Part B Updates: Vendor Won’t Be Ready for 5010? Get Claims in Before 2011 Ends, CMS Advises   (October 2011)

Plus: E-prescribing hardship exemptions are due in November, CMS reminds.Practices from all across the country have contacted the Insider with questions about what they should do if their vendors aren’t ready for 5010 conversion before the deadline of Jan. 1, 2012. CMS chimed in with tips on how to handle these issues during the agency’s Sept. 20 Open Door Forum, and we’ve got the advice for you.The message: If you want to avoid a cash [...]

E/M Coding: Only ‘Treating Physician’ Can Report Subsequent Observation Care, CMS Clarifies   (October 2011)

All other doctors who evaluate the patient must report outpatient E/M codes.In effect for ten months now, CPT’s subsequent observation care codes (99224-99226) have been something of a mystery since they were released, but CMS finally ended that last week by issuing clarifications about how to report these codes. CMS notes that subsequent observation care pay includes “all the care rendered by the treating physician on the day(s) other than the initial or discharge date,” [...]

You Be the Coder: Lacerations At Same Site   (October 2011)

Question: A patient with a 1.5-cm laceration on his eyebrow presented to our dermatology practice. Our dermatologist performed an intermediate repair. The patient also had a 3.6-cm forehead laceration that required a simple repair. Should we add these two wound lengths together and then code the intermediate repair, or does each get its own code?New York SubscriberAnswer: In this instance, you should report code 12051 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or [...]

Reader Questions: Find Your Candida Antigen Code Here   (October 2011)

Question: My dermatologist uses candida antigen for wart destruction. Previously, I used code 17110 for destruction of warts. I think that I should bill code 11900 with add-on J3490. Or shouldn’t I? Illinois Subscriber Answer: Candida antigen injection is a relatively new method for treating warts, not approved by the FDA. In this case, using the code 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or [...]

Reader Question: 99360 Is One to Skip for Medicare Billing   (October 2011)

Question: Our dermatologists sometimes “standby” for other surgeons in some high-risk procedures or cases. They want to code for their time, and we want to use 99360. How should they document their time to be able to charge 99360?Georgia SubscriberAnswer: CMS and many other payers don’t pay for 99360 (Physician standby service, requiring prolonged physician attendance, each 30 minutes [e.g., operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG]), so the [...]

Reader Question: Disregard Generic Code for Plantar Wart   (October 2011)

Question: A patient reports to the dermatologist with a painful right foot. The dermatologist finds a pair of plantar warts, which he removes using a scalpel. I reported 17110 with 078.19 appended, and received a denial. Did I choose the wrong procedure code?Oregon SubscriberAnswer: No, you chose the wrong diagnosis code. Re-submit the claim using 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular [...]

Neoplasms: 238.2 or 239.2? 3 Steps Draw the Line Between Uncertain, Unspecified Neoplasms   (September 2011)

238.2 or 239.2? 3 Steps Draw the Line Between Uncertain, Unspecified Neoplasms Waiting for the path report can provide you with a more specific diagnosis. Do you know the difference between neoplasm codes 238.2 and 239.2? If you assume 239.2 is the right diagnosis for all non-malignant lesions, you could come face to face with a denial. Don’t end up in a compromising situation without first knowing which way you should go with these three [...]

Dermabrasion: 15780-15781 Payments May Be At Risk Without These Tips   (September 2011)

Hint: If you have medical necessity, then get preauthorization.Although most payers consider dermabrasion and microdermabrasion a cosmetic treatment, you can still recoup reimbursement when the patient has one of two conditions: (1) superficial basal cell carcinomas or (2) precancerous actinic keratoses.Get Prior AuthorizationIf you feel the dermabrasion is medically necessary, then you should get prior authorization from your patient’s payer.All dermabrasions and microdermabrasions are considered self-pay and are paid at the time of service. Therefore, [...]

ICD-10 Readiness: Start Small When Prepping for ICD-10 Conversion, CMS Says   (September 2011)

Acquaint yourself with the top 30 diagnoses that your practice sees and you’ll get a head start toward compliance.If you’ve taken a look at the ICD-10 book, you know that it would be virtually impossible to memorize all of the codes that it contains. But preparing for ICD-10 won’t require you to even try to know the codes by heart, CMS reps indicated during the August 3 CMS call, “ICD-10 Implementation Strategies for Physicians.”Take heart: [...]

Version 5010: Make Sure Your Electronic Transactions Don’t Bomb on Jan. 1   (September 2011)

Compliance, payment, and ICD-10 hang in the balance.Say goodbye to forms 4010/4010A1 for electronic transactions starting Jan. 1, 2012. That’s the date you’ll need fully functional form 5010 to comply with the Health Insurance Portability & Accountability Act of 1996 (HIPAA) electronic transaction standards.If you don’t have your 5010 glitches worked out by that date, you won’t be able to submit electronic transactions to Medicare.Get Ready for ICD-10Version 5010 lays out the technical electronic standards [...]