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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).

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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.

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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.

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Be Sure To See Flood of ‘0’ Modifier Indicators

Posted on 16. Aug, 2012 by .


New Correct Coding Initiative (CCI) edit pairs that affect your surgical practice aren’t the only thing you need to know about in the latest update from CMS.

CCI 18.2 also changes the modifier indicator for 532 existing code pairs. “Unfortunately, 531 went from an indicator of ‘1’ (you can use a modifier) to a ‘0’ (you can’t use a modifier),” states Frank D. Cohen, MPA, MBB, senior analyst with Frank Cohen Group, LLC in his analysis of the changes. And unfortunately for your practice, nearly 250 of those changes to “0″ involve general surgery procedures.

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4 Questions Help You Select the Right Gastric Bypass Code

Posted on 10. Aug, 2012 by .


Duodenal switch, Roux-en-Y, limb length … if the language of bariatric surgery has got you stumped, here’s help for you to chose the correct code—and get the deserved reimbursement for your surgeons’ work.

Know the context: Surgeons perform various gastric restrictive procedures for some patients with morbid obesity and co-morbid health conditions. The procedures effectively reduce the stomach size to limit food intake and absorption, leading to weight loss. The most common gastric restrictive surgeries fall into two main categories—bypass procedures, and banding.

When you face an op note for gastric bypass surgery, simply decode the report and zero in on the suitable CPT® code by responding to these four questions.

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What Constitutes a Separate Procedure? Learn The Medicare Guidelines

Posted on 08. Aug, 2012 by .


Having clear documentation of the procedures your surgeon is doing and why one procedure is being listed as a separate procedure in your claim will make all the difference in your claims success. Josie Dunn, CPC, Department of Orthopaedics, University of Maryland Faculty Practices, Maryland shares what Medicare has to say about separate surgical procedures. “The CPT® surgery guidelines further state that the codes listed as “separate procedure “should not be reported in addition to the code for the total procedure or service. In other words, report a separate procedure if it is not performed with a primary procedure that encompasses the “separate” one, or when it adds “appreciably to the time and/or complexity of the procedure.”

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Establish Medical Necessity to Ensure Reimbursement In Scar Revision Claims

Posted on 06. Aug, 2012 by .


If your scar revision claims are meeting denials lately, it’s time you revisit your coding and establish medical necessity for aftercare procedures and reporting tissue transfers. Read on for our experts’ advice to help you master scar revision coding basics.

Establish Medical Necessity

Most payers will not cover cosmetic scar revisions, so you must make sure the dermatologist establishes medical necessity for the procedure.

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Confused Between 00790 and 00840? Documentation Is The Anwer.

Posted on 04. Aug, 2012 by .


While coding for anesthesia during an abdominal procedure, it is absolutely important that you know whether the surgeon worked in the upper or lower abdomen. Read on for our experts’ advice on how to ascertain which area you should report.

Background: Every anesthesia code is associated with multiple surgical procedures that can be performed in that anatomic area. CPT® includes 14 codes for upper abdominal anesthesia and 25 codes for lower abdominal anesthesia. Two prime examples that can confuse coders are:

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Perfect Your Tenotomy With Hammertoe Correction Claims

Posted on 02. Aug, 2012 by .


There can be times when you have to report flexor tenotomy with hammertoe correction. But National Correct Coding Initiative (NCCI) doesn’t bundle the two services together so how do you report the two together. Read on to learn how and when can you report 28285 (Correction, hammertoe [e.g., interphalangeal fusion, partial or total phalangectomy]) for hammertoe correction and 28232 (Tenotomy, open, tendon flexor; toe, single tendon [separate procedure]) for the flexor tenotomy on the same toe when your surgeon performs these procedures.

“Medicare does not always incorporate the CPT® separate procedure codes into the NCCI edits, but rather assumes that the coder will recognize coding scenarios in which a procedure or procedures are an integral part of the progression to the end procedure and, therefore, may not be billed separately,” says Josie Dunn, CPC, Department of Orthopaedics, University of Maryland Faculty Practices, Maryland.

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Try This Port-a-Cath Pop Quiz

Posted on 01. Aug, 2012 by .


Question: How should I report non-tunneled Port-a-Cath placement under fluoroscopy for a 56-year-old patient? There was a 4 cm incision made to incorporate the guidewire in the infraclavicular area.

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