With several possible surgical treatments for cataract procedures, which you probably code more often than any other surgery, there’s a lot of room for error – with over $890 at stake for complex cataract procedures in 2009.
Use these tricky scenarios as a guide through some of the most problematic cataract coding situations:
Document Necessity for Planned Vitrectomy
Scenario: During the course of a cataract removal, the vitreous collapses and the ophthalmologist finds it necessary to perform a vitrectomy.
Problem: Can you code separately for the vitrectomy?
Read more to learn solution …
Your pathologist consults with an outside lab on slides taken from a 2006 lumpectomy and a 2009 lymph node fine needle aspiration (FNA). That’s 88321 x 2 — right?
Maybe. Your payer determines the answer to that question.
The problem: “Although the American Medical Association (AMA) says the unit of service for pathology consultation codes 88321-88325 is ‘each case,’ CMS begs to differ,” says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., publisher of the Pathology Service Coding Handbook, in The Villages, Fla.
Distinguish CPT Rules
CPT provides three codes for pathology consultations on material referred from an outside institution:
• 88321 — Consultation and report on referred slides prepared elsewhere
Question: Our anesthesiologists sometimes mark our C-section tickets as “combined spinal epidural,” but our billing system will only allow us to choose epidural or spinal. Where can I find information about spinal epidurals and how to correctly code them?
Answer: From a coding perspective, whether your physician used spinal or epidural anesthesia doesn’t matter as long as you report the correct obstetrics code. Base your anesthesia code on the case specifics:
• 01961 (Anesthesia for cesarean deliver only) for a straight c-section instead of converting from labor to a csection
• 01967 (Neuraxial labor analgesia/anesthesia for planned vaginal deliver [this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor]) for a standard labor and vaginal delivery
• +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [List separately in addition to code for primary procedure performed]) for a planned vaginal…
Question: A 60-year-old patient reports to the ED with a bandaged left hand. The patient says she was cleaning out the blades of her snow blower and cut her left index finger; the wound is wrapped in gauze, but it is reddening with blood. During an expanded problem focused history and exam, the physician undresses the wound, applies pressure and ice to stop the bleeding, and cleans it using Betadine. During the E/M service, the physician notes a laceration to the index finger but no signs of infection. Using Dermabond, the physician closes a 2.7 cm laceration on the patient’s finger. How should I code this encounter?
Posted on 17. Jan, 2010 by in Toolkit.
With fewer patients following through on procedures because of economic and financial struggles, and an increasing number of patients not paying their bills, your practice needs to find ways to improve your A/R and bring in deserved money. Adapting an up-front deductible collection policy is one proven way to do both — and setting up a policy can be as easy as 1-2-3.
1. Confirm the Deductible With the Payer
Insurance verification services now make it possible for practices to find out if a patient has met his deductible yet. Some services can tell you how much of the deductible remains unpaid. Because this information is available online, your practice can get this information last-minute, the day of, the day before, or several days before the patient is scheduled to come in for a service or procedure.
Question: A patient presents to the ED reporting pain in her spine. During the exam portion of a level-three E/M, the physician discovers that the painful area is red, and slightly warm to the touch. The patient also has a low-grade fever that she says she noticed about two days ago. The physician makes a shallow incision with a scalpel at the base of the patient’s spine and drains the pus from the area. I reported 10060 and received a denial. Why?
Answer: You chose a standard incision and drainage (I&D) code when you should have opted for a pilonidal cyst I&D code. When you re-submit the claim, report the following:
Flip through the Surgery/Respiratory System section of your CPT 2010 manual, and you’ll see the coding committee has been hard at work adding to and revising your options. Discover the added cath removal code, the all new fibrinolytic agent instillation code, and the reshaped bronchoscopy descriptors, so you can rest assured your coding will be ship-shape in 2010.
1. End Your Hunt for 32550’s Removal Code Match
Until now, CPT has offered insertion code 32550 (Insertion of indwelling tunneled pleural catheter with cuff), but you’ve been left in the lurch for removal, using either an E/M or unlisted code.
CPT 2010 adds new code 32552 (Removal of indwelling tunneled pleural catheter with cuff) to solve this problem, said Stephen Hoffman, MD, associate professor of clinical medicine at Ohio State University Medical Center in Columbus and AMA CPT Advisory Committee American Thoracic…
Posted on 14. Jan, 2010 by in Toolkit.
Combination codes for stroke late effects won’t always cover all the details.
Proper sequencing is essential when coding for late effects, so use this handy chart to sequence your codes correctly every time.
Chart provided by Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates and CoDR — Coding Done Right in Denton, Texas.
For easy ICD-9 code lookup and more ICD-9 coding advice, go to Supercoder.com and sign up for a FREE trial today.
You can breathe a sigh of relief — one major payer will stick with 99241-99255.
UnitedHealthcare (UHC) commercial plans will make no change in payment for consultation codes (99241-99255) at this time, according to a UHC e-mail alert. “Physicians may continue to submit claims for these services, and will be reimbursed according to United-Healthcare payment policies”.
Beware: One Medicaid plan will eliminate consult pay and force you to follow Medicare’s rule of using office and hospital codes in lieu of 99241-99255. “For AmeriChoice Medicaid plans that follow Medicare rules for their fee schedules, AmeriChoice will be aligning with CMS rules and implement the change effective January 1, 2010,” the email notice states. “For all other Medicaid states, AmeriChoice will follow the UnitedHealthcare commercial position and continue to pay for the consult codes, until directed otherwise by a state to pursue other strategies.”
Watch your mail for a UHC payer news notice and an article in the January Network Bulletin.…
Don’t even think about billing a consult to Medicare — even if it’s only a secondary payer claim. Medicare may have scratched consultations off of its list of payable services, but many other insurers did not follow suit. This leaves you in a quandary when your physician performs a consult and the primary insurer pays you for it, but Medicare is the secondary payer.
“Medicare Secondary Payer (MSP) will not pay for consults,” says Samantha Daily, billing specialist with Urologic Consultants, PC in Portland, Ore. She points coders toward MLN Matters article MM6740, which indicates the following:
“In MSP cases, physicians and others must bill an appropriate E/M code for the services previously paid using the consultation codes. If the primary payer for the service continues to recognize consultation codes,” you should bill in one of…