37228-+37235 Cover Your Tibial/Peroneal Service Codes

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

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Facing denials on your tibial/peroneal codes? No worries, help is at hand.

The new tibial/peroneal service codes are below. Note that all of the codes include angioplasty in the same vessel when that service is performed.

The first four codes apply to the initial tibial or peroneal vessel treated in a single leg:

  • Angioplasty: 37228 — Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty
  • Atherectomy (and angioplasty): 37229 — … with atherectomy, includes angioplasty within the same vessel, when performed

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Pain Management: Is Headache Coding Giving You Headaches?

Posted on 19. Feb, 2011 by in Hot Coding Topics.

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If your neurologist or pain specialist administers greater occipital nerve blocks, don’t let coding turn into a headache. Verify specifics about the patient’s headache and the service your provider offered to pinpoint the correct diagnosis and procedure codes every time. Our 4 questions will point you to the best diagnosis and injection codes.

Where Is the Occipital Nerve?

The greater occipital nerve (GON) originates from the posterior medial branch of the C2 spinal nerve and provides sensory innervations to the posterior area of the scalp extending to the top of the head. Physicians typically inject the GON at the level of the superior nuchal line just above the base of the skull for occipital headaches or neck pain.

Some physician practices include a small illustration in the chart that the physician can mark with various injection sites. Including this type of tool helps your physician clearly document the

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ICD-10: 2 New H Codes To Take Place Of 366.16 in 2013

Posted on 17. Feb, 2011 by in Hot Coding Topics.

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When ICD-9 becomes ICD-10 in October 2013, the diagnosis codes you’re accustomed to reporting will no longer exist. Many diagnosis codes will include more details than their current counterparts, and some sub-codes of the same family will even move to different locations.

Consider two new commonly reported options for nuclear sclerosis, or nuclear cataract (366.16, Senile nuclear sclerosis).

ICD-10 difference: Diagnosis 366.16 will change to

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Modifiers 52 or 53? Prevent Denials By Making The Correct Choice

Posted on 17. Feb, 2011 by in Hot Coding Topics.

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If you mistake modifiers 52 and 53 as one or the other because they’re both used for incomplete procedures, you’ll end up losing your reimbursement. Remember these two have extremely distinctive functions.

Consider a situation when the gastroenterologist performs an esophagogastroduodenoscopy (EGD) to examine the lining of the esophagus, stomach, and upper duodenum of a patient as part of a GERD evaluation.

Suppose that while inserting the endoscope, the patient registers unstable vital signs. The gastroenterologist, then, decides it is not in the patient’s best interest to continue the procedure. You would report this on your claim using:

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Per New CMS Transmittal Modifier, All Claims With Modifier GZ Will Be Denied Immediately

Posted on 17. Feb, 2011 by in Hot Coding Topics, Provider News.

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As per the latest CMS regulation, all claims with modifier GZ appended will be denied straight away. It is not unusual even in the best-run medical practices that the physician performs a noncovered service and doesn’t get an ABN signed.

If you should have had a patient sign an advance beneficiary notice (ABN) but failed to do so, you should append modifier GZ (Item or service expected to be denied as not reasonable and necessary) to the CPT code describing the noncovered service the physician provided. The advantage to reporting modifier GZ is

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Is Modifier 50 OK for Bilateral Radiology Exams?

Posted on 16. Feb, 2011 by in Coding Challenge, Hot Coding Topics.

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Question: Our physician x-rayed a patient’s symptomatic knee and ordered an x-ray of the other knee for comparative purposes. How should we report the comparison x-ray?

Answer: Report the appropriate radiology code on two separate lines of your claim, such as 73560 (Radiologic examination, knee; 1 or 2 views). Although you’re reporting x-rays of mirror-image body parts,

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GI Tract Reporting: When and When Not To Use 91110, 91111

Posted on 16. Feb, 2011 by in Hot Coding Topics.

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While you know for sure that you can report 91110 and 91111 for capsule study, but knowing just that is not enough to prevent your claims from being denied. We’ll tell you just when it is appropriate to report them  and which modifiers to append.

Reporting a Repeat Procedure with 91110

Sometimes, your gastroenterologist would use a capsule study to image the intraluminal esophagus all the way through the ileum and reaching the colon. In this case, you should report

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Multi-Provider Coding: Modifier 62 Can Save You $4k

Posted on 15. Feb, 2011 by in Hot Coding Topics.

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When you come face-to-face with multi-provider situation, the last thing you would want is to mess up your coding by assigning the wrong modifier(s).

Imagine a 70-year-old female patient presenting with COPD and coronary artery disease, status post myocardial infarction (CAD s/p MI) having a 28 mm of inner diameter thoracic aortic aneurysm. Imaging studies indicate the aneurysm to be descending. The cardiologist, together with a thoracic surgeon, decides to perform an open operative repair with graft replacement of the diseased segment.

The main key in a multi-provider scenario is to treat

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Look Up New Observation Codes When Reporting ‘Middle Days’

Posted on 06. Feb, 2011 by in Hot Coding Topics, Provider News.

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2011 brings a new coding option when reporting the middle day of observations that last longer than two days. Check out this expert advice on how CPT additions will affect your FP’s observation care services coding starting on Jan. 1, 2011.

Until this point, coding for the “middle days” of an observation service caused problems. Although not the norm, there are times when a physician admits a patient to observation and she remains in that status for three or more days. CPT 2011 addresses these middle days between admission and discharge by introducing three new E/M codes. The additions parallel the hospital subsequent care series in terms of

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Myomectomy Claims: Anatomical Location Is Your Key

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

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Deciding which myomectomy code you’ll report depends on three factors: the approach the ob-gyn uses, the number of myomas, and their weight. Here’s how to translate this information into the correct CPT code every time.

If your ob-gyn performs a hysterectomy, you won’t report the myomectomy separately.

When your ob-gyn performs a myomectomy, he is removing myomas or uterine fibroid tumors. Knowing what

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