CCI / CMS / Hot Coding Topics

Red Alert, Cardiology Coders: Expect EP Study + Ablation Denials Until April 1

CMS won’t fix CCI blunder until version 16.1, to be released in the spring. If your heart skipped a beat when you saw that January’s Correct Coding Initiative (CCI) edits bundled catheter ablations with electrophysiology (EP) studies, you weren’t alone. Good news: CMS has decided to delete the edits retroactively because their addition was a mistake, according [...] Related articles:

  1. Take Heart, Cardiology Coders: CCI Deletions Overturn 93296 Denials Go back to the future. 3 months of denials...
  2. Nerve Conduction Study Coding TipDid you know that new medical devices are opening doors...
  3. Bundle of His Recording Coding ChallengeQuestion: How should I report right atrial pacing and recording...

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February 23, 2010
CCI / HCPCS / Hot Coding Topics / Medicare / modifier 59 / NCCI / Oig / Oncology

OIG Hit List: Perfect Your 38220, 38221, and G0364 Usage

Don’t sweat reporting 38220-59 if you meet these Medicare-approved conditions. If your oncologist takes both a bone marrow biopsy and a bone marrow aspiration, whether you’ll see Medicare reimbursement depends on the two guidelines below. But watch out: With OIG scrutiny and a HCPCS twist, these guidelines will put your coding savvy to the test. Append 59 [...] Related articles:

  1. Coding Education: Bone Marrow Harvesting for Autologous TransplantQuestion: Is there a CPT code specific to harvesting bone...
  2. Use This Podiatry Scenario to Perfect Your Emerging Technology ClaimsHint: If you try to use an unlisted code, be...
  3. Multiple Bronchoscopy Coding Crash Course Head off denials & ratchet up reimbursement with these...

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February 21, 2010
E/M / Hot Coding Topics

E/M Coding: Don’t Sell Yourself Short on Problem Sports Exams

Tip: Time-based E/M might be in line when managing diabetes, asthma, ADHD. Overlooking time as the key factor on a camp or sports exam in which the patient has a problem could cut $30 per claim. Opportunity: An office visit (99201-99215, Office or Other Outpatient Services) using time as the key factor might be appropriate, but keep [...] Related articles:

  1. Counseling Must Dominate Exception Claims For Seamless PaymentChoose the service level using the documented history, exam, and...
  2. Mid-Level E/M Coding BreakdownOur chart shows you how to choose among 99212, 99213 &...
  3. E/M Challenge: Can I Report 99214 and +99354?Counseling representing more than 50 percent of E/M visit? Choose...

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February 19, 2010
Hot Coding Topics / modifier LT / modifier RT / Oig

Coding Compliance: OIG Targets Transforaminal Epidural Injections

Verify that you’re counting injections and levels correctly to keep claims clean. The Office of Inspector General (OIG) Work Plan for 2010 includes a closer look at Medicare payments for transforaminal epidural injections. The Work Plan specifically states, “We will review Medicare claims to determine the appropriateness of Medicare Part B payments for transforaminal epidural injections.” Stay [...] Related articles:

  1. Save Time Coding Facet Injections With This Coding Tool Hint: Location, number and substance are key. Several factors...
  2. Anesthesia Coding Education: Combined Spinal EpiduralQuestion: Our anesthesiologists sometimes mark our C-section tickets as “combined...
  3. Trigger Point Injection Coding: Count Targets, Not Shots Become the top TPI gun in your coding department...

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February 17, 2010
BCBS / Hot Coding Topics / Musculoskeletal

Use This Podiatry Scenario to Perfect Your Emerging Technology Claims

Hint: If you try to use an unlisted code, be sure your OP notes include this information. If you don’t know the ins-and-outs of coding cutting edge procedures, you risk getting left in the dust as medicine continues to evolve. A new techniques, however, doesn’t always mean a new, corresponding CPT code. Check out this podiatry [...] Related articles:

  1. Podiatry Coding Clinic: G0245 and G0246Here’s when you may need to get an ABN Medicare...
  2. Podiatry Coding Education: 28293 For Joint Replacement for Hallux LimitusQuestion: Our podiatrist performed a joint replacement for hallux limitus and...
  3. Finger Modifiers Give You a Grip on Hand Surgery Claims Get a Handle On Hand Surgery Claims By Fixating...

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February 15, 2010
Hot Coding Topics / modifier GV / modifier GW

Avoid Hospice Coding Headaches With Modifiers GV and GW

Differentiating between GV and GW is your first step. If your urologist sees and treats hospice patients, you probably feel like you have to jump through hoops to get paid. The key to bringing in every hospice-related dollar your urologist deserves is ensuring you append the right modifier. Base Modifier GV or GW Choice on Diagnosis When reporting [...] Related articles:

  1. Understand and Avoid Costly Mistakes for Modifiers 51, 52, 53, 58, 59, 25, 78 and 22It’s important to understand modifier usage to avoid costly mistakes....
  2. Ophthalmology Coding: GDX, VF, & Temp Plugs — How Many Modifiers?Question: A patient came in for a GDX and visual...
  3. 4 Coding Rules for Multi-Provider ModifiersCheck the work, not dictation, to prevent 42% or more...

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February 11, 2010
CPT / Hot Coding Topics / Medicare

Critical Care Coding FAQ: Become a Master of Time

Beware: CPT, CMS differ on ‘family discussion’ parameters. When the physician treats a patient with a critical illness or injury, you need to know when to start and stop the critical care clock in order to avoid miscoding. Check out this FAQ to find out what’s part of critical care, what’s not, and how to correctly [...] Related articles:

  1. Maximize 99291 Coding with This Critical Care FAQ Physician ‘preventing further deterioration’ keys valid critical care claims....
  2. Critical Care Coding Checklist Certain patient conditions could indicate 99291 service. Given the...
  3. Bust 4 Myths About Pediatric Critical Care Services MYTHBUSTER: Codes 99291, +99292 apply to infants, young pediatric...

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February 8, 2010
Hot Coding Topics

Collections: Banish Co-pay, A/R Problems

5 tips help you recover deserved pay. Collecting money from patients, especially during a recession, can be challenging. If your front desk is responsible for collecting copays and sometimes old balances, its success or failure has a dramatic impact on the practice’s bottom line. Check out five ways you can improve your front desk collection efforts: 1. When [...] Related articles:

  1. Medical Billers: Test Your Collections Know-How Here This nifty tool tells you if collections cluelessness is...
  2. Time Your Surgical Collections Right by Referencing Payer Contracts Find out if you’re legal in collecting patient portion...
  3. Overcome ‘Forgot the Checkbook’ Excuses With This Checklist   When you get the old “I forgot my...

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February 7, 2010
Hot Coding Topics / modifier 25

Newborn Status Change Means Deciding Between Hospital Care Codes

Sort your normal, sick and intensive care options. Choosing the appropriate codes for initial newborn services can be difficult due to the large number of available codes and gray areas between the spectrum of illnesses. If you find yourself getting tripped up by the multiple categories, read on for expert tips and real-world examples that [...] Related articles:

  1. Must Hospital Admit Codes and Admission Show Same DOS? Overlook this rule, and risk leaving rightful E/M dollars on...
  2. Give Your Newborn Coding Skills a Checkup This directive stops the sending physician from committing an...
  3. Answers To Your Hospital Admission, Subsequent Care Coding Questions Revenue Booster: Here’s when you can claim a consult...

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February 4, 2010
Hot Coding Topics / Oncology

Oncology Coding 2010 Update: 3 New Lab Services Codes

Watch for your chance to replace 86316 with more specific 86305. If your oncology practice has its own lab, heads up. You’re sure to find a few new lab codes “in CPT 2010 that you need to know,” says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha. Get started with a [...] Related articles:

  1. CPT 2010 Update: Laboratory & Pathology CodingStop using general codes for analyte-specific tests. Here’s why. You...
  2. ICD-9 Update: Take Your Oncology Coding Specificity Up a Notch With 7 2010 Changes Tumor lysis syndrome is getting its own code —...
  3. Oncology Coding: Update Your PET Claims With This New GuidanceHere are the requirements the exam must meet, according to...

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February 2, 2010
Hot Coding Topics / modifier 59

What Lab Coders Need to Know About CCI 16.0

Look for transcutaneous hemoglobin limitations, and bundling for those new 2010 culture codes. Think you’re ready to use all those brand new CPT lab codes? Not so fast. You better learn Correct Coding Initiative (CCI) restrictions first, before you start billing Medicare for services using new CPT 2010 codes. CCI released version 16.0, effective Jan. 1, which includes 24,060 [...] Related articles:

  1. CCI 15.3 Update: You Can Resubmit Dozens of Previously-Bundled 22526 ClaimsNewsflash: CCI 15.3 retroactively deletes hundreds of edit pairs, but...
  2. What Interventional Radiology Coders Should Know About CCI 15.1 EXTRA–Radiology Reimbursement WEBINAR: Do you know the difference between...
  3. Can’t Locate an H. Pylori Lab Test Code? 2 Clues Point the Way Solve CLO test culture code dilemma and other mysteries....

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January 31, 2010
Hot Coding Topics

Orthopedic Coding Clinic: Labral Tears

10-2:00 in the op note signals SLAP lesion repair. Even experts can land on the wrong ICD-9 code for SLAP lesion repair, but visualizing the injury region as a clock will help you distinguish one type of SLAP (superior labral anterior posterior) tear from another. Research Patient History for Accurate Diagnosis Having a solid understanding of anatomy and [...] Related articles:

  1. Orthopedic Coding Clinic: Complete the ICD-9 Picture with These Tips Code the condition your ortho treats first, followed by...
  2. Orthopedic Coding Clinic: Pull the Plug on PRP Injection Denials Here’s where 86999 comes in. If your orthopedist is...
  3. Orthopedic Coding Quick Start Guide: ASC Shoulder ProceduresShoulder ICD-9 and CPT codes you’ll most likely see in...

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January 28, 2010
Hot Coding Topics / modifier 26 / RAC

Audits: HDI RAC Targets TC, Modifier 26 & More

Want to know what RAC contractors will be looking for next? Here’s the link. Recovery audit contractors (RACs) are working hard to expand their lists of approved issues, and you should keep a close eye on your services in these areas as well. Health Data Insights (HDI), the RAC contractor for Region D, posted 66 new approved [...] Related articles:

  1. CMS COVERAGE DECISIONS: MACs Can Make Exceptions to LCDsRACs can make exceptions only to approve claims. Coders know local coverage...
  2. RAC Fact Did you know that those new RAC auditors out...
  3. RAC Fact: Watch Out For Medicare’s Once-in-a-Lifetime Services G0389 & the IPPE codes may be potential RAC...

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January 26, 2010
CCI / Hot Coding Topics / modifier 59 / mutually exclusive

Ob-Gyn CCI 16.0: Hysterectomy Coding

Here’s where you can bypass the edits with modifier 59. The Correct Coding Initiative (CCI) version 16.0 didn’t overlook the hysterectomy, vaginal graft, and colpopexy codes — nor should you. To make sense of the deletions, break these additions into mutually exclusive and non-mutually exclusive. Note: In all these cases — except those involving the anesthetic injection [...] Related articles:

  1. Hysterectomy Coding Simplified: Look at Weight, Removal Severing these ligaments clues you into whether ob-gyn removed...
  2. CCI 15.2 Retracts Neurostimulator Edits from 15.1Look for new edits that affect eye exam codes, anesthesia,...
  3. 3 Steps Take the Guesswork Out of Coding Vaginal Cuff Repairs Find out what colporrhaphy code you’ll use for an...

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January 22, 2010
E/M / Hot Coding Topics / modifier 25

Wound Closure Coding: Make the Simple, Intermediate Distinction

Accounting for depth is a tricky task when coding closure. Practices interested in ethically boosting their bottom line and getting $80 or more for the same closure repair need to walk the line that separates simple from intermediate. What Makes a Repair “Simple”? A wound closure is a simple repair if the procedure: is simple; is a single-layer closure involving [...] Related articles:

  1. Coding Education: Simple, Intermediate or Complex Closure?Correctly distinguish closure levels every time with this advice from...
  2. Simple Laceration Repair Code or E/M Code? Answer Could Cost Hundreds Not recognizing a laceration repair that’s included in an...
  3. Multi-Laceration Repair Coding Case StudiesDo you know when to code repairs that occur in...

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January 21, 2010
Hot Coding Topics / modifier 58 / modifier 78 / modifier 79 / surgery

Second Surgery Coding: Tips for Modifier 58, 78 Success

Don’t let ‘unplanned’ lead to ‘unpaid.’ The next time a patient takes an extra trip to the operating room, don’t let the added service throw your coding off track. Keep these tips in mind to know when to assign modifier 78 – or something else. Check for Surprise Versus Planned Two modifiers pertain to follow-up trips to the [...] Related articles:

  1. Bone Up On ASC Orthopedic Coding With These Global Period, Modifier Tips 3 ways your physician claim better look different than...
  2. Global Billing: Document ‘Unrelated’ for Modifier 79 ServicesMACs are looking for ‘red flags’ to halt additional global period pay...
  3. Decision Chart: Modifier 78, 58, or 79?Simplify your post operative service claims with this nifty tool....

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January 19, 2010