June 1, 2010 – MedicalCodingNews.Org

Medical Records: 5 Reasons Your EMR Transition Will Pay Off

The hard work and hassle of ditching paper documentation is not in vain.

Question: Our office is weighing the pros and cons of transitioning to electronic medical records (EMRs). We know the process is a huge undertaking that often results in even lower productivity and more confusion. So, is making the change really worth it?

Answer: If you haven’t witnessed or lead a conversion from paper records to an electronic medical record (EMR) system, it’s easy to get overwhelmed by the potential downsides. But experts agree that yes, going electronic is worth it. Here are a few reasons why:

1. You Open More Cash Inlets. Many research studies pull their data via electronic records. So, if you can’t tune in to participate, opportunities for cash perks will fly by. “Grant money and incentive programs are available, for example, and they want data in the electronic form,” points out Francine Wheelock, PT, MPA, manager of clinical systems for MaineGeneral Health.

Just look at nationwide push for value-based purchasing and outcome data, and expect to go electronic if you want to be in the loop.

Stay alert: Last year, the federal government launched the Health Information Technology for Economic and Clinical Health (HITECH) Act, which plans to pay eligible healthcare professionals incentives for the “meaningful use” of certain EMRs.

“SLPs, OTs and PTs are not eligible for the incentive payment,” confirms Kate Romanow, director of health care regulatory advocacy for the American Speech-Language Hearing Association. But they may be eligible in the future, so therapists “may want to consider implementing EHRs now,” she says.

Plus, you can enhance coordination of care with healthcare providers who are eligible for HITECH incentives and are adopting EHRs, points out Sarah Nicholls, assistant director for payment policy and advocacy for the American Physical Therapy Association....

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June 1, 2010

NCCI Edits: Watch Out For These Endoscopy Bundles

Code 31575 includes 92511 and 31231 except under these conditions.

Singling out the correct endoscopy code when your otolaryngologist examines multiple areas in the sinuses and throat isn’t always easy, but in most cases it’s imperative to settle on one, according to National Correct Coding Initiative (CCI) edits. You can adhere to these edits and avoid payback requests if you stick to these guidelines.

3 Rules Guide the Way

Rule #1: Never report 92511 (Nasopharyngoscopy with endoscope[separate procedure]) and 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) together, says Stephen R. Levinson, MD, otolaryngologist and coding consultant based in Easton, Conn. Code 92511 is a component of Column 1 code 31231. The bundle has a modifier indicator of “0” — thus, no modifier can break this bundle.

Rule #2: Code 92511 is a component of Column 1 code 31575 (Laryngoscopy, flexible fiberoptic; diagnostic) but a modifier is allowed in order to differentiate between the services provided (that is, you may append modifier 59 [Distinct procedural services] if there are separate and identifiable services with separate medical indications). Report 92511 in conjunction with 31575 for the same encounter, says Levinson, only if the following conditions are met:

there are separate medical indications for examining each area (for instance, 784.49 for hoarseness with 31575 in an adult patient with a hyperactive gag reflex and 381.4 for a unilateral or bilateral middle ear effusion with 92511, which would be a rare occurrence), and
the ENT uses a different scope for each, separate procedure because there is a documented reason that the fiberoptic scope did not provide adequate visualization of the nasopharynx. “This would be highly unlikely,” emphasizes Levinson.

Rule #3: Code 31231 is a component of Column 1 code 31575 but a modifier is allowed in order...

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June 1, 2010

Hot Coding Topics

Medical Coders: Here’s Your 411 on Femoral Head Resurfacing

Understand what FHR involves and when patients benefit.

An initial femoral head resurfacing (FHR) procedure involves only the femoral head and not the acetabular socket of the hip joint. The surgeon mills the femoral head and implants a metal hemisphere over the bone that exactly matches the size of the original femoral head.

FHR helps “buy time” for patients whose disease or degree of progression doesn’t merit total hip replacement (27130, Arthroplasty, acetabular and proximal femoral prosthetic replacement [total hip arthroplasty], with or without autograft or allograft).

This is especially true for younger patients because femoral head resurfacing preserves more bone stock for possible later revisions.

Judy Larson, CPC, billing manager for Rockford Orthopedic Associates in Rockford, Ill., shares a few advantages of choosing FHR:

Patients are likely to recover a natural gait
The larger size of the implant (ball) reduces the risk of dislocation
The femoral head/canal is preserved
There’s no associated femoral bone loss with future revision
Patients can experience less thigh pain because hip stress transfers in a natural way along the femoral canal and through the femur’s head and neck.

The metal head used during FHR will wear out the socket over time, however, and the patient will need total hip replacement.

Once the patient reaches the point of total hip replacement you’ll code the new procedure as a conversion with 27132 (Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft), says Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network.

@ Orthopedic Coding Alert. Editor: Leigh DeLozier, CPC

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June 1, 2010