Reader Questions: Learn New Use for KX Modifier   (May 2010)

Question: I’ve heard that Medicare has a new way to override genderspecific edits, when appropriate, based on patient circumstances. Are we supposed to use a specific modifier?
Arizona Subscriber
Answer: You’ll use new condition code 45 (Ambiguous gender category) with claims that may be denied “due to sex/diagnosis and sex/procedure edits,” according to MLN Matters article MM6638.
You’ll use this code when “the service performed is gender specific (i.e., services that are considered female or male only),” the [...]

Reader Questions: Condition Doesn’t Change Patient Status   (May 2010)

Question: Our office saw a patient six months ago for dermatitis, and sent the patient back to his primary care provider for further treatment. The same patient was recently referred back to us for plantar warts. Should we bill that patient as new, since he’s coming back for a different reason? New Mexico Subscriber
Answer: This patient should be considered “established” for many reasons.
If your physician sees a patient any time within a 36-month period, that [...]

Reader Questions: Discover Payer Supply Rules   (May 2010)

Question: Can I use 99070 to report the use of supplies at our dermatology office?
Iowa Subscriber
Answer: Typically, no, you should not report 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) for supplies your dermatologist uses in the office.
The AMA and Medicare already factor essentials into a code’s values on the physician [...]

Reader Questions: Infected Ingrown Nails May Be Payable   (May 2010)

Question: A Medicare patient presented with a painful ingrown toenail, and our dermatologist trimmed the nail. Which code should I use? Also, since the patient doesn’t have a systemic condition, will Medicare cover the procedure? Utah Subscriber
Answer: Medicare carriers usually consider nail trimming routine foot care and a noncovered service without a systemic condition and qualifying findings. But Utah’s Part B carrier, Regence Blue  Cross Blue Shield, will pay you to remove an infected ingrown [...]

Reader Questions: ROS Determines ‘Type’ and ‘Extent’ of Exams   (May 2010)

Question: When a dermatologist lists an organ system and documents past medical/surgical history instead of current signs or symptoms, can I use this as review of systems (ROS)?
Illinois Subscriber
Answer: Ask your dermatologist if the past medical/surgical history constitutes an ROS. Show him the CPT guidelines and have him clarify what he believes to be a review of systems. The CPT guidelines indicate that the past medical history indicates a patient’s past experiences with an illness [...]

Reader Questions: Sequence Procedures According to Complexity   (May 2010)

Question: How should I code the following: the physician performed a wide excision of recurrent melanoma on the patient’s back, sentinel lymph node biopsy of groin and axilla. The physician also completed split-thickness skin grafting of the wide excision site on the patient’s back. I know that I should choose from 11606, 38500-59, 38525-59, or 15100, but which codes should I report and in what order? Also, do I need any modifiers?
New Jersey Subscriber
Answer: Assuming certain area [...]

Reader Questions: Solve Flaps and Grafts Together   (May 2010)

Question: The dermatologist excised a basal cell carcinoma from the patient’s right ear. To close the wound, the surgeon inserted a tubed pedicle flap that didn’t match the size of the defect. He then performed a Z-plasty to cover the remaining defect. Can I bill for both the pedicle flap and the Z-plasty?
Utah Subscriber
Answer: Yes. As long as the documentation supports it, you can bill 14060 (Adjacent tissue transfer or rearrangement, eyelids, nose, ears, [...]

You Be the Coder: Myobloc Isn’t Botox, but Coding Is Similar   (May 2010)

Question: How should I report Myobloc injections? Is Myobloc just another name for Botox? California Subscriber
Answer: Myobloc, like Botox, is a serotype of botulinum toxin, but the two are not the same. More precisely, Myobloc is the trade name for botulinum toxin type B (Botox is the trade name for botulinum toxin type A), and you should bill for the drug using the dedicated HCPCS supply code J0587 (Injection, rimabotulinumtoxinb, 100 units).
Myobloc is available in [...]

CCI 16.1 Update: Reporting Wound Repair and Blepharoplasty Separately? Read This First   (April 2010)

Take a second look at your eyelid surgery claims, thanks to the latest edits.Among the thousands of new code pairs announced in Correct Coding Initiative (CCI) 16.1, effective April 1, there are a few that dermatology coders will want to keep their eyelids peeled for, experts say. CCI released version 16.1 in late March, revealing 2,054 new active pairs and 1,947 modifier changes, said Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions. And if [...]

ICD-10: CMS, AHIMA Reps Aim to Bust ICD-10 Myths With Expert Answers   (April 2010)

Hint: You will be able to find hard copy ICD-10 books, CMS confirms.The ICD-10 implementation date (Oct. 1, 2013) may sound far away, but in terms of the prep work you should be doing to get ready, it’s right around the corner.That’s the word from CMS reps during a March 23 Open Door Forum explaining ICD-10.No rolling implementations: No matter where you work (hospital, ambulatory surgical center, physician practice, clinic, etc.), the ICD-10 deadline applies [...]