Tip: Remember modifier 59 is your friend. You’ve been busy applying new and revised procedure or diagnosis codes, but don’t forget the coding guidelines associated with CPT®, HCPCS, or other sources. Case in point: The 2012 Correct Coding Initiative (CCI) coding guidelines include information about reporting post-operative pain management that your anesthesia providers will need to know. Read on for details, thanks to a guideline analysis from Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner of [...]
Avoid These Hot Spots When Coding Burn Care (February 2012)
Hint: Anesthesia coders follow the same tactic as surgical coders. Coding for burns that affect several anatomic areas can get tricky, but that doesn’t mean your claims should go up in smoke. Keep two key points in mind, and you’ll be on your way to correctly reporting your anesthesiologist’s service. Watch the Diagnosis The surgeon will assess burn severity as first, second, or third degree. First-degree burns usually only redden the skin, while second-degree (partial [...]
Clip and Save: Follow This Tool to the Best Modifier for Same-Day Services (February 2012)
A few simple questions help point you in the right direction. If your practice keeps getting dinged for reporting same-day services, it’s time to investigate the reason. Incorrect modifiers can cause many claims errors, especially when you need to determine the most appropriate modifier to explain the clinical circumstances to the payer. The answer: Use this flowchart to quickly assess some of the most common modifier assignments before starting your appeals.
ICD-10: Prepare Now to Separate ‘Burns’ from ‘Corrosions’ (February 2012)
ICD-10 will keep additional TBSA code.Coding burns based on body site and “degree” plus an additional code for total body surface area (TBSA) won’t change when you start using ICD-10 in Oct. 2013. The new detail you’ll include will be reporting the cause of the burn. ICD-10 Distinguishes Burn SourceUnder ICD-9, a burn is a burn. ICD-10 offers another option by giving you the choice of “corrosion,” or chemical burn. Example: Let’s say a patient [...]
You Be the Coder: Modifier 78 Might Not Be Best for OR Return (February 2012)
Question: We have a two-surgery claim for a patient, with the payer denying the second procedure. We billed 00942 (Anesthesia for vaginal procedures [including biopsy of labia, vagina, cervix or endometrium]; colpotomy, vaginectomy, colporrhaphy, and open urethral procedures) for the primary procedure. She experienced post-op bleeding and returned to surgery several hours later, for 55 minutes. A different anesthesiologist from our group participated in the second procedure and billed 00400 (Anesthesia for procedures on the [...]
Reader Question: Choose 01992 or 01992 for Second MD’s Anesthesia During Block (February 2012)
Question: We’ve had several charges lately for epidural injections under anesthesia. The physician administering the injection is not affiliated with our anesthesia group, and did not document any type of guidance. One of our physicians handled the anesthesia. What anesthesia code should we report? Rhode Island SubscriberAnswer: According to the American Society of Anesthesiologists, anesthesia care for epidural steroid injections is warranted only in unusual circumstances, such as “major co-morbidities and mental or psychological impediments [...]
Reader Question: Select Separate Codes for Separate Puncture, Chemo Admin (February 2012)
Question: Our anesthesiologist worked with the oncologist on a case involving a lumbar puncture and intrathecal chemotherapy. The anesthesiologist completed the lumbar puncture and the oncologist completed the chemotherapy administration. Code 96450 includes both services, so we tried filing with modifier 80 and modifier 62. The payer denied everything. How should we report the procedure for both physicians?North Carolina Subscriber Answer: Does the documentation indicate why the bundled service was provided separately by the anesthesiologist [...]
Reader Question: Follow Month, Not Year, for ‘Birthday Rule’ (February 2012)
Question: I just received a call from a patient’s parent claiming that we didn’t follow the birthday rule when we billed the mother’s insurance. The mother’s birthday is 09/30/1965 and the father’s birthday is 11/30/1958. The mother says that since the father is older, we should have billed his insurance rather than hers. What is the birthday rule and whose insurance should we have billed?Iowa Subscriber Answer: You’ll only follow the “birthday rule” in determining [...]
Reader Question: Choose 36556 for Subclavian Vein Catheter (February 2012)
Question: One of our physicians is asking about the correct code for placement of a central line with a catheter that runs through the external jugular and ends in the subclavian vein. He wants to confirm that we should bill 36556. Normally with a central line, the physician uses a guidewire for placement, but he did not use one in this case. Is the external jugular considered peripheral or central? What’s the proper code for [...]
Reader Question: Check Date of Service Before Filing 27096 With Fluoro (February 2012)
Question: Some of our payers deny 77003 when we bill it with SI joint injections during the same session. I realize the fluoroscopy isn’t payable with facet joint injections anymore, but shouldn’t we get paid for the SI joint injection? Texas Subscriber Answer: Your first step in determining whether you can bill the fluoroscopy and sacroiliac (SI) joint injection separately is to check the date of service.Effective Jan. 1, 2012, fluoroscopy is included with the [...]
