Palmetto providers: Your list of diagnoses supporting medical necessity just grew.
A chest X-ray’s professional fee is only $10 or so. Multiply that $10 by the number of services you perform, however, and you’ll quickly see how getting these claims right is important to your practice’s financial health.
In fact, SuperCoder CPT 71010 (Radiologic examination, chest; single view, frontal) and 71020 (Radiologic examination, chest, 2 views, frontal and lateral) rank second and third on the list of the top 10 codes radiologists reported to the CMS database in 2009. That’s according to files recently posted by Frank Cohen, MPA, principal and Senior Analyst for The Frank Cohen Group (www.FrankCohen.com).
Question: An established patient reports to our physician with first and second-degree burns to his abdominal wall from a steam burn. During an E/M service, the physician uses gauze and topical ointment to treat the patient’s burn. Notes indicate that the anterior trunk is “18% burned.” How many diagnosis codes should I include on the claim?
Incident to, critical care must meet certain criteria.
As a family medicine coder, you’re accustomed to reporting office/outpatient E/M codes (99201-99215) on an everyday basis. Some Part B providers are falling prey to several common E/M myths; so read on to be sure you know the facts.
Myth 1: Report Supervising Physician for “Incident to”
Here’s your guide to success with TPI versus other knee injections.
All knee injections – and coding for them – aren’t created equal, especially when you’re coding for trigger points versus a standard joint injection. Keep our experts’ top advice on differentiating procedures in mind, and you’ll be flexing your coding muscles with correct claims.
Report TPI Based on Muscle Numbers
Physicians administer trigger point injections (TPI) to treat painful muscle areas that contain trigger points, or knots of muscle that form when muscles do not relax. The most important factor when coding TPIs is to focus on the number of muscles your physician injects, not the total number of injections. Consider the descriptors for CPT®’s current TPI codes:
Tip: Lyme disease series expands out to five options under ICD-10.
With Lyme disease coding being tricky to begin with, you’re in for more excitement once the diagnosis coding system switches over to ICD-10.
You should currently report 088.81 (Lyme disease) if a patient has a confirmed case of Lyme disease. Under ICD-10, however, your coding options will expand to the following code set:
Here’s what provider needs to provide in his or her documentation.
Menopause that occurs before the age of 40, whether natural or induced, is called ‘premature” menopause. A woman with premature menopause may deal with hot flashes, mood swings, and other symptoms that accompany menopause. Currently, you’ll report this with 256.31 (Premature menopause).
One-to-one cross from ICD-9 eases transition.
When ICD-10 goes into effect in October 2013, you’ll have lots of new codes to learn when your physician diagnoses acute or chronic pain. Fortunately, each existing diagnosis has a straight crossover with a structure almost identical to ICD-9. Common choices under ICD-10 will include:
Check for documentation of each system — or prepare to assign a lower code.
Your surgery practice might see lots of level-four and –five office visits, but if you incorrectly tally the history, exam, and medical decision-making (MDM), you will miss out on the pay you deserve for higher level codes.
The third element for the historical portion of an E/M service, after the chief complaint (CC) and the history of the present illness (HPI) is the review of systems (ROS). This portion of the E/M service trips up many coders because the provider may not document pertinent negative responses, or may inappropriately use the statement “all systems negative.”
Collect $800+ profit for joint 43235, 91035, and E/M.
When evaluating a patient for gastroesophageal reflux disease (GERD), gastroenterologists could perform an esophagogastroduodenoscopy (EGD) to examine the lining of the esophagus, stomach, and upper duodenum.
Background: EGD is a diagnostic endoscopic procedure considered to be minimally invasive since it doesn’t require an incision into one of the major body cavities and doesn’t usually necessitate any significant recovery after the procedure unless anesthesia has been used.
If you think you know your way around EGD coding, go back over it. You might find out that choosing the appropriate ICD-9 code to fit your patient’s condition is just as important as getting your CPT®s right. Steer clear of complications by picking up a few strategies from these two EGD coding cases.
Bill all three or get a denial: supply, injection, and illumination.
Coding for photodynamic therapy (PDT) involves three key components, which means you should look into multiple CPT® codes to describe your claim appropriately. But this could jeopardize your claims for these procedures if you’re not careful of PDT’s time increments and restrictive coverage guidelines.
Check out these tips so as not to lose your way into the complexity of PDT multiple coding.