Coder's Cranium / Hot Coding Topics / modifier 62 / modifier 80 / modifier AS / multi-provider coding / Multiple procedures

Multi-Provider Coding: Modifier 62 Can Save You $4k

When you come face-to-face with multi-provider situation, the last thing you would want is to mess up your coding by assigning the wrong modifier(s).

Imagine a 70-year-old female patient presenting with COPD and coronary artery disease, status post myocardial infarction (CAD s/p MI) having a 28 mm of inner diameter thoracic aortic aneurysm. Imaging studies indicate the aneurysm to be descending. The cardiologist, together with a thoracic surgeon, decides to perform an open operative repair with graft replacement of the diseased segment.

The main key in a multi-provider scenario is to treat each physician’s work as a separate activity. However, deciding when to report a case as co-surgery, assistant surgery — or something else — has more to it than meets the eye. Find out what with this expert’s advice.

You know that a modifier is at hand in this case, but more importantly you should be able to tell what role each modifier plays in order for your procedure codes to blend well together. Here are the most common modifiers used in multi-provider situations:

  • Modifier 62 (Two surgeons). Append this to each surgeon’s procedure when the physicians perform distinct, separate portions of the same procedure. Also referred to as co-surgery, modifier 62 applies when the skill of two surgeons (usually of different skills) is required in the management of a specific surgical procedure.
  • Choose between modifier 80 (Assistant surgeon), modifier 81 (Minimum assistant surgeon), and modifier 82 (Assistant surgeon [when qualified resident surgeon not available]) when one surgeon assists the other with multiple portions of the case rather than completing his work independently. What to look for? Make sure your physician indicates in his documentation that he’s working with an assistant surgeon, what the assistant surgeon did, and why he or she was used during the case.
  • Attach modifier AS

...

Comments Off on Multi-Provider Coding: Modifier 62 Can Save You $4k
February 15, 2011
CPT 2011 / Hot Coding Topics / Provider News

Look Up New Observation Codes When Reporting ‘Middle Days’

2011 brings a new coding option when reporting the middle day of observations that last longer than two days. Check out this expert advice on how CPT additions will affect your FP’s observation care services coding starting on Jan. 1, 2011.

Until this point, coding for the “middle days” of an observation service caused problems. Although not the norm, there are times when a physician admits a patient to observation and she remains in that status for three or more days. CPT 2011 addresses these middle days between admission and discharge by introducing three new E/M codes. The additions parallel the hospital subsequent care series in terms of component requirements and time frames:

  • 99224 – Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient’s hospital floor or unit.
  • 99225 — … an expanded problem focused interval history; an expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/ or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient’s hospital floor or unit.
  • 99226 — … a detailed interval history; a detailed examination; Medical decision making of high complexity. Counseling and/or

...

Comments Off on Look Up New Observation Codes When Reporting ‘Middle Days’
February 6, 2011
Hot Coding Topics

Myomectomy Claims: Anatomical Location Is Your Key

Deciding which myomectomy code you’ll report depends on three factors: the approach the ob-gyn uses, the number of myomas, and their weight. Here’s how to translate this information into the correct CPT code every time.

If your ob-gyn performs a hysterectomy, you won’t report the myomectomy separately.

When your ob-gyn performs a myomectomy, he is removing myomas or uterine fibroid tumors. Knowing what type they are will help you to determine your myomectomy code.

Myomas (also known as uterine fibromas) are the most common growth of the female genital tract. They are round, firm, benign masses of the muscular wall of the uterus and are composed of smooth muscle and connective tissue. You’ll see different types of uterine fibroids based on their location:

  • Intracavitary myomas are fibroids inside the uterus.
  • Submucous myomas are partially in the uterine cavity and partially in the wall of the uterus.
  • Subserous myomas are on the outside wall of the uterus.
  • Intramural myomas are in the wall of the uterus; their size can range from microscopic to larger than a grapefruit. These take a lot more effort to remove than a surface myoma.
  • Pedunculated myomas are connected to the uterus by a stalk and are located inside the uterine cavity or on the outside surface.

Myomas often cause or are coincidental with abnormal uterine bleeding, pressure or pain. They are also one of the most common reasons women in their 30s or 40s have hysterectomies, says Peggy Stilley, CPC, COBGC, ACS-OB, director of auditing services at the American Academy of Professional Coders.

However, women who want to have children in the future or simply do not want their uterus removed look for alternative solutions. The following procedures describe abdominal, vaginal, and laparoscopic approaches.

First of all, look at the abdominal approach. When...

Comments Off on Myomectomy Claims: Anatomical Location Is Your Key
February 5, 2011
Hot Coding Topics

Therapy Progression Is Your Key to Correct Whiplash Coding

Be on a look out for Scans, TPIs, and more

Though coding for whiplash diagnosis and treatment is pretty straightforward, you should still watch out situations when the patient’s symptoms persist despite conservative therapy and warrant more extensive treatment. You will miss your pay if you miss these diagnoses.

When a patient presents with whiplash symptoms, your pain management specialist will conduct a thorough exam and will often order neck x-rays to rule out fractures. On diagnoses of whiplash (847.0, Sprains and strains of other and unspecified parts of back; neck sprain), he typically will prescribe conservative treatment. Common options include physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants. Some patients may also benefit from wearing a soft cervical collar or by using a portable traction device.

If conservative treatment fails, the physician might order additional diagnostic imaging tests. These could include:

  • CT scans – 70490 (Computed tomography, soft tissue neck; without contrast material), 70491 (… with contrast material[s]) and 70492 (… without contrast material followed by contrast material[s] and further sections)
  • MRIs – 70540 (Magnetic resonance [e.g., proton] imaging, orbit, face and/or neck; without contrast material[s]), 70542 (… with contrast material[s]) and 70543 (… without contrast material[s], followed by contrast material[s] and further sequences)
  • Bone scans – CT, MRI, and x-ray tests include basic bone scans. If your physician orders more extensive bone scans for the patient, you might to get authorization for 78300 (Bone and/or joint imaging; limited area) or 78305 (… multiple areas) instead.

Correctly Count Trigger Point Injections

Your physician might also administer trigger point injections to relieve the patient’s pain and muscle tenderness. Code these procedures with 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]) or 20553 (…three or more muscles).

Because of the “one or two muscles” and “three or...

Comments Off on Therapy Progression Is Your Key to Correct Whiplash Coding
February 5, 2011
Coder's Cranium / CPT 2011

Is 96413 + 96365 OK?

Coding is all about applying standardized code sets to situations that don’t always qualify as “standard.” The good news is that authoritative coding resources sometimes address even those encounters you don’t handle on a daily basis. Test your skills with these two scenarios and see whether your responses match the official rules.

Challenge 1: Staff administers a non-chemotherapy therapeutic drug via one IV infusion site, and then following oncologist orders based on protocol, administers chemotherapy intravenously via a second IV site. Should you report the chemotherapy admin or the non-chemotherapy admin as the initial code?

Solution 1: Challenge 1 presents a trick question. You should report initial codes for both the chemotherapy and non-chemotherapy infusions.

CPT guidelines state, “When administering multiple infusions, injections or combinations, only one ‘initial’ service code should be reported, unless protocol requires that two separate IV sites must be used,” notes Gwen Davis, CPC, associate with Washington-based Derry, Nolan, and Associates.

Citing this same rule, Tracy Helget, CPC, in the business office of Medical Associates of Manhattan in Kansas, notes, “The easiest way to think of this is, if we are making more than one stick to the patient, we bill more than one initial code.”

Many payers indicate that when you report two initial codes because each requires a separate access site, you should append modifier 59 (Distinct procedural service). So you may need to append modifier 59 to the secondary “initial” code to indicate the separate IV sites for each infusion in this case. For example, your claim may include the following:

  • 96413 – Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
  • 96365-59 – Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour.

Challenge 2: Documentation indicates your oncologist participated in...

Comments Off on Is 96413 + 96365 OK?
February 4, 2011
Hot Coding Topics / Provider News

Check CCI Edits For New Vaccine Administration Codes

Many of the new code pair additions involve CPT codes that debuted on Jan. 1, with CCI now halting payment if you report certain procedures together.

For instance, you’ll find vaccine administration codes 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid])and 90473 (Immunization administration by intranasal or oral route; 1 vaccine [single or combination vaccine/toxoid]) bundled into new vaccine administration code 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component), and no modifier can separate these edits. This edit prevents mixing and matching the new immunization administration codes with the old, established immunization administration codes when delivering multiple vaccines at the same visit.

In addition, CCI bundles the new subsequent observation care codes 99224-99226 into inpatient neonatal and pediatric critical care codes 99468-99476.

CCI Has Good News on the Modifier Front

Not all news coming out of the new edition of CCI is bad. Effective Jan. 1, you’ll be able to use a modifier (such as 59, Distinct procedural service) to separate the edit bundling wound care management codes 97597-97602 into the newly-revised debridement codes 11042-11044. In the past, if your pediatrician performed both procedures on the same date of service, you could not collect for both no matter what, but now you will be able to if your documentation demonstrates the separate and distinct nature of the services and you append the appropriate modifier.

Swapped pairs: In addition, CCI did an about-face on several edits this round. In the past, if you reported 94660 (Continuous positive airway pressure ventilation) or 94662 (Continuous negative pressure ventilation) with an outpatient E/M code (99201-99215), CCI would reimburse you for the pressure ventilation and deny

...

Comments Off on Check CCI Edits For New Vaccine Administration Codes
February 3, 2011
Hot Coding Topics / MAC / Provider News

New AWV Codes: Here’s What the MACs Are Saying

Stop worrying if your claims were denied, you still hold a chance as many carriers are reprocessing.

Almost a year ago, practices were told that Medicare will cover an annual wellness visit (AWV) for Part B beneficiaries effective Jan. 1 and last month, CMS announced the new codes for the AWVs. Everything seemed to look perfect until came the time for claims submissions and came the denials along with it.

The MACs may have hit a few speedbumps while processing the first of the AWV claims, but are attempting to get their systems rolling smoothly as January closes out for codes G0438 (Annual wellness visit, initial) and G0439 (Annual wellness visit, subsequent). We give you answers to several questions — straight from the MACs themselves — which may help you ensure that your claims go through smoothly.

Which Diagnosis Code Should You Use?

Several subscribers have told the Insider that they submitted their AWV claims using ICD-9 code V70.0 (Routine general medical examination at a health care facility), but faced immediate denials due to MACs claiming that this is the wrong diagnosis code.

It appears that those denials were the result of a computer glitch that made the AWV codes non-payable when billed with V70.0, but some payers have already fixed this problem.

National Government Services, a Part B payer in four states, sent out a notification on Jan. 25 stating that they “omitted the editing for diagnosis code V70.0 that is allowable with HCPCS codes G0438 and G0439, and claims that were initially denied are being reprocessed.

Pinnacle Business Solutions, a Part B MAC in two states, ran a notification on its Web site on Jan. 21 stating that a system error in the claims processing system incorrectly denied claims for G0438-G0439 between Jan. 1 and Jan 20. “A...

Comments Off on New AWV Codes: Here’s What the MACs Are Saying
February 3, 2011
Coding Challenge / Hot Coding Topics

52300 or No 52300 For Ureterocele?

Question: My urologist performed a cystoscopy, transurethral incision of an orthotopic ureterocele, ureteroscopy, and a double J stent placement. I have drawn a blank on how to report the ureterocele incision. Here is the doctor’s note: “A 24 resec...

Comments Off on 52300 or No 52300 For Ureterocele?
February 1, 2011
CPT 2011 / Hot Coding Topics

Make Sure To Check CCI Before You Use The New 2011 Codes

Capture additional pay by separating wound care management codes 97597-97602 from the newly revised debridement codes.

Every year, just when you’re trying to get used to new CPT codes, the Correct Coding Initiative (CCI) comes along and limits how and when you can use the new codes you’ve been given. This year is no exception with CCI 17.0 adding edits involving new Renessa and posterior tibial neurostimulator (PTNS) codes, among others.

The CCI released version 17.0, revealing 19,822 new active pairs and 9,778 code pair deletions, said Frank D. Cohen, MPA, MBB, senior analyst with The Frank Cohen Group, LLC, in a Dec. 14 announcement.

Many of the new code pair additions involve CPT codes that debuted on Jan. 1, 2011 with CCI getting ready to halt payment if you report certain procedures together. Get a grip on the new bundles with this urology-focused rundown.

CPT 2011 deleted Category III code 0193T (Transurethral, radiofrequency microremodeling of the female bladder neck and proximal urethra for stress urinary incontinence), replacing it with a new Category I code 53860 with the same descriptor. CCI targets 53860 with several edits.

When your urologist performs the Renessa procedure, you’ll report 53860, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook.

As of Jan. 1, when 53860 became an active code, CCI 17.0 created edit pairs with the following column 2 codes that Medicare considers usual and necessary parts of any surgery:

  • Venipuncture, IV, infusion, or arterial puncture services represented by codes 36000, 36400- 36440, 36600-36640, and 37202
  • Naso- or oro-gastric tube placement (43752)
  • Bladder catheterization (51701-51703).

“In general CPT code 53680 would include catheter placement for temporary postoperative urinary drainage at the conclusion of the procedure, and therefore, these latter...

Comments Off on Make Sure To Check CCI Before You Use The New 2011 Codes
January 31, 2011
CPT Updates / Hot Coding Topics / modifier 76 / modifier 78 / Modifier GU / Provider News

CPT 2011: New Modifier GU and Revisions to 76, 77, and 78 Change Your Reporting

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 ...

Comments Off on CPT 2011: New Modifier GU and Revisions to 76, 77, and 78 Change Your Reporting
January 19, 2011
CPT Medical Changes / Hot Coding Topics

Turn To 37224-37227 For Your Femoral/Popliteal Codes

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:

  • Angioplasty: 37224 — Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal angioplasty
  • Atherectomy (and angioplasty): 37225 — … with atherectomy, includes angioplasty within the same vessel, when performed
  • Stent (and angioplasty): 37226 — … with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
  • Stent and atherectomy (and angioplasty): 37227 — … with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when 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...

Comments Off on Turn To 37224-37227 For Your Femoral/Popliteal Codes
January 19, 2011
Coding Challenge / Hot Coding Topics

2011 Guidelines For 93922

Question: I’m confused by the 2011 guidelines for 93922-93923. When should I report 93922-52? Answer: You should report 93922-52 (Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries … 1-2 levels; Reduced services)...

Comments Off on 2011 Guidelines For 93922
January 19, 2011
Hot Coding Topics / Provider News

Ordering/Referring PECOS Edits Won’t Be Instituted Until July

Here comes a late holiday gift for Part B practices. Thanks to a new transmittal on the topic, CMS has announced that MACs won’t institute ordering/referring PECOS edits until July.

Currently, if you submit claims for services or items ordered/referred and the ordering or referring physician’s information is not in the MAC’s claims system or in PECOS, your practice will get an informational message letting you know that the practitioner’s information is missing from the system. It was previously announced that MACs would start denying these claims on Jan. 3, but CMS announced on Dec. 16 that claim denials won’t begin until July 5.

In Part B, MACs will take two steps before denying your claims. First, the carrier will check whether the ordering/referring physician is in PECOS. If not, the MAC will try to find the provider in the Claims Processing System Master Provider File. If the physician is in neither system, the claim will be rejected starting this July.

Even though CMS won’t reject your claims this month, you should still take this time to ensure that you and your ordering/referring providers are in PECOS as soon as possible, just in case the MAC edits become a reality, said National Government Services’ Andrea Freibauer during a Nov. 9 webinar on ordered and referred services.

To read the updated CMS transmittal, visit http://www.cms.gov/transmittals/downloads/R825OTN.pdf.

Hospices benefited from a separate holiday gift that CMS delivered just before Christmas – a delay of the enforcement date for the new face to face encounter requirement.

For weeks, hospices, home care providers, and their representatives had been giving CMS the full court press about the burdensome new physician visit requirement. In a Dec. 15 letter to CMS Administrator Donald Berwick, more than 25 senior and long-term care organizations joined the National...

Comments Off on Ordering/Referring PECOS Edits Won’t Be Instituted Until July
January 18, 2011
Coder's Cranium

Report Picture Perfect Annual Wellness Visits With These 5 Tips

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.

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 independent coding consultant in Guadalupita, N.M. “It is therefore important that you convey this information to any new physician the patient sees.”

Tip 3: Add Preventive Service Codes, If Performed

You can bill the new annual visit codes in addition to any other preventive service, such as G0102 (Prostate cancer...

Comments Off on Report Picture Perfect Annual Wellness Visits With These 5 Tips
January 18, 2011