CMS / CPT / Medicare / Provider News

CMS at AMA Chicago: We’re Reducing Consult Request Requirement

CMS auditors will look for 1 less thing in consult documentation. With Medicare’s invalidation of consultation codes 99241-99255 in 2010, your ICD-9 codes better prove why two MDs are necessary on the same patient’s hospital care or the physician better specify why in his note. Separate ICD-9 codes will help substantiate the medical necessity for providing consultative [...] Related articles:

  1. Medicare’s Consult Rule Trickle Down Effect And what it means for pediatric practices. A report...
  2. Medicare Changes to 2010 CPT Inpatient Consultation Codes Prevent 99251-99245 denials in 2010 with this checklist. Multiple...
  3. Medicare 2010 CPT Consultation Code ChangesNew rules for consult coding straight from the AMA Meeting...

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November 13, 2009
CPT 2010 / Hot Coding Topics

PQRI: No Coumadin Due to Fall Risk

Plus, experts at the AMA meeting in Chicago tell you what to do if you can’t get H1N1 vaccine for PQRI Measure 110 or other vaccine measures. Question: My internist decided not to put a patient on Coumadin because the patient has a higher risk of falling than from having a stroke. Our group participates in [...] Related articles:

  1. Smokin’ PQRI Pointers We’ve got the G codes you need to score...
  2. Make Sure These Errors Don’t Sink Your PQRI BonusCMS shows which issues sidelined these practices. Most practices would...
  3. Track Payer’s Preferred H1N1 Admin Code — or Risk RejectionsCode 488.1 does not = confirmed lab. Swine flu has...

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November 13, 2009
CMS / CPT / Medicare / Provider News

Medicare Changes to 2010 CPT Inpatient Consultation Codes

Prevent 99251-99245 denials in 2010 with this checklist. Multiple physicians using the same hospital codes sounds like a recipe for denials, but that’s what Medicare is instructing physician inpatient consultants and care coordinators to do. Whether carriers will kick out these submissions as coordination of care or inpatient admit limiting admit edits is contractor specific, Charles [...] Related articles:

  1. Medicare 2010 CPT Consultation Code ChangesNew rules for consult coding straight from the AMA Meeting...
  2. Medicare’s Consult Rule Trickle Down Effect And what it means for pediatric practices. A report...
  3. Proposed 2010 MPFS: $26 More for ‘Welcome to Medicare’ ExamCMS welcomed health care providers to an July 9 open...

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November 13, 2009
CPT / Hot Coding Topics

2010 Tumor Excision Coding: Lesion Vs. Chunk Size

Straight from the AMA in Chicago — answers to your lesion excision coding questions for 2010. Question: A thigh lesion measures 2 cm but requires a resection down to the subcutaneous layer of 4 cm. Which lesion excision code should I use? Answer: “You should use the larger of the subcutaneous codes,” says Albert E. Bothe, Jr, [...] Related articles:

  1. Lesion Excision Coding Challenge: 2 Lesions, 1 CutQuestion: Our nonphysician practitioner (NPP) discovers a pair of benign...
  2. Shave Duplicate Lesion Excision Denials Question: Our dermatologist shaved three epidermal lesions that the...
  3. Payer Update: NGS Directives Vs. Proper Skin Lesion CodingIgnore the LCD and stick with what you know about...

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November 13, 2009
CPT / Hot Coding Topics / Medicare

Medicare 2010 CPT Consultation Code Changes

New rules for consult coding straight from the AMA Meeting in Chicago — plus where your practice will gain and lose reimbursement. If you can’t figure out how to match a low level consult to an initial hospital care code, you’re not alone. Code 99251 doesn’t crosswalk to 99221, agreed William J. Mangold, Jr., MD, JD, Noridian [...] Related articles:

  1. Medicare Changes to 2010 CPT Inpatient Consultation Codes Prevent 99251-99245 denials in 2010 with this checklist. Multiple...
  2. CMS at AMA Chicago: We’re Reducing Consult Request RequirementCMS auditors will look for 1 less thing in consult...
  3. Consultation 5 R’s Miss 1 element, and invite auditors to check out...

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November 12, 2009
Coding Challenge / modifier 50

Is 30901 Your Nosebleed Code? Not So Fast?

Hint: Look for these keywords in the note to select the correct nosebleed code. Question: The internist stops a patient’s nosebleed. Is this always a procedure? Answer: No, if a patient reports with a nosebleed and the physician stops the bleeding with basic methods, you’ll typically opt for the appropriate-level E/M code. E/M methods: Code minimal attempts at [...] Related articles:

  1. Can You Code ‘Buddy Taping’ Separately? Question: An established patient complains of pain in her...
  2. Should You Code Presenting Symptoms Along With Dx? Question: An established patient complains of trouble breathing and...
  3. How Do I Code Blood Draw Plus E/M?Question: An established type II diabetic patient comes in for...

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November 11, 2009
CPT 2010 / Hot Coding Topics

From the AMA in Chicago: CPT 2010 Out of Order Codes

Here’s where you can find a full list of resequenced codes. Notice that new sign in your CPT book? No, that hash mark’s not to delete a message or to sign into a conference; it’s to alert you to an out of order code. The “#” works like a flashing yellow light: Slow down, there might be [...] Related articles:

  1. 2010 Tumor Excision Coding: Lesion Vs. Chunk SizeStraight from the AMA in Chicago — answers to your lesion...
  2. Lesion Excision Coding Challenge: 2 Lesions, 1 CutQuestion: Our nonphysician practitioner (NPP) discovers a pair of benign...
  3. Radiology Billing Checklist: Rules for Additional Tests without Treating Physician’s OrderKeep these additional test rules at your fingertips if your...

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November 11, 2009
Provider News

CMS Makes Key Changes to ABN Modifiers

We’ve got the new instructions you’ll need to follow. CMS will update the ABN modifiers effective April 1, according to MLN Matters article MM6563, dated Oct. 29. The ABN descriptors will read as follows: Modifier GA — Revised to read, “Waiver of liability statement issued as required by payer policy.” You’ll use this when a required ABN was issued. Modifier GX — [...] Related articles:

  1. CIGNA Opens Black Box: Get Paid With Modifiers 25 & 59 You now have clear-cut policies to apply, including 1...
  2. Still Using the Old ABN, NEMB Forms? Stop Now Surprise! Here’s when the new form puts you on...
  3. Got Multiple Modifiers? How To Sequence Them on the Claim Coders like to say that modifiers help them tell...

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November 10, 2009
Provider News

HCPCS 2010: CMS Debuts New J Codes

Synvisc, penicillin get new codes — along with injectibles for neurology, bleeding. Hot on the heels of the new CPT codes, CMS follows suit by publishing the 2010 HCPCS code set, posted on the CMS Web site on Nov. 3. You’ll find scores of changes. What follows is a small sampling of what you’ll face in 2010: Synvisc: HCPCS will [...] Related articles:

  1. Which HCPCS Code Should I Use for Eovist MRI contrast? Question: Which HCPCS code should I use to report...
  2. 2 New HCPCS Codes for H1N1 Vaccine AdministrationPlus: New Bevacizumab code is effective Oct. 1. If you’re...
  3. 2010 CPT Category II & III Codes You Might Miss Yes, our CPT books are fountains of knowledge, but...

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November 10, 2009
Coding Challenge

Infusion Coding Education: Remicade

Coding Hint: Watch for ‘add-ons’ during Remicade sessions Question: An established patient with a plan of care in place for his Crohn’s disease of the ileum reports to the gastroenterologist for a Remicade infusion. The infusion started at 10:00 a.m. and ended at 11:42. The patient reported nausea during the infusion, so the gastroenterologist administered 200 mg of Benadryl from 10:41 [...] Related articles:

  1. Oncology Coding Challenge: When Infusion Runs Long Question: The oncologist ordered a 90-minute chemotherapy infusion service,...
  2. CODING CHALLENGE: Is V58.11 Right for Patient Not on Chemo? Question: When you use a chemo admin code for...
  3. Gastroenterology Coding Education: Bravo Cap Placements Question: A new patient reports to the gastroenterologist with complaints...

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November 9, 2009
Medicare / Toolkit

Coder’s Navigation Tool: 2010 Medicare Physician Fee Schedule

It’s that time of year coders — yes, time to comb through pages and pages and pages of the final 2010 Medicare Physician Fee Schedule. We’ve got a handy place to start. If you want a quick overview of fee schedule’s financial impact on your physician practice’s specialty, go here and scroll to page 1171. There, [...] Related articles:

  1. Proposed 2010 Physician Fee Schedule: A Closer Look21.5 percent cut looms for your services Last week, Coding...
  2. How Obama’s Medicare Cuts Hit Physician Reimbursement  The budget released Thursday suggests we cut $300 billion from...
  3. CMS Issues Corrections to 2009 Physician Fee Schedule Final RuleIt’s that time of year again — time to get...

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November 8, 2009
Coding Challenge / modifier 59

Cardiology Coding Question: Separate Reporting for 37204

Question: Should I separately report right and left bronchial artery embolization? Answer: You should report 37204 (Transcatheter occlusion or embolization [e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation], percutaneous, any method, non-central nervous system, non-head or neck) twice for right and left lung embolization at the same encounter. In addition, if the cardiologist [...] Related articles:

  1. Cardiology Coding Education: Pacemaker Lead Check Question: The cardiologist documented testing pacemaker leads using fluoroscopy...
  2. 2 New 2010 CPT Codes for High-Tech Cardiology ServicesSteer clear of Cat. I codes for intravascular spectroscopy — here’s...
  3. OB or Not OB: That’s the Ultrasound Coding QuestionQuestion: For an ultrasound, the radiologist documented measurements of the uterus,...

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November 7, 2009
Cardiology / Hot Coding Topics

2 New 2010 CPT Codes for High-Tech Cardiology Services

Steer clear of Cat. I codes for intravascular spectroscopy — here’s where to look instead. The CPT update season is fast approaching. Warm up for the changes coming your way with a look at new-for-2010 Category III codes aimed at diagnosing coronary artery disease. Match 0206T to MCG One of the new Category III codes with a Jan. 1 [...] Related articles:

  1. Cardiology ICD-9 for 2010: All-New Embolism Codes & More A 453.x facelift will require you to hunt for...
  2. Cardiology CPT 2009 Crash Course: Device Monitoring Our programming eval guide can put your 93279-93285 fears...
  3. New CPT Codes for Cardiac CT, Imaging Appear for 2010Plus: Say goodbye to two perfusion codes. If you’ve ever...

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November 7, 2009
CPT 2010 / Provider News

CPT 2010 Update: Non-Face-to-Face Prolonged Services

New Year’s hats & horns for looser guidelines that let you count work spread over days. Groaning thinking of all the time you’ll never capture for complex cases requiring extensive pre-visit time? CPT 2010 brings you hope. Extensive guideline revisions “liberalize prolonged non-face-to-face services codes,” reports Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in [...] Related articles:

  1. Asthma Attack Coding: When To Use Prolonged or High-Level E/M     Checklist deters payback requests for insufficient +99354...
  2. Bust 4 Myths About Pediatric Critical Care Services MYTHBUSTER: Codes 99291, +99292 apply to infants, young pediatric...
  3. Watch Out for 3 Telephone Service Coding PitfallsCaution: You may need to incorporate the call into an...

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November 5, 2009
Hot Coding Topics / modifier 26

Capture Separate CV Access Radiological Guidance

Don’t miss out on $20 per procedure when your surgeon performs central venous (CV) access device placements. If your physician uses fluoroscopic or ultrasonic guidance during the placement, you should separately report that service. We’ll show you how and tell you what modifier moves you need to make to prevent denials. Choose Between +76937 and +77001 If your [...] Related articles:

  1. Focus on Method to Ensure Proper Stereotactic Breast Biopsy CodingWatch out for the 77031 pitfall if the radiologist participates...
  2. Plantar Digital Nerve Coding Education: 64455 & 64632With these 4 tips, you’ll code clean claims every time....
  3. Cardiology Coding Question: Separate Reporting for 37204Question: Should I separately report right and left bronchial artery...

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November 4, 2009
CCI / Coding Challenge / modifier 59

Eye Surgery Coding Challenge: Denials for 15823 & 67904

Question: I started receiving denials for 15823 and 67904. To report this combo, should I use a modifier? Answer: If the ophthalmologist performs the blepharoplasty (bleph) with excessive weight (15823, Blepharoplasty, upper eyelid; with excessive skin weighting down lid) on one eye and the blepharoptosis (ptosis) repair (67904, Repair of blepharoptosis; [tarso] levator resection or advancement, [...] Related articles:

  1. Spinal Surgery Coding Challenge: Is Hemilaminectomy Bundled With Fusion?Question: Our orthopedic surgeon turned in a note that says,...
  2. Avoid This Blepharoplasty Coding Blunder  Don’t settle for denials for a functional surgery that...
  3. Spinal Surgery Coding Challenge: Tethered Cord Release & Dural Tag RemovalQuestion: My neurosurgeon released a tethered cord under the microscope,...

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November 4, 2009