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

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
Coder's Cranium / modifier 50

Know When to Append Modifier 50 on Bilateral CTS Shots

Your orthopedist injects both of a patient’s wrists to treat carpal tunnel syndrome. Should you just file 20526 with modifier 50 appended and forget about it? Not so fast: If the physician injects both the patient’s wrists to treat CTS, you will ty...

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March 8, 2011
Hot Coding Topics

Emergency Reporting: Know When To Use +99140 With These Tips

Reporting any qualifying circumstances (QC) codes for anesthesia can be tricky, but knowing when to classify a situation as a true emergency can be a real challenge unless you’re well-versed in the emergency conditions guidelines. Check coding definitions and your provider’s documentation to know whether you can legitimately add two extra units for +99140 (Anesthesia complicated by emergency conditions [specify] [List separately in addition to code for primary anesthesia procedure]) to your claim.

CPT includes a note with +99140 stating that “an emergency is defined as existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body parts.” Your key to knowing a case meets emergency conditions lies in your anesthesiologist’s notes.

“Quite a number of cases come in where the anesthesiologist marks ‘emergency’ but many times the ‘emergency’ isn’t all that clear,” says Leslie Johnson, CCS-P, CPC, director of coding and education for Medi-Corp., Inc., of New Jersey. Documentation supporting an emergency will depend on each case, so read the chart thoroughly when your provider indicates an emergency.

Solution: Talk with your anesthesia providers to clarify what constitutes an emergency and when you can include +99140. If there’s a real reason to report an emergency (such as a ruptured appendix, 540.0), your physician should clearly document the reason. Another diagnosis code to indicate a problem (such as unstable angina, 411.1) could help show the payer you’re reporting an unusual situation. The second diagnosis can also help in an appeal if a payer that ordinarily recognizes +99140 denies the claim.

“An OB patient who comes in for a cesarean section isn’t automatically an emergency,” explains Scott Groudine, M.D., professor of anesthesiology at Albany Medical Center in New York. “However, a diagnosis of fetal distress and prolapsed cord virtually always...

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March 8, 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...

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February 4, 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...

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January 19, 2011
CPT Medical Changes / Hot Coding Topics

CPT 2011: 37220 to +37223 Revamp Interventional Coding

Think outside the box for iliac atherectomy.

Are you ready to apply CPT’s new revascularization codes starting January 1? Check out these six tips to get you on your way.

CPT 2011 offers up new codes to help you report services more accurately, including endovascular revascularization, 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.

Specifically, CPT 2011 adds several new codes that represent lower extremity endovascular revascularization, meaning angioplasty, atherectomy, and stenting. Here’s how the codes break down:

  • Iliac: 37220-+37223– Revascularization, endovascular, open or percutaneous, iliac artery …

  • Femoral, popliteal: 37224-37227– Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral …

  • Tibial/peroneal: 37228-+37235– Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral …

In this article, iliac artery services are the focus. Look to future articles to discuss femoral, popliteal, and tibial/peroneal services.

Watch Procedure and Vessel to Choose Among 37220-+37223

The new iliac service codes are as follows:

  • 37220– Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty

  • 37221– … with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
  • +37222– Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)

  • +37223– … with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure).

Reading through the definitions, you see that the codes for iliac services differ based on whether you’re coding a service in an initial vessel or in an additional vessel. Your options also differ based on whether you’re reporting (1) angioplasty alone or...

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January 12, 2011
Hot Coding Topics / Provider News

Learn the Best Ways to Navigate Codes For Cisplatin, Cyclophosphamide, and Vincristine

The recently released HCPCS 2011 code-set reveals a slew of deletions, streamlining your drug coding choices. Cisplatin, cyclophosphamide, and vincristine are among the affected drugs.

This change should simplify billing, particularly if the system your practice or facility uses, such as Pyxis or Lynx, limits you to a single code and billable unit for a drug, says Lisa S. Martin, CPC, CIMC, CPC-I, chargemaster specialist for OSF Healthcare System in Peoria, Ill. “As a consultant, I saw different facilities using only the 100 mg code [for example] for that very reason, so this change should facilitate more consistent and compliant billing practices.”

While these changes have a positive side, “there are always considerations that will arise,” Martin says. For example, if your practice uses different vial sizes, you will need to be alert for the different and specific national drug code (NDC) numbers for the agent dispensed to the patient when you send a claim to a payer who requires NDC information, she warns.

Cisplatin, ordered particularly for patients with metastatic testicular or ovarian neoplasms, or advanced bladder cancers, is one of the many agents affected by the HCPCS 2011 shake-up.

HCPCS 2011 makes a small wording revision to J9060, notes Roberta Buell, MBA, of onPoint Oncology in her Nov. 9 e-Reimbursement newsletter:

  • 2010: J9060 – Injection, cisplatin, powder or solution, per 10 mg
  • 2011: J9060 – Injection, cisplatin, powder or solution, 10 mg.

Delete code J9062 (Cisplatin, 50 mg). It will no longer be available for use in 2011. You should use J9060 to report cisplatin, brand name Platinol, when supplied for 2011 dates of service.

Cyclophosphamide is an alkalyting agent that works as an antineoplastic and immunosuppressant. You may see it called Cytoxan or Neosar.

At 1 unit per 100 mg, J9070 (Cyclophosphamide, 100 mg)...

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January 3, 2011
Coder's Cranium

Steer Clear of MUE Denials With These Tips

If you’re receiving denials from Medicare, one possibility is that you’re running up against medically unlikely edits (MUEs). The edits, which are designed to prevent overpayments caused by gross billing errors, usually a result of clerical or billing systems’ mistakes, often confuse even veteran coders.

Ensure you’re not letting MUEs wreak havoc on your urology practice’s coding and reimbursement by uncovering the truth about four aspects of these edits.

While you shouldn’t stress too much, any practice filing a claim with Medicare should know what MUEs are and how they work.

“They limit the frequency a CPT code can be used,” says Chandra L. Hines, business office manager at Capital Urological Associates in Raleigh, N.C. “With our specialty of urology, we need to become aware of the denials and not let every denial go because the insurance company said it was an MUE. We should all be aware of MUEs as they occur, and we cannot always control whether or not we will receive payment.”

The MUE list includes specific CPT or HCPCS codes, followed by the number of units that CMS will pay. CMS developed the MUEs to reduce paid claims error rates in the Medicare Program, says Jillian Harrington, MHA, CPC, CPC-P, CPCI, CCS-P, president of ComplyCode in Binghamton, New York. “The first edits were implemented in January 2007, although the edits themselves became public in October 2008,” she adds.

Some MUEs deal with anatomical impossibilities while others edit automatically the number of units of service you can bill for a service in any 24-hour period. Still others limit codes according to CMS policy. For example, excision of a hydrocele, bilateral (55041) has a bilateral indicator of “2,” so you should never bill two or more units of this code. Additional edits focus on the nature of...

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December 20, 2010
CPT 2011 / Hot Coding Topics / ICD-10

CodingConferences Coding Changes Top Tips from Editor Leigh Delozier

600 coders, physicians, and office managers gathered in Orlando, Fla. for one and a half jam-packed days of education, networking, and shopping at the December 2011 Coding Update and Reimbursement Conference. Coders’ biggest struggle was absorbing all the information – and not overdoing the holiday buying. Experts offered the inside scoop on medical coding changes for 2011 and beyond. Here are my top picks:

  1. E-prescribing is here to stay – and is about to be more strictly enforced. Physicians need to e-prescribe at least 10 medications for patients during the first 6 months of 2011, or they’ll be added to the list for a 1% penalty hit in 2012. “The prescriptions can be for one patient ten different times, or can be spread out among different patients,” said Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, in “Take Steps Now to Prepare for 2011 Pain Management Changes”.  “For pain management practices, the prescriptions can be for any type of pain meds.”
  2. Three PQRI measures apply to anesthesia providers: timing of prophylactic antibiotic (measure 30); maximal sterile barrier technique (measure 76); and active warming/temperature (measure 193). You have three reporting options: measure 76 alone; measures 76 and 193; or measures 30 and 76 said Judith Blaszczyk, RN, CPC, ACS-PM. “You must report on 80% of qualifying cases,” she reminded during her workshop, “Take Steps Now to Prepare for 2011 Anesthesia Changes.”
  3. No matter how many years you’ve been coding, you’ve heard, “ICD-10 is on the way.” Now that it’s looming as a reality, take a deep breath and know that you’ll be OK. “We learned to use ICD-9, and we’ll learn to use ICD-10,” Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, said in “Diagnosis Coding for Anesthesia”. “We can do this! We are not afraid.”

This...

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December 16, 2010
Hot Coding Topics / Medicare / Provider News

Medicare Covers 99406, 99407

If you’ve been writing off tobacco cessation counseling as non-payable, it’s time to change your tune.

The change: In the past, you could collect for tobacco cessation counseling for a patient with a tobacco-related disease or with signs or symptoms of one. But on Aug. 25, CMS announced that “under new coverage, any smoker covered by Medicare will be able to receive tobacco cessation counseling from a qualified physician or other Medicare recognized practitioner who can work with them to help them stop using tobacco.”

“For too long, many tobacco users with Medicare coverage were denied access to evidencebased tobacco cessation counseling,” said Kathleen Sebelius, HHS secretary, in an Aug. 25 statement. “Most Medicare beneficiaries want to quit their tobacco use. Now, older adults and other Medicare beneficiaries can get the help they need to successfully overcome tobacco dependence.”

Count Attempts and Minutes

The new tobacco cessation counseling coverage expansion will apply to services under Medicare Part B and Part A. That means your physicians and coders should know how to correctly document and report the sessions.

“Medicare allows billing for two counseling attempts in a year, but each attempt can occur over multiple sessions, with four sessions per attempt,” explains Jennifer Swindle, CPC, CPC-E/M, CPC-FP, RHIT, CCP-P, director of coding and compliance for PivotHealth LLC in Brentwood, Tenn.

According to section 12 of chapter 32 of the Medicare Claims Processing Manual, “Claims for smoking and tobacco use cessation counseling services shall be submitted with an appropriate diagnosis code. Diagnosis codes should reflect: the condition the patient has that is adversely affected by tobacco use or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use.”

Swindle says 305.1 (Tobacco use disorder) is one diagnosis supporting...

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December 13, 2010
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
CPT 2011 / Provider News

95992: CRP Code Wins Payable Status

Medicare still won’t reimburse audiologist-billed Epley. After two years of battles with CMS over canalith repositioning procedure (CRP) coding, physicians will finally get paid for these specific codes. CPT® 2009 excited ENT coders with new CPT cod...

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November 14, 2010