Reader Question: Opt For Higher Base, Not Multiple Codes   (January 2012)

Question: Should I include any modifiers when submitting claims for a double procedure, such as an upper and lower endoscopy performed during the same session?Wisconsin Subscriber Answer: When your physician provides anesthesia instead of performing the procedure, you should only report one code for his service (with the exception of a few services such as Swan-Ganz line placement, 93503, Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes). Choose the procedure with [...]

Reader Question: Start With RVU Order for Better Billing   (January 2012)

Question: I know that as a general rule the highest RVU has a higher billed amount and that when you bill you should always put the highest amount first. But when it comes to bilateral surgeries is it true that you would sometimes be prudent to put another procedure first because a bilateral code that was done bilateral/unilateral would still be paid at a reduced allowable? Texas Subscriber Answer: Yes, you should sometimes put another [...]

Reader Question: Don’t Get Too Comfortable With 5010 Grace Period   (January 2012)

Question: I saw that CMS moved the 5010 implementation deadline to March 31 – which we were glad to see, because our practice wasn’t quite ready for it on Jan.1. Can you tell us more about that? Rhode Island Subscriber Answer: CMS gave an early holiday gift of sorts to practices by announcing on Nov. 17, 2011, that it would not initiate enforcement action regarding 5010 until March 31, 2012. The official compliance date remained Jan. [...]

Claims Submission: Start Calculating Minutes — Not Units — to Prevent Payment Delays   (December 2011)

5010 standards lead to universal time reporting rules effective Jan. 1. While all physicians will be affected when the 5010 claims form goes into effect, the transition brings one monumental change specific to anesthesia providers. Beginning Jan. 1, 2012, the new standards for electronic claims submission will require you to report all anesthesia time in minutes instead of units. Read on for advice on how to ramp up fast and keep payment flowing. Background: For [...]

Diagnosis Coding: V Codes Might Hold the Answers to Tricky Anesthesia Situations   (December 2011)

Don’t shy from submitting the same V code as surgeons.If you avoid the V code section of ICD-9 because you aren’t sure whether the choices apply to anesthesia claims, it’s time to take a closer look. V codes provide additional information and specificity, which can help get a claim paid. Remember Both MDs Can Report V’sThe surgeon and anesthesiologist can both submit the same V code for a patient’s primary diagnosis or to help explain [...]

Fee Schedule: Prepare for 26.2 Percent ACF Cut in 2012, if Congress Doesn’t Step In   (December 2011)

Plus: National Medicare CF could drop 27 percent.Get ready to end another year wondering how much your Medicare payments will be reduced in 2012. According to the 2012 Medicare Physician Fee Schedule Final Rule printed in the Federal Register on Nov. 1, the 2012 national anesthesia conversion factor (ACF) will be $15.5264 unless Congress acts to avoid the cut. An ACF of $15.5264 represents a 26.2 percent decrease from the national ACF in 2011, due [...]

ICD-10: 455 to I84 Diagnosis Shift Means 2 More Digits   (December 2011)

Tip: Look for complication first before coding in 2013.You’ll need to compare your anesthesiologist’s notes with those of the surgeon even more often when coding for hemorrhoid cases, effective Oct. 1, 2013. That’s because the new code set adds codes for “internal and external” in addition to codes for internal, unspecified, or external hemorrhoids. But that’s not the only change you’ll see when you go to choose a hemorrhoid diagnosis in ICD-10. Hierarchy counts: ICD-9 [...]

ICD-10 News: CMS Clarifies How to Report Services That Span ICD-10 Implementation Date   (December 2011)

As practices prepare for ICD-10 implementation on Oct. 1, 2013, one practical question keeps resurfacing: How should you report diagnosis codes for claims that begin on dates of service before Oct. 1, 2013, but don’t end until Oct. 1 or later? Example: The anesthesiologist begins administering continuous anesthesia for a surgery at 11 p.m. on Sept. 30, 2013. His involvement in the case ends at 2 a.m. on Oct. 1, 2013. CMS has said you [...]

Correction: Double Check New Gastric Band, Respiratory Failure ICD-9 Codes   (December 2011)

New 539 family offers more choices.Several surgical additions to diagnoses in ICD-9 2012 could come in handy for your anesthesia coding. A few codes were incorrectly listed in Anesthesia Coding Alert Vol. 13, No. 9. The corrected code families of interest include: Infection or complications due to gastric band or bariatric procedures (539.01-539.89) Acute or chronic respiration failure, in normal circumstances or following trauma and surgery (518.51, 518.52, 518.53).

You Be the Coder: Choosing Between Modifier QS and Moderate Sedation   (December 2011)

Question: Would you explain the difference between MAC (monitored anesthesia care) and IV sedation? I know we use modifier QS with the anesthesia code for MAC. Should we report both types if our physician indicates IV sedation?Massachusetts Subscriber Answer:  Modifier QS (Monitored anesthesia care service) only applies to anesthesia codes (not surgical codes) and does not cross to the moderate sedation codes.CPT includes six moderate (conscious) sedation codes that differ according to the patient’s age [...]