Hip Arthroscopy, Observation Receive CPT 2011 Coding Updates

2991x, 9922x medical procedure CPT 2011 codes added.

If you’ve been frustrated about the lack of arthroscopic hip surgery codes that CPT offers, CPT 2011 will change that, with three new codes that debut on Jan. 1.

In fact, CPT will introduce over 200 new codes in 2011 to help keep your coding more specific than ever, spanning several categories, from dermatology to orthopedics to cardiology, and beyond.

In orthopedics, you’ll benefit from the following three hip arthroscopy codes, which will be excellent additions to CPT.

  • 29914 – Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion)
  • 29915 – Arthroscopy, hip, surgical; with acetabuloplasty (ie, treatment of pincer lesion)
  • 29916 – Arthroscopy, hip, surgical; with labral repair

Check out New Observation Codes

CPT adds to your E/M coding options with the introduction of three new observation codes, as follows:

  • 99224 – Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient’s hospital floor or unit.
  • 99225 – Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or

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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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ICD-9 2011: 752.3x, V13, V91 Offer Obs More Anomaly, Status Options

Three scenarios show you where to brush up before Oct. 1 hits.

October 1 means it’s time to apply the new 2011 diagnosis codes affecting your obgyn practice, which include new uterine anomaly, placenta, and personal history diagnoses. Are you ready? Take this challenge to find out.

Add Uterine Anomalies to Your Diagnosis Arsenal

Scenario 1:

A) 752.31

B) 752.33

C) 752.35

D) None of the above.

E) All of the above.

Solution 1: E. The American Society of Reproductive Medicine (ASRM) identified seven types of uterine anomalies: agenesis, unicornuate, didelphus, bicornuate, septate, arcuate, and DES related anomalies. Of these, only didelphus and DES related anomalies have unique ICD-9 codes prior to Oct. 1: 752.2 and 760.76, respectively. For the other anomalies, you have no specific diagnosis recourse.

However, as of Oct. 1, you’ll be able to differentiate between these different types, and payers will translate these codes into specific gynecologic and obstetric implications and management. They are:

  • 752.31 – Agenesis of uterus
  • 752.32 – Hypoplasia of uterus
  • 752.33 – Unicornuate uterus
  • 752.34 – Bicornuate uterus
  • 752.35 – Septate uterus
  • 752.36 – Arcuate uterus
  • 752.39 — Other anomalies of uterus.

Multiple Placentae? Make Use of New Dx

Scenario 2: The ob-gyn delivers dichorionic/diamniotic twins vaginally. After October 1, how should you report this?

A) 59400, 59409-51, 651.01, V91.00, V27.2

B) 59400, 59409-51, 651.01, V91.01, V27.2

C) 59400, 59409-51, 651.01, V91.02, V27.2

D) 59400, 59409-51, 651.01, V91.03, V27.2

E) 59400, 59409-51, 651.01, V91.09, V27.2

Solution 2: D. You would report 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) for the first baby and 59409-51 (Vaginal delivery only [with or without episiotomy and/or forceps]; Multiple procedures) for the second. To support these CPT codes, you’d link each to 651.01 (Twin pregnancy; delivered) and

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HHA Referral: More Documentation Requirements Add to Physician Burden

Agencies will have little control over new physician-related payment condition. Home health agencies are hoping for some big changes to one troublesome provision in the 2011 proposed payment rule – the face-to-face physician encounter requirement.

The mandate for the face-to-face encounter was in the Patient Protection and Affordable Care Act health care reform law enacted earlier this year. But the CMS version of the requirement is even stricter than the law requires.

Example: The proposed rule also requires that the encounter be for the primary reason home care services are required and that physicians furnish “unprecedented” physician documentation about the encounter and why the patient meets homebound criteria. “We believe that CMS has gone beyond statutory intent” in those two provisions, says the National Association for Home Care & Hospice.

The proposed face-to-face encounter requirement is riddled with problems for HHAs, industry experts say. To begin with, agencies have little influence over whether their patients make it to the doctor for a visit.

“It is absolutely ridiculous to place a requirement on home health providers for which they have absolutely no control,” protests consultant Pam Warmack with Clinic Connections in Ruston, La. “How in the world is the staff of the home health provider supposed to ensure that the patient visits the physician and that the physician documents appropriately in his/her office records?” Warmack asks.

“We can make appointments for patients, but we can’t ensure they keep them, that their transportation is reliable, that they feel well enough to make the trip, etc.,” Warmack continues. “There are so, so many reasons that patients fail to see the physician despite the best efforts of the home care staff to make it happen.”

The requirement will be “a particular burden on home health patients who are homebound and have difficulty leaving home,” notes…

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Billing Specialist Knowledge Assessment Answer Key

Name: _____________________________________________  Date: _______________

1. A CPT code has ___5_____ digits and an ICD-9-CM code has ___3-5____ digits.

 2. Explain the difference between a CPT code and an ICD-9-CM code.

CPT (Current Procedural Terminology), standardized numeric system (5 digits without modifiers) is used to report WHAT medical services and procedures are done to the patient. 

ICD9 (International Classification of Diseases – Ninth Edition) a Universal coding system is used to describe WHY a service was performed.  Codes range from 3-5 digits.  

3. What is the purpose of a modifier?

To identify in certain circumstances that a service or procedure has been altered by some specific circumstance but it has not changed the basic definition or code  (this is the literal CPT book definition, but anything remotely close to this is acceptable).

4. What are E&M codes?

Evaluation and Management Codes that describe different levels of physician “visits” in various healthcare settings.

5. What does “COB” stand for?   Coordination of Benefits

6. What insurance information do you obtain when the patient contacts our office with new insurance?

Guarantor name, guarantor DOB, guarantor policy and group number, new insurance name, address for claims submission, effective date of new policy, and (if possible) termination date of previous policy.

7.  If the patient has Medicare and Medicaid, which insurance would you bill first?

Medicare would always be billed first.                                              

8. What does HIPAA stand for? And what does it mean to you?        Health Insurance Portability and Accountability Act.

HIPAA designates certain standards and procedures that must be followed to keep secure PHI (protected Health Information). HIPAA also calls for standardization of transaction code sets and various privacy laws (looking for some level of knowledge about the general concept of HIPAA).

9.  How would you handle each of the following EOB rejections?…

<p

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Billing Specialist Knowledge Assessment

Before you hire a biller, you need to make sure he or she is qualified for the position. The following test coupled with a math test will assess whether the candidate will be successful in the role — and an asset to your company.

Name: _____________________________________________  Date: _______________

  1. A CPT code has _______ digits and an ICD-9-CM code has _______ digits
  2. Explain the difference between a CPT code and an ICD-9-CM code
  3. What is the purpose of a modifier?
  4. What are E&M codes?
  5. What does “COB” stand for?  
  6. What insurance information do you obtain when the patient contacts our office with new insurance?
  7. If the patient has Medicare, Tricare and Medicaid, which insurance would you bill first, second, last? 
  8.  Patient is 65; has BCBS through employer w/ 100+ employees and has Medicare Part A only.  Which insurance would you file first?
  9. What does HIPAA stand for? And what does it mean to you? 
  10. What is a CMS 1500 used for?
  11. What is the difference between HCFA and CMS 1500?
  12. How would you handle each of the following EOB rejections?
    • Procedure not a covered benefit
    • Patient not eligible on the date of service
    • Applied to deductible 
    • Bundled Service

 

Multiple Choice

1. A “crossover” claim is:

a. When Medicare forwards a claim electronically to a secondary insurance carrier

b. When duplicate claims are sent and the same claim is returned for more information. (essentially the two claims are “crossing” in the mail)

c. When a claim is sent that has more than one box “crossed out”

d. Sending the claim to the secondary insurance first for administrative purposes, “crossing” the normal procedural policies.

 

2. An EOB is:

a. End of Balance

b….

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Patient Services Coordinator Pre-Test Key

Name: ____________________                                

SS#: ____________________                                  

 

1)      10 Key Math Test:

A)                                                                                                                                                        B)

    7,413.00                                                                                                                                4,100.00

  23,176.00                                                                                                                                5,555.25

          15.27                                                                                                                             -3,125.00

346,789.00                                                                                                                                1,965.42

      -799.02                                                                                                                                4,325.00

           1.02                                                                                                                                       1.82

       792.05                                                                                                                                     13.99

    1,668.32                                                                                                                                8,913.23

         76.00                                                                                                                              13,425.76

         87.88                                                                                                                                      24.00

                        379,219.52                                                                  35,199.47

C)                                                               Addition:                                 D)          Subtraction:

724.063                                                                                                      37              

840.567                                                                                                      -28.759         

+78.224                                            8.241

                   1,642.854

 

E)                                                                Division:                                  F)          Multiplication:

1,253,888.8/79 = 15,872.01                                            57.32       

x3.157         

                                                                             180.95924

G)      Percentage:

70 is 20% of  350            

80% of $235.44 is $188.35

Find 20% of 5,360.00 1,072

An insurance company will cover 80 percent of a 3,900 bill; the patient must pay the non-covered portion.  How much will the patient have to pay? 780.00

Mr. Smith has insurance with a $275 deductible. In addition, he pays 10 percent of the remainder of the bill.  His hospital bill is $1,500.  What is his total payment? 397.50

 

H)      What is 47.8937 rounded to the nearest tenth?  47.9                                   

 


I)                  Mr. Jones is being admitted to the hospital.  His estimated hospital bill is $3,500

room and board; $750 laboratory; $250 pharmacy; $625 physical therapy; and $1025 x-ray.  His insurance will cover 80 percent, Mr. Jones must pay the non-covered portion.  What will he owe the hospital? 1,230.00     

 

J)       Extension:

   23 units @                  $10.95 =     251.85                               

1000 units @                             $7.38 =     7,380.00                            

  586 units @           $0.37 =    215.82                             

    10 units @                                                          $4.95 =     49.50

  895 units @                             $0.95 =     850.25                             

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Patient Services Coordinator Pre-Test

Math is an essential skill for your biller to have. Test candidate’s using this handy mathematics test submitted by Becky Price with Southeastern Primary Care Specialists.

Name: ____________________                                

SS#: ____________________                                  

 

1)      10 Key Math Test:

A)                                                                                                                                                        B)

    7,413.00                                                                                                                                4,100.00

  23,176.00                                                                                                                                5,555.25

          15.27                                                                                                                             -3,125.00

346,789.00                                                                                                                                1,965.42

      -799.02                                                                                                                                4,325.00

           1.02                                                                                                                                       1.82

       792.05                                                                                                                                     13.99

    1,668.32                                                                                                                                8,913.23

         76.00                                                                                                                              13,425.76

         87.88                                                                                                                                      24.00

C)     Addition:                                                                                           D)          Subtraction:

 724.063                                                                                                      37              

840.567                                                                                                      -28.759         

+78.224

 

 

E) Division:                                                                          F)          Multiplication:

 1,253,888.8/79 =                                                             57.32 

                                                                                                    x3.157         

 

G)      Percentage:

70 is 20% of  ______            

80% of $235.44 is ______

Find 20% of 5,360.00 ________

An insurance company will cover 80 percent of a 3,900 bill; the patient must pay the non-covered portion.  How much will the patient have to pay? _________

Mr. Smith has insurance with a $275 deductible. In addition, he pays 10 percent of the remainder of the bill.  His hospital bill is $1,500.  What is his total payment? ________

H)  What is 47.8937 rounded to the nearest tenth?  _________                                 

I)  Mr. Jones is being admitted to the hospital.  His estimated hospital bill is $3,500

room and board; $750 laboratory; $250 pharmacy; $625 physical therapy; and $1025 x-ray.  His insurance will cover 80 percent, Mr. Jones must pay the non-covered portion.  What will he owe the hospital? ________  

 

J)       Extension: 

   23 units @                  $10.95 =     __________________                         

1000 units @                             $7.38 =     __________________                         

  586 units @           $0.37 =    __________________                       

    10 units @                                                          $4.95 =          __________________ 

  895 units @                             $0.95 =     __________________                         

 

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