Does 99360 Merit Medicare Pay?

Posted on 24. Apr, 2011 by in Coding Challenge, Hot Coding Topics.


Question: My doctors stand by for the cardiologists during a pacemaker placement in case they need to place epicardial leads. They want to report their time, and I have found 99360 for this. Do they need to dictate something in order for me to charge for this?

Answer: CMS and many other payers don’t pay for 99360 (Physician standby service, requiring prolonged physician attendance [face-to face] without direct patient contact, each 30 minutes [e.g., operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG]), so the physician may not be able to charge for standby time.

If a third party payer does reimburse for 99360, then be sure the physician has documented the standby service with something such as: I was requested by

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Ensure Trigeminal Nerve Block Success With These Two Tips

Posted on 21. Apr, 2011 by in Hot Coding Topics.


If your physician administers trigeminal nerve blocks to patients for headache relief, brush up on the ins and outs of anatomy and potential diagnoses. Read on for two keys that will keep your coding for these procedures pain free.

Learn the Location

The trigeminal nerve provides sensory innervations to most of the face; providers might also refer to the trigeminal nerve as the “cranial nerve V” or the “fifth cranial nerve.” The name “trigeminal” stems from the fact that the cranial nerve has three major divisions, or branches:

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CCI Edit: 93454-93461 Note These Column Changes For Correct Cardiology Coding

Posted on 18. Apr, 2011 by in Hot Coding Topics, Provider News.


Correct Coding Initiative version 17.1 brings 11,831 new edit pairs, effective April 1 for physicians. That’s the word from a March 17 announcement by Frank Cohen, principal and senior analyst for the Frank Cohen Group. Here’s a look at the major pointers you need to keep in mind to comply with the new cardiology-related edits, including cardiac catheterization, radiological supervision and interpretation, cardiac rehabilitation, and more.

1. Prevent Denials by Remembering 93454-93461 Are Diagnostic

New edits will prevent you from reporting heart catheter/angiography codes 93454- 93461 (column 2) with the following cardiovascular therapeutic services and procedures (column 1):

  • 92975 — Thrombolysis coronary; by intracoronary infusion, including selective coronary angiography
  • 92980 — Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel
  • 92982 — Percutaneous transluminal coronary balloon angioplasty; single vessel
  • 92995 — Percutaneous transluminal coronary atherectomy, by mechanical or other method, with

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Worried about Delayed Pay? Verify Your State’s Prompt Pay Laws

Posted on 16. Apr, 2011 by in Hot Coding Topics, Provider News.


How many times has it happened with you that you submit a clean claim but still don’t get paid even three months later? Do you have any recourse? Yes, thanks to the prompt pay laws that each payer must follow when paying your medical claims.

Verify Which Laws Apply to Your Practice

Each state requires private insurers to pay all clean claims within a certain time frame. If the insurer does not pay the claim in a timely manner, then the payer is subject to paying interest on the charges owed to the practice (or directly to the beneficiary). Most time frames range from 15 to 45 working days, with 30 days about the average.

“If you are a little adventurous, you could search for your state law on the Internet,” says Joseph Lamm, office manager with Stark County Surgeons, Inc. in Massillon, Ohio. Lamm warns, however, that “reading…

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Phototherapy: 96900 or 96910? Check Out These FAQs to Narrow Down On Correct Option

Posted on 14. Apr, 2011 by in Hot Coding Topics.


If your dermatologist is treating vitiligo or dychromia patients with phototherapy, read your physician’s documentation carefully to determine what type of light, wavelength, and materials he used. These two frequently asked questions will help you combat both E/M and multi equipment correct coding initiative (CCI) situations.

Evaluate These Phototherapy + E/M Tips

If you’re charging for an office visit on the same day as phototherapy, your reimbursement may depend on whether your physician’s documentation warrants a different diagnosis code. Payers may reimburse at times if the doctor sees the patient for a different problem, thus with a different diagnosis code, experts say.

Example: If your physician performs 99212 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 10 minutes face-to-face with the patient and/or family) with phototherapy, you will bill it with

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High BMI: To Use Or Not to Use Modifier 22

Posted on 12. Apr, 2011 by in Hot Coding Topics.


The new fifth-digit diagnosis codes for body mass index (BMI) can help you better document a patient’s condition, especially when the patient’s BMI might contribute to more complex risk factors for the anesthesiologist to handle. Having documentation of a high BMI doesn’t automatically lead to more pay, however. Watch two areas before assuming you can automatically append modifier 22 (Increased procedural services) because of BMI and potentially score a 20-30 percent higher pay for the procedure.

Not All Morbid Obesity Means Modifier 22

A patient is considered to be morbidly obese when his or her BMI is 40 or more. New BMI codes for 2011 include:

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Use V Codes to Report Follow-Up Visits

Posted on 06. Apr, 2011 by in Coding Challenge, Hot Coding Topics.


Question: If a patient receives treatment and the condition was resolved, which ICD-9 code should I report if the patient returns in six months for a follow-up visit?

Answer: The most accurate way to code visits to follow up on treatment for a previous condition is to report a V code as the primary diagnosis, with the condition that the optometrist is following up on as the secondary diagnosis.

You can find the follow-up V codes in the V67.x series in the ICD-9 manual. Although none specifically mention eye treatments, these are some examples of V codes that might be applicable:

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Accessory Sinuses Service Coding: Snag $217 with These 3 FAQs

Posted on 05. Apr, 2011 by in Hot Coding Topics.


Given the variety of anatomic sites, surgical techniques, and types of instrumentation involved in transnasal turbinate surgery, it is the one of the most difficult coding scenarios.

Your otolaryngologist removes the middle turbinate during an endoscopic ethmoidectomy (31254, Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior], or 31255, Nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior]) or endoscopic polypectomy (31237, Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]). The middle turbinates are considered access to the sinuses, so you should be able to tell that the removal of the middle turbinate should not be reported separately.

Check out these 3 frequently asked questions (FAQs) to help master your turbinate surgery coding skills.

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Two New CPT Codes Lend Specificity to Interstitial Device Coding

Posted on 02. Apr, 2011 by in Hot Coding Topics, Provider News.


Until now, you could not code for the additional service — and hence not get the pay — when your general surgeon placed interstitial devices for radiation therapy guidance during a distinct open or laparoscopic abdominal procedure. But two new CPT 2011 codes for the procedure help you capture all the pay you deserve.

Open, Lap, or Percutaneous Approach Distinguish Placement

Last year, you had one code to use when your surgeon placed an abdominal interstitial device for radiation therapy guidance — 49411 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], percutaneous, intra-abdominal, intra-pelvic [except prostate], and/or retroperitoneum, single or multiple).

“If your surgeon performed the device placement during an open or laparoscopic procedure

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Sharpen Your Colonic Polyp Vocabulary With These Tips

Posted on 31. Mar, 2011 by in Hot Coding Topics.


Not all patients who present to the office with colon polyps will be diagnosed with colon cancer. This second-leading cause of cancer-related deaths in the US usually begins as small, benign adenomatous lump, and becomes cancerous overtime.

Colon cancer, or colorectal cancer as it’s regularly known, is a cancer which starts in the large bowel portion of the gastrointestinal (GI) system. Because it comes in many forms and symptoms, coding the definitive diagnosis might be risky. Guard your practice’s deserved dollars with these 3 tips.

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