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…
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…
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…
You won’t face the same nail-biting payment woes in 2011 as you did this year, thanks to a Senate Finance Committee bill that will freeze Medicare pay at current levels for another 12 months. The House of Representatives passed the Medicare and M…
Question: I’m receiving contradictory guidance on which modifier to use when a gastroenterologist does an incomplete colonoscopy. Should I use modifier 52 or 53?
Answer: CPT 2011 ends the days of arguing over whether to use modifier 52 or 53 for …
Get ready to change your flu vaccine product code 90658 to one of four Q codes.
For 2010, report 90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use) to signify that your physici…
Medicare beneficiaries will be thrilled that Medicare will cover annual well checks.
The Center for Medicare introduces a new benefit of wellness visits for beneficiaries annually, except during the year of their Welcome to Medicare exam. You’ll use …