• 209-337-5705

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 The scope was then withdrawn through the transverse, descending, sigmoid, and rectal vault area.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…

Read More »

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…

Read More »

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…

Read More »

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…

Read More »

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…

Read More »

Code Correct Closure Level With These Tips

All closures aren’t created equal; one of the nuances of coding these procedures is knowing how to distinguish one type from another. Read on for our experts’ advice on how to assess the three closure levels and assign the best codes.

A simple repair involves primarily the dermis and epidermis. It might involve subcutaneous tissues, but not deep layers.

How do you know when a closure might involve subcutaneous layers but is still considered a simple repair? Your provider’s documentation is the key. The difference is whether the wound is closed in layers or just a single layer, experts note. The provider might decide to include the subcutaneous layer in the closure but does so by bringing the needle through the dermis into the subcutaneous and back. That results in a single-layer closure rather than closing the subcutaneous layer first and then the dermis/epidermis second in separate closure techniques.

But “simple” doesn’t mean the repair is something anyone could do. Simple repairs involve one-layer closure, which helps set them apart from a standard E/M procedure. Simple repair also includes “local anesthesia, and chemical or electrocauterization of wounds not closed,” says Dilsia Santiago, CCS, CCS-P, a coder in Reading, Pa.

For example, if your dermatologist uses adhesive strips to close a laceration, consider it an E/M service that you’ll report with the best-fitting choice from codes 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient …) or 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient …). Most Steri-strip applications are done by nursing staff; but even if the physician applies them, they’re included in the E/M service.

If, however, your dermatologist uses sutures, staples, or tissue adhesives to close the laceration, consider it a separate procedure. Choose…

Read More »

One Medicare Contractor OK’s RNs and LPNs to Furnish Annual Wellness Visit

CMS staffers confirmed this week that MACs can determine whether they’ll allow licensed practical nurses (LPNs) and registered nurses (RNs) to perform annual wellness visits (AWVs) and collect from Medicare for those services. That’s the word from a Feb. 22 CMS Open Door Forum, where providers called in with several questions affecting Part B providers.

One caller phoned into the forum to ask about a Q&A posted on the Web site of WPS Medicare, a Part B payer in four states, which asks whether an RN or LPN can perform “the entire annual wellness visit (AWV, G0438-G0439).” WPS responds on the site, “Yes, an RN or LPN can perform the visit. They need to be under the direct supervision of a physician and the state license needs to allow for them to do all the ocmpoennts of the service.” (http://www.wpsmedicare.com/part_b/education/awv-faq.shtml). The caller asked whether this is a general CMS policy or if it only applies to WPS Medicare.

“Remember, the LPN’s not billing,” said CMS’s William Rogers, MD, reminding the caller that the visit would be billed under the physician’s NPI as “incident to.” But the caller still considered it “odd” that an LPN could perform an AWV, since it’s similar to an E/M service.

“It’s a different sort of service – there’s not really any clinical judgment involved,” Rogers said. “It’s a service which includes a lot of sort of administrative steps, verifying that people have certain preventive services done and things like that, and so it is intended to be a collaborative service.”

Keep in mind that CMS does not have a national policy allowing LPNs and RNs to perform AWVs, but reps from the agency confirmed that it’s within the rights of the individual MACs to make this determination.

For more on this story,…

Read More »

Switch to 43327, 43328 for Esophagogastric Fundoplasty

Open or laparoscopic, through chest or abdominal wall, with or without hiatal hernia repair, with or without mesh … these are the various ways your surgeon might perform an esophagogastric fundoplasty. And these are the factors you’ll need to take into account when you try to pick the proper code(s) from among nine new choices in CPT 2011.

Let our experts show the way with four how-to tips for paraesophageal hiatalhernia repair and fundoplication coding for 2011.

Tip 1: Understand Pathophysiology

“When a patient is described as having a hiatal hernia, it usually means that part of the stomach has herniated through the opening in the diaphragm [esophageal hiatus] into the chest and is usually associated with esophageal reflux disease,” according to Gary W. Barone, MD, a physician and associate professor at the University of Arkansas for Medical Sciences in Little Rock.

The hernia repair typically involves the surgeon reducing the stomach back into the abdomen and suturing the enlarged diaphragmatic hiatus, explains M. Tray Dunaway, MD, FACS, CSP, a general surgeon and an educator with Healthcare Value Inc. in Camden, S.C.

During the fundoplication procedure, such as Nissen, the surgeon additionally wraps part of the fundus (top) of the stomach around the esophagus and sutured in place. This creates a “valve” that allows food to reach the stomach from the esophagus but prevents reflux back to the esophagus.

“I would say the Nissen fundoplication is the most common surgical procedure to treat gastroesophageal reflux disease (GERD),” Dunaway adds. Watch for gastroplasty: Sometimes the esophagus is shortened and the surgeon can’t reduce the hernia. “The surgeon might perform a gastroplasty, forming a tube of stomach to effectively elongate the distal esophagus,” Dunaway says. An example of such a procedure is a Collis gastroplasty.

Tip 2: Use 43332-43337 for Open…

Read More »

37228-+37235 Cover Your Tibial/Peroneal Service Codes

Facing denials on your tibial/peroneal codes? No worries, help is at hand.

The new tibial/peroneal service codes are below. Note that all of the codes include angioplasty in the same vessel when that service is performed.

The first four codes apply to the initial tibial or peroneal vessel treated in a single leg:

  • Angioplasty: 37228 — Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty
  • Atherectomy (and angioplasty): 37229 — … with atherectomy, includes angioplasty within the same vessel, when performed
  • Stent (and angioplasty): 37230 – … with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
  • Stent and atherectomy (and angioplasty): 37231 — … with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed.

The final four codes are add-on codes that you use to report services on each additional ipsilateral (same side) vessel treated in the tibial/peroneal territory:

  • Angioplasty: +37232 — Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) (use with 37228-37231)
  • Atherectomy (and angioplasty): +37233 — … with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) (use with 37229-37231)
  • Stent (and angioplasty): +37234 — … with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) (use with 37230-37231)
  • Stent and atherectomy (and angioplasty): +37235 — … with transluminal stent placement(s) and atherectomy, includes angioplastywithin the same vessel, when performed (List separately in addition to code for primary procedure) (use with 37231).

The general rule for the revascularization codes is that you should report the one code that represents the most intensive service performed in a single…

Read More »
Share on facebook
Share on twitter
Share on linkedin
Share on whatsapp

Most Popular: