2011 adds a new modifier to your coding arsenal and updates the descriptors for several others you might often use. Get ready for modifier GU (Waiver of liability statement issued as required by payer policy, routine notice). You might have times when ...
CPT’s definition of a ‘single vessel’ for this territory is an exception to the rule.
CPT 2011 adds new codes for lower extremity endovascular revascularization covering angioplasty, atherectomy, and stenting, noted Stacy Gregory, CCC, CPC, RCC, of Gregory Medical Consulting Services, in her presentation, “Peripheral Vascular Coding Tactics,” at the 2011 Coding Update and Reimbursement Conference in Orlando (www.codingconferences.com).
This article focuses on the femoral/popliteal codes 37224-37227. “37220 to +37223 Revamp Your Iliac Intervention Coding Options” in Cardiology Coding Alert discussed the iliac codes. Look to a future issue to cover tibial/peroneal codes 37288-+37235.
The new femoral/popliteal service codes are below. Note that all of the codes include angioplasty in the same vessel when that service is performed:
The general rule for 37224-37227 is that you should report the one code that represents the most intensive service performed in a single lower extremity vessel. All lesser services are included in that one code.
When the cardiologist performs a stent placement, atherectomy, and angioplasty in the left popliteal vessel, you should report only 37227.
That code covers stent placement, atherectomy, and angioplasty. You should not report 37224 (angioplasty), 37225 (atherectomy), or 37226 (stent placement) separately or in addition to 37227 in this scenario.
As explained in the last issue of Cardiology Coding Alert, CPT guidelines state that — in addition to the intervention performed...
Remember to check for updated or revised guidelines when preparing to use your new code books for 2011, not just code descriptors. CPT 2011 includes new details for coding some common injection procedures, as pointed out at the AMA’s CPT and RBRVS 2011 Annual Symposium in Chicago. Read on for a few pointers to help stay on the right track.
The introduction of new codes for paravertebral facet joint injections in 2010 (64490-64495) meant changes to how you reported related codes. During the CPT and RBRVS Symposium, Douglas G. Merrill, MD, MBA, of the American Society of Anesthesiologists, pointed out two revised guidelines dealing with paravertebral facet (spinal) joint procedures.
Instructions in CPT 2010 directed you to report 64999 (Unlisted procedure, nervous system) if the provider used ultrasound guidance during paravertebral facet joint injections. The AMA released a correction later in 2010, and the CPT 2011 clarifies the situation. If your provider used ultrasound guidance when administering paravertebral facet joint injections, report the appropriate code(s) from 0213T-0218T (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with ultrasound guidance …).
T12-L1 change: CPT 2010 guidelines mandated that you report 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [for nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level) for an injection to the T12-L1 joint, or nerves innervating that joint. New 2011 guidelines direct you to submit 64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [for nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; single) instead.
In addition, the 2011 guidelines direct providers to report paravertebral facet joint injections performed without image guidance with the appropriate trigger point injection code. Submit either 20552 or 20553 (Injection[s]; single or multiple trigger...
Think outside the box for iliac atherectomy.
Are you ready to apply CPT’s new revascularization codes starting January 1? Check out these six tips to get you on your way.
CPT 2011 offers up new codes to help you report services more accurately, including endovascular revascularization, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle.
Specifically, CPT 2011 adds several new codes that represent lower extremity endovascular revascularization, meaning angioplasty, atherectomy, and stenting. Here’s how the codes break down:
In this article, iliac artery services are the focus. Look to future articles to discuss femoral, popliteal, and tibial/peroneal services.
Watch Procedure and Vessel to Choose Among 37220-+37223
The new iliac service codes are as follows:
Reading through the definitions, you see that the codes for iliac services differ based on whether you’re coding a service in an initial vessel or in an additional vessel. Your options also differ based on whether you’re reporting (1) angioplasty alone or...
How to count components for Boostrix, Pediarix – and other immunizations.
Excited by the new vaccine administration codes’ payment per component but not sure how many components specific vaccines have? This chart does the work for you.
Find the product name for a quick cross reference to how many components the vaccine includes and the administration with counseling code combination to report using the new pediatric/adolescent codes.
Note: The ICD-9 vaccine product code listed in the chart uses the generalized vaccine product code (V06.8, Need for prophylactic vaccination and inoculation against other combinations of diseases). For vaccine administration provided outside of a preventive medicine service, the American Academy of Pediatrics recommends using V06.8 for combination vaccines that do not have their own individual single ICD-9 code.
| Vaccine Product | Manufacturer | Components | CPT Product Code | Number of Components | CPT 2011 Administration with Counseling Code | ICD-9-CM 2011 Code |
| ActHIB | Sanofi Pasteur | Hib | 90648 | 1 | 90460 | V03.81 |
| Adacel | Sanofi Pasteur | Tdap (tetanus- diphtheria-acellular pertussis) | 90715 | 3 | 90460, +90461 x 2 | V06.1 |
| Boostrix | GlaxoSmithKline | Tdap | 90715 | 3 | 90460, +90461 x 2 | V06.1 |
| Cervarix | GlaxoSmithKline | HPV | 90650 | 1 | 90460 | V04.89 |
| Comvax | Merck | HepB-Hib | 90748 | 2 | 90460, +90461 | V06.8 |
| Daptacel |
...
Raise your glass to the new year without worries of 2011 medical code changes. SuperCoder’s got you covered with new CPT codes, CCI edits, and supply coding revisions. Starting Dec. 31, SuperCoder.com will offer the complete codesets for CPT 2011...
600 coders, physicians, and office managers gathered in Orlando, Fla. for one and a half jam-packed days of education, networking, and shopping at the December 2011 Coding Update and Reimbursement Conference. Coders’ biggest struggle was absorbing all the information – and not overdoing the holiday buying. Experts offered the inside scoop on medical coding changes for 2011 and beyond. Here are my top picks:
This...
Pediatricians who were thrilled with CPT 2011’s move to paying vaccines per component got a setback from Medicare’s rejection of the recommended RVUs for new vaccine administration codes 90460 and 90461.
The Relative Update Committe recommended that the 2011 Medicare Physician Fee Schedule and Resource Based Relative Value Scale assign 0.20 practice expense (PE) RVUs to 90460 and 0.16 PE RVUs to 90461. But CMS disagreed with the proposal. “We disagree with the recommendations and will maintain 0.17 RVUs for code 90460 and 0.15 RVUs for code 90461 since these codes would be billed on a per toxoid basis,” said Kenneth Simon, MD, MBA, Senior Medical Officer, Center for Medicare and AMA CPT Editorial Panel Member, in “Medicare Physician Payment Schedule 2011 Changes and Beyond” at the CPT® and RBRVS 2011 Annual Symposium on Nov. 10, 2010.
The increased PEs represent an increase in RVUs from the 2010 values for comparable codes 90465/90467 and 90466/90468. The RUC requested the increase in value due to increased time for patient education. Since the new codes are valued per component, CMS felt no increase was warranted.
CMS assigned RVUs to 90460 and 90461 by crosswalking them with the values of the noncounseling vaccine administration codes 90471 and 90472. This means that new code 90460 has the same RVUs as 90471, and each unit of 90461 has the same RVUs as 90472.
The work and total RVUs for the codes include:
| Code | PE RVU RUC Proposed | PE RVU MPFS Accepted | Total RVUs |
| 90460 | 0.20 | 0.17 | 0.59 |
| 90461 | 0.16 | 0.15 | 0.3 |
| 90465 | <td width="203"
...
When reporting diabetic foot ulcer treatment involving tissue cultured skin substitutes to the lower extremity for a Medicare beneficiary in 2011, you’ll use two temporary G codes. Providers were concerned about the different global periods for two t...
Revascularization, heart catheterization, and more all have new looks in CPT 2011. Here’s an overview of what you can expect. • 37220-37235: Endovascular revascularization, open or percutaneous The codes in this range are distinguished by the vesse...
Medicare still won’t reimburse audiologist-billed Epley. After two years of battles with CMS over canalith repositioning procedure (CRP) coding, physicians will finally get paid for these specific codes. CPT® 2009 excited ENT coders with new CPT cod...
All that fine green print on time in your E/M CPT 2011 manual boils down to one thing: you can round to the closest time code. But that advice from CPT contradicts Medicare’s threshold time guideline. CPT Treats Times as Averages CPT 2011 indicates...
You’ll soon capture counseling per disease.
For combination vaccines that may involve counseling on as many as five different diseases, getting paid as though you counseled on one never seemed fair, but CPT 2011 lets you capture that extra counseling work.
Although multiple component vaccines require counseling on each disease, physicians have only been able to capture counseling for vaccine administration once per administration. CPT 2011 solves the problem with new immunization administration with counseling codes that you’ll code per vaccine component.
CPT 2011 deletes 90465-90468 (Immunization administration younger than 8 years of age … when the physician counsels the patient/family … per day). Codes 90471-90474 (Immunization administration …) remain.
Use 90460 as Vaccine Administration With Counseling Base Code
No more looking at administration route when choosing which immunization administration with counseling code. For vaccine administration, you’ll assign one code for each vaccine’s initial component:
Definition: A component refers to the antigen in a vaccine that prevents disease caused by one organism.
CPT streamlines your coding of the vaccine counseling codes by giving you one universal base code. The code includes “any route of administration.” You no longer have to choose a different code based on whether the code is intramuscular/subcutaneous or oral/intranasal.
Step 2: Report Second Vaccine Component With +90461
Coders can breathe a sigh of relief as the complexities over deciding which 90465-90468 code to use as the base code will soon end. CPT 2011 gives you only one vaccine administration with counseling base code (90460). For each additional vaccine component, you report the same add on code:
...
Denials for mismatched CPT and ICD-9 codes cost practices thousands of dollars every year. SuperCoder.com will soon help you ensure your links are correct helping you further reduce your denials rate. Plus, more code details and pictures will improve y...
2991x, 9922x medical procedure CPT 2011 codes added.
If you’ve been frustrated about the lack of arthroscopic hip surgery codes that CPT offers, CPT 2011 will change that, with three new codes that debut on Jan. 1.
In fact, CPT will introduce over 200 new codes in 2011 to help keep your coding more specific than ever, spanning several categories, from dermatology to orthopedics to cardiology, and beyond.
In orthopedics, you’ll benefit from the following three hip arthroscopy codes, which will be excellent additions to CPT.
Check out New Observation Codes
CPT adds to your E/M coding options with the introduction of three new observation codes, as follows:
...
Don’t assume 90911 is the correct code choice.
Question: Is there a procedure code for billing for Kegel exercise teaching? Can we use code 90911 or possibly 97110?
Answer: There are no specific CPT or HCPCS codes for the performance of or teaching of Kegel exercises. To bill for teaching a patient how to properly perform these exercises, a nurse or medical technician must document a brief history and physical examination as well as the indications for and the expected goals of the Kegel exercises. Under these circumstances, you can then report 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician …) for this encounter.
About the service: Kegel exercises are voluntary contraction and relaxation of the perineal musculature including the urinary sphincter (pelvic diaphragm). These exercises are usually performed outside of the office without medical staff supervision, and are a non-invasive and non-surgical treatment for female and occasionally male stress urinary incontinence.
Pitfall: You should only use 90911 (Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry) for the teaching of biofeedback therapy with face-to-face supervision in office by a trained member of your medical staff.
Additionally, you should use 97110 (Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility) only for pelvic floor muscle rehabilitation (PFMR) performed under one-on-one supervision with a physician, physiotherapist, or ancillary office staff member specifically trained in an accredited physiotherapy program.
@ Urology Coding Alert (Editor: Leesa A. Israel, CPC, CUC, CMBS).
Sign up for the upcoming live audio conference, Risk Management Strategies for Healthcare Providers, or order the CD/transcripts.
Be a hero. Sign up for Supercoder.com, and join...
