E/M Coding Toolkit: Outpatient-to-Inpatient Encounters

Posted on 29. Jun, 2009 by in Toolkit.

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If you’re not sure what to report for hospital admissions from office visits, you can simplify your options with this E/M combination service coding chart.

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Scenario Report Codes
FP admits patient to the hospital from the office and doesn’t see the patient in the hospital on the same date Office visit 99201-99215
FP admits patient to the hospital from the office and sees the patient in the hospital on the same date Initial hospital care 99221-99223
FP admits patient to the hospital from the office and sees the patient in the hospital on the following date Office visit + Initial hospital care 99201-99215; 99221-99223
FP A admits patient to the

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Multi-Laceration Repair Coding Case Studies

Posted on 29. Jun, 2009 by in Hot Coding Topics.

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Do you know when to code repairs that occur in same area separately? Find out here.

Patients often report to the ED with multiple lacerations — and coding will vary depending on several factors.

Remember: “The location and type of closure will tell you whether to add [the repairs] together or use separate codes,” says Kevin Arnold, CPC, business manager for the Emergency Medicine Department at Connecticut’s Norwalk Hospital. Check out these brief case studies so you can cut to the quick when coding more than one laceration fix on the same patient.

Case 1: Cuts of the Same Severity, Location

The first step in coding multi-laceration repairs is to “look to the type of closures; if they are the same type … and both repairs are located in the same anatomical location, then you would add them together,” explains Arnold.

For example, the ED physician performs a 2.1

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Will S Code Pay Off for Cord Blood Collection?

Posted on 26. Jun, 2009 by in Hot Coding Topics.

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Question: My ob-gyn did cord blood collection. I have these codes for the procedure: S2140 and V59.02. Is that right?

Answer: You need to check with your payer before you bill for this service. Otherwise, the patient could receive the bill when she’s not expecting the charge. Some coding experts maintain you shouldn’t charge separately for it.

Code S2140 (Cord blood harvesting for transplantation, allogeneic) is a Blue Cross/Blue Shield specific code, which they use for their own coding purposes. You won’t find any relative value units (RVUs) assigned to this code. Not many payers reimburse for the cord blood collection because it is a preventive service. The ob-gyn is not fixing a problem the patient has.

Documentation and Coding Musts for NSTs, CSTs and BPPs, with Melanie Witt.

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ICD-9 Update: Take Your Oncology Coding Specificity Up a Notch With 7 2010 Changes

Posted on 26. Jun, 2009 by in Hot Coding Topics.

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Tumor lysis syndrome is getting its own code — will you know where to look?

CMS has revealed the 2010 ICD-9 code updates, and the main lesson is that using your ICD-9 index may prove more important than ever.

Here’s why: Most of the new codes will offer additional specificity to existing diseases (unique Merkel cell carcinoma codes, for example), which can help you code more accurately. And getting new diagnosis codes that provide additional specificity can certainly be a plus, says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, of MJH Consulting in Denver.

But the revised code list doesn’t just add specificity to your options. You may find that not all the new codes are located where you expect (don’t make any assumptions about where you’ll find Merkel cell for unknown primary site).

Get the full picture: CMS’s proposed Inpatient Prospective Payment System (IPPS) rule includes

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Sort Out Your Globals With This Quick PFS Tour

Posted on 26. Jun, 2009 by in Hot Coding Topics.

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Our global period crash course puts you on top of the world.

Global periods can vary from procedure to procedure. Some procedures (so-called major procedures) may have a global period of 90 days, while other, minor procedures may have a global period of 10 or zero days based on the Medicare Fee Schedule. You can find the global period for all CPT codes by looking to the column labeled “GLOB DAYS” on the Medicare PFS, as follows:

* 000: This category describes primarily endoscopic or minor procedures. Codes with a zero-day global period include related preoperative and postoperative care on the day of the procedure only.

Examples: Codes 11000 (Debridement of extensive eczematous or infected skin; up to 10% of body surface), 15852 (Dressing change [for other than burns] under anesthesia [other than local]) and 44360 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, with

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Snag Summer Tick-Related Case Dxs With Insect Fast Facts

Posted on 24. Jun, 2009 by in Hot Coding Topics.

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Think a tick is venomous? That error will land you with the wrong ICD-9 code(s).

Get the scoop you need to land all possible diagnoses for a tick removal or tick bite codes with this guide.

Go With 910-919 for Nonvenomous Bite

To support a tick bite or tick removal E/M or foreign body removal (FBR), the first diagnosis code you’ll need is the injury code. What caused the injury that requires care? A bite.

In the ICD-9-CM index, if you look up “bite: insect,” you’re faced with a dilemma. Is a tick venomous or nonvenomous? “Ticks can infect you but they don’t have venom like an ant mite,” notes Jeffrey F. Linzer Sr., MD, MICP, FAAP, FACEP, associate medical director of compliance and business affairs for the division of pediatric emergency medicine, Department of Pediatrics at Children’s Healthcare of Atlanta at Egleston.

AUDIO TRAINING EVENT: Seasonal Coding: Primary Care

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CCI 15.2 News: 3,500 New Code Pairs, Plus Modifier Status Changes

Posted on 24. Jun, 2009 by in Provider News.

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CPT continues to add new codes, and the Correct Coding Initiative (CCI) continues to institute edits that tell you what you can – and cannot –report together.

CCI’s latest version 15.2 takes effect on July 1, and includes over 3,500 new edit pairs, according to Frank Cohen, senior analyst with MIT Solutions, Inc., in a June 17 news release.

CCI makes over 6,000 code pair deletions this time around and makes ten modifier changes. Unfortunately, nine of those modifier changes are bad news for practices, because they change from a “1” (which meant you could append a modifier to separate the code pair) to “0,” which means no modifier can separate the edit.

For instance: CCI used to allow a modifier to separate the edits bundling 62290 (Injection procedure for discography, each level; lumbar) and 72295 (Discography, lumbar, radiological supervision and interpretation) into 63030 (Laminotomy, with decompression of nerve roots]…1 interspace, lumbar), but you can no longer report these codes together under any circumstances, even with a modifier.

Stay tuned to Coding News for more about CCI 15.2.

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Which Code Is Right for Fissure Cauterization?

Posted on 23. Jun, 2009 by in Coding Challenge, Hot Coding Topics.

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Question: Our doctors cauterize fissures to stimulate granulation tissue for better healing. Would 46910 or 46940 be appropriate?

Answer: Call on 46940 (Curettage or cautery of anal fissure, including dilation of anal sphincter [separate procedure]; initial) to describe the procedure.

It sounds like your physician is actually creating a lesion — scar tissue — rather than destroying it.

An anal fissure (565.0) is an unnatural crack or tear in the anus skin. Code 46910 (Destruction of lesion[s], anus [e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle], simple; electrodesiccation) when your physician treats symptoms caused by viral infections: warts, herpes lesions, and so on.

Rectal anatomy from A-Z. Correctly code hemorrhoid procedures and more. An audio training event with Kim Garner-Huey.

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Flow Chart: Select the Correct Pediatric Critical Care Code

Posted on 23. Jun, 2009 by in Toolkit.

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This flow chart solves location, transport, age dilemmas to land you on the right code: either 99291 and +99292 or 99468-99476.

From Pediatric Coding Alert. Download your 2 FREE sample issues here.

Pediatric Specialty Coding & Billing Conference. This July, in Orlando. Can’t make it? Watch this link for session CDs.

Critical Care

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Payer Update: NGS Directives Vs. Proper Skin Lesion Coding

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

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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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