Posted on 18. Oct, 2009 by in Hot Coding Topics.
Here’s a handy introduction to common ICD-9 codes related to the knee, along with examples of CPT codes for procedures physicians perform to treat knee diagnoses.
Chondromalacia patella (717.7) is also known as “patellofemoral syndrome” or “runner’s knee.” This condition results when the cartilage under the patient’s patella becomes damaged and causes pain particularly when the patient climbs stairs or bends his knee.
This is a common condition among runners or other athletes who jump, squat or climb. But chondromalacia patella can also be associated with arthritis, so the condition affects patients in all age groups.
Posted on 15. Oct, 2009 by in Toolkit.
Hang on to this handy table to avoid cath placement coding temptations.
Correct Coding Initiative (CCI) 15.3 offered long lists of new edits, but we’ve boiled them down to the ones that affect cardiology coders and billers most.
Posted on 15. Oct, 2009 by in Hot Coding Topics.
The silver lining to the 18,000 Correct Coding Initiative (CCI) that just came rumbling in with CCI 15.3. Analyzing them can help you master radiology coding essentials — including follow-up CTs, fluoro, and more. Apply these five lessons to keep your claims looking their best.
Remember: The latest round of edits, version 15.3, went into effect Oct. 1. You can download the updates at the beginning of each quarter from the CMS Web site, suggests Alice E. Wonderchek, CMBS, CPC, billing and coding specialist with Franklin & Seidelmann Subspecialty Radiology in Beachwood, Ohio. You can download the CCI manual here, as well.
1. Proceed With Caution When Coding 76380
Randomly choose a code for computed tomography (CT) or computed tomography angiography (CTA), and odds are that CCI 15.3 bundles 76380…
Posted on 13. Oct, 2009 by in Provider News.
If your practice does lab panels, sleep studies, hospice visits and more, take heed.
The HHS Office of Inspector General has published its 2010 Work Plan, which should give us all a heads up on what the watchdog agency will be auditing and evaluating this year.
Why you should care: The 115-page document is like a map for what regulators will be looking at this year, and what potential problems they’ll be passing to MAC, RAC and private payer auditors. Don’t worry. Physician issues are clustered around page 15. However, if you code for other things in your health system besides physician services, you should have a look at the table of contents.
Here’s a summary of what the OIG wants to know about physician reimbursement:
Question: Notes indicate that the gastroenterologist performs a rigid sigmoidoscopy; during the encounter, he also performs an anoscopy without anesthesia and three biopsies of the mucous membrane. How should I report this episode? Can I report the exam separately with 46600?
Answer: You can report a single code for these three services. On the claim, report 45305 (Proctosigmodoscopy, rigid; with biopsy, single or multiple) for the sigmoidoscopy, the anorectal exam, and the three biopsies.
Why: When the gastroenterologist performs an anoscopy (46600 [Anoscopy; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) or mucous membrane biopsy during a sigmoidoscopy, the services are bundled into 45305.
Question: For a chart with a chief complaint of resolving pneumonia, a note indicates, “No coughing, SOB.” Should I give the pediatrician credit for this ‘no coughing & no shortness of breath’ statement under history of present illness (HPI) or as a review of systems (ROS)?
Answer: This is a gray area of E/M coding that you can count under either history type. You could give credit for “no coughing” and “no shortness of breath” (SOB) as associated signs and symptoms under HPI. Some auditors might instead count the notation as a review of the respiratory system under ROS.
Posted on 12. Oct, 2009 by in Hot Coding Topics.
No maybes here: Answer this question wrong and you will code incorrectly.
When your ED physician performs fracture care for a patient, be ready to pounce on evidence of manipulation, as CPT often breaks fracture care codes along the manipulation line.
The $kinny: Let’s say the physician performs closed treatment on a fractured collarbone; if she uses manipulation, the service is worth about $106 more than a nonmanipulation encounter.
Use this FAQ to successfully manipulate both types of fracture care codes — and ethically add to the practice’s bottom line.
Posted on 11. Oct, 2009 by in Hot Coding Topics.
If you’re reporting services your physician provides over the phone, but you’re not getting paid, the reason might be one of two things — you’re not following the coding rules surrounding the codes or your payer just isn’t paying for those services. Check out these top three denial reasons to ensure that you’re not leaving money on the table by misusing these codes.
1. Check With Each Payer on Reimbursement Policy
CPT offers six codes for you to use to report telephone services: 98966-98968 (Telephone assessment and management service provided by a qualified nonphysician health care professional …) and 99441-99443 (Telephone evaluation and management service provided by a physician …). As evident in the code descriptors, you will choose the proper code to report based on the time a practitioner spends on the telephone with the patient.
Question: We didn’t receive payment for an 88280 charge because we did not bill it with a “base procedure,” according to the denial. Can you explain the rejection? How could we avoid future denials?
Answer: Your original bill either missed the base chromosome analysis procedure, or incorrectly listed the base procedure as 88280 (Chromosome analysis; additional karyotypes, each study) instead of the more specific code from 88261-88269.
Tricky: Although CPT does not list 88280 with a “+” to designate that it is an add-on code, it functions as an add-on. Cytogenetic codes 88230-88299 are “building block” codes. You should select the appropriate codes in the range that describe each step that your lab performs for a complete cytogentic study.
For instance, you might report:
• 88237 (Tissue culture for neoplastic disorders; bone marrow, blood cells) for the tissue culture step
• 88261 (Chromosome analysis; count 5 cells, 1…
Posted on 11. Oct, 2009 by in Hot Coding Topics.
If you’re an orthopedic coder, you don’t have to shoulder your shoulder coding burdens alone. We’ve rounded up a handy reference list of shoulder problems (along with sample procedures that fix them) that you’ll come across in an ambulatory surgical center setting.
AC Joint Separation
A separation of the acromioclavicular (AC) joint (831.04, Dislocation of shoulder; acromioclavicular [joint]), also called a “shoulder separation,” occurs when the clavicle and acromion separate due to a strain, sprain or tear of one or more shoulder ligaments. In the most serious form of AC joint separation, both the acromioclavicular ligament and the coracoclavicular ligament are completely torn. These injuries often occur following a fall or a direct blow to the shoulder, often during sports, and can cause intense shoulder pain.
If the injury is a grade 1 separation…