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Coding for Pediatric Chronic Lung Disease
Update your knowledge of chronic lung disease and how to code it in this article from For the Record. Read More

Cardiology Coding: +92973 Coding Is Limited to Mechanical Thrombectomy

The Coding Institute reports in The Cardiac Coding Alert that the aspiration thrombectomy question has finally received an answer with the 2013 addition of the term ‘«£mechanical‘«ō to thrombectomy code +92973:

2012: +92973, Percutaneous transluminal coronary thrombectomy

2013: +92973, Percutaneous transluminal coronary thrombectomy mechanical.

There has been a lot of confusion in the past about whether coders could use +92973 for more than mechanical thrombectomy, specifically whether the code applied tor aspiration thrombectomy, according to Julie Graham, BA, CPC, cardiology coder and compliance specialist for Concentra.

By specifying ‘«£mechanical,‘«ō the code definition change resolves that confusion, says Graham. Be sure to check the guidelines, too, she adds. The 2013 guidelines state, ‘«£Non-mechanical, aspiration thrombectomy is not reported with 92973, and is included in the PCI code for acute myocardial infarction (92941), when performed.‘«ō

The language change aligns with an article in CPT?ę Assistant (March 2002) from the year when the code was created. CPT?ę Assistant stated that +92973 was added to describe a catheter-based angiojet ‘«£procedure using a unique method of fragmenting and removing clots from the coronary artery‘«ō lumen. A vignette in the article describes?Š a reportable thrombectomy that includes advancing the thrombectomy catheter distal to the lesion, activating the catheter using a foot pedal, and then manually withdrawing the catheter to remove the thrombus (repeating as needed).


Gastroenterology Coding: Don‘«÷t Automatically Use 44705 For Fecal Bacteriotherapy
In the Gastroenterology Coding Alert, The Coding Institute advises that if your gastroenterologist performs fecal bacteriotherapy as a treatment for Clostridium difficile infections, you shouldn‘«÷t forget to look at payer policies before you report the assessment and preparation of the fecal microbiota sample with the newly introduced CPT?ęcode 44705. For fecal bacteriotherapy services reporting, turn to two codes: one for the preparation and assessment of the fecal microbiota sample and the other for the instillation in the patient‘«÷s gut.

Use code 44705 (Preparation of fecal microbiota for instillation, including assessment of donor specimen) to cover your gastroenterologist‘«÷s work developing the microbiota sample that will be instilled in the patient‘«÷s digestive tract and for assessing the sample. To indicate the medical necessity for performing fecal bacteriotherapy, you will have to support documentation using the ICD-9 code 008.45 (Intestinal infection due to clostridium difficile).

In addition to reporting 44705, you‘«÷ll report an additional code, depending on the method your gastroenterologist uses to introduce the fecal sample in the patient‘«÷s digestive tract.

Coding for Ovarian Cancer
Get a good review of ovarian cancer in this article, which reviews key issues including coding functional activity. Read More

Internal Medicine and OB/GYN Coding: Bone Density or DEXA Scan Coding: Tips to Help You Out

The restrictions Medicare sets for bone density tests can keep even the most conscientious coders guessing about whether they‘«÷ve met the medical necessity and frequency guidelines. The Coding Institute‘«÷s experts offer real-world advice that will keep you on track and strengthen your chances of success in a recent article:

Tip 1: Gather the Supporting Documentation

Documentation for the bone scan must include an order from a physician or qualified non-physician practitioner who is treating the beneficiary and an interpretation of the test results (Medicare Benefit Policy Manual, Chapter 15, Section 80.5.4). Signing the machine printout doesn‘«÷t count as an interpretation.

The physician also needs to document a complete diagnosis. Medicare doesn‘«÷t offer a national list of covered ICD-9 codes, but it does state that an individual qualifies for coverage when she meets one of five conditions (Medicare Benefit Policy Manual, Chapter 15, Section 80.5.6).

Check your payer‘«÷s local coverage determination (LCD) for the specific ICD-9 codes it says support medical necessity. For example, Aetna lists several diagnoses that may prove medical necessity, such as 627.2 (Symptomatic menopausal or female climacteric states) and 733.90 (Disorder of bone and cartilage, unspecified).

Tip 2: Go With Documented Diagnosis
Only report the documented diagnosis ‘«Ų never choose a diagnosis simply because you know you‘«÷ll get paid for it.

Tip 3: Get the Frequencies Straight
Medicare will pay for bone mass measurements on qualified individuals every two years, but does offer exceptions. (Medicare Benefit Policy Manual, Chapter 15, Section 80.5.5).

Coding for Cognitive Disorders
For the Record offers a good overview of coding for cognitive disorders, from attention-deficit disorder to traumatic head injury. Read More

Neurology Coding: Earn Payment for Psychotherapy Services with Add-On Codes
While managing a chronic debilitating illness like multiple sclerosis, your physician may engage with the patient and/or family to help improve quality of life for the patient. When psychotherapy is part of the treatment that your neurologist provides, a recent article from The Coding Institute advises that you don‘«÷t ignore that component when it‘«÷s time to code. Here‘«÷s their expert advice on how to submit the right codes for situations when your neurologist may provide psychotherapy ‘«Ű and get the pay you deserve.

Determine Duration of Psychotherapy
Your first step to success is to determine the psychotherapy treatment‘«÷s duration. Choose between three codes, depending on how long the session lasted: ?Š90832 ‘«Ű 30 minutes; 90834 ‘«Ű 45 minutes; 90837 ‘«Ű 60 minutes. Be careful, the article notes, as each code now has a specific amount of time.

Look for E/M Services
Check the clinical note to verify whether the psychotherapy was done in conjunction with an evaluation and management (E/M) service. If so, you need to again confirm the duration of the psychotherapy before assigning a code: +90833 ‘«Ű 30 minutes; +90836 ‘«Ű 45 minutes; +90838 ‘«Ű 60 minutes. ?Š(Each should be listed separately in addition to the code for primary procedure.)

Note that all options are add-on codes. Report the appropriate one with the applicable E/M code, such as 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 ‘«™).

Confirm the Family Involvement
Your neurologist might schedule a psychotherapy session to discuss how family interactions can benefit the patient and how the care provided can affect the patient‘«÷s course of illness. The patient may or may not be present for the session, which guides your coding.

Depending upon whether the patient was present, you‘«÷ll report 90846 (Family psychotherapy [without the patient present]) or 90847 (Family psychotherapy [conjoint psychotherapy] [with patient present]). ‘«£It is important it remember that the family psychotherapy codes are not based on the amount of time but rather whether the patient was present or not,‘«ō says Hammer. ‘«£The family psychotherapy codes should be reported only once for the patient, not for each of the family members in attendance.‘«ō

Ophthalmology Coding: Show Blepharoplasty Procedures Aren‘«÷t Always Cosmetic
Many ophthalmologists are not claiming legitimate reimbursement for medically necessary blepharoplasty, advises a recent article from The Coding Institute. Most insurers, the article says, including Medicare carriers, are predisposed to denying payment, and to assuming the procedure is cosmetic. However, they offer expert advice for successful claims such as:

Blepharoplasty Procedures Are Not Always Cosmetic

Whether or not a blepharoplasty procedure is cosmetic depends on the procedure and the patient‘«÷s main complaint. Procedures to remove excess skin and fat from the eyelids are frequently done due to medical necessity ‘«Ų but to support medical necessity and convince Medicare, you need to submit the correct codes and airtight documentation.

For blepharoplasty procedures, look to CPT?ę codes 15820-15823 (Blepharoplasty‘«™). Insurers cover blepharoplasty procedures 15822 (Blepharoplasty, upper eyelid) or 15823 (‘«™ with excessive skin weighting down lid) when the patient suffers from decreased vision or other specific medical problems.

But remember that CPT?ę codes 15820 (Blepharoplasty, lower eyelid) and 15821 (‘«™ with extensive herniated fat pad) are almost never covered. Insurers believe that excessive skin or fat in the lower eyelids do not usually obscure vision.

Keep Everything Documented
Keep this documentation in your blepharoplasty patient‘«÷s file:
– history and physical which documents the patient‘«÷s complaint extensively to support problems with performing activities of daily living (e.g., driving, reading, chronic eye irritation, etc.)
– operative report
– visual fields (taped and untaped)
– photographs (taped and untaped).

The visual field (VF) tests (92081-92083, Visual field examination, unilateral?Š or bilateral, with interpretation and report …) show the extent of the patient‘«÷s decreased vision. Most carriers want two sets of visual fields ‘«Ų one with the upper eyelid at rest and one with the eyelid taped up to demonstrate an expected improvement. Be sure to document both sets of results with the physician‘«÷s interpretation and report. Many LCDs state that the visual fields ‘«£must demonstrate a minimum 12 degrees or 30 percent loss of upper field of vision.‘«ō

Orthopedic Coding: Refine Your Post-Op Infection Coding with These 3 Examples
You could be sabotaging your claims for post-op infections if you aren’t well-versed on individual payers’ global policies and unsure of what modifiers to append, according to a recent article from The Coding Institute. Here are three common scenarios the article offers to facilitate better reporting of postsurgical infection billing:

Coding example 1: Several days following an open repair of distal fibular fracture, 27792 (Open treatment of distal fibular fracture [lateral malleolus], includes internal fixation, when performed), the patient develops a stitch abscess with drainage at the site of the incision. The patient schedules an unplanned visit to the office of the orthopedic surgeon. The surgeon prescribes antibiotics and a follow-up.

For a private payer that follows the AMA CPT?ę guidelines for post-operative complications, you would report an E/M service (such as 99213, Office or other outpatient visit for the evaluation and management of an established patient …) appended with modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period), if the payer requires you to do so. The modifier is usually needed because any service in the global is automatically denied within payer software systems.

Tip: Use the abscess as the diagnosis, not the reason for the open repair. You report this with code 998.59 (Other postoperative infection). The abscess diagnosis shows the ‘«£unrelated‘«ō reason for the E/M service. The modifier indicates that the payer does not include the service in the initial surgery‘«÷s global fee. Had the patient been covered by Medicare, however, the office visit counts as a part of the global package, and you cannot file an additional claim.

Coding example 2: A week following surgery, the surgeon readmits the patient to the hospital for IV antibiotics but does not take the patient back to the operating room. Once again, in this case, you may not report a separate service to Medicare, even though the orthopedist readmitted the patient. CMS guidelines specify that when the physician readmits the patient within the original surgery‘«÷s global period for complications of the original surgery, you cannot charge evaluation and management services for the readmission or for other E&M services if another physician admits the patient.

But for payers not following CMS guidelines, and follow the AMA CPT?ę guidelines, you may be able to report an appropriate admission code (for example, 99221, Initial hospital care, per day, for the evaluation and management of a patient …) with modifier 24 appended.

Coding example 3: The patient from example 1, who developed a stitch abscess, goes on to require an incision and drainage in the OR, for example, 10180 (Incision and drainage, complex, postoperative wound infection).

In this case, you should report 10180-78 for both Medicare and private payers. Don‘«÷t forget the diagnosis to consider is 998.59, to any CPT?ę codes you report.

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We‘«÷ve gathered an assortment of coding and billing tips from expert sources in a variety of specialties to help insure you‘«÷re receiving the maximum reimbursement available.

All Specialties

2013 New and Revised CPT Codes: Here Are the Changes Most Likely to Affect the Most Practices

Texas Medical Association

Here are some of the changes noted by the Texas Medical Association:

– Getting paid for time-based codes now requires passing the midpoint of the time specified in the code. For example, for a code that requires one hour, 31 minutes must be met to bill the time-based code, and it must be documented.

– Multiple new laboratory and pathology (81400-81408 and 81500-81599) codes have been added and coding descriptions for Tier II procedures revised.?ŠCheck the patient‘«÷s benefits and carrier medical policies for coverage, as some of the new codes are for screening a patient for the potential of developing specific conditions.

– Nerve conduction codes (95905-95913):?ŠSeveral codes have been deleted and new codes added.

These are only portion of the changes for 2013.?ŠBe sure to review the CPT 2013 guidelines for the above sections carefully and the sections with codes you use most often.?Š In addition, check with carriers for coverage requirements of the new codes and the patient‘«÷s benefits.



Avoid Surgery Center Claim Denials: 5 Expert Tips

Becker‘«÷s ASC Review

Here are five tips from ambulatory surgery center experts on optimizing billing operations and reducing claim denials from commercial payors, including:

1. Look out for bundled codes
2. Make sure no information is missing
3. Do not misuse modifiers.
4. Check for problem with the payor’s system
5. Work with coding professionals.

Read More



Check CCI Bundling for Motility Studies and Capsule ?ŠEndoscopy; Catch Pairing with Anesthesia and Injection Services

The Coding Institute

When your gastroenterologist performs a gastrointestinal transit and pressure measurement (91112, Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report) using a wireless capsule, you cannot report any other motility studies or a capsule endoscopy procedure that is performed concurrently. The latest round of Correct Coding Initiative edits (19.0) include a host of codes that you cannot report when you are reporting 91112:

– 91020 ‘«Ų Gastric motility [manometric] studies
– 91022 ‘«Ų Duodenal motility [manometric] study
– 91111 ‘«Ų Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus with interpretation and report
– 91117 ‘«Ų Colon motility [manometric] study, minimum 6 hours continuous recording [including provocation tests, e.g., meal, intracolonic balloon distension, pharmacologic agents, if performed], with interpretation and report

Avoid Reporting Therapeutic or Diagnostic Injections with 91112
The Coding Institute also advises that when your gastroenterologist performs gastrointestinal transit and pressure measurement, you cannot report any injection procedures that are performed in the same session, according to CCI edits 19.0, and provides a list of the codes you cannot report along with 91112 when these procedures are performed in the same session.



37211-37214 Focus on Initial, Subsequent, and Final Day for Non-Coronary Thrombolysis Coding

The Coding Institute

Thrombolysis coders trained to find 75898 reporting opportunities will need to develop new habits for 2013. As part of the non-coronary thrombolysis code update, related services all fall under 37211-37214. Here are the details:
2013: Base Code Choice on Vessel and Day
CPT?ę 2013 deletes 37201 and 37209, and replaces them with new options that include S&I. Because the new infusion codes include S&I, 75900 has been deleted for 2013. Codes 75896 and 75898 have not been deleted, but they have been revised to specify they apply to transcatheter therapy infusion ‘«£other than for thrombolysis,‘«ō says Julie Graham, BA, CPC, cardiology coder and compliance specialist for Concentra in Texas.

You‘«÷ll also notice that the new codes apply to an entire day of treatment. Use a ‘«£midnight to midnight time period,‘«ō stated Sean P. Roddy, MD, FACS, of the Society for Vascular Surgery and member of the AMA CPT?ę Advisory Committee, in the ‘«£Vascular Surgery and Interventional Radiology‘«ō presentation at the AMA‘«÷s CPT?ę and RBRVS 2013 Annual Symposium.



2013?ŠBrought New CCI Bundles, Many Targeting New CPT?ę Codes

The Coding Institute

Among their advice on the 2013 coding changes, The Coding Institute advises that OB/GYN coders pay attention to the modifier indicator to determine which ones you can override and which you can‘«÷t.

CCI 19.0, which took effect on January 1, 2013, added 37,587 new bundles and deletes 16, 716. Not surprisingly, many of the new CCI edits target new 2013 CPT?ę codes, and OB/GYN wasn‘«÷t spared any changes. Among those you should watch for:

Add These Column 2 Codes to 52287

You will find new Botox bladder injection CPT?ę code 52287 (Cystourethroscopy with injection[s] for chemodenervation of the bladder) has a variety of new codes that you should consider included in this service. These column 2 codes include:

– Anesthesia 00910 and 00916
– Category III codes 0213T, 0216T, 0228T, and 0230T
– Wound closure codes 12001-12057, 13100-13153
– Intravenous codes 36000, 36405-36406, 36410, 36420-36430, 36440, 36600, 36640
– Transcatheter therapy code 37202
– Gastic tube placement code 43752
– Catheterization codes 51701-51703
– Cystoscopic codes 52000, 52001, 52310, 52315
– Urethrotomy and meatotomy codes 53000-53025
– Urethral dilation codes 53600-53665,
– Pelvic exam under anesthesia code 57410.
– Injection codes 62310-62311, 62318-62319, 64400-64530
– Microsurgical technique code 69990
– Fluoroscopic codes 76000-76001, 77001-77002
– Echocardiography codes 93000-93010, 93040-93042, 93318
– Ventilation and oxygen codes 94002, 94200-94250, 94680-94770
– EEG codes 95812-95955
– Intravenous codes 96360-96365
– Therapeutic injection codes 96372-96376
– Moderate sedation codes 99148-99150
– Lidocaine HCL injection code J2001
– Catheterization for collection of specimen code P9612

Some of these noted edit pairs have a modifier indicator of ‘«£0,‘«ō which means you cannot separate these edits with a modifier. Others, like the wound closure codes, intravenous and venous codes, and 52001 (Cystourethroscopy and evacuation of multiple obstructing clots), have a modifier indicator of ‘«£1.‘«ō That means that you can use a modifier to override the bundling under specific clinical circumstances.



Immunization Coding Affected By Latest CCI Changes; Pay Special Attention to Influenza Vaccines

The Coding Institute

New restrictions to vaccine coding are the biggest area of interest to internal medicine physicians in the latest Correct Coding Initiative (CCI) edits. Here is the lowdown on CCI 19.0 and what you can ‘«Ű and can‘«÷t ‘«Ű report together during the same encounter:
Watch Whether Vaccine Is Reported or Ignored

Physicians often administer multiple vaccinations during the same encounter, but that doesn‘«÷t mean CCI edits allow you to bill for each immunization.

More than 30 mutually exclusive edits under CCI 19.0 involve pairs of immunization codes ‘«Ű particularly those for influenza and hepatitis.

A closer look shows that many of the edits involve two influenza codes and do not permit a modifier to override the edit. This is because it would not be clinically appropriate to administer two different influenza vaccines to the same patient on the same date. If you inadvertently report two influenza vaccines for the same patient on the same date, which one will be paid will depend on the pair that you report. For example, new code 90672 (Influenza virus vaccine, quadrivalent, live, for intranasal use) will be paid instead of other influenza vaccine codes 90653 ‘«Ű 90668 if reported with any of them. Note also that several of the codes are pending FDA approval:

– 90653 ‘«Ű Influenza vaccine, inactivated, subunit, adjuvanted, for intramuscular use
– 90661 ‘«Ű Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use
– 90666 ‘«Ű Influenza virus vaccine, pandemic formulation, split virus, preservative free, for intramuscular use
– 90667 ‘«Ű Influenza virus vaccine, pandemic formulation, split virus, adjuvanted, for intramuscular use
– 90668 ‘«Ű Influenza virus vaccine, pandemic formulation, split virus, for intramuscular use.

Careful: Some of the same influenza vaccine codes that are a Column 2 code in one edit may be a Column 1 code in other situations. Codes 90654-90668, for example, will always be paid instead of 90653 if listed for the same patient on the same date of service.

Hepatitis look: Edits also clarify that some hepatitis vaccines should not be administered (and reported) on the same day as other hepatitis vaccines. For instance, based on the CCI edits, physicians should not administer hepatitis B vaccine 90739 (Hepatitis B vaccine, adult dosage [2 dose schedule], for intramuscular use) during the same encounter as the following hepatitis vaccines:

– 90636 ‘«Ű Hepatitis A and hepatitis B vaccine (HepA- HepB), adult dosage, for intramuscular use
– 90723 ‘«Ű Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and poliovirus vaccine, inactivated (DtaP-HepB-IPV), for intramuscular use
– 90740 ‘«Ű Hepatitis B vaccine, dialysis or immuno- suppressed patient dosage (3 dose schedule), for intramuscular use
– 90743 ‘«Ű Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
– 90744 ‘«Ű Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
– 90746 ‘«Ű Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
– 90747 ‘«Ű Hepatitis B vaccine, dialysis or immuno- suppressed patient dosage (4 dose schedule), for intramuscular use
– 90748 ‘«Ű Hepatitis B and Hemophilus influenza b vaccine (HepB-Hib), for intramuscular use.

‘«£Like the influenza vaccine edits above, these edits make sense clinically. In each case, the Column 1 code already includes the Hepatitis B vaccine, and there is no clinical indication for administering two Hepatitis B vaccines to the same patient on the same date,‘«ō states Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians in Leawood, Ks.



Guidance for Heel Spur Treatment Claims Success

The Coding Institute

If you‘«÷re reporting heel spur excision as a lone procedure, you could be leaving money on the table. Your surgeon may be doing more than just an excision and not capturing those services means lost pay. Let the advice that follows guide you to accurate and complete claims. You report code 28119 (Ostectomy, calcaneus for spur, with or without plantar fascial release) if your surgeon excises a calcaneal spur. You report this code regardless of whether your surgeon makes release incisions on the stressed or irritated plantar fascia. You may read in the operative note to confirm any fasciotomy done by your surgeon.

If your surgeon removes a part of the calcaneus, you report code 28118 (Ostectomy, calcaneus).

Look for Casts and Devices
Check the procedure notes for details on any casts applied. Your surgeon may apply a walking cast at the time of the heel spur surgery. Keep in mind that the first cast applied at the time of surgery is a part of the global package; you may report subsequent casts, if any. For instance, for a short leg cast, you would report 29425 (Application of short leg cast [below knee to toes] walking or ambulatory type

Note: A change of cast in the global period requires you to confirm if there was a cause for the change. For example, your surgeon may decide to change the cast due to a pressure ulcer. In this case, you report 29425 for the cast and append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to the cast application code. In addition, you also report the diagnosis code 707.06 (Pressure ulcer, ankle), 707.07 (Pressure ulcer, heel), or 707.09 (Pressure ulcer, other site) depending upon where the pressure ulcer is located. If your surgeon documentation does not support the location of the ulcer, you may report code 707.00 (Pressure ulcer, unspecified site).

Cast applied later? You may read that your surgeon did apply a cast but only after the surgical excision of the heel spur was completed. For example, your surgeon may choose to defer the cast application due to excessive swelling, although this is fairly rare.

In this case, you‘«÷d append modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) to report the application of a cast in the physician‘«÷s office during the postoperative period. You may bill separately for a cast put on in the office.



92225-92226 Coding: Get to Know These Guidelines for Extended Ophthalmoscopy

The Coding Institute

Many ophthalmology coders aren‘«÷t clear on when it‘«÷s appropriate to report 92225 (Ophthalmoscopy, extended, with retinal drawing [e.g., for retinal detachment, melanoma], with interpretation and report; initial) or 92226 (…subsequent). The procedure pays about $27 each time, so mistakes can add up. Read on to see if one of the following EO myths could be taking money out of your practice‘«÷s pockets.

EO Is Not Always Included in Eye Exam

Routine ophthalmoscopy is included in a comprehensive eye exam (92004 and 92014), but according to the National Correct Coding Initiative, extended ophthalmoscopy isn‘«÷t. CPT codes 92225 and 92226 are not bundled into 92004 or 92014, as of the latest set of NCCI coding edits.

You might still see denials, however. Some carriers have a longtime edit in place not to pay for extended ophthalmoscopy when billed with 92014. If this is the case in your area, you will either need to bill the services and end up in the review and appeal process proving medical necessity.

Bilateral EO Requires Documentation
Despite what some coders may assume, carriers will not automatically pay twice the fee schedule amount for one eye if you report EO bilaterally.

Reality: Carriers will not pay double for bilateral EO unless you can justify medical necessity for performing EO on both eyes. If you‘«÷ve diagnosed a problem in one eye, don‘«÷t assume the other eye has the same diagnosis ‘«Ų although chances are it will. You must report ICD-9 codes showing medical necessity in each eye you performed EO on. The diagnoses don‘«÷t have to be different for each eye, but they do have to demonstrate medical necessity for the EO.



Faced with ADHD Claim Denials? Focus on These Strategies for Improved Results

When you report a follow-up visit for ADD (Attention Deficit Disorder) or ADHD (Attention Deficit Hyperactivity Disorder), do you submit an office visit code or a pharmacological management code? ‘«£Office visit‘«ō is the correct answer ‘«Ų and your ticket to avoiding denials and earning your deserved payment. Here‘«÷s why:

Remember E/M Is an Essential Component

When the neurologist spends time discussing complaints with the patient and/or family and does a physical examination before prescribing medication for ADHD, report an E/M code such as 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components ‘«™ Typically, 10 minutes are spent face-to-face with the patient and/or family) or 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components ‘«™ Typically, 40 minutes are spent face-to-face with the patient and/or family).

Tip: Carefully check the follow-up components. A neurologist will often do a medical examination prior to renewing a prescription. The patient may or may not be on psychotherapy in this case.

We hope you find the tips from these leading sources helpful. For additional help improving your medical billing and coding results, contact at 800-966-9270.

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Radiology Today: Coding Changes for 2013


The Centers for Medicare & Medicaid Services (CMS) has updated the final rules for Medicare payment, and they will have a significant impact on physician payments for diagnostic radiology services. Read More



This two-part article provides a good overview of common coding mistakes related to orthopedic practice, among others.

Common Coding Mistakes in Ambulatory Surgery Centers: Orthopedic & Pain Management (Part 1 of 3)

Procedural coding errors can lead to lost revenue or unintentional upcoding at ambulatory surgery centers.?Š Here are seven trouble areas for coding orthopedic and pain management procedures.?ŠRead More

Common Coding Mistakes in Ambulatory Surgery Centers: 6 Specialties to Know (Part 2 of 3)
Procedural coding errors can lead to lost revenue or unintentional upcoding at ambulatory surgery centers. This article elaborates on 12 trouble areas for coding various specialties. Read More



Summary of 2013 CPT Code Changes for Gastroenterology


Gastroenterologists will find several changes to their coding options, including:

  • Four New Codes – 43206, 43252, 44705, 91112
  • One Revised Code – 91111
  • One Deleted Code – 43234
  • New Category III Codes for Laparoscopic Implantation, Vagus Nerve Blocking Therapy for Morbid Obesity: 0312T, 0313T, 0314T, 0315T, 0316T, 0317T

To see all the changes and review the AMA Powerpoint presentation complete with explanatory anatomic images, visit



2013 CPT Wound Care Code Changes

By H. David Gottlieb, DPM

There are changes to the CPT codes and coding guidelines every year; I am presenting some of the changes for 2013 here for those who might not be aware of them. My information comes from the January 2013 issue of Advances in Skin & Wound Care, and includes:

1.?Š There are no longer degree-specific codes. All CPT codes are now available for all appropriately trained and licensed healthcare practitioners?ō or what’s now called a Qualified Healthcare Professional.

a.?Š That means no PT codes, no RN only codes, and the surgical codes are no longer physician-specific.

b.?Š As long as the code describes a procedure that is appropriate for a providers training and scope of practice it can be used by that qualified healthcare professional.

2.?Š What matters now is whether or not the code describes what was done; so when debriding necrotic tissue from a wound, the code to use is 97597–what used to be a PT-only code.

a.?Š The 1104x codes have been revised and are now for use only when billing for debridement of muscle, fascia, bone. They are not superficial wound codes anymore.

3.?Š Terminology changes:

a. ?ŠThe term “Providers” is now “Professionals”

b.?Š “Practitioners” is now “individuals”

c.?Š “Physicians” is now “qualified healthcare professionals” or “individuals”

Read More

Posted on August 10, 2012 by · Leave a Comment
Filed under: Orthopedics  

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It‘«÷s time for the good news folks! The orthopedics coding routines have been made a little simpler by the AMA and CPT. As such, around 89 modifications were made to the chapter containing the musculoskeletal system codes. Additionally, new codes were added to improve the understanding of the condition. Not to mention, about 8 codes from the 31 new codes accurately describe the arthroscopic surgery. Meaning, you no longer need to use the unlisted procedure codes for the surgeries. The major challenge that lies ahead is the modification of encounter forms and charge sheets to make them adapt to the new coding environment. This article will list a number of old codes and revised codes along with new codes regarding the orthopedics coding routines. On the other hand, there are even minor changes made to the codes that would change the nature of the same. For instance, slightest grammatical changes and even the punctuations may seem quite challenging. Let‘«÷s view the code 20225 for instance. This code reports the biopsy bone trocar during the orthopedics coding routines. The changes made here is a little confusing since it is only the addition of “e.g.‘«ō This essentially tells the carrier that a deep bone biopsy was performed initially by the surgeon and is not restricted to the femur.

Orthopedics coding: revised codes

The code group 21182-21184 suffered minor changes. This group basically reported the reconstruction of orbital walls. An example for this would be the fibrous dysplasia. Additionally, the size of area of bone grafting determines the code choices in this case. Initially the measurements were reported in centimeters. But now, after the revision, the measurements are reported in square centimeters during the orthopedics coding routines. On top of that, codes were added to the injection section which is the 20000 series. The new modification improves the injection level coding making it possible to report the carpal canal injections and trigger-point injections. Initially the code 20526 reported the therapeutic injection during the orthopedics coding process. An example would be local anesthesia corticosteroid. Another important code in this regard is 20550 which reported the injection concerning the tendon cyst. Additionally the code 20551 reported the insertion or tendon origin.

Hope the above article titled ‘«ˇOrthopedics coding guide to understand the changes in musculoskeletal system codes‘«÷ was simple and friendly. Thanks for visiting.



Posted on August 10, 2012 by · Leave a Comment
Filed under: Orthopedics  

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Over the years, many changes have been made to the codes concerning the orthopedics billing routines in order to simplify the process. Let‘«÷s discuss some of the important modifications in this regard. The code 20552 was introduced by the CPT to report the single trigger injection. This also reports the multiple trigger injections as well. Here, more than one muscle group is involved. The code 20553 reports the trigger injections where three or more muscle groups are involved. In order to make things clear, CPT has added certain changes to some of the existing codes. On top of that, certain codes have been rewritten and terms of others have been erased. For instance, the code 21750 reported the median sternotomy separation and closure during the orthopedics billing process. This may include the debridement as a separate procedure. The code 23000 reported the subdeltoid calcareous deposit removal. You must note that this is an open procedure according to the CPT. On the other hand, the code 23350 reported the injection procedure. This code includes the other procedures such as MRI shoulder arthrography. You can use the code 27447 to report the knee condyle arthroplasty during the orthopedics billing routines.

Orthopedics billing guide: coding the Elbow

The elbow section has been made simpler compared to the previous years. Additionally, changes were made to the humerus section also. Medical experts agree that this section was one of those remote parts where no changes were made for many years. In short, you don‘«÷t need to use the unlisted procedure codes which in most cases create additional problems. You can use the code 24075 to report the excision of soft tissue tumor. The location for the procedure is the upper arm. You can use the code 24076 to report the deep excision of the same site during the orthopedics billing procedures. Another important code in this regard is the 24300. This is used to describe the anesthesia manipulation. On top of that, the code 24332 reports the tenolysis triceps. To report the repair of lateral collateral ligament, you can use the codes 24343. You can use the code 24344 to report the reconstruction of the elbow with the help of tendon graft during the orthopedics billing routines.

Hope the above article titled ‘«ˇOrthopedics billing guide regarding the recent coding modifications‘«÷ was easy to understand.. Good day folks!


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