Q: CPT ® code 85660 (sickling of RBC, reduction) has a medically unlikely edit of one unit. We test blood for transfusion for sickle cell before we provide it to a sickle cell patient. If we test three units of blood prior to administering the blood to the patient, which modifier is more appropriate: -59 (distinct procedural service) or -91 (repeat laboratory test)?
As tempting as it might be to append modifier -59 (distinct procedural service) to a claim in order to get paid, doing so poses a huge compliance risk. Karna W. Morrow, CPC, RCC, CCS-P, Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS , Peggy Blue, MPH, CPC, CCS-P, and Kimberly Anderwood Hoy, JD, CPC, walk through five case studies to help coders chose the correct modifier.
Five new CPT ® codes will be used to report services in two new evaluation and management categories: complex chronic care coordination services and transitional care management services. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, details the codes and guidelines for these services.
External cause codes in ICD-10-CM are intended to provide data for injury research and evaluation of injury prevention strategies. Some are humorous and some are confusing. Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, explains how and when to use these codes.
If you’re worried about getting your physicians trained for ICD-10, you’re not alone. Thea Campbell, MBA, RHIA, Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, Donna Smith, RHIA, and Sue Belley , MEd, RHIA, CPHQ, offer tips and strategies to educate physicians about the new code sets.
With the increased specificity required for ICD-10-CM coding, coders need a solid foundation in anatomy and physiology. To help coders prepare for the upcoming transition, JustCoding will provide an occasional article about specific anatomical locations and body parts as part of a larger series for ICD-10-CM preparation. This month’s column addresses the anatomy of the shoulder.
Organizations looking for real-world examples of ICD-10 education can check out the plan created by Ginger Boyle, MD, of Spartanburg Regional Healthcare System in South Carolina.
In order to accurately code physician and provider services, coders must know and understand the place of service (POS) codes. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, details the specific POS codes and how to appropriately report them.
Q: What CPT ® code best describes the Bier block procedure? We are toiling over this and the most recent CPT Assistant says to use 64999 (unlisted procedure, nervous system). But the article referenced is from 2004. We just want to make sure there is nothing more recent.
The rules for coding for facilities and physicians are basically the same for most services, but coders follow different rules for appending certain modifiers. Christi Sarasin, CCS, CCDS, CPC-H, FCS , Kimberly Anderwood Hoy, JD, CPC , and Peggy Blue, MPH, CPC, CCS-P, separate physician and facility rules for using modifiers -26, -TC, and -79.
Providers are beginning to see some translation of CMS’ National Coverage Determinations (NCD) for ICD-10 with the release of Transmittal R1122OTN and Medlearn Matters Article MM7818 .
The CPT ® Editorial Panel revised its guidance for critical care codes to specifically state that, for hospital reporting purposes, critical care codes do not include specified ancillary services. Denise Williams, RN, CPC-H, and Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, discuss how coders should code for critical care services and review which services are bundled into critical care.
Basing a coder’s successful completion of a coding audit only on coding accuracy overlooks importance of local coverage determinations (LCD) and national coverage determinations (NCDs). Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, explains the role LCDs and NCDs play in determining practical day-to-day coding accuracy.
Q: It appears that one requirement for using CPT ® codes 15002–15005 with application of negative pressure wound therapy (NPWT) is that the wound must be healing by primary intention. Can you explain this? We have never used these codes with preparation for vacuum assisted closure (VAC) placement, but it doesn't make sense, as NPWT is almost always used for wounds healing by secondary intention. Our physicians appreciate any clarification.
Hospital medicine is a specialty that provides inpatient services for patients admitted to the hospital. Hospitalists are often called on to consult in regards to and to follow medical problems that occur during hospitalization for surgery, psychiatric hospitalizations, and obstetrical patients. Lois E. Mazza, CPC, explains how to correctly report hospitalist services.
The Hospital Outpatient Payment Panel recommended CMS change the supervision requirements for 15 HCPCS and CPT ® codes during its second meeting this year in August. CMS released details of the meeting September 24.
Accurate reporting of observation services depends on a lot of factors. Deborah K. Hale, CCS, CCDS, and Cheryl Staley, RHIA, CCS, walk though five case studies to explain the ins and outs of observation coding.
