Practices interested in ethically boosting their bottom line and getting $80 or more for the same closure repair need to walk the line that separates simple from intermediate.
What Makes a Repair “Simple”?
A wound closure is a simple repair if the procedure:
- is simple;
- is a single-layer closure involving the epidermis, dermis, or subcutaneous tissues; and
- does not involve deeper structures.
Code these closures with 12001-12021, confirms Dilsia Santiago, CCS, CCS-P, a coder in Reading, Pa. And remember that simple repair includes “local anesthesia, and chemical or electrocauterization of wounds not closed,” she continues.
Example: The ED physician examines a 22-year-old patient’s scalp wound …
Question: A patient reports to the ED after sustaining injuries during a soccer match; she was hit in the face with a ball, her nose is bleeding, and her right eye is blackened. The physician is not able to stop the bleeding with ice or pressure, so she performs repeated and extensive cautery using a silver nitrate stick on both nostrils. The bleeding relents, and the physician orders an x-ray to ensure that the patient’s nose is not broken.
Results are negative. Notes indicate a level-four E/M. Can I report 30903 x 2, since the physician stopped bleeding in both nostrils? No, you’ll report this under bilateral procedure guidelines. On the claim, report the following:
Answer: No, you’ll report this under bilateral procedure guidelines. On the claim, report the following:
The next time a patient takes an extra trip to the operating room, don’t let the added service throw your coding off track. Keep these tips in mind to know when to assign modifier 78 – or something else.
Check for Surprise Versus Planned
Two modifiers pertain to follow-up trips to the OR, but knowing the basic difference helps you choose the right one:
• Modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) represents an expected return to the OR. This could be because the original surgery normally is performed during multiple sessions or the follow-up is more extensive than the original procedure. “The patient’s condition dictates the additional service or the service was planned prior to the original surgery,” explains Linda Parks, office manager for Herrin Family Medicine in Lilburn, Ga. You can also report…
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…