Toolkit

Wound Care: Refer to This Handy Chart to Make Graft Coding a Cinch

Careful: Skip over codes for legs and zero in on foot codes.

With the many graft options — including those taken from cadavers, pigs, and newborns — correctly coding a skin graft procedure can leave you guessing. Use this chart to narrow down the grafting field by matching definitions, product names, and treatment applications to CPT codes. Then, you’ll be sure to sail through coding your next graft claim.

Don’t miss: Nothing will get your claim denied faster than using a CPT code not linked to the diagnosis code. Thus, take care to avoid CPT codes for other body areas, such as the legs, which are generally listed above the code for the feet for each type of graft. Below, you will find only CPT codes that you can use to report grafts performed on feet.

Note: Be sure to periodically review the payer’s local coverage determination to ensure your office is in compliance for your state or region.

Remember: Site preparation, lesion excision, and supply (HCPCS) codes may also apply for these services (in addition to the above listed CPT codes). Look in future issues for more on coding skin graft services by subscribing to Podiatry Coding & Billing Alert. Editor: Stacie Borrello.

Sign up for the upcoming live Webinar, Why That Wound Won’t Heal: Practical Tips to Get Wounds Moving, or order the CD/transcripts.

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May 27, 2010
Coding Challenge / pathology

Medical Coders: Focus on Fibroid Diagnosis

Find out why you should code the pathology exam of uterus with leiomyomas as 88307.

Question: When our pathologist diagnoses uterine fibroid tumors, what ICD-9 code should we use?

Pennsylvania Subscriber

Answer: You should choose the diagnosis based on the fibroid’s location:

  • Submucous fibroids (218.0, Submucous leiomyoma of uterus) grow from the uterine wall toward the uterine cavity. They are also called intracavitary fibroids.
  • Intramural fibroids (218.1, Intramural leiomyoma of uterus) grow within the uterine wall (myometrium). They are also called interstitial fibroids.
  • Subserous fibroids (218.2, Subserous leiomyoma of uterus) grow outward from the uterine wall toward the abdominal cavity. They are also called subperitoneal fibroids.
  • If the physician does not specify the uterine fibroid’s location, assign 218.9 (Leiomyoma of uterus, unspecified) as the diagnosis.

CPT alert: You should code the pathology exam of uterus with leiomyomas as 88307 (Level V — Surgical pathology, gross and microscopic examination, uterus, with or without tubes and ovaries, other than neoplastic/prolapse).

Although ICD9 classifies leiomyoma as a benign neoplasm, a coding convention supported by the American Medical Association and the College of American Pathologists dictates that you code this condition as 88307, not 88309 (Level VI — Surgical pathology, gross and microscopic examination, uterus, with or without tubes and ovaries, neoplastic).

For myomectomy specimens — fibroid tumors that the surgeon removes while leaving the uterus intact — bill the pathology exam as 88305 (Level IV — Surgical pathology, gross and microscopic examination, leiomyoma[s], uterine myomectomy — without uterus).

@ Pathology/Lab Coding Alert. Editor: Ellen Garver, CPC

Sign up for the upcoming live audio conference, Optimize Your Fibroid Coding and Billing: The Bottom-Line Basics for the Best Reimbursement, or order the CD/transcripts.

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May 27, 2010
Cardiology / CMS / MAC / Provider News

MACs Differ on Response to CMS’s Cardiology Payment Adjustments

Don’t look for a raise just yet, in most cases.

CMS may talk, but MACs don’t always listen — at least not quickly.

As we told you in last week’s Insider, CMS recently corrected several “technical errors” published in the 2010 Fee Schedule, and thanks to these corrections, Medicare will increase payment for several cardiology-related testing codes, including codes 75571-75574 (Heart CT) and 78451-78454 (Heart muscle SPECT imaging).

Although many practices are eager to see the payment boosts in their next Medicare payments, that may be an overly ambitious goal at this point.

“I inquired with a few MAC carriers such as Trailblazer, Noridian, and Palmetto, and was told different things by different Medicare payers,” says Terry Fletcher, BS, CPC, CCS-P, CCS, CMSCS, CCC, CEMS, CMS, CEO of Terry Fletcher Consulting Inc.

“One did not even know there was a change,” she says. “Next, Noridian said that they will be making the adjustments when they get the directive from CMS. And Palmetto said they would need the provider to contact them and then batch retroactive to January the myocardial perfusion imaging claims and send a letter to request the increase,” she says.

Bottom line: Until CMS provides a clear answer to the MACs regarding when they must implement the changes, you may not see your pay increases, but keep an eye on your carrier’s Web site for information on when it intends to reprocess claims using the new rates.

@ Part B Insider. Editor: Torrey Kim, CPC

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May 27, 2010