Reader Question: Avoid Automatically Writing Off Secondary Insurance Deductibles (December 2011)
Question: We have many patients with secondary insurance, some of which have deductibles on the secondary. In these cases, should we write off the amount of the deductible because it’s secondary, or do we bill the patient?Virginia SubscriberAnswer: Most practices do bill the secondary insurance on behalf of patients, but if the patient has a deductible on the secondary insurance, you can and should bill the patient for that amount. You can learn about secondary insurers [...]
CPT® 2012: Take An Advanced Peek At Two New Paracentesis Codes For 2012 (November 2011)
CPT deletes intraperitoneal catheter insertion code.Do you know what CPT changes will affect your gastroenterology practice in 2012? Here’s a hint: two peritoneocentesis codes will be missing in your CPT manual. Instead, you need to be ready to report new codes as replacements.Replace Old Peritoneocentesis Codes With Three New OnesThe change will eliminate 49080 (Peritoneocentesis, abdominal paracentesis, or peritoneal lavage [diagnostic or therapeutic]; initial) and 49081 (…subsequent), and will replace them with three new codes:49082 – [...]
Time is a factor when choosing between 91037 and 91038.When your physician’s note suggests impedance and pH tests being performed together, you would look into the 9103x series of your CPT manual. Easy? Not quite. Take the following case in point.Scenario: The motility specialist performs impedance + pH test for over an hour. The patient, who complains of frequent and painful heartburn, leaves the office with the catheter in place until the next day. Dilemma: [...]
ICD-10: Heartburn Takes On R Code For ICD-10 (November 2011)
Tip: Separate codes apply to dyspepsia symptoms. Heartburn, also known as pyrosis or waterbrash, usually poses as a symptom of Gastroesophageal reflux disease (GERD). The chest pain caused by GERD has a distinct ‘burning’ sensation, occurs after eating or at night, and worsens when a person lies down or bends over. Presently, you report heartburn using the ICD-9 code 787.1 (Heartburn).ICD-10 difference: When ICD-9-CM shifts to ICD-10-CM in Oct. 1, 2013, code 787.1 will change [...]
ICD-10 Prep: 2 Tips To Get You Ready For Your ICD-10 Big Leap (November 2011)
Warning: It will be futile to memorize every code set.If you’re educating yourself about ICD-10 implementation, remember one important thing: don’t spend your time trying to memorize code sets.Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC shared that advice 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 the conference entitled “ICD-10: What You Need [...]
You Be the Coder: Skip Modifiers On Subsequent-Day EGDs (November 2011)
Question: My physician plans to perform a repeat EGD on a patient with significant amount of food in his stomach. The initial EGD – although completed – is not satisfactory because of bad visualization of the stomach. What code(s) should I report?Louisiana SubscriberAnswer: From your question we will assume the GI postponed the repeat EGD for another day to allow the food to pass into the small intestine so the stomach is clear enough for visualization. Upper [...]
Reader Question: Get Specific On Ultrasound Abnormal Findings With 793.6 (November 2011)
Question: What ICD-9 code should I bill when physician orders a patient for an ultrasound and he notes down “1.9cm hypoechoic focus in liver”? Virginia SubscriberAnswer: You should go with 793.6 (Nonspecific [abnormal] findings on radiological and other examination of abdominal area, including retroperitoneum). Sometimes, gastroenterologists would review radiographic studies or other studies which, although abnormal, are not diagnostic and do require further studies. ICD-9 793.6 helps explain medical necessity for review of such tests [...]
Reader Question: Mark Colonoscopy Through Stoma Procedures Using 44388-44389 (November 2011)
Question: I heard CPT has a different code for colonoscopies performed thru a colostomy bag. I’m at a lost finding a code for the tattooing of a polyp when the procedure was done this way. What should I report?Delaware SubscriberAnswer: No specific CPT code exists for tattooing when the physician performs colonoscopy via stoma. For standard colonoscopy, you would use 45381 (Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection[s], any substance) for tattooing [...]
Reader Question: Reflect Personal History When Coding Surveillance Colonoscopy (November 2011)
Question: If the physician does not state the type of polyp as adenomatous for a “surveillance colonoscopy,” should I report V12.72 in addition to the V76.51 or just the V76.51? The physician’s note states “This 59-year-old gentleman is referred for surveillance colonoscopy after having polyps removed several years ago.”West Virginia SubscriberAnswer: You should code V12.72 (Personal history of colonic polyps). Code V76.51 (Special screening for malignant neoplasms colon) describes average risk screening performed every ten [...]
Reader Question: Support Your Unplanned Return to OR Claim With Modifier 78 (November 2011)
Question: My gastroenterologist performed 45385, and discharged the patient. Later on the same day, the patient found blood in their stool and returned to the office. The physician, then, performed an inpatient consultation (99253), and did a colonoscopy with control of bleeding. Should I code 45382 for the bleed control?Washington SubscriberAnswer: Since the physician performed the bleed control in a separate procedural session, you should bill 45382 (Colonoscopy, flexible, proximal to splenic flexure; with control [...]
