Diagnosis Coding: Here’s How To Decode Your Physician’s Notes

Posted on 16. Jun, 2010 by Editor.

If the doctor does not circle a diagnosis, it may be up to you to find one.

Don’t let an incomplete superbill damage your chances of submitting an accurate claim. If the doctor in your office fails to indicate the ICD-9 code for the condition that he treated, you should read through his documentation to find which diagnoses you should report.

Open the Notes When You Have to — and Even When You Don’t

Suppose your physician hands you a superbill with the procedures circled and the diagnosis left blank.

You could ask the physician which diagnosis to report, or you could examine the documentation yourself. If your office has a policy that includes “coding by abstraction” by certified/qualified coders, then

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Examine These FAQ to Sort Your Medicare Cancer Screen Codes

Posted on 26. May, 2010 by Editor.

Remember frequency rules differ for average, high risk.

Getting Medicare to pony up for colorectal cancer screenings is not difficult provided you follow its frequency guidelines and eligibility requirements to the letter. A coding slip up on one of these items will knock you out of the saddle, and Medicare won’t accept the claim at all.

Rope in all the coding info you’ll need via this Medicare colorectal cancer screening FAQ.

Who’s Eligible for Average-Risk Test?

If the Medicare patient is 50-plus years old, he is eligible for a covered Medicare screening, confirms Dena Rumisek, CPC, biller at Michigan’s Grand River Gastroenterology PC.

However:

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Migraine ICD-9 Codes: How Do I Get My 5th Digits Right?

Posted on 18. Feb, 2010 by Editor.

Discover what the 5th digit represents and why you need it on your claim.

Question: A presents to the ED with complaints of a headache that’s worsening daily. He is experiencing visual blurring and nausea but no vomiting. This is the third headache of this nature in three weeks, and it has lasted “four or five days.” Documentation indicates a detailed examination and history; after performing the assessment and speaking to the patient, the physician documents migraine with typical aura and status migrainosus Treatment options include acute intervention with prescription, but the physician feels the patient needs to add prophylactic medicine treatments, since the headaches appear to be reoccurring. What migraine ICD-9 code represents this patient’s headache?

Tennessee Subscriber

Answer: This sounds like a migraine with status migrainosus. On the claim, report the following:

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Medicare’s Consult Rule Trickle Down Effect

Posted on 18. Nov, 2009 by jennifer.godreau.

And what it means for pediatric practices. A report from AMA in Chicago.

Although CPT clarifies the transfer of care definition, the fix came too late for Medicare, meaning your private payers may follow suit.

Continued Errors Result in E/M Boon

The Office of Inspector General found a high error rate on consultation codes. Different opinions on when a transfer of care occurs versus a consultation caused $1.1 billion in incorrect payments. “We couldn’t even all agree on some scenarios,” admitted William J. Mangold, Jr., MD, JD, Noridian Administrative Services’ (Arizona, Montana, Utah, Wyoming) Medicare contractor medical director in the carrier response section to Day 2′s opening session at the CPT and RBRVS 2010 Annual Symposium in Chicago.

Pediatricians who don’t regularly code consults could gain from Medicare getting fed up with the inconsistency and invalidating the codes for payment in 2010. CPT still maintains the codes. CMS, however, will take the payments for 99241-99255 (Consultations) and redistribute them to office visits (99201-99215), hospital care (99221-99233), and nursing home (99304-99310) codes. This will create a 6 percent boost for primary care in E/M reimbursement from private payers that adopt the 2010 Medicare Physician Fee Schedule.

Get ready for ‘Dante’s Inferno,’ says one veteran coder.

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Neonatal Critical Care Coding: CPT 2010 Clarifies Resuscitation Guidance

Posted on 15. Nov, 2009 by jennifer.godreau.

Payers denying 99465-25? Here’s help straight from the AMA Symposium in Chicago.

Question: There’s a notation in the CPT 2009 manual that the neonatal critical care codes include delivery room resuscitation. Is this true?

Answer: No, a parenthetical note following 99465 (Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output) incorrectly stated that resuscitation could not be reported with other per day critical care services, said Peter A. Hollmann, MD, AMA CPT Editorial Panel, Vice Chair in his “Evaluation and Management” presentation at the AMA CPT and RBRVS 2010 Annual Symposium in Chicago on Nov. 12.

You can separately report 99465-25 (Significant, separately identifiable evaluation and management service provided by the same physician on the same day of the procedure or other service) provided the resuscitation in the delivery room is provided as a medically necessary service and not as a convenience prior to moving the patient to the neonatal intensive care unit (NICU) for critical care (99468, Initial inpatient neonatal critical care, per day, of r the evaluation and management of a critically ill neonate, 28 days of age or younger) or intensive care (99477, Initial hospital care, per day, for the evaluation and management of the neonate, 28 days of age or younger, who requires intensive observation, frequent interventions, and other intensive care services).

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CMS at AMA Chicago: We’re Reducing Consult Request Requirement

Posted on 13. Nov, 2009 by jennifer.godreau.

CMS auditors will look for 1 less thing in consult documentation.

With Medicare’s invalidation of consultation codes 99241-99255 in 2010, your ICD-9 codes better prove why two MDs are necessary on the same patient’s hospital care or the physician better specify why in his note.

Separate ICD-9 codes will help substantiate the medical necessity for providing consultative services, explained Kenneth B. Simon, MD, MBA, CMS senior medical officer, in “Medicare Physician Payment Schedule 2010 Changes and Beyond” at the AMA CPT and RBRVS 2010 Annual Symposium in Chicago. If an auditor reviews your hospital code (99221-99233) documentation, different diagnoses will show why more than one physician’s E/M was necessary on the same patient. Next — what auditors WON’T be looking for …

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2010 Tumor Excision Coding: Lesion Vs. Chunk Size

Posted on 13. Nov, 2009 by jennifer.godreau.

Straight from the AMA in Chicago — answers to your lesion excision coding questions for 2010.

Question: A thigh lesion measures 2 cm but requires a resection down to the subcutaneous layer of 4 cm. Which lesion excision code should I use?

Answer: “You should use the larger of the subcutaneous codes,” says Albert E. Bothe, Jr, MD, FACS, with the American College of Surgeons in “Excision of Soft Tumors/Bone Tumors” on the final day of the AMA CPT and RBRVS 2010 Annual Symposium. The size of the lesion is the lesion. “The defining size is the size of the resection” or the mass that’s taken out, Bothe stressed.

If all that the surgeon takes out is the lesion, you would use the lesion size or 2 cm as the lesion excision. But if the surgeon indicates the larger size of the tissue he also has to take out, you assign the excision code based on the resection size. You mention that the resection size is 4 cm, which is more than the 3-cm cut point stipulated in 27327′s new 2010 description (Excision, tumor, soft tissue of thigh or knee area, subcutaneous; less than 3 cm). Therefore, you would use 27337 (… 3 cm or greater). Don’t miss this documentation must …

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What’s the Code for ‘Fir Tree in Lung’?

Posted on 24. Apr, 2009 by .

The mainstream press has been buzzing about the live fir tree that Russian doctors removed from a man’s lung. Some say the story just has to be an urban myth. But here at Coding News, we have other fish to fry (or firs to code). How would you code it? Here’s the ‘op note,’ if you will.

Twenty-eight-year-old Artyom Sidorkin presented complaining of chest pain and coughing up blood. An x-ray revealed what doctors thought was a malignant lung tumor, so they took him into surgery. Instead, physicians found a 3-inch live fir tree growing in his lung tissue. One Russian surgeon thinks the young man swallowed a seed, which then grew. Please click here for full story and photos from an English-language Russian news site.

So what would be the correct coding if this case occurred in the US? How about …

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Should You Bill Injection With TB Test?

Posted on 21. Jan, 2009 by .

Challenge: When a patient reports to the physician for a tuberculosis (TB) skin test, can you report the injection separately with 96372?

Answer: No, you cannot report 96372 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) on this claim. The TB test is not a subcutaneous or intramuscular injection, and the code for the TB skin test includes the injection service. On the claim, report the following:

86580 (Skin test; tuberculosis, intradermal) for the test with V74.1 (Special screening examination for bacterial and spirochetal diseases; pulmonary tuberculosis) linked to show the reason for the test.

Testing for other infectious diseases? William Dettwyler can help keep your coding straight.

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