Separate Depth Needed for Modifier 59 Appended Debridement, Per AMA

Posted on 18. May, 2012 by jennifer.godreau.

CPT® Assistant March 2012 gives tons of examples on proper usage of modifier 25 and modifier 59 including with debridement, arthrocentesis, knee pain at a preventive medicine service, and more. Test your skills with this example (“Debridement Guidelines Update”, CPT® Assistant, March 2012, p. 5):

“A patient undergoes debridement of a subcutaneous wound on the left arm measuring 10 sq cm, a subcutaneous wound on the right arm measuring 20 sq cm, and a 10 sq cm wound, including the bone on the left foot.”

“Although located at

Continue Reading

AK Removals: Earn $120 by Following 17000-17111 with 99201

Posted on 21. Mar, 2011 by .

Stick to these 3 tips for your E/M and lesion removal procedures.

You can report both the E/M and lesion removal if the E/M service was a significant and separately identifiable service for an E/M service with actinic keratoses (AK) removal procedure.

Always verify with your carrier before appending modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.

You can only consider reporting modifier 25 when coding an E/M service, says Janet Palazzo, CPC, coder for a practice in Cherry Hill, N.J. If the procedures you are reporting don’t fall under E/M services, it is possible the encounter qualifies for another modifier instead.

Have a look at the following three tips to help you report these services accurately so your practice

Continue Reading

Is 99211 + 95115 OK?

Posted on 06. Dec, 2010 by jennifer.godreau.

Question: If a nurse has to check vitals to make sure an allergy injection is the correct quantity or if she has to educate the patient about the administration or side effects of the injections, we’ve been billing 99211 with 95115 or 95117. There is only 1 diagnosis for both CPT codes. We are getting denials for the injection. Can we attach modifier 25 to 99211 or should we consider 99211 included in the injection?

Answer: You may report 99211 and 95115/95117. There is no National Correct Coding Initiative edit on the codes.
You, however, should not use 99211 every time you are giving an allergy injection. Providers may bill for a nurse-only 99211 when dealing with clinical issues surrounding allergy injection administration, according to a Joint Council of Allergy, Asthma and Immunology (JCAAI) member letter.
The nurse must document the medically necessary E/M service that she provided. The JCAAI suggests the service could represent directing a nurse who gives injections on what to do if a patient was ill;

Continue Reading

No Correct Coding Initiative Bundle? Find Modifier Details in MPFS.

Posted on 23. Nov, 2010 by jennifer.godreau.

Question: Sometimes I cannot find my two-code pair in the CCI edits. How do I know which code would be considered a column 1 code and which would be considered a column 2 code, so that I could put my modifier on the correct code?

Answer: If the codes are not listed, the codes are not bundled per the Correct Coding Initiative (CCI). You would not need a CCI modifier, such as 25 (Significant, separately identifiable evaluation and management service by the same physician on  the same day of the procedure or other service), 57 (Decision for surgery), or 59 (Distinct procedural service), to override the edit when appropriate.

A private payer could have a black box edit. You would need to

Continue Reading

Use 3 CPT, Modifier, and ICD-9 Code Pairs to Ace This X-Ray Claim

Posted on 24. May, 2010 by Editor.

Decipher why you should include a seconding diagnosis.

Question: A 38-year-old patient presents to the emergency room with complaints of wheezing, coughing, and trouble catching her breath. After the nonphysician practitioner (NPP) performs a problem-focused history, the physician performs a detailed history and exam and discovers focal ronchi. The physician orders a two-view chest x-ray to check for upper respiratory infection (URI) The chest x-ray results reveal acute URI, and the ronchi clears up upon reevaluation. The patient is treated with antibiotics. How should I code this scenario?

Answer:

Continue Reading

Ensure Counseling Claims With Pointed Questions

Posted on 09. May, 2010 by Editor.

This modifier is key to E&M and counseling codes cohabiting on your claim.

Question: Can I report alcohol cessation counseling codes along with E/M codes, or do I have to choose one or the other?

Idaho Subscriber

Answer: You can, and in most cases will, report counseling codes along with E/M services. The behavior change intervention codes are intended to be reported in addition to an E/M service when the provider furnishes them. Most counseling sessions occur after the provider performs some sort of E/M. Consider this case study:

Continue Reading

3 Situations Boost Your Migraine Treatment Smarts

Posted on 02. May, 2010 by Editor.

Acute episodes, check-ups are both routine for these patients.

When migraine headache coding comes up, ICD-9 codes typically dominate the conversation.

But what about the procedure codes those complicated migraine diagnoses are attached to? There are several common situations in which a migraine patient might report to the family physician (FP). Check out the top three migraine treatment scenarios, along with expert coding advice on each situation.

Situation 1: Separate E/M and Acute Migraine Tx

One of your FP’s patients might report to the practice with symptoms, and then end up requiring treatment for an acute migraine headache. Consider this example …

Continue Reading

Follow 3 Steps on the Path to Paid Cerumen Removal

Posted on 15. Apr, 2010 by Editor.

Medicare won’t pay 69210 alone, so here’s how to unlock payment.

Impacted cerumen removal is a fairly straightforward procedure, but billing for the procedure is not always so simple.

The problem: Most payers, including Medicare,consider 69210 (Removal impacted cerumen [separate procedure], one or both ears) to be a minor procedure. But unlike with other minor procedures, they only pay for an E/M service as well as the removal of the impacted cerumen when you have two unrelated diagnoses — one for the E/M service and 380.4 (Impacted cerumen) for the removal of impacted cerumen.

The solution:

Continue Reading

Face Off Against Common Sports Physical Coding Challenges

Posted on 15. Apr, 2010 by Editor.

Hint: Gathering upfront pay and watching E/Ms make a difference.

Children need physicals to participate in their favorite sports year round, but the demand can grow with warm weather approaching. Ideally, the need for sports physicals should provide the opportunity to offer complete age-appropriate medical exams following the American Academy of Pediatrician’s Bright Futures Guidelines. If your practice runs into reimbursement obstacles for full-scale physicals, however, follow our experts’ advice to code correctly and still stay in the game.

Tackle Coverage Issues

Continue Reading

Look for Incision Evidence in Foreign Body Removal (FBR) Scenarios

Posted on 28. Mar, 2010 by Editor.

Here’s why you should append modifier 25.

Question: A 47-year-old male reports to the ED complaining of a painful, swollen, and reddening right thumb. The physician performs an expanded problem focused history and examination, which uncovers two splinters. The ED physician cannot grasp the splinters with tweezers, so she uses a scalpel to make two small incisions above the splinters. The physician then uses tweezers to remove both pieces of wood. The notes do not indicate evidence of infection at the extraction site; medical decision making is moderate. Can I code this as a foreign body removal (FBR)?

Kentucky Subscriber

Answer: Since the physician made an incision before removing the splinters, this is an FBR. On the claim, report the following:

Continue Reading