Question: I would like to know the correct codes for billing a PPD test provided in the office. Should I use 86580 with V74.1 and what should I bill for the PPD administration?
Answer: You are using the correct diagnosis code: V74.1 (Special screening …
Revascularization, heart catheterization, and more all have new looks in CPT 2011. Here’s an overview of what you can expect.
• 37220-37235: Endovascular revascularization, open or percutaneous
The codes in this range are distinguished by the vesse…
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…
Only report primary procedure – except for 99455 edits.
The latest version of the National Correct Coding Initiative (CCI) edits went into effect October 1, and introduced a slew of pairings involving two new Category III “T” codes for transforaminal epidural injections:
Explanation: “The new Category III codes 0228T-0231T have added the addition of ultrasound guidance to transforaminal epidural injections,” says Susan Vogelberger, CPC, CPC-H, CPC-I, CMBS, CCP-P, CEO of Healthcare Consulting and Coding Education in Boardman, Ohio. “That will eliminate the need to code the ultrasound independently.” The existing, Category I codes for transforaminal epidural injections of anesthetic and/or steroids (64479-64484) include only the injection itself.
Even Simple Procedures Rule With NME Edits
CCI classifies the bulk of edits involving 0228T and 0230T as non-mutually exclusive.
No breakage: The rationale behind the new bundling edits falls to “standards of medical/surgical practice.” Most edits carry a modifier indicator of “0,” which means you cannot break the edit with a modifier and report both codes during a single encounter.
Examples of common procedures that override the accompanying 0228T or 0230T codes include:
…
New CPT to ICD-9 ‘cross walk’ tool is available to members Nov. 1.
We’ve had so many requests for a CPT to ICD-9 “cross walk” that we moved up our implementation date for this popular denial combating tool to Nov. 1. Advantage members will be able to access the feature under Tools.
Coders are working weekends to bring to you live on Nov. 1, the surgical CPT procedure code to ICD-9-CM CrossRef. By Dec. 1, SuperCoder CPT to ICD-9-CM CrossRef will also include CPT radiology, pathology, and medicine codes. “The CrossRef lets a coder look up a surgical CPT procedure code and see which ICD-9 diagnosis codes Medicare and private payer allow,” explains Jen Godreau, CPC, CPEDC, content director for SuperCoder.com.
Denials for mismatched CPT and ICD-9 codes cost practices thousands of dollars every year. SuperCoder CrossRef will help you ensure your links are correct helping you further reduce your denials rate. Plus, more code details and pictures will improve your coding accuracy.
Lay Terms, Illustrations Help You Understand CPT Codes
Starting Nov. 1, SuperCoder.com will put more accurate coding at your fingertips with Lay Terms for every CPT code for eight major specialties. SuperCoder Codesets & Tools and Advantage members should look for this feature plus visually helpful anatomical illustrations under Code Details. No more guessing what your physician’s doing — anatomical illustrations in code details for CPT procedural cardiology, family practice, gastroenterology, general surgery, ophthalmology, orthopedics, otolaryngology, and pediatrics will put a face with the procedure to make selecting the correct code even easier.
We’ve heard your frustrations on SuperCoder’s slow speed. Our IT is having hardware rushed in. Starting next week, you’ll notice faster searching — the improvements will continue weekly.
Make sure your postop office visit documentation measures up.
The OIG has once again set its sights on several new targets to go with the upcoming new year, and this time the feds will be double- and triple-checking your E/M documentation.
On Oct. 1, the OIG published its 2011 Work Plan, which outlines the areas that the Office of Audit Services, Office of Evaluations and Inspections, Office of Investigations, Office of Counsel to the Inspector General, Office of Management and Policy, and Immediate Office of the Inspector General will address during the 2011 fiscal year. When the OIG targets an issue in its Work Plan, you can expect the agency to carefully review and audit sample claims of those services.
The Work Plan “describes the specific audits and evaluations that we have underway or plan to initiate in the year ahead considering our discretionary and statutorily mandated resources,” the document indicates.
On the agenda for next year, the OIG has indicated that its investigators will “review the extent of potentially inappropriate payments for E/M services and the consistency of E/M medical review determinations.” The OIG also plans to hone in on whether payments for E/M services performed during the global periods of other procedures were appropriate.
In addition, the OIG will scrutinize Medicare payments for Part B imaging services, outpatient physical therapy services, sleep testing, diagnostic tests, and claims with modifier GY on them (Item or service statutorily excluded, does not meet the definition of any Medicare benefit or, for non-Medicare insurers, it is not a contract benefit).
The OIG also intends to “review Medicare payments for observation services provided during outpatient visits in hospitals” to assess whether hospitals’ use of observation services affects Medicare beneficiaries’ care.
Keep your compliance plan up to date with tips from Part B Insider,…
Question: What codes would you use for lower anterior resection with anal anastomosis and divered ileostomy with mobilization of splenic flexure, which was converted to an open procedure?
Answer: You’ll report the open procedure codes for this case. …
Pediatric and family practice coders are all too familiar with ADD-like complaints minus a definitive diagnosis. ICD-9 2011 holds the key to alternative options until further testing is complete.
ICD-9 2011 adds the 799.5x family to the “Ill Defined …
Question: We have always reported A4556 for the electrodes our urologist uses during urodynamics procedures. This year, however, DMERC has refused reimbursement, stating we should instead be using code A4595 or A4557. Those two “replacement” code…