RAC Fact: Watch Out For Medicare’s Once-in-a-Lifetime Services

Posted on 20. Sep, 2009 by in Hot Coding Topics.


G0389 & the IPPE codes may be potential RAC targets

If you’ve been sweating it out, waiting for the recovery audit contractors (RACs) to announce where they’ll be focusing their audit efforts, you may or may not be relieved to know two RAC contractors have posted the areas they’ll have their eye on. More on that below …

Both lists include once-in-a-lifetime procedures, so named because you should report them just once in a beneficiary’s lifetime. Examples of once-in-a-lifetimes codes include G0402, G0403, G0404 and G0405 — HCPCS codes associated with the ‘Welcome to Medicare Visit,’ CMS explains on this info sheet.

Radiology Coders Beware: This ‘once-in-a-lifetime’ RAC focus could bring G0389 (Ultrasound B-scan and/or real time with image documentation; for abdominal aortic aneurysm [AAA] screening) claims under scrutiny because the code represents a onetime AAA screening for Medicare patients referred following an initial preventive physical examination.

You can keep future claims

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Gastroenterology Coding Education: Bravo Cap Placements

Posted on 17. Sep, 2009 by in Coding Challenge, Hot Coding Topics.


Question: A new patient reports to the gastroenterologist with complaints of frequent belching and heartburn. After performing a level-two E/M service, the gastroenterologist performs a diagnostic EGD.

During the EGD, she also inserts a Bravo capsule and performs a reflux test. Tests came back negative for both cancer and gastroesophageal reflux disease (GERD). How should I code this scenario?

Answer: You should be able to report the EGD and the Bravo insertion separately along with an E/M service. On the claim, report the following:

• 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic,with or without collection of specimen[s] by brushing or washing [separate procedure]) for the EGD

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The Truth About Self-Audits

Posted on 17. Sep, 2009 by in Hot Coding Topics.


And one crucial step you should never miss.

How many ticking time bombs are waiting in your medical records?

If you don’t audit your charts regularly, you’ll never know. But even the most thorough set of audits could come to nothing if your staffers believe they’ll lose their jobs if you uncover a problem in an audit.

Reality: “Internal audits (or those conducted by the practice using an outside resource) are the main thing that will protect providers,” says Stephanie Fiedler, CPC, ACS-EM with Loeb & Troper, LLP, in New York City. “Auditing is a method of determining which providers need education related to documentation and proper code selection,” she says.

AUDIO TRAINING EVENT: Your Guide to Coding & Billing Ethics and Compliance. With attorney Wayne Miller.

In fact, a large percentage of the audit focuses on the doctor’s documentation, not how the coders and their managers are doing their jobs.

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Are You Up For ICD-9 2010? Quick Quiz Says For Sure

Posted on 17. Sep, 2009 by in Toolkit.


Surgery Coders: These 5 questions reveal if you need an ICD-9 workout.

October 1 is just around the corner, and that means you’ll soon need to be up and running with the latest ICD- 9 changes. Are you wondering where you should focus your time and energy?

Time-saver: This quiz on the new codes and the basics of diagnosis coding will help you determine whether you’re on the right track, or if you should work on your 2010 diagnosis coding know-how.

Question 1: Once the 2010 ICD-9 changes go into effect on Oct. 1, what diagnosis code should you report when your surgeon documents “chronic venous embolism and thrombosis of superficial veins of left arm”?

A. 453.71

B. 453.8

C. 453.81

D. None of the above.

Question 2: True or false: You can never report a V code as the primary diagnosis.

Question 3: Which of the following is…

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Pediatric Diagnosis Coding Update: ICD-9 2010

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


Always used V20.2? That’s about to change, along with codes for atypical vaccine schedule, dad courtesy visit & more.

Your preventive medicine services’ diagnosis list is about to expand. Prepare your charge ticket — and your staff — for this major pediatric ICD-9 shift.

When ICD-9 2010 becomes effective on Oct. 1, you’ll welcome broader hazardous history of and pediatric birth visit codes. These changes answer some of your top questions.

Will Insurers Cover More First-Year Visits?

You’ve always turned to V20.2 as your go-to-preventive-medicine-services’ ICD-9 linkage. When insurers accept ICD-9 2010 codes, you’ll have two more choices:

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Medicare Forms: Are You Ready for HIPAA 5010?

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


New, standardized reports will show you why your claim was rejected and how to fix it.

You’ve got a few years to implement the HIPAA 5010 form, but CMS wants to make sure you’re completely ready by the time it takes effect on Jan. 1, 2012.

The 5010 form, which will make way for the ICD-10 code set, increases the field size for diagnosis codes from five bytes to seven bytes, allowing for ease of use once the ICD-10 transition occurs. But it also includes other changes that you’ll need to know about.

For instance: Once the 5010 goes into effect, you’ll have to get familiar with the potential claims rejection notices.

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Cardiology Coding Education: Pacemaker Lead Check

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


Question: The cardiologist documented testing pacemaker leads using fluoroscopy (71090) in the hospital. Which code is appropriate for the testing?

Answer: You mention 71090 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation), which is specific to radiological supervision and interpretation at the time of device insertion. So presumably the cardiologist was testing the leads at the time the patient first received the pacemaker.

You can’t report lead evaluation separately at the time of pacemaker insertion (such as 33206-33208).

Verify device: Doctors sometimes document “pacer” when referring to a pacing automatic internal cardioverter defibrillator (AICD), so confirm which device the cardiologist is referring to. You may report one of the following two codes for evaluating leads at the time of an AICD insertion:

• 93640-26 — Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at

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52214 Coding Challenge: Fulguration, Then TUIBNC

Posted on 13. Sep, 2009 by in Coding Challenge, Hot Coding Topics.


Question: If my physician went to do a TUIBNC and found bleeding of prostatic varices, fulgurated them, then did the TUIBNC, can I charge the 52214 for the fulguration of the prostatic varices?

Answer: Yes. You can report both the transurethral incision of the bladder neck contracture (TUIBNC) and the fulguration of the bleeding varices your urologist discovered.

First, report 52450 (Transurethral incision of prostate) for the TUIBN. Append modifier 52 (Reduced services) to show that the incision was only at the bladder neck and not the complete prostatic urethra, bladder neck to the verumontanum.

Then, you can also report 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) for the fulguration. Append modifier 51 (Multiple procedures) to indicate that your urologist performed more than one procedure during the operative session.

Skip 51 sometimes: Many payers, including Medicare, no longer…

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Wake Up to This New Reimbursement Opportunities for Obstructive Sleep Apnea (OSA)

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


Unblock $950 for genioglossus advancement with these coding & billing tips.

Coders have dealt with denials of treatments for obstructive sleep apnea for years, but proper coding should make now make genioglossus advancement —a radical OSA treatment — reimbursable.

Recently, the American Academy of Otolaryngology — Head and Neck Surgery sent letters to Wisconsin Physician Services and Anthem Blue Cross regarding their coverage policies for mandibular segmental osteotomy with genioglossus advancement (21199, Osteotomy, mandible, segmental; with genioglossus advancement) when performed to treat obstructive sleep apnea (OSA).

AUDIO CODING EDUCATION EVENT FOR OTOLARYNGOLOGY CODERS: 5 Tactics that get you paid for endoscopic sinus surgery.

Serious Condition, Radical Treatment

Obstructive sleep apnea (327.23, Organic sleep apnea; obstructive sleep apnea [adult] [pediatric]) describes a blockage of the upper airway that causes the patient to be unable to breathe. One of the ways an ENT can alleviate this potentially life-threatening condition is with genioglossus advancement.

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Don’t Mesh Up Your +57267 Coding

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


An ob-gyn doc with coding know-how tells us how to clean up our mesh claims.

Thinking of using +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect …)? Given that +57267 can get you about $260 more, it’s a good move to consider for some claims — as long as you understand how to use it correctly.

The +57267 mesh add-on code is meant to capture “additional work for putting in mesh grafts where [mesh] is optional,” according to Dr. Harry Stuber, who spoke at an Ob-Gyn Specialty Coding & Billing Conference in Orlando. “If the procedure ALWAYS uses mesh (for example, sling, sacral colpopexy), it’s already been valued in the RVU. Don’t bill extra,” Dr. Stuber explains.

So when can you use +57267?

The answer is ‘NO’ for sling, sacral colpopexy.

But the answer is potentially ‘YES’ for anterior repair, posterior repair, paravaginal repair (that’s a…

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