Archive for 'Hot Coding Topics'

Pain Management: 2 Providers, 2 Postop Pain Injections

Posted on 09. Dec, 2009 by .

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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.

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Facet Joint Injection Coding for 2010

Posted on 08. Dec, 2009 by .

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Marvel Hammer’s Quick Start Guide to changes you’ll face in 2010.

Tons of pain management coders gathered at the Orlando conference this week, and everyone was abuzz about the coding changes the painful reimbursement cuts their practices are going to get next year.

Some big news: Effective January 1, 2010 radiological imaging will be required and bundled for facet joint injections, confirmed instructor Marvel Hammer.

Old way: CPT 2009 used to ask us to separately report radiological imaging for needle placement (1 unit per spinal region for these codes):

77003: Fluoroscopic guidance for needle placement (more…)

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Cataract Surgery Coding: When Optometrist Provides Postop Care

Posted on 08. Dec, 2009 by .

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We’ve got the modifier you need when the ophthalmic surgeon passes the baton.

Question: An ophthalmic surgeon performs cataract surgery, and then turns the patient over to the optometrist for postoperative management only. How should I code between the two providers? Do I need a modifier?

Answer: If the ophthalmic surgeon turns the patient over to the optometrist for all 90 days of postoperative care, the optometrist will report 66984 with modifier 55 (Postoperative management only) appended for 90 days of service. If the surgeon turns over care to the optometrist immediately, the optometrist is responsible for postoperative management for the whole 90 days, regardless of when he first sees the patient.

Split care: If the ophthalmic surgeon does not transfer care immediately, he may report 66984-55 for however many days he remains responsible for postoperative management. The optometrist then reports 66984-55 for however many days remain in the 90-day global period. The ophthalmic surgeon should append modifier 54 (Surgical care only) to the cataract surgery code (for example, 66984, Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]).

Example … (more…)

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How to Code for Screening Mammogram When Radiologist Finds Problem?

Posted on 06. Dec, 2009 by .

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Watch out: Results don’t turn screening into diagnostic

Question: A patient presented for a screening mammogram, and the radiologist determined the patient needed an ultrasound for a closer look. The patient returned for that test at a later date. Should I code the original mammogram as 77056 instead of 77057 because the radiologist found a possible problem?

Answer: If the patient presents for and undergoes a screening mammogram, you should code for a screening, even if the radiologist discovers an abnormality. In the case you describe you would report 77057 (Screening mammography, bilateral [2-view film study of each breast]) rather than 77056 (Mammography; bilateral). When the patient returns for the ultrasound, you would report 76645 (Ultrasound, breast[s] [unilateral or bilateral], real time with image documentation). Remember that Medicare requires a separate order for the ultrasound for nonhospital patients. (more…)

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CPT 2010 Update: Tally Up Common Audiology Code Groups Into Single Codes

Posted on 06. Dec, 2009 by .

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Plus, add this new tympanometry code to your cache next year.

One of CPT 2010’s initiatives is to move several codes typically performed together into one code. Check out these new audiology testing codes and understand the rationale before Jan. 1 hits.

For instance, if your physician performs a vestibular evaluation in 2010, you will report new global code 92540 (Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of four positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording,and oscillating tracking test, with recording).

Note the code descriptor describes “four different things are being done, with recording,” says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, president of CRN Healthcare Solutions. (more…)

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ED Coding Education: FAST Exams

Posted on 03. Dec, 2009 by .

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Watch It: If you fly through FAST exam coding, you could miss vital info

When your physician performs a FAST (focused assessment by sonography for trauma) examination, be sure to go through the notes slowly or you could miss one of the three common codes.

FAST exam patients are almost always in some physical trauma, which requires a high-level E/M service; once the physician makes the decision, she’ll perform a pair of procedures to complete the FAST exam.

Use this guide to correct coding so you’ll be quick on the draw when coding for trauma patients requiring FAST exams in your Emergency Department. (more…)

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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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