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Medicare’s Consult Rule Trickle Down Effect

And what it means for pediatric practices. A report from AMA in Chicago.
Although CPT clarifies the transfer of care definition, the fix came too late for Medicare, meaning your private payers may follow suit.
Continued Errors Result in E/M Boon
The Office of Inspector General found a high error rate on consultation codes. Different opinions on when […]

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ED Coding Question: Observation or Other E/M Code?

Question: A 42-year-old patient reports to the ED early on Tuesday morning for evaluation of uncontrollable shaking in her extremities and severe pain in her neck. The EP admits the patient to observation at 7 a.m. and orders blood tests and a CT scan — however, the shaking continues to worsen. The EP consults with a […]

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Neonatal Critical Care Coding: CPT 2010 Clarifies Resuscitation Guidance

Payers denying 99465-25? Here’s help straight from the AMA Symposium in Chicago.
Question: There’s a notation in the CPT 2009 manual that the neonatal critical care codes include delivery room resuscitation. Is this true?
Answer: No, a parenthetical note following 99465 (Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute […]

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Pain Management Coding: Endoscopic Lumbar Nerve Decompression

Hint: Think ‘unlisted procedure.’

Question: One of our physicians is looking into “endoscopic lumbar spinal nerve decompression.” One of the medical device representatives indicated he could bill it like the lateral extraforaminal approach for lumbar decompression, but I haven’t found much information. What’s your advice?
Answer: Despite what you physician might have heard, your most appropriate choice […]

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CMS at AMA Chicago: We’re Reducing Consult Request Requirement

CMS auditors will look for 1 less thing in consult documentation.
With Medicare’s invalidation of consultation codes 99241-99255 in 2010, your ICD-9 codes better prove why two MDs are necessary on the same patient’s hospital care or the physician better specify why in his note.
Separate ICD-9 codes will help substantiate the medical necessity for providing consultative […]

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PQRI: No Coumadin Due to Fall Risk

Plus, experts at the AMA meeting in Chicago tell you what to do if you can’t get H1N1 vaccine for PQRI Measure 110 or other vaccine measures.
Question: My internist decided not to put a patient on Coumadin because the patient has a higher risk of falling than from having a stroke. Our group participates in […]

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Medicare Changes to 2010 CPT Inpatient Consultation Codes

Prevent 99251-99245 denials in 2010 with this checklist.
Multiple physicians using the same hospital codes sounds like a recipe for denials, but that’s what Medicare is instructing physician inpatient consultants and care coordinators to do.
Whether carriers will kick out these submissions as coordination of care or inpatient admit limiting admit edits is contractor specific, Charles […]

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2010 Tumor Excision Coding: Lesion Vs. Chunk Size

Straight from the AMA in Chicago — answers to your lesion excision coding questions for 2010.
Question: A thigh lesion measures 2 cm but requires a resection down to the subcutaneous layer of 4 cm. Which lesion excision code should I use?
Answer: “You should use the larger of the subcutaneous codes,” says Albert E. Bothe, Jr, […]

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Medicare 2010 CPT Consultation Code Changes

New rules for consult coding straight from the AMA Meeting in Chicago — plus where your practice will gain and lose reimbursement.
If you can’t figure out how to match a low level consult to an initial hospital care code, you’re not alone.
Code 99251 doesn’t crosswalk to 99221, agreed William J. Mangold, Jr., MD, JD, Noridian […]

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Is 30901 Your Nosebleed Code? Not So Fast?

Hint: Look for these keywords in the note to select the correct nosebleed code.
Question: The internist stops a patient’s nosebleed. Is this always a procedure?
Answer: No, if a patient reports with a nosebleed and the physician stops the bleeding with basic methods, you’ll typically opt for the appropriate-level E/M code.
E/M methods: Code minimal attempts at […]

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From the AMA in Chicago: CPT 2010 Out of Order Codes

Here’s where you can find a full list of resequenced codes.
Notice that new sign in your CPT book? No, that hash mark’s not to delete a message or to sign into a conference; it’s to alert you to an out of order code.
The “#” works like a flashing yellow light: Slow down, there might be […]

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CMS Makes Key Changes to ABN Modifiers

We’ve got the new instructions you’ll need to follow.
CMS will update the ABN modifiers effective April 1, according to MLN Matters article MM6563, dated Oct. 29.
The ABN descriptors will read as follows:

Modifier GA — Revised to read, “Waiver of liability statement issued as required by payer policy.” You’ll use this when a required ABN was issued.
Modifier GX — […]

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HCPCS 2010: CMS Debuts New J Codes

Synvisc, penicillin get new codes — along with injectibles for neurology, bleeding.
Hot on the heels of the new CPT codes, CMS follows suit by publishing the 2010 HCPCS code set, posted on the CMS Web site on Nov. 3. You’ll find scores of changes.
What follows is a small sampling of what you’ll face in 2010:
Synvisc: HCPCS will […]

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Infusion Coding Education: Remicade

Coding Hint: Watch for ‘add-ons’ during Remicade sessions

Question: An established patient with a plan of care in place for his Crohn’s disease of the ileum reports to the gastroenterologist for a Remicade infusion. The infusion started at 10:00 a.m. and ended at 11:42. The patient reported nausea during the infusion, so the gastroenterologist administered 200 mg of Benadryl from 10:41 […]

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Coder’s Navigation Tool: 2010 Medicare Physician Fee Schedule

It’s that time of year coders — yes, time to comb through pages and pages and pages of the final 2010 Medicare Physician Fee Schedule. We’ve got a handy place to start.
If you want a quick overview of fee schedule’s financial impact on your physician practice’s specialty, go here and scroll to page 1171. There, […]

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Cardiology Coding Question: Separate Reporting for 37204

Question: Should I separately report right and left bronchial artery embolization?

Answer: You should report 37204 (Transcatheter occlusion or embolization [e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation], percutaneous, any method, non-central nervous system, non-head or neck) twice for right and left lung embolization at the same encounter.
In addition, if the cardiologist […]

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