Answers To Your Hospital Admission, Subsequent Care Coding Questions

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


Revenue Booster: Here’s when you can claim a consult rather than an admit/subsequent care code.

Did you know if your neurosurgeon manages the patient’s head injury while another physician takes care of everything else, then you should hold off on reporting an admission service? Insurers are eager to audit hospital admission codes (99221-99223), as well as subsequent care codes (99231-99233). So you should learn all you need to know to correctly code co-management situations.

These 4 hospital admission coding FAQs help you stay out of auditors’ crosshairs.

1. What Does Hospital Admission Entail?

You may report a hospital admission (99221-99223) for a neurosurgeon (or any other specialist) as long as the neurosurgeon assumes full responsibility for the patient’s care, says Dianne Wilkinson, RHIT, compliance officer and quality manager with MedSouth Healthcare in Dyersburg, Tenn.

Example: From the emergency department the neurosurgeon admits a patient with head

Full Article & Comments

Fetal Non-Stress Test Coding & Billing

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


 Question: What do fetal non-stress tests (NSTs) entail? Are reading NSTs for pregnant mothers who are inpatients a separately billable service?

Answer: A NST is a discrete test that takes 20-40 minutes to complete and requires a notation of fetal movement as part of the test.

If the patient is simply hooked up to a monitor during her hospital stay and the ob-gyn occasionally looks at the strip, you should consider that part of her exam and not a separately billable test.

To separately bill this service with 59025 (Fetal nonstress test), your ob-gyn must document a clear indication for doing the NST (for instance, to measure fetal wellbeing).You must have a report with the findings and a recommendation for further testing or treatment. You should also have a hard copy of the tests strip.

Keep in mind: If the ob-gyn performed this service in the hospital using hospital equipment, you can bill only the

Full Article & Comments

How Do You Code COPD With Acute Bronchitis?

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



Question: An established patient with chronic obstructive pulmonary disorder (COPD) with acute bronchitis reports to the physician for a scheduled spirometry. What is the proper diagnosis coding for this encounter?

Answer: Code with caution on COPD patients; report a single diagnosis code for the patients COPD even when it occurs along with certain conditions, such as bronchitis, emphysema, or asthma.

On the claim, report the following:

• 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[ s], with or without maximal voluntary ventilation) for the spirometry

• 491.22 (Obstructive chronic bronchitis with acute bronchitis) for the COPD.

Explanation: You dont have to report 466.0 (Acute bronchitis) for the obstructive chronic bronchitis because the code descriptor for 491.22 specifies acute bronchitis.

Don’t Miss this AUDIO TRAINING EVENT: Jen Godreau gives you 10 tips to improve your critical care coding.

Full Article & Comments

The First Medicare Bene Ever, Plus a PFS RVU Math Crash Course

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


Yeah, I’ve got a problem. I’m a Medicare history geek, and look what I just found! A picture of the very first Medicare beneficiary ever. In this 1965 photo, Mr. Tony Palcaorolla of Baltimore submits the first Part B application from the general public. LBJ is there to process it personally. Check out Mr. P’s snappy bow tie.

Hang up this snapshot in your cubicle, coders, and for even more excitement, let’s learn some more stuff about the Physician Fee Schedule! Today’s topic: Facility and Non-Facility RVUs. Once you read this little post, you’ll ‘GET’ THE MATH. I promise.

The Physician Fee Schedule establishes different values for codes depending on the setting/site (facility or non-facility) in which the provider performs the service or procedure. For some services, the total RVUs for a given procedure are the same regardless of whether the physician performs the procedure in a facility or a non-facility. In…

Full Article & Comments

Concurrent Care Coding Tips: Pulmonologist & Allergist

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


Allergy season often presents the dilemma of when and how both an allergist and pulmonologist can report services for the same patient. Reimbursement for concurrent care to treat conditions like extrinsic asthma, acute bronchitis is possible

Familiarize Yourself With Medicare’s Slant

Medicare reimburses for concurrent care when physicians provide services more extensive than consultations and when both physicians play an active role in the patient’s ongoing care.

To get paid in a concurrent care scenario, you must be able to justify having two related specialties on board, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.

Follow these 2 rules of thumb to help ensure payment for concurrent care:

1) Diagnosis: Verify that the diagnosis or diagnoses support the medical necessity of involving two specialists in the patient’s care; and,

Full Article & Comments

Cardiology ICD-9 for 2010: All-New Embolism Codes & More

Posted on 04. Jun, 2009 by in Hot Coding Topics.


A 453.x facelift will require you to hunt for more specific upper extremity codes.

Oct. 1 and implementation of the 2010 ICD-9 codes may still be a few months away, but CMS is offering a sneak peak at the added, deleted, and revised codes that cardiology coders will need to know. Keep your focus on the embolism and thrombosis codes so you’ll be ready to report them from day one.

Phlebitis Coding Frustrations? Join the Club

In 2009, your coding options are 451.0-451.9 (Phlebitis and thrombophlebitis) and 453.0-453.9 (Other venous embolism and thrombosis).

Problem: “‘Thrombophlebitis’ is a term that is now rarely used, due to the lack of clinical significance of ‘phlebitis,’” according to Patrick Romano, MD, MPH, professor of medicine and pediatrics at University of California at Davis, in his “Phlebitis and Thrombophlebitis” presentation to the ICD-9 Coordination and Maintenance Committee. He presented the proposal

Full Article & Comments

OK to Code Debridement With Consult?

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


Question: Can you charge for an inpatient consult and a bedside debridement on the same day?

Answer: You can bill for both services as long as the E/M service goes beyond a simple assessment of the area to be treated.

Remember to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service) to the inpatient consultation code (99251-99255, Inpatient consultation for a new or established patient …) you report to inform the payer that the surgeon provided a separate E/M service above and beyond the E/M inherent to the debridement.

Report a code from the 11010-11044 (Debridement …) range, depending on the type of debridement your physician performed.

Diagnosis help: You do not have to have a different diagnosis for the consultation and the debridement. However, the documentation should show the medical necessity for the surgeon to perform

Full Article & Comments

Virtual Colonscopy Coverage Update: 0067T, 0067T

Posted on 03. Jun, 2009 by in Provider News.


If you’ve been holding out hope that CMS would change course on its virtual colonoscopy stance, you’re *&#@ out of luck.

On May 13, CMS issued a decision memorandum indicating that it will not cover screening computed tomography colonographies, which are better known as virtual colonoscopies.

CMS notes in its memo that the “evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test … CT colonography for colorectal cancer remains noncovered.”

Several professional associations announced their disagreement with the decision. “Make no mistake: If let stand, this CMS decision not to pay for CT colonography will cost lives,” noted James H. Thrall, MD, chair of the American College of Radiology’s board of chancellors in a prepared statement.

To read the decision memorandum, go here.

TRAINING EVENT: Managing Colonoscopies: Smart Practice Management in a Tough Economy, with Jill Young.

Full Article & Comments

Capsule Endoscopy Gone Awry: 91110-What?

Posted on 01. Jun, 2009 by in Coding Challenge, Hot Coding Topics.


Question: Our patient came in for a capsule endoscopy, but the capsule got stuck in food on hour five and visuals could not be seen past the stomach. Well have to repeat this to see if we can see the small and large intestine. How should we code this procedure?

 Answer: If your physician is going to repeat the procedure, append modifier 53 (Discontinued procedure) to 91110 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus through ileum, with physician interpretation and report).

Another option: If you weren’t going to repeat the procedure, you could append modifier 52 (Reduced services) to reflect that the capsule imaged the patient’s anatomy until it became lodged in the food.

Whose equipment? For 91110, make sure your place of service is where the capsule’s data was downloaded. If your practice owns the equipment and capsule (and not a facility), check that your place of service was the office (POS code 11).

Full Article & Comments

Medical Coder’s Modifier 25 Checklist

Posted on 01. Jun, 2009 by in Toolkit.


Append 25 with the greatest of ease …

Appending modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is a legitimate and effective method to obtain payment for a significant, separately identifiable E/M service provided on the same day as another service or procedure. To facilitate payment of your modifier -25 claims, check your claim against the following:

__ Have complete and separate documentation for the E/M service, apart from documentation for any other services/procedures the surgeon provides that day. Treat E/M codes as part of a different encounter. Documentation should independently support every code you claim.

E/M Coding doesn’t have to be a circus. Our experts make it simple.

__ Be sure the E/M service you report is significant (in other words, documentation should support at least a level-three patient encounter: 99203, 99213).

Full Article & Comments