Hot Coding Topics

Accessory Sinuses Service Coding: Snag $217 with These 3 FAQs

Given the variety of anatomic sites, surgical techniques, and types of instrumentation involved in transnasal turbinate surgery, it is the one of the most difficult coding scenarios.

Your otolaryngologist removes the middle turbinate during an endoscopic ethmoidectomy (31254, Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior], or 31255, Nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior]) or endoscopic polypectomy (31237, Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]). The middle turbinates are considered access to the sinuses, so you should be able to tell that the removal of the middle turbinate should not be reported separately.

Check out these 3 frequently asked questions (FAQs) to help master your turbinate surgery coding skills.

Should 30130 and 30140 Go Hand-in-Hand?

Suppose the documentation states that the physician entered or excised mucosa and subsequently preserved it. This implies that you should use 30140 (Submucous resection inferior turbinate, partial or complete, any method) to report this service. However, simply reporting that the turbinate was excised is probably not enough documentation for this code. Don’t forget to bill 30130 (Excision inferior turbinate, partial or complete, any method) if there is no evidence of the preservation of the mucosa and the op note just indicates that the inferior turbinate was excised or resected.

Remember that you should not bill 30140 with 30130 — you would bill one or the other, for a single side. “However, if a submucousal resection (preservation of the mucosa) is performed on one side and a straight excision is performed on the other side (no preservation of mucosa), you would code 30140-RT and 30130-59-LT, for example,” explains Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. The RT and LT would represent which side each procedure...

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April 5, 2011
Hot Coding Topics / ICD-10 / Provider News

ICD-10: A J Code To Replace 471.0 In 2013

Nasal cavity polyp also goes by the term “choanal” and “nasopharyngeal.” If the otolaryngologist performed a removal of a middle turbinate endoscopically, you would report it with CPT 31240 — subsequently linking this procedure to a diagnosis...

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March 16, 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
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

Cyst Expression: I&D or Excision?

Question: Documentation reads, “The cyst was excised after performing a central incision directly on the cyst. All the material was expressed, then cyst capsule was removed completely and excised completely. Packing was performed.” Should I code the procedure as an I&D or an excision?

Supercoder.com/forum/

Answer: You should look at the pathology report and any further excision description to reach the correct code set. “Excision is defined as full thickness [through the dermis] removal of a lesion …,” according to CPT’s Excision-Benign Lesions guidelines. The documentation you provided does not indicate what tissue levels the excision involved. A cyst can be epidermal or sebaceous (706.2). A lesion that is removed from the epidermis (top skin layer) does not meet CPT’s excision definition.

The sebaceous gland extends through the dermis. Excision that deep would qualify for an excision code. An excision code (such as 11400, Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less) requires further documentation detailing the lesion’s morphology, size (including margins), and anatomical location. Without this information, the I&D code (10060, Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single) may be more appropriate. The physician made a cut to drain the cyst and then drained (expressed) all the material. The cyst capsule removal is part of the treatment of the I&D to prevent the blockage from reoccurring.

Take more coding challenges with Family Practice Coding Alert. Written by Jen Godreau, BA, CPC, CPEDC, content director of Supercoder.com, Family Practice Coding Alert, Volume 12, Number 6.

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August 12, 2010
Hot Coding Topics

Wound Coding: 3 Tips Help You Recover Your Full Debridement Pay

Maximize 11040-11044 pay with modifier 51.

In most cases, your practice won’t report debridement separate from wound repair codes. But when exceptions arise, follow these three tips to choose the appropriate wound repair code.

If you’re considering reporting debridement separate from a wound closure, make sure your physician’s notes clearly document that the wound was contaminated and required saline or other substances or instrumentation to cleanse and debride the wound.

Don’t miss: If you report a debridement code with your wound closure codes, append modifier 59 (Distinct procedural service) to the debridement code. This informs the payer that you recognize that debridement is generally bundled into wound repair, but that clinical circumstances required the physician to perform debridement as a separate service.

1. Look for Wound Repair With the Debridement

CPT specifies that you may also report debridement codes independently of repair codes when the physician removes large amounts of devitalized or contaminated tissue or when the physician performs debridement without immediate primary repair of a wound, notes Pamela Biffle, CPC, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Watauga, Texas.

The physician may clean debris from the wound without repairing the wound because it was either not deep enough to require repair or the physician delayed the repair due to an extenuating circumstance.

In the case in which the dermatologist excises a lesion, debridement is included in the procedure. However, when the dermatologist only performs debridement or performs the debridement in addition to the wound repair, such as the case when a wound is excessively dirty or contaminated with debris, you would also code the debridement code with the wound repair/excision code, appending modifier 51 (Multiple procedures) for the multiple procedure.

Example: A patient returns to the dermatologist several days after a chemical...

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June 13, 2010
Coder's Cranium

Navigate Your Way to Proper Internal/External Hemorrhoid Coding

Don’t miss CPT 2010 ‘either/or’ instruction for hemorrhoid location.

You can’t choose a hemorrhoidectomy code if you don’t know the distinction between internal and external hemorrhoids. Let our experts guide you through the anatomy and coding maze to help you...

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April 30, 2010
CCI / Coding Challenge / mutually exclusive / NCCI

Correct Coding Initiative: ‘Mutually Exclusive’ and ‘Bundled’ Defined

Decipher what column 1/column 2 means in this neurosurgery bundle example.

Question: Would you explain what the differences are between mutually exclusive and “column 1/column 2″ edits that come from the Correct Coding Initiative (CCI)?

Florida Subscriber

Answer: Mutually exclusive...

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April 11, 2010
Anesthesiologist / Coding Challenge

Burn Coding: Calculate Total Body Surface Area (TBSA)

Investigate your physician’s documentation to determine the body area percentage actually debrided. Question: My anesthesiologist administered anesthesia for a burn excision on the leg of a middle-aged adult male, but he didn’t give clear notes on the patient’s affected body surface area. How do I code for this? Kansas Subscriber Answer: You will start by coding 01952 (Anesthesia [...] Related articles:

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February 17, 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 / surgery

Surgical Coding: Scar Revision on Previous Mastectomy Site

Tip: Find mastectomy scar revision in wound repair Question: Our surgeon performed a scar revision on the site of a previous mastectomy. The procedure involved excising a 16.5 cm curved scar before performing a layered closure. How should we code this? Answer: You should use complex wound repair codes for the scar revision procedure that you describe. [...] Related articles:

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December 14, 2009
Coding Challenge

Coding Keloid Scar Removal

Watch out: Avoid this unlisted code. Question: Is removal of a keloid scar considered an unlisted procedure? What is the right code? Answer: Use 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular lesions; up to 14 lesions) with diagnosis 701.4 (Keloid scar). 17110 and 7111 [...] Related articles:

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December 11, 2009
Coding Challenge / Pain Management

Pain Management Coding: Endoscopic Lumbar Nerve Decompression

Hint: Think ‘unlisted procedure.’ Question: One of our physicians is looking into “endoscopic lumbar spinal nerve decompression.” One of the medical device representatives indicated he could bill it like the lateral extraforaminal approach for lumbar decompression, but I haven’t found much information. What’s your advice? Answer: Despite what you physician might have heard, your most appropriate choice [...] Related articles:

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November 14, 2009