Tag Archives | Medical Record

93224-93227 Take on Extra Jobs in 2011 to Make Up for Code Deletions


12, 24, and 48 hour services all have roles in this coding shake-up.

Cardiology codes are always changing, trying to keep pace with technology and current practice. For this reason, Holter monitor codes saw big changes this year. Here’s what you need to know.

Start With a Nutshell Holter Service Description

Dynamic electrocardiography (ECG), also called Holter monitoring, involves ECG recording, usually over 24 hours. The goal is to obtain and analyze a record of the patient’s ECG activity during a typical day. The medical record usually will include the reason for the test, copies of ECG strips showing abnormalities or symptomatic episodes, the patient’s diary of symptoms, statistics for abnormal episodes, the physician’s interpretation, and documentation of recording times.

Understand Your Newly Reduced Coding Options

In 2010, you chose among the following code ranges for these services:

  • 93224-93227, Wearable electrocardiographic rhythm derived monitoring for 24 hours by continuous original waveform recording and storage, with visual superimposition scanning
  • 93230-93233, Wearable electrocardiographic rhythm derived monitoring for 24 hours by continuous original waveform recording and storage without superimposition scanning utilizing a device capable of producing a full miniaturized printout
  • 93235-93237, Wearable electrocardiographic rhythm derived monitoring for 24 hours by continuous computerized monitoring and non-continuous recording, and real-time data analysis using a device capable of producing intermittent full-sized waveform tracings, possibly patient activated

In 2011, your coding options have changed. A new note under 93229 tells you “93230-93237 have been deleted. To report external electrocardiographic rhythm derived monitoring for up to 48 hours, see 93224-93227.” CPT® Changes 2011: An Insider’s View states that 93224-93227 have been revised to accommodate reporting the services described by 93230-93233 and 93235-93237.


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238.2 Should Only Be Used in Medical Record Under 1 Condition

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…

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ICD-9 2011: Avoid H1N1, Fecal Incontinence Denials With 5th Digit Savvy

488.1x Cheat sheet makes fast work of snagging correct code.

Don’t let rumors of few ICD-9 changes in prep for ICD-10 blindside you to top diagnosis changes for 2011. Without the scoop on expansion to the 488, 784, and 787 categories, denials for invalid codes will derail your claims delaying your payments.

In ICD-9 2011, “Codes continue to become more and more specific necessitating a provider to document clearly and thoroughly to allow for selection of the most specific and accurate code,” says Jennifer Swindle, RHIT, CCS-P, CEMC, CFPC, CCP-P, PCS, Director Coding & Compliance Division, PivotHealth, LLC.

Good news: Updating your ICD-9 coding by the Oct. 1, 2010, effective date doesn’t have to be a chore. Start using your new choices in no time flat following these guidelines.

Look at Manifestation When Assigning “Swine Flu” Dx

This fall, when a patient has H1N1 (“swine flu”) pay attention to two details. The medical record will have to identify the correct influenza and you will have to capture the appropriate manifestation to select the codes to the degree of specificity now required, Swindle points out.

With the change “category 488 (Influenza due to certain identified influenza viruses) would mirror the structure of category 487 (Influenza),” according to the Summary of March 2010 ICD-9-CM Coordination and Maintenance Committee Meeting. The current 488.x sub-category didn’t provide the level of detail that category 487 (Influenza) does.

Change: There will be “tremendous expansion of the H1N1 category,” Swindle explains. ICD-9 2011 deletes 488.0 and 488.1 and adds six new five-digit codes. New codes 488.0x (Influenza due to identified avian influenza virus) and 488.1x (Influenza due to identified novel H1N1 influenza virus) allow you “to uniquely capture pneumonia, other respiratory manifestations, and other manifestations occurring with these types of influenza,” states the summary.

Starting Oct….

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Compliance Red Flag: Update Your Modifier 59 and ‘Incident To’ Guidelines

Keep signature, modifier 59, and ‘Incident To’ guidelines front and center.

If you’ve been worrying that the oncologist’s illegible signature on an order is going to come back to haunt your practice in an audit, CMS has offered

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Use Shared Visit to Capitalize on NPP/Physician Teamwork

Forget about incident-to in the facility, but consider this similar billing technique.

ED coders that have never heard of “incident-to” billing have nothing to worry about, as you cannot code for “incident-to” services in the hospital. Coders that don’t understand…

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CMS Publishes Q&As Regarding Services Previously Billed As Consults

Medicare’s elimination of payment for consultation services has caused mass confusion throughout the coding community, not just due to the changes it has caused in your billing procedures, but also due to lack of information from CMS.

In an apparent…

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Counseling Must Dominate Exception Claims For Seamless Payment

Choose the service level using the documented history, exam, and MDM.
Question: A new patient with a chronic gastric ulcer meets the gastroenterologist for management of her condition. The gastroenterologist meets for 34 minutes with the patient, and performs an expanded problem focused history and exam and straightforward medical decision making. The note also indicate that […]

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Set the Record Straight: ICD Code Options for COPD

What your pulmonologist writes in the documentation matters.
The pulmonologist’s documentation, along with the patient’s medical record can make or break your chronic obstructive pulmonary disease (COPD) reporting. One key is making sure that your coding accurately identifies the patient’s specific pulmonary condition and any other associated acute condition (if necessary).
Background: According to the National Heart […]

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Get Paid for EM Visits: How Much ROS Documentation Is Enough?

Caution: Keep enough paperwork on hand to back up EHR.
Transitioning to the world of Electronic Health Records (EHR) can make your coding easier on many levels, but don’t take it for granted. Physicians often fall short in their review of systems (ROS) documentation whether you use paper charts or rely on EHR, but you can […]

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Neurosurgery Coding: Previous Injury Means Multiple Dx Options

Find out what additional information V codes provide to the payer.
Question: We have a patient with previous spinal injury that is now causing neck pain. How should I code the diagnosis?
North Carolina Subscriber
Answer: Document and code prior conditions that contribute to a patient’s current complaint — if they affect the management of the current condition. Prior trauma, […]

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Newborn Status Change Means Deciding Between Hospital Care Codes

Sort your normal, sick and intensive care options.
Choosing the appropriate codes for initial newborn services can be difficult due to the large number of available codes and gray areas between the spectrum of illnesses. If you find yourself getting tripped up by the multiple categories, read on for expert tips and real-world examples that […]

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Ophthalmology Coding Challenge: Flashers & Floaters

How’s Your EO Coding & Billing? Test Yourself With This Scenario.
Question: A patient reports flashes and floaters but the ophthalmologist does not find evidence of retinal pathology on routine ophthalmoscopy. Are we justified in billing for extended ophthalmoscopy (EO)?
Answer: If the ophthalmoscopy is a routine part of a patient’s eye exam, do not […]

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