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)
We’re starting to learn what new CPT codes we’ll be using come January 1, 2010. Coding News will keep you posted over the coming weeks, along with analysis from coding experts around the country so that you know what to expect for your practice’s bottom line.
CPT 2010 has created over a dozen tumor excision codes that require you to designate the tumor size. For instance, code 21930 represents a tumor excision of the soft tissue of the back or flank measuring less than 3 cm, while 21931 describes the same tumor but 3 cm or greater.
“Until these codes, there has never been a way to express the depth of removing a tumor or tumorous mass except with modifier 22 (Unusual procedural services),” says Leslie Johnson, CPC, quality control auditor for Duke University Health System and owner of the billing and…
Question: Does a certified nurse specialist (CNS) count as a nurse practitioner (NP) for reporting 99213 based on time?
Answer: Yes, for CPT purposes, a certified nurse specialist billing under his own provider number counts the same as a nurse practitioner or physician assistant. So if the office visit meets the requirements for time-based billing — counseling and/or coordination of care comprises more than 50 percent of the face-to-face CNS-patient encounter and documentation indicates the encounter’s total face-to-face time, the counseling minutes, and a discussion summary — the CNS can choose the office level using time, such as 15 face-to-face minutes for 99213 (Office or other outpatient visit for the evaluation and management of an established patient …) as the sole criteria.
Be careful: Check your state law. State scope of practice laws may restrict services and procedures that nonphysician practitioners may…
Correctly billing your nonphysician practitioners (NPPs) incident-to services means the difference between 85 and 100 percent reimbursement. But if you bill incident-to haphazardly, you’re just waving a red flag at auditors.
And those auditors are jonesin’ to find incident to billing problems. Just check out this recent report from the HHS Office of Inspector General to learn the kinds of mistakes they’re looking for.
But have no fear. If you use the following list of questions to evaluate your incident-to claims for all the must-have components, and be sure the documentation includes the same, you’ll have nothing to worry about if auditors come knocking.
1. Do the Services Involve Direct Supervision?
Direct means that the supervising physician must be in the immediate office suite while incident-to services are being provided. But if…
Question: During a practice meeting last week, the subject of Clinical Laboratory Improvement Amendments (CLIA) waivers came up. We are currently not CLIA-waived, and we will discuss it again at next month’s meeting. I was wondering if you could offer any input? Should we apply for a CLIA waiver?
Answer: Whether or not the waiver is worth it is up to your individual practice. However, a practice is not allowed to perform many basic laboratory services without CLIA-waived status. So if your practice does not get the waiver, you could be missing out on possible pay for some simple screens.
Example: Here are a few of the tests that have CLIA-waived status to help you decide:
• 81002 — Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy