Hot Coding Topics / modifier 59

What Lab Coders Need to Know About CCI 16.0

Look for transcutaneous hemoglobin limitations, and bundling for those new 2010 culture codes. Think you’re ready to use all those brand new CPT lab codes? Not so fast. You better learn Correct Coding Initiative (CCI) restrictions first, before you start billing Medicare for services using new CPT 2010 codes. CCI released version 16.0, effective Jan. 1, which includes 24,060 [...] Related articles:

  1. CCI 15.3 Update: You Can Resubmit Dozens of Previously-Bundled 22526 ClaimsNewsflash: CCI 15.3 retroactively deletes hundreds of edit pairs, but...
  2. What Interventional Radiology Coders Should Know About CCI 15.1 EXTRA–Radiology Reimbursement WEBINAR: Do you know the difference between...
  3. Can’t Locate an H. Pylori Lab Test Code? 2 Clues Point the Way Solve CLO test culture code dilemma and other mysteries....

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January 31, 2010
CMS / Coding Challenge / E/M

E/M Challenge: Can I Report 99214 and +99354?

Counseling representing more than 50 percent of E/M visit? Choose level based on time. Question: I have a family physician who documented 60 minutes on an established patient’s office visit. The FP diagnosed the patient with morbid obesity (278.01). Since the patient was newly diagnosed and had some difficulty understanding the doctor’s orders, the FP spent [...] Related articles:

  1. Asthma Attack Coding: When To Use Prolonged or High-Level E/M     Checklist deters payback requests for insufficient +99354...
  2. Does CNS Count as NP for Time-Based Coding? CNS = NP = PA for CPT, but Check...
  3. CPT 2010 Update: Non-Face-to-Face Prolonged ServicesNew Year’s hats & horns for looser guidelines that let...

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January 31, 2010
Hot Coding Topics

Orthopedic Coding Clinic: Labral Tears

10-2:00 in the op note signals SLAP lesion repair. Even experts can land on the wrong ICD-9 code for SLAP lesion repair, but visualizing the injury region as a clock will help you distinguish one type of SLAP (superior labral anterior posterior) tear from another. Research Patient History for Accurate Diagnosis Having a solid understanding of anatomy and [...] Related articles:

  1. Orthopedic Coding Clinic: Complete the ICD-9 Picture with These Tips Code the condition your ortho treats first, followed by...
  2. Orthopedic Coding Clinic: Pull the Plug on PRP Injection Denials Here’s where 86999 comes in. If your orthopedist is...
  3. Orthopedic Coding Quick Start Guide: ASC Shoulder ProceduresShoulder ICD-9 and CPT codes you’ll most likely see in...

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January 28, 2010
CCI / Coding Challenge / surgery

Surgery Coding Challenge: Master Microsurgery Units With This Advice

Check your EOB to make sure payers don’t apply a multiple-procedure reduction to +69990. Question: When my ENT uses a microscope during a procedure, what guidelines can I use for choosing between 92504 and +69990? Is there a rule governing how many times you can report the add-on code 69990? Answer… You can use 92504 (Binocular microscopy [separate [...] Related articles:

  1. Spinal Surgery Coding Challenge: Tethered Cord Release & Dural Tag RemovalQuestion: My neurosurgeon released a tethered cord under the microscope,...
  2. Know Your Magnifiers for Microscope Coding Success Your ENT has invested training time and money in...
  3. Take Our Multi-Level Spinal Surgery Coding Challenge AUDIO TRAINING EVENT: Receive Optimum Reimbursement for Spinal Co-Surgeries,...

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January 28, 2010
CMS / Toolkit

Want to Integrate PQRI Measures Into Your Practice? Look Here.

Participation can put extra bread in your basket. Back again for 2010 is Medicare’s incentive-driven physician quality reporting initiative (PQRI), aimed at tracking quality metric or patient care services that physicians provide. When the practice treats enough patients in the same category, some PQRI dollars might be only a few codes away. If you know the basics [...] Related articles:

  1. PQRI 2010: Tips That Boost Your Practice’s RevenueFollow our links and advice to put more plusses in...
  2. New PQRI, E-Prescribe Tool from CMS If your head is spinning with all of the...
  3. Keep These 2009 PQRI Eye Care Measures HandyOphthalmologists and optometrists who want to recoup a bonus from...

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January 28, 2010
Coding Challenge

How Should I Code a Fibrinolytic Agent Instillation Via Chest Tube?

Different calendar dates matter, but multiple instillations the same day do not. Question: My pulmonologist inserted a chest tube and then instilled a fibrinolytic agent to break up multiloculations to free up an entrapped lung. Usually, I use 32560 for this procedure, which is for pleurodesis, not fibrinolysis. What code should I use for fibrinolytic agent [...] Related articles:

  1. Radiology Coding: CPT 2010 Breathes New Life Into Your Respiratory CodingMaster 32561’s guidelines to prevent a major units gaffe. Flip...
  2. Signs & Symptoms Coding Coach: Chest Pain 786.50-786.59: One of the most common symptoms that cardiovascular...
  3. PFS Treasure Chest: Read Medicare’s MindIt seems like dry reading, but the physician fee schedule...

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January 27, 2010
Coder's Cranium / ICD-10 / ICD-9

Pick the Right ICD-9, ICD-10 Code for Postmenopausal Abnormalities

Do N95.0 and N95.2 look foreign? Get your ob-gyn ICD-10 equivalents now. Spare yourself denial hot flashes by taking this three-part postmenopausal abnormality scenario challenge. Fill In These Blanks Using Your ICD-9 Book Question 1: Your ob-gyn sees a post menopausal patient with an inflamed vagina because the tissues are thinning and shrinking. The ob-gyn notes decreased vaginal [...] Related articles:

  1. Coder’s Anatomy: Cardiac Cath & Congenital AbnormalitiesTime Saver: Before you start assigning cardiac catherization codes, make...
  2. Nuclear Medicine Code Crosswalk: Bone Scans If your practice has trouble following which bone scan...
  3. What Diagnosis Code Do I Use for a Fern Test?Ob-Gyn Coding Tip: Scan for leukorrhea signs when fluid is...

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January 26, 2010
Hot Coding Topics / modifier 26 / RAC

Audits: HDI RAC Targets TC, Modifier 26 & More

Want to know what RAC contractors will be looking for next? Here’s the link. Recovery audit contractors (RACs) are working hard to expand their lists of approved issues, and you should keep a close eye on your services in these areas as well. Health Data Insights (HDI), the RAC contractor for Region D, posted 66 new approved [...] Related articles:

  1. CMS COVERAGE DECISIONS: MACs Can Make Exceptions to LCDsRACs can make exceptions only to approve claims. Coders know local coverage...
  2. RAC Fact Did you know that those new RAC auditors out...
  3. RAC Fact: Watch Out For Medicare’s Once-in-a-Lifetime Services G0389 & the IPPE codes may be potential RAC...

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January 26, 2010
Coding Challenge

Ophthalmology Coding Challenge: Flashers & Floaters

How’s Your EO Coding & Billing? Test Yourself With This Scenario. Question: A patient reports flashes and floaters but the ophthalmologist does not find evidence of retinal pathology on routine ophthalmoscopy. Are we justified in billing for extended ophthalmoscopy (EO)? Answer: If the ophthalmoscopy is a routine part of a patient’s eye exam, do not [...] Related articles:

  1. Ophthalmology Coding: RT/LT or Modifier 50? Prevent Uni-Bi Reporting Errors With This Expert Insight Don’t...
  2. Ophthalmology Coding: GDX, VF, & Temp Plugs — How Many Modifiers?Question: A patient came in for a GDX and visual...
  3. Eye Surgery Coding Challenge: Denials for 15823 & 67904Question: I started receiving denials for 15823 and 67904. To...

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January 24, 2010
CCI / Hot Coding Topics / modifier 59 / mutually exclusive

Ob-Gyn CCI 16.0: Hysterectomy Coding

Here’s where you can bypass the edits with modifier 59. The Correct Coding Initiative (CCI) version 16.0 didn’t overlook the hysterectomy, vaginal graft, and colpopexy codes — nor should you. To make sense of the deletions, break these additions into mutually exclusive and non-mutually exclusive. Note: In all these cases — except those involving the anesthetic injection [...] Related articles:

  1. Hysterectomy Coding Simplified: Look at Weight, Removal Severing these ligaments clues you into whether ob-gyn removed...
  2. CCI 15.2 Retracts Neurostimulator Edits from 15.1Look for new edits that affect eye exam codes, anesthesia,...
  3. 3 Steps Take the Guesswork Out of Coding Vaginal Cuff Repairs Find out what colporrhaphy code you’ll use for an...

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January 22, 2010
Coder's Cranium / surgery

Time Your Surgical Collections Right by Referencing Payer Contracts

Find out if you’re legal in collecting patient portion before providing the surgical service. Don’t be too hasty in collecting a patient’s copay and deductible up front. “While in theory, the practice of collecting deductibles up front may sound good, you should check your carrier contracts to be sure you are allowed to do this before requesting [...] Related articles:

  1. Checklist: Collect Surgical Deductibles Up Front to Improve A/RThis 3-step checklist will boost your bottom line. With fewer...
  2. Medical Billers: Test Your Collections Know-How Here This nifty tool tells you if collections cluelessness is...
  3. 10 Carrier Contract Negotiation Tips Carrier contract negotiation is often a long, difficult process....

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January 21, 2010
Coding Challenge

Pulmonology Coding Challenge: Why Are My 94664 Claims Getting Denied?

Before coding 94664, check off these items. Question: Under the direction of my pulmonologist I recently submitted 94664 for reimbursement for training time, but the bill was rejected? Can I challenge this? Answer: You can challenge training denials, provided your documentation supports the education’s reason. However, “not all payers will pay for 94664,” notes Gary N. Gross, [...] Related articles:

  1. Surgery Coding Challenge: Master Microsurgery Units With This AdviceCheck your EOB to make sure payers don’t apply a...
  2. 52214 Coding Challenge: Fulguration, Then TUIBNCQuestion: If my physician went to do a TUIBNC and...
  3. Radiology Coding Challenge: Why is Medicare Denying a 38792, 78195 ClaimTip: Discover true meaning of 38792 note Question: The physician...

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January 21, 2010
E/M / Hot Coding Topics / modifier 25

Wound Closure Coding: Make the Simple, Intermediate Distinction

Accounting for depth is a tricky task when coding closure. Practices interested in ethically boosting their bottom line and getting $80 or more for the same closure repair need to walk the line that separates simple from intermediate. What Makes a Repair “Simple”? A wound closure is a simple repair if the procedure: is simple; is a single-layer closure involving [...] Related articles:

  1. Coding Education: Simple, Intermediate or Complex Closure?Correctly distinguish closure levels every time with this advice from...
  2. Simple Laceration Repair Code or E/M Code? Answer Could Cost Hundreds Not recognizing a laceration repair that’s included in an...
  3. Multi-Laceration Repair Coding Case StudiesDo you know when to code repairs that occur in...

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January 21, 2010
Coding Challenge / E/M / modifier 25 / modifier 50

How Do I Code a 2-Sided Nosebleed?

Heads up: 2 nosebleed codes are not the answer. Question: A patient reports to the ED after sustaining injuries during a soccer match; she was hit in the face with a ball, her nose is bleeding, and her right eye is blackened. The physician is not able to stop the bleeding with ice or pressure, so [...] Related articles:

  1. Is 30901 Your Nosebleed Code? Not So Fast?Hint: Look for these keywords in the note to select...
  2. Winter Laceration Repair: How Do I Code For Dermabond?Warning: Your coding will vary depending on who’s getting the...
  3. How Do I Code This Multiple Fracture Accident Patient?Question: A 30-year-old female presents to a rural ED with...

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January 19, 2010
Hot Coding Topics / modifier 58 / modifier 78 / modifier 79 / surgery

Second Surgery Coding: Tips for Modifier 58, 78 Success

Don’t let ‘unplanned’ lead to ‘unpaid.’ The next time a patient takes an extra trip to the operating room, don’t let the added service throw your coding off track. Keep these tips in mind to know when to assign modifier 78 – or something else. Check for Surprise Versus Planned Two modifiers pertain to follow-up trips to the [...] Related articles:

  1. Bone Up On ASC Orthopedic Coding With These Global Period, Modifier Tips 3 ways your physician claim better look different than...
  2. Global Billing: Document ‘Unrelated’ for Modifier 79 ServicesMACs are looking for ‘red flags’ to halt additional global period pay...
  3. Decision Chart: Modifier 78, 58, or 79?Simplify your post operative service claims with this nifty tool....

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January 19, 2010