Archive for 'Hot Coding Topics'
Watch Your Back: Bust These 5 Spinal Instrumentation Myths
Posted on 20. Feb, 2009 by .
Same-session arthrodesis errors? Read on to discover where you might be going wrong.
Myth #1: When coding instrumentation, you need to know the type of device before anything else.
Reality: When you choose CPT codes for instrumentation, location — rather than the type of device — is the most important selection criterion. “I would first look at the approach: anterior versus posterior,” confirms Rebecca Woodward, CPC, coding representative for MedVentures, LLC in High Point, N.C.
Instrumentation may be described as anterior (attaching to the front portion of the spine or vertebral segment, toward the “center” of the body) or posterior (attaching to the back of the spine or vertebral segment, facing toward the back), and can consist of rods, cages, plates, wires, and/or other mechanical devices, says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Lawrenceville, Ga. (more…)
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Op Note Decoder Ring: IVR & ‘Roadmapping’
Posted on 20. Feb, 2009 by .
Interventional radiology coders: If you see the term ‘roadmapping’ in a note, that means the physician has superimposed a stored image upon a current image, explains Coding Institute speaker Betty Johnson.
Roadmapping helps doctors view blood vessels, because a stored image of a vessel filled with contrast material can be superimposed on a catheter image made during fluoroscopy.
Don’t Get Lost: Some physicians use the term ‘roadmapping’ much more generally. In their notes, ‘roadmapping’ doesn’t involve superimposing one image upon another, but simply looking around with the fluoroscope to get the lay of the land, warns Johnson. Make sure you understand exactly what your interventional radiologists mean when they use the term.
Betty Johnson’s Guide to Anatomy, Terminology & Physiology for IVR coders.
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PFS Treasure Chest: Read Medicare’s Mind
Posted on 19. Feb, 2009 by .
It seems like dry reading, but the physician fee schedule is a treasure chest of tools that help you prevent denials and save time filing appeals when you might as well beat a dead horse, says Coding Institute speaker Betty Johnson.
Take the PFS status indicators as just one example. “If you see a ‘C’ you know you’re going to have to wait awhile for payment because the code is carrier-priced,” Johnson explains. You’ll often see ‘C’ next to new procedures.
If you see ‘I,’ you know Medicare doesn’t every want to see that code on a claim, Johnson adds. Example: Codes involving the pelvis. CPT says the pelvis is bilateral. Medicare argues that the pelvis is one structure. “So when you’re billing Medicare for pelvis stuff, you’ll need to use their G codes,” Johnson advises.
Stay tuned to Coding News for more jewels from Betty’s PFS treasure chest.
Unlock all the secrets to good coding with Betty Johnson’s Everything You Always Wanted to Know About Coding … But Were Afraid to Ask.
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Get Those Injections Paid: 4 Tips for Peripheral Nerve ICD-9 Accuracy
Posted on 19. Feb, 2009 by .
350.1 or 729.2? Here’s where your doctor’s terminology will throw you off track.
You are coding a peripheral nerve procedure performed by your neurologist, but her documentation mentions only the trigeminal nerve — a type of cranial nerve. Do you know the right diagnosis code? Clear up any diagnosis code confusion with these inside secrets.
Marvel Hammer’s Pieces & Parts: Must-Know Anatomy Coding Tips for Office-Based Injections.
Tip 1: Note Differences In Physician’s/Coding Terms
The nervous system is divided into two parts: the central nervous system (or CNS), which consists of the brain and spinal cord; and the peripheral nervous system (or PNS), which consists of spinal nerves and cranial nerves. (more…)
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The ABI Blunder That Blows Away $120 Per Cardiology Claim
Posted on 17. Feb, 2009 by .
5 essentials help keep your noninvasive study codes watertight.
Your practice may use ankle/brachial indices (ABIs) to help diagnose some of the 8 million Americans who have peripheral arterial disease. But if you miss CPT’s guidance on hardcopies for noninvasive arterial studies, you could be headed for trouble.
Just posted: The agenda & speakers for our 2009 cardiology coding conference!
Work your way through these 5 important rules to keep your accuracy rate at its best.
1. Single vs. Multiple Matters
Take a close look at the descriptors for these noninvasive arterial study codes: (more…)
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Cardiac Cath Reimbursement Trap: Balloon Angioplasty & Stenosis
Posted on 17. Feb, 2009 by .
IVR Coders: If you see the term ‘high-grade stenosis’ or ‘high degree of stenosis’ in a balloon note, query the physician about the specific percentage of stenosis involved, warns Dr. David Zielske.
That’s because most insurers will deny a balloon for a stenosis less than 60 percent, Dr. Z explains. If it’s not specifically documented, insurers will assume lack of medical necessity.
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Coder’s Anatomy: ‘Dorsal’
Posted on 16. Feb, 2009 by .
Da Dum. Da Dum. DaDumDaDumDaDum. If you can’t always remember all the anatomical terms of location you see in op notes, just think about the movie Jaws for ‘dorsal,’ suggests Joanne Schade-Boyce.
The super-scary fin that comes out of the water is the “dorsal fin” or the fin on the shark’s back. ‘Dorsal’ means “being at the back.”
ASC & surgery coders: Tackle those scary op notes like Captain Quint with more handy tips from Joanne.
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Mind Your Modifiers When Your Surgeon Works With Others
Posted on 16. Feb, 2009 by .
Automatically appending modifier 52 could be costing you hundreds.
When your surgeon works with another physician during a procedure, you can face major coding challenges. If you don’t coordinate your coding with the other physician’s coder, both doctors could lose money and face audits.
Learn how to correctly code for these shared procedures with this real-world case study.
AUDIO CD: Two-fers! How to get paid for co-surgery and surgical assistance.
Review the Surgical Case
Scenario: A urologist and a general surgeon performed surgery on a patient. The urologist did the orchiopexy and performed the opening and closing. The general surgeon performed an inguinal hernia repair.
Coding dilemma: Which codes should each physician report, and what modifiers should the coders use, (more…)
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Coder’s Anatomy: Cardiac Cath & Congenital Abnormalities
Posted on 13. Feb, 2009 by .
Time Saver: Before you start assigning cardiac catherization codes, make sure you scan a note first for the presence of congenital abnormalities, suggests IVR reimbursement expert Dr. David Zielske.
Why: A congenital abnormality, like a bovine arch, makes a difference in how many ‘turns’ an interventional radiologist makes during a procedure, and therefore affects your choice of non-selective, first order, second order, and third order vascular family codes, Dr. Z explains. If you assume ‘normal’ anatomy, you may have to start over after choosing 10-20 codes. Yikes.
Tip: Train your docs to mention any congenital abnormalities at the beginning of the note.
More cardiac cath reimbursement tips from Dr. Z.
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CCI 15.0 Update for Orthopedic Coders
Posted on 13. Feb, 2009 by .
Consider Nerve Blocks, Injections Inherent to Most New Ortho Codes — Or Face Denials
Correct Coding Initiative (CCI) version 15.0 has lots of edits for orthopedic codes, but our simple 5-step action plan will steer your orthopedic practice clear of Medicare payback requests for fixation, fasciotomy, and aspiration services.
Step 1: Include X-Rays in Multiplane Fixation Codes
First off, your new multiplane external fixation codes (20696, Application of multiplane [pins or wires in more than one plane], unilateral, external fixation with stereotactic computer-assisted adjustment [e.g.,spatial frame], including imaging; initial and subsequent alignment[s], assessment[s], and computation[s] of adjustment schedule[s]); and 20697 (… exchange [i.e., removal and replacement] of strut, each) did not escape CCI 15.0’s notice.
AUDIO ON DEMAND: 2009 Orthopedic Coding Update with Annette Grady.
Codes 20696 and 20697 include dozens of edits, including many x-ray, CT, and MRI codes. Also, these two new codes will now include: (more…)
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