Coding Keloid Scar Removal

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

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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.

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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.

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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.

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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.

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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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Facet Joint Injection Coding for 2010

Posted on 08. Dec, 2009 by in Hot Coding Topics.

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Marvel Hammer’s Quick Start Guide to changes you’ll face in 2010.

Tons of pain management coders gathered at the Orlando conference this week, and everyone was abuzz about the coding changes the painful reimbursement cuts their practices are going to get next year.

Some big news: Effective January 1, 2010 radiological imaging will be required and bundled for facet joint injections, confirmed instructor Marvel Hammer.

Old way: CPT 2009 used to ask us to separately report radiological imaging for needle placement (1 unit per spinal region for these codes):

77003: Fluoroscopic guidance for needle placement

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Cataract Surgery Coding: When Optometrist Provides Postop Care

Posted on 08. Dec, 2009 by in Coding Challenge, Hot Coding Topics.

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We’ve got the modifier you need when the ophthalmic surgeon passes the baton.

Question: An ophthalmic surgeon performs cataract surgery, and then turns the patient over to the optometrist for postoperative management only. How should I code between the two providers? Do I need a modifier?

Answer: If the ophthalmic surgeon turns the patient over to the optometrist for all 90 days of postoperative care, the optometrist will report 66984 with modifier 55 (Postoperative management only) appended for 90 days of service. If the surgeon turns over care to the optometrist immediately, the optometrist is responsible for postoperative management for the whole 90 days, regardless of when he first sees the patient.

Split care: If the ophthalmic surgeon does not transfer care immediately, he may report 66984-55 for however many days he remains responsible for postoperative management. The optometrist then reports 66984-55 for however many days remain in the 90-day global…

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How to Code for Screening Mammogram When Radiologist Finds Problem?

Posted on 06. Dec, 2009 by in Coding Challenge, Hot Coding Topics.

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Watch out: Results don’t turn screening into diagnostic

Question: A patient presented for a screening mammogram, and the radiologist determined the patient needed an ultrasound for a closer look. The patient returned for that test at a later date. Should I code the original mammogram as 77056 instead of 77057 because the radiologist found a possible problem?

Answer: If the patient presents for and undergoes a screening mammogram, you should code for a screening, even if the radiologist discovers an abnormality. In the case you describe you would report 77057 (Screening mammography, bilateral [2-view film study of each breast]) rather than 77056 (Mammography; bilateral). When the patient returns for the ultrasound, you would report 76645 (Ultrasound, breast[s] [unilateral or bilateral], real time with image documentation). Remember that Medicare requires a separate order for the ultrasound for nonhospital patients.

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CPT 2010 Update: Tally Up Common Audiology Code Groups Into Single Codes

Posted on 06. Dec, 2009 by in Hot Coding Topics.

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Plus, add this new tympanometry code to your cache next year.

One of CPT 2010’s initiatives is to move several codes typically performed together into one code. Check out these new audiology testing codes and understand the rationale before Jan. 1 hits.

For instance, if your physician performs a vestibular evaluation in 2010, you will report new global code 92540 (Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of four positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording,and oscillating tracking test, with recording).

Note the code descriptor describes “four different things are being done, with recording,” says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, president of CRN Healthcare Solutions.

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Zero In On Correct Nasal-Specimen Coding With This Quick Quiz

Posted on 06. Dec, 2009 by in Toolkit.

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Missing multiple 88304 specimens could cost your practice $125.

Busting the polyps’ “s” myth and identifying separately billable nasal specimens could add hundreds of dollars to a pathology claim. Make sure you’re not falling into two common coding traps by trying your hand at these two questions; then checking your answers.

Question 1: The lab receives the following tissue individually labeled by the surgeon: right septum polyp, left septum polyp, and left lateral nasal polyp. The pathologist microscopically examines representative portions of tissue from each sample and individually reports each specimen as “nasal polyps.” How should you code the case?

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