New options replace 49420 for tunneled catheter.
Choosing an intraperitoneal catheter insertion used to mean deciding between “permanent” and “temporary” — but CPT 2011 changes all that. Now you’ll need to know if the procedure is open, lap…
Tag Archives | Ccc
New options replace 49420 for tunneled catheter.
Until now, you could not code for the additional service — and hence not get the pay — when your general surgeon placed interstitial devices for radiation therapy guidance during a distinct open or laparoscopic abdominal procedure. But two new CPT 2011 codes for the procedure help you capture all the pay you deserve.
Open, Lap, or Percutaneous Approach Distinguish Placement
Last year, you had one code to use when your surgeon placed an abdominal interstitial device for radiation therapy guidance — 49411 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], percutaneous, intra-abdominal, intra-pelvic [except prostate], and/or retroperitoneum, single or multiple).
“If your surgeon performed the device placement during an open or laparoscopic procedure prior to 2011, you had no way to capture the service,” says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle.
Now CPT 2011 adds two new add-on codes to describe interstitial device placement during another procedure, as follows:
- +49327 — Laparoscopy, surgical; with placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple [List separately in addition to code for primary procedure])
- +49412 — Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], open, intra-abdominal, intrapelvic, and/or retroperitoneum, including image guidance, if performed, single or multiple [List separately in addition to code for primary procedure]).
Choose +49327 for a laparoscopic approach, and +49412 for an open procedure. “Note that these are add-on codes, which means you can report them only in addition to a primary procedure,” Bucknam advises.
Continue to report 49411 for percutaneous interstitial device placement as a stand-alone procedure.
Use codes 49411, +49412, and +49327…
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 (www.codingconferences.com).
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…
Think outside the box for iliac atherectomy.
Are you ready to apply CPT’s new revascularization codes starting January 1? Check out these six tips to get you on your way.
CPT 2011 offers up new codes to help you report services more accurately, including endovascular revascularization, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle.
Specifically, CPT 2011 adds several new codes that represent lower extremity endovascular revascularization, meaning angioplasty, atherectomy, and stenting. Here’s how the codes break down:
- Iliac: 37220-+37223– Revascularization, endovascular, open or percutaneous, iliac artery …
- Femoral, popliteal: 37224-37227– Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral …
- Tibial/peroneal: 37228-+37235– Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral …
In this article, iliac artery services are the focus. Look to future articles to discuss femoral, popliteal, and tibial/peroneal services.
Watch Procedure and Vessel to Choose Among 37220-+37223
The new iliac service codes are as follows:
- 37220– Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty
- 37221– … with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
- +37222– Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)
- +37223– … with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure).
Reading through the definitions, you see that the codes for iliac services differ based on whether you’re coding a service in an initial vessel or in an additional vessel. Your options also differ based on whether you’re reporting (1) angioplasty alone or…
The Correct Coding Initiative (CCI) came down hard on practitioners who perform vestibular testing earlier this year, but a new correction, effective Oct. 1, should ease the restrictions and help the otolaryngology, neurology, and audiology practices that report these services.
The problem: CCI edits currently restrict practices from reporting 92541, 92542, 92544, and 92545 individually if three or less of the tests are performed, notes Debbie Abel, Au.D., director of reimbursement and practice compliance with the American Academy of Audiology.
The solution: Starting October 1, 2010, “if two or three of these codes are reported for the same date of service by the same provider for the same beneficiary, an NCCI-associated modifier may be utilized to bypass the NCCI edits,” CMS wrote in a decision to alter the edits.
The American Speech-Language-Hearing Association (ASHA) has requested “clarification regarding the correct NCCI-modifier to use when reporting the codes to Medicare,” noted Lemmietta G. McNeilly, PhD, CCC-SLP, CAE, chief staff officer of Speech-Language Pathology with ASHA, in a July 29 announcement.
Look for Changes to Vestibular Testing Descriptors
The root of the CCI problem began when the 2010 CPT manual was published, including new code 92540 (Basic vestibular evaluation …) and the subsequent codes following it, which make up the individual components of 92540. “The clarification that resulted in the NCCI edits being lifted should be included in upcoming versions of the manual,” Abel tells Part B Insider.
According to the AMA’s Errata page, code descriptors should read as follows, effective Oct. 1:
- 92540 — Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and
CMS may talk, but MACs don’t always listen — at least not quickly.
As we told you in last week’s Insider, CMS recently corrected several “technical errors” published in the 2010 Fee Schedule, and thanks to these corrections, Medicare will increase payment for several cardiology-related testing codes, including codes 75571-75574 (Heart CT) and 78451-78454 (Heart muscle SPECT imaging).
Although many practices are eager to see the payment boosts in their next Medicare payments, that may be an overly ambitious goal at this point.
“I inquired with a few MAC carriers such as Trailblazer, Noridian, and Palmetto, and was told different things by different Medicare payers,” says Terry Fletcher, BS, CPC, CCS-P, CCS, CMSCS, CCC, CEMS, CMS, CEO of Terry Fletcher Consulting Inc.
“One did not even know there was a change,” she says. “Next, Noridian said that they will be making the adjustments when they get the directive from CMS. And Palmetto said they would need the provider to contact them and then batch retroactive to January the myocardial perfusion imaging claims and send a letter to request the increase,” she says.
Bottom line: Until CMS provides a clear answer to the MACs regarding when they must implement the changes, you may not see your pay increases, but keep an eye on your carrier’s Web site for information on when it intends to reprocess claims using the new rates.
@ Part B Insider. Editor: Torrey Kim, CPC
Sign up for the upcoming live Webinar, You Can Use the Appeals Process Like a Pro, or order the CD/transcripts.
Correct Coding Initiative (CCI) version 16.1 has the news you’ve been waiting for.
The latest version, effective April 1, deletes 142 edit pairs, Frank D. Cohen,…
Applying modifier 22 (Increased procedural services) can help increase reimbursement if your neurosurgeon documents a greater-than-usual effort during a surgical service. To ensure your claims’ success, surgeons and coders must also…
Whether you call them ECGs or EKGs, chances are you see a lot of electrocardiograms in your practice. That means that even the tiniest coding errors…
CMS won’t fix CCI blunder until version 16.1, to be released in the spring.
If your heart skipped a beat when you saw that January’s Correct Coding Initiative (CCI) edits bundled catheter ablations with electrophysiology (EP) studies, you weren’t alone.
Good news: CMS has decided to delete the edits retroactively because their addition was a mistake, according […]
- Take Heart, Cardiology Coders: CCI Deletions Overturn 93296 Denials Go back to the future. 3 months of denials…
- Nerve Conduction Study Coding TipDid you know that new medical devices are opening doors…
- Bundle of His Recording Coding ChallengeQuestion: How should I report right atrial pacing and recording…
- ICD-10 Is Ready To Serve October 31, 2014
- CMS to Feature ICD-10 Codes on its CMS-2728 End Stage Renal Disease Patient Registration Form November 4, 2014
- 5 Steps To Address The Coding Talent Shortage In 2015 November 13, 2014
- 100 Tips for ICD-10-PCS Coding: Tips 1-10 November 7, 2014
- Managing Denials After ICD-10 November 14, 2014
- 5 Project Management Keys To ICD-10 Planning December 18, 2014
- ICD-10 Testing: Why Test – and Why Test Right Now? December 17, 2014
- Consortium Working to Help Small Businesses Transition to ICD-10 November 25, 2014
- ICD-10 Testing Consultants Dish Out the Good, the Bad, and the Ugly November 24, 2014
- Organizations Urge Congress to Avoid Further ICD-10 Delays November 19, 2014
- Managing Denials After ICD-10 | scrubs and suits: […] post Managing Denials After ICD-10 appea...
- 5 Steps To Address The Coding Talent Shortage In 2015 | scrubs and suits: […] post 5 Steps To Address The Coding Talen...
- 100 Tips for ICD-10-PCS Coding: Tips 1-10 | scrubs and suits: […] post 100 Tips for ICD-10-PCS Coding: Tip...
- CMS to Feature ICD-10 Codes on its CMS-2728 End Stage Renal Disease Patient Registration Form | scrubs and suits: […] post CMS to Feature ICD-10 Codes on its ...
- CMS Update Policies, Payment Rates for Dialysis Facilities for 2015 | scrubs and suits: […] post CMS Update Policies, Payment Rates ...