Coder's Cranium / General / Hot Coding Topics / Provider News

Follow 4 Simple Tips for Modifier 62 to Get your Game Plan in place for both Codes and Documentation

When two surgeons work together to perform one procedure, each physician’s individual documentation requirements can get jumbled up.  Make sure your physician isn’t passing the documentation buck and that he or she knows to follow these four tips when you submit claims with modifier 62.

Tip 1: Each physician should identify the other as a co-surgeon. Also make sure that the other physician is billing with modifier 62. A lot of confusion can arise when physicians from different practices are reporting the same procedure.

You may find yourself in a situation where one physician may report the other physician’s work as that of an assistant surgeon, in which case the claims would not correspond. This means a denial will hit your desk. One surgeon cannot simply indicate the other as the co-surgeon. Both physicians must submit claims for the same procedure, both with modifier 62. To accomplish this all you only need to call with a simple courtesy to the other physician’s billing or coding department.

Tip 2: Each physician should document her own operative notes. When surgeons are acting as “co-surgeons,” it is implied that they are each performing a distinct part of the procedure, which means they can’t “share” the same documentation. Each physician should provide a note detailing what portion of the procedure he or she performed, how much work was involved, and how long the procedure took. Including a brief explanation of the need for co-surgeons will help to avoid denials and reimbursement delays.

Tip 3: Each physician must link the same diagnosis code to the common procedure code. Though this requirement may seem obvious, if two physicians serve as co-surgeons to perform one procedure, the diagnosis code(s) they link to the CPT® code should be the same.  Before submitting a claim with modifier 62, someone...

Comments Off on Follow 4 Simple Tips for Modifier 62 to Get your Game Plan in place for both Codes and Documentation
June 8, 2011
General / Hot Coding Topics

64704 Denials? 5 ways to Fix Your Neuroplasty Claims

If you’re just plodding though nerve surgery claims, you could be stepping over a great deal of well-earned reimbursement.  Coding and billing peripheral nerve surgeries for conditions such as tarsal tunnel and diabetic neuropathy can involve a frazzling number of codes.   Podiatry coders often struggle to navigate the various coding guidelines that payers use for these procedures.  Use these five tips to maximize payment for your podiatrist’s hard work on nerve surgeries:

Tip 1: Check CCI edits and your local Medicare guidelines

If you’re billing codes that the Correct Coding Initiative bundles together — and your documentation and diagnosis codes can’t justify breaking the bundle — you’re not going to see one extra cent for that bundled procedure code.

Example: A California Medicare patient injures his foot when he falls off a ladder and requires peripheral nerve surgery to correct the damage the injury caused.  The podiatrist performs the following:

28035 — Release, tarsal tunnel (posterior tibial nerve decompression)

64712 — Neuroplasty, major peripheral nerve, arm or leg, open; sciatic nerve

64704 — Neuroplasty; nerve of hand or foot

+64727 — Internal neurolysis, requiring use of operating microscope (List separately in addition to code for neuroplasty) (Neuroplasty includes external neurolysis)

64708 — Neuroplasty, major peripheral nerve, arm or leg, open; other than specified.

If you report all these codes, you’re bound to get a denial on 64704 — this is one of the codes the Correct Coding Initiative (CCI) bundles into 28035.  Unless you can justify billing 64704 separately (and if that’s the case, append modifier 59, Distinct procedural service, to the code), you shouldn’t list it all.

Unbundling is not automatic: Be aware that you can’t automatically override a CCI edit with modifier 59 just because documentation supports a separate site,...

Comments Off on 64704 Denials? 5 ways to Fix Your Neuroplasty Claims
June 8, 2011
Coder's Cranium / General / Hot Coding Topics / Provider News

Follow 4 Simple Tips for Modifier 62 to Get your Game Plan in place for both Codes and Documentation

When two surgeons work together to perform one procedure, each physician’s individual documentation requirements can get jumbled up. Make sure your physician isn’t passing the documentation buck and that he or she knows to follow these four tips when you submit claims with modifier 62.

Tip 1: Each physician should identify the other as a co-surgeon.  Also make sure that the other physician is billing with modifier 62. A lot of confusion can arise when physicians from different practices are reporting the same procedure.

You may find yourself in a situation where one physician may report the other physician’s work as that of an assistant surgeon, in which case the claims would not correspond. This means a denial will hit your desk. One surgeon cannot simply indicate the other as the co-surgeon.  Both physicians must submit claims for the same procedure, both with modifier 62. To accomplish this all you only need to call with a simple courtesy to the other physician’s billing or coding department.

Tip 2: Each physician should document her own operative notes. When surgeons are acting as “co-surgeons,” it is implied that they are each performing a distinct part of the procedure, which means they can’t “share” the same documentation. Each physician should provide a note detailing what portion of the procedure he or she performed, how much work was involved, and how long the procedure took. Including a brief explanation of the need for co-surgeons will help to avoid denials and reimbursement delays.

Tip 3: Each physician must link the same diagnosis code to the common procedure code. Though this requirement may seem obvious, if two physicians serve as co-surgeons to perform one procedure, the diagnosis code(s) they link to the CPT® code should be the same.  Before submitting a claim with modifier 62, someone...

Comments Off on Follow 4 Simple Tips for Modifier 62 to Get your Game Plan in place for both Codes and Documentation
June 8, 2011
Coder's Cranium / General / Hot Coding Topics / Provider News

4 Amazing Ways to Code for ‘Get Acquainted’ Visits

Do you ever meet with parents before their baby is even born?  In these cases, you might be hesitant to charge for the visits because the patient isn’t present yet—but can you collect anything for the physician’s time?  Check out the following 4 options, along with our expert advice before billing to insurance.

1. Consider an Office Visit

Some practices think of meet-and-greets, in which they tell the parents about the way they run their practice, more as an office visit, such as 99201.  However, this would need to be billed based on time to the mother’s insurance company and would likely be questioned by the insurance company.  For practices that do charge for these services, there’s a diagnosis code you can use: V65.11. ICD-9 guidelines allow you to list the code as a first or additional diagnosis.

2. Ensure You Meet Criteria Before Using 99401-99404

As an alternative to use a problem-oriented office visit code, the American Academy of Pediatrics (AAP) suggests the pediatrician may deem an appropriate counseling or risk factor reduction code.  You may report these codes for prenatal counseling “if a family comes to the pediatrician/neonatologist either self-referred or sent by another provider to discuss a risk-reduction intervention (i.e., seeking advice to avoid a future problem or complication),” according to the AAP’s Coding for Pediatrics 2009.

You would report the service under the mother’s insurance, according to the AAP. Make sure you don’t use 99401-99404 if the mother or her fetus has any existing symptoms, an identified problem, or a specific illness.  As per CPT®’s Counseling Risk Factor Reduction and Behavior Change Intervention guidelines, “these codes are used to report services for the purpose of promoting health and preventing illness or injury.”

Codes 99401-99404 aren’t necessarily shoo-ins for typical meet and greets.  The AAP gives...

Comments Off on 4 Amazing Ways to Code for ‘Get Acquainted’ Visits
June 8, 2011
General / Hot Coding Topics

3 FAQs Banish Your Coding Frustrations on Vaginal Cuff Repair

Find out what colporrhaphy code you’ll use for an injury repair.

If you’re stuck trying to figure out what code to use for a vaginal cuff repair, you should ask yourself one main question: Why did the ob-gyn need to perform the repair?  The answer is the best way to decide what code (and possibly modifiers) to choose.  Follow these three expert steps, and you’ll find the solution to one of the most frequently asked questions in an ob-gyn office: “Which CPT® code should I use for repair of vaginal cuff?”

Q1: How Do I Decide What Repair Code to Use?

The first thing you should do when the ob-gyn performs a vaginal cuff repair is examine the operative report to determine why the patient required the repair, says Cindy Foley, Billing Manager for three separate gynecology practices in Syracuse, N.Y.

Q2: If Repair Dealt With Loose Sutures, What Should I Do?

You read your op notes and discovered the vaginal cuff repair dealt with loose sutures.  Suppose the patient, who underwent a total abdominal hysterectomy (58150, Total abdominal hysterectomy corpus and cervix], with or without removal of tube[s],with or  without removal of ovary[s]), needs to return to the operating room for a vaginal cuff repair because the original sutures became loose and a simple re-closure is documented.  In this case, you should report 58999 (Unlisted procedure, female genital system [nonobstetrical]). You would also need to submit your op report along with a cover letter that explains in simple, straightforward language exactly what your ob-gyn did, says Melanie Witt, RN, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M.

Remember to explicitly reference the nearest equivalent listed procedure in your explanatory note. For example, you might consider comparing the work to 12020 (Treatment of superficial wound dehiscence; simple closure), which...

Comments Off on 3 FAQs Banish Your Coding Frustrations on Vaginal Cuff Repair
June 8, 2011
General / Hot Coding Topics

3 Steps to Keep Discontinued Procedure Claims Moving

You often turn to modifier 53 (discontinued procedure) when your anesthesiologist or the surgeon sees some risk that could threaten the patient’s health if the procedure continues.   However, Payers do recoil when it comes to reimbursing these claims.  Here are three easy steps by the experts to help you to get on the right track for reimbursement.

1) Conquer Electronic Filing Challenges

Gone are the days when you were told to submit paper claims reporting modifier 53 so you can append a written explanation with the claim.  With HIPAA and electronic standards, you can do the billing electronically.  Once you have billed electronically with modifier 53, the payer might request more information.  Thus the note should contain all the information the carrier needs.  For failed procedure, the record should state the reasons for the failure.  If your physician discontinued the procedure due to the patient’s condition, the record should detail what factors prevented the procedure from going forward.

2) Verify the Timing of Cancellation

Knowing exactly when the case was canceled in terms of the physician’s work will help guide your code choices.  If the physician cancels the procedure after induction, the case technically became a surgical procedure.  Determine the correct surgical code, such as 45380 for a colonoscopy with biopsy.  Then cross to the correct anesthesia code, such as 00810.  If the cancelled procedure took place in an outpatient hospital or ambulatory surgical center, some payers require modifier 73 or modifier 74.  In those situations, append modifier 73 or 74 to the anesthesia code instead of modifier 53 as modifiers 73 and 74 are specifically for outpatient hospital use.

3) Include the Correct Diagnosis

Indicate the reason for cancellation by reporting the appropriate diagnosis code or codes.   For a patient who experiences syncope while still in the...

Comments Off on 3 Steps to Keep Discontinued Procedure Claims Moving
June 8, 2011
General / Hot Coding Topics

Are you sure that your coding complies with ICD-9 official guidelines for pain management?

If you don’t know when to check ICD-9 official guidelines, you may have just a 50-50 chance of choosing the proper order for your diagnosis codes.  Patients may present to the office for treatment related to pain caused by a neoplasm.  In such cases, you will need to determine which diagnosis codes to report and you will need to decide what order to list the codes in on your claim.  With that in mind, consider how you should code the scenario below.

Start by Examining the Neoplasm-Related Pain Case

Read the following scenario and determine proper ICD-9 coding based on the information given.  You’ll find a helpful hint on which section of the official guidelines to review if you get stuck.

Scenario: The physician documents that a patient with lung cancer (middle lobe, primary malignant neoplasm) was presented to the office for the purpose of pain management.  The pain is documented as acute and caused by the neoplasm.

Hint: See section I.C.6.a.5 of the Official Guidelines for instructions on properly coding these sorts of encounters. The CDC posts ICD-9 guidelines online at: http://www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm

Next, Determine Which Neoplasm and Pain Codes Apply

For this scenario, before you can decide what order to put the codes in, you will need to decide which codes to report.

Neoplasm: For a primary malignant neoplasm of the lung’s middle lobe, you should report 162.4 (Malignant neoplasm of middle lobe bronchus or lung), says Denae M. Merrill, CPC, HCC coding specialist in Michigan.

Pain: To choose the proper pain diagnosis code, you want to be sure you keep in mind that the neoplasm is the cause. The ICD-9 index entry for pain has several subentries to consider:

  • Cancer associated
  • Neoplasm related (acute) (chronic)
  • Tumor associated.

...

Comments Off on Are you sure that your coding complies with ICD-9 official guidelines for pain management?
June 8, 2011
General / Hot Coding Topics / Provider News

Ensure Your Physician’s Signatures Pass Muster By Answering 2 Key Questions

EMR signature pitfalls could be a daily challenge with which you often deal. Check your answers against our experts’ advice to verify your group’s signature compliance.

Question 1: Some of our physicians use handwritten signatures on their charts and others prefer electronic signatures. Is either kind acceptable?

Answer 1: According to CMS documents, Medicare requires a legible identifier for services provided or ordered.  The identifier — or signature — can be electronic or handwritten, as long as the provider meets certain criteria. Legible first and last names, a legible first initial with last name, or even an illegible signature over a printed or typed name are acceptable.  You’re also covered if the provider’s signature is illegible but is on a page with other information identifying the signer (letterhead, addressograph, etc.).  Also be sure to include the provider’s credentials.  The credentials themselves can be with the signature or they can be identified elsewhere on the note.

Pre-printed forms might include the physician’s name and credentials at the top, side, or end.  All qualify as acceptable documentation as long as the coder or auditor can identify the provider’s credentials.  You can also use a signature log to back up your physician’s documentation.  The log should contain each provider’s printed or typed name and credentials, along with their signatures and initials. You can reference the signature log in order to verify a note that contains an otherwise unidentifiable signature.  This is an important resource when providers are signing notes that do not include their typed or pre-printed name.

Make sure that you update signature logs at least once a year.  Create separate logs by provider (physicians, CRNAs, AAs, residents, etc.) to help simplify tracking.  Stamped signatures don’t meet the CMS requirements.  Because a signature stamp can be used...

Comments Off on Ensure Your Physician’s Signatures Pass Muster By Answering 2 Key Questions
June 8, 2011
Coder's Cranium / General / Hot Coding Topics / Provider News

Stop Forfeiting Level Four and Five E/Ms With 3 PFSH Tips

Make your physician’s job easier by letting the patient or nurse document the history.

If your physician glosses over a patient’s past, family, and social history (PFSH), you may be missing out on up to $69 per E/M.  Accurately counting the number of PFSH items could result in more money for an encounter, because the top-level E/M codes require PFSH elements in addition to an extended history of present illness, and more than 1 system reviewed. Learn these three quick tips to ensure your physician is capturing, and you’re recognizing, every history component the patient mentions.

1. Determine the Level of PFSH

For coding purposes, the history portion of an E/M service requires all three elements — history of present illness (HPI), review of systems (ROS), and a past, family and social history (PFSH).  Therefore, the PFSH helps determine patient history level, which has a great effect on the E/M level you can report.  If you do not know the PFSH level, you may have to select a lower level of E/M service than might otherwise be warranted.  There are three levels of PFSH: none, pertinent, and complete, says Leah Gross, CPC, coding lead at Metro Urology in St. Paul, Minn.

Pertinent: To reach a detailed level of history for the encounter (in addition to an extended HPI and the review of 2-9 systems), you need a pertinent PFSH.  According to Medicare’s Documentation Guidelines for E/M Services, you need at least one specific item from any of the three PFSH areas to achieve the pertinent level.  When the physician asks only about one history area related to the main problem, this is a pertinent PFSH.

Complete: To reach a comprehensive level of history for the encounter (in addition to an extended HPI and the...

Comments Off on Stop Forfeiting Level Four and Five E/Ms With 3 PFSH Tips
June 8, 2011
Coding Challenge / General

Know the Ropes for Problem Discovered During Well-Visit

Question: We have a Medicaid patient that came in for a ten year-old physical and was found to be sick, so we would like to append modifier 25 to report the well turned-sick visit. Is that accurate?- Virginia Subscriber Answer: Yes. In this situation, ...

Comments Off on Know the Ropes for Problem Discovered During Well-Visit
June 8, 2011