Reader Question: Know the Path Codes for Scar Examination

Posted on 28. Mar, 2013 by rpandit in Coding Challenge.

Question: When our pathologist examines scar tissue, or tissue with a diagnosis related to scarring, can we bill 88305 if the specimen difficulty warrants the charge? Is there any time that a scar should not be 88305?

Answer: Yes, you can sometimes bill a scar specimen as 88305, but some guidelines might clarify when you should and shouldn’t do so.

You might report your surgical pathologist’s exam of scar or “scar related” tissue using any of the following codes, depending on the circumstances:

88302 — Level II – Surgical pathology, gross and microscopic examination… plastic repair…

88304 — Level III – Surgical pathology, gross and microscopic examination… skin – cyst/tag/debridement or Soft tissue, debridement…

88305 — Level IV – Surgical pathology, gross and microscopic examination… Skin, other than cyst/tag/debridement/plastic repair….

The code choice depends on the circumstances of the case, including the tissue origin of the scar (skin or soft tissue) and the extent of the service. Look at the following tips to help you decide when a scar fits under each code:

88302: Use this when the scar originates in the skin, and the pathologist’s work essentially involves tissue from “plastic repair.” That means the scar is an incidental part of a plastic repair procedure, and the specimen shows no significant pathology.

88304: A scar that originates in soft tissue or skin could qualify for 88304 when the specimen is essentially equivalent to a debridement. A “simple scar” removed for pathologic diagnosis, not as an incidental part of plastic repair, would qualify for 88304.

88305: A more complex skin scar specimen, such as a keloid scar or a tumor excision/re-excision, qualifies for this surgical pathology level under the catch-all skin code “other than cyst/tag/debridement/plastic repair.

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Know the Rhinitis Cause to Report This Dx Under ICD-10

Posted on 28. Mar, 2013 by rpandit in ICD-10.

You’ll be checking the ‘J30.x’ section to find the right rhinitis code next year.

Although rhinitis cases are probably heating up now as spring approaches, your practice may see this diagnosis all year-round, so you’ll need to know how to report it when ICD-10 takes effect next year. Once again, careful and complete physician documentation will be necessary to support the ICD-10 code for this condition.

Rhinitis is inflammation of the nasal membranes characterized by a combination of the sneezing, nasal congestion, nasal itching, and rhinorrhea.

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Documentation: New CMS Guidelines To Be Followed To Keep Record Amendments Updated

Posted on 25. Mar, 2013 by rpandit in Provider News.

Heads up: Single-line corrections are fine.

No practice – or physician – is immune to documentation that needs to be updated. Maybe the physician left out an important piece of information, such as the amount of time spent counseling the patient, or the patient’s diagnosis. When records need to be amended, be sure your practice follows the latest CMS rules, which were revised on Dec. 7, 2012, in Transmittal 442.

In the transmittal, CMS encourages providers to “enter all relevant documents and entries” into the record at the time of service. However, CMS also acknowledges that “occasionally, upon review a provider may discover that certain entries, related to actions that were actually performed at the time of service but not properly documented, need to be amended, corrected, or entered after rendering the service.”

Do this: When adding, correcting, or entering information after the date of service, you should identify it as an amendment, and the physician should sign and date it. Never delete the original entry—instead, ensure that all original content is identifiable. You can do this on a paper record by using a single strike line through the original content. For electronic records, you must “provide a reliable means to clearly identify the original content, the modified content, and the date of authorship of each modification of the record,” CMS says in the transmittal.

If an auditor ever reviews your files, CMS directs them to consider your amended entries—but only if you follow the rules. Auditors “shall not consider undated or unsigned entries handwritten in the margin of the document,” for instance, the Transmittal advises.

CMS advises MACs and auditors that see potential fraud in the documentation to refer those cases to the ZPIC auditors. To read the complete transmittal, visit www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R442PI.pdf.

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Beware: Don’t Automatically Use 44705 for Fecal Bacteriotherapy

Posted on 25. Mar, 2013 by rpandit in Hot Coding Topics.

Hint: Use additional code for instillation when reporting 44705

If your gastroenterologist performs fecal bacteriotherapy as a treatment for Clostridium difficile infections, don’t forget to look at payer policies before you report the assessment and preparation of the fecal microbiota sample with the newly introduced CPT^®code 44705.

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New ‘J’ Code Will Replace 034.0 for Strep Throat Dx

Posted on 11. Mar, 2013 by rpandit in ICD-10.

Fortunately, however, coding choices for this condition won’t expand dramatically.

 Your otolaryngology practice probably sees patients with symptoms of strep throat every day, and this common illness is marked by pain and redness in the throat, potential fever, and sometimes a rash.

 ICD-9 Coding Rules: When using the ICD-9-CM code set, you report 034.0 (Streptococcal sore throat) if the patient suffers from streptococcal sore throat. The ICD-9 manual also directs you to this code if the patient suffers from streptococcal tonsillitis.

 ICD-10 Changes: Effective Oct. 1, 2014, you won’t have a simple catch-all code for streptococcal throat infections. Instead, ICD-10 will differentiate between streptococcal pharyngitis and streptocollal tonsillitis, as follows:

                        J02.0 (Streptococcal pharyngitis)

                        J03.00 (Acute streptococcal tonsillitis, unspecified)

                        J03.01 (Acute recurrent streptococcal tonsillitis)

 Documentation: You should not report the strep throat diagnosis code unless your practice receives confirmation from a lab test (either rapid strep or throat culture) indicating that the patient tested positive for a streptococcal throat infection. If you don’t have a positive lab test confirming strep throat, you should simply report the diagnosis codes for the symptoms (such as sore throat, fever, etc.)

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Fee Schedule Update Offers Bilateral Pay Boost for 10 Procedures

Posted on 11. Mar, 2013 by rpandit in Hot Coding Topics.

In the Q2 updates to the Medicare Physician Fee Schedule, CMS offers payment boosts for several procedures, including catheter placement and cardiac Doppler monitoring. Although the Q2 updates have an official implementation date of April 1, many of the changes are effective retroactive to Jan. 1, 2013.

 Bilateral Boosts

 You’ll now be able to collect more when you perform selective catheter placement (36222-36228) bilaterally. Previously, the bilateral procedure indicator on these codes was “0,” which meant that no additional payment was assigned when surgeons performed the procedure on both sides. However, effective Jan. 1, 2013, the bilateral indicator is “1,” so you can append modifier 50 (Bilateral procedure) and the payment amount will be 150 percent of the fee schedule RVUs.

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Part B Payment: CMS Offers Bilateral Pay Boost for 10 Procedures

Posted on 11. Mar, 2013 by rpandit in Provider News.

 Plus: G9157 is now payable under the Fee Schedule.

Not all fee schedule changes are bad news.

In the case of the Q2 updates to the Medicare Physician Fee Schedule, CMS offers payment boosts for several procedures, including catheter placement and cardiac Doppler monitoring. Although the Q2 updates have an official implementation date of April 1, many of the changes are effective retroactive to Jan. 1, 2013.

Bilateral Boosts

You’ll now be able to collect more when you perform selective catheter placement (36222-36228) bilaterally. Previously, the bilateral procedure indicator on these codes was “0,” which meant that no additional payment was assigned when surgeons performed the procedure on both sides. However, effective Jan. 1, 2013, the bilateral indicator is “1,” so you can append modifier 50 (Bilateral procedure) and the payment amount will be 150 percent of the fee schedule RVUs.

The same good news awaits for codes 23000 (Removal of subdeltoid calcareous deposits, open), 32997 (Total lung lavage; unilateral), and 32998 (Ablation therapy for reduction or eradication of one or more pulmonary tumor[s] including pleura or chest wall when involved by tumor extension, percutaneous, radiofrequency, unilateral), which will all be billable with modifier 50 going forward. The payment for the bilateral procedures will be 150 percent of the fee schedule amount.

Positive Payment News for This G Code

CMS will now allow payment for G9157 (Transesophageal Doppler use for cardiac monitoring), making its procedural status code now “A” (active) going forward, which means that it will be payable once RVUs are assigned to it. In addition, the procedure has been assigned a PC/TC indicator of “2,” meaning the professional component only will be paid (modifiers 26 and TC are not valid with this code). This is effective Jan. 1, 2013, so your MAC should pay claims retroactively for dates…

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Reader Question: Provider-Neutral Language Shouldn’t Impact Too Harshly

Posted on 11. Mar, 2013 by rpandit in Coding Challenge.

Question: Does our practice need to make any changes to our systems to accommodate the fact that CPT^® 2013 changed so many descriptors from “physician” to “other qualified health care provider?”

Answer: The most widespread changes throughout CPT^® 2013 — the switch to more inclusive or provider-neutral language — shouldn’t be difficult for physician practices to put into place.

“The concepts are pretty straightforward,” said Richard Duszak, Jr., MD, an AMA CPT^® Editorial Panel member and practicing radiologist, during his presentation at the American Medical Association’s (AMA) annual CPT^® and RBRVS Symposium, held Nov. 14-16 in Chicago. “There’s been an evolution in CPT^® for how codes report services by non-physicians.”

Result: Hundreds of codes were revised for 2013 to include “provider neutral language.” Codes throughout the book have replaced designations of “physician” with “individual” or “qualified health care provider.”

 Exception: A few codes retained the “physician” language, such as those related to skilled nursing facility admissions, because regulations require that a physician admit the patient.

“CPT^® is not the turf police,” Duszak said. “We’re focusing on the services provided and recognize that sometimes professionals other than physicians are qualified to provide some services. As a nationally recognized reporting system, it’s important for CPT^® to maintain provider neutrality.”

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Visual Fields: Don’t Pick Intermediate VF Code When Extended Code Is Justified

Posted on 11. Mar, 2013 by rpandit in Hot Coding Topics.

Choosing between 92082 or 92083 can be tricky – let our expert advice guide you.

Even small practices are likely to have a Humphrey visual field analyzer, yet many ophthalmologists don’t know the secrets for securing adequate reimbursement for these services — and they even go so far as to put themselves at risk for costly audits due to lack of documentation.

Stop Shortchanging Yourself With Intermediate Codes

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Expand Your Undescended, Retractile Testicle Diagnoses in 2014

Posted on 26. Feb, 2013 by rpandit in ICD-10.

Make sure your urologist gets specific in his documentation.

When your urologist performs an orchiopexy procedure, you’ll most likely use one of the following diagnosis codes along with the procedure code:

• 752.51 – Undescended testis (includes ectopic testicle)
• 752.52 – Retractile testis.

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