Coder's Cranium / ICD-9

Avoid CVA Diagnosis Coding Pitfalls with 438.13, 438.14

You’ll turn to a V code when your neurologist reports ‘no effects,’ however.

When your neurologist sees a patient who had a stroke, either recently or in the distant past, he may record a number of different conditions — which makes your job more difficult. If you remember a few guidelines, you’ll select the proper ICD-9 codes for every cerebrovascular accident (CVA) case your neurologist treats.

Get Specific With 2 CVA Diagnosis Codes

When your neurologist sees a patient who has had a stroke, or CVA, he may document multiple deficiencies, both new and lingering. When the patient presents with...

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May 16, 2010
Coder's Cranium / modifier 22

2 Tips Lead to Modifier 22 Success Every Time

Watch frequency and provide documentation to rationalize extra pay.

Applying modifier 22 (Increased procedural services) can help increase reimbursement if your neurosurgeon documents a greater-than-usual effort during a surgical service. To ensure your claims’ success, surgeons and coders must also...

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April 15, 2010
E/M / Hot Coding Topics

Consider Observation Codes for Patients In Apparent Limbo

Medicare clears up confusion surrounding ‘8-hour rule.’

Reporting your FP’s observation services can be tricky business, as there is confusion about how, when, and why to choose from one observation code set or another.

Add to that a common misconception...

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March 21, 2010
CMS / E/M / Hot Coding Topics

Get Paid for EM Visits: How Much ROS Documentation Is Enough?

Caution: Keep enough paperwork on hand to back up EHR. Transitioning to the world of Electronic Health Records (EHR) can make your coding easier on many levels, but don’t take it for granted. Physicians often fall short in their review of systems (ROS) documentation whether you use paper charts or rely on EHR, but you can [...] Related articles:

  1. Bullet-Proof Level-4, Level-5 E/Ms with These ROS Documentation TipsROS documentation musts that most practices get wrong. Gastroenterology Coders:...
  2. E/M Coding Focus: Geriatric Patients & DementiaDetermine HPI or ROS during assessment for geriatric patients. Your...
  3. Bulletproof Your Doc’s PSA Documentation with This Form You’re just one click away from a code-focused order....

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February 25, 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
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
Toolkit

Checklist: Collect Surgical Deductibles Up Front to Improve A/R

This 3-step checklist will boost your bottom line. With fewer patients following through on procedures because of economic and financial struggles, and an increasing number of patients not paying their bills, your practice needs to find ways to improve your A/R and bring in deserved money. Adapting an up-front deductible collection policy is one proven way [...] Related articles:

  1. Front Desk Data Tracking ChecklistClean data means more than just a healthy bottom line....
  2. Medical Billers: Test Your Collections Know-How Here This nifty tool tells you if collections cluelessness is...
  3. Time Your Surgical Collections Right by Referencing Payer Contracts Find out if you’re legal in collecting patient portion...

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January 16, 2010
CPT 2010 / Hot Coding Topics

2010 CPT General Surgery Coding Update: Changes for Lap, Abdominal Repair & Hemorrhoidectomy

Can you find codes in 2010’s resequencing mess? We show you how. Reporting your general surgeon’s service with an unlisted code means more documentation work and a payment guessing game — that’s why you’ll welcome CPT 2010’s more specific codes. General surgery can get all the details at this on-demand, specialty-specific audio update. But we won’t keep you in [...] Related articles:

  1. What’s the Code for Lap Hiatal Hernia Repair? Question: In accordance with the new laparoscopic hernia codes, does 49652...
  2. Multi-Laceration Repair Coding Case StudiesDo you know when to code repairs that occur in...
  3. Surgical Coding: Scar Revision on Previous Mastectomy SiteTip: Find mastectomy scar revision in wound repair Question: Our...

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December 30, 2009
HCPCS / Pain Management / Provider News

Check New HCPCS Codes to Keep Pain Management Claims on Track

Catch the changes to botulinum toxin and neurostimulator electrode codes. As a pain management coder, you’re facing new CPT codes for posterior intrafacet implants, paravertebral facet joint injections, and sacroplasty. While preparing to implement these additions, don’t overlook HCPCS changes for botulinum toxin injections and implantable neurostimulator electrodes. Pay Attention to Botox Units A new code for botulinum [...] Related articles:

  1. Botox Wastage: How Do I Code It Correctly? Question: My pain management physician treated a patient’s migraine...
  2. HCPCS 2010: CMS Debuts New J CodesSynvisc, penicillin get new codes — along with injectibles for neurology,...
  3. Pain Management Coding: TPI Do’s and Don’ts for Pay You Can KeepSample ICD-9 codes to support medical necessity for trigger point...

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December 8, 2009
Coding Challenge / Pain Management

How Do I Code an Epidural Blood Patch on Same Day as L&D

Don’t forget to double-check these 2 things to find the correct code. Question: How do I code an epidural blood patch procedure on the same day as labor and delivery? Should I include a modifier? Answer: Administering a blood patch on the same day as labor and delivery is unusual because most physicians try to manage spinal [...] Related articles:

  1. 64450 or 64421: Which Code to Tap for TAP Block?Question: What exactly is a “tap block,” and what code...
  2. How Do I Code Blood Draw Plus E/M?Question: An established type II diabetic patient comes in for...
  3. Will S Code Pay Off for Cord Blood Collection?Question: My ob-gyn did cord blood collection. I have these...

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December 2, 2009
Coding Challenge / modifier 52 / multiple wake test

Can a Sleep Study Code Describe an Awake Test?

Question: A sleep study was ordered for a patient diagnosed with hypersomnolence. The neurologistincluded a multiple wake test in the sleep study. What CPT code should I use for the multiple wake test? Answer: You should use 95805 (Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during [...] Related articles:

  1. Protect Sleep Study Pay With These Documentation Essentials How to keep your polysomnography claims off Medicare’s hit...
  2. Sleep Study Reimbursement: How to Claim Your Piece of the Pie Medicare promises to cover facility and home-based testing —...
  3. CMS: Apnea is Key for Sleep Testing Coverage Medicare benes who suffer from obstructive sleep apnea (OSA)...

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November 29, 2009
Anesthesia / Coding Challenge / modifier 59

Anesthesia Coding Education: Sciatic Nerve Block & Same-Day General Anesthesia

Question: My anesthesiologist performed a sciatic nerve block for a patient with postoperative pain on the same day he provided general anesthesia for that patient’s knee surgery. How should I code this? Answer: Use modifier 59 (Distinct procedural service) when you need to show that your physician performed two distinct services on the same day. When [...] Related articles:

  1. 64450 or 64421: Which Code to Tap for TAP Block?Question: What exactly is a “tap block,” and what code...
  2. Anesthesia Coding: Unlisted Procedures, E/M and Nerve BlocksThere’s no denying that anesthesia coding is like no other...
  3. Plantar Digital Nerve Coding Education: 64455 & 64632With these 4 tips, you’ll code clean claims every time....

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October 21, 2009