Plus, learn endoscopic and bone marrow limitations.
Keeping up with Correct Coding Initiative (CCI) quarterly updates to the edit-pair lists will only get you so far in Medicare billing compliance. You also need to study guidance that CMS puts out in the National Correct Coding Initiative Policy Manual, the latest being a Jan. 2012 update that could have significant impact on your general surgery practice.
We’ve got the lowdown on a few important changes that are sure [...]
CCI 18.0: 15271-+15278 and Beyond: Navigate Edit Pairs to Optimize Pay (January 2012)
Identify standard surgical services to steer through bundle traps. Not one new CPT® 2012 code that you’re likely to use in your general surgery practice escapes the latest edition of Medicare’s Correct Coding Initiative (CCI). CCI released version 18.0, effective Jan. 1, revealing 15,530 new active pairs and 6,197 code pair terminations, according to Frank D. Cohen, MPA, MBB, senior analyst with Frank Cohen Group, LLC. From new skin to abdominal surgical codes, make sure [...]
Catch Up Your Outpatient Edits to CCI 18.0 (January 2012)
Counting on version 17.3 will put you behind.If you’re used to ignoring new CCI edits for the Hospital Outpatient Prospective Payment Systems (OPPS) because the implementation date lags by a quarter – don’t count on it.Here’s why: CMS has announced that the outpatient code editor (OCE) version 18.0 will include the OCE version 17.3 and the new version 18.0, both of which will be implemented at the same time on Jan. 1. That means you’ll need [...]
ICD-10: Await 6 Renal Tumor Diagnosis Codes in 2013 (January 2012)
Right and left will matter under ICD-10.If your surgeon performs renal-artery catheter placement or other procedures for a patient with a kidney tumor, you can expect one of two codes to describe the neoplasm under ICD-9: 189.0 – Malignant neoplasm of kidney and other and unspecified urinary organs; kidney, except pelvis 189.1 – Malignant neoplasm of renal pelvis.Starting on Oct. 1, 2013, you will have six codes to describe renal tumors. Under ICD-10 you will first have [...]
News brief: Expect 2-Month Medicare Payment Reprieve (January 2012)
SGR formula fix is key.You won’t face a 27 percent Medicare pay cut beginning Jan. 1 after all – at least not for two months. That’s because the rate reduction was once again kicked to the curb by Congress, resulting in a Medicare Physician Fee Schedule conversion factor of $34.0376 through Feb. 29.On Dec. 23, the House followed the Senate’s lead in voting to halt the Medicare pay cut for two months, which will freeze Medicare [...]
CPT® 2012: 37191-37193: Banish Unlisted Codes From Your IVC Filter Claims (January 2012)
Get ready for new renal catheter placement codes, too.Surgical codes that describe the whole package are becoming the norm, and CPT® 2012 continues the trend. Inferior vena cava (IVC) filter procedures and renal angiography have new codes that combine surgical and imaging services into one neat bundle. Clarify Your IVC Filter OptionsPrepare for an all new way to report IVC filter services, defining the service as insertion, repositioning, or retrieval:37191 – Insertion of intravascular vena cava [...]
+15777: Avoid New Biologic Implant Code With Hernia (January 2012)
Save it for fascia support in soft tissue.If your surgeon frequently performs hernia repairs, you may have been delighted to spy new add-on code +15777 (Implantation of biologic implant [e.g., acellular dermal matrix] for soft tissue reinforcement [e.g., breast, trunk]) in CPT® 2012. But make no mistake – this code does not apply to mesh used in hernia procedures, said Christopher K. Senkowski, MD, at the CPT® 2012 Annual Symposium in Chicago during his Nov. 17 [...]
CPT® 2012: Capture E/M Billing Opportunity for New Thoracoscopy Codes (January 2012)
Note CMS’ surprise 0-day global.Not only did CPT® 2012 change the heading of its “Thoracoscopy” section to include the term “VATS” (video-assisted thoracic surgery), it also debuted three new diagnostic thoracoscopy codes.Read on to see how the new codes allow more specific reporting beginning Jan. 1, as well as how you might gain E/M pay for the service.Specify Lung Biopsy Tissue With New Codes CPT® 2012 deletes 32602 (Thoracoscopy, diagnostic [separate procedure]; lungs and pleural [...]
You Be the Coder: Depend on 78 for Bleeding Control Return (January 2012)
Question: Our surgeon performed a colonoscopy with polyp removal 45385, and discharged the patient. The patient returned later the same day complaining of bloody stool. The surgeon then did a second colonoscopy to control bleeding. Should we separately code the second colonoscopy?Indiana SubscriberAnswer: Because the surgeon performed the bleed control in a separate procedural session, you can bill for it in addition to the primary procedure.Do this: Report the initial colonoscopy as 45385 (Colonoscopy, flexible, [...]
Reader Question: Save ‘Uncertain’ Neoplasm for Specific Diagnosis (January 2012)
Question: When one of our surgeons removes a breast mass, he insists on putting the diagnosis in the op report “uncertain behavior neoplasm, breast” if the pathology report is not back. When is it appropriate to use this diagnosis, as opposed to “breast mass?”Texas SubscriberAnswer: You should not use an uncertain behavior code, such as 238.3 (Neoplasm of uncertain behavior of breast), unless the surgeon has reviewed the pathology report and confirms that the neoplasm [...]
