Urology Coding Challenge: Gold Seed Marker Placement Plus TRUS

Posted on 07. Aug, 2009 by in Coding Challenge, Hot Coding Topics.


Question: How should I report the placement of gold seed markers and a TRUS done in the office setting?

Answer: First, you should report 55876 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], prostate [via needle, any approach], single or multiple) for the gold seed marker placement. If the urologist also examined the prostate gland transrectally with ultrasound, report 76872 (Ultrasound, transrectal) for the transrectal ultrasound (TRUS).

You should also report 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) for the ultrasound guidance your urologist used to place the gold seed markers.

Plus: For the actual cost of the markers, also report A4648 (Tissue marker, implantable, any type, each). Some payers will request your patient’s invoice before paying for the markers, while others will never pay for this code.

AUDIO: Your coding & billing guide to urinary diversion

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Modifier Cheat Sheet: Banish Your E/M Modifier Phobias Forever

Posted on 07. Aug, 2009 by in Toolkit.


Once you have this tool, you’ll never again wonder which modifier applies to minor vs. major procedures.

If you’re often mixing up your E/M modifiers, then print this post and hang it near your desk. You’ll be sure to apply the appropriate modifier every time.

Pick Modifier 24 for Post-Op Cases

When you report modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period), the E/M service must meet these criteria:

• The E/M service occurs during the postoperative period of another procedure.

• The current E/M service is unrelated to the previous procedure.

• The same physician (or tax ID or same group and specialty) who performed the previous procedure provides the E/M.

Red flag: This is true even if the two physicians have different specialties or sub-specialties.

WEBINAR: E/M for Ortho. Where are you losing money?

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97597 or 11040 for Partial Thickness Excisional Debridement?

Posted on 05. Aug, 2009 by in Coding Challenge, Hot Coding Topics.


Question: Encounter notes indicate that the physician performed a partial thickness excisional debridement of a patient’s wound. Should I use 97597 or 11040 for this service?

Answer: Since the physician performed the debridement and the notes indicate that it was an excisional debridement, you should report 11040 (Debridement; skin, partial thickness) for the service.

Key: Physician role should drive your debridement coding. Coders typically choose 97597 (Removal of devitalized tissue from wound[s], selective debridement, without anesthesia [e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps] …) when non-physician providers (physical therapists, wound care nurses, etc.) perform non-surgical debridement on a patient’s wound. If a physician such as a dermatologist performs a surgical debridement, choose from the debridement codes (11040-11044).

© Dermatology Coding Alert.

Don’t let site size throw your lesion excision coding for a loop. Attend this audio training event with Betty Johnson.

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Pssssssst. Payer Report Cards Are Out

Posted on 05. Aug, 2009 by in Provider News.


If you know your payers’ strengths and weaknesses, you’re better equipped to fight denials and negotiate contracts that are in your best interest.

So check out the American Medical Association’s second annual National Health Insurer Report Card. The AMA has gathered data and rated large payers on criteria like payment timeliness, accuracy, claim edit sources and denials, according to an American Medical News article that summarizes trends in the report card.

Drawback: The AMA’s payer report card looks only at big, national insurers (Aetna, Anthem, Blue Cross and Blue Shield, Cigna, Coventry, Health Net, Humana, UnitedHealthcare and Medicare). To get the dirt on smaller or regional payers, check out this resource from Athenahealth.

To see the AMA’s payer report card, go here.

Are your payers ‘remedial’ at best? USE THE APPEALS PROCESS LIKE A PRO, with APPEALS QUEEN Barbara Cobuzzi.

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Diabetes Coding Blunders That Cause Denials

Posted on 05. Aug, 2009 by in Hot Coding Topics.


Do you know the 5 fourth digits for 250.xx you should avoid?

A diabetes diagnosis code shows up on millions of dollars worth of claims each year, and that number is climbing rapidly. Make sure you code correctly to get every penny your practice deserves for managing the disease and treating manifestations and related conditions.

Diabetes is an underlying systemic disease, so you should code for it when it’s documented that your patient has the condition, even if you don’t have an active intervention planned, said Jill Young, CPC, CPC-ED, CPC-IM, with Young Medical Consulting in Lansing, Mich. during the Coding Institute-sponsored audioconference Diabetes: What do YOU need to know about 249.xx and 250.xx?

Don’t miss this audio training event. Hospitalist documentation and coding tactics that get you paid. With Linda Martien.

Base your selection on the physician’s documentation of these items, says Young:

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Coding Critical Care? What You Can’t Bill Separately

Posted on 03. Aug, 2009 by in Hot Coding Topics.


Although there are some physician services you can report separately from critical care, watch out. There are many services you can’t unbundle from critical care, including:

  • cardiac output measurements (93561, 93562)
  • chest x-rays (71010, 71015, 71020)
  • pulse oximetry (94760, 94761, 94762)
  • information data stored in computers (such as electrocardiograms, blood pressures, hematologic data, etc.)
  • blood gasses
  • gastric intubation (43752, 91105)
  • temporary transcutaneous pacing
  • ventilator management (94656, 94675, 94660, 94662)
  • certain vascular access procedures (36000, 36410, 36415, 36540, 36600)

Is there a dispute about who provided the critical care? How to prove YOUR physician was the one providing critical care. With Jill Young.

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Suture Removal Coding: 5 Questions That Lead You to Maximum Ethical Reimbursement

Posted on 03. Aug, 2009 by in Hot Coding Topics.


Eye-Opener: Your E/M usually ranks higher than problem-focused.

If you pigeonhole encounters involving suture removal as 99212s, you could be cutting yourself short — or possibly overcharging your service. To tell whether you need to code more or less for laceration follow-up care, answer these 5 questions.

1: Did Your Physician Complete the Repair?

Yes: If your dermatologist or a physician within your group places the sutures, you shouldn’t bill for their removal, confirms Tracy Russell, CBCS, a coder in Westminster, Md. The laceration repair code includes uncomplicated, related postoperative follow-up visits and suture removal.

No: If another physician places the sutures and your dermatologist removes them, you can bill for the wound check and removal.

AUDIO EXTRA: Lesion excision coding made easy. With Betty Johnson.

2: Are You Providing a 2-Day Post-ER Check?


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Should I Use Modifier 76 for a Repeat Procedure?

Posted on 03. Aug, 2009 by in Coding Challenge, Hot Coding Topics.


Question:A patient has pressure sores that were 20 sq cm on his right ankle and right hip that the dermatologist debrided in the morning. Because of the patient’s condition, selective debridement of a 17 sq cm sacral pressure sore was performed at a separate session in the afternoon on that same date by the same physician.

Answer: Report modifier 76 (Repeat procedure or service by same physician) when the same physician has to duplicate the same procedure (such as when the first was unsuccessful). Therefore, you should use modifier 59 (Distinct procedural service), rather than modifier 76.

Use modifier 59 when documentation shows that medically necessary circumstances, such as separate sessions, make reporting two codes that would not normally be reported together acceptable. In your case, the dermatologist would report the same debridement code (such as 11040, Debridement; skin, partial thickness) with modifier 59 appended

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Must Hospital Admit Codes and Admission Show Same DOS?

Posted on 31. Jul, 2009 by in Hot Coding Topics.


Overlook this rule, and risk leaving rightful E/M dollars on the table.

When the physician admits a patient from another site of service on day 1, but doesn’t see the patient in the hospital until day 2, choosing the date of service for your claim can raise some questions. Knowing the answers not only keeps your date of service accurate, but also may add to your bottom line.

Audio Training Event with Jill Young: When good payments go bad. Must-know fraud-proofing tips for hospital physician services billers.

Consider the following scenario offered by Dolly Cooper, CMC, and Brenda Mantia, CMC, who work with a 10-physician practice in Shreveport, La.

Scenario: The patient is admitted at 11:57 p.m., May 1, to the physician. The physician sees the patient in the hospital for the first time at 2:00 a.m. on May 2.

What would you do? Would you choose May 1 or May 2 as the date of service (DOS) for the physician’s visit?

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ICD-9 Coding Tool for Hand, Wrist Fractures

Posted on 31. Jul, 2009 by in Toolkit.


Here’s how to differentiate the tiquetrum from the trapezium.

Orthopedic surgeons dealing with hand procedures don’t only treat dislocations — they also treat fractures, and it’s up to you to link the correct diagnosis to the upper-extremity fracture repair code.

Use the anatomic drawing here to locate the site that your surgeon addressed, and match that to the sampling of applicable ICD-9 codes in the chart at the bottom of this page.

Your hand surgery claims will come out picture-perfect, and denial-free. 

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