NCCI Edits: Watch Out For These Endoscopy Bundles

Posted on 01. Jun, 2010 by Editor.

Code 31575 includes 92511 and 31231 except under these conditions.

Singling out the correct endoscopy code when your otolaryngologist examines multiple areas in the sinuses and throat isn’t always easy, but in most cases it’s imperative to settle on one, according to National Correct Coding Initiative (CCI) edits. You can adhere to these edits and avoid payback requests if you stick to these guidelines.

3 Rules Guide the Way

Rule #1: Never report 92511 (Nasopharyngoscopy with endoscope[separate procedure]) and 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) together, says Stephen R. Levinson, MD, otolaryngologist and coding consultant based in Easton, Conn. Code 92511 is a component of Column 1 code 31231. The bundle has a modifier indicator of “0” — thus, no modifier can break this bundle.

Rule #2: Code 92511 is a component of Column 1 code 31575 (Laryngoscopy, flexible fiberoptic; diagnostic) but a modifier is allowed in order to differentiate between the services provided (that is, you may append modifier 59 [Distinct procedural services] if there are separate and identifiable services with separate medical indications). Report 92511 in conjunction with 31575 for the same encounter, says Levinson, only if the following conditions are met:

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Make Sure You’re Applying Massive Prostate Biopsy, Urethral Dilation Bundlings

Posted on 20. May, 2010 by Editor.

Modifier 59 sometimes will rescue your reimbursement.

Just when you’re finally getting a handle on all the 2010 coding changes, here comes round two of the Correct Coding Initiative (CCI) edits. Version 16.1, which took effect April 1, will tie your hands when coding many common urology procedures, including prostate biopsies and urethral dilations.

Heads up: CCI 16.1 includes 2,054 new active pairs and 1,947 modifier changes, says Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions Inc. in Clearwater, Fla.

“For urology, there will be 78 edit pair additions and two edit pair deletions,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook.To ensure you get paid appropriately for your urologist’s services this quarter, here’s the rundown of the most important changes.

Say Goodbye to Biopsy with Several Prostate Procedures

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Compliance Red Flag: Update Your Modifier 59 and ‘Incident To’ Guidelines

Posted on 23. Apr, 2010 by Editor.

Keep signature, modifier 59, and ‘Incident To’ guidelines front and center.

If you’ve been worrying that the oncologist’s illegible signature on an order is going to come back to haunt your practice in an audit, CMS has offered
answers on when you’re in the clear and when that untidy scrawl could have reviewers requesting additional information.

1. Get Signature Guidelines Down Pat

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Put Your Rehab Coding and Billing Knowledge to the Test

Posted on 19. Apr, 2010 by Editor.

This quick quiz will show you where you fall.

Want to stay polished on your coding and billing skills to ensure stellar reimbursement and compliance? Give this quiz a whirl, and then turn to page 21 for the answers — where the experts chime in with their two cents.

Questions:

1) Which of the following is an example of a skilled AND billable therapy service?

• a) A patient is exercising on a bike while you monitor him, and you code for therapeutic exercise (CPT 97110).
• b) A patient is exercising on a bike while you actively coach the patient on technique and muscles he needs to strengthen to reduce knee pain. You code for therapeutic exercise (CPT 97110).
• c) A patient is doing self stretching exercises for the shoulder using the pulleys while you are performing manual therapy on another patient.

2) You get a new Medicare patient who needs occupational therapy for two unrelated diagnoses from different physicians. How should you charge for your initial eval?

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CCI 16.1: Seize the Opportunity to Report 0193T — But Don’t Get Tripped Up By These Edits

Posted on 15. Apr, 2010 by Editor.

Overlooking these new Interstim and hemorrhoid destruction bundles could mean denial headaches.

Payers like Noridian Part B will cover the female stress urinary incontinence treatment code 0193T, but before you submit a 0193T claim, you’ll have to check with the correct coding initiative (CCI) version 16.1’s edits. For instance, as of April 1, the work represented by 0193T will include that of cystourethroscopy codes 52000-52001 and 52281.

Don’t let CCI version 16.1’s lack of ob-gyn mutually exclusive edits lull you into a false sense of security. Here’s what you need to know to prevent a denial from landing on your desk.

1. Look For 0193T in Both the Column 1, Column 2 Position

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Among 2054 Edits, Correct Coding Initiative 16.1 Scraps Cardiology Bundle

Posted on 28. Mar, 2010 by Editor.

Help is here: One troublesome, confusing edit is no longer an issue.

You may still be getting to know your CPT 2010 manual, but the new edition of CCI, effective April1, is already looking to make some code pairings impossible.

The Correct Coding Initiative (CCI) released version 16.1 earlier this week, revealing 2,054 new active pairs and 1,947 modifier changes, said Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc., in a March 22 announcement.

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Build a Firm Foundation for Plantar Fasciitis Coding And Get Your Claim Paid

Posted on 25. Mar, 2010 by Editor.

Keep tabs on details to help justify more extensive treatments later.

Plantar fasciitis — a condition in which the plantar fascia becomes inflamed and painful — is the most common form of heel pain and can be treated many different ways. Keep up with the latest on correct diagnosis and treatment options so you’ll have a paper trail to support medical necessity at every level.

Start With a Single Diagnosis

With heel pain affecting nearly 2 million Americans and ranging from mild discomfort to debilitating pain, it’s not uncommon for a patient to call on your orthopedist before visiting a podiatrist, especially if your surgeon has treated the patient for other problems. Most plantar fasciitis pain is located close to where the fascia attaches to the calcaneous, or heel bone.

The exact cause is unknown, but once your physician diagnoses plantar fasciitis you’ll report diagnosis 728.71 (Plantar fascial fibromatosis) says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Lawrenceville, Ga.

Know the Most Likely Injection Options

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Horizon BCBS Modifier Cut May Threaten Your Income

Posted on 24. Mar, 2010 by Editor.

Upcoming policy change will slash your payments by half.

Big changes are on the horizon if you participate with insurance provider Horizon Blue Cross Blue Shield (BCBS) of New Jersey.

In a recent memo, BCBS states that effective May 17, 2010, they will cut reimbursement by half on many modifiers, regardless of the circumstances surrounding their use. Your practice might stand to lose thousands of dollars. Take a look at the policy details.

Beware a New Reimbursement Trend

The February 2010 memo offers a list of modifiers that BCBS states “will be considered nonstandard — that either the full service was not performed or that the service in question was performed in conjunction with another service or procedure.”

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Modifiers, not Math, Make Multi-Excision Claims Go

Posted on 15. Mar, 2010 by Editor.

Measuring total removal lengths is a no-no … here’s why.

Your ED physician removes a pair of benign lesions from the patient’s left thigh; you add the repair lengths and code based on those numbers. You’ve coded correctly … right?

Wrong: Many coders get tripped up by lesion removal codes, which are governed by different rules than lesion excision codes. Get the real lowdown on coding multiple lesion excisions right here, and you’ll get it right every time.

CPT, Experts Agree: Don’t Add Lengths

When your physician removes multiple lesions, “code for each individual lesion; this is not like laceration repairs, where you combine the length of all of the same body area/complexity wounds,” explains Sharon Richardson, RN, compliance officer at Emergency Groups’ Office in Arcadia, Calif.

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Surgery Coding: Look at Service Date Before Appending Modifier 59

Posted on 12. Mar, 2010 by Editor.

Make sure your documentation supports the additional substantial complexity of the hernia repair and mesh.

Question: A patient presented for a colectomy for colon cancer. The physician also discovered that the patient had a ventral incarcerated hernia that required a complex repair using mesh. Because of the separate work, we reported 44140 and then reported 49561 with modifier 59. The payer denied the claim. Were we wrong to append modifier 59?

Mississippi Subscriber

Answer: You might think you can append modifier 59 (Distinct procedural service) to the hernia repair code and bill it separately. After all, the hernia repair seems to qualify as a different reason for surgery than the colectomy — for example, if the patient has a recurrent hernia. But modifier 59 tells the payer the hernia repair happened at a separate session, which isn’t true in your case.

If the physician’s documentation proves justification, you might try …

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