Archive for 'Hot Coding Topics'

10060 Won’t Wash for Some I&Ds

Posted on 14. Jan, 2010 by .


Careful: A pilonidal cyst I&D is a separate animal.

Question: A patient presents to the ED reporting pain in her spine. During the exam portion of a level-three E/M, the physician discovers that the painful area is red, and slightly warm to the touch. The patient also has a low-grade fever that she says she noticed about two days ago. The physician makes a shallow incision with a scalpel at the base of the patient’s spine and drains the pus from the area. I reported 10060 and received a denial. Why?

Answer: You chose a standard incision and drainage (I&D) code when you should have opted for a pilonidal cyst I&D code. When you re-submit the claim, report the following: (more…)

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Radiology Coding: CPT 2010 Breathes New Life Into Your Respiratory Coding

Posted on 14. Jan, 2010 by .


Master 32561’s guidelines to prevent a major units gaffe.

Flip through the Surgery/Respiratory System section of your CPT 2010 manual, and you’ll see the coding committee has been hard at work adding to and revising your options. Discover the added cath removal code, the all new fibrinolytic agent instillation code, and the reshaped bronchoscopy descriptors, so you can rest assured your coding will be ship-shape in 2010.

1. End Your Hunt for 32550’s Removal Code Match

Until now, CPT has offered insertion code 32550 (Insertion of indwelling tunneled pleural catheter with cuff), but you’ve been left in the lurch for removal, using either an E/M or unlisted code.

CPT 2010 adds new code 32552 (Removal of indwelling tunneled pleural catheter with cuff) to solve this problem, said Stephen Hoffman, MD, associate professor of clinical medicine at Ohio State University Medical Center in Columbus and AMA CPT Advisory Committee American Thoracic Society representative, at AMA’s 2010 annual CPT and RBRVS symposium.

Tube trivia: “Initially, when code 32550 was created, an indwelling tunneled pleural catheter with cuff was inserted for drainage and management of malignant pleural effusions at the end of a patient’s life; therefore, the removal of the catheter was not included in the valuation of 32550,” according to The ACR’s Radiology Coding Source (Sept./Oct. 2009).

Code 32552 now covers the incisions and “subcutaneous dissection of the indwelling cuff” needed to remove the catheter, ACR explains.

Next, watch out for the coding pitfall … (more…)

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CMS’s Refusal to Pay Consults Makes MSP Claims a Headache

Posted on 12. Jan, 2010 by .


If you bill consults to private payers, good luck collecting the balance from Medicare secondary payers.

Don’t even think about billing a consult to Medicare — even if it’s only a secondary payer claim. Medicare may have scratched consultations off of its list of payable services, but many other insurers did not follow suit. This leaves you in a quandary when your physician performs a consult and the primary insurer pays you for it, but Medicare is the secondary payer.

“Medicare Secondary Payer (MSP) will not pay for consults,” says Samantha Daily, billing specialist with Urologic Consultants, PC in Portland, Ore. She points coders toward MLN Matters article MM6740, which indicates the following:

“In MSP cases, physicians and others must bill an appropriate E/M code for the services previously paid using the consultation codes. If the primary payer for the service continues to recognize consultation codes,” you should bill in one of the following two ways: (more…)

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How Do I Bill For Follow-Up Visits After the Global?

Posted on 12. Jan, 2010 by .


Tip: Make sure the ICD-9 coding & documentation support follow-up visits after the global.

Question: Code 19101 has a 10-day global period, which means you cannot bill an E/M for anything related to that procedure within that time frame. If the patient continues to have follow-up visits outside the global period, should we then report the appropriate E/M level?

Example: Patient has an open breast biopsy on June 15, so the global period goes through June 25. The patient then has additional follow-up visits on June 26, July 3, and July 10. What is the most appropriate way to bill for the three follow-up visits that the surgeon provides outside the global period? Does modifier 24 apply?

Answer … (more…)

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Radiology Coding Challenge: Why is Medicare Denying a 38792, 78195 Claim

Posted on 10. Jan, 2010 by .


Tip: Discover true meaning of 38792 note

Question: The physician performed a sentinel node injection with lymphoscintigraphy. A note with 38792 states to report 78195 for imaging. So why did Medicare deny a claim that included both codes?

Answer: You should report 78195 (Lymphatic and lymph nodes imaging) for this service and leave 38792 (Injection procedure; for identification of sentinel node) off the claim. The Correct Coding Initiative (CCI) edits consider 38792 and 78195 to be mutually exclusive.

Helpful: CPT Assistant (December 1999) explains that imaging code 78195 includes the injection: “The injection of radioactive tracer is included in the lymphoscintigraphy procedure performed at the same session and is not reported separately. Therefore, it is inappropriate to report 38792 when lymphoscintigraphy is performed.” (more…)

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PQRI 2010: Tips That Boost Your Practice’s Revenue

Posted on 10. Jan, 2010 by .


Follow our links and advice to put more plusses in your claims column

Back again for 2010 is Medicare’s incentive-driven physician quality reporting initiative (PQRI), aimed at tracking quality metric or patient care services that physicians provide. When the practice treats enough patients in the same category, some PQRI dollars might be only a few codes away.

If you know the basics and focus your efforts, PQRI reporting can be a breeze and a boon to your bottom line. Check out this rundown on “The Whats?” of PQRI.

What’s In it for Me?

Coders can garner an extra payout for PQRI-eligible patients that your group treats and you code correctly; for 2010, Medicare will fork over a 2 percent bonus if you meet certain criteria.

Lowdown: In order to qualify for the PRQI bonus, you have to report on at least three of 179 PQRI measures in 80 percent of the eligible cases, explains Alice Marie Reybitz, RN, BA, CPC, CPC-H, CHI, a healthcare coding and billing consultant based in Belleair, Fla.

What Extra Coding Work Is Involved? (more…)

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Global Billing: Document ‘Unrelated’ for Modifier 79 Services

Posted on 07. Jan, 2010 by .


MACs are looking for ‘red flags’ to halt additional global period pay

Billing for additional services during a global surgery period is always tricky, but now you can expect special scrutiny for modifier 79 claims.

After the OIG got wind of fraudulent surgery billing with modifier 79 (Unrelated procedure or service by the same physician during the postoperative period), CMS contractors have been on the hunt for modifier 79 abuse. Implement our expert tips below to keep your 79 claims clean.

Obey Global Package Model

The starting point for clean modifier 79 claims is not breaching the global surgical billing concept. Once you understand the global package rules, you’ll know when you have an exception that warrants an additional claim with an appropriate modifier. (more…)

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Radiology Coding Challenge: Total Spine MRI Without Contrast

Posted on 05. Jan, 2010 by .

MRI sagittal image of sacral and dorso-lumbar perineural cysts. Malisan.mrosa.

MRI sagittal image of sacral and dorso-lumbar perineural cysts. Malisan.mrosa.

Question: Which CPT code should I use for a total spine MRI without contrast?

Answer: You won’t find a single CPT code that describes a “total spine” MRI, but you may report a code for each region the radiologist examines:

• 72141 — Magnetic resonance (e.g., proton) imaging, spinal canal and contents, cervical; without contrast material

• 72146 — Magnetic resonance (e.g., proton) imaging, spinal canal and contents, thoracic; without contrast material

• 72148 — Magnetic resonance (e.g., proton) imaging, spinal canal and contents, lumbar; without contrast material.

Support: Reporting all three spine regions (cervical, thoracic, lumbar) is appropriate when the radiologist performs and interprets an MRI of all three regions, according to the July/August 2003 issue of The ACR’s Radiology Coding Source. The ACR recommends that the radiologist dictate separate reports for each separate region studied.

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CPT 2010 Update: Urogynecology Coding

Posted on 05. Jan, 2010 by .


Remember, supervision requirements still apply to new codes.

CPT 2010 brings some big changes to urogynecology coding. Your urodynamics coding — and income — changes drastically as of Jan. 1.

Get to Know These 3 New Complex Cystometrogram Codes

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. (more…)

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How Do I Code An Arthroscopic To Open Ankle Surgery?

Posted on 04. Jan, 2010 by .


Question: Our surgeon attempted to remove a loose body in the ankle arthroscopically, but it was too large so he had to perform an open removal. Do I bill only for the open procedure, or include the arthroscopic attempt as a discontinued procedure?

Answer: Because your surgeon completed the procedure as an open case, you’ll report only 27620 (Arthrotomy, ankle, with joint exploration, with or without biopsy, with or without removal of loose or foreign body) Include V64.43 (Arthroscopic surgical procedure converted to open procedure) as a secondary diagnosis.

Arthroscopic answer: If the physician had completed the procedure arthroscopically, you would submit 29894 (Arthroscopy, ankle, [tibiotalar and fibulotalar joints], surgical; with removal of loose body or foreign body) instead.

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Orthopedic Coders: Do you understand the new consult coding rules? Get clear answers from our 2010 orthopedic coding audio update on January 7th.

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