CMS Will Cover HIV Screening As Preventive Care Service

Posted on 15. Dec, 2009 by in Provider News.


Bonus: Effective immediately!

You’re probably accustomed to CMS taking away coverage for certain services, but in an early holiday gift to practices, CMS has actually added a preventive care service to its roster of covered screenings, effective immediately.

CMS issued a final decision on Dec. 8 declaring that HIV testing will now be covered for Medicare beneficiaries who are at increased risk for HIV (including pregnant women) — as well as any Medicare beneficiary who requests the test.

The new coverage decision could signal additional coverage announcements, now that the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) gives CMS the flexibility of adding to CMS’s list of preventive services. Previously, Congress had to authorize Medicare to cover additional preventive screening tests, according to a Dec. 8 CMS press release.

“Today’s decision marks an important milestone in the history of the…

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CCI 16.0: Now Allows a Modifier to Separate Hundreds of Edits

Posted on 15. Dec, 2009 by in Hot Coding Topics.


But other new bundles that 16.0 has in store might put a dent in your reimbursement.

You may still be poring through your 2010 CPT manual, but the new edition of CCI, effective Jan. 1, is already looking to make some code pairings impossible.

The Correct Coding Initiative (CCI) released version 16.0 earlier this week, revealing 24,060 new active pairs and 869 modifier changes, said Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc., in a Dec. 8 announcement.

Good news: CCI version 16.0 attempts to untangle at least one troublesome set of edits in its next round with the announcement that effective Jan. 1, you’ll be able to use a modifier to separate the edits bundling E/M codes (99201-99215;99221-99223) into over 100 of the radiation oncology codes.

For instance, if you currently report new patient E/M code 99204 with 77261 (Therapeutic radiology treatment planning; simple), Medicare will…

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Surgical Coding: Scar Revision on Previous Mastectomy Site

Posted on 15. Dec, 2009 by in Coding Challenge, Hot Coding Topics.


Tip: Find mastectomy scar revision in wound repair

Question: Our surgeon performed a scar revision on the site of a previous mastectomy. The procedure involved excising a 16.5 cm curved scar before performing a layered closure. How should we code this?

Answer: You should use complex wound repair codes for the scar revision procedure that you describe. Specifically, you should use the trunk codes 13101 (Repair,complex, trunk; 2.6 cm to 7.5 cm) and +13102 (… each additional 5 cm or less [List separately in addition to code for primary procedure]).

Measure repair: Whether straight, curved, angular, or stellate, the operative report should note the length of the repair. Because your report stated 16.5 cm, you should report 13101 for the first 7.5cm and +13102 x 2 for the additional 9 cm.

You should not code separately for the scar excision. When the surgeon removes the scar, he creates the “defect”…

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CPT 2010: Add New AV Shunt Codes to Your Toolbox

Posted on 13. Dec, 2009 by in Hot Coding Topics.


Initial vs. additional access matters in 2010.

Love them or hate them, the trend toward guidance-inclusive codes doesn’t seem to be slowing.

Case in point: CPT 2010 ousts 36145 (Introduction of needle or intracatheter; arteriovenous shunt created for dialysis [cannula, fistula, or graft]) and 75790 (Angiography, arteriovenous shunt [e.g., dialysis patient], radiological supervision and interpretation) and instead instructs you to consider the following new surgical codes — which include imaging:

• 36147 — Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula); initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report (includes access of shunt, injection[s] of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava)

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The ASC Coder’s Resource Guide for 2010

Posted on 12. Dec, 2009 by in Hot Coding Topics.


Our Chicago reporter's trusty CPT book & conference bag.

Here’s a quick, handy way to get to all of Medicare’s new rules and reimbursement rates

Ambulatory surgery center coders have a lot to learn for 2010, stressed Joanne Schade-Boyce at the ASC 2010 Coding & Reimbursement Update in Orlando.

It’s absolutely essential that ASC coders study the AMA’s CPT Changes this year, Schade-Boyce recommended. Why? Because CPT 2010′s wacky resequencing affects codes many ASC coders use a lot. Checking out Appendix M and Appendix N of your CPT book will also help you get a handle on the resequenced codes.

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Coding Keloid Scar Removal

Posted on 12. Dec, 2009 by in Coding Challenge, Hot Coding Topics.


Watch out: Avoid this unlisted code.

Question: Is removal of a keloid scar considered an unlisted procedure? What is the right code?

Answer: Use 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular lesions; up to 14 lesions) with diagnosis 701.4 (Keloid scar). 17110 and 7111 (… 15 or more lesions) are now used for destruction of common or plantar warts.

Rewind: In 2007, these codes were revised to include destruction of benign lesions other than skin tags or cutaneous vascular lesions.

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Podiatry Coding Clinic: G0245 and G0246

Posted on 10. Dec, 2009 by in Hot Coding Topics.


Here’s when you may need to get an ABN

Medicare policies covering routine foot care for diabetic patients suffering from peripheral neuropathy with loss of protective sensation (LOPS) have been in force since 2002. Yet many still find the related G codes confusing. Today, let’s nail down the what documentation should be in the podiatrist’s note when you use G0245 or G0246.

First, let’s review CMS’s descriptors for these two codes:

• G0245 (Initial physician Evaluation and Management (E/M) of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) …) — You’ll use this code when a patient sees your podiatrist for the first time. This G code represents routine foot care for patients who have adequate circulation and diabetes, but who also have a documented loss of sensation.

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CPT 2010 Code Selection Chart for Paravertebral Facet Joint Injections

Posted on 10. Dec, 2009 by in Toolkit.


CPT 2010 introduces a slew of new codes for paravertebral facet injections, so why not consult our handy flow chart to help you select the correct code?

© Neurology Coding Alert. To read the full article on the new facet joint injection codes for 2010, download your 2 FREE sample issues here.

Was it painful for you to miss the 2010 Pain Management Coding & Reimbursement Conference? Get CDs or MP3s of sessions from Joanne Mehmert, Marvel Hammer & more!

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Pain Management: 2 Providers, 2 Postop Pain Injections

Posted on 09. Dec, 2009 by in Coding Challenge, Hot Coding Topics.


Double 76942 OK for second provider?

Question: Two providers from the same physician group performed two separate postoperative pain injections on the same patient, on the same day. Each provider used ultrasonic guidance during the procedure, but I’ve been told to report 76942 only once per day. How should we report both services?

Answer: You can bill 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) twice in this case because you’re reporting the service for different providers. Your payer might want you to append modifier 77 (Repeat procedure by another physician) to the second instance to distinguish it from the first provider and service and include supporting documentation, depending on how the claims are processed. Check your local guidelines to verify before filing the claim.

© Anesthesia & Pain Management

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Check New HCPCS Codes to Keep Pain Management Claims on Track

Posted on 08. Dec, 2009 by in Provider News.


Catch the changes to botulinum toxin and neurostimulator electrode codes.

As a pain management coder, you’re facing new CPT codes for posterior intrafacet implants, paravertebral facet joint injections, and sacroplasty. While preparing to implement these additions, don’t overlook HCPCS changes for botulinum toxin injections and implantable neurostimulator electrodes.

Pay Attention to Botox Units

A new code for botulinum toxin type A — and revisions to the older codes for botulinum toxin types A and B — will have you double-checking calculations before filing claims.

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