93224-93226: Snag Extra Cash With These Tips

The catch is you have to make the request for your rightful dollars.

Here’s a piece of good news for you. As per the Medicare’s April update, three Holter monitor codes will get a slight boost in pay.

The change has an implementation date of April 4, 2011, and an effective date of Jan. 1, 2011. That means contractors have to be ready to comply with the change by April 4, but the change in practice expense relative value units (PE RVUs) is retroactive to Jan. 1 dates of service.

Medicare isn’t requiring contractors to search their files to adjust claims they have already paid (which is good news for any physician who reports a code seeing a fee decrease). But contractors do have to adjust claims if you bring them to their attention. Take a look at how many 93224-93227 services you provided from January to March to see if making the claim for the small increase in RVUs is worth your time.

93224: The PE RVUs for 93224 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, physician review and interpretation) will change from 2.30 to 2.53. That’s a difference of .23 RVUs. Multiply that by the 2011 conversion factor (33.9764), and you can expect roughly an additional $7.81 for this code. (Remember that geographic region will affect your fee, as well).

93225: For 93225 (…recording [includes connection, recording, and disconnection]), the PE RVUs only increase by .09, changing from 0.82 to 0.91. So the additional reimbursement should be roughly $3.06.

93226: You may see an additional $4.76 for 93226 (… scanning analysis with report). Its PE RVUs change from 1.21 to 1.35.

Swan-Ganz: If you ever report 93503 (Insertion and placement of flow directed catheter [e.g.,...

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96446 And Dozen Others Join The List of CCI Edits

Effective Jan. 1, 2011, new CPT codes and, inevitably, new Correct Coding Initiative (CCI) physician edits are there for physicians. For version 17.0, “19,822 new edit pairs have been added to the database while 9,778 have been terminated, for a net gain of 10,044 new edit pairs,” according to Frank Cohen, MPA, MBB, of the Frank Cohen Group, in his Dec. 14, 2010, “NCCI Version 17.0 Change Analysis” announcement.

The main edits you want to be sure to watch for are those related to new code 96446 (Chemotherapy administration to the peritoneal cavity via indwelling port or catheter).

The 96446 non-mutually exclusive (NME) edits are largely what you would expect based on other chemotherapy code edits — bundles with E/M, anesthesia, venipuncture and other vascular procedures, for example. You want to be sure to watch which is the column 1 code and which is the column 2 code for these bundles.

CCI places E/M codes 99217-99239 in the column 1 position and 96446 in the column 2 position. On the other hand, CCI places 96446 in the column 1 position and E/M codes 99201-99215 in the column 2 position, as shown below:

Column 1 Column 2
99217-99239 96446
96446 99201-99215

Remember that if you report both codes in an NME edit pair without a modifier, Medicare (and payers who adopt these edits) will deny the column 2 code and pay you only for the column 1 code. The edits in the table above all have a modifier indicator of 1, meaning that you may override the edits with a modifier when appropriate, such as in the case of distinct,...

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Ace CPT and ICD-9 Coding for Intra-Arterial Cases

Whether liver neoplasm is primary or secondary will change your coding.

Good news: You can apply many of the same rules you already know for intravenous chemotherapy coding to intra-arterial coding, too. So take your chemo coding expertise to the next level by adding intra-arterial skills to your arsenal.

Start here: For intra-arterial (IA) chemotherapy, you should choose from the following codes, says Gwen Davis, CPC, associate with Washington-based Derry, Nolan, and Associates.

  • 96420 — Chemotherapy administration, intra-arterial; push technique
  • 96422 — … infusion technique, up to 1 hour
  • +96423 — … infusion technique, each additional hour, (List separately

...

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How Should I Code a Fibrinolytic Agent Instillation Via Chest Tube?

Different calendar dates matter, but multiple instillations the same day do not. Question: My pulmonologist inserted a chest tube and then instilled a fibrinolytic agent to break up multiloculations to free up an entrapped lung. Usually, I use 32560 for this procedure, which is for pleurodesis, not fibrinolysis. What code should I use for fibrinolytic agent [...] Related articles:

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Radiology Coding: CPT 2010 Breathes New Life Into Your Respiratory Coding

Master 32561’s guidelines to prevent a major units gaffe. Flip through the Surgery/Respiratory System section of your CPT 2010 manual, and you’ll see the coding committee has been hard at work adding to and revising your options. Discover the added cath removal code, the all new fibrinolytic agent instillation code, and the reshaped bronchoscopy descriptors, so [...] Related articles:

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Keep All the Urodynamics Codes Straight With This Handy Cheat Sheet

Knowing the differences between the tests is your key to proper code choice. When your urologist says he performed urodynamics tests, you need to dig deeper into his documentation for clues about which code to report. Tack this overview up by your computer to help you quickly choose the right code every time. • In a simple [...] Related articles:

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Capture Separate CV Access Radiological Guidance

Don’t miss out on $20 per procedure when your surgeon performs central venous (CV) access device placements. If your physician uses fluoroscopic or ultrasonic guidance during the placement, you should separately report that service. We’ll show you how and tell you what modifier moves you need to make to prevent denials. Choose Between +76937 and +77001 If your [...] Related articles:

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