Are You Up For ICD-9 2010? Quick Quiz Says For Sure

Posted on 17. Sep, 2009 by in Toolkit.


Surgery Coders: These 5 questions reveal if you need an ICD-9 workout.

October 1 is just around the corner, and that means you’ll soon need to be up and running with the latest ICD- 9 changes. Are you wondering where you should focus your time and energy?

Time-saver: This quiz on the new codes and the basics of diagnosis coding will help you determine whether you’re on the right track, or if you should work on your 2010 diagnosis coding know-how.

Question 1: Once the 2010 ICD-9 changes go into effect on Oct. 1, what diagnosis code should you report when your surgeon documents “chronic venous embolism and thrombosis of superficial veins of left arm”?

A. 453.71

B. 453.8

C. 453.81

D. None of the above.

Question 2: True or false: You can never report a V code as the primary diagnosis.

Question 3: Which of the following is…

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Pediatric Diagnosis Coding Update: ICD-9 2010

Posted on 15. Sep, 2009 by in Hot Coding Topics.


Always used V20.2? That’s about to change, along with codes for atypical vaccine schedule, dad courtesy visit & more.

Your preventive medicine services’ diagnosis list is about to expand. Prepare your charge ticket — and your staff — for this major pediatric ICD-9 shift.

When ICD-9 2010 becomes effective on Oct. 1, you’ll welcome broader hazardous history of and pediatric birth visit codes. These changes answer some of your top questions.

Will Insurers Cover More First-Year Visits?

You’ve always turned to V20.2 as your go-to-preventive-medicine-services’ ICD-9 linkage. When insurers accept ICD-9 2010 codes, you’ll have two more choices:

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Medicare Forms: Are You Ready for HIPAA 5010?

Posted on 15. Sep, 2009 by in Provider News.


New, standardized reports will show you why your claim was rejected and how to fix it.

You’ve got a few years to implement the HIPAA 5010 form, but CMS wants to make sure you’re completely ready by the time it takes effect on Jan. 1, 2012.

The 5010 form, which will make way for the ICD-10 code set, increases the field size for diagnosis codes from five bytes to seven bytes, allowing for ease of use once the ICD-10 transition occurs. But it also includes other changes that you’ll need to know about.

For instance: Once the 5010 goes into effect, you’ll have to get familiar with the potential claims rejection notices.

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Cardiology Coding Education: Pacemaker Lead Check

Posted on 15. Sep, 2009 by in Coding Challenge, Hot Coding Topics.


Question: The cardiologist documented testing pacemaker leads using fluoroscopy (71090) in the hospital. Which code is appropriate for the testing?

Answer: You mention 71090 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation), which is specific to radiological supervision and interpretation at the time of device insertion. So presumably the cardiologist was testing the leads at the time the patient first received the pacemaker.

You can’t report lead evaluation separately at the time of pacemaker insertion (such as 33206-33208).

Verify device: Doctors sometimes document “pacer” when referring to a pacing automatic internal cardioverter defibrillator (AICD), so confirm which device the cardiologist is referring to. You may report one of the following two codes for evaluating leads at the time of an AICD insertion:

• 93640-26 — Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at

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52214 Coding Challenge: Fulguration, Then TUIBNC

Posted on 13. Sep, 2009 by in Coding Challenge, Hot Coding Topics.


Question: If my physician went to do a TUIBNC and found bleeding of prostatic varices, fulgurated them, then did the TUIBNC, can I charge the 52214 for the fulguration of the prostatic varices?

Answer: Yes. You can report both the transurethral incision of the bladder neck contracture (TUIBNC) and the fulguration of the bleeding varices your urologist discovered.

First, report 52450 (Transurethral incision of prostate) for the TUIBN. Append modifier 52 (Reduced services) to show that the incision was only at the bladder neck and not the complete prostatic urethra, bladder neck to the verumontanum.

Then, you can also report 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) for the fulguration. Append modifier 51 (Multiple procedures) to indicate that your urologist performed more than one procedure during the operative session.

Skip 51 sometimes: Many payers, including Medicare, no longer…

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Wake Up to This New Reimbursement Opportunities for Obstructive Sleep Apnea (OSA)

Posted on 13. Sep, 2009 by in Hot Coding Topics.


Unblock $950 for genioglossus advancement with these coding & billing tips.

Coders have dealt with denials of treatments for obstructive sleep apnea for years, but proper coding should make now make genioglossus advancement —a radical OSA treatment — reimbursable.

Recently, the American Academy of Otolaryngology — Head and Neck Surgery sent letters to Wisconsin Physician Services and Anthem Blue Cross regarding their coverage policies for mandibular segmental osteotomy with genioglossus advancement (21199, Osteotomy, mandible, segmental; with genioglossus advancement) when performed to treat obstructive sleep apnea (OSA).

AUDIO CODING EDUCATION EVENT FOR OTOLARYNGOLOGY CODERS: 5 Tactics that get you paid for endoscopic sinus surgery.

Serious Condition, Radical Treatment

Obstructive sleep apnea (327.23, Organic sleep apnea; obstructive sleep apnea [adult] [pediatric]) describes a blockage of the upper airway that causes the patient to be unable to breathe. One of the ways an ENT can alleviate this potentially life-threatening condition is with genioglossus advancement.

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Don’t Mesh Up Your +57267 Coding

Posted on 13. Sep, 2009 by in Hot Coding Topics.


An ob-gyn doc with coding know-how tells us how to clean up our mesh claims.

Thinking of using +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect …)? Given that +57267 can get you about $260 more, it’s a good move to consider for some claims — as long as you understand how to use it correctly.

The +57267 mesh add-on code is meant to capture “additional work for putting in mesh grafts where [mesh] is optional,” according to Dr. Harry Stuber, who spoke at an Ob-Gyn Specialty Coding & Billing Conference in Orlando. “If the procedure ALWAYS uses mesh (for example, sling, sacral colpopexy), it’s already been valued in the RVU. Don’t bill extra,” Dr. Stuber explains.

So when can you use +57267?

The answer is ‘NO’ for sling, sacral colpopexy.

But the answer is potentially ‘YES’ for anterior repair, posterior repair, paravaginal repair (that’s a…

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69210? Listen Up to These 3 Cerumen Removal Coding Tactics

Posted on 10. Sep, 2009 by in Hot Coding Topics.


Check the notes from this instrumentation before you code 69210.

If your PCP is billing 69210 (Removal impacted cerumen [separate procedure], one or both ears), you can bet the auditors will be checking your documentation. If you follow these 3 tips, you can be sure you’re using the code correctly.

1. Check If Wax Is Impacted

The first thing that you need to do is to fully understand the definition of impacted cerumen (384.0). “Remember that 69210 is actually a surgical procedure,” urges Kris Cuddy, CPC, CIMC, independent consultant in DeWitt, Minn.

The American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) says that if any one or more of the following are present, cerumen is considered clinically “impacted”:

Visual considerations: Cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition.

Qualitative considerations: Extremely hard, dry, irritative cerumen causing symptoms such as…

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Self-Audit Pointer: Critical Care Claims

Posted on 10. Sep, 2009 by in Toolkit.


If you’re looking to self-audit your practice’s critical care claims, consider this tip from Dr. Bruce Rappaport, who taught us all about what government and payer auditors are looking for when we heard him speak at this summer’s Specialty Coding Conference in Orlando.

If your physician has billed for critical care, look at the notes from other clinicians surrounding your own physician’s note, recommends Dr. Rappaport.

Why? One thing critical care claims auditors do is look at notes from other nurses and doctors before and after the period of critical care your physician has billed, Dr. Rappaport explains. If notes from other clinicians say things like ‘patient stable and doing fine,’ ‘on the mend,’ or ‘expected to be released from ICU next day,’ for example, auditors are going to wonder why your physician has billed critical care.

If your doctor has simply checked…

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IUD Insertion a No-Go: Which Modifier Do I Use?

Posted on 10. Sep, 2009 by in Coding Challenge, Hot Coding Topics.


Question: My ob-gyn tried to place an IUD, but the patient had a stenotic cervix. The physician could not place the device. What modifier should I use?

Answer: The answer depends on whose advice your payer follows.

According to the American Academy of Obstetricians and Gynecologists (ACOG), you should report 58300 (Insertion of intrauterine device [IUD]) and attach modifier 53 (Discontinued service). The ob-gyn started but discontinued the service, and your practice should be able to receive partial payment for this work.

Opponents of this method point out that CPT’s definition of modifier 53 states, “due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued.” CPT’s definition indicates that the physician must also have performed the surgical prep and anesthesia induction prior to discontinuing the procedure. Note that not every…

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