Collect HPV Pay with Proper Screening vs. Reflex Diagnoses

Posted on 10. Jun, 2010 by Editor.

Align ‘medical necessity’ with ICD-9 instruction.

Ordering a human papillomavirus (HPV) screen with a Pap test isn’t the same as ordering a reflex HPV screen following an abnormal Pap. Although ICD-9 instruction and coverage rules might appear to be at loggerheads, our experts can show you the way out.

Question: Should the physician order a screening and/or reflex HPV Pap test (such as 87621, Infectious agent detection by nucleic acid [DNA or RNA]; papillomavirus, human, amplified probe technique) with V73.81 (Special screening examination for human papillomavirus [HPV])?

What you stand to gain: “Many ‘V’ codes are paid as part of a screening benefit for patients who have those specific benefits,” says Tina Burkhalter, billing manager with SouthEastern Pathology in Rome, Ga. On the other hand,

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Avoid CVA Diagnosis Coding Pitfalls with 438.13, 438.14

Posted on 17. May, 2010 by Editor.

You’ll turn to a V code when your neurologist reports ‘no effects,’ however.

When your neurologist sees a patient who had a stroke, either recently or in the distant past, he may record a number of different conditions — which makes your job more difficult. If you remember a few guidelines, you’ll select the proper ICD-9 codes for every cerebrovascular accident (CVA) case your neurologist treats.

Get Specific With 2 CVA Diagnosis Codes

When your neurologist sees a patient who has had a stroke, or CVA, he may document multiple deficiencies, both new and lingering. When the patient presents with speech and language deficits you have two diagnosis codes to choose from.

To help both differentiate the etiology of speech and language deficits, and to add specificity to those deficits, ICD-9 2010 includes two cerebrovascular disease lateeffects codes: 438.13 (Late effects of cerebrovascular disease, speech and language deficits, dysarthria) and 438.14 (…, fluency disorder [stuttering]).

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Unlock Pay With Anesthesia V Code Advice

Posted on 07. May, 2010 by Editor.

Don’t be caught asleep: Patient history is one element of proper Dx coding.

Many coders hesitate to report V codes, or simply use them incorrectly, but sometimes this section of ICD-9 most accurately describes the reason for the patient’s condition. In fact, V codes are often essential to reporting an anesthesia patient’s medical history.

If you’re not clear on the importance of V codes, check out these expert-approved answers to some often-asked questions:

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CMS Announces Over 100 New ICD9 Codes, Effective Oct. 1

Posted on 05. May, 2010 by Editor.

Get ready for the dawn of new jaw pain, BMI codes, among others.

If you’ve got high hopes that you’ll benefit from many new ICD-9 codes starting this fall, CMS delivers, with over 130 new diagnosis codes debuting on Oct. 1. CMS published the full listing of codes in a 1,000+ page Federal Register file, but we’ve reviewed the list, and it offers a few surprises.

Over one-third of the new codes can be found in the “V” code section, which describe “supplementary classification of factors influencing health status and contact with health services,” according to the ICD-9 manual.

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PT Coders: Clinging to MD Approval? Check This Out

Posted on 16. Apr, 2010 by Editor.

Question: Our hospital billing and medical departments say that diagnoses we add to a claim for reimbursement must have a physician endorsement. We’ve researched our Local Coverage Determination (L26884) from National Government Services, the Ingenix Coding & Payment Guide for the Physical Therapist, and our Indiana Practice Act but can’t find a conclusive reference stating a physical therapist can make a treating diagnosis without an MD’s endorsement. Our billing dept suggested we send all POCs to the MDs for co-signature. But we’d rather not increase the paper flow to the MDs.

Can you offer a reference that states PTs can make treating diagnoses that can stand alone without the MD endorsement?

Indiana subscriber

Answer:

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Get a Glimpse at ICD-10 Codes for Cough, Back Pain, and More

Posted on 24. Mar, 2010 by Editor.

Wrap your brain around using letters in your diagnosis codes.

If you aren’t curious about how the ICD-9 codes crosswalk to ICD-10, maybe you should be.

“The transition date for ICD-10 codes is Oct 1, 2013,” stressed CMS’s Stewart Streimer during a CMS-sponsored Open Door Forum. “That’s really the drop-dead date for those of you that have familiarized yourselves with the Final Rule regarding ICD-10 … but there are a lot of things that must happen before then, and I expect many of the payers may even require ICD-10 codes before then so a sufficient amount of testing can take place,” he said.

Choosing Vendors? Speak Up

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Coding Generalized Bronchitis? Prepare for Denials

Posted on 24. Mar, 2010 by Editor.

Relying on the physician’s encounter form could be a big mistake.

Question: I used 491.9 to report a patient’s bronchitis, but the payer denied my claim and requested additional information. What was wrong?

Vermont Subscriber

Answer: Your claim may have been denied because you chose an unspecified chronic bronchitis code (491.9, Unspecified chronic bronchitis) instead of a more specific ICD-9 code.

Here’s how to avoid “diagnosis coding” denials next time:

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Ob-gyn Coding Challenge: Deliver Postpartum V Codes With Care

Posted on 10. Mar, 2010 by Editor.

Bonus: Get exposure to ICD-10 coding equivalents.

Question: A mentally-challenged patient who delivered at home was admitted to the hospital for postpartum care. The patient delivered the placenta at home, and once admitted, she had no complications, but the ob-gyn did perform a first degree laceration repair. I’m not sure what diagnosis code to report. Should I look at routine postpartum care or pregnancy complications? And if I use a complication code, what would the fifth digit to a “1″ or “0?”

Texas Subscriber

Answer: Under most situations where the ob-gyn treated no problems during the admission, you would code V24.0 (Postpartum care and examination; immediately after delivery) on the admission date and V24.2 (Routine postpartum follow-up) for any subsequent routine care.

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Ob-gyn Coding Challenge: EM End-Result Tells You What ICD Code To Go For

Posted on 03. Mar, 2010 by Editor.

Check out these ICD-10 ob-gyn diagnosis coding equivalents.

Question: A patient presented for an initial OB visit. Another clinic confirmed her pregnancy, but she has never received prenatal care. The patient got her usual initial OB service (i.e. lab orders), Pap smear, and chlamydia trachomatis (CT)/neisseria gonorrhoeae (GC) screening. After discussing some concerns with the patient, the ob-gyn ordered another pregnancy test which came out negative. He ordered an ultrasound (US) which showed no intrauterine pregnancy. The ob-gyn noted bilateral polycystic ovaries, however. In short, the office completed the initial OB visit prior to knowledge of a negative pregnancy test (given the confirmation documentation of a positive pregnancy test). I’m not sure whether to bill it as an initial or an office visit. What code should I use for the first diagnosis?

California Subscriber

Answer: Your clue is to code what you know at the end of the visit. Since the patient was not pregnant, you should report …

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ICD-9 Coding: Stop Asking ‘Which Diagnosis Code Will Get My Claim Paid?’

Posted on 22. Feb, 2010 by Editor.

Assigning an ICD-9 code merely to get your claim paid could land you in legal hot water.

Medical coders face a lot of questions each day in the course of their work, but one question you should not be asking is “which diagnosis code should I put on this claim if I want to collect?”

When the Insider solicited subscribers’ questions last week, the overwhelming majority asked questions such as, “We performed xyz procedure — can you tell me which diagnosis codes we can report to Medicare to get this claim paid?”

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