Archive for 'Hot Coding Topics'

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…)

Continue Reading

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…)

Continue Reading

Urology Reimbursement: Coding for MESA, TESA

Posted on 17. Dec, 2009 by .


Question: Could you please give me the most current coding guidelines for the MESA and TESA procedures? The last I was aware, we were to use unlisted procedure codes. Is that still correct?

Answer: You should still use unlisted procedure codes to report microsurgical epididymal sperm aspiration (MESA) and testicular sperm aspiration (TESA, sometimes called TESE for testicular sperm extraction).

There are no Category I procedure codes for these procedures. For MESA, however, there is an S code: S4028 (Microsurgical epididymal sperm aspiration).

Bad news: Unfortunately, not all payers, including Medicare, will pay for S4028. S codes, found in the HCPCS manual, are temporary national codes for which Medicare will not reimburse you. You may typically report S codes to some private payers and Medicaid, but doublecheck the rules for your particular state and payer.

For payers that do not recognize S codes, you should report the unlisted procedure code, 55899 (Unlisted procedure, male genital system), for MESA. You should also use this unlisted code for all payers when reporting TESA/TESE.

Charge the patient: Many payers will not pay for male infertility diagnostic procedures or treatments, including MESA and TESA/TESE diagnostic procedures. Check with the patient’s insurance before the urologist performs the infertility service, and remember to request and obtain precertification from the payer before the procedure. You should also obtain a signed advance beneficiary notice (ABN) from the patient if you expect the payer to deny payment.

Remember: ABNs help patients decide whether they want to proceed with a service even though they may have to pay for it. A signed ABN helps ensure that your office will receive payment directly from the patient if a carrier refuses to pay. Without a valid ABN, you cannot hold a Medicare beneficiary responsible for the denied charges.

© Urology Coding Alert. Download your 2 FREE sample issues here.

Thursday on AUDIO: Dr. Ferragamo’s 2010 Coding & Reimbursement Update.

Continue Reading

CCI 16.0: Now Allows a Modifier to Separate Hundreds of Edits

Posted on 15. Dec, 2009 by .

Santa brings gifts; CCI brings bundles

Santa brings gifts; CCI brings bundles

But other new bundles that 16.0 has in store might put a dent in your reimbursement.

You may still be poring through your 2010 CPT manual, but the new edition of CCI, effective Jan. 1, is already looking to make some code pairings impossible.

The Correct Coding Initiative (CCI) released version 16.0 earlier this week, revealing 24,060 new active pairs and 869 modifier changes, said Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc., in a Dec. 8 announcement.

Good news: CCI version 16.0 attempts to untangle at least one troublesome set of edits in its next round with the announcement that effective Jan. 1, you’ll be able to use a modifier to separate the edits bundling E/M codes (99201-99215;99221-99223) into over 100 of the radiation oncology codes.

For instance, if you currently report new patient E/M code 99204 with 77261 (Therapeutic radiology treatment planning; simple), Medicare will deny the E/M code and no modifier can separate the edits. However, CCI 16.0 makes the modifier indicator for these bundles “1,” meaning you will be able to separate the edits with a modifier in some situations.

The bad news … (more…)

Continue Reading

Surgical Coding: Scar Revision on Previous Mastectomy Site

Posted on 15. Dec, 2009 by .


Tip: Find mastectomy scar revision in wound repair

Question: Our surgeon performed a scar revision on the site of a previous mastectomy. The procedure involved excising a 16.5 cm curved scar before performing a layered closure. How should we code this?

Answer: You should use complex wound repair codes for the scar revision procedure that you describe. Specifically, you should use the trunk codes 13101 (Repair,complex, trunk; 2.6 cm to 7.5 cm) and +13102 (… each additional 5 cm or less [List separately in addition to code for primary procedure]).

Measure repair: Whether straight, curved, angular, or stellate, the operative report should note the length of the repair. Because your report stated 16.5 cm, you should report 13101 for the first 7.5cm and +13102 x 2 for the additional 9 cm.

You should not code separately for the scar excision. When the surgeon removes the scar, he creates the “defect” that he then repairs. The scar excision plus the layered closure justifies selecting the complex wound repair codes rather than intermediate wound repair.

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

2010 General Surgery Coding Update. An audio class with Terri Brame, MBA, CPC-GENSG, CPC-H, CPC-I.

Continue Reading

CPT 2010: Add New AV Shunt Codes to Your Toolbox

Posted on 13. Dec, 2009 by .


Initial vs. additional access matters in 2010.

Love them or hate them, the trend toward guidance-inclusive codes doesn’t seem to be slowing.

Case in point: CPT 2010 ousts 36145 (Introduction of needle or intracatheter; arteriovenous shunt created for dialysis [cannula, fistula, or graft]) and 75790 (Angiography, arteriovenous shunt [e.g., dialysis patient], radiological supervision and interpretation) and instead instructs you to consider the following new surgical codes — which include imaging:

• 36147 — Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula); initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report (includes access of shunt, injection[s] of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava) (more…)

Continue Reading

The ASC Coder’s Resource Guide for 2010

Posted on 12. Dec, 2009 by .


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

Here’s a quick, handy way to get to all of Medicare’s new rules and reimbursement rates

Ambulatory surgery center coders have a lot to learn for 2010, stressed Joanne Schade-Boyce at the ASC 2010 Coding & Reimbursement Update in Orlando.

It’s absolutely essential that ASC coders study the AMA’s CPT Changes this year, Schade-Boyce recommended. Why? Because CPT 2010′s wacky resequencing affects codes many ASC coders use a lot. Checking out Appendix M and Appendix N of your CPT book will also help you get a handle on the resequenced codes. (more…)

Continue Reading

Coding Keloid Scar Removal

Posted on 12. Dec, 2009 by .


Watch out: Avoid this unlisted code.

Question: Is removal of a keloid scar considered an unlisted procedure? What is the right code?

Answer: Use 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular lesions; up to 14 lesions) with diagnosis 701.4 (Keloid scar). 17110 and 7111 (… 15 or more lesions) are now used for destruction of common or plantar warts.

Rewind: In 2007, these codes were revised to include destruction of benign lesions other than skin tags or cutaneous vascular lesions. (more…)

Continue Reading

Podiatry Coding Clinic: G0245 and G0246

Posted on 10. Dec, 2009 by .


Here’s when you may need to get an ABN

Medicare policies covering routine foot care for diabetic patients suffering from peripheral neuropathy with loss of protective sensation (LOPS) have been in force since 2002. Yet many still find the related G codes confusing. Today, let’s nail down the what documentation should be in the podiatrist’s note when you use G0245 or G0246.

First, let’s review CMS’s descriptors for these two codes:

• G0245 (Initial physician Evaluation and Management (E/M) of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) …) — You’ll use this code when a patient sees your podiatrist for the first time. This G code represents routine foot care for patients who have adequate circulation and diabetes, but who also have a documented loss of sensation. (more…)

Continue Reading

Pain Management: 2 Providers, 2 Postop Pain Injections

Posted on 09. Dec, 2009 by .


Double 76942 OK for second provider?

Question: Two providers from the same physician group performed two separate postoperative pain injections on the same patient, on the same day. Each provider used ultrasonic guidance during the procedure, but I’ve been told to report 76942 only once per day. How should we report both services?

Answer: You can bill 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) twice in this case because you’re reporting the service for different providers. Your payer might want you to append modifier 77 (Repeat procedure by another physician) to the second instance to distinguish it from the first provider and service and include supporting documentation, depending on how the claims are processed. Check your local guidelines to verify before filing the claim.

© Anesthesia & Pain Management Coding Alert. Download your 2 FREE sample issues here.

AUDIO: 2010 Pain Management Coding Update, with Marvel Hammer.

Continue Reading