You Be the Coder: Multiple Lesion Fragment Excisions (September 2011)
Question: I just received a pathology report back that reads: “The largest segment measures 3.5 x 3.5 x 2.0 cm. A second fragment measures 3.0 x 3.0 x 3.0 cm and then in aggregate, the smaller fragments measure 3.5 x 3.0 x 2.0cm.” The surgeon excised these lesions from the patient’s back and neck. How should I code this?Missouri SubscriberAnswer: You cannot code this excision solely from the pathology report. You need to go back [...]
Reader Question: 99214: Give Credit For Time Spent With Patient (September 2011)
Question: Our physician spends a lot of time discussing treatment options, imaging results, and other issues with patients. How should she document this to support coding E/M based on time?Arizona SubscriberAnswer: When counseling and/or coordination of care take up more than 50 percent of the encounter, and you choose to code based on time, CPT®’s E/M guidelines tell you “the extent of counseling and/or coordination of care must be documented in the medical record.” Medicare’s [...]
Reader Question: 14040 Includes Lesion Removal and Tissue Transfer (September 2011)
Question: If the dermatologist performs an adjacent tissue transfer, can I also code for a lesion removal?Georgia SubscriberAnswer: No. Unlike intermediate or complex closures, you cannot report lesion removal if the dermatologist performed adjacent tissue transfer, because the tissue transfer is part of the lesion removal. After the scar is excised and debrided, the dermatologist performs an adjacent tissue transfer to repair the wound. If you report adjacent tissue repair, the tissue transfer includes the [...]
Reader Question: Can Provider Change Tax ID? (September 2011)
Question: One of our physicians wants to stop billing under the group’s tax ID and start billing under his own tax ID. I’m concerned that doing so will confuse the insurance companies and slow down his income, even though he has personally called some to notify them of the change and the effective date. Some payers are now asking for new W9 forms. Is there an easy way to do it?North Dakota SubscriberAnswer: If your [...]
Reader Question: Condition Doesn’t Change Patient Status (September 2011)
Question: Our office saw a patient six months ago for a certain condition, and sent the patient back to his primary care provider for further treatment. The same patient was recently referred back to us for a different condition. Should we bill that patient as new, since he’s coming back for a different reason?New Mexico SubscriberAnswer: This patient should be considered “established” for many reasons. If your physician sees a patient any time within a [...]
Burn Treatments: 16000-16030 May Not Tell Entire Burn Treatment Story (August 2011)
There’s more to the procedures than dressing, debridement – sometimes almost $900 more.
If you’re reporting 16000-16036 codes, you might be forfeiting pay – nearly $900 – for separately reimbursable procedures, because procedures such as skin grafts are not included in these codes. Our coding experts offer these three tips for improving your burn treatment reimbursement.
Tip 1: Size Determines Anesthesia Code Choice
If the doctor only debrides a burn, you should select an initial treatment code from the 16000-16030 series.
Here’s [...]
Halt 15340, 15360 ‘global days’ prejudice.
When your dermatologist applies a tissue-cultured skin or dermal substitute for Medicare patients with lower extremity ulcers due to venous stasis or diabetes, you have two temporary “G” codes you should be using this year.
Shift From CPT® to HCPCS for Medicare
Whether Apligraf or Dermagraft, you should use G0440 (Application of tissue cultured allogeneic skin substitute or dermal substitute; for use on lower limb, includes the site preparation and debridement if [...]
ABN: You Must Use New Form by Nov. 1, CMS Says (August 2011)
Don’t expect major changes, but you are required to switch.
You should be used to the combined Advance Beneficiary Notification (ABN)/ Notice of Exclusion of Medicare Benefits (NEMB) form implemented last year. But did you know it’s time again to upgrade to a newer version?
The latest version of the ABN – form CMS-R-193, with the release date of March 20, 2011 – is now available at www.cms.gov/BNI by clicking the “revised ABN” link, said CMS’s Donna Williamson during [...]
Diagnosis Coding: Follow 5 Steps for Audit-Proof Medical Necessity (August 2011)
Keep current and accurate training and records.
With a solid ICD-9 coding policy, your dermatology practice can ensure strong documentation to show medical necessity for services your physicians provide. Here’s how to establish a policy that will go the distance when auditors come calling:
Establish Coding Resources
Step 1. The first building block of a well-designed coding policy is to indicate that you adhere to the ICD-9-CM Official Guidelines for Coding and Reporting, says Tricia A. Twombly, BSN, [...]
You Be the Coder: Layered Closure After Melanoma Excision (August 2011)
Question: Following a melanoma excision, our surgeon performed a layered closure. I’ve heard that we should add the dimensions of the lesion excision to determine the code choice for the closure – this correct?New Mexico Subscriber
Answer: No, you should not base the closure code on the lesion excision size at all. Instead, you should base it on the closure size. When the surgeon excises a lesion, the code includes simple (single layer) closure. But if the [...]
