injection site and number of injections: (more…)

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Use This Podiatry Scenario to Perfect Your Emerging Technology Claims

Posted on 15. Feb, 2010 by suzanne.leder.

Hint: If you try to use an unlisted code, be sure your OP notes include this information.

If you don’t know the ins-and-outs of coding cutting edge procedures, you risk getting left in the dust as medicine continues to evolve. A new techniques, however, doesn’t always mean a new, corresponding CPT code. Check out this podiatry Topaz coding example.

What is Topaz: “The TOPAZ MicroDebrider is a tool which utilizes Coblation® technology to perform a small incision in the fascia and is considered an alternative to the use of standard surgical instruments such as scalpels, low frequency electrocautery, and so forth,” according to CPT Assistant, September 2009. This technology enables the physician to “microdebride” soft tissue present within the tendons of the knee, shoulder, elbow, ankle, and foot.

Read on to unravel the mystery surrounding Topaz procedure coding and billing. (more…)

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Avoid Hospice Coding Headaches With Modifiers GV and GW

Posted on 12. Feb, 2010 by suzanne.leder.

Differentiating between GV and GW is your first step.

If your urologist sees and treats hospice patients, you probably feel like you have to jump through hoops to get paid. The key to bringing in every hospice-related dollar your urologist deserves is ensuring you append the right modifier.

Base Modifier GV or GW Choice on Diagnosis

When reporting services your urologist provides to a hospice enrolled patient, “the most important thing you need to pay attention to is the correct modifier to use,” says Jane Marks, financial services manager at Anne Arundel Urology in Annapolis, Md. “You also need to pay attention to the diagnosis that is on your claim and whether that diagnosis is related to the terminal illness or not.”

The diagnoses the hospice submits for its patients affect how you bill and what reimbursement (if any) your urologist will receive. If you know which diagnosis the hospice uses, you’ll know whether to append modifier GV (Attending physician not employed or paid under agreement by the patient’s hospice provider) or modifier GW (Service not related to the hospice patient’s terminal condition).

Here’s how: (more…)

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Critical Care Coding FAQ: Become a Master of Time

Posted on 09. Feb, 2010 by suzanne.leder.

Beware: CPT, CMS differ on ‘family discussion’ parameters.

When the physician treats a patient with a critical illness or injury, you need to know when to start and stop the critical care clock in order to avoid miscoding. Check out this FAQ to find out what’s part of critical care, what’s not, and how to correctly count the minutes to ensure the most accurate and profitable 99291-+99292 claims.

Q. What Must I Carve Out of Critical Care Time?

Be careful when considering critical care minutes; many services that you might think are part of the 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) package are actually separately billable procedures, pointed out Caral Edelberg, CPC, CCS-P, CHC, president of Edelberg Compliance Associates in Baton Rouge, La., during her recent presentation on ED trauma coding at The Coding Institute’s multi-specialty conference in Orlando, Fla. (more…)

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Collections: Banish Co-pay, A/R Problems

Posted on 07. Feb, 2010 by Editor.

5 tips help you recover deserved pay.

Collecting money from patients, especially during a recession, can be challenging. If your front desk is responsible for collecting copays and sometimes old balances, its success or failure has a dramatic impact on the practice’s bottom line.

Check out five ways you can improve your front desk collection efforts:

1. When calling to remind patients about their visit date, also remind them of their co-pay amount and any old balances so they come prepared to pay at the visit.

2. When a patient complains about paying a bill, send her to a manager so the bill can be reviewed and explained.

3. Most practice management software will allow front desk staff to view outstanding balances. Your front desk staff can politely remind the patient that there is a balance and say something like, “How would you like to pay your bill today?” Assume that the patient is planning to pay. (more…)

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Newborn Status Change Means Deciding Between Hospital Care Codes

Posted on 04. Feb, 2010 by suzanne.leder.

Sort your normal, sick and intensive care options.

Choosing the appropriate codes for initial newborn services can be difficult due to the large number of available codes and gray areas between the spectrum of illnesses. If you find yourself getting tripped up by the multiple categories, read on for expert tips and real-world examples that will point you in the right direction every time.

Normal Care Means No Problems

A “normal” newborn has no medical conditions or need for special care. Report the history and examination with 99460 (Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant).

Donelle Holle, RN, a consultant with Pedscoding.com in Indiana says this initial care includes five things: (more…)

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Oncology Coding 2010 Update: 3 New Lab Services Codes

Posted on 02. Feb, 2010 by Editor.

Watch for your chance to replace 86316 with more specific 86305.

If your oncology practice has its own lab, heads up.

You’re sure to find a few new lab codes “in CPT 2010 that you need to know,” says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.

Get started with a look at these three codes you’re likely to use in your oncology/hematology practice.

Heed New HE4 Code, 86305 … (more…)

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What Lab Coders Need to Know About CCI 16.0

Posted on 31. Jan, 2010 by Editor.

Look for transcutaneous hemoglobin limitations, and bundling for those new 2010 culture codes.

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