CMS / Hot Coding Topics / ICD-10

Heads Up Coders: 2013 ICD-10 Implementation Date Is Firm

Plus: CMS has proposed freezing the ICD-9 codeset after next year.

If you were hoping that the Oct. 1, 2013 ICD-10 implementation date wasn’t set in stone, you are out of luck. That’s the word from CMS during a June 15 CMS Open Door Forum entitled “ICD-10 Implementation in a 5010 Environment.”

“There will be no delays on this implementation period, and no grace period,” said Pat Brooks, RHIA, with CMS’s Hospital and Ambulatory Policy Group, during the call. “A number of you have contacted us about rumors you’ve heard about postponement of that date or changes to that date, but I can assure you that that is a firm implementation date,” she stressed.

Brooks indicated that the rumor about a potential delay in the implementation date continues to persist throughout the physician community, and recommended that practice managers alert their physicians to the fact that that the rumor is untrue.

The Oct. 1, 2013 date will be in effect for both inpatient and outpatient services. Keep in mind that the ICD-10 implementation will have no impact on CPT and HCPCS coding, Brooks said. You will still continue to bill your CPT and HCPCS procedure codes as before.

You’ll Find Nearly 55,000 Additional Codes

Currently, CMS publishes about 14,000 ICD-9 codes, but there are over 69,000 ICD-10 codes. The additional codes will allow you to provide greater detail in describing diagnoses and procedures, Brooks said.

If you’re wondering which specific codes ICD-10 includes for your specialty, you can check out the entire 2010 ICD-10 codeset, which CMS has posted on its Web site. “Later this year, we’ll be posting the 2011 update,” Brooks said during the call.

@ For more details on CMS’ upcoming plans, subscribe to Part B Insider (Editor: Torrey Kim, CPC).

Sign...

Comments Off on Heads Up Coders: 2013 ICD-10 Implementation Date Is Firm
June 18, 2010
Hot Coding Topics

Radiology Coding: Bone Scan Rate Benefitting From Healthcare Reform

Don’t let 2006 DXA code references lead you to use wrong codes. Which codes should you use to reap the benefit of CMS’s new calculations for bone scan payment? During an April 13 CMS Open Door Forum, that’s what one caller wanted to know. Good ne...

Comments Off on Radiology Coding: Bone Scan Rate Benefitting From Healthcare Reform
June 16, 2010
Coder's Cranium

Billing How-To: Should A Provider Change Tax IDs?

Despite disadvantages, a new tax ID is a must when physicians leave your group.

Question: One of our optometrists wants to stop billing under the group’s tax ID and start billing under his own tax ID. I’m concerned that doing so will confuse the insurance companies and slow down his income, even though he has personally called some to notify them of the change and the effective date. Some payers are now asking for new W9 forms. Is there an easy way to do it?

Answer: Your optometrist can change his tax ID at any time, but you must submit a new W9 to your payers, in addition to a letter explaining that he will no longer be practicing under the group’s tax ID.

Downside: Yes, the optometrist’s income will be slowed. You also run the risk that the payer’s enrollment department does not handle the paperwork properly. Other billers have reported instances of the income being paid to the old tax ID or not being paid at all. Claims can also be lost even though the correct paperwork has been submitted multiple times.

If your optometrist is currently part of a group, and he is leaving the group, he needs his own tax ID. Many legal issues will arise from this. For example, if he is staying in the same office suite, he will have to pay market rent for the offices and staff that he is using. When patients move between the old practice and his new practice, questions will arise about which patients are considered new and which are considered established patients.

Much of this will have to be determined by the legal structure that is set up as he leaves the group. This can be a much more complex change than it appears on the...

Comments Off on Billing How-To: Should A Provider Change Tax IDs?
June 16, 2010
Coding Challenge

Ophthalmology Coders: Does Old BB-Gun Injury Have Bearing on Coding?

The reason your patient is visiting is key. Question: We have a patient who came in for a routine eye exam, but reported retinal damage from a BB-gun incident six years ago. What would be the best way to code this? This is a new patient, and I do not h...

Comments Off on Ophthalmology Coders: Does Old BB-Gun Injury Have Bearing on Coding?
June 13, 2010
CPT / HCPCS / Hot Coding Topics

Urology Coding: Capture Kegel Exercise Pay With E/M

Don’t assume 90911 is the correct code choice.

Question: Is there a procedure code for billing for Kegel exercise teaching? Can we use code 90911 or possibly 97110?

Answer: There are no specific CPT or HCPCS codes for the performance of or teaching of Kegel exercises. To bill for teaching a patient how to properly perform these exercises, a nurse or medical technician must document a brief history and physical examination as well as the indications for and the expected goals of the Kegel exercises. Under these circumstances, you can then report 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician …) for this encounter.

About the service: Kegel exercises are voluntary contraction and relaxation of the perineal musculature including the urinary sphincter (pelvic diaphragm). These exercises are usually performed outside of the office without medical staff supervision, and are a non-invasive and non-surgical treatment for female and occasionally male stress urinary incontinence.

Pitfall: You should only use 90911 (Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry) for the teaching of biofeedback therapy with face-to-face supervision in office by a trained member of your medical staff.

Additionally, you should use 97110 (Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility) only for pelvic floor muscle rehabilitation (PFMR) performed under one-on-one supervision with a physician, physiotherapist, or ancillary office staff member specifically trained in an accredited physiotherapy program.

@ Urology Coding Alert (Editor: Leesa A. Israel, CPC, CUC, CMBS).

Sign up for the upcoming live audio conference, Risk Management Strategies for Healthcare Providers, or order the CD/transcripts.

Be a hero. Sign up for Supercoder.com, and join...

Comments Off on Urology Coding: Capture Kegel Exercise Pay With E/M
June 8, 2010
Medicare / Toolkit

Chiropractic Coding: Avoid This Common Documentation Mistake

Treatment plans are a must, experts say.

You’ve treated your chiropractic patient, you’ve selected the correct codes, and you’ve submitted your claim. All set, right? Not quite. Check out this common mistake that chiropractors make.

“Many chiropractors do not create written chiropractic treatment plans for every new patient,” says Marty Kotlar, DC, CHCC, CBCS, president of Target Coding, a chiropractic coding and billing consulting firm. Use this checklist to ensure you send Medicare the information CMS most wants to see included “with every new patient plan of care,” Kotlar says:

__ The history
__ Present illness
__ Family history
__ The past health history
__ The physical examination
__ The diagnosis
__ The plan — This should include:

  • Therapeutic modalities to effect cure or relief (patient education and exercise training)
  • The level of care that is recommended (the duration and frequency of visits)
  • Specific goals that are to be achieved with treatment
  • The objective measures that will be used to evaluate the effectiveness of treatment
  • Date of initial treatment.

__ Signature/initials to authenticate the records.

@ Part B Insider (Editor: Torrey Kim, CPC).

Sign up for the upcoming live audio conference, Risk Management Strategies for Healthcare Providers, or order the CD/transcripts.

Be a hero. Sign up for Supercoder.com, and join the coding community at the Supercoder.com Facebook Fan Page.

Comments Off on Chiropractic Coding: Avoid This Common Documentation Mistake
June 8, 2010