Neonatal Critical Care Coding: CPT 2010 Clarifies Resuscitation Guidance

Posted on 15. Nov, 2009 by in Provider News.


Payers denying 99465-25? Here’s help straight from the AMA Symposium in Chicago.

Question: There’s a notation in the CPT 2009 manual that the neonatal critical care codes include delivery room resuscitation. Is this true?

Answer: No, a parenthetical note following 99465 (Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output) incorrectly stated that resuscitation could not be reported with other per day critical care services, said Peter A. Hollmann, MD, AMA CPT Editorial Panel, Vice Chair in his “Evaluation and Management” presentation at the AMA CPT and RBRVS 2010 Annual Symposium in Chicago on Nov. 12.

You can separately report 99465-25 (Significant, separately identifiable evaluation and management service provided by the same physician on the same day of the procedure or other service) provided the resuscitation in the delivery room is provided as a medically necessary service and…

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Pain Management Coding: Endoscopic Lumbar Nerve Decompression

Posted on 15. Nov, 2009 by in Coding Challenge, Hot Coding Topics.


Hint: Think ‘unlisted procedure.’

Question: One of our physicians is looking into “endoscopic lumbar spinal nerve decompression.” One of the medical device representatives indicated he could bill it like the lateral extraforaminal approach for lumbar decompression, but I haven’t found much information. What’s your advice?

Answer: Despite what you physician might have heard, your most appropriate choice probably is 64999 (Unlisted procedure, nervous system).

Many pain management providers are being introduced to different endoscopic approach systems. The AMA confirms that the descriptors for lumbar decompression procedures, such as those mentioned to your physician (63055-+63057, Transpedicular approach with decompression of spinal cord, equina and/or nerve root[s] [e.g., herniated intervertebral disc], single segment …) do not include an endoscopic technique and should not be used to report this type of approach.

If the provider doesn’t complete the laminectomy (hemilaminectomy) required to meet the criteria for reporting 63020-+63035 (Laminotomy [hemilaminectomy], with

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CMS at AMA Chicago: We’re Reducing Consult Request Requirement

Posted on 13. Nov, 2009 by in Provider News.


CMS auditors will look for 1 less thing in consult documentation.

With Medicare’s invalidation of consultation codes 99241-99255 in 2010, your ICD-9 codes better prove why two MDs are necessary on the same patient’s hospital care or the physician better specify why in his note.

Separate ICD-9 codes will help substantiate the medical necessity for providing consultative services, explained Kenneth B. Simon, MD, MBA, CMS senior medical officer, in “Medicare Physician Payment Schedule 2010 Changes and Beyond” at the AMA CPT and RBRVS 2010 Annual Symposium in Chicago. If an auditor reviews your hospital code (99221-99233) documentation, different diagnoses will show why more than one physician’s E/M was necessary on the same patient. Next — what auditors WON’T be looking for …

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PQRI: No Coumadin Due to Fall Risk

Posted on 13. Nov, 2009 by in Hot Coding Topics.


Plus, experts at the AMA meeting in Chicago tell you what to do if you can’t get H1N1 vaccine for PQRI Measure 110 or other vaccine measures.

Question: My internist decided not to put a patient on Coumadin because the patient has a higher risk of falling than from having a stroke. Our group participates in PQRI easure 33 for risk of clotting. How can I indicate performing the measure wasn’t appropriate so that the physician isn’t penalized for not prescribing the anti-blood clotting medication?

Answer: You should report the measure and append the denominator exclusion indicator 1p. This indicator shows the physician chose not to prescribe the drug due to the art of medicine, or factors that make performing the measure not clinically appropriate.

If, however, the internist prescribed Coumadin but the patient isn’t taking it because she can’t afford the medication, you instead would use 2P. Your group…

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Medicare Changes to 2010 CPT Inpatient Consultation Codes

Posted on 13. Nov, 2009 by in Provider News.


Prevent 99251-99245 denials in 2010 with this checklist.

Multiple physicians using the same hospital codes sounds like a recipe for denials, but that’s what Medicare is instructing physician inpatient consultants and care coordinators to do.

Whether carriers will kick out these submissions as coordination of care or inpatient admit limiting admit edits is contractor specific, Charles E. Haley, MD, MS, FACP, Medicare medical director for Trailblazer Health Enterprises, LLC, told the audience during the E/M session at the 2010 CPT symposium. “If come January you’re getting denials, work out the issues with your specific contractor.”

You can, however, prevent many rejections from Medicare’s invalidation of 99251-99245 by following this checklist.

√ Use Initial Hospital Day Codes on Day 1

If a physician consults a patient on his first day in the hospital, you should use an initial hospital code (99221-99223), according to Medicare’s new consultation guidelines for 2010. “Stop thinking of…

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2010 Tumor Excision Coding: Lesion Vs. Chunk Size

Posted on 13. Nov, 2009 by in Hot Coding Topics.


Straight from the AMA in Chicago — answers to your lesion excision coding questions for 2010.

Question: A thigh lesion measures 2 cm but requires a resection down to the subcutaneous layer of 4 cm. Which lesion excision code should I use?

Answer: “You should use the larger of the subcutaneous codes,” says Albert E. Bothe, Jr, MD, FACS, with the American College of Surgeons in “Excision of Soft Tumors/Bone Tumors” on the final day of the AMA CPT and RBRVS 2010 Annual Symposium. The size of the lesion is the lesion. “The defining size is the size of the resection” or the mass that’s taken out, Bothe stressed.

If all that the surgeon takes out is the lesion, you would use the lesion size or 2 cm as the lesion excision. But if the surgeon indicates the larger size of the tissue he also has to take out, you assign…

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Medicare 2010 CPT Consultation Code Changes

Posted on 12. Nov, 2009 by in Hot Coding Topics.


New rules for consult coding straight from the AMA Meeting in Chicago — plus where your practice will gain and lose reimbursement.

If you can’t figure out how to match a low level consult to an initial hospital care code, you’re not alone.

Code 99251 doesn’t crosswalk to 99221, agreed William J. Mangold, Jr., MD, JD, Noridian Administrative Services’ (Arizona, Montana, Utah, Wyoming) Medicare contractor medical director in the carrier response section to Day 2′s opening session at the CPT and RBRVS 2010 Annual Symposium in Chicago. “They don’t have the same criteria.”

Medicare will consider the consult codes (99241-99255) invalid codes for payment, effective Jan. 1. Experts expect some large carriers, including Blue Cross Blue Shield, Aetna, and Humana to adopt the same policy for uniformity. For carriers and private payers that no longer recognize consult codes, let these examples help you decide what code to instead use.


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Is 30901 Your Nosebleed Code? Not So Fast?

Posted on 12. Nov, 2009 by in Coding Challenge, Hot Coding Topics.


Hint: Look for these keywords in the note to select the correct nosebleed code.

Question: The internist stops a patient’s nosebleed. Is this always a procedure?

Answer: No, if a patient reports with a nosebleed and the physician stops the bleeding with basic methods, you’ll typically opt for the appropriate-level E/M code.

E/M methods: Code minimal attempts at stoppage — including ice or brief, direct pressure — as an E/M service. CPT does not consider these types of treatments separately billable procedures, so an E/M is the way to capture the services the physician provides.

For example, a 62-year-old established patient reports to the internist with an active right-nostril nosebleed that has lasted for three hours. The internist performs a problem focused history and exam, then uses ice and pressure to treat the nosebleed. Read on for how to code this scenario …

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From the AMA in Chicago: CPT 2010 Out of Order Codes

Posted on 11. Nov, 2009 by in Hot Coding Topics.


Here’s where you can find a full list of resequenced codes.

Notice that new sign in your CPT book? No, that hash mark’s not to delete a message or to sign into a conference; it’s to alert you to an out of order code.

The “#” works like a flashing yellow light: Slow down, there might be something unexpected. Rather than moving groups of codes to new sections, the AMA has created another option. “Resequencing makes a lot of sense to avoid renumbering the codes,” explained William T. Thorwarth, Jr., MD, in “CPT 2010 Overview” at the CPT and RBRVS 2010 Annual Symposium’s opening session in Chicago.

Watch for the Out of Order Placard

When you’re coding a lesion excision, you usually assume the code increases by one as the excision’s size class goes up. But that truism will no longer hold true. Fortunately, watching for # will alert you…

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CMS Makes Key Changes to ABN Modifiers

Posted on 10. Nov, 2009 by in Provider News.


We’ve got the new instructions you’ll need to follow.

CMS will update the ABN modifiers effective April 1, according to MLN Matters article MM6563, dated Oct. 29.

The ABN descriptors will read as follows:

  • Modifier GA — Revised to read, “Waiver of liability statement issued as required by payer policy.” You’ll use this when a required ABN was issued.
  • Modifier GX — New modifier defined as “Notice of liability issued, voluntary under payer policy.” You’ll append this modifier to claims when you’ve issued a voluntary ABN.

Currently, you can append modifier GA when you issue the ABN for either required or voluntary reasons, says Zia Clarkson, a coding, reimbursement, and practice management consultant in Long Island, N.Y.

Keep in mind: When you know an item is statutorily non-covered, you don’t have to issue an ABN and submit the claim to your carrier with a modifier appended, but…

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