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

Posted on 12. Nov, 2012 by .


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 –

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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 .


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.

rel=”nofollow”>Code Search Next year you’ll have new ways to report thoracentesis and pleural drainage. Be the first to get code updates as 2013 CPT Code Changes are now live on SuperCoder’s Code Search. rel=”nofollow”>Click here to buy.

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Power Up for Prolonged Service Claims Using Latest AMA Guidance

Posted on 22. Oct, 2012 by .



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 rel=”nofollow”>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.

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CMS Coverage: 0256T-0259T Decision Memo Is a Must-Read for TAVR Practices

Posted on 10. Oct, 2012 by .


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).

rel=”nofollow”>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. rel=”nofollow”>Click here to buy.

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CPT® 2013: CCI Past Is Seen in 64561’s Future

Posted on 01. Oct, 2012 by .


 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.

rel=”nofollow”>SuperCoder’s CCI Edits Checker 233241 new edit pairs were added effective October 1, 2012, marking this as one of the biggest CCI changes ever! But you can prepare for this massive overhaul with SuperCoder’s CCI Edit Checker. rel=”nofollow”>Click here to buy.

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Coding Case: Dig Deep To Nail The Right Code For Subacromial Calcific Tendinitis

Posted on 26. Sep, 2012 by .


Curettage and tendon repair are inclusive to 23000.

When your surgeon removes calcific deposits in the shoulder, you’ll stand a better chance of capturing full reimbursement if you’re well versed in the procedure’s complexities, which typically include cutting the muscle, incising the bursa, and curettage of the cavity to remove the damaged tissue. “It is one of the most painful conditions in the shoulder that can come on acutely without an injury,” offers Bill Mallon, MD, medical director, Triangle Orthopedic Associates, Durham, N.C.

rel=”nofollow”>SuperCoder’s CCI Edits Checker233241 new edit pairs were added effective October 1, 2012. News is your orthopedic practice will one of the hardest hit. So Get ready today with SuperCoder’s CCI Edit Checker. rel=”nofollow”>Click here to buy.

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Coding Strategies: Nail Your Proctosigmoidoscopy Coding With These 5 Easy-to-Use Tips

Posted on 14. Sep, 2012 by .


Use appropriate modifiers to unbundle codes, when necessary.

To assess a patient with rectal hemorrhage or pain, your gastroenterologist might opt for a proctosigmoidoscopy. Since this procedure is significantly similar to a more extensive sigmoidoscopy, you will have to know how to differentiate these two procedures for accurate coding or face denials to your claims.

1. Ascertain Insertion Approach

Since proctosigmoidoscopy involves examination of the most distal portions of the sigmoid colon and the rectum, your gastroenterologist has to perform this procedure by inserting the scope through the anus. This approach differs from upper endoscopy procedures where the scope is inserted through the mouth.

For example, if the documentation reads, “Scope inserted anally,” you can be rest assured that your gastroenterologist performed a lower gastrointestinal (GI) endoscopy and not an endoscopy of the upper GI tract.

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Biopsy: Increase Accuracy And Success With Site Specific Codes

Posted on 26. Aug, 2012 by .


While 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion)is most commonly reported by dermatology coders, a site-specific biopsy code may help you get your job done better and increase the accuracy of your reporting.

Not only this, a site-specific code will bring in more reimbursement than when you report generic integumentary based biopsy (11100).

Report the correct codes each time and increase your coding success and reimbursement with  Dermatology Coding Alert — your one stop destination for optimizing coding, reimbursement, and efficiency for Dermatology practices. Click here to buy the monthly Dermtology Coding Alert.

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Percutaneous Vertebroplasty: Report Codes For Surgery And RS&I Separately

Posted on 22. Aug, 2012 by .


It is quite common to package surgery and related radiology services into a single CPT® code, but assuming that percutaneous vertebroplasty falls into that category means leaving dollars on the table. Keep these guidelines in mind for accurate supervision and interpretation coding.

Separate Codes For Surgery and RS&I

Percutaneous vertebroplasty typically involves using anteroposterior (AP) and lateral views to confirm a needle’s path into a vertebral body. The physician then injects a resin mixture into the vertebral body until it is adequately filled.

Need to learn more about supervision and interpretation coding? Do you know which codes can be packaged? Radiology Coding Alert shows you how to apply guidelines from a variety of authoritative resources to simplify your job and keep your claims compliant.Click here to buy.

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3 Quick Tips Help You Get Complete Strapping Reimbursement

Posted on 18. Aug, 2012 by .


Although strapping might seem like a simple treatment, there are more details to coding than you might realize—and missing key items means your bottom line gets impacted with every claim. Check out these top rules when coding for injuries that require strapping, so report the correct code each time.

Step 1: Learn Unna Boot, Buddy Tape Definitions

Payers generally define strapping as the application of adhesive tape, one layer overlapping the other, to support and/or restrict movement of ligament structures by exerting pressure upon the extremity or other area of the body. Strapping requires specialized skill and knowledge of the anatomical structures as well as application technique, says Betty Ann Price BSN, RN, President and CEO of PRCS, Inc. in Palmetto Florida.

Part B Insider Get up-to-the-minute Part B reimbursement guidance, compliance news, and coding strategies so you

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