CCI 18.0 Edits Update: Latest CCI Edits Nix Anesthesia With New Neurostim Array Codes   (January 2012)

TPI and tendon injections override 100+ other procedures. Now that 2012 is here, it’s time to put those new procedure and diagnosis codes to use – and see which ones are affected by the latest Correct Coding Initiative (CCI) edits. CCI 18.0 effective Jan. 1, 2012, changes how you should report anesthesia services for two new Category III codes and some long-time injection procedures. Report Anesthesia, Not Neurostim Electrode Array CCI 18.0 includes 544 edits listing [...]

Modifiers: Use This 4 Step Plan to Justify Reporting Modifier 23   (January 2012)

Tip: Watch for patient-specific details to support unusual circumstances.If your anesthesiologist provides service above and beyond the norm for a case, you might be able to append modifier 23 (Unusual anesthesia) to the procedure code. Reporting modifier 23 doesn’t affect your reimbursement, but payers do have rules regarding modifier 23’s use. Follow these four steps to ensure your claim meets certain criteria and won’t kick back as an automatic denial. 1. Dissect the Descriptor The [...]

Compliance: Let These 3 FAQs Guide Your ICD-10 Implementation Efforts   (January 2012)

Part of your 2012 plan should include focusing on your most common codes.Despite recent rumors, CMS has no intention of delaying the implementation of ICD-10 beyond the Oct. 1, 2013 date, according to CMS’s Kyle Miller. That means every physician group should be taking steps toward the transition. Keep moving in the right direction with three top FAQs based on CMS representative comments in recent CMS ICD-10 teleconferences. Know Penalties for NonparticipationQuestion: What are the [...]

ICD-10: Prepare for ‘Greater Detail’ Pneumothorax Codes in 2013   (January 2012)

But first, fifth-digit requirements on NOS go into effect next year.When a patient experiences accumulation of air or gas in the pleural space, which may occur spontaneously or as a result of trauma or a pathological process, your anesthesiologist might be present during surgery to correct the problem. Under ICD-9, you would choose diagnosis 512.x (Pneumothorax).ICD-10 difference: When ICD-9 transforms to ICD-10 on Oct. 1, 2013, you will modify your pneumothorax coding from 512.x to [...]

You Be the Coder: Narrow Choices for Lumbar Cath Placement With Follow-Up   (January 2012)

Question: Our anesthesiologist placed a lumbar plexus catheter for anesthetic, and made visits to check on the patient for several days afterward. Should we report 01996 or 64449?Mississippi Subscriber Answer: If the catheter placement was the only service the anesthesiologist provided, code with 64449 (Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter [including catheter placement]). Code 64449 no longer has any associated global days, and an evaluation and management (E/M) code that [...]

Reader Question: Look to Payer Policy For 01967/+01968 Claim   (January 2012)

Question: The anesthesiologist started an epidural for a Medicaid patient on Nov. 3, then the patient needed a c-section on Nov. 4. Medicaid won’t accept the charge for 01967 on Nov. 3 and 01968 on Nov. 4. How do we handle the claim? Kentucky SubscriberAnswer: Submit a paper claim with a copy of the anesthesia record documenting your physician’s service. Include a note such as “delivery spans into day 2″ and point out the dates [...]

Reader Question: Codes 62310-62319 Apply to Intrathecal Injection   (January 2012)

Question: The anesthesiologist administered an intrathecal injection prior to a patient’s hip replacement surgery. What code do we use for intrathecal injections with Duramorph? Florida SubscriberAnswer: You’re reporting an epidural injection, so will need to check the injection site and whether the physician administered a single-shot or continuous epidural. Once you have that information, choose from the four common epidural options: 62310 – Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), [...]

Reader Question: Compare Charts to Decide on 76 or 78 for Second Surgery   (January 2012)

Question: A patient had a CABG procedure, then had to return to surgery later the same day because of complications. The same anesthesiologist handled both cases. The insurance company is denying our second claim with 00560 and modifier 78 as a duplicate claim. Someone suggested we resubmit with modifier 59 so it will be paid. What should we do? Nebraska SubscriberAnswer: Compare the two operative reports to determine whether the surgeon performed the exact same [...]

Reader Question: Payer Determines Whether Basic Anesthesia Covers TEE   (January 2012)

Question: Is transesophageal echocardiography included in basic anesthesia administration services?Alabama Subscriber Answer: If your payer applies Correct Coding Initiative (CCI) edits, you will be able to bill for intraoperative transesophageal echocardiography (TEE) codes, provided the service is diagnostic and not for monitoring. Payers who apply CCI allow providers to bill for the probe placement when they perform and document a diagnostic TEE during anesthesia. What to do: To report the diagnostic service, look to TEE [...]

Reader Question: Start With 29825 When Coding for ‘Frozen Shoulder’   (January 2012)

Question: Our anesthesiologist participated in a procedure for the arthroscopic release of adhesions to a patient’s shoulder that included manipulation. What do I need to include to code correctly for this?Georgia Subscriber Answer: Start with finding the code for the procedure to release the patient’s “frozen shoulder,” as this condition is also known, because a lack of synovial fluid prevents the subject’s shoulder from moving properly. For this procedure, choose 29825 (Arthroscopy, shoulder, surgical; with [...]