Posted on 21. Aug, 2009 by in Hot Coding Topics.
Tip: Watch how you support medical necessity for warfarin therapy. Here’s where many coders make the wrong ICD-9 choice.
Don’t get stuck with the bill for your physician’s in-office monitoring of Coumadin use — instead, learn the Coumadin coding ropes. One surefire way is to follow these 3 guidelines.
1. Put Proper Code to Periodic PT Test
“Physicians often use PT [prothrombin time] to assess patient response to the drug warfarin,” says Barb Miller, MT (ASCP) SH, with Nebraska Medical Center.
When patients on warfarin therapy come to your “Coumadin clinic” for periodic testing to assess their anticoagulation status, you should report 85610 (Prothrombin time) for the test.
Remember the modifier: Be sure to append modifier QW (CLIA waived test) to 85610 (and that you operate with a CLIA certificate of waiver).
Posted on 19. Aug, 2009 by in Hot Coding Topics.
Experts reveal the best ICD-9 coding move, plus what you need to do beginning October 1.
If you’re one of the many labs performing influenza testing spurred by the World Health Organization’s (WHO) June 11 pandemic declaration for novel influenza A (H1N1), you need to read this.
Despite the Centers for Disease Control and Prevention (CDC) guidelines that involve fee-exempt testing for surveillance purposes, your lab can expect to see increased billable flu testing. That’s why you need to bone up on how to code tests your lab might perform.
Stick With Your Influenza A/B Billing
If your lab processes specimens for suspected swine flu cases by performing existing lab tests and panels, your procedure coding and billing will remain the same.
Example: “Our lab performs a respiratory viral panel that physicians may order for patients with certain flu-like symptoms,” says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha. “We bill for the panel using three codes that describe the test processes:”
• 87252 — Virus isolation; tissue culture inoculation, observation, and presumptive identification by cytopathic effect
Question: What is the difference between a primary and secondary neoplasm? I’m confused about which code to use for a metastatic tumor once the original tumor has been removed.
Answer: Continue to report the metastatic tumor as “secondary” even if the primary tumor has been eradicated.
Primary: A primary neoplasm code indicates the original tumor site.
Secondary: A secondary neoplasm indicates a site to which the cancer has spread.
History of: According to ICD-9 2009 official guidelines, if the patient’s tumor is eradicated and no longer requires treatment, you should use a “history of” code, such as V10.3 (Personal history of malignant neoplasm; breast).
Here’s the exact language: “When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from category V10, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy. Any mention of extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site. The secondary site may be the principal or first-listed with the V10 code used as a secondary code” (page 24).
Posted on 19. Aug, 2009 by in Provider News.
Be a hero. Figure out how you can get an extra $44K per physician in your practice.
As a coder, you’re where the buck stops when it comes to the practice’s bottom line. So, you’re no doubt wondering whether your practice should go for the $44,000-per-physician bonus payment available to practices that adopt electronic medical records system early.
Potential pitfall: While the ARRA incentive money seems attractive, it could be more trouble than it’s worth for some practices.
Help is here: To get an overview ARRA perks for your practice, and assess your readiness to take advantage of them, check out this cool tool from the American Health Information Management Association.
Some things to consider, according to AHIMA:
- hardware the practice currently uses, including PDAs, etc.
- computer savvy among physicians and staff
- EHR vendor types … More …
Question: The dermatologist treated an established patient with a cut on her lip and used Dermabond to close the 1.8-cm laceration. Should I use a laceration repair code when the only adhesive he used was Dermabond?
Answer: Your code choice will depend on the patient’s insurance. Check out these two coding options:
Patient has Medicare: If the physician uses Dermabond as the only closure material for a simple repair on a Medicare patient, report G0168 (Wound closure utilizing tissue adhesive[s] only) for the service.
Patient has commercial insurance: If the commercial carrier follows Medicare rules, use G0168. However, if the payer does not observe Medicare guidelines, you’ll most likely choose a laceration repair code, even when Dermabond is the only adhesive the physician uses. On the claim, report 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less).
Either way: Append 873.43 (Other open wound of head; face, without mention of complication; lip) to the procedure code to represent the patient’s injury.
Posted on 17. Aug, 2009 by in Hot Coding Topics.
Do diagnosis coding choices for your FP’s preventive medicine services drive you batty?
Turns out there’s a one-stop solution for ICD-9 coding for a preventive medicine service with screenings or immunization administration — V20.2 for all. Save time assigning V codes by checking out these case studies.
Link Check, Screening to Same Diagnosis
When the FP performs screenings during a periodic well-child visit, you’ll typically append V20.2 (Routine infant or child health check) as the primary diagnosis for all the services, confirms Jeffrey Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance at Emergency Pediatric Group Children’s Healthcare of Atlanta at Egleston.
Under the descriptor, there is a list of services you should code with V20.2 — as well as other coding instructions, such as “excludes special screening for developmental handicaps [V79.3].”
Example: A 10-year-old established patient receives a well-child exam, pure tone air test, and visual acuity test in the same session. On the claim, Linzer says you would report the following:
Posted on 17. Aug, 2009 by in Hot Coding Topics.
Some practices code for services performed in ambulatory surgery centers (ASCs) every day, while others are just getting started. To determine how much you know about coding and billing for ASC procedures, take this quick quiz. Then, click the ‘Full Article’ button to find out how you fared.
Question 1: Physician Performed A Non-Approved Service?
We recently learned that our Medicare payer will deny the ASC’s charges for any procedures that aren’t on the ASC’s list of approved services, but what happens if the physician performs a nonapproved service anyway? How can we collect for our portion of the charges?
Hint: For a list of CMS-approved ASC procedures, visit here.
Question 2: Do You Need Modifiers 78, 79?
I code for an ASC, and my payer won’t reimburse me for claims with modifiers 78 (Return to the operating room for a related procedure during the postoperative period) and/or 79 (Unrelated procedure or service by the same physician during the postoperative period) appended to them. Should we appeal?
Question 3: Should You Rely on All Physician Code Selections?
Our ASC requires the physician to dictate his CPT codes directly into the operative report. They tell us that this way, the surgeon and the ASC are sure to report the same code as one another.
But in my experience, I find that our surgeon doesn’t always select the correct code, so I’m uneasy about this. Should we follow the ASC’s advice and have the physician select the codes, or is there another way that our codes can match the ASC-billed codes?
Question 4: How Do We Append Modifier SG?
I know that when I bill services performed in an ASC, I must append modifier SG (ASC facility service) to the…
Posted on 14. Aug, 2009 by in Hot Coding Topics.
If you don’t take advantage of all the E/M services a nonphysician practitioner (NPP) can provide, you are missing out on a serious revenue stream, as these providers can simultaneously lighten physicians’ loads and fatten the practice’s bottom line.
Check out these FAQs to get the lowdown on when it’s OK to take the higher-paying path for your NPP’s services.
What Is Incident-To Billing?
Incident-to billing occurs when you report an office E/M service the NPP provides under the physician’s National Provider Identifier (NPI). Using the physician’s NPI garners you 100 percent reimbursement for the E/M, while an NPP’s NPI pays 15 percent less.
The NPP must perform incident-to services “under the direct supervision of the physician as an integral part of the physician’s personal in-office service,” confirms Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant in Guadalupita, N.M.
Answer: The procedure removes adhesions (tags) from the dura to correct any neurological deficits. Physicians often remove a specimen to send for lab review, but that service is included in the primary procedure.
In this situation, you’ll report 63200 (Laminectomy, with release of tethered spinal cord, lumbar) for the cord release and +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) for the microscope use. Don’t report the dural tag removal separately, as it is incidental to the tethered cord release.
Posted on 14. Aug, 2009 by in Toolkit.
Unless you want to grapple with denials, the procedure notes that support your physicians’ laceration repair claims should contain these 8 elements. How do the physicians in your practice measure up?
• decontamination (including foreign material removed)
• tissue management
• exploration of wound and contiguous structures