Coder's Cranium

Here’s How You Can Bill The Correct New G Code

If you find choosing the right G code for your claims difficult, help is at hand.

Starting Jan. 1, CMS is requiring eight new billing codes in addition to the existing six codes for home health agency services. Those include new nursing codes for RN management and evaluation of the plan of care (G0162), LPN or RN observation and assessment (G0163), and LPN or RN training and education (G0164). CMS is revising G0154 to cover only direct skilled care by an RN or LPN, CMS notes in Dec. 17 Transmittal No. 824 (CR 7182).

“We recognize that, in the course of a visit, a nurse or qualified therapist could likely provide more than one of the nursing or therapy services reflected in the new and revised codes,” CMS says.

But “HHAs must not report more than one G-code for the nursing visit regardless of the variety of nursing services provided during the visit.” The same goes for therapy.

“In cases where more than one nursing or therapy service is provided in a visit, the HHA must report the G-code which reflects the service for which the clinician spent most of his/her time,” CMS instructs. Hopefully this will ease providers’ concerns, voiced at the most recent home health Open Door Forum, about how to choose the right code.

“If direct skilled nursing services are provided, and the nurse also provides training/education of a patient or family member during that same visit, we would expect the HHA to report the G-code which reflects the service for which most of the time was spent during that visit,” CMS says in the transmittal. “Similarly, if a qualified therapist is performing a therapy service and also establishes a maintenance program during the same visit, the HHA should report the G-code which reflects...

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January 3, 2011
Coding Challenge / Hot Coding Topics

Primary vs. Secondary Diagnosis

Question: Many of our ophthalmology patients claim general reasons for their visit, such as “I can’t see well,” or “My vision is foggy.” We code these visits with 368.8 as the primary diagnosis because this is the primary reason for the visit. Any other problems or underlying causes of the blurry vision we report as secondary diagnoses. Is 368.8 the most appropriate code to use in these situations, and should we list it first?

Answer: You should only report 368.8 (Other specified visual disturbances) as a primary diagnosis code when the ophthalmologist doesn’t find a more definitive diagnosis during the course of the visit.

Carriers often consider a visit for blurred vision the same thing as a routine exam— and Medicare will not pay for this service.

Primary vs. secondary: Whenever possible, you should list a more definitive diagnosis as primary and then the patient’s complaint of blurred vision as secondary. For example, if the ophthalmologist discovers that a cataract is causing the patient’s blurry vision, you would first list 366.12 (Incipient cataract) and then 368.8. You should always strive to report the most descriptive and accurate ICD-9 codes possible. If a patient claims her only reason for the visit is a routine exam, experts recommend that the ophthalmologist ask her a series of detailed questions to uncover any other complaints she may have but doesn’t think of right away. In obtaining a comprehensive history when a patient denies any blurriness of vision, the ophthalmologist should also ask, “Do your eyes chronically itch, burn, or water?” This may lead you to report dry eye syndrome (375.15, Tear film insufficiency, unspecified) or allergic conjunctivitis (372.14, Other chronic allergic conjunctivitis).

Do this: Rather than ask if a patient’s vision is blurry, ask if there is...

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January 3, 2011
Hot Coding Topics / Provider News

Watch Changes to EEG, Joint Injection Guidelines

You report several EEG codes such as 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes) and 95813 (… greater than 1 hour) based on the amount of recording time. But what constitutes recording time?

Jeffrey Cozzens, MD, professor and chair of the neurosurgery division of Southern Illinois University School of Medicine and a presenter at the AMA’s CPT and RBRVS 2011 Annual Symposium in Chicago, addressed the issue during his presentation about neurosurgery and neurology changes for 2011. Keep two things in mind when calculating recording time for these EEGs:

  • Recording time is when the recording is underway and the healthcare provider is collecting data.
  • Recording time excludes set-up and take-down time.

Other EEG codes, however, focus on the amount of physician time rather than recording time. Watch for that specificity in guidelines for 95961 (Functional cortical and subcortical mapping by stimulation and/or recording of electrodes or brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of physician attendance) and +95962 (… each additional hour of physician attendance [List separately in addition to code for primary procedure). If the physician is in attendance for a total of 30 minutes or less, only report 95961 and append modifier 52 (Reduced services) to indicate he didn’t fulfill the full hour represented by the code.

Two codes for special EEG tests now specify who attends during the procedure:

  • 95953 -- Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic (EEG) recording and interpretation, each 24 hours, unattended
  • 95956 -- Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, electroencephalographic (EEG) recording and interpretation, each 24 hours, attended by a technologist or nurse.

According to information on the...

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January 3, 2011
Hot Coding Topics / Provider News

Learn the Best Ways to Navigate Codes For Cisplatin, Cyclophosphamide, and Vincristine

The recently released HCPCS 2011 code-set reveals a slew of deletions, streamlining your drug coding choices. Cisplatin, cyclophosphamide, and vincristine are among the affected drugs.

This change should simplify billing, particularly if the system your practice or facility uses, such as Pyxis or Lynx, limits you to a single code and billable unit for a drug, says Lisa S. Martin, CPC, CIMC, CPC-I, chargemaster specialist for OSF Healthcare System in Peoria, Ill. “As a consultant, I saw different facilities using only the 100 mg code [for example] for that very reason, so this change should facilitate more consistent and compliant billing practices.”

While these changes have a positive side, “there are always considerations that will arise,” Martin says. For example, if your practice uses different vial sizes, you will need to be alert for the different and specific national drug code (NDC) numbers for the agent dispensed to the patient when you send a claim to a payer who requires NDC information, she warns.

Cisplatin, ordered particularly for patients with metastatic testicular or ovarian neoplasms, or advanced bladder cancers, is one of the many agents affected by the HCPCS 2011 shake-up.

HCPCS 2011 makes a small wording revision to J9060, notes Roberta Buell, MBA, of onPoint Oncology in her Nov. 9 e-Reimbursement newsletter:

  • 2010: J9060 – Injection, cisplatin, powder or solution, per 10 mg
  • 2011: J9060 – Injection, cisplatin, powder or solution, 10 mg.

Delete code J9062 (Cisplatin, 50 mg). It will no longer be available for use in 2011. You should use J9060 to report cisplatin, brand name Platinol, when supplied for 2011 dates of service.

Cyclophosphamide is an alkalyting agent that works as an antineoplastic and immunosuppressant. You may see it called Cytoxan or Neosar.

At 1 unit per 100 mg, J9070 (Cyclophosphamide, 100 mg)...

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January 3, 2011