Archive for 'Hot Coding Topics'

The ASC Coder’s Resource Guide for 2010

Posted on 12. Dec, 2009 by .

0

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 .

0

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 .

4

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 .

2

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

Facet Joint Injection Coding for 2010

Posted on 08. Dec, 2009 by .

3

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…)

Continue Reading

Cataract Surgery Coding: When Optometrist Provides Postop Care

Posted on 08. Dec, 2009 by .

0

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…)

Continue Reading

How to Code for Screening Mammogram When Radiologist Finds Problem?

Posted on 06. Dec, 2009 by .

0

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…)

Continue Reading

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

Posted on 06. Dec, 2009 by .

0

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…)

Continue Reading

ED Coding Education: FAST Exams

Posted on 03. Dec, 2009 by .

0

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…)

Continue Reading

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

Posted on 03. Dec, 2009 by .

0

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…)

Continue Reading