Archive for 'Hot Coding Topics'

How Do I Code an Epidural Blood Patch on Same Day as L&D

Posted on 03. Dec, 2009 by .

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Don’t forget to double-check these 2 things to find the correct code.

Question: How do I code an epidural blood patch procedure on the same day as labor and delivery? Should I include a modifier?

Answer: Administering a blood patch on the same day as labor and delivery is unusual because most physicians try to manage spinal headaches conservatively before turning to an invasive treatment. Double check a few things before coding the blood patch procedure:

• Ensure that what you call a blood patch wasn’t simply injecting blood through the epidural catheter before removing it after labor and delivery. If this is the case, you shouldn’t bill the injection separately. (more…)

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What Diagnosis Code Do I Use for a Fern Test?

Posted on 01. Dec, 2009 by .

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Ob-Gyn Coding Tip: Scan for leukorrhea signs when fluid is present.

Question: My physician performs a fern test on a patient, trying to rule out rupture of membranes. What diagnosis code applies?

Answer: If the test result proves positive, then you should report 658.13 (Premature rupture of membranes with antepartum condition or complications). Otherwise, use V89.01 (Suspected problem with amniotic cavity and membrane not found), provided the patient showed no verifiable signs or symptoms.

Supplement: If the physician found fluid, but the patient did not rupture her membranes and was not in labor, report 623.5 (Leukorrhea, not specified as infective) as secondary diagnosis to the primary diagnosis 648.93 (Other current conditions classifiable elsewhere, but complicating pregnancy; antepartum condition or complication).

Keep in mind: If the patient is at her term, you will not likely be reimbursed extra to rule out labor.

Red flag: Coding for a fern test (Q0114) must indicate that the physician — not the lab — actually performed this Clinical Laboratory Improvement Amendments (CLIA) waived procedure.

© Ob-Gyn Coding Alert. Download your 2 FREE sample issues here.

Melanie Witt teaches you 2010′s ob-gyn coding must-knows, including new rules for urodynamics, hyperplasia, consultations & more.

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Celebrate CT Colonography’s 2010 Move to Category I

Posted on 01. Dec, 2009 by .

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But don’t assume the new codes will yield improved fees.

Virtual colonoscopy coverage may be a mixed bag, but the AMA showed some confidence in the service by moving its codes from temporary Category III status to full-fledged Category I in 2010.

The switch from Category III to Category I does offer some hope of better reimbursement in the future, says Rhonda Townley, CPC, with University Radiology in Knoxville, Tenn. But don’t make assumptions.

For example, you should continue to check and follow coverage policies for Medicare beneficiaries, she warns. Medicare’s current policy is noncoverage, as announced in its “Decision Memo for Screening Computed Tomography Colonography (CTC) for Colorectal Cancer” (CAG-00396N).

Watch Contrast Use for Diagnostic Test

The details: CPT 2010 deletes 0066T (Computed tomographic [CT] colonography [i.e., virtual colonoscopy]; screening) and 0067T (… diagnostic). But in their place, you’ll have the following 3 codes:

• 74261 — Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material (more…)

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CPT 2010 Update: Laboratory & Pathology Coding

Posted on 29. Nov, 2009 by .

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Stop using general codes for analyte-specific tests. Here’s why.

You have 15 new codes scattered throughout the pathology/laboratory CPT chapter, so we’ll help you jump start your 2010 claims with this how-to inventory. “From chemistry to surgical pathology, you’ll find new codes in CPT 2010 that you need to know,” says Peggy Slagle, CPC, billingcompliance coordinator at the University of Nebraska Medical Center in Omaha.

Chemistry changes — CPT 2010 has three new chemistry codes

• 83987 — pH; exhaled breath condensate
• 84145 — Procalcitonin (PCT)
• 84431 — Thromboxane metabolite (s), including thromboxane if performed, urine.

In addition to the new pH code (83987), CPT 2010 revises pH code 83986 to change “except blood” to “not otherwise specified.” “The change clarifies what has been proper coding all along — that you should not use 83986 for urine pH, because existing urinalysis codes 81000-81003 describe that test, says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Focus on immunology: Three new immunology codes give your lab more specific means to report certain tests, as follows: (more…)

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Can a Sleep Study Code Describe an Awake Test?

Posted on 29. Nov, 2009 by .

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Question: A sleep study was ordered for a patient diagnosed with hypersomnolence. The neurologistincluded a multiple wake test in the sleep study. What CPT code should I use for the multiple wake test?

Answer: You should use 95805 (Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness). Code 95805 is the only sleep study code (95803-95811) that mentionswakefulness testing. Check if you need a modifier on 95805.

Sleep services codes (95805-95811) include recording, interpretation, and report. For cases when the neurologist does only the interpretation, use modifier 26 (Professional component) on the sleep study code.

All sleep studies must have a minimum of six hours. If the sleep study does not last that long, append modifier 52 (Reduced services) to your code.

The multiple wake test measures the patient’s ability to stay awake during a time when she is normally awake. During the wakefulness test the physician or technologist records the time it takes the patient to fall asleep during a course of four to five 20-minute nap opportunities provided during the testing period in the sleep lab.

The patient does not need to be asleep during the tests.

© Neurology Coding & Reimbursement. Download your 2 free sample issues here.

AUDIO TRAINING EVENT: Neurology Coding & Reimbursement Update for 2010. With Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO.

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Urology CPT 2010: 3 New Codes, 2 Deletions Change Your Urodynamics Coding

Posted on 22. Nov, 2009 by .

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Urodynamics income will go down by half, experts calculate.

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

• 51728 — … with voiding pressure studies (ie, bladder voiding pressure), any technique

• 51729 — … with voiding pressure studies (ie, bladder voiding pressure) and urethral pressure profile studies (ie, urethral closure pressure profile), any technique.

To make room for these three new codes, the AMA deleted urodynamics codes 51772 (Urethral pressure profile studies) and 51795 (Bladder voiding pressure studies). “To reduce costs and payments, CPT combined several of the urodynamic codes into one of several new codes,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook. “So doctors will not be able to bill each individual urodynamic procedure as they have in the past.” What you must know about +51797 …

(more…)

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Surgical Coding Mysteries: The Case of the Separate Mesh

Posted on 22. Nov, 2009 by .

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Beware Separate Mesh Removal

Question: The surgeon performed the following: Made 10 cm supraumbilical transverse incision with 15-blade scalpel carried down through subcutaneous tissue using Bovie. Used combination electrocautery and blunted dissection to isolate area of scar tissue on patient’s right side. Noted sutures from previous umbilical hernia repair and mesh from right-lower abdominal hernia repair.

Excised mesh and surrounding scar tissue to level of fascia using combination Bovie and blunt dissection. Closed with 30 Vicrylc and interrupted nylons. Can we bill separately for abdominal exploration (49000), mesh removal (+11008), and scar revision (13101) based on this operative note?

Answer: No, you should not code three separate procedures. You should report 22999 (Unlisted procedure, abdomen, musculoskeletal system) alone for the service described by this operative note.

Here’s why: You should not list +11008 (Removal of prosthetic material or mesh, abdominal wall for infection [e.g., for chronic or recurrent mesh infection or necrotizing soft tissue infection] [List separately in addition to code for primary procedure]) because there is no indication of a post-op infection or a more extensive debridement for necrotizing soft tissue infection.

Although you are correct that complex repair codes such as 13101 (Repair, complex, trunk; 2.6 cm to 7.5 cm) describe scar revision, you should not use that code in this case. The service you describe goes deeper than the skin, and the surgeon does not document the length of repair or closure in layers as required for complex repair codes.

You cannot bill 49000 (Exploratory laparotomy, exploratory deliotomy with or without biopsy[s]  [separate procedure]) because the surgeon did notperform a laparotomy — he did not document entering the abdomen, only working to the fascia level. The correct service is a foreign body removal from the abdominal wall. Although there are a number of codes that describe foreign body removal, none describe foreign body removal on the abdominal wall, so you must use the unlisted code. For pricing, you could refer to codes 13101 and 11008 if your surgeon feels that correctly represents his effort.

© General Surgery Coding Alert: Download your 2 free sample issues here.

AUDIO TRAINING EVENT: 2010 General Surgery Coding Updates

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Lab Fee G Codes Crosswalk to CPT

Posted on 18. Nov, 2009 by .

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Question: Did you get any info at the CPT 2010 conference about the “Table of Drugs and the Appropriate Qualitative Screening, Confirmatory, and Quantitative Codes” on page 386 CPT? This is brand new, and I need to learn about it.

Answer: CMS created lab fee G codes to substitute for CPT codes due to concern about how the CPT codes were being used. “I thought the descriptions were the same,” said Kenneth Simon, MD, MBA, FACS, CMS for the hospital and ambulatory policy group senior medical officer in “Medicare Physician Payment Schedule 2010 Changes and Beyond” at the CPT and RBRVS 2010 Annual Symposium in Chicago on Nov. 11, 2009. “It was supposed to be a straight cross walk.”

AUDIO: 2010 Pathology/Lab Coding Update. With Peggy Slagle.

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AMA Symposium Report: Low-Level Consult Reporting in 2010

Posted on 18. Nov, 2009 by .

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Dawn in Chicago. And a new day for consult coding.

Dawn in Chicago. And a new day for consult coding.

Hey, Coding News readers! It’s your turn to weigh in on the consult controversy.

Question: What should you do for Medicare 2010 coding if an inpatient consult on a patient’s initial hospital day does not support 99221?

Answer: Kenneth Simon, MD, MBA, FACS, CMS, senior medical officer at the CPT symposium was very adamant that you would have to use 99221. When questioners kept asking “But how could you use 99221 if the documentation didn’t support that level?” he continued to say, “On day 1, use 99221-99223.” His blunt repetition angered many attendees.

Ken, however, based his idea on data that Medicare used for the consult elimination that indicated most consult are coded as high-level consult. Therefore, he seemed to think the low levels would not be problematic.

How many of you currently are using low level consults (99251, 99252)? Let us know in a reply to this question.

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Medicare’s Consult Rule Trickle Down Effect

Posted on 18. Nov, 2009 by .

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Our Chicago reporter's trusty CPT book & conference bag.

Our Chicago reporter

And what it means for pediatric practices. A report from AMA in Chicago.

Although CPT clarifies the transfer of care definition, the fix came too late for Medicare, meaning your private payers may follow suit.

Continued Errors Result in E/M Boon

The Office of Inspector General found a high error rate on consultation codes. Different opinions on when a transfer of care occurs versus a consultation caused $1.1 billion in incorrect payments. “We couldn’t even all agree on some scenarios,” admitted William J. Mangold, Jr., MD, JD, Noridian Administrative Services’ (Arizona, Montana, Utah, Wyoming) Medicare contractor medical director in the carrier response section to Day 2′s opening session at the CPT and RBRVS 2010 Annual Symposium in Chicago.

Pediatricians who don’t regularly code consults could gain from Medicare getting fed up with the inconsistency and invalidating the codes for payment in 2010. CPT still maintains the codes. CMS, however, will take the payments for 99241-99255 (Consultations) and redistribute them to office visits (99201-99215), hospital care (99221-99233), and nursing home (99304-99310) codes. This will create a 6 percent boost for primary care in E/M reimbursement from private payers that adopt the 2010 Medicare Physician Fee Schedule.

Get ready for ‘Dante’s Inferno,’ says one veteran coder. (more…)

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