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New CPT Codes to Better Support Telehealth

New codes are coming for the Current Procedural Terminology (CPT) code set to bring more specificity to coding for an expanding range of telehealth services. Best Medical Coding Course!

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How and Where to Look Up CPT Codes for Free

As patients, we don’t have the thousands of dollars it costs to tap into the extensive database information required for the entire body of CPT codes. But the AMA does offer us an easy way to look up one code at a time, for free.

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AAFP, Others Push Back on Proposed Changes in CPT Code Valuation Process

The AAFP recently joined several dozen physician and other health care professional organizations, including the AMA, the American College of Physicians and the American Osteopathic Association, in asking CMS to reconsider some of its proposals in the 2015 Medicare physician fee schedule that relate to valuing CPT codes.

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Easily Import Codes Using New CPT® 2015 Data File

Simplify CPT® coding by importing the 2015 CPT code set into your claims and billing software using the CPT® 2015 Data File on CD-ROM. This product consists of easy-to-understand features to support your daily coding needs, including:

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Revised CPT Codes Delayed Until 2016 for Additional Testing

The American Physical Therapy Association (APTA) reports that due to the magnitude of proposed changes to an entire family of physical medicine and rehabilitation codes, the editorial panel of the American Medical Association’s (AMA) Current Procedural Terminology (CPT) document has opted to postpone the finalization of the revisions.

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Countdown To ICD-10

From patient accounting systems to sticky notes and “cheat sheets” posted in exam rooms, ICD-9 codes permeate the health care environment, translating the information in medical records to numbers on claim forms and ensuring that providers get paid for the care they give.

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Approved Manuals For The Medical Coding CPC Exam From AAPC

One question we are asked a lot is “what are the approved manuals for the medical coding CPC exam from AAPC?”

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Big Changes Coming To The Wound Care Market In 2014

The Center for Medicare and Medicaid Services (CMS) has proposed switching wound care reimbursement from the current pay-for-service model, in which the treating physician bills the government based on the number and type of procedures performed, to a pay-for-performance model in which reimbursement is fixed for a given diagnosis.

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Expect 329 Total CPT® Code Changes in 2014

The numbers are in! According to the American Medical Association (AMA), there will be 329 total code changes in 2014, to include 175 new codes, 107 revised codes, and 47 deleted codes.

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Data Shows Rise in Use of Some CPT Codes

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Look Up New Observation Codes When Reporting ‘Middle Days’

2011 brings a new coding option when reporting the middle day of observations that last longer than two days. Check out this expert advice on how CPT additions will affect your FP’s observation care services coding starting on Jan. 1, 2011.

Until this point, coding for the “middle days” of an observation service caused problems. Although not the norm, there are times when a physician admits a patient to observation and she remains in that status for three or more days. CPT 2011 addresses these middle days between admission and discharge by introducing three new E/M codes. The additions parallel the hospital subsequent care series in terms of component requirements and time frames:

  • 99224 – Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient’s hospital floor or unit.
  • 99225 — … an expanded problem focused interval history; an expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/ or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient’s hospital floor or unit.
  • 99226 — … a detailed interval history; a detailed examination; Medical decision making of high complexity. Counseling and/or

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Is 96413 + 96365 OK?

Coding is all about applying standardized code sets to situations that don’t always qualify as “standard.” The good news is that authoritative coding resources sometimes address even those encounters you don’t handle on a daily basis. Test your skills with these two scenarios and see whether your responses match the official rules.

Challenge 1: Staff administers a non-chemotherapy therapeutic drug via one IV infusion site, and then following oncologist orders based on protocol, administers chemotherapy intravenously via a second IV site. Should you report the chemotherapy admin or the non-chemotherapy admin as the initial code?

Solution 1: Challenge 1 presents a trick question. You should report initial codes for both the chemotherapy and non-chemotherapy infusions.

CPT guidelines state, “When administering multiple infusions, injections or combinations, only one ‘initial’ service code should be reported, unless protocol requires that two separate IV sites must be used,” notes Gwen Davis, CPC, associate with Washington-based Derry, Nolan, and Associates.

Citing this same rule, Tracy Helget, CPC, in the business office of Medical Associates of Manhattan in Kansas, notes, “The easiest way to think of this is, if we are making more than one stick to the patient, we bill more than one initial code.”

Many payers indicate that when you report two initial codes because each requires a separate access site, you should append modifier 59 (Distinct procedural service). So you may need to append modifier 59 to the secondary “initial” code to indicate the separate IV sites for each infusion in this case. For example, your claim may include the following:

  • 96413 – Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
  • 96365-59 – Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour.

Challenge 2: Documentation indicates your oncologist participated in…

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Make Sure To Check CCI Before You Use The New 2011 Codes

Capture additional pay by separating wound care management codes 97597-97602 from the newly revised debridement codes.

Every year, just when you’re trying to get used to new CPT codes, the Correct Coding Initiative (CCI) comes along and limits how and when you can use the new codes you’ve been given. This year is no exception with CCI 17.0 adding edits involving new Renessa and posterior tibial neurostimulator (PTNS) codes, among others.

The CCI released version 17.0, revealing 19,822 new active pairs and 9,778 code pair deletions, said Frank D. Cohen, MPA, MBB, senior analyst with The Frank Cohen Group, LLC, in a Dec. 14 announcement.

Many of the new code pair additions involve CPT codes that debuted on Jan. 1, 2011 with CCI getting ready to halt payment if you report certain procedures together. Get a grip on the new bundles with this urology-focused rundown.

CPT 2011 deleted Category III code 0193T (Transurethral, radiofrequency microremodeling of the female bladder neck and proximal urethra for stress urinary incontinence), replacing it with a new Category I code 53860 with the same descriptor. CCI targets 53860 with several edits.

When your urologist performs the Renessa procedure, you’ll report 53860, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook.

As of Jan. 1, when 53860 became an active code, CCI 17.0 created edit pairs with the following column 2 codes that Medicare considers usual and necessary parts of any surgery:

  • Venipuncture, IV, infusion, or arterial puncture services represented by codes 36000, 36400- 36440, 36600-36640, and 37202
  • Naso- or oro-gastric tube placement (43752)
  • Bladder catheterization (51701-51703).

“In general CPT code 53680 would include catheter placement for temporary postoperative urinary drainage at the conclusion of the procedure, and therefore, these latter…

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CPT 2011: New Modifier GU and Revisions to 76, 77, and 78 Change Your Reporting

2011 adds a new modifier to your coding arsenal and updates the descriptors for several others you might often use.
Get ready for modifier GU (Waiver of liability statement issued as required by payer policy, routine notice). You might have times when …

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Turn To 37224-37227 For Your Femoral/Popliteal Codes

CPT’s definition of a ‘single vessel’ for this territory is an exception to the rule.

CPT 2011 adds new codes for lower extremity endovascular revascularization covering angioplasty, atherectomy, and stenting, noted Stacy Gregory, CCC, CPC, RCC, of Gregory Medical Consulting Services, in her presentation, “Peripheral Vascular Coding Tactics,” at the 2011 Coding Update and Reimbursement Conference in Orlando (

This article focuses on the femoral/popliteal codes 37224-37227. “37220 to +37223 Revamp Your Iliac Intervention Coding Options” in Cardiology Coding Alert discussed the iliac codes. Look to a future issue to cover tibial/peroneal codes 37288-+37235.

The new femoral/popliteal service codes are below. Note that all of the codes include angioplasty in the same vessel when that service is performed:

  • Angioplasty: 37224 — Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal angioplasty
  • Atherectomy (and angioplasty): 37225 — … with atherectomy, includes angioplasty within the same vessel, when performed
  • Stent (and angioplasty): 37226 — … with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
  • Stent and atherectomy (and angioplasty): 37227 — … with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed.

The general rule for 37224-37227 is that you should report the one code that represents the most intensive service performed in a single lower extremity vessel. All lesser services are included in that one code.

When the cardiologist performs a stent placement, atherectomy, and angioplasty in the left popliteal vessel, you should report only 37227.

That code covers stent placement, atherectomy, and angioplasty. You should not report 37224 (angioplasty), 37225 (atherectomy), or 37226 (stent placement) separately or in addition to 37227 in this scenario.

As explained in the last issue of Cardiology Coding Alert, CPT guidelines state that — in addition to the intervention performed…

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CPT 2011: Pay Attention To These New Joint Injection Guidelines

Remember to check for updated or revised guidelines when preparing to use your new code books for 2011, not just code descriptors. CPT 2011 includes new details for coding some common injection procedures, as pointed out at the AMA’s CPT and RBRVS 2011 Annual Symposium in Chicago. Read on for a few pointers to help stay on the right track.

The introduction of new codes for paravertebral facet joint injections in 2010 (64490-64495) meant changes to how you reported related codes. During the CPT and RBRVS Symposium, Douglas G. Merrill, MD, MBA, of the American Society of Anesthesiologists, pointed out two revised guidelines dealing with paravertebral facet (spinal) joint procedures.

Instructions in CPT 2010 directed you to report 64999 (Unlisted procedure, nervous system) if the provider used ultrasound guidance during paravertebral facet joint injections. The AMA released a correction later in 2010, and the CPT 2011 clarifies the situation. If your provider used ultrasound guidance when administering paravertebral facet joint injections, report the appropriate code(s) from 0213T-0218T (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with ultrasound guidance …).

T12-L1 change: CPT 2010 guidelines mandated that you report 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [for nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level) for an injection to the T12-L1 joint, or nerves innervating that joint. New 2011 guidelines direct you to submit 64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [for nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; single) instead.

In addition, the 2011 guidelines direct providers to report paravertebral facet joint injections performed without image guidance with the appropriate trigger point injection code. Submit either 20552 or 20553 (Injection[s]; single or multiple trigger

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