Posted on 06. Jun, 2009 by in Hot Coding Topics.
Question: What do fetal non-stress tests (NSTs) entail? Are reading NSTs for pregnant mothers who are inpatients a separately billable service?
Answer: A NST is a discrete test that takes 20-40 minutes to complete and requires a notation of fetal movement as part of the test.
If the patient is simply hooked up to a monitor during her hospital stay and the ob-gyn occasionally looks at the strip, you should consider that part of her exam and not a separately billable test.
To separately bill this service with 59025 (Fetal nonstress test), your ob-gyn must document a clear indication for doing the NST (for instance, to measure fetal wellbeing).You must have a report with the findings and a recommendation for further testing or treatment. You should also have a hard copy of the test’s strip.
Keep in mind: If the ob-gyn performed this service in the hospital using hospital equipment, you can bill only the…
Question: An established patient with chronic obstructive pulmonary disorder (COPD) with acute bronchitis reports to the physician for a scheduled spirometry. What is the proper diagnosis coding for this encounter?
Answer: Code with caution on COPD patients; report a single diagnosis code for the patient’s COPD even when it occurs along with certain conditions, such as bronchitis, emphysema, or asthma.
On the claim, report the following:
• 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[ s], with or without maximal voluntary ventilation) for the spirometry
• 491.22 (Obstructive chronic bronchitis with acute bronchitis) for the COPD.
Explanation: You don’t have to report 466.0 (Acute bronchitis) for the obstructive chronic bronchitis because the code descriptor for 491.22 specifies acute bronchitis.
Posted on 05. Jun, 2009 by in Hot Coding Topics.
Yeah, I’ve got a problem. I’m a Medicare history geek, and look what I just found! A picture of the very first Medicare beneficiary ever. In this 1965 photo, Mr. Tony Palcaorolla of Baltimore submits the first Part B application from the general public. LBJ is there to process it personally. Check out Mr. P’s snappy bow tie.
Hang up this snapshot in your cubicle, coders, and for even more excitement, let’s learn some more stuff about the Physician Fee Schedule! Today’s topic: Facility and Non-Facility RVUs. Once you read this little post, you’ll ‘GET’ THE MATH. I promise.
The Physician Fee Schedule establishes different values for codes depending on the setting/site (facility or non-facility) in which the provider performs the service or procedure. For some services, the total RVUs for a given procedure are the same regardless of whether the physician performs the procedure in a facility or a non-facility. In…
Posted on 05. Jun, 2009 by in Hot Coding Topics.
Allergy season often presents the dilemma of when and how both an allergist and pulmonologist can report services for the same patient. Reimbursement for concurrent care to treat conditions like extrinsic asthma, acute bronchitis is possible
Familiarize Yourself With Medicare’s Slant
Medicare reimburses for concurrent care when physicians provide services more extensive than consultations and when both physicians play an active role in the patient’s ongoing care.
To get paid in a concurrent care scenario, you must be able to justify having two related specialties on board, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.
Follow these 2 rules of thumb to help ensure payment for concurrent care:
1) Diagnosis: Verify that the diagnosis or diagnoses support the medical necessity of involving two specialists in the patient’s care; and,
Posted on 04. Jun, 2009 by in Hot Coding Topics.
A 453.x facelift will require you to hunt for more specific upper extremity codes.
Oct. 1 and implementation of the 2010 ICD-9 codes may still be a few months away, but CMS is offering a sneak peak at the added, deleted, and revised codes that cardiology coders will need to know. Keep your focus on the embolism and thrombosis codes so you’ll be ready to report them from day one.
Phlebitis Coding Frustrations? Join the Club
In 2009, your coding options are 451.0-451.9 (Phlebitis and thrombophlebitis) and 453.0-453.9 (Other venous embolism and thrombosis).
Problem: “‘Thrombophlebitis’ is a term that is now rarely used, due to the lack of clinical significance of ‘phlebitis,’” according to Patrick Romano, MD, MPH, professor of medicine and pediatrics at University of California at Davis, in his “Phlebitis and Thrombophlebitis” presentation to the ICD-9 Coordination and Maintenance Committee. He presented the proposal…
Answer: You can bill for both services as long as the E/M service goes beyond a simple assessment of the area to be treated.
Remember to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service) to the inpatient consultation code (99251-99255, Inpatient consultation for a new or established patient …) you report to inform the payer that the surgeon provided a separate E/M service above and beyond the E/M inherent to the debridement.
Report a code from the 11010-11044 (Debridement …) range, depending on the type of debridement your physician performed.
Diagnosis help: You do not have to have a different diagnosis for the consultation and the debridement. However, the documentation should show the medical necessity for the surgeon to perform…
Posted on 03. Jun, 2009 by in Provider News.
If you’ve been holding out hope that CMS would change course on its virtual colonoscopy stance, you’re *&#@ out of luck.
On May 13, CMS issued a decision memorandum indicating that it will not cover screening computed tomography colonographies, which are better known as virtual colonoscopies.
CMS notes in its memo that the “evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test … CT colonography for colorectal cancer remains noncovered.”
Several professional associations announced their disagreement with the decision. “Make no mistake: If let stand, this CMS decision not to pay for CT colonography will cost lives,” noted James H. Thrall, MD, chair of the American College of Radiology’s board of chancellors in a prepared statement.
Question: Our patient came in for a capsule endoscopy, but the capsule got stuck in food on hour five and visuals could not be seen past the stomach. We’ll have to repeat this to see if we can see the small and large intestine. How should we code this procedure?
Answer: If your physician is going to repeat the procedure, append modifier 53 (Discontinued procedure) to 91110 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus through ileum, with physician interpretation and report).
Another option: If you weren’t going to repeat the procedure, you could append modifier 52 (Reduced services) to reflect that the capsule imaged the patient’s anatomy until it became lodged in the food.
Whose equipment? For 91110, make sure your place of service is where the capsule’s data was downloaded. If your practice owns the equipment and capsule (and not a facility), check that your place of service was the office (POS code 11).…
Posted on 01. Jun, 2009 by in Toolkit.
Append 25 with the greatest of ease …
Appending modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is a legitimate and effective method to obtain payment for a significant, separately identifiable E/M service provided on the same day as another service or procedure. To facilitate payment of your modifier -25 claims, check your claim against the following:
__ Have complete and separate documentation for the E/M service, apart from documentation for any other services/procedures the surgeon provides that day. Treat E/M codes as part of a different encounter. Documentation should independently support every code you claim.
__ Be sure the E/M service you report is significant (in other words, documentation should support at least a level-three patient encounter: 99203, 99213).
Posted on 29. May, 2009 by in Hot Coding Topics.
Question: In accordance with the new laparoscopic hernia codes, does 49652 incorporate the hiatal hernia repair? I was told that epigastric hernia repair is the same, but our surgeon does not agree. What is the correct code to use for laparoscopic repair of hiatal hernia?
Answer: CPT does not contain a specific code to describe laparoscopic hiatal hernia repair, even with the addition of the new laparoscopic hernia repair codes this year. Therefore, to describe a procedure of this type, you must select the unlisted procedure code 39599 (Unlisted procedure, diaphragm).
If the surgeon performed an open hiatal hernia repair, however, you would select 39520 (Repair, diaphragmatic hernia [esophageal hiatal]; transthoracic) for a transthoracic approach, or choose between 39530 (…combined, thoracoabdominal) and 39531 (… combined, thoracoabdominal, with dilation of stricture [with or without gastroplasty]), as appropriate.
Clinical rationale: Your surgeon is correct that an epigastric hernia is not the same as a hiatal hernia. An epigastric hernia is usually through anterior wall fascia, above the umbilicus and below the zyphoid. The hiatal hernia is internal, at the esophageal hiatus where…