CPT 2011 / Hot Coding Topics / ICD-10

CodingConferences Coding Changes Top Tips from Editor Leigh Delozier

600 coders, physicians, and office managers gathered in Orlando, Fla. for one and a half jam-packed days of education, networking, and shopping at the December 2011 Coding Update and Reimbursement Conference. Coders’ biggest struggle was absorbing all the information – and not overdoing the holiday buying. Experts offered the inside scoop on medical coding changes for 2011 and beyond. Here are my top picks:

  1. E-prescribing is here to stay – and is about to be more strictly enforced. Physicians need to e-prescribe at least 10 medications for patients during the first 6 months of 2011, or they’ll be added to the list for a 1% penalty hit in 2012. “The prescriptions can be for one patient ten different times, or can be spread out among different patients,” said Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, in “Take Steps Now to Prepare for 2011 Pain Management Changes”.  “For pain management practices, the prescriptions can be for any type of pain meds.”
  2. Three PQRI measures apply to anesthesia providers: timing of prophylactic antibiotic (measure 30); maximal sterile barrier technique (measure 76); and active warming/temperature (measure 193). You have three reporting options: measure 76 alone; measures 76 and 193; or measures 30 and 76 said Judith Blaszczyk, RN, CPC, ACS-PM. “You must report on 80% of qualifying cases,” she reminded during her workshop, “Take Steps Now to Prepare for 2011 Anesthesia Changes.”
  3. No matter how many years you’ve been coding, you’ve heard, “ICD-10 is on the way.” Now that it’s looming as a reality, take a deep breath and know that you’ll be OK. “We learned to use ICD-9, and we’ll learn to use ICD-10,” Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, said in “Diagnosis Coding for Anesthesia”. “We can do this! We are not afraid.”

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December 16, 2010
Hot Coding Topics

Medical Coders: Here’s Your 411 on Femoral Head Resurfacing

Understand what FHR involves and when patients benefit.

An initial femoral head resurfacing (FHR) procedure involves only the femoral head and not the acetabular socket of the hip joint. The surgeon mills the femoral head and implants a metal hemisphere over the bone that exactly matches the size of the original femoral head.

FHR helps “buy time” for patients whose disease or degree of progression doesn’t merit total hip replacement (27130, Arthroplasty, acetabular and proximal femoral prosthetic replacement [total hip arthroplasty], with or without autograft or allograft).

This is especially true for younger patients because femoral head resurfacing preserves more bone stock for possible later revisions.

Judy Larson, CPC, billing manager for Rockford Orthopedic Associates in Rockford, Ill., shares a few advantages of choosing FHR:

  • Patients are likely to recover a natural gait
  • The larger size of the implant (ball) reduces the risk of dislocation
  • The femoral head/canal is preserved
  • There’s no associated femoral bone loss with future revision
  • Patients can experience less thigh pain because hip stress transfers in a natural way along the femoral canal and through the femur’s head and neck.

The metal head used during FHR will wear out the socket over time, however, and the patient will need total hip replacement.

Once the patient reaches the point of total hip replacement you’ll code the new procedure as a conversion with 27132 (Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft), says Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network.

@ Orthopedic Coding Alert. Editor: Leigh DeLozier, CPC

Sign up for the upcoming live audio conference, Coding Tips for Hip Procedures, or order the CD/transcripts.

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June 1, 2010
Coding Challenge / modifier 26

Hip Injection With Fluoro — Is Coding Both Allowed?

You have two options depending on how the physician performed the procedure.

Question: Our orthopedist administered a hip injection under fluoroscopy. Can I report both codes?

Wyoming Subscriber

Answer: You can code both the injection and fluoroscopy, but the correct choices depend on how your physician completed the procedure.

Option 1: If your orthopedist injected radiopaque dye and performed the arthrography concurrently, code the procedure with 27093 (Injection procedure for hip arthrography; without anesthesia).

Option 2: If he completed the guidance and injection as separate procedures, submit 20610 (Arthrocentesis, aspiration, and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) for the injection. Include 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) for the fluoroscopic guidance.

Remember to append modifier 26 (Professional component) to 77002 because your physician performed the service but doesn’t own the fluoroscopy equipment.

SI change: If the physician injects the sacroiliac joint instead of the hip joint, choose either 20610 (Arthrocentesis, aspiration, and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) or 27096 (Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid).

@ Orthopedic Coding Alert. Editor: Leigh DeLozier, CPC

Sign up for the upcoming live audio conference, Coding Tips for Hip Procedures, or order the CD/transcripts.

Be a hero. Sign up for Supercoder.com, and join the coding community at the Supercoder.com Facebook Fan Page.

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May 20, 2010
Coding Challenge

Check for Fracture Diagnosis Before Coding Repair

Don’t code a closed fracture treatment code without more information.

Question: Our orthopedist saw a patient in the emergency department for a gunshot wound and diagnosed a metacarpal fracture. He irrigated the site and removed a foreign body. Can we...

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April 22, 2010