Question: Notes indicate that the gastroenterologist performs a rigid sigmoidoscopy; during the encounter, he also performs an anoscopy without anesthesia and three biopsies of the mucous membrane. How should I report this episode? Can I report the exam separately with 46600?
Answer: You can report a single code for these three services. On the claim, report 45305 (Proctosigmodoscopy, rigid; with biopsy, single or multiple) for the sigmoidoscopy, the anorectal exam, and the three biopsies.
Why: When the gastroenterologist performs an anoscopy (46600 [Anoscopy; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) or mucous membrane biopsy during a sigmoidoscopy, the services are bundled into 45305.
Question: For a chart with a chief complaint of resolving pneumonia, a note indicates, “No coughing, SOB.” Should I give the pediatrician credit for this ‘no coughing & no shortness of breath’ statement under history of present illness (HPI) or as a review of systems (ROS)?
Answer: This is a gray area of E/M coding that you can count under either history type. You could give credit for “no coughing” and “no shortness of breath” (SOB) as associated signs and symptoms under HPI. Some auditors might instead count the notation as a review of the respiratory system under ROS.
Posted on 12. Oct, 2009 by in Hot Coding Topics.
No maybes here: Answer this question wrong and you will code incorrectly.
When your ED physician performs fracture care for a patient, be ready to pounce on evidence of manipulation, as CPT often breaks fracture care codes along the manipulation line.
The $kinny: Let’s say the physician performs closed treatment on a fractured collarbone; if she uses manipulation, the service is worth about $106 more than a nonmanipulation encounter.
Use this FAQ to successfully manipulate both types of fracture care codes — and ethically add to the practice’s bottom line.
Posted on 11. Oct, 2009 by in Hot Coding Topics.
If you’re reporting services your physician provides over the phone, but you’re not getting paid, the reason might be one of two things — you’re not following the coding rules surrounding the codes or your payer just isn’t paying for those services. Check out these top three denial reasons to ensure that you’re not leaving money on the table by misusing these codes.
1. Check With Each Payer on Reimbursement Policy
CPT offers six codes for you to use to report telephone services: 98966-98968 (Telephone assessment and management service provided by a qualified nonphysician health care professional …) and 99441-99443 (Telephone evaluation and management service provided by a physician …). As evident in the code descriptors, you will choose the proper code to report based on the time a practitioner spends on the telephone with the patient.
Question: We didn’t receive payment for an 88280 charge because we did not bill it with a “base procedure,” according to the denial. Can you explain the rejection? How could we avoid future denials?
Answer: Your original bill either missed the base chromosome analysis procedure, or incorrectly listed the base procedure as 88280 (Chromosome analysis; additional karyotypes, each study) instead of the more specific code from 88261-88269.
Tricky: Although CPT does not list 88280 with a “+” to designate that it is an add-on code, it functions as an add-on. Cytogenetic codes 88230-88299 are “building block” codes. You should select the appropriate codes in the range that describe each step that your lab performs for a complete cytogentic study.
For instance, you might report:
• 88237 (Tissue culture for neoplastic disorders; bone marrow, blood cells) for the tissue culture step
• 88261 (Chromosome analysis; count 5 cells, 1…
Posted on 11. Oct, 2009 by in Hot Coding Topics.
If you’re an orthopedic coder, you don’t have to shoulder your shoulder coding burdens alone. We’ve rounded up a handy reference list of shoulder problems (along with sample procedures that fix them) that you’ll come across in an ambulatory surgical center setting.
AC Joint Separation
A separation of the acromioclavicular (AC) joint (831.04, Dislocation of shoulder; acromioclavicular [joint]), also called a “shoulder separation,” occurs when the clavicle and acromion separate due to a strain, sprain or tear of one or more shoulder ligaments. In the most serious form of AC joint separation, both the acromioclavicular ligament and the coracoclavicular ligament are completely torn. These injuries often occur following a fall or a direct blow to the shoulder, often during sports, and can cause intense shoulder pain.
If the injury is a grade 1 separation…
Posted on 08. Oct, 2009 by in Hot Coding Topics.
A pregnant patient moves out-of-state mid-pregnancy. Do you know how to report the services your ob-gyn provided up to the date of the move? Prepare for these situations by adopting the following approaches based on the number of visits.
For 1-3 Visits, Rely on Office E/M Codes
If your ob-gyn sees a patient for only one, two, or three antepartum visits, you need to report the appropriate E/M codes to be reimbursed, says Tracy Anderson, CPC, credentialing/coding specialist for ACMH Physician Services in Kittanning, Pa.
Posted on 08. Oct, 2009 by in Toolkit.
When Part B MACs publish the top errors that they see in claims submitted by physicians, incorrectly billed drugs are always near the top of the list. If you’re one of the coders that has trouble assigning units to drug claims, one MAC has a solution for you.
Palmetto GBA, a Part B payer, now offers a “Drug Lookup and Calculator Tool,” which was created “to help providers submit the correct number of units on their claims by calculating and converting the dosage administered to the patient.”
Plus: The calculator displays the current maximum allowable units assigned to the drug.
For instance, if you enter J2920 (Injection methylprednisolone sodium succinate) into the system, it will ask you how many milligrams you administered. The system will then tell you how many units to report, with a notation that 83 units are the maximum allowed for this drug.
To access the tool,…
Question: An established type II diabetic patient comes in for a blood draw for glycohemoglobin. After the draw, the patient reports a sore left shoulder; she says it is a 4 on the 10 pain scale, with pain diminishing in the past few days. The nonphysician practitioner (NPP) takes a history related to shoulder pain, performs an examination of the shoulder, and diagnoses a mild coracohumeral sprain. The NPP recommends ibuprofen and rest for the shoulder, and sends the patient home. Should I roll the blood draw into the overall E/M level?
Answer: You should report separate codes for the NPP’s shoulder exam and blood draw, with corresponding diagnosis codes to separate the services. On the claim, report the following:
• 36415* (Collection of venous blood by venipuncture) for the draw
• 250.00 (Diabetes mellitus without mention of complication; type II or unspecified type, not stated as uncontrolled) appended to…
Posted on 06. Oct, 2009 by in Hot Coding Topics.
Before you can capture qualifying circumstances pay for hypothermia, pay attention to certain documentation details and requirements. Checking the details in your provider’s notes and paying close attention to the applicable anesthesia code can help you ward off any fears of incorrect reporting.
To find the code for hypothermia, you’ll need to flip to the back of your CPT book to “Qualifying Circumstances for Anesthesia.” The code you’ll focus on is +99116 (Anesthesia complicated by utilization of total body hypothermia [List separately in addition to code for primary anesthesia procedure]).
1. Ensure Hypothermia Is Induced
Dissecting the hypothermia code descriptor tells you two important things about correctly reporting +99116:
• The term “utilization” lets you know that the patient’s hypothermic state…