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…
Question: Code 19101 has a 10-day global period, which means you cannot bill an E/M for anything related to that procedure within that time frame. If the patient continues to have follow-up visits outside the global period, should we then report the appropriate E/M level?
Example: Patient has an open breast biopsy on June 15, so the global period goes through June 25. The patient then has additional follow-up visits on June 26, July 3, and July 10. What is the most appropriate way to bill for the three follow-up visits that the surgeon provides outside the global period? Does modifier 24 apply?
Question: The physician performed a sentinel node injection with lymphoscintigraphy. A note with 38792 states to report 78195 for imaging. So why did Medicare deny a claim that included both codes?
Answer: You should report 78195 (Lymphatic and lymph nodes imaging) for this service and leave 38792 (Injection procedure; for identification of sentinel node) off the claim. The Correct Coding Initiative (CCI) edits consider 38792 and 78195 to be mutually exclusive.
Helpful: CPT Assistant (December 1999) explains that imaging code 78195 includes the injection: “The injection of radioactive tracer is included in the lymphoscintigraphy procedure performed at the same session and is not reported separately. Therefore, it is inappropriate to report 38792 when lymphoscintigraphy is performed.”
Back again for 2010 is Medicare’s incentive-driven physician quality reporting initiative (PQRI), aimed at tracking quality metric or patient care services that physicians provide. When the practice treats enough patients in the same category, some PQRI dollars might be only a few codes away.
If you know the basics and focus your efforts, PQRI reporting can be a breeze and a boon to your bottom line. Check out this rundown on “The Whats?” of PQRI.
What’s In it for Me?
Coders can garner an extra payout for PQRI-eligible patients that your group treats and you code correctly; for 2010, Medicare will fork over a 2 percent bonus if you meet certain criteria.
Lowdown: In order to qualify for the PRQI bonus, you have to report on at least three of 179…
When your urologist says he performed urodynamics tests, you need to dig deeper into his documentation for clues about which code to report. Tack this overview up by your computer to help you quickly choose the right code every time.
• In a simple CMG (51725, Simple cystometrogram [e.g., spinal manometer]), the urologist places a small catheter in the bladder, fills the bladder by gravity, and measures capacity and storage pressures using a spinal manometer.
• A complex CMG (51726, Complex cystometrogram [e.g., calibrated electronic equipment]) involves filling the bladder through a catheter and measuring the pressures with calibrated electronic equipment. If your urologist also performs a urethral pressure profile (UPP), report 51727 (Complex cystometrogram [i.e., calibrated electronic equipment]; with urethral pressure profile studies [i.e., urethral closure pressure profile], any technique). For a complex CMG with voiding…
Watch those Taxotere units, or kiss 95 percent of your reimbursement goodbye.
A brand new list of HCPCS codes — including docetaxel and bevacizumab updates — goes into effect Jan. 1 and our 8-step superbill maintenance plan will stop denials in their tracks for 2010.
Not using the proper codes will lead to claim rejection, which means “not receiving the proper reimbursement. And no one wants to start out their new year that way,” points out Lisa Martin, CPC, CIMC, CPC-I, who oversees the charge operations for a large, independent community cancer center in central Illinois and is an active instructor for the AAPC’s Professional Medical Coding Curriculum.
1. Docetaxel Do: Swap J9170 for J9171
The most widely used of the new chemotherapy HCPCS codes may prove to be J9171 (Injection, docetaxel, 1 mg), says Martin. Oncologists may prescribe docetaxel (Taxotere) for breast cancer, non-small cell lung cancer, prostate cancer, gastric cancer, and head…