Archive for 'Hot Coding Topics'

Shoulders: Don’t Let Tissue Scaffolding Procedures Complicate Your RCR Claims

Posted on 18. Dec, 2014 by .


Scrutinize the op report to determine whether the physician used a tissue scaffolding device.

If your orthopedic surgeon documents using a tissue scaffold such as the GraftJacket, Conexa or another similar implant during rotator cuff repairs, you may find yourself in a coding quagmire — CPT® does not include a code for the tissue scaffolding procedure, but the physician thinks that the extra work is worth more than a standard rotator cuff repair.

You can code RCRs with tissue scaffolding like a pro, even if you’re a first-timer. Read our experts’ advice, and find out just how to get your coding on the straight and narrow.

Recognize Tissue Scaffolding in the Documentation

The first step in determining whether your surgeon performed a tissue scaffolding procedure is to examine the op note. For example, the physician might refer to an “acellular dermal matrix,” “GraftJacket,” “GJA,” “Restore implant,” or “tissue scaffold” when explaining the procedure he performed. (more…)

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Medicare Incentives: Avoid Pay Cuts with PQRS

Posted on 10. Dec, 2014 by .


Deadlines rush your lab clients to EHR, too.

With more than enough pay cuts to go around, nearly anything your lab can do to hold on to earnings is a step worth taking.

Read on to make sure you know what’s happening with certain Medicare program options, such as the Physician Quality Reporting System (PQRS), that could impact your bottom line.

Look for PQRS Penalty Notifications

The 2013 PQRS incentive program feedback reports are currently available if you’re interested in reviewing yours, said CMS’s Christina Phillips during a recent Open Door Forum call. “There are two different types of reports you can access—one is the NPI identifier level report, (more…)

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Streamline Your Care Management Services with new 2015 E/M Changes

Posted on 09. Dec, 2014 by .


The October 2014 CPT® Assistant is jam-packed with updates for the newly-created Care Management Services in the E/M section. Get the inside scoop on services that care management includes and what’s involved when calculating total time. Evaluate provider requirements for care management and additional E/M services you can report with care management codes.

Nail down correct codes for endovascular treatment for lower extremity venous incompetency and positive airway pressure (PAP) therapy. Sharpen your skills for coding trigger point injections using dry needling technique, and much more. Put’s Code Connect code and keyword search to good use to deepen your understanding of these topics:

  • Care management services: 90951-90970, 98960-98962, 98966-98968, 98969, 99071, 99078, 99080, 99090, 99091, 99201-99215, 99324-99328, 99334-99337, 99339-99340, 99341-99345, 99347-99350, 99358-99359, 99363-99364, 99366, 99368, 99374-99380, 99441- 99443, 99444, 99487-99490, 99495-99496, 99605-99607
  • Endovascular treatment for lower extremity venous incompetency: 29581, 29582, 36000-36005, 36410, 36425, 36478, 36479, 37241-37244, 36468-36479, 37765-37766, 37799, 75894, 75898, 76000, 76001, 76937, 76942, 76998, 77022, 93970, 93971
  • ICD-10: Table of Drugs and Chemicals
  • Positive pressure therapy: 94660, 94002-94005, 94660,  95811, 95783, 99201- 99499
  • Trigger point injections: 20550-20553, 20999

You’ll also find the customary FAQ section in the latest CPT® Assistant to help you resolve your toughest coding cases. To find the help you need, search for these codes and keywords on Code Connect: (more…)

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Epidural Adhesiolysis: Top 3 Tips Help You Steer Your Way To Clean Claims

Posted on 26. Nov, 2014 by .


Check with your payer before you report endoscopic procedure. 

You won’t find it too challenging to report epidural adhesiolysis if you know how to construe the operative note to confirm what your physician did. Here is how you can flawlessly report this procedure and earn your deserved payment.

1. Do Not Limit Yourself to One Day

Your surgeon may continue the procedure of adhesiolysis over a period of time. Carefully read through the operative note to determine the number of days the catheter remains in the anatomical location. You will choose the right code depending upon how many days the procedure was done. Accordingly, (more…)

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Pay Attention, Radiology Coders! More Than Half of This CPT® Assistant Is Dedicated to You!

Posted on 19. Nov, 2014 by .


The September 2014 CPT® Assistant is brimming with recent coding updates and coding tips for deciding when to report fluoroscopy separately. Find out how the CPT® 2015 code set will impact bundling of intrathecal contrast administration via lumbar injection and myelographic radiologic S & I.  The issue also briefs you on how to append modifier 59 to computed tomography of the spine with contrast if the provider performs CT subsequent to a myelogram on the same patient the same day.

Reviewing the latest issue will also improve your understanding of how to report an anogenital examination. To get spot-on guidance, simply type a code or keyword into’sCode Connect to see the September article that suits your needs:

  • Anogenital Examination: 99170
  • Fluoroscopy Codes: 76000, 76001, 71023, 71034, 36597, 64581, 49440, 49441, 49442, 49446, 49450, 49451, 49452, 49460, 49465, 64561
  • ICD-10-CM “Z” Codes
  • Myelography and Injection Procedure Codes : 72240, 72255, 72265, 72270, 62284, 62270, 61055, 72126, 72129, 72132

The latest selection of CPT® Assistant FAQs also provides guidance for a variety of areas. Find authoritative answers in a snap by looking for these codes and topics on Code Connect:


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Pain Management: Keep These 5 Tips in Mind Before Coding Post-op Pain Control Injections

Posted on 12. Nov, 2014 by .


Documentation of your provider’s role is crucial.

Postoperative pain control is a standard part of care for some patients, such as those who have arthroscopic shoulder surgery. Being reimbursed for your pain management specialist’s service isn’t automatic, however, so remember some key points before submitting a separate claim for the injection or catheter placement.

1. The injection or catheter placement must be administered by a different physician than the surgeon who performed the surgery. You won’t have any problem meeting this criterion, but it’s still good to be aware of the guidelines.

2. Your provider should complete a separate procedure report for the post-op pain management procedure. (more…)

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ICD-10-CM: Alert Your Cardiologists to Increase the Pulmonary Valve Disorder Details for ICD-10

Posted on 22. Oct, 2014 by .


Specific documentation of stenosis and insufficiency will simplify finding the proper code.

When you start using ICD-10 codes in place of ICD-9, your nonrheumatic pulmonary valve disorder code choices will multiply by five. But a little prep work will make choosing among the more specific codes easy to do.

ICD-9-CM Code

  • 424.3, Pulmonary valve disorders

ICD-10-CM Code (more…)

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Capture Every Audiologic Function Test Using August 2014 CPT® Assistant

Posted on 10. Oct, 2014 by .


The August 2014 CPT® Assistant features the diagnostic audiology test codes that require use of calibrated electronic equipment. You’ll get clarification on the codes for audiologic function tests that you can report separately, or with E/M services, and get the facts on use of modifier 52 to report the services. Not sure where certain tests fall in the code range? The issue also presents the audiology test codes that enable the provider to identify the degree or type of hearing loss, assess the abnormal growth of loudness perception, detect defects in adaptation to sound, and evaluate the devices related to hearing.

Other topics this CPT® Assistant covers include reporting time based codes, visual evoked potential coding, and much more. Put’s Code Connect code and keyword search to good use to deepen your understanding of these topics:

  • Audiologic Function Tests : 92550-92597, 92620-92625, 99201-99205, 99211-99215, 99241-99245, 0208T-0212T
  • Evaluation and Management (E/M) Services Guidelines
  • ICD-10-CM Diagnosis Coding Process
  • Time Based Codes: 00100-01999, 90832, 90833, 90839, 90840, 95972, 95974, 95978, 97110, 99143-99150, 99291-99292, 99401-99404
  • Visual Evoked Potential : 0333T, 95930.


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Condition Focus: Get the Lowdown on Sleep Apnea and Hearing Loss

Posted on 08. Oct, 2014 by .


Hint: Knowing the type points you to the diagnosis.

A study presented at the 2014 American Thoracic Society International Conference in May found that people with sleep apnea might have a higher risk of hearing loss – which means your otolaryngologist might start treating more patients who’ve been diagnosed with sleep apnea. Be sure you understand the condition so you can correctly code the associated diagnosis.

Determine Obstructive Vs. Central Type

Sleep apnea is a serious disorder characterized by a person’s breathing being interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, which can deprive the brain — and the rest of the body — of getting enough oxygen.

There are two types of sleep apnea: (more…)

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Diagnosis Update: 733.11 Crosswalks to 85 Code Choices in ICD-10

Posted on 24. Sep, 2014 by .


Remember 7th digit for encounter.

How much more can you say about a disease-related humeral fracture (733.11, Pathological fracture of humerus)?

A lot, apparently, based on the fact that ICD-10 provides 85 different codes for that condition.

Simplify: Don’t get too overwhelmed by that number — you really just need to know five codes, but the number explodes to 85 because each of the five codes requires a sixth digit for right/left/unspecified, and each of those fifteen codes requires a seventh digit (there are six choices) to describe the encounter.

Here are the five base codes you need to know:

  • M80.02__ — Age-related osteoporosis with current pathological fracture, … humerus,
  • M80.82__ — Other osteoporosis with current pathological fracture, … humerus, …
  • M84.42__ — Pathological fracture, … humerus,
  • M84.52__ — Pathological fracture in neoplastic disease, … humerus, …
  • M84.62__ — Pathological fracture in other disease, … humerus, …

And here are the sixth digits that you’ll apply to each of the preceding codes: (more…)

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