Guidance for coding OB delivery lacerations sometimes differs between the CPT ® Manual and the American Congress of Obstetricians and Gynecologists. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , explains the difference in guidance and documentation necessary to report tears to the proper degree.
Q: If the clinical impression is physical assault, vomiting, blunt injury to abdomen, and head injury with loss of consciousness, can I code the history of hypertension, diabetes mellitus, headache, bipolar disorder, and depression?
Recovery Auditors have found that modifier misuse is resulting in underpayments to providers, according to the most recent Medicare Quarterly Provider Compliance Newsletter .
As the role of radiologists has expanded to new procedures, so have the codes to report their work in the CPT ® Manual . Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, writes about key terms for coders to look for in documentation to correctly report these procedures.
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.
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.
Q: I read that CPT ® code 20680 (removal of implant; deep, e.g., buried wire, pin, screw, metal band, nail, rod, or plate) is commonly used for deep hardware removal. What would be the proper code for removal on one screw that has already made its way out, is not under any muscle, and is easy to visualize?
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 .
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.
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?
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.
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.
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.
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 .
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.
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.
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.
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.
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.
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?
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?
Changes implemented by the 2014 OPPS Final Rule resulted in the addition and deletion of many codes in the January I/OCE update. Dave Fee, MBA , reviews some of the most important modifications, including changes to evaluation and management services and device reporting.
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.
Hierarchical Condition Category (HCC) coding may be a foreign concept for some coders, but making sure documentation for Medicare Advantage patients supports it can be critical. Holly J. Cassano, CPC , discusses what criteria needs to be met for complete documentation.
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.
Q: I am auditing a note for a fusion. The note lacks detail, therefore is hard to justify. The patient had a prior hardware placement. The note describes dissecting down, debridement of necrotic bone, and tissue work done. This is the entire note, after describing dissection, “Vigorous irrigation with 10 liters of saline and antibiotics was carried out. Hemostasis was maintained. The right S1 screw and rod portion was removed as it was notably loose. Additional decortication and onlay bone grafting was performed at L1-S1. Drains were placed…” They coded: 22612 (arthrodesis, posterior or posterolateral technique, single level; lumbar) Add-on code 22614 (each additional vertebral segment) x4 22852 (removal of posterior segmental instrumentation) In the procedures performed area of the note, they state: Hardware removal, lumbar Revision fusion L1-S1 with onlay bone graft Irrigation and debridement of lumbar spine wound Since there is nothing in the note regarding autografting, I assume this is an allograft? Should this be coded? Also is that documentation enough to justify arthrodesis? Modifier -GC (this service has been performed in part by a resident under the direction of a teaching physician) was appended, although the language was not added for this. I can only assume a resident dictated this.
Not surprisingly, coders will have many more options to report how a patient was injured in ICD-10-CM. Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD , and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS , explain how the codes differ from ICD-9-CM E codes, when to report them, and why coders should not be too worried about the transition.
The auditory system has its own code category in ICD-10-CM because of the number of new codes and specificity available. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I , reviews ear anatomy and how to report newly introduced diseases and conditions.
Coders will have many more options to report wrist and hand injuries in ICD-10-CM, with codes for individual fingers, wrist bones, and joints, as well as laterality. Review the anatomy of the wrists and hands in order to take advantage of the specificity available in ICD-10-CM.
CMS Administrator Marilyn Tavenner reiterated last week that ICD-10 implementation would not be delayed again, as CMS prepares for end-to-end testing of providers this summer.
Debbie Mackaman, RHIA, CPCO, and Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS, discuss the purpose of medically unlikely edits (MUEs) and how they are calculated by CMS.
Q: Can we report CPT ® code 32609 (thoracoscopy; with biopsy of pleura) with 32666 (thoracoscopy, surgical; with therapeutic wedge resection, initial unilateral)? We have researched thoroughly and were not able to find a clear answer.
The added specificity of ICD-10 may require coders to learn more about disease processes and terminology in order to code accurately. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, reviews some medical terms coders should know and steps to take to improve communication between providers and coders.
An overwhelming 87% of respondents to a recent survey by Navicure of physician practices said they are at least "somewhat confident" they will be ready for ICD-10 implementation by October 1.
While the 2014 CPT ® Manual features many new combination codes among its hundreds of changes this year, it was also updated to reflect newly recognized technologies and procedures . Denise Williams, RN, CPC-H, looks atsome of the changes made in the Radiology and Laboratory sections.
Q: I have a question regarding CPT® code 22558 (arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace; lumbar). I perform this exposure as a vascular surgeon, with the orthopedic surgeon preforming the spinal surgery. If I perform an anterior exposure for a spine deformity using code 22808 (arthrodesis, anterior, for spinal deformity, with or without cast; two to three vertebral segments), do I bill 22558 for the exposure?
Jugna Shah, MPH, and Valerie A. Rinkle, MPA, examine the 2014 OPPS Final Rule and explain which services are now packaged, including drugs and biological that function as supplies when used in diagnostic or surgical procedures, clinical diagnostic lab tests, and device removal procedures.
CMS will present the eHealth Summit: Road to ICD-10 from 9 a.m. to 3:30 p.m., Friday, February 14, in Baltimore and is inviting interested parties who cannot attend in person to register for a live webcast of the sessions .
In part two of a series, Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, explains how to identify various types of viral skin infections and how reporting for them will change in ICD-10-CM.
While the digestive and integumentary sections had extensive edits in the latest CPT ® update, many sections were left relatively unchanged. Joanne Schade-Boyce, BSDH, MS, CPC, ACS , and Denise Williams, RN, CPC-H, review which sections only had minor updates and take a closer look at evaluation and management and chemodenervation changes in the 2014 CPT Manual.
The transition to ICD-10-CM may require coders to brush up on their anatomy and physiology in order to report the most accurate codes. We take a look at the anatomy of the knee and how coding for knee injuries will change in ICD-10-CM.
The added specificity available in ICD-10-CM allows for more details to be included when reporting bacterial skin infections, such as the location of the infection. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, explains how to identify various types of infection and which codes to use to report them.
A recent survey of healthcare payers and providers by accounting firm KPMG shows that many organizations are lagging when it comes to ICD-10 testing. Nearly three-quarters of respondents said they had yet to begin end-to-end ICD-10 testing or were not planning on conducting it.
With the ICD-10-CM implementation date approaching, training and retaining staff that knows the new system is paramount for coding departments. Sabita Ramnarace, MS, RHIA, CCS, CHP , and Rudy Braccili, Jr., MBA, CPAM, review strategies that can help providers develop retention plans in their organization.
Q: I am looking for information about to how to bill for a transnasal-endoscope approach in removing a skull-base tumor. I have never been comfortable with the doctors wanting to use CPT ® 61600 (resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; extradural) to bill a non-invasive procedure. I am perplexed about which CPT code(s) to report for this type of procedure.
Coders have until September 30, 2015, to pass AAPC’s ICD-10 proficiency test in order to retain their credentials. AAPC recently added another way to prove proficiency that includes an online training portion, in addition to the previously available timed assessment.
Joanne Schade-Boyce, BSDH, MS, CPC, ACS , and Denise Williams, RN, CPC-H, look at the changes in the integumentary and cardiovascular systems and how they demonstrate a trend toward bundling in the 2014 CPT® Manual.
CMS did not finalize a proposal to collapse all evaluation and management visits into three codes, but did change clinic visit level coding. Jugna Shah, MPH, and Valerie A. Rinkle, MPA, review some of the major changes to E/M levels for 2014 and the new codes introduced. introduced.
