A major insurer will now pay for turbinate fracture in addition to septoplasty. Thanks to advocacy from the American Academy of Otolaryngology–Head and Neck Surgeons (AAO-HNS), Aetna has overturned its coverage position on 30520 and 30930 bille…
Medicare still won’t reimburse audiologist-billed Epley.
After two years of battles with CMS over canalith repositioning procedure (CRP) coding, physicians will finally get paid for these specific codes.
CPT® 2009 excited ENT coders with new CPT cod…
All that fine green print on time in your E/M CPT 2011 manual boils down to one thing: you can round to the closest time code.
But that advice from CPT contradicts Medicare’s threshold time guideline.
CPT Treats Times as Averages
CPT 2011 indicates…
Get used to using letters in your diagnosis coding.
Take a look at some of the ways your urology diagnosis coding will change in 2013 by reviewing this chart of some common diagnoses you see in your urology practice.
This rundown, based on the ICD-10 2…
Question: A doctor recently told me that appending modifier GY to the refraction code would guarantee payment by a secondary insurer when Medicare denies it. Is this true?
Answer: Modifier GY (Item or service statutorily excluded or does not meet the …
Version 16.3 of the National Correct Coding Initiative (CCI) edits initiated many new edit pairs on Oct. 1. You’ll need to get to know new edits affecting your small and large bowl injury repairs, open ureterotomy stentings, and diagnostic laparoscopy coding.
Count Bowl, Splenic Injury Repairs With Main Surgery
If your urologist has to perform a small or large bowl repair for an intestinal injury that occurs during an open urological or urogynecological procedure, you’ll likely be facing a new CCI edit dilemma.
CCI bundles column 2 codes 44602 (Suture of small intestine [enterorrhaphy] for perforated ulcer, diverticulum, wound, injury or rupture; single perforation), 44603 (… multiple perforations), 44604 (Suture of large intestine [colorrhaphy] for perforated ulcer, diverticulum, wound, injury or rupture [single or multiple perforations]; without colostomy), and 44605 (… with colostomy) into many of the procedures in the 50010-57280 range.
Silver lining: These edits have a modifier indicator of “1,” which means you can bypass the edits in some clinical circumstances, using a modifier such as 59 (Distinct procedural service). “These bundles indicate that a repair of an inadvertent small or large bowl injury occurring during urological or urogynecological surgery will be included in the primary procedure under most circumstances and should not be billed separately,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. “If such an injury does occur and is repaired, the surgeon should check CCI, version 16.3 edits to determine if their primary procedure is involved in these edits.”
If, during a urological procedure such as a difficult left nephrectomy, an inadvertent splenic injury occurs, resulting in an open splenectomy (38100, Splenectomy; total [separate procedure]), a partial splenectomy (38101, … partial [separate procedure]), or a laparoscopic splenectomy (38120, Laparoscopy, surgical, splenectomy)…
Hint: You can report complications before or after delivery.
You can receive increased reimbursement when your ob-gyn provides additional visits outside of the normal global ob package, but you’ll have to make sure you’ve coded high-risk or complicated obstetrical care correctly – and that means perfecting your ICD-9 coding skills.
Insist on Perfect ICD-9s
You have to link the ICD-9 code on the CMS-1500 claim form (boxes 21 and 24E) to an E/M code, for example, to demonstrate the reason for the additional service. You can add this to the claim that includes the global service, or you can submit it as an additional claim.
Example: A 33-year-old patient, gravida 3, para 2 (both normal spontaneous vaginal delivery [NSVD] full term), is seen in the office 19 times due to developing pre-eclampsia. After the delivery, you review the case and find that the patient required six additional visits (beyond the usual 13) for this care. The documentation for three of these visits supports reporting 99212 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 10 minutes face-to-face with the patient and/or family), while three of the visits have more extensive documentation that supports reporting 99213 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 15 minutes face-to-face with the patient and/or family).
In addition, after delivery, the patient experiences prolonged pain and irritation due to a hemorrhoid. The ob-gyn sees her for a thrombosed hemorrhoid, which he incises in the office two weeks post-delivery. Finally, the ob-gyn rechecks the patient at her six weeks postpartum visit.
Break it down: When coding for this patient, remember the claim form must note both the CPT codes describing the additional services, as well as the diagnoses that…
Forget about digging through the latest Medicare Physician Fee Schedule and calculating the conversion factor when it comes to determining your Part B reimbursement rate for flu shots. CMS has come out with a handy MLN Matters article explaining this i…
You’ll soon capture counseling per disease.
For combination vaccines that may involve counseling on as many as five different diseases, getting paid as though you counseled on one never seemed fair, but CPT 2011 lets you capture that extra counseling work.
Although multiple component vaccines require counseling on each disease, physicians have only been able to capture counseling for vaccine administration once per administration. CPT 2011 solves the problem with new immunization administration with counseling codes that you’ll code per vaccine component.
CPT 2011 deletes 90465-90468 (Immunization administration younger than 8 years of age … when the physician counsels the patient/family … per day). Codes 90471-90474 (Immunization administration …) remain.
Use 90460 as Vaccine Administration With Counseling Base Code
No more looking at administration route when choosing which immunization administration with counseling code. For vaccine administration, you’ll assign one code for each vaccine’s initial component:
Definition: A component refers to the antigen in a vaccine that prevents disease caused by one organism.
CPT streamlines your coding of the vaccine counseling codes by giving you one universal base code. The code includes “any route of administration.” You no longer have to choose a different code based on whether the code is intramuscular/subcutaneous or oral/intranasal.
Step 2: Report Second Vaccine Component With +90461
Coders can breathe a sigh of relief as the complexities over deciding which 90465-90468 code to use as the base code will soon end. CPT 2011 gives you only one vaccine administration with counseling base code (90460). For each additional vaccine component, you report the same add on code:
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Get ready for another year of nail-biting to find out if your Medicare payments will be slashed. “The calendar year 2011 Physician Fee Schedule conversion factor is $25.5217,” notes the 2011 Medicare Physician Fee Schedule Final Rule, printed in th…