Coding Challenge

Pulmonology Coding Challenge: Why Are My 94664 Claims Getting Denied?

Before coding 94664, check off these items. Question: Under the direction of my pulmonologist I recently submitted 94664 for reimbursement for training time, but the bill was rejected? Can I challenge this? Answer: You can challenge training denials, provided your documentation supports the education’s reason. However, “not all payers will pay for 94664,” notes Gary N. Gross, [...] Related articles:

  1. Surgery Coding Challenge: Master Microsurgery Units With This AdviceCheck your EOB to make sure payers don’t apply a...
  2. 52214 Coding Challenge: Fulguration, Then TUIBNCQuestion: If my physician went to do a TUIBNC and...
  3. Radiology Coding Challenge: Why is Medicare Denying a 38792, 78195 ClaimTip: Discover true meaning of 38792 note Question: The physician...

Comments Off on Pulmonology Coding Challenge: Why Are My 94664 Claims Getting Denied?
January 21, 2010
ICD-9 / Toolkit

ICD-9 Sequencing: Ace Late Effects Diagnosis Coding With This Flow Chart

Combination codes for stroke late effects won’t always cover all the details. Proper sequencing is essential when coding for late effects, so use this handy chart to sequence your codes correctly every time. Chart provided by Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates and CoDR — Coding Done Right in Denton, Texas. For easy [...] Related articles:

  1. Flow Chart: Tame the Diabetes Diagnosis Coding Beast When coding for diabetes (250.xx), the fourth and fifth...
  2. Our Flow Chart Does the Incident-To Decision Making for YouSuppose your nonphysician practitioner sees a patient on a day...
  3. Flow Chart: Select the Correct Pediatric Critical Care CodeThis flow chart solves location, transport, age dilemmas to land...

Comments Off on ICD-9 Sequencing: Ace Late Effects Diagnosis Coding With This Flow Chart
January 13, 2010
Coding Challenge

How Do I Code An Arthroscopic To Open Ankle Surgery?

Question: Our surgeon attempted to remove a loose body in the ankle arthroscopically, but it was too large so he had to perform an open removal. Do I bill only for the open procedure, or include the arthroscopic attempt as a discontinued procedure? Answer: Because your surgeon completed the procedure as an open case, you’ll report [...] Related articles:

  1. 4 Tips Position Your ‘Multiple Scope’ Codes PerfectlyOrtho coders: Here’s what you should do when there’s no...
  2. Coding Challenge: Foot Foreign Body Removal Vs. Soft-Tissue FBRQuestion: Our physician performed a foreign-body removal (FBR) on a...
  3. Medicare Coverage for Bariatric Surgery: Do You Know These BMI Guidelines?Question: I heard that Medicare made some changes about diabetic...

Comments Off on How Do I Code An Arthroscopic To Open Ankle Surgery?
January 3, 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:

  1. Surgical Coding Mysteries: The Case of the Separate MeshBeware Separate Mesh Removal Question: The surgeon performed the following:...
  2. Surgical Coding: Modifiers 58, 78, and 79SURGICAL MODIFIER CHOICES Surgery Modifier Choices are Key to Surgery...
  3. Partial Mastectomy Coding: 19302 Vs. 19301 Plus 38500 Here’s how you know when to include a lymph...

Comments Off on Surgical Coding: Scar Revision on Previous Mastectomy Site
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:

  1. Check Destruction Method Before Assuming 17110You could gain $30 if a shave is also performed....
  2. Surgical Coding: Scar Revision on Previous Mastectomy SiteTip: Find mastectomy scar revision in wound repair Question: Our...
  3. Lesion Destruction Coding: Match Dx & Procedure Codes Like a Pro Tip: All ‘Verruca’ codes fall under one CPT code,...

Comments Off on Coding Keloid Scar Removal
December 11, 2009
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...
  2. Facet Joint Injection Coding for 2010Marvel Hammer’s Quick Start Guide to changes you’ll face in...
  3. Save Time Coding Facet Injections With This Coding Tool Hint: Location, number and substance are key. Several factors...

Comments Off on CPT 2010 Code Selection Chart for Paravertebral Facet Joint Injections
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...
  2. Pain Management Coding: TPI Do’s and Don’ts for Pay You Can KeepSample ICD-9 codes to support medical necessity for trigger point...
  3. Check New HCPCS Codes to Keep Pain Management Claims on TrackCatch the changes to botulinum toxin and neurostimulator electrode codes....

Comments Off on Pain Management: 2 Providers, 2 Postop Pain Injections
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...
  2. Pain Management Coding Update: Facet Joint Injection CPT Changes for 2010Pain management, anesthesia, orthopedic, physiatry & neurology coders get ready...
  3. Audit Hot Spot: Facet Joint Injection ClaimsHere’s why the OIG wants to stick it to facet...

Comments Off on Facet Joint Injection Coding for 2010
December 8, 2009
Provider News

Coding News Travels to Florida for 2010 Updates

Do you have a question about how you should code in 2010? Write us and we’ll ask the experts. Princesses have their castles, but the big news in Orlando this weekend is that the Coding Queens are coming to town! This week in Orlando, nationally known coding & billing experts like Marvel Hammer, Melanie Witt, Leslie Johnson [...] Related articles:

  1. CCI 15.2 News: 3,500 New Code Pairs, Plus Modifier Status Changes CPT continues to add new codes, and the Correct Coding...
  2. News Flash: Over 300,000 New Code Pair Edits from CCIExtra! CCI also creates a few welcome deletions. If you...
  3. AboutCoding News is the essential digest of updates and advice...

Comments Off on Coding News Travels to Florida for 2010 Updates
December 4, 2009
Provider News

CMS Will Offer New Modifier to Denote Admitting Physician on Claims

Pop the champagne cork & get ready for brand new inpatient coding rules. With the changes to consult coding in 2010, it will be more important than ever to report hospital visits properly. In the past, only the admitting physician reported initial hospital care codes (99221- 99223), and specialists who saw the patient separately often billed inpatient [...] Related articles:

  1. Answers To Your Hospital Admission, Subsequent Care Coding Questions Revenue Booster: Here’s when you can claim a consult...
  2. Medicare Changes to 2010 CPT Inpatient Consultation Codes Prevent 99251-99245 denials in 2010 with this checklist. Multiple...
  3. Proposed 2010 Physician Fee Schedule: A Closer Look21.5 percent cut looms for your services Last week, Coding...

Comments Off on CMS Will Offer New Modifier to Denote Admitting Physician on Claims
November 21, 2009
Coding Challenge / CPT 2010 / Medicare

AMA Symposium Report: Low-Level Consult Reporting in 2010

Hey, Coding News readers! It’s your turn to weigh in on the consult controversy. Question: What should you do for Medicare 2010 coding if an inpatient consult on a patient’s initial hospital day does not support 99221? Answer: Kenneth Simon, MD, MBA, FACS, CMS, senior medical officer at the CPT symposium was very adamant that you [...] Related articles:

  1. Medicare’s Consult Rule Trickle Down Effect And what it means for pediatric practices. A report...
  2. CMS at AMA Chicago: We’re Reducing Consult Request RequirementCMS auditors will look for 1 less thing in consult...
  3. OK to Code Debridement With Consult?Question: Can you charge for an inpatient consult and a bedside...

Comments Off on AMA Symposium Report: Low-Level Consult Reporting in 2010
November 18, 2009
Provider News

CMS Makes Key Changes to ABN Modifiers

We’ve got the new instructions you’ll need to follow. CMS will update the ABN modifiers effective April 1, according to MLN Matters article MM6563, dated Oct. 29. The ABN descriptors will read as follows: Modifier GA — Revised to read, “Waiver of liability statement issued as required by payer policy.” You’ll use this when a required ABN was issued. Modifier GX — [...] Related articles:

  1. CIGNA Opens Black Box: Get Paid With Modifiers 25 & 59 You now have clear-cut policies to apply, including 1...
  2. Still Using the Old ABN, NEMB Forms? Stop Now Surprise! Here’s when the new form puts you on...
  3. Got Multiple Modifiers? How To Sequence Them on the Claim Coders like to say that modifiers help them tell...

Comments Off on CMS Makes Key Changes to ABN Modifiers
November 10, 2009
Medicare / Toolkit

Coder’s Navigation Tool: 2010 Medicare Physician Fee Schedule

It’s that time of year coders — yes, time to comb through pages and pages and pages of the final 2010 Medicare Physician Fee Schedule. We’ve got a handy place to start. If you want a quick overview of fee schedule’s financial impact on your physician practice’s specialty, go here and scroll to page 1171. There, [...] Related articles:

  1. Proposed 2010 Physician Fee Schedule: A Closer Look21.5 percent cut looms for your services Last week, Coding...
  2. How Obama’s Medicare Cuts Hit Physician Reimbursement  The budget released Thursday suggests we cut $300 billion from...
  3. CMS Issues Corrections to 2009 Physician Fee Schedule Final RuleIt’s that time of year again — time to get...

Comments Off on Coder’s Navigation Tool: 2010 Medicare Physician Fee Schedule
November 8, 2009
Coding Challenge / radiology

Radiology Coding Education: Is 76705 OK for Back?

Question: For a lower back ultrasound of a soft tissue mass, which CPT code is appropriate? Answer: Code 76705 (Ultrasound, abdominal, real time with image documentation; limited [e.g., single organ, quadrant, follow-up]) is appropriate for this lower back ultrasound. Although the code descriptor states “abdominal” and not “back,” CPT Assistant (May 2009) clarifies that 76705 is appropriate [...] Related articles:

  1. New From CPT Assistant: Help with Trunk Ultrasound Coding Do you know exactly what’s in the mediastinum? Your US...
  2. Double Ultrasound Codes Spell Double Trouble With AuditorsAuthorities scrutinize medical necessity for 76830 & 76856. The OIG...
  3. 5 Lessons Radiology Coders Should Learn From CCI 15.3Wonder if there’s a method to the 76001 madness? Here’s...

Comments Off on Radiology Coding Education: Is 76705 OK for Back?
November 2, 2009
Coding Challenge

Does CNS Count as NP for Time-Based Coding?

CNS = NP = PA for CPT, but Check State Law Question: Does a certified nurse specialist (CNS) count as a nurse practitioner (NP) for reporting 99213 based on time? Answer: Yes, for CPT purposes, a certified nurse specialist billing under his own provider number counts the same as a nurse practitioner or physician assistant. So if [...] Related articles:

  1. Asthma Attack Coding: When To Use Prolonged or High-Level E/M     Checklist deters payback requests for insufficient +99354...
  2. E/M Coding Basics: MDM Maximizes Payup for Hepatitis Diagnosis4 ways to get what your practice really deserves for...
  3. Mid-Level E/M Coding BreakdownOur chart shows you how to choose among 99212, 99213 &...

Comments Off on Does CNS Count as NP for Time-Based Coding?
October 26, 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....

Comments Off on Anesthesia Coding Education: Sciatic Nerve Block & Same-Day General Anesthesia
October 21, 2009