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…
MACs are looking for ‘red flags’ to halt additional global period pay
Billing for additional services during a global surgery period is always tricky, but now you can expect special scrutiny for modifier 79 claims.
After the OIG got wind of fraudulent surgery billing with modifier 79 (Unrelated procedure or service by the same physician during the postoperative period), CMS contractors have been on the hunt for modifier 79 abuse. Implement our expert tips below to keep your 79 claims clean.
Obey Global Package Model
The starting point for clean modifier 79 claims is not breaching the global surgical billing concept. Once you understand the global package rules, you’ll know when you have an exception that warrants an additional claim with an appropriate modifier.
Question: Which CPT code should I use for a total spine MRI without contrast?
Answer: You won’t find a single CPT code that describes a “total spine” MRI, but you may report a code for each region the radiologist examines:
• 72141 — Magnetic resonance (e.g., proton) imaging, spinal canal and contents, cervical; without contrast material
• 72146 — Magnetic resonance (e.g., proton) imaging, spinal canal and contents, thoracic; without contrast material
• 72148 — Magnetic resonance (e.g., proton) imaging, spinal canal and contents, lumbar; without contrast material.
Support: Reporting all three spine regions (cervical, thoracic, lumbar) is appropriate when the radiologist performs and interprets an MRI of all three regions, according to the July/August 2003 issue of The ACR’s Radiology Coding Source. The ACR recommends that the radiologist dictate separate reports for each separate region studied.
Remember, supervision requirements still apply to new codes.
CPT 2010 brings some big changes to urogynecology coding. Your urodynamics coding — and income — changes drastically as of Jan. 1.
Get to Know These 3 New Complex Cystometrogram Codes
You will have three new urodynamics codes to learn starting Jan. 1. CPT 2010 adds the following codes:
• 51727 — Complex cystometrogram (ie, calibrated electronic equipment); with urethral pressure profile studies (ie, urethral closure pressure profile), any technique.
We’ve got the links you need to keep up with these bottom-line changers from HHS, CMS.
While most of us were celebrating the last few days the Old Year and preparing to welcome the New Year, the federal regulators had one last, little rulemaking frenzy for 2009. The result is a 555-page proposed rule implementing the HITECH portion of the ‘ARRA’ stimulus bill, as well as a last-minute change to the Medicare Physician Fee Schedule.
Why you should care about the proposed HITECH rule: Remember ARRA, that economic stimulus bill Congress passed last February? In the mammoth bill is the HITECH Act, which mandates a $44,000-per-physician incentive for practices that adopt electronic medical records early. To obtain the incentive, practices must meet certain criteria, which the feds have outlined in this 555-page proposed rule published December 30th.
Not exactly light reading,…
Question: Our surgeon attempted to remove a loose body in the ankle arthroscopically, but it was too large so he had to perform an open removal. Do I bill only for the open procedure, or include the arthroscopic attempt as a discontinued procedure?
Answer: Because your surgeon completed the procedure as an open case, you’ll report only 27620 (Arthrotomy, ankle, with joint exploration, with or without biopsy, with or without removal of loose or foreign body) Include V64.43 (Arthroscopic surgical procedure converted to open procedure) as a secondary diagnosis.
Arthroscopic answer: If the physician had completed the procedure arthroscopically, you would submit 29894 (Arthroscopy, ankle, [tibiotalar and fibulotalar joints], surgical; with removal of loose body or foreign body) instead.
© Orthopedic Coding Alert. Download your 2 FREE sample issues here.
Orthopedic Coders: Do you understand the new consult coding rules? Get clear answers…
We’ve got the link to a nifty ICD-9 to ICD-10 code translator.
Maybe I’m getting old, but I just can’t believe we’re about to ring in the second decade of the 21st century. It seems like just yesterday I was toasting the new millennium and breathing a sigh of relief that “Y2K” wasn’t the big catastrophe we all dreaded.
With time whizzing by so fast, now’s the time to prepare for ICD-10 implementation. And some coders dread ICD-10 as much as anyone ever dreaded Y2K. The number of our diagnosis codes will swell from 13,500 to 120,000, for example. And if we’re certified coders, we’ll have to demonstrate our ICD-10 expertise in order to maintain our certifications. I know I’m too old for another test!
If you feel like you’re already behind on ICD-10, here are 3 links to help you learn more.
For some free webinars that teach you ICD-10…
Reporting your general surgeon’s service with an unlisted code means more documentation work and a payment guessing game — that’s why you’ll welcome CPT 2010’s more specific codes.
General surgery can get all the details at this on-demand, specialty-specific audio update. But we won’t keep you in complete suspense. Here’s a peek at what you’ll learn in the audio.
Capture Large Abdominal Repairs With New Code
When your general surgeon repairs a large abdominal wall defect, you didn’t have a way to report the work — until now.
Limit 96040 to Trained Counselor
Question: May we report 96040 if our physician is performing genetic counseling?
Answer: You should report 96040 (Medical genetics and genetic counseling services, each 30 minutes face-toface with patient/family) only for a trained genetic counselor’s services. (Currently, the American Board of Genetic Counselors [ABMG] certifies genetic counselors in the US and Canada.) Don’t use 96040 for genetic counseling by a physician or nonphysician who is not a genetic counselor.
Although nothing precludes a physician from also being a genetic counselor, CPT states that if a physician provides genetic counseling to an individual, choose the appropriate E/M code. If the physician counsels a patient without symptoms or an established disease, CPT points you instead to 99401-99402 (Preventive medicine counseling …).
You can leave confusing “not otherwise classified” codes behind for a few more of the contrast agents that you use.
For services on or after Jan. 1, be sure you’re using the product-specific codes detailed below. 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, CPC-IM, CPC-I, an instructor for the AAPC’s Professional Medical Coding Curriculum.
Turn to A958x to See New Options
HCPCS 2010 adds A9583 (Injection, gadofosveset trisodium, 1 ml) to report Vasovist, an intravascular contrast agent designed for MRI.