Hot Coding Topics

Phototherapy: 96900 or 96910? Check Out These FAQs to Narrow Down On Correct Option

If your dermatologist is treating vitiligo or dychromia patients with phototherapy, read your physician’s documentation carefully to determine what type of light, wavelength, and materials he used. These two frequently asked questions will help you combat both E/M and multi equipment correct coding initiative (CCI) situations.

Evaluate These Phototherapy + E/M Tips

If you’re charging for an office visit on the same day as phototherapy, your reimbursement may depend on whether your physician’s documentation warrants a different diagnosis code. Payers may reimburse at times if the doctor sees the patient for a different problem, thus with a different diagnosis code, experts say.

Example: If your physician performs 99212 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 10 minutes face-to-face with the patient and/or family) with phototherapy, you will bill it with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the E/M service. You can only consider reporting modifier 25 when coding an E/M service, Janet Palazzo, CPC, a coder in Cherry Hill, N.J., says. Remember your E/M documentation has to show medical necessity for the additional work.

If you reported the nurse visit code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician …), your payer would likely consider it bundled into the light treatment.

Ask 2 Questions to Choose Best Light Therapy Code

For patients with vitiligo (709.01), your dermatologist may use narrow band UVB phototherapy.

The dermatologist administers phototherapy two to three times per week for several months until the patient achieves repigmentation of the skin. For this procedure, you need to pinpoint what types the...

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April 14, 2011
Hot Coding Topics / modifier 25

AK Removals: Earn $120 by Following 17000-17111 with 99201

Stick to these 3 tips for your E/M and lesion removal procedures.

You can report both the E/M and lesion removal if the E/M service was a significant and separately identifiable service for an E/M service with actinic keratoses (AK) removal procedure.

Always verify with your carrier before appending modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.

You can only consider reporting modifier 25 when coding an E/M service, says Janet Palazzo, CPC, coder for a practice in Cherry Hill, N.J. If the procedures you are reporting don’t fall under E/M services, it is possible the encounter qualifies for another modifier instead.

Have a look at the following three tips to help you report these services accurately so your practice won’t miss out on about $41 for 99201 and $80 for 17000 or more, according to national averages indicated in Medicare’s 2011 Physician Fee Schedule.

1. Know When You Should Charge an E/M

Each insurer has its own guidelines for office visits (99201- 99215, Office or other outpatient visit …) and lesion removals (17000-17111, Destruction, Benign or Premalignant Lesions). So, knowing whether to appeal an E/M denial is difficult unless you know that the service deserves payment.

You should report the office visit (99201-99215) in addition to the procedure when the dermatologist performs a significant, separately identifiable E/M service from the AK removal, especially if the patient is new to your practice.

Along with the appropriate E/M code, report any diagnoses that come with that examination, which may include more than just the AK.

For example, if a patient comes in for an initial AK visit, you should charge an E/M service, since the physician has to examine the area and discuss...

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March 21, 2011
Hot Coding Topics

Stop Letting Complex Dermatitis Tests Rob You Of Your Deserved Pay

Keeping track of all the different potential allergens that may be causing a patient’s skin rash is challenging enough. But when you add the complexity of different kinds of dermatitis tests that a dermatologist can perform, it’s enough to cause a coder to break out in a rash herself. The variety and complexity of allergy tests can certainly lead to coding mishaps — but understanding the codes and having clear documentation can help clear things up.

The tests that dermatologists commonly perform to learn the source of a patient’s allergic dermatitis include scratch tests and patch tests. Knowing what code to use means understanding what each test does, and how.

Count Each Allergen in Scratch Tests

Procedure: Percutaneous tests

AKA: Scratch tests, prick tests, puncture tests, Multi-Test

Codes: 95004 (Percutaneous tests [scratch, puncture, prick] with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests) and 95010 (Percutaneous tests [scratch, puncture, prick] sequential and incremental, with drugs, biologicals or venoms, immediate type reaction, including test interpretation and report by a physician, specify number of tests).

In these tests, the dermatologist applies test solutions of possible allergens to scratches or shallow punctures of the skin. The code you report will depend on the type of solutions applied — allergenic extracts, such as dust, cat dander, and molds (95004), or antibiotics, biologicals, stinging insects, and local anesthetic agents (95010).

Dermatologists usually want to test several substances at once (often in blocks of eight), and each substance counts as a separate test, notes Pamela Biffle, CPC, CPC-P, CPC-I, CCSP, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Watauga, Texas. Be sure to code for each allergen administered by putting the number in the “units” field of your claim form.

Hidden trap: Code...

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March 14, 2011
Coder's Cranium / Hot Coding Topics

Code Correct Closure Level With These Tips

All closures aren’t created equal; one of the nuances of coding these procedures is knowing how to distinguish one type from another. Read on for our experts’ advice on how to assess the three closure levels and assign the best codes.

A simple repair involves primarily the dermis and epidermis. It might involve subcutaneous tissues, but not deep layers.

How do you know when a closure might involve subcutaneous layers but is still considered a simple repair? Your provider’s documentation is the key. The difference is whether the wound is closed in layers or just a single layer, experts note. The provider might decide to include the subcutaneous layer in the closure but does so by bringing the needle through the dermis into the subcutaneous and back. That results in a single-layer closure rather than closing the subcutaneous layer first and then the dermis/epidermis second in separate closure techniques.

But “simple” doesn’t mean the repair is something anyone could do. Simple repairs involve one-layer closure, which helps set them apart from a standard E/M procedure. Simple repair also includes “local anesthesia, and chemical or electrocauterization of wounds not closed,” says Dilsia Santiago, CCS, CCS-P, a coder in Reading, Pa.

For example, if your dermatologist uses adhesive strips to close a laceration, consider it an E/M service that you’ll report with the best-fitting choice from codes 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient …) or 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient …). Most Steri-strip applications are done by nursing staff; but even if the physician applies them, they’re included in the E/M service.

If, however, your dermatologist uses sutures, staples, or tissue adhesives to close the laceration, consider it a separate procedure. Choose...

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February 28, 2011
Hot Coding Topics

Wound Coding: 3 Tips Help You Recover Your Full Debridement Pay

Maximize 11040-11044 pay with modifier 51.

In most cases, your practice won’t report debridement separate from wound repair codes. But when exceptions arise, follow these three tips to choose the appropriate wound repair code.

If you’re considering reporting debridement separate from a wound closure, make sure your physician’s notes clearly document that the wound was contaminated and required saline or other substances or instrumentation to cleanse and debride the wound.

Don’t miss: If you report a debridement code with your wound closure codes, append modifier 59 (Distinct procedural service) to the debridement code. This informs the payer that you recognize that debridement is generally bundled into wound repair, but that clinical circumstances required the physician to perform debridement as a separate service.

1. Look for Wound Repair With the Debridement

CPT specifies that you may also report debridement codes independently of repair codes when the physician removes large amounts of devitalized or contaminated tissue or when the physician performs debridement without immediate primary repair of a wound, notes Pamela Biffle, CPC, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Watauga, Texas.

The physician may clean debris from the wound without repairing the wound because it was either not deep enough to require repair or the physician delayed the repair due to an extenuating circumstance.

In the case in which the dermatologist excises a lesion, debridement is included in the procedure. However, when the dermatologist only performs debridement or performs the debridement in addition to the wound repair, such as the case when a wound is excessively dirty or contaminated with debris, you would also code the debridement code with the wound repair/excision code, appending modifier 51 (Multiple procedures) for the multiple procedure.

Example: A patient returns to the dermatologist several days after a chemical...

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June 13, 2010