Archive for 'Hot Coding Topics'

Pain Management Coding: Endoscopic Lumbar Nerve Decompression

Posted on 15. Nov, 2009 by .


Hint: Think ‘unlisted procedure.’

Question: One of our physicians is looking into “endoscopic lumbar spinal nerve decompression.” One of the medical device representatives indicated he could bill it like the lateral extraforaminal approach for lumbar decompression, but I haven’t found much information. What’s your advice?

Answer: Despite what you physician might have heard, your most appropriate choice probably is 64999 (Unlisted procedure, nervous system).

Many pain management providers are being introduced to different endoscopic approach systems. The AMA confirms that the descriptors for lumbar decompression procedures, such as those mentioned to your physician (63055-+63057, Transpedicular approach with decompression of spinal cord, equina and/or nerve root[s] [e.g., herniated intervertebral disc], single segment …) do not include an endoscopic technique and should not be used to report this type of approach.

If the provider doesn’t complete the laminectomy (hemilaminectomy) required to meet the criteria for reporting 63020-+63035 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial  facetectomy, foraminotomy and/or excision of herniated intrevertebral disc, including open and endoscopically-assisted approaches …), the AMA directs you to report the “unlisted” procedure code.

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PQRI: No Coumadin Due to Fall Risk

Posted on 13. Nov, 2009 by .


Plus, experts at the AMA meeting in Chicago tell you what to do if you can’t get H1N1 vaccine for PQRI Measure 110 or other vaccine measures.

Question: My internist decided not to put a patient on Coumadin because the patient has a higher risk of falling than from having a stroke. Our group participates in PQRI easure 33 for risk of clotting. How can I indicate performing the measure wasn’t appropriate so that the physician isn’t penalized for not prescribing the anti-blood clotting medication?

Answer: You should report the measure and append the denominator exclusion indicator 1p. This indicator shows the physician chose not to prescribe the drug due to the art of medicine, or factors that make performing the measure not clinically appropriate.

If, however, the internist prescribed Coumadin but the patient isn’t taking it because she can’t afford the medication, you instead would use 2P. Your group can then have the patient referred to a social worker to help the patient figure out her financial hardship and find a way to obtain the medically necessary drug.

The third denominator exclusion in this group is 3p, which shows the medication was not available. Read on to learn what to do when you can’t get H1N1 vaccine supply … (more…)

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2010 Tumor Excision Coding: Lesion Vs. Chunk Size

Posted on 13. Nov, 2009 by .


Straight from the AMA in Chicago — answers to your lesion excision coding questions for 2010.

Question: A thigh lesion measures 2 cm but requires a resection down to the subcutaneous layer of 4 cm. Which lesion excision code should I use?

Answer: “You should use the larger of the subcutaneous codes,” says Albert E. Bothe, Jr, MD, FACS, with the American College of Surgeons in “Excision of Soft Tumors/Bone Tumors” on the final day of the AMA CPT and RBRVS 2010 Annual Symposium. The size of the lesion is the lesion. “The defining size is the size of the resection” or the mass that’s taken out, Bothe stressed.

If all that the surgeon takes out is the lesion, you would use the lesion size or 2 cm as the lesion excision. But if the surgeon indicates the larger size of the tissue he also has to take out, you assign the excision code based on the resection size. You mention that the resection size is 4 cm, which is more than the 3-cm cut point stipulated in 27327′s new 2010 description (Excision, tumor, soft tissue of thigh or knee area, subcutaneous; less than 3 cm). Therefore, you would use 27337 (… 3 cm or greater). Don’t miss this documentation must … (more…)

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Medicare 2010 CPT Consultation Code Changes

Posted on 12. Nov, 2009 by .


New rules for consult coding straight from the AMA Meeting in Chicago — plus where your practice will gain and lose reimbursement.

If you can’t figure out how to match a low level consult to an initial hospital care code, you’re not alone.

Code 99251 doesn’t crosswalk to 99221, agreed 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. “They don’t have the same criteria.”

Medicare will consider the consult codes (99241-99255) invalid codes for payment, effective Jan. 1. Experts expect some large carriers, including Blue Cross Blue Shield, Aetna, and Humana to adopt the same policy for uniformity. For carriers and private payers that no longer recognize consult codes, let these examples help you decide what code to instead use.

1. Apply Patient Status Rules to Outpatient Encounters

“CMS is saying the consult codes are going away,” Mangold explains. Instead, you should choose the appropriate code based on the applicable guidelines. (more…)

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Is 30901 Your Nosebleed Code? Not So Fast?

Posted on 12. Nov, 2009 by .


Hint: Look for these keywords in the note to select the correct nosebleed code.

Question: The internist stops a patient’s nosebleed. Is this always a procedure?

Answer: No, if a patient reports with a nosebleed and the physician stops the bleeding with basic methods, you’ll typically opt for the appropriate-level E/M code.

E/M methods: Code minimal attempts at stoppage — including ice or brief, direct pressure — as an E/M service. CPT does not consider these types of treatments separately billable procedures, so an E/M is the way to capture the services the physician provides.

For example, a 62-year-old established patient reports to the internist with an active right-nostril nosebleed that has lasted for three hours. The internist performs a problem focused history and exam, then uses ice and pressure to treat the nosebleed. Read on for how to code this scenario … (more…)

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From the AMA in Chicago: CPT 2010 Out of Order Codes

Posted on 11. Nov, 2009 by .


Here’s where you can find a full list of resequenced codes.

Notice that new sign in your CPT book? No, that hash mark’s not to delete a message or to sign into a conference; it’s to alert you to an out of order code.

The “#” works like a flashing yellow light: Slow down, there might be something unexpected. Rather than moving groups of codes to new sections, the AMA has created another option. “Resequencing makes a lot of sense to avoid renumbering the codes,” explained William T. Thorwarth, Jr., MD, in “CPT 2010 Overview” at the CPT and RBRVS 2010 Annual Symposium’s opening session in Chicago.

Watch for the Out of Order Placard

When you’re coding a lesion excision, you usually assume the code increases by one as the excision’s size class goes up. But that truism will no longer hold true. Fortunately, watching for # will alert you to these inconsistencies. Read more for examples … (more…)

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Infusion Coding Education: Remicade

Posted on 10. Nov, 2009 by .


Coding Hint: Watch for ‘add-ons’ during Remicade sessions

Question: An established patient with a plan of care in place for his Crohn’s disease of the ileum reports to the gastroenterologist for a Remicade infusion. The infusion started at 10:00 a.m. and ended at 11:42. The patient reported nausea during the infusion, so the gastroenterologist administered 200 mg of Benadryl from 10:41 to 10:52. How should I report this encounter?

Answer: This claim has a lot of moving parts; you can code for both the Remicade and the Benadryl administrations. Because your Benadryl infusion time was so short, however, you should not report an infusion code for that service.

Follow this two-step guidance on how to ethically maximize this claim:

Step 1 — Remicade: The total infusion time for the Remicade treatment was an hour and 42 minutes. Represent this time with the following: (more…)

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Cardiology Coding Question: Separate Reporting for 37204

Posted on 08. Nov, 2009 by .


Question: Should I separately report right and left bronchial artery embolization?

Answer: You should report 37204 (Transcatheter occlusion or embolization [e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation], percutaneous, any method, non-central nervous system, non-head or neck) twice for right and left lung embolization at the same encounter.

In addition, if the cardiologist provides supervision and interpretation (S&I), you should report 75894 (Transcatheter therapy, embolization, any method, radiological supervision and interpretation) twice.

Support: CPT Assistant (October 1998) states you should report 37204 once “for each operative field addressed.” When the cardiologist embolizes the right and left bronchial arteries, he addresses two separate operative fields (right and left lung). CPT Assistant suggests appending modifier 59 (Distinct procedural service) to the codes for the second and subsequent fields.

Bonus tip: You should report one pair of codes (37204, 75894) per field even if the physician treats multiple vessels in that field or uses many coils or other embolic materials in a single vessel, states CPT Assistant (September 1998).

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2 New 2010 CPT Codes for High-Tech Cardiology Services

Posted on 08. Nov, 2009 by .


Steer clear of Cat. I codes for intravascular spectroscopy — here’s where to look instead.

The CPT update season is fast approaching. Warm up for the changes coming your way with a look at new-for-2010 Category III codes aimed at diagnosing coronary artery disease.

Match 0206T to MCG

One of the new Category III codes with a Jan. 1 implementation date is 0206T (Algorithmic analysis, remote, of electrocardiographic-derived data with computer probability assessment, including report), which is appropriate for Premier Heart’s Multifunction CardioGram (MCG). (more…)

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Capture Separate CV Access Radiological Guidance

Posted on 05. Nov, 2009 by .


Don’t miss out on $20 per procedure when your surgeon performs central venous (CV) access device placements.

If your physician uses fluoroscopic or ultrasonic guidance during the placement, you should separately report that service. We’ll show you how and tell you what modifier moves you need to make to prevent denials.

Choose Between +76937 and +77001

If your surgeon uses ultrasound guidance, report +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites,documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry,with permanent recording and reporting [List separately in addition to code for primary procedure]) in addition to the CV access device placement code, says John F.Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop and Associates. Read on for an important caveat … (more…)

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