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AMA Symposium Report: Low-Level Consult Reporting in 2010

Hey, Coding News readers! It’s your turn to weigh in on the consult controversy.
Question: What should you do for Medicare 2010 coding if an inpatient consult on a patient’s initial hospital day does not support 99221?
Answer: Kenneth Simon, MD, MBA, FACS, CMS, senior medical officer at the CPT symposium was very adamant that you […]

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CMS at AMA Chicago: We’re Reducing Consult Request Requirement

CMS auditors will look for 1 less thing in consult documentation.
With Medicare’s invalidation of consultation codes 99241-99255 in 2010, your ICD-9 codes better prove why two MDs are necessary on the same patient’s hospital care or the physician better specify why in his note.
Separate ICD-9 codes will help substantiate the medical necessity for providing consultative […]

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PQRI: No Coumadin Due to Fall Risk

Plus, experts at the AMA meeting in Chicago tell you what to do if you can’t get H1N1 vaccine for PQRI Measure 110 or other vaccine measures.
Question: My internist decided not to put a patient on Coumadin because the patient has a higher risk of falling than from having a stroke. Our group participates in […]

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2010 Tumor Excision Coding: Lesion Vs. Chunk Size

Straight from the AMA in Chicago — answers to your lesion excision coding questions for 2010.
Question: A thigh lesion measures 2 cm but requires a resection down to the subcutaneous layer of 4 cm. Which lesion excision code should I use?
Answer: “You should use the larger of the subcutaneous codes,” says Albert E. Bothe, Jr, […]

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Is 30901 Your Nosebleed Code? Not So Fast?

Hint: Look for these keywords in the note to select the correct nosebleed code.
Question: The internist stops a patient’s nosebleed. Is this always a procedure?
Answer: No, if a patient reports with a nosebleed and the physician stops the bleeding with basic methods, you’ll typically opt for the appropriate-level E/M code.
E/M methods: Code minimal attempts at […]

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Does CNS Count as NP for Time-Based Coding?

CNS = NP = PA for CPT, but Check State Law
Question: Does a certified nurse specialist (CNS) count as a nurse practitioner (NP) for reporting 99213 based on time?

Answer: Yes, for CPT purposes, a certified nurse specialist billing under his own provider number counts the same as a nurse practitioner or physician assistant. So if […]

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5 Lessons Radiology Coders Should Learn From CCI 15.3

Wonder if there’s a method to the 76001 madness? Here’s where to look for answers.
The silver lining to the 18,000 Correct Coding Initiative (CCI) that just came rumbling in with CCI 15.3. Analyzing them can help you master radiology coding essentials — including follow-up CTs, fluoro, and more. Apply these five lessons to keep your claims looking […]

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Looking for Tonsil Biopsy Code?

Question: My physician did a punch excisional biopsy of the left tonsil, but I’m not seeing a code for this. What should I do?
Answer: You don’t see a code, because no specific code exists for a biopsy of the tonsils.
You should instead report the code based on whether the otolaryngologist used a scope. If he […]

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Podiatry Coding Education: 28293 For Joint Replacement for Hallux Limitus

Question: Our podiatrist performed a joint replacement for hallux limitus and thinks we should report 28293. I disagree because the patient does not have a bunion. How should we code this procedure?
Answer: CPT does not include a code for hallux arthroplasty with implant, so it’s time to turn to unlisted codes.
Your best option is to report 28899 (Unlisted […]

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IVR & Modifier 22: Obesity Isn’t Automatic Support

It takes extra work to perform interventional radiology procedures on morbidly obese patients, so why not append modifier 22 to any obese patient’s claim and get paid more, right?
Wrong: The fact that the patient is obese is not enough reason to append modifier 22. Payers reason that the “easy” and “hard” procedures will average out […]

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