The April quarterly I/OCE update brought relatively few changes, though CMS has continued to refine skin substitute reporting. Dave Fee, MBA, reviews the updated skin substitute categories, as well as updates to laboratory billing.
Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD , looks at common dermatology conditions, including non-pressure chronic ulcers and psoriasis, as well as new concepts coders will need to look for to report these conditions in ICD-10-CM.
Recovery Auditors have found that modifier misuse is resulting in underpayments to providers, according to the most recent Medicare Quarterly Provider Compliance Newsletter .
Some facilities plan to use both CPT ® and ICD-10-PCS to code procedures after implementation. Kristi Stanton, RHIT, CCS, CPC, CIRCC, and Angie Comfort, RHIT, CDIP, CCS, discuss the advantages and challenges of this strategy, and how to implement it.
Q: My office often has denials of evaluation and management (E/M) visits with our OB patients when using HCPCS modifier -GB (claim being resubmitted for payment because it is no longer covered under a global payment demonstration). Would coding with V22.2 (pregnant state, incidental) as a secondary diagnosis possibly alleviate this issue?
Coders are very familiar with the diagnosis codes they use frequently, but the look of those codes will change in ICD-10-CM. Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD , reviews common dermatology conditions and how they will be reported with the new code set.
CMS' Comprehensive Error Rate Testing (CERT) program found "many" improper payments in a review of Part B psychiatry and psychotherapy services claims, according to the most recent Medicare Quarterly Provider Compliance Newsletter .
The ICD-10 implementation delay has impacted training timelines for many providers. Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC , talks about how this time can be used to improve physician documentation, easing the transition for both coders and providers.
Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, reviews which diagnosis codes, in both ICD-9-CM and ICD-10-CM, Medicare recently approved to provide medically necessary for inserting pacemaker systems.
A review of Medicare CT scan claims from July 2011 to June 2012 found that 16% claims had an improper payment rate, according to the most recent Medicare Quarterly Provider Compliance Newsletter .
Q: I have been told to use the general surgery CPT ® codes in the 20000 series for reporting excisions of sebaceous cysts when the surgeon must cut into the subcutaneous layer. I don’t agree with this, since the 20000 codes do not give ICD-9-CM code 706.2 (sebaceous cyst) as a billable diagnosis code. Because a sebaceous, epidermal, or pilar cyst begins in the skin and may grow large enough to press into the subcutaneous layer, I think we should report an excision code from the 11400 series, and if need be, the 12000 codes for closure.
Providers struggle to reconcile conflicts between recent CMS regulations and the CPT® Manual and other AMA publications. Jugna Shah, MPH , Valerie A. Rinkle, MPA , and Linda S. Dietz, RHIA, CCS, CCS-P , look at specific areas of confusion and how to code them accurately.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, explains how reporting multiple gestations will change in ICD-10-CM, including greatly expanded specificity and replacements for V codes from ICD-9-CM.
Q: My question is about the time interval requirement of the CPT ® add-on code 96376 (each additional sequential intravenous push of the same substance/drug provided in a facility [list separately in addition to code primary procedure]), which says that more than 30 minutes must pass between administrations of same substances in order to report it. In our ED, cardiac patients are frequently started on heparin—a bolus given for less than 16 minutes and a drip given over several hours. These are frequently charted in the electronic record as having been given at the same time. In this case, is it still appropriate to report 96365 (intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour) for the first hour of drip and 96376 for the bolus, or must the administration be given greater than 30 minutes apart?
Hyperbaric oxygen therapy is only covered for certain diagnoses after extensive prequalification. Gloria Miller, CPC, CPMA, reviews how HBO therapy can be used for wound care, as well as 2014 changes for wound care clinics.
On Monday, the Senate passed a House of Representatives bill on Medicare payments that included a provision to delay ICD-10 implementation until at least October 1, 2015.
In the Medicare Quarterly Provider Compliance Newsletter , CMS writes about auditor findings for MRI scans that did not meet medical necessity and how to ensure documentation that supports it.
Q: When coding excision of a breast mass with needle localization using stereotactic guidance, we report CPT ® code 19125 (excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion) and new code 19283 (placement of breast localization devices, percutaneous; first lesion, including stereotactic guidance). The 3M system says Medicare NCCI edits consider this separate reporting of codes that are components of the comprehensive procedure if billed for services provided to the same beneficiary by the same physician on the same day. These codes will be rebundled by the Medicare payer and payment will be based on code 19125 only. Does that mean to only report 19125 for this kind of case? If there is an excision of a lesion by one surgeon and needle localization done by a radiologist, can we report 19125, with 19283 and modifier -59 (distinct procedural service)? We can’t find any official reference for this issue for 2014. How do we code excision of a breast mass with needle localization now?
Even though ICD-10-CM respiratory changes are relatively minor, coders will still have to learn the new guidelines and review anatomy and physiology in order to report them accurately. Tara L. Bell, RN, MSN, CCM, AHIMA-approved ICD-10-CM/PCS trainer, and Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CPC-I, CHA, AHIMA-approved ICD-10-CM/PCS trainer, highlight the changes and new guidelines.
