General / Hot Coding Topics

5 Tips Lead You to G0438, G0439 Coding Success

Boost your bottom line by reporting new annual wellness visits correctly.  If you want your annual visit claims to be picture perfect in 2011, then follow these five tips to avoid future denials and keep your physician’s claim on the fast track to success.

Background: The Affordable Care Act (ACA) extended preventive coverage to more than 88 million patients covered by health insurance, and Medicare has codified that benefit in the form of an annual wellness visit. Medicare valued the new annual wellness codes based on a level 4, problem-oriented new and established E/M service.

The two new codes are:

G0438 — Annual wellness visit; includes a personalized prevention plan of service (PPPS), first visit

G0439 — Annual wellness visit; includes a personalized prevention plan of service (PPPS), subsequent visit.

Tip 1: Apply G0438 to Second Year of Coverage

Be wary of applying these codes to new Medicare patients coming in to your physician’s practice in 2011.  The reason is that Medicare will only reimburse the initial visit (G0438) during the second year the patient is eligible for Medicare Part B. In other words, during the first year of the patient’s coverage, Medicare will only cover the Initial Preventive Physical Exam (IPPE), also known as the Welcome to Medicare exam.

Tip 2: CMS Limits G0438 to One Physician

If your FP sees the patient for the initial visit (G0438) and the patient sees a different physician for the next annual wellness visit, that second physician will only receive reimbursement for the subsequent visit (G0439), despite having never seen the patient before.

Here’s why: CMS has indicated that when a patient returns to the same or new physician in a third year, they might only pay for the subsequent visit, says Melanie Witt, RN, COBGC, MA, an...

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May 5, 2011
Hot Coding Topics

Ensure Trigeminal Nerve Block Success With These Two Tips

If your physician administers trigeminal nerve blocks to patients for headache relief, brush up on the ins and outs of anatomy and potential diagnoses. Read on for two keys that will keep your coding for these procedures pain free.

Learn the Location

The trigeminal nerve provides sensory innervations to most of the face; providers might also refer to the trigeminal nerve as the “cranial nerve V” or the “fifth cranial nerve.” The name “trigeminal” stems from the fact that the cranial nerve has three major divisions, or branches:

  • The ophthalmic nerve (V1 division) primarily innervates the forehead and eye area
  • The maxillary nerve (V2 division) provides innervation to the upper jaw area from below the eye to the upper lip
  • The mandibular nerve (V3 division) provides both sensory and motor innervation to the lower jaw area.

Providers can administer trigeminal injections at any of the three divisions or branches of the divisions, says Debbie Farmer, CPC, ACS-AN, with Auditing and Compliance Education in Leawood, Kan. You should report injections with 64400 (Injection, anesthetic agent; trigeminal nerve, any division or branch).

Patients who need trigeminal nerve injections can have conditions ranging from severe headache to postherpetic neuralgia to trigeminal neuralgia (also known as tic douloureux). Common diagnosis codes can include:

  • 053.12 — Postherpetic trigeminal neuralgia
  • 350.1 — Trigeminal neuralgia
  • 350.2 — Atypical face pain.

Review Bilateral Rules

If your provider administers bilateral injections, include extra details with the claim that will help garner the appropriate reimbursement. Medicare and many other payers allow you to report trigeminal injections bilaterally by appending modifier 50 (Bilateral procedure).

Most Medicare contractors request that providers report bilateral services as one line item with modifier 50 appended and one unit of service noted (64400-50 x 1). Medicare will process the service at...

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April 21, 2011
Cardiology / CCI / Hot Coding Topics / Provider News

CCI Edit: 93454-93461 Note These Column Changes For Correct Cardiology Coding

Correct Coding Initiative version 17.1 brings 11,831 new edit pairs, effective April 1 for physicians. That’s the word from a March 17 announcement by Frank Cohen, principal and senior analyst for the Frank Cohen Group. Here’s a look at the major pointers you need to keep in mind to comply with the new cardiology-related edits, including cardiac catheterization, radiological supervision and interpretation, cardiac rehabilitation, and more.

1. Prevent Denials by Remembering 93454-93461 Are Diagnostic

New edits will prevent you from reporting heart catheter/angiography codes 93454- 93461 (column 2) with the following cardiovascular therapeutic services and procedures (column 1):

  • 92975 — Thrombolysis coronary; by intracoronary infusion, including selective coronary angiography
  • 92980 — Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel
  • 92982 — Percutaneous transluminal coronary balloon angioplasty; single vessel
  • 92995 — Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; single vessel.

The 929xx codes in column 1 describe coronary therapies. The 934xx codes in column 2 are diagnostic procedures. You should never use the 934xx diagnostic codes in column 2 to report catheter placement and coronary angiography performed as an integral part of the therapeutic column 1 services.

Opportunity: The edits have a modifier indicator of 1, so you may override them with an appropriate modifier when the procedures are distinct. If you report both codes in the edit pair and don’t append a modifier to the column 2 code, Medicare (and payers applying Medicare rules) will reimburse you for only the column 1 code.

The AMA, via CPT Assistant (April 2005), indicates that you may report a true diagnostic catheterization in addition to the therapeutic procedures described by 92980 and 92982: “These two distinct procedures (diagnostic catheterization and therapeutic procedures), therefore, should...

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April 18, 2011
Hot Coding Topics / Provider News

Worried about Delayed Pay? Verify Your State’s Prompt Pay Laws

How many times has it happened with you that you submit a clean claim but still don’t get paid even three months later? Do you have any recourse? Yes, thanks to the prompt pay laws that each payer must follow when paying your medical claims.

Verify Which Laws Apply to Your Practice

Each state requires private insurers to pay all clean claims within a certain time frame. If the insurer does not pay the claim in a timely manner, then the payer is subject to paying interest on the charges owed to the practice (or directly to the beneficiary). Most time frames range from 15 to 45 working days, with 30 days about the average.

“If you are a little adventurous, you could search for your state law on the Internet,” says Joseph Lamm, office manager with Stark County Surgeons, Inc. in Massillon, Ohio. Lamm warns, however, that “reading through state laws and their multiple exceptions, references to other sections of state law, and ‘legalese’ can make this a very frustrating exercise.”

“Take advantage of your local or state medical society and the experts they employ to see if your state has a prompt pay law, and to which insurance companies it applies,” Lamm suggests. “The medical societies are on your side and will give you the correct information.”

State prompt pay laws do not apply to federal insurers, because the Federal Government dictates that clean claims must be paid in 30 days for Medicare Part B.

“If a state wants a prompt pay rule that’s longer or shorter, they certainly can do that with reference to other payer services,” says Connie A. Raffa, Esq., partner with Arent Fox, LLP in New York, NY. “But Medicare rules are federal and span across the country.”

If your private payer...

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April 16, 2011
Hot Coding Topics

Phototherapy: 96900 or 96910? Check Out These FAQs to Narrow Down On Correct Option

If your dermatologist is treating vitiligo or dychromia patients with phototherapy, read your physician’s documentation carefully to determine what type of light, wavelength, and materials he used. These two frequently asked questions will help you combat both E/M and multi equipment correct coding initiative (CCI) situations.

Evaluate These Phototherapy + E/M Tips

If you’re charging for an office visit on the same day as phototherapy, your reimbursement may depend on whether your physician’s documentation warrants a different diagnosis code. Payers may reimburse at times if the doctor sees the patient for a different problem, thus with a different diagnosis code, experts say.

Example: If your physician performs 99212 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 10 minutes face-to-face with the patient and/or family) with phototherapy, you will bill it with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the E/M service. You can only consider reporting modifier 25 when coding an E/M service, Janet Palazzo, CPC, a coder in Cherry Hill, N.J., says. Remember your E/M documentation has to show medical necessity for the additional work.

If you reported the nurse visit code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician …), your payer would likely consider it bundled into the light treatment.

Ask 2 Questions to Choose Best Light Therapy Code

For patients with vitiligo (709.01), your dermatologist may use narrow band UVB phototherapy.

The dermatologist administers phototherapy two to three times per week for several months until the patient achieves repigmentation of the skin. For this procedure, you need to pinpoint what types the...

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April 14, 2011
Anesthesia / Hot Coding Topics

High BMI: To Use Or Not to Use Modifier 22

The new fifth-digit diagnosis codes for body mass index (BMI) can help you better document a patient’s condition, especially when the patient’s BMI might contribute to more complex risk factors for the anesthesiologist to handle. Having documentation of a high BMI doesn’t automatically lead to more pay, however. Watch two areas before assuming you can automatically append modifier 22 (Increased procedural services) because of BMI and potentially score a 20-30 percent higher pay for the procedure.

Not All Morbid Obesity Means Modifier 22

A patient is considered to be morbidly obese when his or her BMI is 40 or more. New BMI codes for 2011 include:

  • V85.41 — Body Mass Index 40.0-44.9, adult
  • V85.42 — Body Mass Index 45.0-49.9, adult
  • V85.43 — Body Mass Index 50.0-59.9, adult
  • V85.44 — Body Mass Index 60.0-69.9, adult
  • V85.45 — Body Mass Index 70 and over, adult.

While morbid obesity can be an appropriate reason to report modifier 22, don’t assume you should always append the modifier just because the patient is morbidly obese.

Example 1: During surgical procedures that are performed because of morbid obesity (such as bariatric surgery), the patient must meet the morbidly obese criteria too support medical necessity for the procedure. In those type instances, simply having a patient who is morbidly obese doesn’t support using modifier 22. Remember, if you report a physical status modifier for a patient who is morbidly obese, it is not appropriate to also include modifier 22. Keep in mind that Medicare does not pay for physical status, qualifying circumstances, or extra work modifiers.

The anesthesia provider’s documentation should direct you to the correct BMI code as well as support when you can append modifier 22.

Example 2: The patient’s obesity might contribute to breathing problems that lead to lower oxygen and...

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April 12, 2011
Hot Coding Topics

Accessory Sinuses Service Coding: Snag $217 with These 3 FAQs

Given the variety of anatomic sites, surgical techniques, and types of instrumentation involved in transnasal turbinate surgery, it is the one of the most difficult coding scenarios.

Your otolaryngologist removes the middle turbinate during an endoscopic ethmoidectomy (31254, Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior], or 31255, Nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior]) or endoscopic polypectomy (31237, Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]). The middle turbinates are considered access to the sinuses, so you should be able to tell that the removal of the middle turbinate should not be reported separately.

Check out these 3 frequently asked questions (FAQs) to help master your turbinate surgery coding skills.

Should 30130 and 30140 Go Hand-in-Hand?

Suppose the documentation states that the physician entered or excised mucosa and subsequently preserved it. This implies that you should use 30140 (Submucous resection inferior turbinate, partial or complete, any method) to report this service. However, simply reporting that the turbinate was excised is probably not enough documentation for this code. Don’t forget to bill 30130 (Excision inferior turbinate, partial or complete, any method) if there is no evidence of the preservation of the mucosa and the op note just indicates that the inferior turbinate was excised or resected.

Remember that you should not bill 30140 with 30130 — you would bill one or the other, for a single side. “However, if a submucousal resection (preservation of the mucosa) is performed on one side and a straight excision is performed on the other side (no preservation of mucosa), you would code 30140-RT and 30130-59-LT, for example,” explains Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. The RT and LT would represent which side each procedure...

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April 5, 2011
Hot Coding Topics / Provider News

Two New CPT Codes Lend Specificity to Interstitial Device Coding

Until now, you could not code for the additional service — and hence not get the pay — when your general surgeon placed interstitial devices for radiation therapy guidance during a distinct open or laparoscopic abdominal procedure. But two new CPT 2011 codes for the procedure help you capture all the pay you deserve.

Open, Lap, or Percutaneous Approach Distinguish Placement

Last year, you had one code to use when your surgeon placed an abdominal interstitial device for radiation therapy guidance — 49411 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], percutaneous, intra-abdominal, intra-pelvic [except prostate], and/or retroperitoneum, single or multiple).

“If your surgeon performed the device placement during an open or laparoscopic procedure prior to 2011, you had no way to capture the service,” 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.

Now CPT 2011 adds two new add-on codes to describe interstitial device placement during another procedure, as follows:

  • +49327 — Laparoscopy, surgical; with placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple [List separately in addition to code for primary procedure])
  • +49412 — Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], open, intra-abdominal, intrapelvic, and/or retroperitoneum, including image guidance, if performed, single or multiple [List separately in addition to code for primary procedure]).

Choose +49327 for a laparoscopic approach, and +49412 for an open procedure. “Note that these are add-on codes, which means you can report them only in addition to a primary procedure,” Bucknam advises.

Continue to report 49411 for percutaneous interstitial device placement as a stand-alone procedure.

Use codes 49411, +49412, and +49327...

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April 2, 2011
Hot Coding Topics

Sharpen Your Colonic Polyp Vocabulary With These Tips

Not all patients who present to the office with colon polyps will be diagnosed with colon cancer. This second-leading cause of cancer-related deaths in the US usually begins as small, benign adenomatous lump, and becomes cancerous overtime.

Colon cancer, or colorectal cancer as it’s regularly known, is a cancer which starts in the large bowel portion of the gastrointestinal (GI) system. Because it comes in many forms and symptoms, coding the definitive diagnosis might be risky. Guard your practice’s deserved dollars with these 3 tips.

1. Don’t Go Looking For ‘Benign’, ‘Malignant’

Whether or not you’re dealing with a full-blown colorectal cancer, you should be looking at the different terms used to describe benign or malignant colonic polyps. Some of these include:

  • Adenomas including tubular adenomas and tubulovillous adenomas
  • Hyperplastic polyps
  • Inflammatory polyps
  • Familial adenomatous polyposis, a rare hereditary disorder that causes hundreds of polyps in the lining of the colon beginning in the teenage years. If this is left untreated, the patient becomes high risk to develop colon cancer.
  • Hereditary nonpolyposis colorectal cancer, a hereditary disorder that causes an increased risk of developing colon cancer.

But first, you have to accomplish the task of determining — without a doubt — if a polyp is benign or malignant. If you think you would find the clues in the pathology report (PR), think again. Usually, the PR will not use the term “benign” or “malignant.” However, it will use a description that points to the usual behavior of the polyp. It’s up to you to interpret those descriptions into benign or malignant.

Experts advise that you always wait for the pathology report to come back before deciding on a particular ICD-9. Even the gastroenterologists, themselves, usually defer to the pathology report before making a recommendation.

2....

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March 31, 2011
Hot Coding Topics

Bone Scans: 3 Tips Help You Code Osteoporosis Screening Successfully

Your practice is going to have more patients coming in for bone density screenings, thanks to new recommendations from the U.S. Preventive Services Task Force (USPSTF) that might lower the age at which family physicians could begin screening some women for osteoporosis. Act now to ensure you’re assigning the correct diagnosis codes and verifying medical necessity.

1. Know Osteoporosis, Osteopenia Differences

Many people think of osteoporosis when they hear the term “bone density screening.” Osteoporosis — which literally means “porous bone” — is a disease characterized by low bone mass and structural deterioration of bone tissue. The changes lead to bone fragility and an increased risk of hip, spine, and wrist fractures. The condition is essentially a bone disease caused by dropping estrogen levels in postmenopausal women.

When your physician diagnoses osteoporosis, you’ll select from code family 733.0x (Osteoporosis). Choose the diagnosis based on the patient’s specific type of osteoporosis (such as postmenopausal, idiopathic, etc.). A less-thought-of diagnosis related to bone density screenings is osteopenia (733.90, Disorder of bone and cartilage, unspecified). Patients with osteopenia have lower than normal bone density.

Although osteopenia can be a risk factor or precursor for osteoporosis, not every patient with osteopenia develops osteoporosis.

Screening: Your physician will most likely order a dual-energy x-ray absorptiometry (DXA), which measures bone density, to diagnose the condition. DXA is the gold standard for measuring bone density, coder Donna Richmond with CodeRyte taught in The Coding Institute’s audioconference “Surefire Bone Density Screening Strategies.” Your code choices include:

  • 77080 — Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine)
  • 77081 — … appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
  • 77082 — … vertebral fracture assessment.

2. Check for Documented Necessity

Medicare guidelines dictate that your documentation must include an...

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March 29, 2011
Hot Coding Topics / ICD-10 / Provider News

ICD-10: Prep Yourself for New Hyperlipidemia Codes

When ICD-10 goes into effect in 2013, high cholesterol will still be a challenge for your patients. Here’s a look at how coding for this, and similar diagnoses, compares between ICD-9 and ICD-10.

ICD-9-CM Codes:

  • 272.0, Pure hypercholesterolemia
  • 272.1, Pure hyperglyceridemia
  • 272.2, Mixed hyperlipidemia
  • 272.4, Other and unspecified hyperlipidemia

ICD-10 Codes:

  • E78.0, Pure hypercholesterolemia
  • E78.1, Pure hyperglyceridemia
  • E78.2, Mixed hyperlipidemia
  • E78.4, Other hyperlipidemia
  • E78.5, Hyperlipidemia, unspecified

Change: ICD-10 offers a one-to-one code match with ICD-9 for pure hypercholesterolemia (272.0, E78.0), pure hyperglyceridemia (272.1, E78.1), and mixed hyperlipidemia (272.2, E78.2). But where ICD-9 offers one code for “other and unspecified hyperlipidemia” (272.4), ICD-10 offers one code for “other” (E78.4) and a different code for “unspecified” (E78.5).

Documentation: Your clinicians’ documentation shouldn’t need to change from its current form. All you need to do as a coder to capture this already present information is to format your superbill to capture the difference between “other” and “unspecified” hyperlipidemia. “Other” means the physician documented the type, but ICD-10 doesn’t offer a code specific to the documented type. “Unspecified” means the physician did not document the type of hyperlipidemia.

Bonus tip: The notes with the ICD-9 and ICD-10 codes for lipid metabolism disorders are very similar, but there are a few differences. For example, while 272.1 includes “hypertriglyceridemia, essential,” E78.1 includes “elevated fasting triglycerides.”

Under E78.2, ICD-10 adds “combined hyperlipidemia NOS,” “elevated cholesterol with elevated triglycerides NEC,” and “Hyperlipidemia, group C.” Code E78.2 also has an Excludes1 note, telling you instead to code E78.4 for “familial combined hyperlipidemia” and E78.5 for “cerebrotendinous cholesterosis [van Bogaert-Scherer- Epstein] (E75.5).”

Remember: When ICD-10 goes into effect on Oct. 1, 2013, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and...

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March 25, 2011
Hot Coding Topics

Coding Retrobulbar Blocks? Three Questions Help You Decide How

Coding your anesthesia provider’s service is never cut and dried, especially with intricate procedures such as retrobulbar block placement. Answer these three questions regarding your anesthesiologist’s involvement in the case to know how to correctly code her services every time.

Does The Anesthesiologist Handle Everything?

Because administering anesthesia for retrobulbar blocks is riskier than other ocular injections, some surgeons (or facilities) prefer to have the anesthesia team handle everything. If your anesthesiologist is involved throughout the case, she administers the initial block and then administers monitored anesthesia care (MAC) during the case.

Code it: Your anesthesiologist places the block in preparation for the procedure, not as a separate pain management service. Therefore, you only code for the eye procedure instead of the procedure and block. Choose the appropriate code from 00140-00148 (Anesthesia for procedures on eye …). Depending on carrier requirements, append modifier QS (Monitored anesthesia care service) to indicate MAC, says Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla.

Expect your anesthesiologist to report discontinuous time in this scenario. She will place the block, leave the room while the block takes effect, and return in time for the procedure. Because she won’t be with the patient from start to finish, watch your time units. Calculate the time she spends placing the block and with the patient during the procedure for the total minutes.

Caution: Patients needing retrobulbar blocks often are scheduled back to back, which can make tracking your anesthesia provider’s time tricky. Be careful to ensure that case times don’t overlap when calculating the number of cases your anesthesiologist medically directs or supervises. Some practices decide to avoid potential compliance risks by not trying to capture the discontinuous time.

Does the Anesthesiologist Only Monitor?

Some facilities — and many...

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March 24, 2011
Hot Coding Topics / modifier 25

AK Removals: Earn $120 by Following 17000-17111 with 99201

Stick to these 3 tips for your E/M and lesion removal procedures.

You can report both the E/M and lesion removal if the E/M service was a significant and separately identifiable service for an E/M service with actinic keratoses (AK) removal procedure.

Always verify with your carrier before appending modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.

You can only consider reporting modifier 25 when coding an E/M service, says Janet Palazzo, CPC, coder for a practice in Cherry Hill, N.J. If the procedures you are reporting don’t fall under E/M services, it is possible the encounter qualifies for another modifier instead.

Have a look at the following three tips to help you report these services accurately so your practice won’t miss out on about $41 for 99201 and $80 for 17000 or more, according to national averages indicated in Medicare’s 2011 Physician Fee Schedule.

1. Know When You Should Charge an E/M

Each insurer has its own guidelines for office visits (99201- 99215, Office or other outpatient visit …) and lesion removals (17000-17111, Destruction, Benign or Premalignant Lesions). So, knowing whether to appeal an E/M denial is difficult unless you know that the service deserves payment.

You should report the office visit (99201-99215) in addition to the procedure when the dermatologist performs a significant, separately identifiable E/M service from the AK removal, especially if the patient is new to your practice.

Along with the appropriate E/M code, report any diagnoses that come with that examination, which may include more than just the AK.

For example, if a patient comes in for an initial AK visit, you should charge an E/M service, since the physician has to examine the area and discuss...

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March 21, 2011
Hot Coding Topics

Inhaler Education Claims: 4 Quick Guidelines to Help You Report Correct Claims

When reporting inhaler service, you should remember the type of device the provider is using, but shouldn’t stop with just that. Documentation requirements and qualifying modifiers are just as important when coding for inhaler services.

When you’re confused why some payers would deny reimbursement for certain inhaler claims, the following ideas could guide you to a better understanding of how inhaler service codes work out.

94664 Is Your Ticket to Diskus Demo Pay

The Advair Diskus is an “aerosol generator.” If the nurse/medical assistant taught someone to use an Advair Diskus — or any other diskus — you should report 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).

For example, a pulmonologist starts a patient with asthma (493.00, Extrinsic asthma; unspecified or 493.20, Chronic obstructive asthma; unspecified) on Advair. A nurse then teaches the patient how to use the Diskus. As per CPT guidelines, you should report 99201-99215 for the office visit and 94664 without a modifier, says Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta.

In addition, CMS transmittal R954CP also indicates that modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) applies only to E/M services performed with procedures that carry a global fee, which 94664 does not have.

Nonetheless, many payers will only pay for the service if you append modifier 25 to the visit code. It’s always best to check with your major insurers’ policy first.

Bundle Dose in Teaching Session

The patient may administer medication dose during the teaching session. Both services (treatment + teaching) are bundled into one CPT: 94640 (Pressurized or nonpressurized inhalation treatment for acute...

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March 16, 2011
Hot Coding Topics / ICD-10 / Provider News

ICD-10: A J Code To Replace 471.0 In 2013

Nasal cavity polyp also goes by the term “choanal” and “nasopharyngeal.” If the otolaryngologist performed a removal of a middle turbinate endoscopically, you would report it with CPT 31240 — subsequently linking this procedure to a diagnosis...

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March 16, 2011
Hot Coding Topics

Stop Letting Complex Dermatitis Tests Rob You Of Your Deserved Pay

Keeping track of all the different potential allergens that may be causing a patient’s skin rash is challenging enough. But when you add the complexity of different kinds of dermatitis tests that a dermatologist can perform, it’s enough to cause a coder to break out in a rash herself. The variety and complexity of allergy tests can certainly lead to coding mishaps — but understanding the codes and having clear documentation can help clear things up.

The tests that dermatologists commonly perform to learn the source of a patient’s allergic dermatitis include scratch tests and patch tests. Knowing what code to use means understanding what each test does, and how.

Count Each Allergen in Scratch Tests

Procedure: Percutaneous tests

AKA: Scratch tests, prick tests, puncture tests, Multi-Test

Codes: 95004 (Percutaneous tests [scratch, puncture, prick] with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests) and 95010 (Percutaneous tests [scratch, puncture, prick] sequential and incremental, with drugs, biologicals or venoms, immediate type reaction, including test interpretation and report by a physician, specify number of tests).

In these tests, the dermatologist applies test solutions of possible allergens to scratches or shallow punctures of the skin. The code you report will depend on the type of solutions applied — allergenic extracts, such as dust, cat dander, and molds (95004), or antibiotics, biologicals, stinging insects, and local anesthetic agents (95010).

Dermatologists usually want to test several substances at once (often in blocks of eight), and each substance counts as a separate test, notes Pamela Biffle, CPC, CPC-P, CPC-I, CCSP, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Watauga, Texas. Be sure to code for each allergen administered by putting the number in the “units” field of your claim form.

Hidden trap: Code...

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March 14, 2011