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93224-93226: Snag Extra Cash With These Tips

The catch is you have to make the request for your rightful dollars.

Here’s a piece of good news for you. As per the Medicare’s April update, three Holter monitor codes will get a slight boost in pay.

The change has an implementation date of April 4, 2011, and an effective date of Jan. 1, 2011. That means contractors have to be ready to comply with the change by April 4, but the change in practice expense relative value units (PE RVUs) is retroactive to Jan. 1 dates of service.

Medicare isn’t requiring contractors to search their files to adjust claims they have already paid (which is good news for any physician who reports a code seeing a fee decrease). But contractors do have to adjust claims if you bring them to their attention. Take a look at how many 93224-93227 services you provided from January to March to see if making the claim for the small increase in RVUs is worth your time.

93224: The PE RVUs for 93224 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, physician review and interpretation) will change from 2.30 to 2.53. That’s a difference of .23 RVUs. Multiply that by the 2011 conversion factor (33.9764), and you can expect roughly an additional $7.81 for this code. (Remember that geographic region will affect your fee, as well).

93225: For 93225 (…recording [includes connection, recording, and disconnection]), the PE RVUs only increase by .09, changing from 0.82 to 0.91. So the additional reimbursement should be roughly $3.06.

93226: You may see an additional $4.76 for 93226 (… scanning analysis with report). Its PE RVUs change from 1.21 to 1.35.

Swan-Ganz: If you ever report 93503 (Insertion and placement of flow directed catheter [e.g.,…

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92082 or 92083? Choose The Most Appropriate Code with Expert Help

Even small ophthalmology practices are likely to have a Humphrey visual field analyzer, yet many ophthalmologists don’t know the secrets for securing adequate reimbursement for these services — and they even go so far as to put themselves at risk for costly audits due to lack of documentation.

CPT lists three different visual field examinations — and the higher the code, the higher the reimbursement.:

  • 92081 — Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (e.g., tangent screen, Autoplot, arc perimeter or single stimulus level automated test, such as Octopus 3 or 7 equivalent)
  • 92082 — … intermediate examination (e.g., at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33)
  • 92083 — … extended examination (e.g., Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30 degrees, or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2 or 30/60-2).

A common mistake ophthalmologists make is billing 92082 when they could legitimately bill 92083.

The key to choosing the correct VF code is in the code descriptors themselves. For example, if the ophthalmologist plots only two isopters on the Goldmann perimeter, CPT would call that “intermediate,” based on its description of 92082. If you plotted three isopters, however, that would be an “extended” examination that would qualify for 92083.

Rule of thumb: An intermediate test is one of the screening tests that you would use if you suspect neurological damage. But ophthalmologists use the threshold exam (92083) when they suspect something that causes a slow, progressive dimming of peripheral vision, like glaucoma. Glaucoma causes a loss of vision like a light bulb slowly becoming…

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Emergency Reporting: Know When To Use +99140 With These Tips

Reporting any qualifying circumstances (QC) codes for anesthesia can be tricky, but knowing when to classify a situation as a true emergency can be a real challenge unless you’re well-versed in the emergency conditions guidelines. Check coding definitions and your provider’s documentation to know whether you can legitimately add two extra units for +99140 (Anesthesia complicated by emergency conditions [specify] [List separately in addition to code for primary anesthesia procedure]) to your claim.

CPT includes a note with +99140 stating that “an emergency is defined as existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body parts.” Your key to knowing a case meets emergency conditions lies in your anesthesiologist’s notes.

“Quite a number of cases come in where the anesthesiologist marks ‘emergency’ but many times the ‘emergency’ isn’t all that clear,” says Leslie Johnson, CCS-P, CPC, director of coding and education for Medi-Corp., Inc., of New Jersey. Documentation supporting an emergency will depend on each case, so read the chart thoroughly when your provider indicates an emergency.

Solution: Talk with your anesthesia providers to clarify what constitutes an emergency and when you can include +99140. If there’s a real reason to report an emergency (such as a ruptured appendix, 540.0), your physician should clearly document the reason. Another diagnosis code to indicate a problem (such as unstable angina, 411.1) could help show the payer you’re reporting an unusual situation. The second diagnosis can also help in an appeal if a payer that ordinarily recognizes +99140 denies the claim.

“An OB patient who comes in for a cesarean section isn’t automatically an emergency,” explains Scott Groudine, M.D., professor of anesthesiology at Albany Medical Center in New York. “However, a diagnosis of fetal distress and prolapsed cord virtually always…

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Diagnosis Coding: G Codes Are Your Key To Coding Correct High Risk Colonoscopy

Get your hemorrhoid report right and stress-free in a snap. We’ll tell you the difference between internal and external hemorrhoids, but you can learn more from this sample physician’s report:

PREPROCEDURE DIAGNOSIS: History of colon polyps and partial colon resection, right colon.

POSTPROCEDURE DIAGNOSES:

  1. Normal operative site.
  2. Mild diverticulosis of the sigmoid colon.
  3. Internal hemorrhoids.

PROCEDURE: Total colonoscopy.

PROCEDURE IN DETAIL: The 60-year-old patient presents to the office to be evaluated for the preprocedure diagnosis. The patient also apparently had an x-ray done at the hospital and it showed a dark spot, and because of this, a colonoscopy was felt to be needed. She was prepped the night before and on the morning of the test with oral Fleet’s, brought to the second floor and sedated with a total of 50 mg of Demerol and 3.75 mg of Versed IV push. Digital rectal exam was done, unremarkable. At that point, the Pentax video colonoscope was inserted. The rectal vault appeared normal. The sigmoid showed diverticula throughout, mild to moderate in nature. The scope was then passed through the descending and transverse colon over to the hepatic flexure area and then the anastomosis site was visualized. The scope was passed a short distance up the ileum, which appeared normal. The scope was then withdrawn through the transverse, descending, sigmoid, and rectal vault area. The scope was then retroflexed, and anal verge visualized showed some internal hemorrhoids.

RECOMMENDATIONS: Repeat colonoscopy in three years.

Let Location Guide You

You can easily identify external hemorrhoids (455.3-455.5) because of its place of appearance. This type of hemorrhoid has a fleshy growth and occurs around the anus — specifically, outside the anal verge which is at the distal end of the anal canal. On the other hand, internal hemorrhoids (455.0-455.2) occur inside the…

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CCI UPDATE 97597-97598: CCI Will Correct Debridement Glitch

Hang on to your claims for these wound care management codes.

As most veteran coders know, you can’t report an add-on code unless you report it along with its “parent code” on the same claim. But an NCCI glitch has made it impossible for you to collect for both the debridement add-on code 97598 and its partner code 97597 — creating denied claims and confusion for practices that perform active wound care management. However, a new announcement indicating that the NCCI is fixing the problem should ease your coding angst.

The American Podiatric Medical Association (APMA) issued a release on its Web site stating that the National Correct Coding Initiative (NCCI) edits currently bundle the following two codes together:

97597 — Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, 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
+97598 — …each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

This edit bundle has an indicator of “0,” meaning that no modifier can separate these codes. Fortunately, the APMA caught the error and contacted the NCCI director about it.

“The NCCI is currently working on a solution and recommends that APMA members delay submission of claims reporting combination of CPT 97597 and CPT 97598 until the NCCI replacement file is in place and implemented by CMS,” the APMA’s statement says. “The April 1, 2011 version of NCCI does not contain this edit error.”

The APMA has not yet gotten word on whether Medicare contractors will automatically reprocess claims that were paid in error…

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Know the Types of Graft

Question: What’s the difference between a spinal allograft and an autograft?
Answer: If the surgeon harvests bone from the patient’s own body, you’ll code for an autograft with one of the following codes:
+20936 — Autograft for spine surger…

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Ensure Compliance With ICD-10 With These 3 Tips

When ICD-9 becomes ICD-10 in 2013, you will not always have a simple crosswalk relationship between old codes and the new ones. Often, you’ll have more options that may require tweaking the way you document services and a coder reports it. Check out the following examples of how ICD-10 will change your coding options when the calendar turns to Oct. 1, 2013.

Celebrate Sinusitis Codes’ One-to-One Relationship for ICD-10

When your physician treats a patient for sinusitis, you should report the appropriate sinusitis code for sinus membrane lining inflammation. Use 461.x for acute sinusitis. For chronic sinusitis — frequent or persistent infections lasting more than three months — assign 473.x.

For both acute and chronic conditions, you’ll choose the fourth digit code based on where the sinusitis occurs. For example, for ethmoidal chronic sinusitis, you should report (473.2, Chronic sinusitis; ethmoidal). Your otolaryngologist will most likely prescribe a decongestant, pain reliever or antibiotics to treat sinusitis.

ICD-10 difference: Good news. These sinusitis options have a one-to-one match with upcoming ICD-10 codes. For acute sinusitis diagnoses, you’ll look at the J01.-0 codes. For instance, 461.0 (Acute maxillary sinusitis) translates to J01.00 (Acute maxillary sinusitis, unspecified). Code 461.1 (Acute frontal sinusitis) maps directly to J01.10 (Acute frontal sinusitis). Notice how the definitions are mostly identical. Like ICD-9, the fourth digit changes to specify location.

For chronic sinusitis diagnoses, you’ll look to the J32.- codes. For instance, in the example above, 473.2 maps direction to J32.2 (Chronic ethmoidal sinusitis). Again, this is a direct one-to-one ratio with identical definitions. Like ICD-9, the fourth digit changes to specify location.

Physician documentation: Currently, the physician should pinpoint the location of the sinusitis. This won’t change in 2013.

However, you’ll scrap the 461.x and 473.x options and turn to J01.-0 and J32.- in your ICD-10…

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4 Tips Help You Ensure Inhaler Service Success

Often a nurse or medical assistant helps a patient with an inhaler demo or evaluation, but whenever coding it, you must keep these three areas in mind: the type of device used, documentation requirements, and qualifying modifiers. Follow these four tips from our experts to understand why some payers might deny payment for the service — and what you can do to win deserved dollars.

1. Categorize the Diskus Correctly

Many physician offices use the Advair Diskus for their patients, which is an aerosol generator. “An aerosol generator is a device that produces airborne suspensions of small particles for inhalation therapy,” explains Peter Koukounas, owner of Hippocratic Solutions medical billing service in Fairfield, N.J. If the nurse or medical assistant taught someone to use an Advair Diskus — or any other diskus — you should report 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).

The physician starts a patient with asthma (493.00, Extrinsic asthma; unspecified or 493.20, Chronic obstructive asthma; unspecified) on Advair. A nurse then teaches the patient how to use the Diskus. According to CPT guidelines, you should report 99201-99215 for the office visit (depending on whether you’re treating a new or established patient). Then report 94664, but don’t append a modifier, says Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta.

CMS transmittal R954CP indicates that modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) applies only to E/M services performed with procedures that have a global fee period. Code 94664 does not have a global fee period, which is why you don’t automatically include modifier 25.

Despite what CMS guidelines might…

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