Swine flu has made an early arrival in several states and in your 2009 preventive and sick coding. To avoid denials for H1N1 vaccination administration, you’re going to have to check which of three administration code options your major payers want. “Some payers want you to use the new code, others want you to use Medicare’s code, and others want you to use the regular vaccine administration codes,” says Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville.
Best bet: Create an Excel spreadsheet that lists which H1N1 vaccine administration code each of your payers requires. Here are the options.
Use AMA-Preferred 90470 as New CPT 2009 Code
The AMA fast-tracked a CPT code for vaccine administration specifically for H1N1, Tuck says. Code 90470 (H1N1 immunization administration [intramuscular] [intranasal] including counseling when performed]) is effective immediately.
A US Senate probe confirms what many coders and billers have been suspecting all along — that six major medical insurers aren’t spending as much as they should providing actual health care.
Insurance industry officials say that all health insurers spend an average of 87 cents of every dollar on medical care, reports The Wall Street Journal. For the trade-group-curious, America’s Health Insurance Plans (AHIP) came up with the ’87 cents’ figure.
And I bet you can tell me the names of the insurers that ‘underspend’ without reading the rest of the article. But just for grins — they’re Aetna Inc., Cigna Corp., Coventry Health Care Inc., Humana Inc., Unitedhealth Group Inc. and Wellpoint Inc., reports the Journal. These big fish spend an average of 74 cents on every dollar individuals pay in…
Question: For a lower back ultrasound of a soft tissue mass, which CPT code is appropriate?
Answer: Code 76705 (Ultrasound, abdominal, real time with image documentation; limited [e.g., single organ, quadrant, follow-up]) is appropriate for this lower back ultrasound.
Although the code descriptor states “abdominal” and not “back,” CPT Assistant (May 2009) clarifies that 76705 is appropriate for a lower back or abdominal wall soft tissue mass ultrasound.
Bonus tip: You might be surprised to discover these other not-so-obvious anatomy/code pairings that CPT Assistant supports:
• chest wall, upper back: 76604 (Ultrasound chest [includes mediastinum], real time with image documentation)
• pelvic wall, buttock, perineum: 76857 (Ultrasound, pelvic [nonobstetric], real time with image documentation; limited or follow-up [e.g., for follicles])
• upper extremity, axilla, groin, lower extremity: 76880 (Ultrasound, extremity, nonvascular, real time with image documentation).
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In last week’s Coder’s Cranium, we started a checklist of 3 things you should know to correctly bill for a nonphysician practitioner’s services — and stay compliant. This week, we complete the checklist with advice for items 4, 5 & 6.
4. Have You Distinguished Auxiliary Personnel From NPP Services?
NPPs can supervise auxiliary personnel (registered nurses [RNs], licensed practical nurses [LPNs] and technicians) for incident-to services just as a physician would supervise the NPP.
The catch: You must bill the auxiliary personnels services under the NPPs number, and you may only receive 85 percent reimbursement. For example, the physician is out of the suite doing rounds in a hospital while a PA sees patients in the suite under her provider number. A patient comes in for a blood draw, which a nurse on staff performs. The nurse…
Anatomy know-how points you in the right direction every time.
How do you tell the difference between 61790 (Creation of lesion by stereotactic method, percutaneous, by neurolytic agent [e.g., alcohol, thermal, electrical, radiofrequency]; gasserian ganglion) and 61791 (… trigeminal medullary tract)?
That’s the question a Neurosurgery Coding Alert reader posed when she wrote, “What is the difference between the gasserian ganglion and trigeminal medullary tract, and how do you determine which code to use?” The answer lies in knowing your anatomy so you can assign codes accordingly.
1. Know Your Nerve Anatomy
Understanding the nerve branches and how they relate to each other is your first step in distinguishing between 61790 and 61791. Here’s what you need to know:
• The trigeminal nerve provides sensation to the face. It’s the fifth (and largest) cranial nerve, also called the fifth nerve (or “V.”)
Question: A patient came in for a GDX and visual field (VF) tests. During the same visit, the ophthalmologist put in temporary plugs. Can we get paid for all services on the same day? I know the office visit needs a modifier. Do I need to put one on the GDX & VF, too?
Answer: Provided the ophthalmologist made the decision to perform the tests during this visit, you may bill for the office visit and the testing. You should be able to get paid for all services using four modifiers — one on the office visit as you indicated, one on each plug code, and one on the GDX. You do not need a modifier on the VF (92081-92083, Visual field examination, unilateral or bilateral, with interpretation and report …).
Warning: If the patient was scheduled to come in for the GDX and VF testing as the result of a previous office…
The 2010 version of CPT attempts to organize the facet joint injection codes by deleting 64470-64476 and debuting 64490- 64495 in their place, as follows:
• 64490 — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level
• 64491 — … second level
• 64492 — … third and any additional level(s)
• 64493 — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level
• 64494 — … second level
Question: My physician removed a catheter in an outpatient hospital exam room. Should I include this removal as part of the E/M? If E/M is appropriate, will the hospital also report an E/M? And, if so, do the physician and hospital E/M codes need to match?
Answer: You should include simple Foley catheter removal as part of an E/M service. These follow-up visits will often be low-level visits (such as 99212, Office or other outpatient visit …). Inpatient E/M codes would also be appropriate when your physician performs these services in the hospital (for example, 99231, Subsequent hospital care, per day, for the evaluation and management of a patient …).
The hospital sometimes may have the option of whether or not to report an outpatient E/M code for an outpatient ambulatory payment classifications (APC) reimbursement. For example, if the patient has another procedure during the same encounter as the catheter…
Not enough hours in the day? Are you always looking for ways to save time? Many medical offices report that sending out new patient packets in advance of the patient’s visit greatly reduces the number of incidents at patient check-in and saves time.
“Normally, it would take patients 15-plus minutes to complete the forms,” says Stephanie Mayer, front desk receptionist for a pediatrician in Queens, NY. “Also, there is the distraction of other patient activity in the waiting room, which could keep patients from concentrating on forms they are supposed to complete.”
Put forms online
If you are not already doing so, talk to your practice administrator about putting new patient packets online.
“Sending or having a patient access our packets from our Web site gives the patient the opportunity to input the information leisurely and accurately, and if needed, the time…
If you’ve ever wondered whether Medicare actually pays attention to CPT’s Category III codes, the AMA offers an answer with the release of the new codes included in CPT 2010.
First and foremost, CPT will delete the Category III cardiac computed tomography (CT) imaging codes 0144T-0151T and replace them with new, permanent Category I codes, as follows:
• 75571 — CT, heart, without contrast material, with quantitative evaluation of coronary calcium
• 75572 — CT, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)