87324 Alert: Capture Extra $17 for C. Diff Toxin A & Toxin B

Posted on 24. Aug, 2009 by in Coding Challenge, Hot Coding Topics.


Question: We’ve gotten denials when we bill 87324 x 2 for two EIA tests for C. diff toxin A and toxin B. Can our lab code for tests for both toxins if we use the same lab method for both tests?

Answer: Yes, you can bill for both Clostridium difficile toxin A and toxin B if a physician orders the tests for medically necessary reasons. C. difficile is a bacterium that can cause diarrhea and can worsen to severe colon inflammation. Although C. difficile occurs in most normal, healthy digestive tracts, the organism can create problems when allowed to grow unchecked, as might happen when a patient takes antibiotics to treat another illness.

C. difficile produces toxins A and B that can cause the diarrhea and colitis. That’s why lab tests focus on identifying the presence of one or both of these toxins.

Labs can detect the toxins by different methods, such as those described by the following codes:

• 87230 — Toxin

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Create Your Own Medical Necessity Quick Reference Tool

Posted on 21. Aug, 2009 by in Toolkit.


If you want to keep denials and compliance problems at bay, your claims must support medical necessity.

So retrofit your own, customized medical necessity quick power-reference tool with these tips from Sandy Nicholson, who taught some classes at the recent E/M Coding & Billing Conference in Orlando.

Step 1: Identify services which you provide for which CMS has established an NCD (National Coverage Determination) or LCD (Local Coverage Determination).

Step 2: Identify diagnoses and corresponding ICD-9 code or code range.

Step 3: Create spreadsheet to allow identification of service and corresponding diagnosis/code.

Sandy shared a few lines of how such a spreadsheet might look, as an example …

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Spinal Surgery Coding Challenge: Is Hemilaminectomy Bundled With Fusion?

Posted on 21. Aug, 2009 by in Coding Challenge, Hot Coding Topics.


Question: Our orthopedic surgeon turned in a note that says, “Performed a bilateral hemilaminectomy with discectomy and foraminotomy for nerve decompression.Then I did a lumbar decompression with posterior lumbar interbody fusion and posterior lateral transverse fusion with pedicular screws.”

How should I report this? Is the hemilaminectomy bundled with the fusion?

Answer: No, you shouldn’t consider the hemilaminectomy with decompression part of the fusion (although more payers are beginning to bundle these procedures).

To report both, your physician must document he decompressed the spinal cord and/or nerve roots Report 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, including open and endoscopically-assisted approaches; 1 interspace, lumbar) for this part of the surgery. Be sure to append modifier 50 (Bilateral procedure) to indicate that the hemilaminectomy was bilateral.

Next, report the posterior lumbar interbody fusion (PLIF), in which the vertebral endplates are…

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Conquer In-Office Coumadin Coding, Easy as 1-2-3

Posted on 21. Aug, 2009 by in Hot Coding Topics.


Tip: Watch how you support medical necessity for warfarin therapy. Here’s where many coders make the wrong ICD-9 choice.

Don’t get stuck with the bill for your physician’s in-office monitoring of Coumadin use — instead, learn the Coumadin coding ropes. One surefire way is to follow these 3 guidelines.

1. Put Proper Code to Periodic PT Test

“Physicians often use PT [prothrombin time] to assess patient response to the drug warfarin,” says Barb Miller, MT (ASCP) SH, with Nebraska Medical Center.

When patients on warfarin therapy come to your “Coumadin clinic” for periodic testing to assess their anticoagulation status, you should report 85610 (Prothrombin time) for the test.

AUDIO: If you’re like most practices, many of your Coumadin patients are Medicare benes. Don’t let new enrollment rule slip-ups hold up reimbursement. Get the facts here.

Remember the modifier: Be sure to append modifier QW (CLIA waived test) to 85610 (and that you…

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Snag Lab Test Reimbursement With These Swine Flu Fast Facts

Posted on 19. Aug, 2009 by in Hot Coding Topics.


Experts reveal the best ICD-9 coding move, plus what you need to do beginning October 1.

If you’re one of the many labs performing influenza testing spurred by the World Health Organization’s (WHO) June 11 pandemic declaration for novel influenza A (H1N1), you need to read this.

Despite the Centers for Disease Control and Prevention (CDC) guidelines that involve fee-exempt testing for surveillance purposes, your lab can expect to see increased billable flu testing. That’s why you need to bone up on how to code tests your lab might perform.

Stick With Your Influenza A/B Billing

If your lab processes specimens for suspected swine flu cases by performing existing lab tests and panels, your procedure coding and billing will remain the same.

Path/Lab Coders & Billers: We’ve got a conference JUST FOR YOU in Orlando, Florida this December.

Example: “Our lab performs a respiratory viral panel that physicians may order…

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How Do You Code for a Metastatic Tumor?

Posted on 19. Aug, 2009 by in Coding Challenge, Hot Coding Topics.




Question: What is the difference between a primary and secondary neoplasm? I’m confused about which code to use for a metastatic tumor once the original tumor has been removed.

Answer: Continue to report the metastatic tumor as “secondary” even if the primary tumor has been eradicated.

Primary: A primary neoplasm code indicates the original tumor site.

Secondary: A secondary neoplasm indicates a site to which the cancer has spread.

History of: According to ICD-9 2009 official guidelines, if the patient’s tumor is eradicated and no longer requires treatment, you should use a “history of” code, such as V10.3 (Personal history of malignant neoplasm; breast).

Here’s the exact language: “When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary  malignancy, a code from category V10, Personal history of malignant neoplasm,

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Assessment Tool: Is Your Practice Ready for EHR?

Posted on 19. Aug, 2009 by in Provider News.


Be a hero. Figure out how you can get an extra $44K per physician in your practice.

As a coder, you’re where the buck stops when it comes to the practice’s bottom line. So, you’re no doubt wondering whether your practice should go for the $44,000-per-physician bonus payment available to practices that adopt electronic medical records system early.

Potential pitfall: While the ARRA incentive money seems attractive, it could be more trouble than it’s worth for some practices.

Help is here: To get an overview ARRA perks for your practice, and assess your readiness to take advantage of them, check out this cool tool from the American Health Information Management Association.

Some things to consider, according to AHIMA:

  • hardware the practice currently uses, including PDAs, etc.
  • computer savvy among physicians and staff
  • EHR vendor types … More …
AUDIO TRAINING EVENT: Your Guide to EMR Adoption, Pitfalls, Performance.

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Coding Challenge: Dermabond for Laceration Repairs

Posted on 17. Aug, 2009 by in Coding Challenge, Hot Coding Topics.


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

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Select the Correct V Code Every Time for Pediatric Well-Checks

Posted on 17. Aug, 2009 by in Hot Coding Topics.


Denials possible without separate ICD-9s for immunization admin, supply.

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].”

Prep for your CEMC™ specialty certification. Coming soon to a city near

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Think Your ASC Coding Skills Are Top-Notch? Take This Quiz

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

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