Watch for inconsistencies in injection guidance coding requirements.
Medical coding for whiplash diagnosis and treatment is usually pretty straightforward. Watch for times to take extra care, however, especially if the patient’s symptoms persist despite conservative therapy and warrant more extensive treatment.
Watch for Move From Therapy to Scans
When a patient presents with whiplash symptoms, the treating physician will often order neck X-rays, such as CPT Code 70360 (Radiologic examination; neck, soft tissue). Once the patient has a confirmed diagnosis of whiplash (847.0, Sprains and strains of other and unspecified parts of back; neck sprain), the treating physician typically will prescribe conservative treatment. Common options include physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants. Some patients also may benefit from wearing a soft cervical collar or by using a portable traction device.
Staying with basic 99211 might be safest option.
If you’re shaky on how to report Gilenya (fingolimod) as a first-line treatment for relapsing forms of multiple sclerosis (MS, ICD-9 Code 340), you’re not alone. Gilenya questions have circulated ever since the FDA approved the drug in September 2010. Check our answers to three of the most common questions coders have so you’ll be ready when your neurologist offers the initial treatment dose to patients.
Don’t forget: Apply 150 percent adjustment for bilateral procedures when calculating revenue.
Many Medical Coders think that coding functional endoscopic sinus surgery (FESS) is a tricky business –and with good reason. FESS is not just one operation, but rather a series of diagnostic and treatment procedures that ENTs perform with the help of rigid nasal endoscopes. However, many patients who undergo FESS will only need diagnostic procedures, not a surgical functional operation.
If FESS continues to give you a hard time, the following case study could boost your confidence for distinguishing diagnostic from surgical procedures.
The challenge: Examine this sample operative note, and then compare your answers to the solution from our experts.
Question: Our physicians do follow-up groin checks in the office after catheterization (different day). Is it appropriate to code these separately?
The agency won’t provide a standard AWV diagnosis code.
It has never been simple to navigate the rules and regulations of CMS’s preventive service payment structure, but the agency has attempted to simplify the process with a new publication that outlines the ins and outs of collecting for these visits.
Although you’ll now have access to all of the preventive service specs in one place, it won’t be a quick read. The new document, entitled, “The Guide to Medicare Preventive Services,” is 298 pages long. To read the complete book, visit www.cms.gov/MLNProducts/downloads/MPS_guide_web-061305.pdf. But in the meantime, we’ve distilled the guidebook down to share the most essential issues that you’ll need to code these services.
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: