Reader Question: For E/M, 3 ‘Vitals’ Equals 1 Exam Bullet   (November 2011)

Question: Would you please explain how taking the vital signs contributes to determining the E/M service’s physical exam?Georgia Subscriber Answer: Checking any three of seven vital signs will count as one bullet in the physical exam, based on the current (1997) documentation guidelines for E/M services, which you can find at (www.cms.gov/MLNEdWebGuide/25_EMDOC.asp). Here’s how it works: Under the 1997 documentation guidelines for E/M services, performing (and documenting) any three of the following seven vital signs [...]

Reader Question: Forget Modifier 55 for Suture Removal   (November 2011)

Question: An 11-year-old established patient went to the emergency room in another state over the weekend because of a laceration to his arm. The ER staff sutured the cut and told his parents to follow up with his physician at home. At the office visit, the family physician removed the stitches, cleaned and re-bandaged the area, and spoke with the parent about wound care. We reported an E/M code with modifier 55, but insurance only [...]

Reader Question: Submit 95250, Then 95251 for Glucose Monitoring   (November 2011)

Question: What is the best way to bill for continuous glucose monitoring? Do we bill for the initial visit and when the patient returns to the office after five days of monitoring, or report only one visit? Nevada Subscriber Answer: You can bill for both dates of service related to continuous glucose monitoring (CGM). The codes are: 95250 – Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 [...]

Reader Question: Choose 10120 for Punch Biopsy FBR   (November 2011)

Question: The physician used a punch biopsy to remove a thickly embedded tick from a patient’s back. Do we code differently because of the punch biopsy? Michigan Subscriber Answer: Disregard the tool your physician used, and simply report the service – a foreign body removal. In this case, submit 10120 (Incision and removal of foreign body, subcutaneous tissues; simple), which includes closure for repair.

HCPCS Supplies: Check Out Modifiers NU, KX to Clear Supply Claims   (October 2011)

Prescribing crutches or other supplies? Get sharp on modifiers. When a patient leaves your office with crutches, your automatic response might be to report an appropriate HCPCS code, such as E0110 (Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips). If you get denials from your DME (durable medical equipment) MAC in return, get a leg up on collecting for equipment by getting to know two important modifiers. [...]

CCI Edits Update: Latest CCI Edits Target Annual Wellness Codes Again   (October 2011)

New bundles for G0438 and G0439 shouldn’t hit your bottom line. The latest updates from the Correct Coding Initiative (CCI) went into effect Oct. 1, with more pairings affecting the new annual wellness visit (AWV) codes G0438 (Annual wellness visit; includes a personalized prevention plan of service [PPS], initial visit) and G0439 (Annual wellness visit, includes a personalized prevention plan of service [PPS], subsequent visit). Edits bundle both G0438 and G0439 into G0402 (Initial preventive [...]

ICD-10 Watch: Follow 2 Steps Now to Prepare for ICD-10 Conversion   (October 2011)

Analyze your practice’s top 30 diagnoses to get a head start toward compliance.It’s not too early to start educating yourself about ICD-10 implementation, but don’t spend your time trying to memorize code sets. That was the advice Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, shared with attendees at the AAPC’s regional conference in Nashville Sept. 7-9. Buckholtz is vice president of ICD-10 education and training at AAPC and led a general session at [...]

ICD-10: Narrow Choice for Essential Hypertension to I10   (October 2011)

ICD-10 streamlines to single diagnosis. Many diagnoses will expand to multiple options with ICD-10 in October 2013, but that’s not always the case. Essential hypertension is one diagnosis your family physician might report that will actually have fewer choices with ICD-10. Currently: ICD-9 2011 includes three diagnosis options for essential hypertension: 401.0 – Essential hypertension; malignant 401.1 – … benign 401.9 – … unspecified. ICD-10, however, includes only a single code for essential hypertension: I10 (Essential [primary] hypertension). [...]

You Be the Coder: Correctly Reporting Arthrocentesis with Meds   (October 2011)

Question: The physician used ultrasound guidance when performing arthrocentesis on the patient’s knee to withdraw fluid from a baker’s cyst; she then injected the area with Kenalog. Do we report the aspiration and injection separately and the ultrasound guidance for each, or do we consider everything a single procedure? Washington SubscriberAnswer: You should report 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) once. Most providers will not [...]

Reader Question: Choose Between 99213, 99214 for Pre-Op Exam   (October 2011)

Question: The local orthopedist requires clearance before scheduling patients for total knee replacement surgery, so we see a lot of Medicare patients for their pre-surgical exams. What is the best way to bill these visits? West Virginia SubscriberAnswer: Because your physician is not the surgeon scheduled to perform the procedure, you can code for a pre-op exam (a pre-op exam with the surgeon is considered part of the surgical global package). Choose the appropriate office [...]