Oncology Coding Challenge: When Infusion Runs Long

Posted on 14. Jul, 2009 by in Coding Challenge, Hot Coding Topics.


Question: The oncologist ordered a 90-minute chemotherapy infusion service, but the infusion lasted a few minutes longer than that. Is it OK to report the entire infusion time?

Answer: You may report the codes for the entire infusion time, but be sure the medical record notes why the infusion took longer than the prescribed time. You want to be able to prove medical necessity to an auditor because it is not appropriate to extend an infusion time just to increase reimbursement.

For example: If the patient has a chemotherapy infusion for one hour and 33 minutes, you would report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the first hour and +96415 (… each additional hour [List separately in addition to code for primary procedure]) for the additional 33 minutes beyond the first hour.

As your question suggests, if the patient receives a…

Full Article & Comments

Bundle of His Recording Coding Challenge

Posted on 13. Jul, 2009 by in Coding Challenge, Hot Coding Topics.


Question: How should I report right atrial pacing and recording when performed with bundle of His recording? May I report 93619 or should I append modifier 52?

Answer: When the cardiologist performs right atrial pacing and recording as well as bundle of His recording, but does not perform the other services described in 93619 (Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia), you should not report 93619.

You also should not report 93619-52 (Reduced services) because you have a more appropriate coding option:

• 93600 — Bundle of His recording

• 93602 — Intra-atrial recording

• 93610 — Intra-atrial pacing.

You should report these three individual codes because the cardiologist did not perform and document the other services listed in 93619’s descriptor.


Full Article & Comments

Is Modifier 50 Appropriate? Here’s an Easy Way to Check

Posted on 13. Jul, 2009 by in Hot Coding Topics.


Not sure whether it’s appropriate to use modifier 50? Let the Medicare Physician Fee Schedule be your trusty guide. Here’s how it works.

By checking the fee schedule’s BILAT SURG column, you can determine whether Medicare will reimburse for a given code with modifier 50 (Bilateral surgery), when appropriate.

Quick explanation: You should apply modifier 50 only when the BILAT SURG column contains a “1″ for the chosen code.

A “0” indicator means that you should not apply modifier 50 (or modifiers LT, Left side; and RT, Right side). In these cases, a bilateral adjustment is inappropriate because of physiology or anatomy, or because the code description specifically states that it is a unilateral procedure and there is an existing code for the bilateral procedure, according to CMS guidelines.

Example: Code 51102 (Aspiration of bladder; with insertion of suprapubic catheter) contains a 0 in the BILAT SURG column. Because the…

Full Article & Comments

Coding & Billing for Physicians’ After-Hours Services

Posted on 13. Jul, 2009 by in Hot Coding Topics.


Show your payer the cost of not paying on after-hours codes.

If your practice is open during “non-traditional” hours, or your physician provides after-hours services to a patient, and you aren’t billing for those “extra” services, your practice may be missing out on additional reimbursement.

To make sure you’re bringing in every dollar your physicians deserve, you need to know the proper codes to bill for after-hours services, as well as what qualifies as “after-hours.”

Let the Clock Determine 99050 vs. 99051

If your physician sees a patient in the office during hours when the practice would normally be closed, such as on weekends or after 6 p.m., CPT guidelines allow you to bill 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed [e.g., holidays, Saturday or Sunday], in addition to basic service) as long as the…

Full Article & Comments

64450 or 64421: Which Code to Tap for TAP Block?

Posted on 10. Jul, 2009 by in Coding Challenge, Hot Coding Topics.


Question: What exactly is a “tap block,” and what code do I use?

Answer: A transverse abdominus plane (TAP) block is typically used for post-operative pain management following major abdominal surgery. Your provider may also use it as an adjunct to his anesthesia for abdominal laparoscopic procedures. If performed for postoperative pain management, report 64450 (Injection, anesthetic agent; other peripheral nerve or branch). Another option is 64421 (Injection, anesthetic agent; intercostal nerves,multiple, regional block).

Watch out: If the block is used as part of the anesthesia — not for post-operative pain management — do not report it separately from the anesthesia services code.A TAP block is particularly useful for patients where an epidural is contraindicated or refused. The TAP can be performed unilaterally (for example, for an appendectomy), or bilaterally when the incision crosses the midline (such as a Pfannenstiel incision). A single injection can be utilized, or a catheter…

Full Article & Comments

This 4-Step Coding Process Grabs $125 Extra in Vasectomy-Related Payment

Posted on 10. Jul, 2009 by in Hot Coding Topics.


Turn to V25.x for your diagnosis code choice.

Vasectomies are commonplace in most urology practices. But choosing the proper codes to report can prove challenging, starting with the pre-vasectomy “consultation” visit most urologists perform. If you’re not billing out each piece of the vasectomy process, you could be costing your practice hundreds over the course of one year. Follow these four steps to ensure you capture all the reimbursement your urologist deserves.

1. Avoid Automatically Assigning Consult Codes for the First Visit

Before a urologist performs a vasectomy, he usually meets with the patient to discuss the procedure and ensure that the patient understands the consequences of the procedure and wishes to undergo this elective sterilization. You’ll report this office visit using the appropriate E/M code, says Kelly Young, a coder with Scottsdale Center for Urology in Scottsdale, Ariz.

The coding challenge comes when you try to determine whether you…

Full Article & Comments

Medicare Fraud Fighter Reveals 9 Billing Patterns That Draw HEAT

Posted on 10. Jul, 2009 by in Toolkit.


A Department of Justice senior trial attorney behind the widely publicized new federal health care fraud-fighting team, HEAT, has revealed 9 billing patterns that he and his team look for when they’re data mining. Bookmark this list of billing patterns if you’re looking to safeguard your practice via internal audits.

What is data mining? The government has lost millions “paying and chasing,” explained the DOJ’s John S. Darden, who spoke at the recent American Health Lawyers Association Annual Meeting. Sometimes, health care fraud operations can go on for years, and even become franchises, before the feds realize what is happening. While many of the criminals have been caught, the money they stole from U.S. taxpayers is gone forever. Cases like the long-lived HIV infusion schemes in Miami and Detroit have taught the government to analyze claims as they come in to look for patterns that signal

Full Article & Comments

What’s the ICD-9 Code for TFCC?

Posted on 08. Jul, 2009 by in Coding Challenge, Hot Coding Topics.


Question: What Dx code should we use for TFCC (triangular fibrocartilage complex) of the wrist?

Answer: Is the injury acute? If not, you should report 718.03 (Articular cartilage disorder; forearm) rather than an acute code. If so, report 842.01 (Sprains and strains ofwrist and hand; wrist; carpal [joint]).

Note: TFCC occurs on the ulnar side of the wrist and is made of cartilage and ligaments. Sports injuries may also cause TFCC tears, typically by the patient landing on his outstretched arm or repetitive heavy lifting with the ulnar side of the wrist.

Get your doc in the loop: these simple op note tweaks from Lynn Anderanin are key to your orthopedic reimbursement.

Full Article & Comments

Diagnostic Radiology ICD-9 Code Update: New Mammo Code 793.82

Posted on 08. Jul, 2009 by in Hot Coding Topics.


New code 793.82 shakes up the whole 793.x range in 2010.

The switch to ICD-9 2010 is only a few short months away; preparing now for a crucial change in diagnostic imaging will put you ahead of the game.

Remember: ICD-9 2010 codes will be appropriate for services performed on or after Oct. 1, 2009.

Dense breasts may require testing beyond a mammogram to confirm no malignancies, and the request for an appropriate code to describe this resulted in 793.82 (Inconclusive mammogram), according to the ICD-9 Committee’s September 2008 meeting agenda.

“The new code may help get insurance companies to pay for additional testing,” says Cheryl Scott, CPC, CPC-H, CCS, CCS-P, with HealthTexas in Dallas. “Prior to the 2010 code, the choices were to bill it as screening or to code dense breasts as an ‘abnormality’” – which they aren’t, she…

Full Article & Comments

When Patient Payment Plans Pay Off Better Than Collection Agencies

Posted on 06. Jul, 2009 by in Hot Coding Topics.


Recession Relief: Ready to call a collector? Here’s a cheaper, alternate plan that can save patient relations & bring in more cash.

If you’re like many medical practices, you’re struggling with how to collect from patients who are struggling financially. But before you shell out money for a collector, consider the advantages of patient payment plans.

Wayne Miller reveals more ways to recession-proof your practice. Learn about the stimulus law, mortgage terms, capital avenues and more.

Although it may take longer to get your money, a payment plan will help financially struggling patients avoid an outside collector, says Catherine Brink, CMM, CPC, CMSCS, president of Healthcare Resource Management in Spring Lake, N.J.

With payment plans, “you have some income coming in versus sending [patients] to collections and possibly never getting paid,” agrees Michelle Radmer, billing specialist for Greater Milwaukee Otolaryngology in Greenfield, Wis. Offering payment plans

Full Article & Comments