Sleep Study Reimbursement: How to Claim Your Piece of the Pie

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


Medicare promises to cover facility and home-based testing — as long as you meet these criteria.

Thanks to the green light CMS gave sleep testing in March, you may have an easier time receiving reimbursement for sleep studies–provided you meet certain guidelines for the types of patients you test and the equipment you use. Here’s what’s on your plate.

Which will bring in more reimbursement for your practice? Home sleep studies or lab studies. Jill Young answers all your C-PAP questions.

New: CMS announced March 3 that it will cover specified sleep tests that pulmonologists use to confirm the diagnosis in patients who have clinical signs and symptoms of obstructive sleep apnea (327.23). The agency will cover tests your pulmonologist conducts in a sleep laboratory facility in addition to many types of home sleep testing.

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Flow Chart: Tame the Diabetes Diagnosis Coding Beast

Posted on 27. Apr, 2009 by in Toolkit.


When coding for diabetes (250.xx), the fourth and fifth digits provide the specificity you need to document the care you provide your patients.

AUDIO EXTRA: Correct Coding Guide for Secondary Diabetes Mellitus Services, Diagnoses and the Ankle Brachial Indices, with Linda Martien.

Use this flow chart to remember which questions you need to ask yourself to select the correct codes for your patients. Next, find the answers in the patient’s medical documentation, and follow up by checking your ICD-9 manual to be certain you’ve coded correctly. Please click ‘read more’ to see flow chart.

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Anatomy for Coders: Meckel’s Diverticulum (751.0)

Posted on 27. Apr, 2009 by in Hot Coding Topics.


Meckel’s diverticulum (751.0) is a congenital anomaly of the ileum that resembles the appendix of the cecum and can serve as a potential site for a malignancy.

Acute Meckel’s diverticulitis is characterized by abdominal pain and tenderness of the type associated with appendicitis, but localized below or to the left of the umbilicus.

Surgical treatment includes resection of either the diverticulum or, in more serious cases, a larger portion of the bowel.

Rock & Roll Trivia Extra: Nirvana’s Kurt Cobain reportedly suffered from Meckel’s Diverticulum.

Get Out of Your Level-3 Gut Rut: The 3 Keys to Billing Level-4 Gastro E/Ms, with Jill Young.

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Virtual Colonoscopy Reimbursement: Still ‘Virtual’ For Now

Posted on 27. Apr, 2009 by in Provider News.


Many cancer clinicians are all for virtual colonoscopy because they feel people are more likely to get colon cancer screenings if they have this less invasive option available. Most payers will not pay for virtual colonoscopy, however.

One major drawback to virtual colonoscopy from the payer perspective? If the physician spots an image of a polyp, she must do a separate procedure to biopsy or remove it, Dr. Bruce Rappaport explained to coders at AAPC’s Anatomy Expo. In an instrument colonoscopy, the physician is ‘already in there’ and can do a little surgery along the way.

Don’t let your colonoscopy coding knowledge stay ‘virtual.’ Make it real with Jill Young’s down-to-earth instruction.

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Coder’s Anatomy Double-Take: Diverticulitis & Diverticulosis

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


Don’t miss Colonoscopy-Coding Confusion: Expert Tips and Answers Revealed, with Jill Young.

DIVER … WHAT? Make sure you stay ‘in the loop’ when it comes to diverticuitis and diverticulosis. I have trouble keeping them straight, so I know I’ll be using Coding News‘ search tool to find these definitions again.

Diverticulitis (562.11 [...without mention of hemorrhage, 562.13 [...with hemorrhage]) is inflammation of a diverticulum (an outpouching of a hollow or a fluid filled structure–”in this case, in the bowel), which can lead to peritonitis, perforation, fistula or abscess, among other conditions.

Diverticulosis (562.10 [...without mention of hemorrhage], 562.12 [...with hemorrhage]) is the presence of multiple diverticula in the colon, which may become inflamed or cause bleeding. Essentially, the diverticula are bulges that jut outward from weak spots in the bowel, which are probably the result of intraluminal pressure.

Interestingly, the American colon is more likely to have diverticulitis than…

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What’s the Code for ‘Fir Tree in Lung’?

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


The mainstream press has been buzzing about the live fir tree that Russian doctors removed from a man’s lung. Some say the story just has to be an urban myth. But here at Coding News, we have other fish to fry (or firs to code). How would you code it? Here’s the ‘op note,’ if you will.

Twenty-eight-year-old Artyom Sidorkin presented complaining of chest pain and coughing up blood. An x-ray revealed what doctors thought was a malignant lung tumor, so they took him into surgery. Instead, physicians found a 3-inch live fir tree growing in his lung tissue. One Russian surgeon thinks the young man swallowed a seed, which then grew. Please click here for full story and photos from an English-language Russian news site.

So what would be the correct coding if this case occurred in the US? How about …

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Boost HIT Security with This HIPAA Checklist

Posted on 24. Apr, 2009 by in Toolkit.


The scenario: A patient in your financial planner’s office gets too good a look at the planner’s computer screen, which includes other patients’ information. How do you prevent future leaks like this?

The resolution: Use this checklist to help you catch HIPAA violations and track problem areas in your medical office. For each item listed, check whether you observed the activity, the number of occurrences, and any pertinent comments.

• Staff discusses confidential information in public areas.

• Conversations with patient or family regarding confidential information are held in public areas.

Did you know that the stimulus bill just gave HIPAA much sharper teeth? Find out your new HIPAA compliance obligations here.

• Overhead and intercom announcements include confidential information.

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The Latest on the New Epley Maneuver CPT Code

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


Medicare slaps ‘bundled’ status on 95992, denies reimbursement for new code.

In January, you finally got a code to describe the Epley maneuver, a simple but time-consuming treatment for a type of dizziness. But now you’re having even more trouble getting paid for the work.

The Epley maneuver treats a form of vertigo (386.11, Benign paroxysmal positional vertigo) that is caused by small calcium carbonate stones that have moved from the vestibule of the inner ear into the semicircular canals, where your sense of balance rests. The stones stimulate nerves and cause a spinning sensation, nausea, and unsteadiness.

Otolaryngology Specialty Coding Conference, plus a special audiology coding workshop: Orlando, July 9-11.

In the Epley, the patient’s head is maneuvered so the calcium crystals roll out of the sensing tube and into another inner chamber of the ear, from which the body can absorb them.

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A Press Release Is Not a Legal Ruling, PECOS Pundits Point Out

Posted on 23. Apr, 2009 by in Provider News.


Keep an eye on the Federal Register as you use Medicare’s Internet-based Provider Enrollment, Chain and Ownership System (PECOS), analysts who have reviewed the process tell Part B Insider.

Background: CMS issued a press release on April 1 from Valerie Haugen, a director with CMS, announcing that the person filling out the PECOS form need not be the physician or non-physician practitioner, but “may be an employee of the provider or supplier organization, or an employee of a separate organization.”

The update: During an April 7 CMS Open Door forum, CMS reiterated its position that the physician doesn’t need to personally fill out the PECOS form. However, CMS press releases and phone conferences don’t make the rule legal, says Robert Burleigh, CHBME, president of Brandywine Healthcare Consulting in West Chester, Pa.

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7 Steps to the Correct Anesthesia Code

Posted on 23. Apr, 2009 by in Toolkit.


When it comes to correct anesthesia coding, think ‘LUCKY 7.

Check information in these seven places to ensure you report the right procedure code.

1. Anesthesia cover sheet (or charge sheet)

2. Complete anesthesia record

3. Operative (or surgical) report

4. Related consultation notes (history and physical, etc.)

5. Pathology report

6. Hospital medical record and codes

7. Nurses’ notes

© Anesthesia & Pain Management Coding Alert

AUDIO: Self-Auditing Secrets for Your Anesthesia Department

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