Stop Letting Complex Dermatitis Tests Rob You Of Your Deserved Pay

Posted on 14. Mar, 2011 by in Hot Coding Topics.

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Keeping track of all the different potential allergens that may be causing a patient’s skin rash is challenging enough. But when you add the complexity of different kinds of dermatitis tests that a dermatologist can perform, it’s enough to cause a coder to break out in a rash herself. The variety and complexity of allergy tests can certainly lead to coding mishaps — but understanding the codes and having clear documentation can help clear things up.

The tests that dermatologists commonly perform to learn the source of a patient’s allergic dermatitis include

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How Should You Report Cannulation of Colovesical Fistula?

Posted on 13. Mar, 2011 by in Coding Challenge, Hot Coding Topics.

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Question: I’m unsure how to code for cannulation of colovesical fistula. The doctor also did a cystoscopy with bilateral retrogrades and bladder biopsies. How should I report this procedure?

Answer: There is no specific CPT code for cannulation of the tract. Therefore, you should report the unlisted code 53899 (Unlisted procedure, urinary system), and explain fully what was performed. If your urologist cannulated the fistulous tract and injected contrast you could report

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93224-93226: Snag Extra Cash With These Tips

Posted on 13. Mar, 2011 by in Provider News.

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The catch is you have to make the request for your rightful dollars.

Here’s a piece of good news for you. As per the Medicare’s April update, three Holter monitor codes will get a slight boost in pay.

The change has an implementation date of April 4, 2011, and an effective date of Jan. 1, 2011. That means contractors have to be ready to comply with the change by April 4, but the change in practice expense relative value units (PE RVUs) is retroactive to Jan. 1 dates of service.

Medicare isn’t requiring contractors to search their files to adjust claims they have already paid (which is good news for any physician who reports a code seeing a fee decrease). But contractors do have to

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Be In The Know With Chemodenervation and Botulinum Toxin Changes

Posted on 12. Mar, 2011 by in Hot Coding Topics, Provider News.

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Effective April 1, your practice’s bottom line is going to be hit, especially if your provider uses chemodenervation to treat patients. Reason: Medicare Physician Fee Schedule is all set to introduce a bunch of changes. So here’s the big news.

Bilateral Indicator Shifts to ‘2’

Neurologists and pain management specialists sometimes use chemodenervation to help relieve symptoms of spasmodic torticollis (333.83), cerebral palsy (such as 343.x), or other conditions. The codes you rely on for these procedures include:

  • 64613 — Chemodenervation of muscle(s); neck muscle(s) (e.g., for spasmodic torticollis, spasmodic dysphonia)
  • 64614 — … extremity(s) and/or trunk muscle(s) (e.g., for dystonia, cerebral palsy, multiple sclerosis).

Previous versions of the physician fee schedule listed a bilateral status indicator of “1” for 64613 and 64614. That meant you could

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A-Scans: Report Denial Proof 76511 Claim With Accurate Bilateral, Modifier Reporting

Posted on 12. Mar, 2011 by in Hot Coding Topics.

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One of the most common procedures in ophthalmology is A-scan ultrasound biometry, which is associated with some of the most uncommon coding problems.

According to CPT, A-scans — 76511, 76516, and 76519 — are the shortened names for amplitude modulation scans, “one-dimensional ultrasonic measurement procedures,” notes Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, Director, Best Practices-Network Operations at Mount Sinai Hospital in New York City.

Ophthalmologists use 76511 (Ophthalmic ultrasound, diagnostic; quantitative A-scan only) to diagnose

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In 2013, Reporting Ureteral Stone Diagnoses Will Include More Options

Posted on 10. Mar, 2011 by in Hot Coding Topics.

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Here is what you should check in your physician’s documentation.

As the conversion takes place from ICD-9 to ICD-10 in 2013, you will not be treating the codes in a way you always did. Often, you will have more options that may need tweaking the way your physician documents a service and a coder reports it.

Have a look at this common ureteral stone diagnosis, and find out what you’ll report after October 1, 2013.

When your urologist treats a ureteral stone, you now apply ICD-9 code 592.1 (Calculus of ureter) to a specific procedure code (such as 52353, Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]).

ICD-10 difference is that

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92082 or 92083? Choose The Most Appropriate Code with Expert Help

Posted on 08. Mar, 2011 by in Hot Coding Topics.

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Even small ophthalmology practices are likely to have a Humphrey visual field analyzer, yet many ophthalmologists don’t know the secrets for securing adequate reimbursement for these services — and they even go so far as to put themselves at risk for costly audits due to lack of documentation.

CPT lists three different visual field examinations — and the higher the code, the higher the reimbursement.:

  • 92081 — Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (e.g., tangent screen, Autoplot, arc perimeter or single stimulus level automated test, such as Octopus 3 or 7 equivalent)
  • 92082 — … intermediate examination (e.g., at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33)
  • 92083 — … extended examination (e.g., Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30 degrees,

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Know When to Append Modifier 50 on Bilateral CTS Shots

Posted on 08. Mar, 2011 by in Hot Coding Topics.

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Your orthopedist injects both of a patient’s wrists to treat carpal tunnel syndrome. Should you just file 20526 with modifier 50 appended and forget about it?

Not so fast: If the physician injects both the patient’s wrists to treat CTS, you will typically append modifier 50 (Bilateral procedure) to 20526 (Injection, therapeutic [e.g. local anesthetic, corticosteroid], carpal tunnel), says Kathleen F. Nelson, CPC, orthopedics professional coder at Fletcher Allen Health Care in Burlington, Vt. There are, however, some exceptions.

“This code carries a ‘1’ bilateral status indicator, which means this injection can be reported

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Emergency Reporting: Know When To Use +99140 With These Tips

Posted on 08. Mar, 2011 by in Hot Coding Topics.

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Reporting any qualifying circumstances (QC) codes for anesthesia can be tricky, but knowing when to classify a situation as a true emergency can be a real challenge unless you’re well-versed in the emergency conditions guidelines. Check coding definitions and your provider’s documentation to know whether you can legitimately add two extra units for +99140 (Anesthesia complicated by emergency conditions [specify] [List separately in addition to code for primary anesthesia procedure]) to your claim.

CPT includes a note with +99140 stating that “an emergency is defined as existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body parts.” Your key to knowing a case meets emergency conditions lies in

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Diagnosis Coding: G Codes Are Your Key To Coding Correct High Risk Colonoscopy

Posted on 07. Mar, 2011 by in Hot Coding Topics.

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Get your hemorrhoid report right and stress-free in a snap. We’ll tell you the difference between internal and external hemorrhoids, but you can learn more from this sample physician’s report:

PREPROCEDURE DIAGNOSIS: History of colon polyps and partial colon resection, right colon.

POSTPROCEDURE DIAGNOSES:

  1. Normal operative site.
  2. Mild diverticulosis of the sigmoid colon.
  3. Internal hemorrhoids.

PROCEDURE: Total colonoscopy.

PROCEDURE IN DETAIL: The 60-year-old patient presents to the office to be evaluated for the preprocedure diagnosis. The patient also apparently had an x-ray done at the hospital and it showed a dark spot, and because of this, a colonoscopy was felt to be needed. She was prepped the night before and on the morning of the test with oral Fleet’s, brought to the second floor and sedated with a total of 50 mg of Demerol and 3.75 mg of Versed IV push. Digital rectal exam was done, unremarkable. At…

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