Don’t Let Modifier Glitches Sideline Your Capsule Endoscopy Claims

Posted on 08. Apr, 2015 by in Hot Coding Topics.


Ask for pre-authorization from the carrier to repeat a capsule study due to previous technical problems.

Reporting capsule endoscopy is not just about knowing the procedure codes and when to use them. It is also about being proficient enough to report interrupted procedures, delayed procedures, or other such contingencies. Remain on top of these situations armed with the knowledge of the correct modifiers.

If you are reporting only the professional component for your capsule endoscopy services ((i.e., interpretation and report of the results), you should append professional component modifier 26 (Professional component) to the appropriate code. For example, if your physician is part of a facility, and the facility owns the equipment used for the endoscopy, the gastroenterologist will only report the professional component.

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Capture 2015 Medicare Physician Payment Changes With the Latest CPT® Assistant

Posted on 05. Apr, 2015 by in Hot Coding Topics.


The February 2015 CPT® Assistant highlights the changes made in the Medicare physician payment schedule in 2015. You will see how the final conversion factor takes into account the adjustment the Protecting Access to Medicare Act of 2014 (PAMA) brought about for the sustainable growth rate (SGR). Also, check out the Relative Value Scale Update Committee (RUC) recommendations of fee schedule changes for 2015.

You can also sharpen your skills for appropriately reporting arthrocentesis codes with the latest CPT® Assistant. Plus, nail down correct codes for reporting paravertebral facet joint nerve destruction. You can use’sCode Connect search to update your skills on all of these topics:

  • Arthrocentesis: 20600-20611, 27370, 76942, 77002, 77012, 77021
  • Medicare Physician Payment Changes in 2015: 92961, 92986-92990, 92997-92998, 99490
  • Paravertebral Facet Joint Nerve Destruction: 64633-64636, 64999.

The customary FAQ section is also available in the latest CPT® Assistant to help you resolve

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ICD-10: Keep Abreast of What CMS Plans for Future ICD-10 Testing

Posted on 30. Mar, 2015 by in ICD-10.


Here’s your chance to see how prepared you are for the new system. 

With the ICD-10 implementation date only months away, CMS is taking a four-pronged approach to ensuring that CMS and Medicare Fee-for-Service (FFS) practices are prepared. Read on to know what to expect, based on what Stacey Shagena with Medicare Contractor Management Group/CMS shared about Medicare’s testing plan during an MLN Connects call “Transitioning to ICD-10” on Nov. 5, 2014.

The four areas of focus for CMS are: 

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Reader Question: Procedure Specifics Dictate Whether 96372 Can Be Billed With 62310 or 62311

Posted on 30. Mar, 2015 by in Coding Challenge.


Question: A patient visited our office for therapeutic injections of Toradol and Kenalog. Do I report the injection codes or HCPCS medication codes? Would they be billable with an epidural injection?

Oklahoma Subscriber


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Physician Notes: Ever Feel Like Auditors Are on A Witch Hunt? CMS Responds

Posted on 30. Mar, 2015 by in Provider News.


If you get frustrated over auditors’ reviews of your claims, you aren’t alone. A caller to CMS’s Jan. 7 Open Door Forum questioned whether CMS is just performing fishing expeditions, finding practices guilty until proven innocent—and one CMS official explained why.

“Observation management codes, if they’re less than eight hours, they don’t count,” the caller said. Auditors, however, have no idea about whether submitted observation care codes reflect services performed for less than eight hours or not until they receive the practices’ paperwork.

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Final Rule: Beware Potential ‘Ides of March’ Pay Cut

Posted on 30. Mar, 2015 by in Hot Coding Topics.


Only an act of Congress can save the day.

You might have experienced little change in Medicare pay in January, thanks to a stipulation in the Protecting Access to Medicare Act of 2014 (PAMA) that halts sustainable growth rate (SGR) cuts until April 1, 2015.

But the ticking SGR time bomb, along with aggregate RVU changes that bode well or ill for service providers depending on their specialty, could mean that your lab or pathology practice’s financial outlook is not that stable after all.

Read on to see what Medicare pay changes you might expect this year — now and possibly later, too.

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Take Advantage of Molecular Pathology Tables and Tips in the Latest CPT® Assistant

Posted on 19. Mar, 2015 by in Hot Coding Topics.


The January 2015 CPT® Assistant is jam-packed with advice on 2015′s molecular pathology code updates. Get the inside scoop on revisions made to the gene table to include claim designators for Tier 2 Molecular pathology codes. Find out how the new section in CPT® 2015 for genomic sequencing procedures (GSPs) and other molecular multi analyte assays impacts reporting of 21 new codes to describe gene panel analysis.

Reviewing the latest issue will also improve your understanding of how to appropriately report percutaneous vertebroplasty and vertebral augmentation codes as well as aqueous shunt procedures and visual field assessment. Make the most of’sCode Connect code and keyword search to keep your skills up to date on these topics:

  • Aqueous Shunt Procedures and Visual Field Assessment: 66180, 67255, 66185, 0378T-0379T
  • Maternity Care and Delivery: 99201-99205, 99211-99215, 99241-99245, 99281-99285, 99384-99386, 99394-99396
  • Molecular Pathology Update: 81246, 81288, 81292, 81313, 81400-81408, 81410-81471, 81445-81455, 81479,

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ICD-10: Right, Left, Bilateral Options Expand Carotid Artery Stenosis Choices

Posted on 18. Mar, 2015 by in ICD-10.


433.10 leads to more choices.

When your cardiologist performs angiography, catheterization, or stent procedures in the carotid artery for conditions such as stenosis, you’ll need more information to accurately report the condition under ICD-10.

You should be ready to implement these changes when ICD-10 goes into effect on Oct. 1, 2015.

ICD-9 offers two codes for carotid artery stenosis:

  • 433.10 — Occlusion and stenosis of carotid artery without cerebral infarction
  • 433.11 — Occlusion and stenosis of carotid artery with cerebral infarction.

But each of these codes grows to four different code choices under ICD-10.

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Reader Question: CCI Edits Direct Whether 96372 Is Allowed With Scope

Posted on 18. Mar, 2015 by in Coding Challenge.


Question: When the otolaryngologist performs a scope in the office and also gives a shot (using 96372 for administration and a separate code for the medication), is there any reason to put a modifier on the administration 96372 code? 

Nebraska Subscriber


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CPT® 2015: Get to Know 2 New 2015 Advanced Planning Codes

Posted on 18. Mar, 2015 by in Hot Coding Topics.


Pay attention to time documentation for correct use. 

If your urologist does advance care planning for patients, you will likely make use of two new codes that CPT® added for 2015. Read on to learn about the new additions and the lingering questions experts have about how you’ll use these codes.

Add 99497-99498 to Your Coding Arsenal

CPT® 2015 adds two new advance care planning codes: 99497 (Advance care planning including the explanation and discussion of advance directives such as standard forms [with completion of such forms, when performed], by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member[s], and/or surrogate) and add-on code +99498 (... each additional 30 minutes .…).

According to CPT® 2015,

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