CCI 18.0: Latest Edits Clarify TPI, Tendon Injections Override 100+ Other Procedures (January 2012)
Plus: 94150 ’separate procedure’ doesn’t always mean separate coding. New codes aren’t the only things that affect your coding in 2012 – you also need to cull through the latest Correct Coding Initiative (CCI) edits to ensure you correctly report multiple procedures. CCI 18.0 went into effect Jan. 1, 2012, with substantial changes to how you should code familiar injection or incision/drainage procedures. Report Injection Over Compression, Aspiration CCI 18.0 includes 15,530 new edit pairs, according [...]
Checking schedules and avoiding multi-problem visits streamline your filing. Worker’s compensation (WC) cases raise ongoing questions when it’s time to code your family physician’s services. Begin your journey toward reimbursement by collecting pertinent information before the patient arrives for his appointment, and by focusing on the state where the claim originated, even if it’s different from the state where your physician practices. (See “2 Tips Point You Toward Pain Free Workers’ Compensation Billing” in Family [...]
Trap: You might not only be losing revenue – you’re also coding improperly.National insurer data shows that physicians undercode E/M claims to the tune of more than $1 billion annually. That’s money physicians could have collected based on their documentation but missed out on because they reported a lower-level E/M code than they should have. Read on for three reasons to always file claims based on the physician’s documentation instead of “playing it safe” with lower-end [...]
CPT® 2012: Don’t Miss Terminology Change in 96110, 96111 (January 2012)
Developmental ‘testing’ changes to ’screening.’ Focusing on new codes will help keep your claims compliant in 2012, but descriptor revisions or clarifications can also affect your code selection. Case in point: New wording for codes 96110 and 96111 shifts from describing “testing” to “screening.” The new descriptors are: 96110 – Developmental screening, with interpretation and report, per standardized instrument form96111 – Developmental testing, (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments) [...]
ICD-10: Watch for Product, Addiction Clues for Nicotine Dependence Coding (January 2012)
Choices expand from 305.1 to F17.2– beginning Oct. 1, 2013.When the family physician sees a patient who is nicotine dependent (to the detriment of the patient’s health or social functioning), you have one diagnosis choice: 305.1 (Nondependent abuse of drugs; tobacco use disorder). Once ICD-10 goes into effect on Oct. 1, 2013, however, you’ll modify your tobacco use disorder coding in several ways. You’ll start with code series F17.2 (Nicotine dependence). Because specificity is a [...]
You Be the Coder: Differentiating a Self-Limited or Minor Problem (January 2012)
Question: An established patient saw the physician with a new complaint. Through the E/M, the physician discovered the patient had bronchitis and prescribed medication. Should we consider it “self limited/minor” or “new problem/no additional work-up” when coding?Indiana SubscriberAnswer: CPT® defines a “self-limited or minor” problem as one “that runs a definite and prescribed course, is transient in nature, and is not likely to permanently alter health status OR has a good prognosis with management/compliance.” In [...]
Reader Question: Remember Debridement Includes Dressings (January 2012)
Question: Can our practice be reimbursed for the surgical dressing (supplies) of a partial-thickness burn?Georgia SubscriberAnswer: Medicare and most private payers already factor supplies such as surgical dressings into the value of debridement codes. In these cases, you cannot recoup additional reimbursement using any codes.Some commercial insurers might accept 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, [...]
Reader Question: Inadequate Height Increase Could Lead to 783.43 (January 2012)
Question: The physician documented that the patient has inadequate growth (in terms of his height, not his weight). What is the best diagnosis? California SubscriberAnswer: Look to 783.43 (Short stature). As noted in the guidelines, you can report diagnosis 783.43 for patients who experience growth failure, growth retardation, lack of growth, or physical retardation. The code would also be appropriate for inadequate growth such as you describe.
Reader Question: Choose 23650 Over 23655 for Local Anesthesia (January 2012)
Question: One of our physicians administered a shot of meperidine HCL while treating a shoulder dislocation. I’m not sure whether “anesthesia” always means conscious sedation with IVs and such. Should we consider this a manipulation with or without anesthesia when coding? North Dakota Subscriber Answer: Your coding choices are 23650 (Closed treatment of shoulder dislocation, with manipulation; without anesthesia) and 23655 (… with anesthesia). The “anesthesia” referenced in code 23655’s descriptor represents general anesthesia, which [...]
Reader Question: No HPI Equals No Coding for New Patient (January 2012)
Question: A new patient visits the physician with a chief complaint. I don’t have a review of system (ROS) or full history because the doctor didn’t document a history of present illness (HPI). He did include a brief HPI in the medical assessment that I credited toward the chief complaint. The physician completed an extended, problem-focused exam and medical decision making of low complexity. Can we bill for this encounter? Minnesota Subscriber Answer: According to [...]
