General / Hot Coding Topics

3 Steps to Keep Discontinued Procedure Claims Moving

You often turn to modifier 53 (discontinued procedure) when your anesthesiologist or the surgeon sees some risk that could threaten the patient’s health if the procedure continues.   However, Payers do recoil when it comes to reimbursing these claims.  Here are three easy steps by the experts to help you to get on the right track for reimbursement.

1) Conquer Electronic Filing Challenges

Gone are the days when you were told to submit paper claims reporting modifier 53 so you can append a written explanation with the claim.  With HIPAA and electronic standards, you can do the billing electronically.  Once you have billed electronically with modifier 53, the payer might request more information.  Thus the note should contain all the information the carrier needs.  For failed procedure, the record should state the reasons for the failure.  If your physician discontinued the procedure due to the patient’s condition, the record should detail what factors prevented the procedure from going forward.

2) Verify the Timing of Cancellation

Knowing exactly when the case was canceled in terms of the physician’s work will help guide your code choices.  If the physician cancels the procedure after induction, the case technically became a surgical procedure.  Determine the correct surgical code, such as 45380 for a colonoscopy with biopsy.  Then cross to the correct anesthesia code, such as 00810.  If the cancelled procedure took place in an outpatient hospital or ambulatory surgical center, some payers require modifier 73 or modifier 74.  In those situations, append modifier 73 or 74 to the anesthesia code instead of modifier 53 as modifiers 73 and 74 are specifically for outpatient hospital use.

3) Include the Correct Diagnosis

Indicate the reason for cancellation by reporting the appropriate diagnosis code or codes.   For a patient who experiences syncope while still in the...

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June 8, 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

Pain Management: Is Headache Coding Giving You Headaches?

If your neurologist or pain specialist administers greater occipital nerve blocks, don’t let coding turn into a headache. Verify specifics about the patient’s headache and the service your provider offered to pinpoint the correct diagnosis and procedure codes every time. Our 4 questions will point you to the best diagnosis and injection codes.

Where Is the Occipital Nerve?

The greater occipital nerve (GON) originates from the posterior medial branch of the C2 spinal nerve and provides sensory innervations to the posterior area of the scalp extending to the top of the head. Physicians typically inject the GON at the level of the superior nuchal line just above the base of the skull for occipital headaches or neck pain.

Some physician practices include a small illustration in the chart that the physician can mark with various injection sites. Including this type of tool helps your physician clearly document the injection location, which helps you choose the correct nerve injection code and submit more accurate claims.

What Type of Headache Does the Patient Have?

Your physician’s documentation might include notes ranging from “occipital headache” to “occipital neuralgia” to “cervicogenic headache.” Your job is to ensure that you interpret the notes and assign the most accurate diagnosis.

Occipital headache: ICD-9’s alphabetic index does not include a specific listing for occipital headache. Because of this, report the general code 784.0 (Headache), which includes “Pain in head NOS.” More details in your provider’s notes might lead to diagnoses such as 307.81 (Tension headache), 339.00 (Cluster headaches), 339.1x (Tension type headache), or 346.xx (Migraine).

Occipital neuralgia: You have a more specific diagnosis to code when your provider documents occipital neuralgia. Greater occipital neuralgia produces an aching, burning, or throbbing pain or a tingling or numbness along the back of the head. You’ll report diagnosis 723.8...

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February 19, 2011
Coding Challenge

What Items Does 86580 Include?

Question: I would like to know the correct codes for billing a PPD test provided in the office. Should I use 86580 with V74.1 and what should I bill for the PPD administration? Answer: You are using the correct diagnosis code: V74.1 (Special screening ...

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November 16, 2010
Toolkit

Handle Your Hand, Wrist Diagnoses With Care by Pinpointing Anatomic Site

Here’s how to differentiate the tiquetrum from the trapezium. Doctors dealing with hand procedures don’t only treat carpal tunnel syndrome, and it’s up to you to link the correct diagnosis to the upper-extremity repair codes. Use this anatomic dr...

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October 28, 2010
pathology

238.2 Should Only Be Used in Medical Record Under 1 Condition

Eliminate ‘uncertain behavior’ confusion with expert tips

If you always use diagnosis code 238.2 (Neoplasm of uncertain behavior of skin) when you’re reporting 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) for a biopsy procedure your surgeon performs, you’re setting your practice up for disaster. The key to knowing when to use the “uncertain behavior” diagnosis code is understanding what that code descriptor really means. Follow these expert tips to ensure you’re choosing the correct diagnosis code for all your 11100 claims.

Wait For Pathology Before Choosing a Code

When your general surgeon performs a biopsy you should always wait until the pathology report comes back to choose the proper diagnosis and procedure codes to report – even though this will not always affect the CPT code you will wind up choosing.

Reason: The biopsy specimen’s pathology will affect the ICD-9 code you report, but most CPT procedure codes are not based on the specimen’s results. “There are a few CPT codes which are linked to specific diagnoses (for instance, excision of benign and malignant lesions), but overall CPT is about what you did; ICD-9 is about the outcome or the reason for it,” 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.

Get to Know the Meaning Behind ‘Uncertain’ Codes

When you report 238.2 as the diagnosis for a biopsy procedure, you’re telling the payer that the pathologist said in his path report that he was uncertain as to the morphology of the lesion, says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J., and senior coder and auditor for...

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September 20, 2010
Coding Challenge / modifier 22

Surgical Coding: Capture Extra Work for Choledochal Cyst

Discover these subsequent reconstruction codes. Question: The surgeon treated a patient with a large choledochal cyst. The procedure involved an open cholecystectomy with en bloc excision of extrahepatic bile ducts (roux-en-Y reconstruction) with hepaticojejunostomy. What are the correct CPT and ICD-9 codes? Answer: The correct ICD-9 code will depend on whether the patient has an acquired [...] Related articles:

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February 9, 2010
Coding Challenge

What Diagnosis Code Do I Use for a Fern Test?

Ob-Gyn Coding Tip: Scan for leukorrhea signs when fluid is present. Question: My physician performs a fern test on a patient, trying to rule out rupture of membranes. What diagnosis code applies? Answer: If the test result proves positive, then you should report 658.13 (Premature rupture of membranes with antepartum condition or complications). Otherwise, use V89.01 [...] Related articles:

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November 30, 2009
Coding Challenge / ICD-9

What’s the Correct Diagnosis Code for a Urine Drug Test?

Question: What is the proper ICD-9 code when the lab performs a urine drug test? Answer: ICD-9 does not provide one specific code for a urine drug test. The correct diagnosis code to report when billing for the lab test depends on the signs, symptoms, patient condition, or other reason for the test, such as screening. [...] Related articles:

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October 19, 2009