Payer Update: NGS Directives Vs. Proper Skin Lesion Coding

Posted on 22. Jun, 2009 by in Hot Coding Topics.


Ignore the LCD and stick with what you know about lesion excision coding.

If the recent National Government Services (NGS) information about lesion excision coding has your practice up in arms, you’re not alone. Coders have been asking questions and raising red flags about the recent local coverage determination (LCD). But don’t fret: NGS plans to rescind the LCD advice about lesion excisions, experts say.

Decipher the NGS LCD

The portion of the NGS LCD that has led to controversy is in the general information section toward the bottom of the LCD. That section reads:

“While it is recognized that some diagnoses resulting from an excision will at times be malignant, the diagnosis at the time the procedure was performed would most likely be 239.2 (Neoplasms of unspecified nature, bone, soft tissue, and skin), and this would be the appropriate code, since proper coding requires the

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Orthopedic Coding Clinic: Pull the Plug on PRP Injection Denials

Posted on 22. Jun, 2009 by in Hot Coding Topics.


Here’s where 86999 comes in.

If your orthopedist is performing platelet rich plasma (PRP) injections with surgical reconstructions and you’re looking for a way to report this, you may be making your life more difficult than it should be. Most likely, you should consider this inherent to the surgical procedure.

That’s not what most coders and physicians want to hear. “This is currently a great challenge for our physicians who are performing this procedure with excellent outcomes — yet they are being told they should not be paid for it,” laments Gloria Caballero, director of finance at OED Orthopaedics in Warrenville, Ill.

But take heart: In one situation, you might be able to get away with an unlisted procedure code to reflect the additional work.

To minimize denials and save precious time, discover what PRP involves, what you should report, and what codes you should avoid.

What Is PRP?


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997.4 or 998.11 for Bleeding After Polyp Removal?

Posted on 20. Jun, 2009 by in Hot Coding Topics.


Here’s the question: Would 997.4 or 998.11 be the correct diagnosis code for a postpolypectomy bleed?

Answer: The correct code for post-operative bleeding is 998.11 (Hemorrhage or hematoma or seroma complicating a procedure; hemorrhage complicating a procedure).

You would code 997.4 (Digestive system complications) for other complications, such as intestinal anastomosis, where formerly distant sections of the intestine have been surgically joined.

AUDIO TRAINING EVENT: Coding for hemorrhoid procedures has always been a pain in the… well, you know. With the 2009 coding updates, it can be even more problematic. One mistake and you’re watching your revenue slip through the crack. Join coding expert Kim Garner-Huey for Hemorrhoid Coding Made Easy.

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Correct Coding for H1N1 (Swine Flu) Screening in the ED

Posted on 18. Jun, 2009 by in Coding Challenge, Hot Coding Topics.


Question: A patient reports to the ED worried about a fever and chills; to rule out the H1N1 flu, the physician orders an immunoassay influenza screening. The patient does not have any type of flu. Should I report modifier 26 with 87804?

Answer: You should not report 87804 or modifier 26 (Professional component) on this claim. When the ED physician orders a lab test to check for flu, you should consider the work part of the overall E/M.

So if the notes indicate a level-two E/M, report 99282 (Emergency department visit for the evaluation and management of a patient …) for the service.

Remember to append 780.60 (Fever, unspecified) to the E/M to indicate the patient’s presenting symptoms, and V73.89 (Other specified viral diseases) to identify the type of screening.

Explanation: When the ED physician orders a lab test, the hospital charges for it. So the facility would report 87804…

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Correct ICD-9 Coding for H1N1 (Swine Flu)

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


Before you carry your swine flu diagnosis over to the bird category 488 (Influenza due to identified avian influenza virus), get the facts on correct ICD-9 coding for right now AND for this fall.

Truth 1. Stick With 487.x – For Now

Provided you’re up-to-date with the latest ICD-9 coding expert recommendations, your coding for confirmed cases should be on track. 487.x (Influenza) is the best choice for H1N1 right now.

Reason: The current 488 is specific for avian flu. The National Center for Health Statistics (NCHS) has indicated they feel under the current code titles that 487 is the appropriate code, reports Jeffrey F. Linzer Sr., MD, MICP, FAAP, FACEP, associate medical director of compliance and business affairs for the division of pediatric emergency medicine in the department of pediatrics at Children’s Healthcare of Atlanta at Egleston.


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CMS Adds 5 New Codes Effective July 1, Changes Bilateral Status

Posted on 17. Jun, 2009 by in Provider News.


Yes. It’s true. Fireworks aren’t the only excitement you can look forward to this July.

You’ll have five new codes to report for your services in just a few short weeks, thanks to an update to the Medicare Physician Fee Schedule that takes effect on July 1.

Even more EXCITEMENT: A specialty coding cert exam prep training camp is coming to a city near you.

The following four new procedure codes carry the status of “C,”meaning that individual carriers will establish payment amounts:

• 0199T – Physiologic recording of tremor using accelerometer(s) and gyroscope(s), … including interpretation and report

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E/M Coding Basics: MDM Maximizes Payup for Hepatitis Diagnosis

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


4 ways to get what your practice really deserves for the initial visit, hepatitis diagnosis & follow-up.

Think ‘tortoise’ when it comes to diagnosing hepatitis, slow and steady wins the race. Because diagnosing hepatitis takes longer than diagnosing many other conditions, your practice’s bottom line depends on good documentation, a sound understanding of lab panel billing, and strategic NPP use along the way.

1. Fully Document the Initial Visit

The first service you’ll report for a potential hepatitis patient may be an initial visit (if a new patient to the practice such as 99201-99205).

Most first visits with a potential hepatitis patient involve a higher level of medical decision making (MDM). Your physician evaluates risk factors, orders lab tests, and often provides counseling to the patient. MDM, therefore, can frequently fall into the moderate-complexity range for most patients.

Last chance to sign up for the E/M Coding Conference

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Where Anesthesia Coders Go Wrong With CS Cath Placement

Posted on 16. Jun, 2009 by in Hot Coding Topics.



Your doc needs to do this to get paid on more than CS cath placement.

Quick — look up the CPT code for coronary sinus (CS) catheter placement used during cardiac surgery. No luck? Then an unlisted code reporting is in your future. Coding News is here to bust 3 myths that may fool you into selecting the wrong anesthesia code for this procedure:

Myth 1: Code 93508 Applies to CS Cath

Fact: Code 93508 (Catheter placement in coronary artery[s], arterial coronary conduit[s], and/or venous coronary bypass graft[s] for coronary angiography without concomitant left heart catheterization) does not apply to coronary sinus catheter placement, even if you append modifier 52 (Reduced services). In addition, the 936xx range of codes (those for EP studies) are inappropriate. Instead, an unlisted code is your best choice.

Anesthesiologists insert coronary sinus catheters for minimally invasive heart valve surgery, says

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Coding Challenge: Foot Foreign Body Removal Vs. Soft-Tissue FBR

Posted on 16. Jun, 2009 by in Coding Challenge, Hot Coding Topics.


Question: Our physician performed a foreign-body removal (FBR) on a patient with a splinter in the subcutaneous tissues of his left foot. We reported 10120 and received a denial. Should I appeal, or did I code improperly?

Answer: : In this case, there is a more specific code for a foot FBR. Code 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) is in the “Integumentary” part of CPT’s “Surgery” section. It is for simple, subcutaneous incision and removal of foreign bodies when no more specific code exists.

For reporting subcutaneous FBRs from the foot, a more specific code does exist.

When your physician removes a foreign body from a patient’s foot, choose from:

• 28190 — Removal of foreign body, foot; subcutaneous

• 28192 — … deep

• 28193 — … complicated.

Ahhh, Summer. That’s means FBRs, sunburn diagnosis coding challenges, tetanus denials & more. Tackle them all…

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Got Missed Appointments? These 2 Sample Letters Hold Patients Accountable

Posted on 15. Jun, 2009 by in Toolkit.


Missed appointments cost you money. And if you want your no-show policy to be effective, your patients must be crystal clear about the fees you’ll charge for missed appointments, as well as the potential for dismissal if they miss multiple appointments.

Don’t waste time trying to write no-show policy letters from scratch. Simply customize these two sample letters to ensure your medical practice doesn’t lose time and money on no-shows. The first is a sample warning form, and the second is a sample dismissal letter.

COMING TO A CITY NEAR YOU! Everything you wanted to know about coding, but were afraid to ask.


Dear ______________,

It has been noted in your chart that you have missed at least two scheduled appointments with our office. We ask you to show consideration by notifying our office at least 24 hours in advance

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