The FY21 ICD-10-CM codes were released by the Center for Disease Control and Prevention (CDC) on July 1, 2020. The new and updated diagnosis codes are another part of the…
A total of 1,900 codes and 3,651 hospital inpatient procedure codes will be added for fiscal year 2017. The shift from ICD-9 to ICD-10 marked the introduction of a more…
Much has been written about the pro’s and con’s of the ICD-10 delay. To date, CMS has yet to issue the new deadline, or provide guidelines for how organizations are…
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…
As of Oct. 1, 2013, claims submitted in the United States must use ICD-10 codes and insurers will reject claims with ICD-9 codes. So what happens if a claim for…
Be sure your coding complies with ICD-9 official guidelines for pain management.
If you don’t know when to check ICD-9 official guidelines, you may have just a 50-50 chance of choosing the proper order for your diagnosis codes.
Case in point: Patients may present to the office for treatment related to pain caused by a neoplasm. In such cases, you will need to determine, which diagnosis codes to report, and you will need to decide what order to list the codes in on your claim. With that in mind, consider how you should code the scenario below.
Start by Examining the Neoplasm-Related Pain Case
Read the following scenario and determine proper ICD-9 coding based on the information given. You’ll find a helpful hint on which section of the official guidelines to review if you get stuck.
Scenario: The physician documents that a patient with lung cancer (middle lobe, primary malignant neoplasm) presented to the office for the purpose of pain management. The pain is documented as acute and caused by the neoplasm.
Hint: See section I.C.6.a.5 of the Official Guidelines for instructions on properly coding these sorts of encounters. The CDC posts ICD-9 guidelines online at: www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm
Next, Determine Which Neoplasm and Pain Codes Apply
For this scenario, before you can decide what order to put the codes in, you will need to decide which codes to report.
Neoplasm: For a primary malignant neoplasm of the lung’s middle lobe, you should report 162.4 (Malignant neoplasm of middle lobe bronchus or lung), says Denae M. Merrill, CPC, HCC coding specialist in Michigan.
Pain: To choose the proper pain diagnosis code, you want to be sure you keep in mind that the neoplasm is the cause. The ICD-9 index entry for pain has several subentries to consider:
...
Many new codes abound in final update to proposed ICD-9-CM code set
If you’ve felt that your skin cancer diagnoses could use a bit more specificity, ICD-9 will deliver this October if the proposed list of new, deleted, and revised diagnosis codes becomes final. The list of ICD-9 changes was recently posted to the CMS Website, and includes the final full set of changes that the agency will make to ICD-9 codes. After the new codes take effect on Oct. 1, CMS will only add new ICD- 9 codes on an emergency basis as it prepares to switch over the diagnosis coding system to ICD-10.
Seek Out Skin Cancer Changes
You’ll find a significant expansion to the 173.x (Other malignant neoplasm of skin) categories, including changes to 173.0x (…Skin of lip), 173.1x (Eyelid, including canthus), 173.2x (Skin of ear and external auditory canal), 173.3x (Skin of other and unspecified parts of face), 173.4x (Scalp and skin of neck), 173.5x (Skin of trunk, except scrotum), 173.6x (Skin of upper limb, including shoulder), 173.7x (Skin of lower limb, including hip), 173.8x (Other specified sites of skin), and 173.9x (Skin, site unspecified).
Among these changes, for example, you’ll find the following new codes to delineate various types of skin cancers:
The changes in the other skin cancer categories referenced above follow this pattern, with the fifth digit of “0” referring to an unspecified malignant neoplasm, “1” denoting a basal cell cancer, “2” referring to a squamous cell carcinoma,” and “9”...
Many new codes abound in final update to proposed ICD-9-CM code set.
If you’ve felt that your skin cancer diagnoses could use a bit more specificity, ICD-9 will deliver this October if the proposed list of new, deleted, and revised diagnosis codes becomes final. The list of ICD-9 changes was recently posted to the CMS Website, and includes the final full set of changes that the agency will make to ICD-9 codes. After the new codes take effect on Oct. 1, CMS will only add new ICD- 9 codes on an emergency basis as it prepares to switch over the diagnosis coding system to ICD-10.
Seek Out Skin Cancer Changes
You’ll find a significant expansion to the 173.x (Other malignant neoplasm of skin) categories, including changes to 173.0x (…Skin of lip), 173.1x (Eyelid, including canthus), 173.2x (Skin of ear and external auditory canal), 173.3x (Skin of other and unspecified parts of face), 173.4x (Scalp and skin of neck), 173.5x (Skin of trunk, except scrotum), 173.6x (Skin of upper limb, including shoulder), 173.7x (Skin of lower limb, including hip), 173.8x (Other specified sites of skin), and 173.9x (Skin, site unspecified).
Among these changes, for example, you’ll find the following new codes to delineate various types of skin cancers:
The changes in the other skin cancer categories referenced above follow this pattern, with the fifth digit of “0” referring to an unspecified malignant neoplasm, “1” denoting a basal cell cancer, “2” referring to a squamous cell carcinoma,” and “9” describing another...
If you’re just plodding though nerve surgery claims, you could be stepping over a great deal of well-earned reimbursement. Coding and billing peripheral nerve surgeries for conditions such as tarsal tunnel and diabetic neuropathy can involve a frazzling number of codes. Podiatry coders often struggle to navigate the various coding guidelines that payers use for these procedures. Use these five tips to maximize payment for your podiatrist’s hard work on nerve surgeries:
Tip 1: Check CCI edits and your local Medicare guidelines
If you’re billing codes that the Correct Coding Initiative bundles together — and your documentation and diagnosis codes can’t justify breaking the bundle — you’re not going to see one extra cent for that bundled procedure code.
Example: A California Medicare patient injures his foot when he falls off a ladder and requires peripheral nerve surgery to correct the damage the injury caused. The podiatrist performs the following:
28035 — Release, tarsal tunnel (posterior tibial nerve decompression)
64712 — Neuroplasty, major peripheral nerve, arm or leg, open; sciatic nerve
64704 — Neuroplasty; nerve of hand or foot
+64727 — Internal neurolysis, requiring use of operating microscope (List separately in addition to code for neuroplasty) (Neuroplasty includes external neurolysis)
64708 — Neuroplasty, major peripheral nerve, arm or leg, open; other than specified.
If you report all these codes, you’re bound to get a denial on 64704 — this is one of the codes the Correct Coding Initiative (CCI) bundles into 28035. Unless you can justify billing 64704 separately (and if that’s the case, append modifier 59, Distinct procedural service, to the code), you shouldn’t list it all.
Unbundling is not automatic: Be aware that you can’t automatically override a CCI edit with modifier 59 just because documentation supports a separate site,...
You often turn to modifier 53 (discontinued procedure) when your anesthesiologist or the surgeon sees some risk that could threaten the patient’s health if the procedure continues. However, Payers do recoil when it comes to reimbursing these claims. Here are three easy steps by the experts to help you to get on the right track for reimbursement.
1) Conquer Electronic Filing Challenges
Gone are the days when you were told to submit paper claims reporting modifier 53 so you can append a written explanation with the claim. With HIPAA and electronic standards, you can do the billing electronically. Once you have billed electronically with modifier 53, the payer might request more information. Thus the note should contain all the information the carrier needs. For failed procedure, the record should state the reasons for the failure. If your physician discontinued the procedure due to the patient’s condition, the record should detail what factors prevented the procedure from going forward.
2) Verify the Timing of Cancellation
Knowing exactly when the case was canceled in terms of the physician’s work will help guide your code choices. If the physician cancels the procedure after induction, the case technically became a surgical procedure. Determine the correct surgical code, such as 45380 for a colonoscopy with biopsy. Then cross to the correct anesthesia code, such as 00810. If the cancelled procedure took place in an outpatient hospital or ambulatory surgical center, some payers require modifier 73 or modifier 74. In those situations, append modifier 73 or 74 to the anesthesia code instead of modifier 53 as modifiers 73 and 74 are specifically for outpatient hospital use.
3) Include the Correct Diagnosis
Indicate the reason for cancellation by reporting the appropriate diagnosis code or codes. For a patient who experiences syncope while still in the...
If you don’t know when to check ICD-9 official guidelines, you may have just a 50-50 chance of choosing the proper order for your diagnosis codes. Patients may present to the office for treatment related to pain caused by a neoplasm. In such cases, you will need to determine which diagnosis codes to report and you will need to decide what order to list the codes in on your claim. With that in mind, consider how you should code the scenario below.
Start by Examining the Neoplasm-Related Pain Case
Read the following scenario and determine proper ICD-9 coding based on the information given. You’ll find a helpful hint on which section of the official guidelines to review if you get stuck.
Scenario: The physician documents that a patient with lung cancer (middle lobe, primary malignant neoplasm) was presented to the office for the purpose of pain management. The pain is documented as acute and caused by the neoplasm.
Hint: See section I.C.6.a.5 of the Official Guidelines for instructions on properly coding these sorts of encounters. The CDC posts ICD-9 guidelines online at: http://www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm
Next, Determine Which Neoplasm and Pain Codes Apply
For this scenario, before you can decide what order to put the codes in, you will need to decide which codes to report.
Neoplasm: For a primary malignant neoplasm of the lung’s middle lobe, you should report 162.4 (Malignant neoplasm of middle lobe bronchus or lung), says Denae M. Merrill, CPC, HCC coding specialist in Michigan.
Pain: To choose the proper pain diagnosis code, you want to be sure you keep in mind that the neoplasm is the cause. The ICD-9 index entry for pain has several subentries to consider:
...
Question: Our state’s Medicaid carrier denies our claims when we submit 62311 with modifier 59 for postoperative pain management. They say the 62311 is bundled with the anesthesia procedure code. How should we handle this? -Ohio Subscriber Answer: ...
Lolita Jones, RHIA, CSS, independent coding and billing consultant, discusses five ways ICD-10 will affect “front office” processes in an ambulatory surgery center. This article is the second installation in a four-part series. -memberlock Login to Read More
If your physician administers trigeminal nerve blocks to patients for headache relief, brush up on the ins and outs of anatomy and potential diagnoses. Read on for two keys that will keep your coding for these procedures pain free.
Learn the Location
The trigeminal nerve provides sensory innervations to most of the face; providers might also refer to the trigeminal nerve as the “cranial nerve V” or the “fifth cranial nerve.” The name “trigeminal” stems from the fact that the cranial nerve has three major divisions, or branches:
Providers can administer trigeminal injections at any of the three divisions or branches of the divisions, says Debbie Farmer, CPC, ACS-AN, with Auditing and Compliance Education in Leawood, Kan. You should report injections with 64400 (Injection, anesthetic agent; trigeminal nerve, any division or branch).
Patients who need trigeminal nerve injections can have conditions ranging from severe headache to postherpetic neuralgia to trigeminal neuralgia (also known as tic douloureux). Common diagnosis codes can include:
Review Bilateral Rules
If your provider administers bilateral injections, include extra details with the claim that will help garner the appropriate reimbursement. Medicare and many other payers allow you to report trigeminal injections bilaterally by appending modifier 50 (Bilateral procedure).
Most Medicare contractors request that providers report bilateral services as one line item with modifier 50 appended and one unit of service noted (64400-50 x 1). Medicare will process the service at...
The new fifth-digit diagnosis codes for body mass index (BMI) can help you better document a patient’s condition, especially when the patient’s BMI might contribute to more complex risk factors for the anesthesiologist to handle. Having documentation of a high BMI doesn’t automatically lead to more pay, however. Watch two areas before assuming you can automatically append modifier 22 (Increased procedural services) because of BMI and potentially score a 20-30 percent higher pay for the procedure.
Not All Morbid Obesity Means Modifier 22
A patient is considered to be morbidly obese when his or her BMI is 40 or more. New BMI codes for 2011 include:
While morbid obesity can be an appropriate reason to report modifier 22, don’t assume you should always append the modifier just because the patient is morbidly obese.
Example 1: During surgical procedures that are performed because of morbid obesity (such as bariatric surgery), the patient must meet the morbidly obese criteria too support medical necessity for the procedure. In those type instances, simply having a patient who is morbidly obese doesn’t support using modifier 22. Remember, if you report a physical status modifier for a patient who is morbidly obese, it is not appropriate to also include modifier 22. Keep in mind that Medicare does not pay for physical status, qualifying circumstances, or extra work modifiers.
The anesthesia provider’s documentation should direct you to the correct BMI code as well as support when you can append modifier 22.
Example 2: The patient’s obesity might contribute to breathing problems that lead to lower oxygen and...
When ICD-9 becomes ICD-10 in October 2013, the diagnosis codes you’re accustomed to reporting will no longer exist. Many diagnosis codes will include more details than their current counterparts, and some sub-codes of the same family will even move t...