3 Big Fee Schedule Changes for Radiology Coding & Billing

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


Capture additional $2,305 for Bilateral 50593 by Applying Fee Schedule Correction

CMS is adding some sizzle to your summer with three exciting physician fee schedule changes. Sacroplasty, renal tumor ablation, and stereoscopic x-ray guidance for radiation therapy all have news you need to know now  or you could risk leaving hundreds or even thousands of dollars on the table.

Effective date: CMS transmittal 1748 reveals the changes. The implementation date, when carriers must execute the changes, is July 6. But the effective date is Jan. 1, 2009, meaning that the changes actually apply to services performed as far back as Jan. 1. And that means retroactive cash.

AUDIO: Do you understand the latest Stark law rules? Wayne Miller tells radiology practices how to restructure IDTF shared office and staff arrangements.

1. CPT Says 72291, 72292 for Sacroplasty

The AMA announced new spine-related Category III codes, implemented July 1. CMS added them…

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Weber B Fracture Repair: 27786, 27788 or 27792?

Posted on 24. Jul, 2009 by in Coding Challenge, Hot Coding Topics.


Question:Which CPT and ICD-9 codes should we report when the surgeon dictates a Weber B fracture repair?

Answer: Depending on whether the surgeon performed an open or closed repair, you should select a code from the following range for a Weber B fracture:

• 27786 – Closed treatment of distal fibular fracture (lateral malleolus); without manipulation

• 27788 – … with manipulation

• 27792 — Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed.

Orthopedic surgeons often use terms in their dictation that don’t appear in CPT, and “Weber B” is one of those. When a surgeon addresses a Weber B fracture, he is usually treating a fracture in the distal fibula, which is coded as a lateral malleolar fracture (824.2-824.3).

The Weber classification describes only the level of the distal fibular fracture, which could also be part of a bimalleor or trimalleolar fracture pattern (although rare), or…

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Sample Modifier 25 Appeals Letter

Posted on 24. Jul, 2009 by in Toolkit.


It’s not so easy a chimp could do it — but almost.

Next time you’re sweating over what to write in a modifier 25 appeals letter, let someone else do the phrasing and punctuation for you. That way, you can use your brain for the most important and hardest part — explaining the specifics of the case to your carrier.

The American College of Emergency Physicians has a treasure trove of sample appeals letters. Some apply specifically to ED claims, but many other practices can adapt their modifier 25 appeals letter, says Jill Young, who taught us all about modifiers at the recent Family Practice & Internal Medicine Specialty Coding Conference in Orlando. Just fill in the details of the claim you’re appealing and send. And don’t forget to send a copy to state regulators, Young reminded attendees.

If you missed July’s conference, you’re in luck. There’s another one coming in December.

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Proposed 2010 MPFS: $26 More for ‘Welcome to Medicare’ Exam

Posted on 22. Jul, 2009 by in Provider News.


CMS welcomed health care providers to an July 9 open door forum on the proposed Medicare Physician Fee Schedule. One of most welcome pieces of news?

Your practice’s ‘Welcome to Medicare’ exam services will net you an extra $26 next year, if the proposed 2010 Medicare Physician Fee Schedule takes effect in January.

AUDIO: Are you getting denials because of Medicare’s new enrollment rules? Linda Martien can help.

Although CMS proposed a conversion factor for 2010 of $28.3208, which results in a -21.5 percent payment update, not all reimbursements would be negatively affected. When it comes to the initial preventive physical exam (IPPE), CMS has proposed increasing the work RVUs “to the same level as a 99204, which requires a comprehensive history and examination, and moderate complexity medical decision-making,” noted CMS’s Whitney May during the forum. “In 2009, the payment for this service is about $92.69; for 2010 the payment…

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Modifier 22 Moves for Ob-Gyn Coders

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


This U/S tactic will save you time — and add money to your bottom line.

Appending modifier 22 (Increased procedural services) may be something you think you’ve got down pat, but that doesn’t mean your ob-gyn coding will always be error-proof.

Review the following three frequently asked modifier 22 questions — answered by our ob-gyn coding experts —  and discover solid advice on how much longer a procedure should take to append modifier 22, if you can use an unlisted procedure code instead, and whether you have regular CPT code alternatives.

Service Should Take 25 Percent More Than Usual

Question: How much longer should the procedure take in order for me to bill modifier 22?

Answer: Some experts suggest that you shouldn’t use modifier 22 unless the procedure takes at least twice as long as usual. Several memorandums from Medicare carriers indicate that time is an important factor when deciding to use…

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ICD-9 Coding for Rotator Cuff Pain: 727.61 or 840.4?

Posted on 22. Jul, 2009 by in Coding Challenge, Hot Coding Topics.


Question: In treating pain stemming from an injury to the rotator cuff, how do you determine which code to use: 727.61 or 840.4?

Answer: Miscoding either one of these scenarios is a fairly common mistake. Typically, 840.4 (Sprains and strains of shoulder and upper arm, rotator cuff [capsule]) should be used for an acute injury, while 727.61 (Complete rupture of rotator cuff) is used to report a chronic condition. The difference is traumatic versus nontraumatic. Sometimes you may find clues based on the patient’s age and whether it was accident- or sportsrelated.

You should look for supporting documentation to determine if the rotator cuff has suffered a traumatic (840.4) versus non-traumatic (727.61) tear, sprain, strain, or rupture. You’ll see the non-traumatic diagnosis more frequently in older patients.

If you can’t find a definitive diagnosis in the documentation – for example, if the documentation states “rotator cuff syndrome”– use 726.10 (Disorders of

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3 Pulmonary Diagnosis Coding Tips

Posted on 20. Jul, 2009 by in Hot Coding Topics.


Remember to focus on acute conditions & exacerbations.

Correctly reporting asthma, bronchitis, and chronic obstructive pulmonary disease (COPD) depends on the internist’s documentation and the patient’s medical record. Making sure the documentation supports the patient’s diagnosis and that you code for any associated acute conditions will ensure that you’re correctly reporting pulmonary diagnoses.

1. Look to 493 for Asthma With COPD

One condition that can be associated with asthma is COPD. You can find all of the asthma codes in the 493 category of the ICD-9 codes. When your physician diagnoses both COPD and asthma together, you’ll refer to his documentation in the medical record to settle on a code. The three asthma codes you’ll choose from are:

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PRC Coding: Put Your Finger on Proximal Row Bones

Posted on 20. Jul, 2009 by in Coding Challenge, Hot Coding Topics.


Question: Our surgeon performed a proximal row carpectomy (PRC) and circled code 25215. That code refers to all the bones in the proximal row, though, and he only dictated working on four bones. Aren’t there five bones in the proximal row?

Answer: Your physician circled the correct code if he addressed the scaphoid, lunate, triquetrum, and pisiform bones. These four bones make up the proximal row of the patient’s hand.

If the physician documented carpectomies of these bones, you should report 25215 (Carpectomy; all bones of proximal row). If he did not refer to all four of these, you may want to consider reporting 25210 (… one bone) instead. You can report additional units of 25210 if he documented carpectomies of more than one bone.

Note: The surgeon may remove just part of the scaphoid rather than the entire bone, but this should not change your code choice….

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Decision Chart: Modifier 78, 58, or 79?

Posted on 20. Jul, 2009 by in Toolkit.


Simplify your post operative service claims with this nifty tool.

If you have trouble targeting just when modifiers 78 (Unplanned return to the operating room for a related procedure during the postoperative period), 58 (Staged or related procedure or service by the same physician  during thepostoperative period), and 79 (Unrelated procedure or service by the same physician during the postoperative period) apply to your claims, check out this handy flow chart which can lead you to the correct modifier decisions every time.

AUDIO: Surgical vs. Non-Surgical Modifiers Guide. Avoid mayhem and denials.

Please click ‘read more’ to get decision chart.

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Audit-Proof Your Modifier 25 Claims

Posted on 17. Jul, 2009 by in Hot Coding Topics.


Getting ready to append a modifier 25 to that E/M code?

Before you do that, let’s spend a few moments in an auditor’s shoes and learn how to think like the auditors who will potentially review our modifier 25 claims.

“I audit, and I highlight everything that pertains to the procedure” when I’m looking at modifier 25 claims, reports Catherine Gray, who spoke at the recent Family Practice & Internal Medicine Specialty Coding Conference in Orlando. The rest is simple. If there’s not enough left un-hilighted in the note that supports the level of E/M service reported, the modifier 25 is inappropriate.

Tip: Document the procedure and the E/M as separate notes, or as separate parts of the same note, advises Jill Young, who taught a great modifiers class at the conference. A different diagnosis code is not…

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