Reader Question: Turn to Q5 for Vacation-Coverage Billing   (November 2011)

Question: One physician from our group covered another physician’s days while he went on vacation. Whose name should appear on the claim?Florida SubscriberAnswer: You may submit the claim in the vacationing physician’s name and receive payment, according to section 30.2.10 of Chapter 1 of the Medicare Claims Processing Manual (www.cms.gov/manuals/downloads/clm104c01.pdf). There are, of course, several conditions the visit must meet, which you can read about in the manual. One condition you want to be sure [...]

Cardiac Anesthesia: Clarify CABG Coding With 4 Do’s and Don’ts   (October 2011)

Tip: Surgeon’s documentation can also help your coding accuracy. When coding for anesthesia during coronary artery bypass graft (CABG) procedures, factors such as the patient’s age and whether physicians used specialized equipment during surgery can affect your reporting. You’ll be on your way to pain-free CABG coding if you remember three do’s – and one don’t – offered by cardiac anesthesia coder Judy A. Wilson, CPC, CPC-H, CPC-P, CPC-I, CANPC, CMBSI, CMRS, business administrator for Anesthesia Specialists, [...]

Pain Management Corner: Follow Treatment Site to Find Correct Codes for Trigeminal Neuralgia   (October 2011)

Tip: Narrow anatomy options to simplify code selection.When your pain management specialist treats trigeminal neuralgia, verifying the site and structure approached makes all the difference in your coding. Make coding – and obtaining correct pay – easier by following four simple steps. 1. Brush Up On Anatomy BasicsKnowing cranial nerve anatomy simplifies your code selection. The trigeminal nerve is the largest cranial nerve, and is a mixed nerve with a predominant sensory component. It mainly supplies innervations [...]

ICD-10 Prep: Focus on A&P When Prepping for ICD-10 Conversion   (October 2011)

Analyze your practice’s top 30 diagnoses to get a head start toward compliance.Education is an important part of preparing for ICD-10 implementation, but don’t spend your time trying to memorize code sets. That was the advice Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, shared with attendees at the AAPC’s regional conference in Nashville Sept. 7-9. Buckholtz is vice president of ICD-10 education and training at AAPC and led a general session at the [...]

ICD-10: Prepare for More Detailed DVT Code Choices With I82.4-   (October 2011)

Check all records for documentation of right, left, or bilateral.ICD-10 will bring code changes for every specialty, but cardiology will be especially affected. When your anesthesiologist participates in surgery to treat deep vein thrombosis (DVT) after October 2013, be prepared to choose from much more detailed diagnosis options. Currently ICD-9-CM includes one code for DVT: 453.42 (Acute venous embolism and thrombosis of deep vessels of distal lower extremity). ICD-10 will expand to 12 choices: I82.441, [...]

You Be the Coder: Crosswalk Confusion for 64483   (October 2011)

Question: We crosswalked 64483 to anesthesia code 01992, but the payer denied our claim. What should we do differently?Colorado Subscriber Answer: The ASA Crosswalk changed the anesthesia code associated with 64483 (Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level) in 2011. The previous crosswalk was 01992 (Anesthesia for diagnostic or therapeutic nerve blocks and injections [when block or injection is performed by a different provider]; [...]

Reader Question: Yes, You Can Report 77003 With 62311   (October 2011)

Question: Medicare denies our claim when we bill 62311, 77003, and 64483 together. The physician performs the separate injections on the same day and uses fluoroscopic guidance for the epidural. Medicare denies the 77003 as bundled. We know it is bundled into 64483, but it’s not bundled into 62311. How should we handle this situation? Massachusetts Subscriber Answer: Assuming the provider performs the epidurals at separate levels, your claim should include three lines: 64483 (Injection, [...]

Reader Question: Code Line Placement Even if Standby Won’t Fly   (October 2011)

Question: The anesthesiologist placed an IV for saline and monitored the patient’s vital signs, but did not administer any anesthesia agents. We cannot report 99360 because the anesthesiologist was directing CRNAs at the same time. Can we report anything for his work? South Carolina SubscriberAnswer: You are correct in saying you can’t report 99360 (Physician standby service, requiring prolonged physician attendance, each 30 minutes [e.g., operative standby, standby for frozen section, for cesarean/high risk delivery, [...]

Reader Question: Verify Whether Multi-Service Claim Needs -59   (October 2011)

Question: A patient came to the office for treatment of L3 radiculitis and ankylosis. The pain management specialist administered a transforaminal epidural steroid injection and an SI joint injection during the same session because the patient is on long-term anticoagulants and would be at risk for DVT if the anticoagulants had to be repeatedly stopped and restarted. He used epidurography to confirm epidural spreading and fluoroscopic guidance to assist with the joint injection. The payer [...]

Reader Question: Multiple 01992 Is Allowed for Multiple Providers   (October 2011)

Question: One of our providers is billing 01992-QY and 01992-QX for a diagnostic spinal injection with a time of 6 minutes. Neither the anesthesiologist nor the CRNA performed the actual injection. The documentation supports conscious sedation. Are they both entitled to bill 01992? New Jersey Subscriber Answer: Yes, you can bill 01992 (Anesthesia for diagnostic or therapeutic nerve blocks and injections [when block or injection is performed by a different provider]; prone position) for both [...]