General / Hot Coding Topics

338.3 Example Boosts Your Non-Chemo Encounter Coding Savvy

Be sure your coding complies with ICD-9 official guidelines for pain management.

If you don’t know when to check ICD-9 official guidelines, you may have just a 50-50 chance of choosing the proper order for your diagnosis codes.

Case in point: Patients may present to the office for treatment related to pain caused by a neoplasm. In such cases, you will need to determine, which diagnosis codes to report, and you will need to decide what order to list the codes in on your claim. With that in mind, consider how you should code the scenario below.

Start by Examining the Neoplasm-Related Pain Case

Read the following scenario and determine proper ICD-9 coding based on the information given. You’ll find a helpful hint on which section of the official guidelines to review if you get stuck.

Scenario: The physician documents that a patient with lung cancer (middle lobe, primary malignant neoplasm) presented to the office for the purpose of pain management. The pain is documented as acute and caused by the neoplasm.

Hint: See section I.C.6.a.5 of the Official Guidelines for instructions on properly coding these sorts of encounters. The CDC posts ICD-9 guidelines online at: www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm

Next, Determine Which Neoplasm and Pain Codes Apply

For this scenario, before you can decide what order to put the codes in, you will need to decide which codes to report.

Neoplasm: For a primary malignant neoplasm of the lung’s middle lobe, you should report 162.4 (Malignant neoplasm of middle lobe bronchus or lung), says Denae M. Merrill, CPC, HCC coding specialist in Michigan.

Pain: To choose the proper pain diagnosis code, you want to be sure you keep in mind that the neoplasm is the cause. The ICD-9 index entry for pain has several subentries to consider:

  • Cancer associated
  • Neoplasm

...

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June 27, 2011
General / Hot Coding Topics

Are you sure that your coding complies with ICD-9 official guidelines for pain management?

If you don’t know when to check ICD-9 official guidelines, you may have just a 50-50 chance of choosing the proper order for your diagnosis codes.  Patients may present to the office for treatment related to pain caused by a neoplasm.  In such cases, you will need to determine which diagnosis codes to report and you will need to decide what order to list the codes in on your claim.  With that in mind, consider how you should code the scenario below.

Start by Examining the Neoplasm-Related Pain Case

Read the following scenario and determine proper ICD-9 coding based on the information given.  You’ll find a helpful hint on which section of the official guidelines to review if you get stuck.

Scenario: The physician documents that a patient with lung cancer (middle lobe, primary malignant neoplasm) was presented to the office for the purpose of pain management.  The pain is documented as acute and caused by the neoplasm.

Hint: See section I.C.6.a.5 of the Official Guidelines for instructions on properly coding these sorts of encounters. The CDC posts ICD-9 guidelines online at: http://www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm

Next, Determine Which Neoplasm and Pain Codes Apply

For this scenario, before you can decide what order to put the codes in, you will need to decide which codes to report.

Neoplasm: For a primary malignant neoplasm of the lung’s middle lobe, you should report 162.4 (Malignant neoplasm of middle lobe bronchus or lung), says Denae M. Merrill, CPC, HCC coding specialist in Michigan.

Pain: To choose the proper pain diagnosis code, you want to be sure you keep in mind that the neoplasm is the cause. The ICD-9 index entry for pain has several subentries to consider:

  • Cancer associated
  • Neoplasm related (acute) (chronic)
  • Tumor associated.

...

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June 8, 2011
Coding Challenge / General

Remember Diagnosis to Support 62311 Post-Op

Question: Our state’s Medicaid carrier denies our claims when we submit 62311 with modifier 59 for postoperative pain management. They say the 62311 is bundled with the anesthesia procedure code. How should we handle this?  -Ohio Subscriber Answer: ...

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May 9, 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
CPT Updates / Hot Coding Topics / modifier 76 / modifier 78 / Modifier GU / Provider News

CPT 2011: New Modifier GU and Revisions to 76, 77, and 78 Change Your Reporting

2011 adds a new modifier to your coding arsenal and updates the descriptors for several others you might often use. Get ready for modifier GU (Waiver of liability statement issued as required by payer policy, routine notice). You might have times when ...

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January 19, 2011
Provider News

CCI 16.2 Bundles Paravertebral Facets With Anesthesia Procedures

Don’t assume separate coding for J0670, anymore.

The latest Correct Coding Initiative (CCI) edits contain plenty of anesthesia and pain management pairs you should check — and straight away. They went into effect July 1. CCI 16.2 encompasses 16,843 new edit pairs, according to analyst Frank Cohen, MPA, of MIT Solutions, Inc., in Clearwater, Fla. With 11 percent of all active edits affecting anesthesia procedures, you can’t afford to miss any of the changes.

Other Work Includes Paravertebral Facet Injection

Although the current CPT book doesn’t include them, you could begin using several new codes for paravertebral facet joint injections in January 2010. Now CCI edits bundle two of the new codes with every anesthesia code (00100-01999) and many nerve destruction procedures. The paravertebral injection codes affected are:

  • 0213T — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level
  • 0216T — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level.

Procedures paired with 0213T and 0216T range from 64600 (Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch) and 64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level) to 64650 (Chemodenervation of eccrine glands; both axillae). Most of the edit pairs carry a “0” modifier indicator, but CCI lists a few with modifier indicator “1.” Check the full CCI file to verify whether you can use a modifier to break specific edits.

ME Edits Also Hit 0213T-0218T

Paravertebral facet joint injection codes 0213T-0218T come into play as part of mutually exclusive (ME) edits, as well.

CCI 16.2 pairs each choice with corresponding codes involving fluoroscopy or CT guidance: 64490-64492 (Injection[s], diagnostic or...

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August 12, 2010
Coding Challenge

RFA: 64622, 64623 Vs. 64640

With multiple ways to denervate the sensory nerve/nerve branches, pain management coders may argue about which 64xxx code is right. You’ve got to dig into the chart note to identify the method used. See if you’re up to the challenge with this Supercoder Forum Insight.

Question: A provider is doing RFA’s of the left L4, L5, S1, S2, S3 and SA. He is billing 64622 x 1 and 64623 x 4. The other pain provider states this is incorrect and that he should be billing 64640 for S1, S2, S3 and SA. Which coding is correct?

Answer: This is a complex coding issue because there are several different methods to denervate the sensory nerve/nerve branches that provide innervations from the SI joint. Because of this, the coding will depend somewhat on the method used.

However, I can say that reporting 64622 and 64623 x 4 is incorrect. The “paravertebral facet joint nerves” that provide innervations to the facet joints in the cervical, thoracic, and lumbar regions are the medial branches off the dorsal ramus. In the sacrum, there are indeed medial branches, but – as their name indicates – the path for these nerve branches is to the midline to provide innervations to the multifidus muscles and not laterally to the SI joint. So, following the published CPT Instructions for Use of the CPT Codebook – “Do not select a CPT code that merely approximates the service provided”, even though they are similar, procedures performed on the lateral branches of the sacral nerves should not be reported as paravertebral facet joint nerve procedures (i.e., paravertebral facet joint injections or destructions).

A few of the more common techniques are:

  • Separate destruction of each nerve/nerve branch. According to CPT Assistant (Dec. 2009), you would code 64622 for the L5

...

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August 12, 2010
Anesthesiologist / Hot Coding Topics / modifier 52 / modifier 53 / modifier 73 / modifier 74 / Pain Management

Employ Modifier 53 For Discontinued Anesthesia Services

Pain management specialties might make use of modifier 52 as well.

The situation is bound to happen: A patient undergoing surgery has complications, and your anesthesiologist must stop his services. Are you prepared to recognize a situation that calls for...

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May 9, 2010
Coding Challenge

Neurosurgery Coding: Previous Injury Means Multiple Dx Options

Find out what additional information V codes provide to the payer. Question: We have a patient with previous spinal injury that is now causing neck pain. How should I code the diagnosis? North Carolina Subscriber Answer: Document and code prior conditions that contribute to a patient’s current complaint — if they affect the management of the current condition. Prior trauma, [...] Related articles:

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  3. How Do I Code This Multiple Fracture Accident Patient?Question: A 30-year-old female presents to a rural ED with...

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February 15, 2010
Anesthesia / Coding Challenge

Anesthesia Coding Education: Combined Spinal Epidural

Question: Our anesthesiologists sometimes mark our C-section tickets as “combined spinal epidural,” but our billing system will only allow us to choose epidural or spinal. Where can I find information about spinal epidurals and how to correctly code them? Answer: From a coding perspective, whether your physician used spinal or epidural anesthesia doesn’t matter as long [...] Related articles:

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January 17, 2010
CPT 2010 / Pain Management / Toolkit

CPT 2010 Code Selection Chart for Paravertebral Facet Joint Injections

CPT 2010 introduces a slew of new codes for paravertebral facet injections, so why not consult our handy flow chart to help you select the correct code? © Neurology Coding Alert. To read the full article on the new facet joint injection codes for 2010, download your 2 FREE sample issues here. Was it painful for you to [...] Related articles:

  1. Pain Management Coding Update: Facet Joint Injection CPT Changes for 2010Pain management, anesthesia, orthopedic, physiatry & neurology coders get ready...
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  3. Save Time Coding Facet Injections With This Coding Tool Hint: Location, number and substance are key. Several factors...

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December 10, 2009
Coding Challenge / modifier 77

Pain Management: 2 Providers, 2 Postop Pain Injections

Double 76942 OK for second provider? Question: Two providers from the same physician group performed two separate postoperative pain injections on the same patient, on the same day. Each provider used ultrasonic guidance during the procedure, but I’ve been told to report 76942 only once per day. How should we report both services? Answer: You can bill [...] Related articles:

  1. Pain Management Coding: Endoscopic Lumbar Nerve DecompressionHint: Think ‘unlisted procedure.’ Question: One of our physicians is...
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  3. Check New HCPCS Codes to Keep Pain Management Claims on TrackCatch the changes to botulinum toxin and neurostimulator electrode codes....

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December 8, 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:

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  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
CPT 2010 / Hot Coding Topics / Pain Management

Facet Joint Injection Coding for 2010

Marvel Hammer’s Quick Start Guide to changes you’ll face in 2010. Tons of pain management coders gathered at the Orlando conference this week, and everyone was abuzz about the coding changes the painful reimbursement cuts their practices are going to get next year. Some big news: Effective January 1, 2010 radiological imaging will be required and bundled [...] Related articles:

  1. MAC Auditors Will Stick It To Facet Joint Injection Claims We hook you up with CMS instructions for when...
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  3. Audit Hot Spot: Facet Joint Injection ClaimsHere’s why the OIG wants to stick it to facet...

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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:

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December 2, 2009