A-Scans: Report Denial Proof 76511 Claim With Accurate Bilateral, Modifier Reporting

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

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One of the most common procedures in ophthalmology is A-scan ultrasound biometry, which is associated with some of the most uncommon coding problems.

According to CPT, A-scans — 76511, 76516, and 76519 — are the shortened names for amplitude modulation scans, “one-dimensional ultrasonic measurement procedures,” notes Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, Director, Best Practices-Network Operations at Mount Sinai Hospital in New York City.

Ophthalmologists use 76511 (Ophthalmic ultrasound, diagnostic; quantitative A-scan only) to diagnose

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In 2013, Reporting Ureteral Stone Diagnoses Will Include More Options

Posted on 10. Mar, 2011 by in Hot Coding Topics.

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Here is what you should check in your physician’s documentation.

As the conversion takes place from ICD-9 to ICD-10 in 2013, you will not be treating the codes in a way you always did. Often, you will have more options that may need tweaking the way your physician documents a service and a coder reports it.

Have a look at this common ureteral stone diagnosis, and find out what you’ll report after October 1, 2013.

When your urologist treats a ureteral stone, you now apply ICD-9 code 592.1 (Calculus of ureter) to a specific procedure code (such as 52353, Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]).

ICD-10 difference is that

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92082 or 92083? Choose The Most Appropriate Code with Expert Help

Posted on 08. Mar, 2011 by in Hot Coding Topics.

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Even small ophthalmology 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.

CPT lists three different visual field examinations — and the higher the code, the higher the reimbursement.:

  • 92081 — Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (e.g., tangent screen, Autoplot, arc perimeter or single stimulus level automated test, such as Octopus 3 or 7 equivalent)
  • 92082 — … intermediate examination (e.g., at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33)
  • 92083 — … extended examination (e.g., Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30 degrees,

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Know When to Append Modifier 50 on Bilateral CTS Shots

Posted on 08. Mar, 2011 by in Hot Coding Topics.

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Your orthopedist injects both of a patient’s wrists to treat carpal tunnel syndrome. Should you just file 20526 with modifier 50 appended and forget about it?

Not so fast: If the physician injects both the patient’s wrists to treat CTS, you will typically append modifier 50 (Bilateral procedure) to 20526 (Injection, therapeutic [e.g. local anesthetic, corticosteroid], carpal tunnel), says Kathleen F. Nelson, CPC, orthopedics professional coder at Fletcher Allen Health Care in Burlington, Vt. There are, however, some exceptions.

“This code carries a ‘1’ bilateral status indicator, which means this injection can be reported

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Emergency Reporting: Know When To Use +99140 With These Tips

Posted on 08. Mar, 2011 by in Hot Coding Topics.

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Reporting any qualifying circumstances (QC) codes for anesthesia can be tricky, but knowing when to classify a situation as a true emergency can be a real challenge unless you’re well-versed in the emergency conditions guidelines. Check coding definitions and your provider’s documentation to know whether you can legitimately add two extra units for +99140 (Anesthesia complicated by emergency conditions [specify] [List separately in addition to code for primary anesthesia procedure]) to your claim.

CPT includes a note with +99140 stating that “an emergency is defined as existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body parts.” Your key to knowing a case meets emergency conditions lies in

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Diagnosis Coding: G Codes Are Your Key To Coding Correct High Risk Colonoscopy

Posted on 07. Mar, 2011 by in Hot Coding Topics.

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Get your hemorrhoid report right and stress-free in a snap. We’ll tell you the difference between internal and external hemorrhoids, but you can learn more from this sample physician’s report:

PREPROCEDURE DIAGNOSIS: History of colon polyps and partial colon resection, right colon.

POSTPROCEDURE DIAGNOSES:

  1. Normal operative site.
  2. Mild diverticulosis of the sigmoid colon.
  3. Internal hemorrhoids.

PROCEDURE: Total colonoscopy.

PROCEDURE IN DETAIL: The 60-year-old patient presents to the office to be evaluated for the preprocedure diagnosis. The patient also apparently had an x-ray done at the hospital and it showed a dark spot, and because of this, a colonoscopy was felt to be needed. She was prepped the night before and on the morning of the test with oral Fleet’s, brought to the second floor and sedated with a total of 50 mg of Demerol and 3.75 mg of Versed IV push. Digital rectal exam was done, unremarkable. At…

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CCI UPDATE 97597-97598: CCI Will Correct Debridement Glitch

Posted on 03. Mar, 2011 by in Hot Coding Topics.

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Hang on to your claims for these wound care management codes.

As most veteran coders know, you can’t report an add-on code unless you report it along with its “parent code” on the same claim. But an NCCI glitch has made it impossible for you to collect for both the debridement add-on code 97598 and its partner code 97597 — creating denied claims and confusion for practices that perform active wound care management. However, a new announcement indicating that the NCCI is fixing the problem should ease your coding angst.

The American Podiatric Medical Association (APMA) issued a release on its Web site stating that the National Correct Coding Initiative (NCCI) edits currently bundle the following two codes together:

97597 — Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical

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Know the Types of Graft

Posted on 02. Mar, 2011 by in Coding Challenge, Hot Coding Topics.

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Question: What’s the difference between a spinal allograft and an autograft?

Answer: If the surgeon harvests bone from the patient’s own body, you’ll code for an autograft with one of the following codes:

+20936 — Autograft for spine surgery only (includes harvesting the graft); local (e.g., ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure)

+20937 — … morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure)

+20938 — … structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure).

Example: The surgeon removes a portion of bone from the patient’s rib through

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Ensure Compliance With ICD-10 With These 3 Tips

Posted on 01. Mar, 2011 by in Hot Coding Topics.

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When ICD-9 becomes ICD-10 in 2013, you will not always have a simple crosswalk relationship between old codes and the new ones. Often, you’ll have more options that may require tweaking the way you document services and a coder reports it. Check out the following examples of how ICD-10 will change your coding options when the calendar turns to Oct. 1, 2013.

Celebrate Sinusitis Codes’ One-to-One Relationship for ICD-10

When your physician treats a patient for sinusitis, you should report the appropriate sinusitis code for sinus membrane lining inflammation. Use 461.x for acute sinusitis. For chronic sinusitis — frequent or persistent infections lasting more than three months — assign 473.x.

For both acute and chronic conditions, you’ll choose

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4 Tips Help You Ensure Inhaler Service Success

Posted on 01. Mar, 2011 by in Hot Coding Topics.

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Often a nurse or medical assistant helps a patient with an inhaler demo or evaluation, but whenever coding it, you must keep these three areas in mind: the type of device used, documentation requirements, and qualifying modifiers. Follow these four tips from our experts to understand why some payers might deny payment for the service — and what you can do to win deserved dollars.

1. Categorize the Diskus Correctly

Many physician offices use the Advair Diskus for their patients, which is an aerosol generator. “An aerosol generator is a device that produces airborne suspensions of small particles for inhalation therapy,” explains Peter Koukounas, owner of Hippocratic Solutions medical billing service in Fairfield, N.J. If the nurse or medical assistant taught someone to use an Advair Diskus — or any other diskus — you should report 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler

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