Zero In On Correct Nasal-Specimen Coding With This Quick Quiz

Posted on 06. Dec, 2009 by in Toolkit.


Missing multiple 88304 specimens could cost your practice $125.

Busting the polyps’ “s” myth and identifying separately billable nasal specimens could add hundreds of dollars to a pathology claim. Make sure you’re not falling into two common coding traps by trying your hand at these two questions; then checking your answers.

Question 1: The lab receives the following tissue individually labeled by the surgeon: right septum polyp, left septum polyp, and left lateral nasal polyp. The pathologist microscopically examines representative portions of tissue from each sample and individually reports each specimen as “nasal polyps.” How should you code the case?

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Coding News Travels to Florida for 2010 Updates

Posted on 04. Dec, 2009 by in Provider News.


Do you have a question about how you should code in 2010? Write us and we’ll ask the experts.

Princesses have their castles, but the big news in Orlando this weekend is that the Coding Queens are coming to town!

This week in Orlando, nationally known coding & billing experts like Marvel Hammer, Melanie Witt, Leslie Johnson & Barbara Cobuzzi and more will be teaching classes to 500 conference attendees.

I’ll be soaking up all the good things they have to teach me, and writing up real time highlights just for Coding News readers. Some colleagues from the Coding Alerts will also be there to teach classes and and pick up insider tips for their publications. I’m looking forward to seeing Jennifer Godreau, Suzanne Leder, Deborah Dorton, Ellen Garver & Leigh DeLozier.


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ED Coding Education: FAST Exams

Posted on 03. Dec, 2009 by in Hot Coding Topics.


Watch It: If you fly through FAST exam coding, you could miss vital info

When your physician performs a FAST (focused assessment by sonography for trauma) examination, be sure to go through the notes slowly or you could miss one of the three common codes.

FAST exam patients are almost always in some physical trauma, which requires a high-level E/M service; once the physician makes the decision, she’ll perform a pair of procedures to complete the FAST exam.

Use this guide to correct coding so you’ll be quick on the draw when coding for trauma patients requiring FAST exams in your Emergency Department.

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Pain Management Coding: TPI Do’s and Don’ts for Pay You Can Keep

Posted on 03. Dec, 2009 by in Toolkit.


Sample ICD-9 codes to support medical necessity for trigger point injections.

Counting the right items, knowing insurer-allowed diagnoses, and documenting affected muscles will get your trigger point injection (TPI) claims paid while protecting you from paybacks.

Further, knowing each insurers’ covered diagnoses for TPIs is vital to healthy coding.

√ Do Count Muscles Injected

Coders should report 20552 (Injection[s]; single or multiple trigger point[s], 1 or 2 muscles) when the internist injects one or two muscles, confirms Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, of MJH Consulting in Denver.

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How Do I Code an Epidural Blood Patch on Same Day as L&D

Posted on 03. Dec, 2009 by in Coding Challenge, Hot Coding Topics.


Don’t forget to double-check these 2 things to find the correct code.

Question: How do I code an epidural blood patch procedure on the same day as labor and delivery? Should I include a modifier?

Answer: Administering a blood patch on the same day as labor and delivery is unusual because most physicians try to manage spinal headaches conservatively before turning to an invasive treatment. Double check a few things before coding the blood patch procedure:

• Ensure that what you call a blood patch wasn’t simply injecting blood through the epidural catheter before removing it after labor and delivery. If this is the case, you shouldn’t bill the injection separately.

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What Diagnosis Code Do I Use for a Fern Test?

Posted on 01. Dec, 2009 by in Coding Challenge, Hot Coding Topics.


Ob-Gyn Coding Tip: Scan for leukorrhea signs when fluid is present.

Question: My physician performs a fern test on a patient, trying to rule out rupture of membranes. What diagnosis code applies?

Answer: If the test result proves positive, then you should report 658.13 (Premature rupture of membranes with antepartum condition or complications). Otherwise, use V89.01 (Suspected problem with amniotic cavity and membrane not found), provided the patient showed no verifiable signs or symptoms.

Supplement: If the physician found fluid, but the patient did not rupture her membranes and was not in labor, report 623.5 (Leukorrhea, not specified as infective) as secondary diagnosis to the primary diagnosis 648.93 (Other current conditions classifiable elsewhere, but complicating pregnancy; antepartum condition or complication).

Keep in mind: If the patient is at her term, you will not likely be reimbursed extra to rule out labor.

Red flag: Coding for a fern test (Q0114)…

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Celebrate CT Colonography’s 2010 Move to Category I

Posted on 01. Dec, 2009 by in Hot Coding Topics.


But don’t assume the new codes will yield improved fees.

Virtual colonoscopy coverage may be a mixed bag, but the AMA showed some confidence in the service by moving its codes from temporary Category III status to full-fledged Category I in 2010.

The switch from Category III to Category I does offer some hope of better reimbursement in the future, says Rhonda Townley, CPC, with University Radiology in Knoxville, Tenn. But don’t make assumptions.

For example, you should continue to check and follow coverage policies for Medicare beneficiaries, she warns. Medicare’s current policy is noncoverage, as announced in its “Decision Memo for Screening Computed Tomography Colonography (CTC) for Colorectal Cancer” (CAG-00396N).

Watch Contrast Use for Diagnostic Test

The details: CPT 2010 deletes 0066T (Computed tomographic [CT] colonography [i.e., virtual colonoscopy]; screening) and 0067T (… diagnostic). But in their place,…

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SGR Update: What’s Up With That 21 Percent Physician Pay Cut?

Posted on 30. Nov, 2009 by in Provider News.



Here’s what you should be watching on Capitol Hill.

It’s that time of year again — the time when we all bite our nails wondering if Medicare will slash physician payments in the New Year.

This year, the drama is more intense as Congress decides whether to permanently repeal the Sustainable Growth Rate (SGR) formula that creates the annual physician pay cut kerfluffle.

Traditionally, Congress has stepped in to reverse such dramatic cuts before they take place, and unless that happens this year, you’ll face a conversion factor of $28.4061 effective Jan. 1, according to calculations published in the Nov. 25 in the Federal Register. That translates to a 21.2 percent cut for CY 2010, the FR notes.

The good news: On Nov. 19, the U.S. House of Representatives passed H.R. 3961, the “Medicare Physician Payment Act of 2009,” by a vote of 243-183. The bill would permanently

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CPT 2010 Update: Laboratory & Pathology Coding

Posted on 29. Nov, 2009 by in Hot Coding Topics.


Stop using general codes for analyte-specific tests. Here’s why.

You have 15 new codes scattered throughout the pathology/laboratory CPT chapter, so we’ll help you jump start your 2010 claims with this how-to inventory. “From chemistry to surgical pathology, you’ll find new codes in CPT 2010 that you need to know,” says Peggy Slagle, CPC, billingcompliance coordinator at the University of Nebraska Medical Center in Omaha.

Chemistry changes — CPT 2010 has three new chemistry codes

• 83987 — pH; exhaled breath condensate
• 84145 — Procalcitonin (PCT)
• 84431 — Thromboxane metabolite (s), including thromboxane if performed, urine.

In addition to the new pH code (83987), CPT 2010 revises pH code 83986 to change “except blood” to “not otherwise specified.” “The change clarifies what has been proper coding all along — that you should not use 83986 for urine pH, because existing urinalysis codes 81000-81003 describe that test, says…

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Test Yourself: ICD-9 2010 for Ob-Gyn Coders

Posted on 29. Nov, 2009 by in Toolkit.


Is your ob-gyn practice using the new codes correctly? 3 quick questions say for sure.

This year, ICD-9 2010 brought new hyperplasia, mammogram, and fertility preservation codes. In some cases, these codes simply expanded on existing options, and it’sup to you to spot when you should report the new versus old alternatives. Dig in to these three scenarios to see if you can choose the proper code for services performed on or after Oct. 1.

Scenario 1: Pick Apart New Puerperal Options Your ob-gyn documents “a puerperal infection,” a bacterial illness following childbirth. How would you report this?

A. 670.0 — Major puerperal infection
B. 670.1x [0,2,4] — Puerperal endometritis
C. 670.2x [0,2,4] — Puerperal sepsis
D. 670.3x [0,2,4] — Puerperal septic thrombophlebitis
E. 670.8x [0,2,4] — Other major puerperal infection

Scenario 2: Don’t Overlook 671 Category Notes You’re reporting a code from the 671 (Venous complications in pregnancy

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