Reader Question: Lack of History Can’t Support Comprehensive Exam   (December 2011)

Question: Our physician admitted someone as an initial inpatient, but couldn’t get all her information. He performed a comprehensive exam and used medical decision making of high complexity, but was unable to obtain a complete history due to the patient’s current condition. Can we give credit for a comprehensive history even though he couldn’t obtain a comprehensive ROS (review of systems) due to the patient being mentally confused? South Carolina Subscriber Answer: There is no [...]

Reader Question: Don’t Count On Pay for Anesthetic Before Injection   (December 2011)

Question: We’ve had increasing problems billing and being paid for the medications we use for trigger point and nerve block injections. We bill J1094 for Dexamethasone 4 mg, S0020 for Marcaine 0.5% and J2010 for Lidocaine 2%. We never get paid for the Marcaine and rarely get paid for the Dexamethasone. Are there other drugs we should be using? Or are we using the correct drugs with the wrong codes? What should I change when [...]

Reader Question: Stick With 86580 for TB Skin Test   (December 2011)

Question: Can we bill for an administration fee or injection when giving a PPD test? Or is it considered part of the PPD?Iowa SubscriberAnswer: No, you should not bill an administration fee or injection fee for a PPD (tuberculosis) skin test. Explanation: Your staff is not administering a vaccine or a subcutaneous or intramuscular injection, so codes such as 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) do not apply. [...]

Reader Question: Extent of FBR Work Separates 10120 From 10121   (December 2011)

Question: A patient had a head injury but could not have an MRI because of decorative studs in his face. The studs had embedded backs, so required surgical removal. Our physician removed four studs from his facial cheeks, using four separate incisions. I’m looking at codes 10120 and 10121. What is the difference between these, and do I report the correct code four times?Washington Subscriber Answer: You are correct to be choosing between 10120 (Incision [...]

Code Changes: CPT® 2012 Includes Intradermal Flu Vaccine Option With 90654   (November 2011)

Don’t miss revisions to other vaccine, E/M codes. CPT® 2012 goes into effect in a matter of weeks, so prepare now for new and revised choices related to vaccine administration and prolonged E/M service to ensure your claims stay accurate. Look for Official Inclusion of 90654 CPT® 2012 adds another choice to your flu vaccine coding with the inclusion of 90654 (Influenza virus vaccine, split virus, preservative-free, for intradermal use). The addition expands on the [...]

Rural Care: Protect Your Bottom Line: Implement These Revalidation Letter Requirements   (November 2011)

Here’s the lowdown on how these CMS changes apply to your practice.If you’re a rural healthcare provider, you’ll want to know the latest news CMS officials discussed during an Open Door Forum call on October 18. Read on for a few highlights about revalidation letters that your practice might need to know. Watch for Your Revalidation Letter From CMS As part of the Patient Care and Affordable Care Act (section 6401(a)), all new and existing [...]

Version 5010: The Countdown’s On for Electronic Transaction Changes Jan. 1   (November 2011)

Compliance, payment, and ICD-10 hang in the balancesAre you ready to say goodbye to version 4010/4010A1 for electronic transactions? You’ll need to be, starting Jan. 1, 2012, when your practice should be fully functional with version 5010 to comply with the Health Insurance Portability & Accountability Act of 1996 (HIPAA) electronic transaction standards.Consequence: If you don’t have your 5010 glitches worked out by January, you won’t be able to submit electronic transactions to Medicare and [...]

ICD-10: Train Physicians Now for Extra Osteoarthritis Documentation in 2013   (November 2011)

Unspecified location? Look to the M19 codes.When ICD-9 becomes ICD-10 in October 2013, physicians will need to be more conscious of documentation when noting a patient has osteoarthritis. Current diagnosis choices (e.g., 715.xx) specify the arthritis location and whether it is primary or secondary to other conditions. ICD-10 difference: Under ICD-10, you’ll have several code families to search for the best diagnosis: M15 (Polyosteoarthritis)M16 (Osteoarthritis of hip)M17 (Osteoarthritis of knee)M18 (Osteoarthritis of first carpometacarpal joint)M19 [...]

You Be the Coder: Choose the Correct Code for Kenalog Injections   (November 2011)

Question: How should I report an intra-epididymal injection of Kenalog?South Carolina SubscriberAnswer: Report 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the injection. Then, choose between J3300 (Injection, triamcinolone acetonide, preservative free, 1 mg) or J3301 (…not otherwise specified, 10 mg) for the Kenalog itself, based on your physician’s documentation.

Reader Question: Turn to 99214 to Give Credit for Extra Time   (November 2011)

Question: Our family physician spends a lot of time discussing treatment options, imaging results, and other issues with patients. How should she document these activities to support coding E/M based on time? Arizona Subscriber Answer: 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 state, “the extent of counseling and/or coordination of care must be documented in the [...]