Specialists, take note of these valuable tips for improving your coding, for cardiologists, neurologists, OB/GYNs, ophthalmologists and others.
Coding for Acute Coronary Syndrome
Acute coronary syndrome (ACS) is classified to ICD-9-CM code 411.1, which is the same code assigned for unstable angina. It is vital to review the entire medical record to make sure the information presented supports the final code assignment. Therefore, if the record contains evidence that the patient may have experienced an AMI but only ACS is documented, then it may be appropriate to query the physician for clarification of the final diagnosis. Final code assignment always is based on physician documentation… Read More
The Coding Corner: Coding for an Incomplete Colonoscopy
Medicare rules for coding colonoscopy differ from American Medical Association (AMA) rules, particularly with regard to “incomplete”ť colonoscopies. For a Medicare patient undergoing a screening colonoscopy, if the surgeon is able to advance the scope past the splenic flexure, consider the colonoscopy “complete”ť and report the appropriate code… Read More
Modifier Indicators: Keys to Success for 64615 Edit Pairs
The latest Correct Coding Initiative (CCI) edits–version19.1, effective April 1, 2013–introduced a number of edits for new chemodenervation code 64615 (Chemodenervation of muscle[s]; muscle[s] innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral [e.g., for chronic migraine]). Read on for the rundown of how the changes could affect your pain management coding.
Check Whether a Bypass Is Possible
Some of the edits involving 64615 can be “bypassed”ť by appending a modifier in order to report both procedure codes. You can’t slip past the edit for other pairs, however, so pay attention to the assigned modifier indicators.
Bypass option: Approximately 20 other edits involving 64615 are classified with modifier indicator “1″which means you can sometimes append a modifier to break the edit and report both services. The most appropriate modifier will depend on the situation, but coders often turn to modifier 59 (Distinct procedural service).
Some of the edits in these pairs that you might be able to unbundle and report with 64615 include:
- 92585 - Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive
- 95822 - Electroencephalogram (EEG); recording in coma or sleep only
- 95907-95913 - Nerve conduction studies
- 95925 - Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs
- 95928 - Central motor evoked potential study (transcranial motor stimulation); upper limbs
- 95938 … - in upper and lower limbs.
How to Avoid Making Modifier 22 Mistakes
Appending modifier 22 (Increased procedural services) may be something you think you’ve got down pat, but that doesn’t mean your coding will always be error-proof.
The following three modifier 22 tips will clarify how much longer a procedure should take to append modifier 22, if you can use an unlisted procedure code instead, and whether you have regular CPT® code alternatives.
1. Some experts suggest that you shouldn’t use modifier 22 unless the procedure takes at least twice as long as usual. Several memorandums from Medicare carriers indicate that time is an important factor when deciding to use this modifier. The additional time and work must be significant. Rule: A procedure should take at least 25 percent more time and effort than usual.
2. Using an unlisted-procedure code instead of modifier 22 is a big mistake. Some coders go this route because they think the payer will manually review such claims and the carrier’s computer cannot automatically deny them. But you could be setting your practice up for missed reimbursement, because quite a few insurers will deny the service on first submission–which will lead to appeals. Conversely, all claims that go in with a modifier 22 will be reviewed.
3. Instead of attaching modifier 22 when a procedure is above and beyond its normal scope, you should consider reporting a CPT® code that more specifically explains why the procedure was prolonged or unusual. In other words, before you use modifier 22, you should always look to see if there’s another CPT® code that more accurately reflect the work the OB/GYN did.
Include Lens Fitting In These Cornea Codes
If your ophthalmologist is using a relatively new code for the fitting of a therapeutic contact lens, you will need to know the new CCI rules.
According to the new set of CCI edits, CPT® code 92071 (Fitting of contact lens for treatment of ocular surface disease), introduced in 2012, is now bundled into:
- 65220-65222 - Removal of foreign body, external eye …
- 65275-65286 - Repair of laceration …
- 65400 - Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium
- 65410 - Biopsy of cornea
- 65420 - Excision or transposition of pterygium; without graft
- 65426 - Excision or transposition of pterygium; with graft
- 65430-65600 - Removal or destruction procedures on the cornea
- 65710-65757 - Keratoplasty procedures on the cornea
- 65760-65782 - Other procedures on the cornea.
These edits all carry a modifier indicator of “1″,ť meaning that you can use a modifier to break the bundle under the appropriate clinical circumstances, and report the two bundled codes separately.
For more information on the Correct Coding Initiative, visit http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html?redirect=/nationalcorrectcodinited/.
3 Steps to Sharpen Your Skills for Strapping Codes
A simple treatment like strapping could really tie you in knots–if you’re not clear on some coding fundamentals. Take these three steps to strapping coding success.
1: Understand Unna Boot, Buddy Tape Definitions
Before you go ahead and assign a code for strapping, you’ll need to understand how your payer defines strapping. Strapping may be done to support and/or restrict movement of ligament structures by exerting pressure upon the extremity or other area of the body.
Unna boot application is one method of strapping. An Unna boot is a type of paste bandage.
The Unna boot bandage restricts the volume of the distal lower extremity, controls edema, and promotes venous blood return. You report Unna boot application with (29580, Strapping; Unna boot).
A common mistake is to overlook the removal of an Unna boot. Check if the removal was done by same or another provider. Removal of an Unna boot applied by another provider outside the practice may be reported using CPT® code 29700 (Removal or bivalving; gauntlet, boot or body cast).
Remember: Confirm with your payer specific reporting guidelines for Unna boot removal.
Another example of strapping is buddy tape or “buddy splint.” Buddy straps are prefabricated straps made of canvas or foam and Velcro and are reported with codes 29280 (Strapping; hand or finger) or 29550 (Strapping; toes).
Step 2: Look to Body Area for Code Selection
CPT® arranges strapping codes by body area. Begin with code family 29000-29799 (Application of casts and strapping), then narrow your code choices by anatomic area (body, upper extremity, or lower extremity). Each anatomic section has options for splints, casts, and strapping. In particular, the strapping codes are in ranges 29200-29280 (body and upper extremity) and 29520- 29590 (lower extremity).
Step 3: Keep Up With Payers’ Supplies Guidelines
Payers support strapping when the physician has stabilized a joint with non-rigid materials allowing the patient to retain some range of motion, such as tape, web rolls and possibly an elastic (e.g., ACE) bandage. But the sole use of elastic bandages as strapping may be controversial among certain payers. Check with your payer to see if specific codes are applicable.
Avoid Separate Imaging with Thoracentesis
Thoracentesis is a puncture made between the ribs into the pleural cavity to aspirate or remove accumulated fluid (pleural effusion) from the chest cavity. A needle attached to a syringe is introduced through the skin and chest wall until it penetrates the pleura.
For 2013, CPT® deleted 32421 and 32422, previously used to describe thoracentesis, and replaced them with two new codes… Read More