CCI 18.0: 93279-93299 Guidelines Are Bolstered by Latest Bundles   (January 2012)

Edits reveal how CMS expects you to use 2012 codes.January 1 doesn’t just mean the switch to new CPT® codes. It also means the release of Correct Coding Initiative (CCI) edits that incorporate all those new codes.This round of edits became effective Jan. 1, 2012, for physicians. The edits are intended for use by Medicare, but many private payers adopt them, too. “For version 18.0, 15,530 new edit pairs have been added to the database [...]

ICD-10-CM: 424.1 Splits Multiple Ways Under the New Code Set   (January 2012)

Watch for when combo codes are most appropriate.The switch to ICD-10-CM on Oct. 1, 2013, doesn’t sound so far away now that 2012 is here. To be sure your practice is ready to report aortic valve disorders, check out how the new code set divides this diagnosis.ICD-9-CM Code424.1, Aortic valve disordersICD-10-CM CodesI35.0, Nonrheumatic aortic (valve) stenosisI35.1, Nonrheumatic aortic (valve) insufficiencyI35.2, Nonrheumatic aortic (valve) stenosis with insufficiencyI35.8, Other nonrheumatic aortic valve disordersI35.9, Nonrheumatic aortic valve disorder, [...]

Errata: 99358-99359 Become Clearer With ‘Qualified Health Care Professional’ Definition   (January 2012)

The impact on 90460-90461 has some practices unhappy.At the request of many physicians, CPT® 2012 now defines the term “other qualified healthcare professional.” Although this definition didn’t make it into the 2012 manual, the AMA lists it as part of the “CPT® 2012 Errata” on its website (www.ama-assn.org/resources/doc/cpt/cpt-corrections.pdf). The definition is as follows:“A ‘physician or other qualified health care professional’ is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging [...]

You Be the Coder: 410.31 or 410.32 for Follow-Up?   (January 2012)

Question: The patient is seen in the hospital for a 410.31, and then is discharged. The patient is scheduled to be seen in the office for a follow-up visit. For this follow-up visit, which is less than 8 weeks from the myocardial infarction, is it appropriate to use the fifth digit of “2″ on the MI (410.32), or would you still use 410.31?SuperCoder.com MemberAnswer: You should use 410.32 (Acute myocardial infarction of inferoposterior wall; subsequent [...]

Reader Question: 36245-36248 Land on Selective Cath List   (January 2012)

Question: I’m new to the peripheral vascular side of coding, and I’m having trouble distinguishing between nonselective and selective vascular services. What exactly distinguishes the two types?Wisconsin SubscriberAnswer: In peripheral procedures, you may see any of the following: Non-selective: The physician places a needle or catheter directly into an artery or vein with no further advancement (for example, a direct stick or direct puncture) past the punctured vessel, OR the physician places a catheter into [...]

Reader Question: 368.10 Joins Palmetto LCD ICD-9 Options   (January 2012)

Question: I saw a notice that our LCD for Noninvasive Vascular Testing (L31712) was revised. How has it changed?North Carolina SubscriberAnswer: The Palmetto GBA local coverage determination (LCD) you refer to has had two revisions since September. Both add ICD-9 codes supporting coverage for a variety of services. Effective for dates of service on or after Sept. 1, 2011, the LCD added multiple diagnosis codes supporting noninvasive vascular testing. The LCD pairs specific ICD-9 codes [...]

Reader Question: 93015 Includes Stress Agent Admin   (January 2012)

Question: When we perform stress tests, may we report an injection code for the administration of the pharmacologic agent?Virginia SubscriberAnswer: No, you should not report a separate injection code to represent administration of a pharmacologic agent during a stress test. You should consider the administration included in the stress test code, such as 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with [...]

Electrophysiology: 33202-33211 Get Bulked Up Guidelines in 2012   (December 2011)

Hint: Understanding RS&I coding is the key to denial prevention.The huge number of changes to CPT®’s pacemaker (PM) and implantable cardioverter-defibrillator (ICD) section is challenging even veteran coders. You can simplify the switch by breaking the changes into manageable chunks and mastering one group before moving to the next. This article will focus on changes to 33202-33211. Verify Provider Before Reporting 33202-33203When reviewing 33202-33211 in the 2012 manual, the first change you’ll notice is a [...]

E/M 2012: Nip New Patient Questions in the Bud With CPT®’s Latest E/M Tweaks   (December 2011)

The AMA’s example directly addresses cardiology practices.It’s an age-old debate – when an established patient presents to your practice to see a new physician, should you report a new patient office visit code? CPT® 2012 attempts to clarify when that’s possible with a revision to the “New and Established Patient” section of the CPT® manual.The rules: Currently, CPT® indicates that a “new patient” refers to a patient who has not received any professional services, such as [...]

Correction:   (December 2011)

“Crosswalk: 33206 and 71090 No Longer Pair Up for Pacemaker Implant – Here’s Why” in Cardiology Coding Alert, vol. 14, no. 12, should include a row 9 reference to an RV lead, and rows 12 and 13 do not need 71090 in the column for 2011 codes. Those rows should appear as follows:To view or print a corrected crosswalk, please access the online version of the issue. If you need help accessing your online account, please [...]