Raise your glass to the new year without worries of 2011 medical code changes. SuperCoder’s got you covered with new CPT codes, CCI edits, and supply coding revisions.
Starting Dec. 31, SuperCoder.com will offer the complete codesets for CPT 2011…
Despite adjusted rate of 33.9764, overall change is zero.
The President locked in a zero percent adjustment to your Medicare Part B payments but that doesn’t mean you’ve got the same rate.
The Medicare and Medicaid Extenders Act of 2010, wh…
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…
600 coders, physicians, and office managers gathered in Orlando, Fla. for one and a half jam-packed days of education, networking, and shopping at the December 2011 Coding Update and Reimbursement Conference. Coders’ biggest struggle was absorbing all the information – and not overdoing the holiday buying. Experts offered the inside scoop on medical coding changes for 2011 and beyond. Here are my top picks:
This…
Make the transition to new iliac revascularization codes a little simpler by using this chart. Be sure to read “37220 to +37223 Revamp Your Iliac Intervention Coding Options” on the cover to get more information on these new codes.
Use the appropri…
If you’ve been looking for a code on colon motility study and being frustrated for the lack of it, your search is over. CPT 2011 debuts a new code for a manometric study, along with two revised codes for esophageal pH monitoring.
For gastroenterology, you have a lot of changes to sort through — many involving deletions on low use codes or clean-up work.
Here’s How to Use New Manometric Study Codes
You should pay attention on two new codes for a manometric study: 91117 (Colon motility [manometric] study, minimum 6 hours continuous recording [including provocation tests, e.g., meal, intracolonic balloon distension, pharmacologic agents, if performed], with interpretation and report), and 91013 (Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study with interpretation and report; with stimulation or perfusion during 2-dimensional data study [e.g., stimulant, acid or alkali perfusion] [List separately in addition to code for primary procedure]).
CPT 91117 is just for the study itself, not for the same session with catheter placement. The radiologist may place the catheter in a prior procedure and the gastroenterologist may come in and out to supervise the testing and any provocations that are performed. Thus, you should include the provocations in the study and report 97117 only once no matter how many times the testing is done.
You can use 91013 in cases like assessment of the effect on the measured esophageal motility when the patient’s esophagus is exposed to different stimulant liquids, says Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA’s CPT Advisory Panel. The code also applies when intravenous medications are administered to try to produce symptoms. CPT 91010 is included in 91013 and would not be billed separately, he adds.
Use 91034, 91035 in a New Way
Aside from debuting…
With more patients turning in for a variety of ear conditions, you cannot afford to lose any reimbursement. Look to our expert advice to ensure you’re coding correctly for all of the ear associated diagnoses.
1. Verify Documentation for E/M With 69210
Cerumen removal can present several coding challenges for your practice, particularly if the physician performs the service as a gateway to visualize the ear. Knowing when you can report 69210 (Removal impacted cerumen [separate procedure], 1 or both ears) is key to collecting for this service.
Example: Suppose a patient presents with ear pain, but the physician has to remove impacted cerumen before he can visualize the tympanic membrane. He subsequently diagnoses an ear infection. Your practice wants to bill an office visit and modifier along with 69210 – is that acceptable?
Key: “Whether to report 69210 is always a value judgment because if you just flick a little wax aside to visualize the eardrum, you shouldn’t bill for cerumen removal,” says Charles Scott, MD, FAAP, with Advocare Medford Pediatric and Adolescent Medicine in New Jersey. “Typically, I’ll use that code if I have to use a special device that allows me to curette the ear before I can visualize the tympanic membrane,” he advises.
The July 2005 CPT Assistant states that cerumen is considered “impacted” in several circumstances, one of which is, “cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition.” Therefore, if the cerumen is blocking the physician’s view and he has to use special instrumentation to remove it above and beyond irrigation, most payers allow you to report 69210.
You should ensure that you have separate documentation of the E/M service and procedure to support reporting both codes. Some practices overuse 69210, which means many…
Confused about when to choose a debridement code and an active wound code? CPT 2011 is here to your rescue with revised debridement code guidelines that clarify how to choose between the two code groups — and the key word that will tighten up your coding is depth.
“Depth is the only documentation item you need to determine the correct code,” explained Chad Rubin, MD, FACS, AMA Specialty Society Relative Value Scale Update Committee (RUC) Alternate Member with Albert E. Bothe, Jr. MD, FACS, American College of Surgeons, AMA CPT Editorial Panel Member at their joint presentation “General Surgery” at last month’s CPT Symposium in Chicago.
Active wound care, which has a 0 day global period, is for active wound care of the skin, dermis, or epidermis. For deeper wound care, use debridement codes in the appropriate location.
Example: Codes 11040 (Debridement; skin, partial thickness) and 11041 (…full thickness) have been deleted. The parenthetical note under the codes’ deletion reads, “For debridement of skin, i.e., epidermis and/or dermis only, see 97597, 97598.” The codes are revised for 2011 to reflect this change. For instance, the revision for code 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less) removes “Skin, and” and adds after subcutaneous tissue “includes epidermis and dermis, if performed.”
Code 97597 is revised to (Debridement [e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], open wound, [e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm], including topical application[s], wound assessment, use of a whirlpool, when performed and instruction[s] for ongoing care, per session, total wound[s] surface area; first 20 sq cm or less]).
Code 97597’s revision involves “mainly rewording to make clear how active wound care is separate from integumentary wound care,” Bothe explained.
CPT…
Question: Our surgeon assisted another surgeon from a different practice on a laparoscopic partial colon resection for a patient with Crohn’s disease. The other surgeon scrubbed out, and our surgeon proceeded to ligate an internal hemorrhoid. How can…
If you’ve been writing off tobacco cessation counseling as non-payable, it’s time to change your tune.
The change: In the past, you could collect for tobacco cessation counseling for a patient with a tobacco-related disease or with signs or symptoms of one. But on Aug. 25, CMS announced that “under new coverage, any smoker covered by Medicare will be able to receive tobacco cessation counseling from a qualified physician or other Medicare recognized practitioner who can work with them to help them stop using tobacco.”
“For too long, many tobacco users with Medicare coverage were denied access to evidencebased tobacco cessation counseling,” said Kathleen Sebelius, HHS secretary, in an Aug. 25 statement. “Most Medicare beneficiaries want to quit their tobacco use. Now, older adults and other Medicare beneficiaries can get the help they need to successfully overcome tobacco dependence.”
Count Attempts and Minutes
The new tobacco cessation counseling coverage expansion will apply to services under Medicare Part B and Part A. That means your physicians and coders should know how to correctly document and report the sessions.
“Medicare allows billing for two counseling attempts in a year, but each attempt can occur over multiple sessions, with four sessions per attempt,” explains Jennifer Swindle, CPC, CPC-E/M, CPC-FP, RHIT, CCP-P, director of coding and compliance for PivotHealth LLC in Brentwood, Tenn.
According to section 12 of chapter 32 of the Medicare Claims Processing Manual, “Claims for smoking and tobacco use cessation counseling services shall be submitted with an appropriate diagnosis code. Diagnosis codes should reflect: the condition the patient has that is adversely affected by tobacco use or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use.”
Swindle says 305.1 (Tobacco use disorder) is one diagnosis supporting…