Nasal cavity polyp also goes by the term “choanal” and “nasopharyngeal.”
If the otolaryngologist performed a removal of a middle turbinate endoscopically, you would report it with CPT 31240 — subsequently linking this procedure to a diagnosis…
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Nasal cavity polyp also goes by the term “choanal” and “nasopharyngeal.”
Facing denials on your tibial/peroneal codes? No worries, help is at hand.
The new tibial/peroneal service codes are below. Note that all of the codes include angioplasty in the same vessel when that service is performed.
The first four codes apply to the initial tibial or peroneal vessel treated in a single leg:
- Angioplasty: 37228 — Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty
- Atherectomy (and angioplasty): 37229 — … with atherectomy, includes angioplasty within the same vessel, when performed
- Stent (and angioplasty): 37230 – … with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
- Stent and atherectomy (and angioplasty): 37231 — … with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed.
The final four codes are add-on codes that you use to report services on each additional ipsilateral (same side) vessel treated in the tibial/peroneal territory:
- Angioplasty: +37232 — Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) (use with 37228-37231)
- Atherectomy (and angioplasty): +37233 — … with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) (use with 37229-37231)
- Stent (and angioplasty): +37234 — … with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) (use with 37230-37231)
- Stent and atherectomy (and angioplasty): +37235 — … with transluminal stent placement(s) and atherectomy, includes angioplastywithin the same vessel, when performed (List separately in addition to code for primary procedure) (use with 37231).
The general rule for the revascularization codes is that you should report the one code that represents the most intensive service performed in a single…
If you mistake modifiers 52 and 53 as one or the other because they’re both used for incomplete procedures, you’ll end up losing your reimbursement. Remember these two have extremely distinctive functions.
Consider a situation when the gastroenterologist performs an esophagogastroduodenoscopy (EGD) to examine the lining of the esophagus, stomach, and upper duodenum of a patient as part of a GERD evaluation.
Suppose that while inserting the endoscope, the patient registers unstable vital signs. The gastroenterologist, then, decides it is not in the patient’s best interest to continue the procedure. You would report this on your claim using:
- 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) for the EDG
- Modifier 53 (Discontinued procedure) to show that the GI discontinued the EGD.
Other situations that would call for a discontinued procedure include respiratory distress (786.09), hypoxia (799.02), irregular heart rhythm (427.9), and others usually related to the sedation medications.
Modifier 53 Defined: Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances, or those that threaten the well-being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued.
In addition, you shouldn’t disregard the importance of submitting documentation that shows:
- that the physician began the procedure;
- why the procedure was discontinued;
- the percentage of the procedure performed.
Taking on the same scenario, the gastroenterologist begins the diagnostic EGD but stopped without examining the entire upper gastrointestinal tract because she encounters an obstructing lesion in the middle of the stomach. In this case, you should attach modifier 52 to the CPT, says Margaret Lamb, RHIT, CPC, of Great Falls Clinic…
Only report primary procedure – except for 99455 edits.
The latest version of the National Correct Coding Initiative (CCI) edits went into effect October 1, and introduced a slew of pairings involving two new Category III “T” codes for transforaminal epidural injections:
- 0228T – Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level
- 0230T – Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level.
Explanation: “The new Category III codes 0228T-0231T have added the addition of ultrasound guidance to transforaminal epidural injections,” says Susan Vogelberger, CPC, CPC-H, CPC-I, CMBS, CCP-P, CEO of Healthcare Consulting and Coding Education in Boardman, Ohio. “That will eliminate the need to code the ultrasound independently.” The existing, Category I codes for transforaminal epidural injections of anesthetic and/or steroids (64479-64484) include only the injection itself.
Even Simple Procedures Rule With NME Edits
CCI classifies the bulk of edits involving 0228T and 0230T as non-mutually exclusive.
No breakage: The rationale behind the new bundling edits falls to “standards of medical/surgical practice.” Most edits carry a modifier indicator of “0,” which means you cannot break the edit with a modifier and report both codes during a single encounter.
Examples of common procedures that override the accompanying 0228T or 0230T codes include:
- Incision and drainage (such as 10060, Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single)
- Foreign body removal (such as 10120, Incision and removal of foreign body, subcutaneous tissues; simple) Lesion paring (such as 11055, Paring or cutting of benign hyperkeratonic lesion (e.g., corn or callus); single lesion)
- Skin tag removal (beginning with 11200, Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions)
- Lesion shaving (including 11300,
If you’ve been frustrated about the lack of arthroscopic hip surgery codes that CPT offers, CPT 2011 will change that, with three new codes that debut on Jan. 1.
In fact, CPT will introduce over 200 new codes in 2011 to help keep your coding more specific than ever, spanning several categories, from dermatology to orthopedics to cardiology, and beyond.
In orthopedics, you’ll benefit from the following three hip arthroscopy codes, which will be excellent additions to CPT.
- 29914 – Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion)
- 29915 – Arthroscopy, hip, surgical; with acetabuloplasty (ie, treatment of pincer lesion)
- 29916 – Arthroscopy, hip, surgical; with labral repair
Check out New Observation Codes
CPT adds to your E/M coding options with the introduction of three new observation codes, as follows:
- 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 – Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: 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
Eliminate ‘uncertain behavior’ confusion with expert tips
If you always use diagnosis code 238.2 (Neoplasm of uncertain behavior of skin) when you’re reporting 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) for a biopsy procedure your surgeon performs, you’re setting your practice up for disaster. The key to knowing when to use the “uncertain behavior” diagnosis code is understanding what that code descriptor really means. Follow these expert tips to ensure you’re choosing the correct diagnosis code for all your 11100 claims.
Wait For Pathology Before Choosing a Code
When your general surgeon performs a biopsy you should always wait until the pathology report comes back to choose the proper diagnosis and procedure codes to report – even though this will not always affect the CPT code you will wind up choosing.
Reason: The biopsy specimen’s pathology will affect the ICD-9 code you report, but most CPT procedure codes are not based on the specimen’s results. “There are a few CPT codes which are linked to specific diagnoses (for instance, excision of benign and malignant lesions), but overall CPT is about what you did; ICD-9 is about the outcome or the reason for it,” 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.
Get to Know the Meaning Behind ‘Uncertain’ Codes
When you report 238.2 as the diagnosis for a biopsy procedure, you’re telling the payer that the pathologist said in his path report that he was uncertain as to the morphology of the lesion, says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J., and senior coder and auditor for…
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…
Improve your reimbursement chances by applying modifier 58 in this situation.
When your surgeon targets the brain or spine with stereotactic radiosurgery (also called gamma knife surgery) to treat multiple lesions over multiple sessions, you need to know two crucial things: what stereotactic radiosurgery codes to use and how many units to include.
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