Archive for 'Hot Coding Topics'

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

Posted on 10. Jan, 2010 by .


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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PQRI 2010: Tips That Boost Your Practice’s Revenue

Posted on 10. Jan, 2010 by .


Follow our links and advice to put more plusses in your claims column

Back again for 2010 is Medicare’s incentive-driven physician quality reporting initiative (PQRI), aimed at tracking quality metric or patient care services that physicians provide. When the practice treats enough patients in the same category, some PQRI dollars might be only a few codes away.

If you know the basics and focus your efforts, PQRI reporting can be a breeze and a boon to your bottom line. Check out this rundown on “The Whats?” of PQRI.

What’s In it for Me?

Coders can garner an extra payout for PQRI-eligible patients that your group treats and you code correctly; for 2010, Medicare will fork over a 2 percent bonus if you meet certain criteria.

Lowdown: In order to qualify for the PRQI bonus, you have to report on at least three of 179 PQRI measures in 80 percent of the eligible cases, explains Alice Marie Reybitz, RN, BA, CPC, CPC-H, CHI, a healthcare coding and billing consultant based in Belleair, Fla.

What Extra Coding Work Is Involved? (more…)

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Global Billing: Document ‘Unrelated’ for Modifier 79 Services

Posted on 07. Jan, 2010 by .


MACs are looking for ‘red flags’ to halt additional global period pay

Billing for additional services during a global surgery period is always tricky, but now you can expect special scrutiny for modifier 79 claims.

After the OIG got wind of fraudulent surgery billing with modifier 79 (Unrelated procedure or service by the same physician during the postoperative period), CMS contractors have been on the hunt for modifier 79 abuse. Implement our expert tips below to keep your 79 claims clean.

Obey Global Package Model

The starting point for clean modifier 79 claims is not breaching the global surgical billing concept. Once you understand the global package rules, you’ll know when you have an exception that warrants an additional claim with an appropriate modifier. (more…)

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Radiology Coding Challenge: Total Spine MRI Without Contrast

Posted on 05. Jan, 2010 by .

MRI sagittal image of sacral and dorso-lumbar perineural cysts. Malisan.mrosa.

MRI sagittal image of sacral and dorso-lumbar perineural cysts. Malisan.mrosa.

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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CPT 2010 Update: Urogynecology Coding

Posted on 05. Jan, 2010 by .


Remember, supervision requirements still apply to new codes.

CPT 2010 brings some big changes to urogynecology coding. Your urodynamics coding — and income — changes drastically as of Jan. 1.

Get to Know These 3 New Complex Cystometrogram Codes

You will have three new urodynamics codes to learn starting Jan. 1. CPT 2010 adds the following codes:

• 51727 — Complex cystometrogram (ie, calibrated electronic equipment); with urethral pressure profile studies (ie, urethral closure pressure profile), any technique. (more…)

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How Do I Code An Arthroscopic To Open Ankle Surgery?

Posted on 04. Jan, 2010 by .


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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A Medical Coder’s ICD-10 Resource Guide

Posted on 30. Dec, 2009 by .


We’ve got the link to a nifty ICD-9 to ICD-10 code translator.

Maybe I’m getting old, but I just can’t believe we’re about to ring in the second decade of the 21st century. It seems like just yesterday I was toasting the new millennium and breathing a sigh of relief that “Y2K” wasn’t the big catastrophe we all dreaded.

With time whizzing by so fast, now’s the time to prepare for ICD-10 implementation. And some coders dread ICD-10 as much as anyone ever dreaded Y2K. The number of our diagnosis codes will swell from 13,500 to 120,000, for example. And if we’re certified coders, we’ll have to demonstrate our ICD-10 expertise in order to maintain our certifications. I know I’m too old for another test!

If you feel like you’re already behind on ICD-10, here are 3 links to help you learn more.

For some free webinars that teach you ICD-10 basics and help you plan for implementation, go here. The AAPC’s Deborah Grider gives you some quick tutorials and some helpful slides. (more…)

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2010 CPT General Surgery Coding Update: Changes for Lap, Abdominal Repair & Hemorrhoidectomy

Posted on 30. Dec, 2009 by .


Can you find codes in 2010′s resequencing mess? We show you how.

Reporting your general surgeon’s service with an unlisted code means more documentation work and a payment guessing game — that’s why you’ll welcome CPT 2010’s more specific codes.

General surgery can get all the details at this on-demand, specialty-specific audio update. But we won’t keep you in complete suspense. Here’s a peek at what you’ll learn in the audio.

Capture Large Abdominal Repairs With New Code

When your general surgeon repairs a large abdominal wall defect, you didn’t have a way to report the work — until now. (more…)

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How Do I Code Genetic Counseling By A Physician

Posted on 21. Dec, 2009 by .


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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Ask 3 Questions to Head Off 2010 Consult Problems Before They Start

Posted on 17. Dec, 2009 by .


Ever used an unlisted E/M code? Get ready.

By now, you’ve heard that CMS is doing away with all inpatient (99251-99255) and outpatient (99241- 99245) consultation codes in 2010 — but are you prepared for the issues this may cause, starting Jan. 1? Ask these three questions of your practice and payers, and you’ll fend off headaches before they start.

Keep in mind: While Medicare has released the transmittal letter to all carriers instructing them about the policy change to no longer payer for consultations, Senator Arlen Specter (D-PA) introduced an amendment to the Patient Protection and Affordable Care Act (H.R. 3590) to delay this policy change by one year. This amendment was added on Dec. 14, 2009.  If Congress does not pass this bill before the end of the year, the Medicare policy will go in as planned.  Check the Ob-gyn Coding Alert and SuperCoder for more developments, but be prepared just in case.

Ask 3 Questions to Head Off 2010 Consult Problems from Erin masercola on Vimeo.

1. Do Medicaid and Private Payers Have Consult Advice?

If a physician sends a Medicare patient to your ob-gyn for a consultation, you should use regular E/M codes (99201-99215, Office of other outpatient visit for a new or established patient …) instead. But what about the other insurers? (more…)

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