Archive for 'Hot Coding Topics'

Newborn Status Change Means Deciding Between Hospital Care Codes

Posted on 04. Feb, 2010 by .


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 in Indiana says this initial care includes five things: (more…)

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Is E/M Possible Pre-Colonoscopy?

Posted on 03. Feb, 2010 by .






Question: A local family physician refers a patient to our gastroenterologist for a diagnostic colonoscopy. The patient reports to the practice and meets the gastroenterologist for the first time. After answering some patient questions during a brief introduction, the gastroenterologist performs a diagnostic colonoscopy with brushing. The patient had never met the gastroenterologist before. Is the time he spent with the patient pre-screening a separate E/M?

Answer: Do not report a separate E/M for this encounter. On the claim, report 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) for the service.

Explanation … (more…)

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Oncology Coding 2010 Update: 3 New Lab Services Codes

Posted on 02. Feb, 2010 by .


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 .




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

Think you’re ready to use all those brand new CPT lab codes? Not so fast. You better learn Correct Coding Initiative (CCI) restrictions first, before you start billing Medicare for services using new CPT 2010 codes.

CCI released version 16.0, effective Jan. 1, which includes 24,060 new active pairs and 869 modifier changes, according to Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions.

Let our experts walk you through the edits that could make billing for some code pairings difficult for your lab.

Block Out Transcutaneous Hemoglobin

CPT 2010 provides a new code for in situ hemoglobin testing: 88738 (Hemoglobin [Hgb], quantitative, transcutaneous). But according to the latest CCI edits, you can never bill 88738 for a patient on the same day that the lab performs any of the following “mutually exclusive” tests:

• 85013 — Blood count; spun microhematocrit

• 85014 —… hematocrit (Hct)

• 85018 —… hemoglobin (Hgb)

• 88740 — Hemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin

• 88741 —… methemoglobin.

“Because CCI 16.0 lists these bundled codes with a modifier indicator of ‘0,’ you can’t override the edit pair under any circumstances,” says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Beware CBC bundles: CCI 16.0 also bundles 88738 as a component (column 2) code of the following blood count codes:

• 85025 — Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC, and platelet count) and automated differential WBC count

• 85027 —… complete (CBC), automated (Hgb, Hct, RBC, WBC, and platelet count).

Since CCI assigns a modifier indicator of “0” to these pairs as well, you won’t ever be able to break the bundles

Problem: Your lab might get requests for two medically necessary hemoglobin tests by different methods in a single day. Based on these new CCI edits, the lab would not be able to bill for both procedures. “For instance, the lab might perform a complete blood count (CBC, such as 85025) for an infant, and based on a low hemoglobin count, perform a transcutaneous hemoglobin later in the day,” Dettwyler says. “With these edit pairs in place, the lab could not bill both procedures.”

Pick 1 Culture Typing Procedure

Your lab might also be ready to use these new CPT 2010 codes for culture typing:

• 87150 — Culture, typing; identification by nucleic acid (DNA or RNA), probe, amplified probe technique, per culture or isolate, each organism probed • 87153 -Culture, typing: identification by nucleic acid sequencing method, each isolate (e.g., sequencing of the 16SrRNA gene).

Watch out: CCI 16.0 places many restrictions on how you can use these codes. Based on the latest edit pairs, you would not expect to report 87150 or 87153 with any other culture typing procedure described by the following codes:

• 87140 — Culture, typing; immunofluorescent method, each antiserum

• 87143 —… gas liquid chromatography (GLC) or high pressure liquid chromatography (HPLC) method

• 87147 —… immunologic method, other than immunofluoresence (e.g., agglutination grouping), per antiserum

• 87152 —… identification by pulse field gel typing

• 87158 —… other methods.

Capture distinct isolates: Although your lab would only use one culture typing technique on a single culture, the lab might perform typing on multiple isolates in a single day. “Labs often process more than one culture from a patient on a single day, such as identifying multiple isolates from a wound culture,” Dettwyler says. When that happens, you might need to report two culture typing methods, such as 87150 and 87140. Because CCI lists these edit pairs with a modifier indicator of “1,” you can override the edit pair by appending modifier 59 (Distinct procedural service) to the column 2 code (87150).

Avoid Method ‘Double Dipping’

If your lab performs an infectious agent antigen detection test using nucleic acid probes (87470-87799, Infectious agent detection by nucleic acid [DNA or RNA] …) you can’t additionally report the new nucleic acid culture typing codes (87150-87153) to describe the lab method, according to CCI 16.0.

“The bundling is common sense,” Dettwyler explains. “87470-87799 describe nucleic acid probes for direct specimens while 87150 and 87153 describe nucleic acid methods for cultures.” The new CCI bundles ensure that you don’t “double dip” these code pairs.

Hurdle: Your lab might process two distinct specimens for the same patient on the same day and legitimately need to report two of the bundled codes. “For example, the lab might process a positive Chlamydia culture (87110, Culture, Chlamydia, any source) by performing a culture typing test such as 87150, and also process a direct smear for gonorrhea on the same day (such as 87591, Infectious agent detection by nucleic acid[DNA or RNA]; Neisseria gonorrhoeae, amplified probe technique),” Dettwyler says.

“Labs need to be alert to this type of bundling restriction and make sure to use modifier 59 to override the edit pair when the lab legitimately performs two bundled tests on two separate pecimens,” he advises.

Watch for molecular diagnostics method bundles:

CCI 16.0 adds a long list of edit pairs to ensure that you don’t list molecular diagnostics steps (from the range 83890-83913, Molecular diagnostics …) to describe procedures your lab follows while performing culture typing (87149-87153).

HLA crossmatch includes flow cytometry methods:

Following the same logic of bundling “method” codes into specific tests that use those methods, CCI 16.0 also adds several edit pairs for the following new HLA crossmatch codes:

• 86825 — Human leukocyte antigen [HLA] crossmatch, non-cytotoxic (e.g., using flow cytometry); first serum sample or dilution

• +86826 —… each additional serum sample or sample dilution (List separately in addition to primary procedure).

The edit pairs bundle 86825 and +86826 with each of the flow cytometry codes 88184-88189. “Labs perform the HLA crossmatch using flow cytometry methods, but you shouldn’t separately report the flow codes because 86825 +86826 are all-inclusive,” Dettwyler says. CCI 16.0 also bundles the HLA codes with B cell (86355) and T cell (86359), because you would not ordinarily quantify B and T cells in addition to an HLAcrossmatch.

Choose 1 Method for pH

CCI 16.0 creates edit pairs for new CPT 2010 code 83987 (pH; exhaled breath condensate). According to the edits, you shouldn’t list 83987 with blood pH (82800), other body fluid pH (83986), or expired gases (94250).

“CCI lists these edit pairs with a modifier indicator of ‘1,’ so you can override the edit pair if the lab performs more than one of these tests on separate specimens on the same day,” Dettwyler says.

© Pathology/Lab Coding Alert. Download 2 sample issues here.

AUDIO: 2010 update for lab & path coders. With Peggy Slagle.


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What Medical Coders Should Know About HIPAA Compliance

Posted on 31. Jan, 2010 by .


If you haven’t been paying much attention to HIPAA compliance lately, here are some good reasons to start.

The Health Insurance Portability and Accountability Act (HIPAA) has been around for awhile, but now more than ever, you need to make sure your practice keeps patients’ protected health information (PHI) private and secure.

Eye opener: HITECH, a part of the ARRA stimulus bill passed last year, raises the fines providers must pay if they are responsible for a PHI breach and fail to notify people affected. HITECH also allows state prosecutors to use the federal HIPAA law to prosecute breaches on their own. And the Attorney General in Connecticut is already trying his hand at enforcing HIPAA penalty provisions for security violations.

Supercoder- A Complete Online Medical Guide from Erin masercola on Vimeo.

This past month, AG Richard Blumenthal sued Health Net, a health plan, for breaching private patient medical records and financial information involving 446,000 of its enrollees. To make matters worse, Health Net didn’t notify enrollees about the breach until 6 months after a portable disk drive containing their PHI was stolen from the plan’s corporate office, Blumenthal alleges. Data on the drive was unencrypted, and included sensitive information like social security numbers and bank account numbers. (more…)

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E/M Challenge: Can I Report 99214 and +99354?

Posted on 31. Jan, 2010 by .


Counseling representing more than 50 percent of E/M visit? Choose level based on time.

Question: I have a family physician who documented 60 minutes on an established patient’s office visit. The FP diagnosed the patient with morbid obesity (278.01). Since the patient was newly diagnosed and had some difficulty understanding the doctor’s orders, the FP spent more than half the office visit time on counseling on therapeutic lifestyle changes and the treatment regimen. Should I code this as 99214 for the first 25 minutes and +99354 for the remaining time?

Answer: (more…)

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Orthopedic Coding Clinic: Labral Tears

Posted on 28. Jan, 2010 by .


10-2:00 in the op note signals SLAP lesion repair.

Even experts can land on the wrong ICD-9 code for SLAP lesion repair, but visualizing the injury region as a clock will help you distinguish one type of SLAP (superior labral anterior posterior) tear from another.

Research Patient History for Accurate Diagnosis

Having a solid understanding of anatomy and knowing the severity of the patient’s situation give your coding a firm foundation.

Define it: The labrum is the rim of cartilage that deepens the shoulder socket (glenoid) and increases joint stability. The superior portion of the labrum can be torn when the shoulder dislocates forwardly (anteriorly). This results in a SLAP lesion — a tear of the superior labrum, anterior to posterior, says William J. Mallon, MD, an orthopedic surgeon and medical director of Triangle Orthopaedic Associates in Durham, N.C.

Patients can acquire a SLAP lesion after falling down, or following repeated overhead actions such as throwing a football. Symptoms include pain, swelling, and an occasional “clicking” sound when moving the arm in a throwing position. (more…)

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Surgery Coding Challenge: Master Microsurgery Units With This Advice

Posted on 28. Jan, 2010 by .


Check your EOB to make sure payers don’t apply a multiple-procedure reduction to +69990.

Question: When my ENT uses a microscope during a procedure, what guidelines can I use for choosing between 92504 and +69990? Is there a rule governing how many times you can report the add-on code 69990?


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How Should I Code a Fibrinolytic Agent Instillation Via Chest Tube?

Posted on 28. Jan, 2010 by .


Different calendar dates matter, but multiple instillations the same day do not.

Question: My pulmonologist inserted a chest tube and then instilled a fibrinolytic agent to break up multiloculations to free up an entrapped lung. Usually, I use 32560 for this procedure, which is for pleurodesis, not fibrinolysis. What code should I use for fibrinolytic agent instillation?

Answer: As of Jan. 1, you should be using one of two new fibrinolytic agent instillation codes depending on the treatment day:

• For instillation on the initial day, use 32561 (Instillation[ s], via chest tube/catheter, agent for fibrinolysis [e.g., fibrinolytic agent for breakup of multiloculated effusion]; initial day). (more…)

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Pick the Right ICD-9, ICD-10 Code for Postmenopausal Abnormalities

Posted on 26. Jan, 2010 by .


Do N95.0 and N95.2 look foreign? Get your ob-gyn ICD-10 equivalents now.

Spare yourself denial hot flashes by taking this three-part postmenopausal abnormality scenario challenge.

Fill In These Blanks Using Your ICD-9 Book

Question 1: Your ob-gyn sees a post menopausal patient with an inflamed vagina because the tissues are thinning and shrinking. The ob-gyn notes decreased vaginal wall lubrication. This patient is experiencing vaginal soreness and itching, painful intercourse, and bleeding after intercourse. The ob-gyn diagnoses the patient with _________, and you should report this with _________.

Question 2: Your ob-gyn sees a post menopausal patient with unusual or abnormal vaginal bleeding. You should report _________.

Question 3: Because _________ occurs more frequently in postmenopausal women, your ob-gyn assesses and treats this bone disease. You should report it with _________.

How Did You Do? Click ‘read more’ to find out … (more…)

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