12, 24, and 48 hour services all have roles in this coding shake-up.
Cardiology codes are always changing, trying to keep pace with technology and current practice. For this reason, Holter monitor codes saw big changes this year. Here’s what you need to know.
Start With a Nutshell Holter Service Description
Dynamic electrocardiography (ECG), also called Holter monitoring, involves ECG recording, usually over 24 hours. The goal is to obtain and analyze a record of the patient’s ECG activity during a typical day. The medical record usually will include the reason for the test, copies of ECG strips showing abnormalities or symptomatic episodes, the patient’s diary of symptoms, statistics for abnormal episodes, the physician’s interpretation, and documentation of recording times.
Verify evidence of previous treatments for successful claims.
If you’re coding for a patient’s carpal tunnel syndrome (CTS) injection, double check for previous, less invasive CTS treatments before getting too far with your claim. If the physician administers an injection during the patient’s initial visit for CTS, you could be facing a denial. Some payers allow CTS injection therapy only when other treatments have failed. Check out these FAQs to make each CTS coding scenario a snap.
Should the Physician Try Other Treatments Before 20526?
Yes. The FP would likely try less invasive treatments before resorting to CTS injection (20526, Injection, therapeutic [e.g. local anesthetic, corticosteroid], carpal tunnel), confirms Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver. These treatments might include, but are not limited to:
Question: Eight days after an initial wart freezing, the patient returns, and the physician freezes another wart. Is the second procedure bundled into the first, or can we report it with a modifier?
Question: A new patient presented to the office because of an injured left ankle she hurt while doing yard work. The FP performed a detailed history and examination. He suspected a fracture and ordered a two-view ankle x-ray, which revealed a bimalleolar fracture. The physician provided local anesthesia and used closed treatment to manipulate the fracture. He then ordered a second two-view ankle x-ray to confirm proper alignment. Notes indicated moderate medical decision making. Can I code both ankle x-rays in this scenario?
Be sure your coding complies with ICD-9 official guidelines for pain management.
If you don’t know when to check ICD-9 official guidelines, you may have just a 50-50 chance of choosing the proper order for your diagnosis codes.
Case in point: Patients may present to the office for treatment related to pain caused by a neoplasm. In such cases, you will need to determine, which diagnosis codes to report, and you will need to decide what order to list the codes in on your claim. With that in mind, consider how you should code the scenario below.
Start by Examining the Neoplasm-Related Pain Case
Read the following scenario and determine proper ICD-9 coding based on the information given. You’ll find a helpful hint on which section of the official guidelines to review if you get stuck.
Scenario: The physician documents that a patient with lung cancer (middle lobe, primary malignant…
Hint: Just because your doctor visits the ICU doesn’t mean he can report critical care.
Most medical practices report outpatient E/M codes (99201-99215) every day, but some Part B providers are still falling victim to several of the most common E/M myths. Button up your coding processes by dispelling these three commonly-held misunderstandings.
Myth 1: When reporting 99211 “incident to” a physician, you should bill it under the name of the physician on record for that patient.
Keep your CCI edits in mind for PFT bundles.
When a patient presents with common respiratory conditions, your pulmonologist should perform an extensive history and examination, and may order several diagnostic tests before he can settle with a definite diagnosis to report in the claim. Along with the primary diagnosis (if achieved), you should report the patient’s signs and symptoms or else risk an audit.
Consider this scenario: The pulmonologist sees a patient for fever, shortness of breath, chest pain, weight loss, and fatigue. After undergoing a detailed history and examination, the patient becomes suspect for hypersensitivity pneumonitis, otherwise known as extrinsic allergic alveolitis (495.x). The physician orders a diagnostic bronchoscopy with fluoroscopic guidance, as well as a spirometry to verify the patient’s condition. To justify each service performed by the same provider or group, you might be accumulating payer inquiries or denials. This 2-step technique should carry you through…
Learn when prolonged services should not apply.
Reporting your pulmonologist’s asthma attack treatments can be crafty business, as you can be confused about what, how and when to choose from the E/M and treatment codes that describe different situations.
Learn a few secrets of the trade from these scenarios:
Scenario 1: A patient suffering from hay fever with exacerbated asthma (493.02, Extrinsic asthma; with [acute exacerbation) requires two nebulizer treatments and 55-minute treatment time. What coding option would you report?
Scenario 2: A child patient with asthma experiences active wheezing and shortness of breath. The patient’s parent brings the child to the office, and demands the physician to see her child right away because the child is restless and screams in pain.
Dodge a Bullet by Putting Modifier 76 in Its Right Place
Take a hint from a CPT®’s global period when choosing between modifiers 25 or 57
Contrary to popular thinking, modifier 57 does not apply exclusively for consultation codes only. Medicare may have stopped paying for consult codes, but this doesn’t mean you have to stop using modifier 57. Here are two tips on how you can use this modifier to suit your practice’s needs.
Background: Starting January 1, 2010, the Centers for Medicare and Medicaid Services (CMS) eliminated consult codes from the Medicare fee schedule.
Non-Consult Inpatient Codes Keep Modifier 57 Alive
Boost co-surgery, multiple surgery, and bilateral surgery pay for these select procedures
You’ll no longer have to eat the cost of your services if your physician acts as co-surgeon on spine revisions. Thanks to several Fee Schedule changes that CMS recently enacted. CMS had good news in MLN Matters article MM7430, which had an effective date of Jan. 1, 2011 and an implementation date of July 5, 2011.
Look for Potential Co-Surgery Payment for These Codes: