Question:The dermatologist treated an established patient with a cut on her lip and used Dermabond to close the 1.8-cm laceration. Should I use a laceration repair code when the only adhesive he used was Dermabond?
Answer: Your code choice will depend on the patient’s insurance. Check out these two coding options:
Patient has Medicare: If the physician uses Dermabond as the only closure material for a simple repair on a Medicare patient, report G0168 (Wound closure utilizing tissue adhesive[s] only) for the service.
Patient has commercial insurance: If the commercial carrier follows Medicare rules, use G0168. However, if the payer does not observe Medicare guidelines, you’ll most likely choose a laceration repair code, even when Dermabond is the only adhesive the physician uses. On the claim, report 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or…
Posted on 17. Aug, 2009 by in Hot Coding Topics.
Do diagnosis coding choices for your FP’s preventive medicine services drive you batty?
Turns out there’s a one-stop solution for ICD-9 coding for a preventive medicine service with screenings or immunization administration — V20.2 for all. Save time assigning V codes by checking out these case studies.
Link Check, Screening to Same Diagnosis
When the FP performs screenings during a periodic well-child visit, you’ll typically append V20.2 (Routine infant or child health check) as the primary diagnosis for all the services, confirms Jeffrey Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance at Emergency Pediatric Group Children’s Healthcare of Atlanta at Egleston.
Under the descriptor, there is a list of services you should code with V20.2 — as well as other coding instructions, such as “excludes special screening for developmental handicaps [V79.3].”
Posted on 17. Aug, 2009 by in Hot Coding Topics.
Some practices code for services performed in ambulatory surgery centers (ASCs) every day, while others are just getting started. To determine how much you know about coding and billing for ASC procedures, take this quick quiz. Then, click the ‘Full Article’ button to find out how you fared.
Question 1: Physician Performed A Non-Approved Service?
We recently learned that our Medicare payer will deny the ASC’s charges for any procedures that aren’t on the ASC’s list of approved services, but what happens if the physician performs a nonapproved service anyway? How can we collect for our portion of the charges?
Hint: For a list of CMS-approved ASC procedures, visit here.
Question 2: Do You Need Modifiers 78, 79?
I code for an ASC, and my payer won’t reimburse me for claims with modifiers 78 (Return to the operating room for a related procedure during the postoperative period) and/or 79 (Unrelated procedure or service…
If you don’t take advantage of all the E/M services a nonphysician practitioner (NPP) can provide, you are missing out on a serious revenue stream, as these providers can simultaneously lighten physicians’ loads and fatten the practice’s bottom line.
Check out these FAQs to get the lowdown on when it’s OK to take the higher-paying path for your NPP’s services.
What Is Incident-To Billing?
Incident-to billing occurs when you report an office E/M service the NPP provides under the physician’s National Provider Identifier (NPI). Using the physician’s NPI garners you 100 percent reimbursement for the E/M, while an NPP’s NPI pays 15 percent less.
The NPP must perform incident-to services “under the direct supervision of the physician as an integral part of the physician’s personal in-office service,” confirms Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant in Guadalupita,…
Answer: The procedure removes adhesions (tags) from the dura to correct any neurological deficits. Physicians often remove a specimen to send for lab review, but that service is included in the primary procedure.
In this situation, you’ll report 63200 (Laminectomy, with release of tethered spinal cord, lumbar) for the cord release and +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) for the microscope use. Don’t report the dural tag removal separately, as it is incidental to the tethered cord release.
Audio Training Event: Spinal Surgery Coding Secrets, with Dr. Greg Przybylski.
Unless you want to grapple with denials, the procedure notes that support your physicians’ laceration repair claims should contain these 8 elements. How do the physicians in your practice measure up?
AUDIO EXTRA: Secrets to optimal reimbursement for lesion excision, repair.
• decontamination (including foreign material removed)
• tissue management
• exploration of wound and contiguous structures
Check out V80.01 and V80.09 for special screenings.
The newest edition of ICD-9 changes goes into effect Oct. 1, so adjust your system to reflect some new diagnosis codes for special neurological screenings — and one that’s about to become invalid — to be sure your claims stay on par.
Extend ‘Other Conditions’ Dx From 348.8 to 348.89
Diagnosis 348.8 (Other conditions of brain) will be invalid starting Oct. 1, but ICD-9 2010 introduces a new fifth-digit replacement: 348.89. The descriptor remains the same, so you’ll be able to use it for the same circumstances as 348.8.
“I seldom used 348.8 because I do mostly surgery coding and use the final pathology report for diagnoses,” says Kathryn Gemmell, RHIT, in the physician coding department of Luke’s Hospital in Bethlehem, Pa. “Something like calcium deposits on the brain or brain death could be coded to 348.89.” You might also turn to 348.89 to show a…
Posted on 12. Aug, 2009 by in Provider News.
Keep in mind: CMS notes that Medicare beneficiaries “are eligible for telehealth services only if they are presented from an originating sitelocated in a rural health professional shortage area or in a county outside of a Metropolitan Statistical Area.”
Allowable telehealth services include certain consults, office visits, psychotherapy, end-stage renal disease, and pharmacologic managementcodes, and you should always append modifier GT (Via interactive audio and video telecommunications system) to the applicable CPT code.
For more on Medicare’s coverage of telehealth services, visit here.
Question:Our dermatologist shaved three epidermal lesions that the patient chose not to have submitted to pathology: a 0.4 cm lesion from the patient’s chest, a 0.3 lesion from the patient’s back, and a 0.2 lesion from the patient’s stomach. Will I need to include modifiers?
Answer: Because CPT classifies the shaves with the same anatomic area and size code, you will need a modifier on the second and third shave removal codes. Without the modifiers, the insurer’s software system may throw out the additional shaves as duplicates.
You should technically use modifier 51 (Multiple procedures) on the second shave (11300, Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less). Then separate the third excision from the second with modifier 59 (Distinct procedural service). The claim would contain: 11300, 11300-51, and 11300-59.
If you’re reporting the claim…
CPT code selection is easier if you know your fracture anatomy. Illustrations included!
Fractures are defined as a disruption in the integrity of a living bone, bone marrow, periosteum, and adjacent soft tissues. Fractures occur when a bone cannot withstand outside forces, the integrity of the bone has been lost, and the bone structure fails. Fracture care usually involves the expertise of an orthopedic physician who monitors the fracture’s healing. The ultimate goal is to secure union and to restore normal function.
Fracture healing involves 5 phases:
- fracture and inflammatory phase
- granulation tissue formation
- callus formation
- lamellar bone deposition
Become Familiar With Site Vocab
Orthopedic coders also need to understand the many eponyms and terms that pertain to specific fracture. They will help you to recognize a fracture’s location. They are:
Bankart fracture — This is usually seen with an anterior dislocation of the shoulder where a…