Red Alert, Cardiology Coders: Expect EP Study + Ablation Denials Until April 1

CMS won’t fix CCI blunder until version 16.1, to be released in the spring.
If your heart skipped a beat when you saw that January’s Correct Coding Initiative (CCI) edits bundled catheter ablations with electrophysiology (EP) studies, you weren’t alone.
Good news: CMS has decided to delete the edits retroactively because their addition was a mistake, according […]

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OIG Hit List: Perfect Your 38220, 38221, and G0364 Usage

Don’t sweat reporting 38220-59 if you meet these Medicare-approved conditions.
If your oncologist takes both a bone marrow biopsy and a bone marrow aspiration, whether you’ll see Medicare reimbursement depends on the two guidelines below. But watch out: With OIG scrutiny and a HCPCS twist, these guidelines will put your coding savvy to the test.
Append 59 […]

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8 Simple Steps Organize Your Op Note Coding

This aspect of op note coding is the “horse that pulls the cart.”
Stuck on how to tackle this op note or those sitting on your desk? Follow this advice, provided by Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M. and co-presenter of the “Ob-Gyn Op Notes” session at the […]

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What Lab Coders Need to Know About CCI 16.0

Look for transcutaneous hemoglobin limitations, and bundling for those new 2010 culture codes.
Think you’re ready to use all those brand new CPT lab codes? Not so fast. You better learn Correct Coding Initiative (CCI) restrictions first, before you start billing Medicare for services using new CPT 2010 codes.
CCI released version 16.0, effective Jan. 1, which includes 24,060 […]

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Ob-Gyn CCI 16.0: Hysterectomy Coding

Here’s where you can bypass the edits with modifier 59.
The Correct Coding Initiative (CCI) version 16.0 didn’t overlook the hysterectomy, vaginal graft, and colpopexy codes — nor should you. To make sense of the deletions, break these additions into mutually exclusive and non-mutually exclusive.
Note: In all these cases — except those involving the anesthetic injection […]

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Cataract Surgery Coding Skill Builder

Determine ‘planned or unplanned’ before separately coding vitrectomy.
With several possible surgical treatments for cataract procedures, which you probably code more often than any other surgery, there’s a lot of room for error – with over $890 at stake for complex cataract procedures in 2009.
Use these tricky scenarios as a guide through some of the most […]

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Radiology Coding Challenge: Why is Medicare Denying a 38792, 78195 Claim

Tip: Discover true meaning of 38792 note
Question: The physician performed a sentinel node injection with lymphoscintigraphy. A note with 38792 states to report 78195 for imaging. So why did Medicare deny a claim that included both codes?
Answer: You should report 78195 (Lymphatic and lymph nodes imaging) for this service and leave 38792 (Injection procedure; for […]

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