Here’s How You Can Bill The Correct New G Code

Posted on 04. Jan, 2011 by in Hot Coding Topics.

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If you find choosing the right G code for your claims difficult, help is at hand.

Starting Jan. 1, CMS is requiring eight new billing codes in addition to the existing six codes for home health agency services. Those include new nursing codes for RN management and evaluation of the plan of care (G0162), LPN or RN observation and assessment (G0163), and LPN or RN training and education (G0164). CMS is revising G0154 to cover only direct skilled care by an RN or LPN, CMS notes in Dec. 17 Transmittal No. 824 (CR 7182).

“We recognize that, in the course of a visit, a nurse or qualified therapist could likely provide more than

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Primary vs. Secondary Diagnosis

Posted on 03. Jan, 2011 by in Coding Challenge, Hot Coding Topics.

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Question: Many of our ophthalmology patients claim general reasons for their visit, such as “I can’t see well,” or “My vision is foggy.” We code these visits with 368.8 as the primary diagnosis because this is the primary reason for the visit. Any other problems or underlying causes of the blurry vision we report as secondary diagnoses. Is 368.8 the most appropriate code to use in these situations, and should we list it first?

Answer: You should only report 368.8 (Other specified visual disturbances) as a primary diagnosis code when the ophthalmologist doesn’t find a more definitive diagnosis during the course of the visit.

Carriers often consider a visit for blurred vision the same thing as a routine exam and Medicare will not pay for this service.

Primary vs. secondary: Whenever possible, you should list a more definitive diagnosis as primary and then the patient’s…

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Watch Changes to EEG, Joint Injection Guidelines

Posted on 03. Jan, 2011 by in Hot Coding Topics, Provider News.

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You report several EEG codes such as 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes) and 95813 (… greater than 1 hour) based on the amount of recording time. But what constitutes recording time?

Jeffrey Cozzens, MD, professor and chair of the neurosurgery division of Southern Illinois University School of Medicine and a presenter at the AMA’s CPT and RBRVS 2011 Annual Symposium in Chicago, addressed the issue during his presentation about neurosurgery and neurology changes for 2011. Keep two things in mind when calculating recording time for these EEGs:

  • Recording time is when the recording is underway and the healthcare provider is collecting data.
  • Recording time excludes set-up and take-down time.

Other EEG codes, however, focus on the amount of physician time rather than recording time. Watch for that specificity in guidelines for 95961 (Functional cortical and subcortical mapping by stimulation and/or recording of electrodes or brain

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Learn the Best Ways to Navigate Codes For Cisplatin, Cyclophosphamide, and Vincristine

Posted on 03. Jan, 2011 by in Hot Coding Topics, Provider News.

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The recently released HCPCS 2011 code-set reveals a slew of deletions, streamlining your drug coding choices. Cisplatin, cyclophosphamide, and vincristine are among the affected drugs.

This change should simplify billing, particularly if the system your practice or facility uses, such as Pyxis or Lynx, limits you to a single code and billable unit for a drug, says Lisa S. Martin, CPC, CIMC, CPC-I, chargemaster specialist for OSF Healthcare System in Peoria, Ill. “As a consultant, I saw different facilities using only the 100 mg code [for example] for that very reason, so this change should facilitate more consistent and compliant billing practices.”

While these changes have a positive side, “there are always considerations that will arise,” Martin says. For example, if your practice uses different vial sizes, you will need to be alert for the different and specific national drug code (NDC) numbers for the agent dispensed to the patient…

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2011 Medical Coding Updates Are Available on Supercoder.com

Posted on 29. Dec, 2010 by in Hot Coding Topics.

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Raise your glass to the new year without worries of 2011 medical code changes. SuperCoder’s got you covered with new CPT codes, CCI edits, and supply coding revisions.

Starting Dec. 31, SuperCoder.com will offer the complete codesets for CPT 2011, HCPCS Level II 2011, and

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CMS Releases 2011 Conversion Factor Rate

Posted on 28. Dec, 2010 by in Hot Coding Topics, Provider News.

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Despite adjusted rate of 33.9764, overall change is zero.

The President locked in a zero percent adjustment to your Medicare Part B payments but that doesn’t mean you’ve got the same rate.

The Medicare and Medicaid Extenders Act of 2010, which was signed into law on Dec. 15, established a payment update for 2011 of zero percent. To cover the cost of the provision, Medicare had to modify a physical therapy provision that was in the proposed 2011 Medicare Physician Fee Schedule final rule. “In addition, the final rule made other changes to the conversion factor, including a re-weighting of the work, practice expense and liability expense components of the relative value scale that resulted in a reduction in the numerical value of the conversion factor, even though

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Steer Clear of MUE Denials With These Tips

Posted on 21. Dec, 2010 by in Hot Coding Topics.

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If you’re receiving denials from Medicare, one possibility is that you’re running up against medically unlikely edits (MUEs). The edits, which are designed to prevent overpayments caused by gross billing errors, usually a result of clerical or billing systems’ mistakes, often confuse even veteran coders.

Ensure you’re not letting MUEs wreak havoc on your urology practice’s coding and reimbursement by uncovering the truth about four aspects of these edits.

While you shouldn’t stress too much, any practice filing a claim with Medicare should know what MUEs are and how they work.

“They limit the frequency a CPT code can be used,” says Chandra L. Hines, business office manager at Capital Urological Associates in Raleigh, N.C. “With our specialty of urology, we need to become aware of the denials and not let every denial go because the insurance company said it was an MUE. We should all be aware of MUEs…

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CodingConferences Coding Changes Top Tips from Editor Leigh Delozier

Posted on 16. Dec, 2010 by in Hot Coding Topics.

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600 coders, physicians, and office managers gathered in Orlando, Fla. for one and a half jam-packed days of education, networking, and shopping at the December 2011 Coding Update and Reimbursement Conference. Coders’ biggest struggle was absorbing all the information – and not overdoing the holiday buying. Experts offered the inside scoop on medical coding changes for 2011 and beyond. Here are my top picks:

  1. E-prescribing is here to stay – and is about to be more strictly enforced. Physicians need to e-prescribe at least 10 medications for patients during the first 6 months of 2011, or they’ll be added to the list for a 1% penalty hit in 2012. “The prescriptions can be for one patient ten different times, or can be spread out among different patients,” said Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, in “Take Steps Now to Prepare for 2011 Pain Management Changes”.  “For pain

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37220 to+37223: Narrow Down On Correct Code With This Handy Tool

Posted on 16. Dec, 2010 by in Toolkit.

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Make the transition to new iliac revascularization codes a little simpler by using this chart. Be sure to read “37220 to +37223 Revamp Your Iliac Intervention Coding Options” on the cover to get more information on these new codes.

Use the appropriate modifiers to report bilateral services. And if the physician also performs iliac atherectomy, also report 0238T (Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; iliac artery, each vessel).

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Pay Attention To These Revised Codes for Colon Motility and Manometric Studies

Posted on 16. Dec, 2010 by in Hot Coding Topics.

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If you’ve been looking for a code on colon motility study and being frustrated for the lack of it, your search is over. CPT 2011 debuts a new code for a manometric study, along with two revised codes for esophageal pH monitoring.

For gastroenterology, you have a lot of changes to sort through — many involving deletions on low use codes or clean-up work.

Here’s How to Use New Manometric Study Codes

You should pay attention on two new codes for a manometric study: 91117 (Colon motility [manometric] study, minimum 6 hours continuous recording [including provocation tests, e.g., meal, intracolonic balloon distension, pharmacologic agents, if performed], with interpretation and report), and 91013 (Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study with interpretation and report; with stimulation or perfusion during 2-dimensional data study [e.g., stimulant, acid or alkali perfusion] [List separately in addition to code for primary procedure])….

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