Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, reviewsCPT® coding for interrupted pregnancies, while also highlighting changes coders can expect for related diagnoses in ICD-10-CM.
Dave Fee, MBA, identifies updates to CMS' programming logic for comprehensive APCs and provides a step-by-step approach to determine whether a complexity adjustment will be applied.
Reporting procedures for the skin can require a variety of documented details, such as location, severity, and size. John David Rosdeutscher, MD, and Gloria Miller, CPC, CPMA, CPPM, explainwhich details coder should look forto accurately report excisions, closures, and other wound care services.
Peggy Blue, MPH, CPC, CCS-P, CEMC, and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, review code changes in the 2015 CPT® Manual's Medicine section, including newly available products and services.
Q: If a patient is given Reglan ® intravenously at 12:20, 13:00, and 13:20, would this be considered an IV push because the clinician did not document a stop time?
A Comprehensive Error Rate Testing (CERT) study of transcatheter aortic valve replacement/implantation (TAVR/TAVI) services found that approximately one third of the claims received improper payments, mostly due to insufficient documentation, according to the latest Medicare Quarterly Compliance Newsletter.
Q: Our electronic health record system only provides for a "yes/no" choice under smoker. How can we capture the additional details necessary for an ICD-10-CM code assignment?
Shelley C. Safian, PhD, RHIA, CCS-P, CPC-H, CPC-I, discusses how to code for burns and corrosions in ICD-10-CM, which requires at least three codes to indicate the site and severity, extent, and external causes.
Providers who want to volunteer to participate in CMS' final round of ICD-10 end-to-end testing have until April 17 to sign up through their Medicare Administrative Contractor's (MAC) website.
Cardiovascular coding can be challenging even without the introduction of new codes and concepts in ICD-10-CM. Laura Legg, RHIT, CCS, and Shelley C. Safian, PhD, RHIA, CCS-P, CPC-H, CPC-I, review the anatomy of the cardiovascular system and highlight some of the key changes in ICD-10-CM.
Jennifer E. Avery, CCS, CPC-H, CPC, CPC-I, and Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD, look at frequently diagnosed mental disordersand note changes for reporting them in ICD-10-CM.
Q: I have a question regarding a National Correct Coding Initiative (NCCI) edit. I reported CPT ® code 80053 (comprehensive metabolic panel) and 84132 (potassium; serum, plasma or whole blood), resulting in an NCCI conflict. This code pair does allow modifier -59 (distinct procedural service) to be appended to one of the codes to be paid for both tests. Does it matter if we append modifier -59 to the primary code or the secondary?\ In my case, sometimes the secondary code is already dropped into the system and now the edit is asking me to append the modifier. Can I add modifier -59 to 80053 whether it's the primary code or not?
Coders may be familiar with the term "fetal distress" in physician documentation, but its lack of specificity can limit code selection. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, explains what coders can look for in documentation to report the most accurate ICD-9-CM and ICD-10-CMfetal status codes.
Physician coders won't be able to just report the CPT ® code that best describes the procedure for some digestive system services in 2015. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC, explain why some payers, including CMS, may require new G codes for certain procedures and how the G codes map to related CPT codes.
The musculoskeletal and nervous system sections of the 2015 CPT Manual include dozens of new and revised codes to accommodate the latest technologies and procedures. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Peggy Blue, MPH, CPC, CCS-P, CEMC, review the codes and highlight important instructional notes in the guidelines.
CPT ® codes in 2015 for cardiovascular procedures include the ability to report several new technologies and procedures. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC, explain the procedures and what coders will need to look for in documentation to select the correct code.
Q: Would it be appropriate to report CPT ® code 75984 (change of percutaneous tube or drainage catheter with contrast monitoring [e.g., genitourinary system, abscess], radiological supervision and interpretation) for the following procedure: A small amount of contrast was injected through the indwelling nephrostomy drainage catheter. This demonstrated the catheter is well positioned within the renal collecting system. There is a small amount of thrombus attached to the tip of the pigtail catheter. The existing catheter was cut and a guidewire was advanced through the catheter into the renal collecting system. The existing catheter was removed over the wire and exchanged for a new 10 French nephrostomy tube. The catheter was secured to the skin with 2-O suture and covered with a sterile dressing.
Providers report excessive units for initial IV infusions for both chemotherapy and non-chemotherapy drugs, according to the results of an audit reported in the January 2015 Medicare Quarterly Provider Compliance Newsletter .
CMS' January I/OCE update brought many changes, including new codes, status indicators, and modifiers. Dave Fee, MBA, reviewsthe latest changes and when they will be implemented by CMS.
Debbie Mackaman, RHIA, CPCO, CCDS, discusses modifier -59 (distinct procedural service) use, including the latest guidance from CMS on the four new, more specific replacements—and how more guidance is needed before providers can feel comfortable using them.
Drug administration coding and billing remains a challenge despite no code changes in six years. Jugna Shah, MPH, and Valerie RInkle, MPA, examine how to apply the new -X{EPSU} modifiers with drug administration codes and review other common questions they receive about injections and infusions.
Eighty-four percent of providers experienced no major problems with early ICD-10 acknowledgement testing, according to a recent AAPC survey of more than 2,000 providers.
Q: Is it correct to append modifier -52 (reduced services) to a procedure code when the physician performed the procedure, but did not find a mass? This was unexpected, so the surgeon went deeper into the subcutaneous tissue and still did not find anything. This is the outpatient note for a patient with a history of breast cancer and a new lump on her arm with an indeterminate ultrasound: Under local anesthesia and sterile conditions, a vertical incision was made over the area of the palpable abnormality. We dissected down beneath the subcutaneous tissues. I could encounter no definitive mass or lesions in this area. We went down to the fascia of her bicep. Her biceps appear normal, and the skin and subcutaneous tissue appear normal. My presumption is that this represented some sort of venous anomaly, and I either popped it or incised it during our entry into the skin, and it is now resolved. Would CPT ® code 24075-52 (excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; less than 3 cm) be correct to report?
In the 2015 OPPS final rule, CMS introduced a new modifier for services provided in an off-campus, provider-based clinic. Jugna Shah, MPH, and Valerie Rinkle, MPA, review when the modifier will become required and how it should be reported.
The AMA added a new CPT ® code for chronic care management. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, writes about the time and documentation requirements for reporting this service.
The switch to ICD-10-CM won't bring many changes in the codes for reporting genital prolapse, but understanding the nuances of the diagnoses is key for choosing the correct code. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, highlights terms to look for in documentation and provides a sample operative report to test your knowledge.
Q: When would we use codes from ICD-10-CM category E13 (other specified diabetes mellitus)? If it's secondary diabetes but not due to an underlying condition or drug and is not chemically induced, what kind of diabetes could it be?
Blood tests are a common diagnostic tool for providers trying to determine a patient's condition. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, reviews the components of blood, detailing key terms and conditions coders should know to prepare for ICD-10-CM.
CMS made incorrect payments to hospitals for established patient clinic visits estimated at approximately $4.6 million in 2012, according to a recent Office of Inspector General (OIG) audit.
ICD-10 implementation requires organizational coordination from a variety of departments. Chloe Phillips, MHA, RHIA, and Kayce Dover, MSHI, RHIA, discuss how organizations can overcome challenges regarding staffing, productivity, and data analytics as they prepare for the change.
The nervous system consists of the brain, spinal cord, sensory organs, and other specialized cells throughout the body, and is involved in nearly every bodily function. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, reviews the anatomy of the nervous system and some guidelines changes for it in ICD-10-CM.
After years of consideration, CMS introduced extensive changes for modifier -59 (distinct procedural service) for 2015. Jugna Shah, MPH , explains these changes and when to use the new modifiers instead of modifier -59.
CMS accepted 76% of all national ICD-10 test claims submitted during its November 2014 ICD-10 acknowledgement testing week. More than 500 providers, suppliers, billing companies, and clearinghouses participated in the tests, which identified no issues with Medicare's system.
CMS expanded packaging and finalized Comprehensive APCs in the 2015 OPPS final rule. Jugna Shah, MPH, and Valerie Rinkle, MPA, analyze the changes and the potential impact on providers.
With the ICD-10 implementation date set for October 1, 2015, CMS has continued its efforts to provide education and information to help organizations prepare for the change. Recently, CMS published a recording of its Transitioning to ICD-10 Provider Call and a new Coding for ICD-10-CM video to YouTube.
In part two of a series, Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I , reviews ICD-10-CM Z codes, explaining how and when to use them and how they differ from ICD-9-CM V codes.
Q: If the physician does not perform a formal myelography and just administers an injection before the patient goes straight for computed tomography (CT), which CPT ® code would we report in 2015? The 2015 combination codes are for use when the same radiologist or physician who performs the injection reads his or her own study.
We've compiled the numbers from the latest JustCoding Salary Survey and now you can see how you compare to the average coder in terms of salary, experience, and other factors. Monica Lenahan, CCS, and Susan E. Garrison, CHCA, CHCAS, CHC, CCS-P, CPC, CPC-H , analyze the results and discuss the future of coder salary and responsibilities.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about how to reduce queries by highlighting the information providers need to document for the most common OB ultrasound procedures.
Recovery Auditors have identified improper payments for claims involving end-stage renal disease (ESRD) services when more than one monthly service was billed per month and per-day codes exceeded the limit, according to the latest Medicare Quarterly Provider Compliance Newsletter .
Q: I have a question regarding CPT ® code 99184 (initiation of selective head or total body hypothermia in critically ill neonate, includes appropriate patient selection by review of clinical, imaging, and laboratory data, confirmation of esophageal temperature probe location, evaluation of amplitude EEG, supervision of controlled hypothermia, and assessment of patient tolerance of cooling) in the 2015 CPT Manual . What if the neonate is in the hospital for several weeks? The total body hypothermia is performed, the baby improves, but remains in the hospital and then needs the procedure performed a second time. Can we report it a second time if several weeks have elapsed?
The added detail found in ICD-10-CM may require coders to brush up on their anatomy and physiology training to select the most appropriate codes. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I , reviews the anatomy of the male reproductive system and how coding for it will change in ICD-10-CM.
AHIMA is calling for coders, billers, and providers to contact Congress to ask for no additional delays to ICD-10 after physician groups have recently started to advocate for members to petition Congress to introduce a new, two-year implementation delay to push the compliance date to October 1, 2017.
Q: We have a patient diagnosed with neuropathy due to poorly controlled insulin-dependent Type 1 diabetes mellitus. What should we report in ICD-10-CM?
With the increased specificity required for ICD-10-CM coding, coders need a solid foundation in anatomy and physiology. Review the anatomy of the endocrine system and how to code for conditions affecting it.
The majority of providers either stopped or slowed their ICD-10 preparations as a result of the latest implementation delay, but now providers have less than a year to become ready. CMS' Denesecia Green and Stacey Shagena offer advice on how providers can create an action plan to be ready by October 1, 2015—even if they haven't started yet.
Nearly 30% of Medicare patients are enrolled in Medicare Advantage (MA) programs, which come with specific coding and documentation challenges. Elaine King, MHS, RHIA, CHP, CHDA, CDIP, FAHIMA, and Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS, highlight key requirements for reporting diagnoses that map to Hierarchical Condition Category codes, the basis of MA plans.
