Question: Our surgeon excised mass in the finger. The procedure is as follows:
“Excision of multiple soft tissues masses was done. These appeared to be benign tumors encapsulated from the right fifth finger and the dorsum of the DIP base of the distal phalanx and also extended palmar radially. These appeared to originate possibly from the radial edge of the extensor tendon insertion. The second lobule was on the ulnar side of the extensor insertion and it was hard to say if this came from underneath the extensor tendon or across the top of the original radial lobules. There was a separate palmar nodule on the radial side accessible from the mid axial incision with this being deep to the neurovascular bundle and that was resected as well.”
What is the most appropriate code we can use to report this procedure?
Answer: If all the masses excised are through different incisions, report 26160 (Excision of lesion of tendon sheath or joint capsule [e.g., cyst, mucous cyst, or ganglion], hand or finger). You report multiple units of 26160 for the number of incision with modifier 59 (Distinct procedural service….). If it is through one incision only, report 26160 once only.
However, in the most ideal case, you should review the surgical pathology report to determine the nature of the nodules. The final code selection will depend on what the nodules are and/or where these nodules originated from.
Prepare now for 50+ new codes associated with 998.11.
When your anesthesiologist participates in a surgical case because the patient had bleeding (hemorrhage) problems, you typically include 998.11 (Hemorrhage complicating a procedure) as one of your diagnosis codes. That will change once ICD-10 goes into effect, so start thinking now about ways to review the anesthesiologist’s documentation — and possibly the surgeon’s — for important details about the hemorrhage location and timing.
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If you’ve got prolonged service E/M questions, you certainly aren’t alone. Luckily, authoritative answers are now available in the just released August 2012 CPT® Assistant. Once you understand why the AMA deleted “face-to-face” from 99358-99359, you can be confident your claims will stand up to payer scrutiny.
Don’t confuse ‘other’ with ‘unspecified.’
Although coding morbid obesity won’t tell the whole “medical necessity” story for lap-band procedures, you’ll need to know how to report the condition once ICD-10 is implemented.
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Question: Some of our Medicare patients want to drop by and have blood drawn so that when they come for their next visit we’ll have the test results. We code 36415 to track the lab work, but the payers deny our claims. Does Medicare view this as part of either the prior visit, or the next when the doctor discusses lab results?
Answer: No, Medicare should pay for the service if the patient hasn’t had a recent blood draw elsewhere for the same diagnosis. Continue to report 36415 (Collection of venous blood by venipuncture). Include a supporting diagnosis that relates to the lab test for which the blood is being drawn, such as hypertension (401-405, Hypertensive disease) or high cholesterol (such as 272.0, Disorders of lipoid metabolism; pure hypercholesterolemia). Include the patient’s usual physician as the referring doctor.
These services may get their own set of Category I codes in 2013.
Practices performing transthoracic aortic valve replacement (TAVR) have some work to do to see if they meet Medicare’s strict requirements for coverage with evidence development (CED).
|Cardiology Coding Alert TAVR is not covered for patients in whom existing co-morbidities would preclude the expected benefit from correction of the aortic stenosis. Gear up for new codes to code correctly for TAVR procedures and stay compliant with this monthly newsletter. Click here to buy.|
Avoid separately reporting 76000 or 77002.
Not all of the coding changes for next year involve new codes. You should pay close attention to code descriptor revisions as well. Of note, CPT® 2013 alters the wording for 64561. Take a look at the change to ensure you don’t inaccurately report this neurostimulator code.
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You’ll only need to note small exclusion note changes.
While ICD-10 will bring a lot of changes, one thing you won’t have to worry about is making your urologist change his documentation for peritoneal adhesions. Under the new codeset, the new code for the condition has a one-to-one correspondence with the old ICD-9 code.
Don’t forget: CMS has announced a proposed implementation date change from Oct. 1, 2013 to Oct. 1, 2014 for the new diagnosis code set.
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Question: Patient had hysteroscopy with lysis of adhesions and a dilation and curettage (D&C). Diagnoses are infertility and Asherman’s syndrome. Path report for curettage shows “Placental site nodule,” “is
lands of intermediate trophoblast,” and “HCG and inhibin are weakly positive.” I queried the MD if he considered this to be a hydatidiform mole or something else pertaining to products of conception.
The ob-gyn discussed with pathologist who believes it is a remnant of placental tissue after the last delivery, which was two years ago. Placenta had been manually removed. Would 667.14 and 677 be appropriate as diagnosis codes in this case, even if delivery was two years ago?
Check whether your practice might come under extra scrutiny.
Here’s your latest heads up for auditing: Beginning August 27, 2012, CMS started its Recovery Audit Prepayment Review prepayment audits in 11 states. The information comes from an announcement on the CMS Web site.