Poll Results: E/M Levels Sited as Biggest Compliance Worry

Posted on 27. Nov, 2012 by jennifer.godreau in Hot Coding Topics.

Results from Nov. 14, 2012

E/M levels are hands down your top compliance concern. The most recent CodingNews poll found that most respondents are most worried about whether their documentation supports the provider selected evaluation and management code. An internal or external chart audit is the best way to identify your weaknesses now – and confirm your strengths – so that you can proactively fix your E/M documentation and coding errors.

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Scope Out AMA’s Latest Lung Coding Examples

Posted on 27. Nov, 2012 by jennifer.godreau in Hot Coding Topics.

Lung and pleural procedures are in the spotlight in the just released September 2012 CPT® Assistant. Whether you want details about how thoracotomy and thoracoscopy codes changed for 2012 or you’re longing for VATS clinical examples, this authoritative AMA resource has you covered.

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Top Takeaways from AMA 2013 Symposium

Posted on 20. Nov, 2012 by rpandit in Provider News.

The AMA’s annual CPT® and RBRVS Symposium took place November 14-16 in Chicago, with experts from more than a dozen medical specialties sharing glimpses into what coding and reimbursement will be like for 2013. As a first time attendee, here are my top takeaways:

• I have a fresh admiration and respect for people who code for cardiology services. It’s such a complex specialty, and their coding goes through major changes every year. New codes, interim codes, bundled services, updated definitions, new technology that needs reconsideration and re-valuation — it’s enough to hopefully ensure job security for cardiology coders everywhere.
• I would never survive as a molecular pathology coder. Aside from the fact that I don’t know enough to understand the code descriptors, the entire codeset in CPT® 2013 has been restructured. As presenter Mark S. Synovec, M.D., explained, Tier 1 consists of 105 codes (13 of which are new) for tests focusing on specific genes. Tier 2 codes represent other tests that might be lower volume, but are used and need to be included in CPT®. The way code descriptors are formatted has even changed for 2013.

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New Code Woes, Old Code Deaths, and Payment Celebrations

Posted on 20. Nov, 2012 by rpandit in Provider News.

 Day 2 of the AMA Symposium gave rundowns of 2013 changes for neurology, cardiothoracic surgery, and pathology. Read on for some top predictions and black-and-white facts.

 “There’s going to be gnashing of teeth over the new chemodenervation codes,” Gregory L. Barkley, M.D., predicted when referring to new code 64615. “Providers have been used to reporting multiple codes when they treat different nerves during an encounter, but the new code changes that. Providers will take a big hit for that.”

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AMA 2013 CPT® and RBRVS Symposium: 5 Need-to-Know Points for MPPS Changes in 2013 and Beyond

Posted on 19. Nov, 2012 by rpandit in Provider News.

 If you’re wondering what the most important changes are for the 2013 Medicare Physician Payment Schedule (MPPS), look no further. Kathy Bryant, deputy director of the department of physician services at CMS, gave a rundown of salient points at the AMA’s annual CPT® and RBRVS Symposium in Chicago. Here are five that apply to the majority of providers:

 Payment rates: Medicare rates are scheduled to take a 26.5 percent hit in 2013 unless Congress takes action to avert the cut. “The President’s budget calls for an aversion of the cut and a permanent fix,” Bryant told attendees. “They seem to be working on it, but we haven’t heard yet where it’s going.”

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AMA 2013 Annual Symposium: Attendees Ask for CMS Answers to EHR Upcoding Glitches

Posted on 19. Nov, 2012 by rpandit in Provider News.

 The AMA’s 2013 CPT® and RBRVS Symposium kicked off on November 14, with attendees demanding answers to widespread problems with electronic health records (EHR) systems.

 “I’m bringing back an issue that was asked about during this meeting last year and we were told that some things would be put in place to correct problems,” one attendee said during an open Q&A time. “And that issue is: CMS is giving a two-sided message regarding electronic records. You offer incentives for physicians to purchase electronic systems for meaningful use, yet those systems are promoting inaccurate E/M levels that lead to inaccurate billing.”

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Fill in 2 Blanks to Report This Carotid Bypass Procedure Code

Posted on 12. Nov, 2012 by rpandit in ICD-10.

Without key information, you will have too many potential codes.

Drastic changes are coming for inpatient coders, and the way providers currently document procedures will become incomplete in 2014. Check out this carotid bypass scenario and find out what you need to know for accurate ICD-10-PCS claims.

Scenario: The physician’s operative notes indicate right common carotid to internal carotid bypass. This was to treat a critical right internal carotid artery stenosis. Currently, you can code this procedure with 39.29 (Other [peripheral] vascular shunt or bypass).

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Reader Question: Ask Physicians How to Count ‘Supple Neck’

Posted on 12. Nov, 2012 by rpandit in Coding Challenge.

Question: When my pediatrician writes “Neck is supple,” should I count the phrase as part of the musculoskeletal exam or the lymph system when tallying the E/M level?

Alabama Subscriber

Answer: Supple means “able to bend.” So you can always give the physician credit for the phrase “Neck is supple,” as range of motion under the musculoskeletal section.

Some pediatricians may use the phrase to refer to the lymph system. The term “Neck is supple” has also come to mean the physician checked the patient’s node and found no swelling, meaning the patient doesn’t have enlarged lymph nodes. Not all physicians like using the term this way.

Regardless of which way your practice feels, be careful that you don’t double-count the phrase. You can use the note under either the musculoskeletal system or the lymph system, but you shouldn’t count it under both exams at the same time.

Exception: You can consider the term part of both systems if the note states, “The neck is supple without adenopathy.” That means the neck is bendable and the nodes aren’t swollen.

Communication is key: Discuss this as a practice. Ask the practitioners what they are looking for and what they specifically mean when they refer to the neck as supple.

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Compliance: 88305: Is 4 the New Prostate Biopsy Maximum for Medicare?

Posted on 12. Nov, 2012 by rpandit in Provider News.

Palmetto GBA policy sets the tone.

“I’m concerned that payers may interpret the NCCI Policy Manual to be distinguishing 88305 vs. G0416-G0419 on sample number alone,” states William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

That’s what we published earlier this year in “Mark 5 Prostate Biopsies as the Magic Cutoff for 88305″ (Pathology/Lab Coding Alert Volume 13, Number 5). Now it seems that the concern is becoming reality.

That was Then – 88305 x 10

In 2009, CMS implemented HCPCS Level II codes for pathology exam of specimens from a prostate saturation biopsy (55706 – Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance), which often yields 20 or more specimens, as follows:

• G0416 – Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling; 1-20 specimens
• G0417 – … 21-40 specimens
• G0418 – … 41-60 specimens
• G0419 – … greater than 60 specimens.

For prostate biopsies from other procedures such as 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach), pathologists were to continue billing 88305 (Level IV – Surgical pathology, gross and microscopic examination, Prostate, needle biopsy) for each distinct biopsy core.

Urology standard: The American Urological Association and several international organizations recommend 10-12 core biopsy protocols to improve prostate cancer detection rates and staging/grading of the disease.

“It’s not uncommon to examine 10 or more distinct prostate biopsy specimens and bill 88305 x 10 or more,” explains R.M. Stainton Jr., MD, president of Doctors’ Anatomic Pathology Services in Jonesboro, Ark.

This is Now – Palmetto GBA Caps 88305 x 4

Palmetto GBA jurisdictions 1 (Calif., Nev., Hawaii) and 11 (N.C., S.C., Va., W Va.) implemented a policy in August that states, “Medicare has limited the number of prostate biopsies that may be reported for…

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CPT® 2013: 32555 and 32557 Promise a Simpler Path to Pleural Aspiration and Drainage Coding

Posted on 12. Nov, 2012 by rpandit in Hot Coding Topics.

Catheter aspiration will have an obvious code choice.

The preliminary list of CPT® 2013 code changes is out, and you may be glad to have some extra time to prepare. There are numerous changes affecting radiology, starting with new ways to report thoracentesis and pleural drainage.

Keep in mind, these changes aren’t yet final, so they may change before the codes become official this fall.

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