Reader Question: 99241-99255: Keep Consults When Possible   (January 2012)

Question: Can we still use “consult” E/M codes?North Carolina SubscriberAnswer: The answer to that question depends on the payer. If your insurer accepts the codes, then yes, you can continue to use E/M consult codes.Starting in 2010, Medicare discontinued recognition of the consult codes 99241-99255 (Office or other outpatient consultation …). Some payers continued to accept these codes, however, and CPT® maintained the codes in 2011 and again in 2012. Opportunity: You shouldn’t stop using [...]

Reader Question: Decide Billing Order for Bilateral Procedures   (January 2012)

Question: When billing multiple surgeries, we usually put the procedure with the highest RVUs first. But when billing a unilateral bilateral surgery, would it be beneficial to put the other procedure first, even if it has lower RVUs than the bilateral code?Arkansas Subscriber Answer: Yes, if the surgeon performs multiple procedures, including a bilateral procedure performed unilaterally, you should sometimes list a lower relative value units (RVUs) procedure first, even if the bilateral code has [...]

Reader Question: Note Must Lead Diagnosis Selection   (January 2012)

Question: When I bill Medicare for deep debridement (11042) using the diagnosis the surgeon supplied – 709.9 – I’m getting denied payment. What diagnosis should I use for debridement?California SubscriberAnswer: You should use the diagnosis code that describes the patient’s condition. You should never assign a code just because it is a “payable” diagnosis for the procedure (11042, Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq. cm or less). In this case, your [...]

Physician Fee Schedule 2012: Brace Your Practice for 27% Medicare Conversion Factor Cut   (December 2011)

Plus: Thoracic, integumentary rates on the line. ‘Tis the season for another round of tense waiting to see if you’ll get a dramatic reduction in 2012 Medicare payments for your general surgical services. “The calendar year 2012 Physician Fee Schedule [PFS] conversion factor is $24.6712,” notes the 2012 Medicare Physician Fee Schedule Final Rule, printed in the Nov. 28 Federal Register – and that could mean a big cut in your pay. Look for Congressional Relief [...]

Beware: Medicare’s ‘3-Day Payment Window’ Could Impact Your Practice   (December 2011)

Ownership is the key for general surgeons.Did you know that one of the least publicized changes in the 2012 Medicare Physician Fee Schedule could be one of the costliest if it applies to you? That’s the word from Marc Hartstein, deputy director of the Hospital and Ambulatory Policy Group at CMS, who spoke about the “three-day payment window” during the CPT® 2012 Annual Symposium in Chicago on Nov. 16.Hospital Ownership Triggers RuleIf a Medicare patient [...]

CPT® 2012: You’ll Get Closure With New Skin Repair Guidelines   (December 2011)

Also, don’t miss separate debridement opportunity.Feeling overwhelmed by all the changes in the CPT® 2012 integumentary section? We’ve got the scoop for you, with a little help from the AMA’s CPT® Editorial Committee, to keep your skin repair claims clean and earn all the pay you deserve.Note New Modifier Advice for Repairs2012 offers new introductory notes that provide guidance on how to report skin closures (12001-13160). While the guidelines previously advised the use of modifier [...]

ICD-10: Get Ready for ICD-10 With These CMS Templates, Planning Assistance   (December 2011)

Whether large or small, you’ll find guidance for your practice.With less than two years to get ready for the diagnosis coding system transition from ICD-9 to ICD-10, your general surgery practice can use all the help you can find. Now, CMS aims to offer a helping hand in the process with the issuance of several new educational documents.Take CMS’ HelpOn Nov. 9, CMS announced that it had developed four Implementation Handbooks that offer step-by-step instructions [...]

CPT® 2012: Use Latest E/M Tweaks to Establish New Patient Status   (December 2011)

Same practice and specialty no longer preclude new patients.You’ve faced the dilemma before – when an established patient presents to your practice to see a different physician that he’s never seen before, should you report a new patient office visit code? With a revision to the “New and Established Patient” section of the CPT® 2012 manual, you’ll find a solution that could affect your bottom line.‘Subspecialty’ Rules the DayCurrently, CPT® indicates that a “new patient” refers [...]

You Be the Coder: Decubitus Ulcer: Look for Closure Documentation and More   (December 2011)

Question: Our surgeon performed an ischiectomy during excision of an ischial pressure ulcer and closed the wound with sutures. How should we code the service?Arkansas SubscriberAnswer: The correct code for the procedure you describe is 15941 (Excision, ischial pressure ulcer, with primary suture; with ostectomy [ischiectomy]). You have several pressure-ulcer codes to choose from, depending on your surgeon’s documentation regarding closure and extent of the procedureFor instance: If the surgeon sutured the wound site following [...]

Reader Question: Count Time Differently for CPT® vs. CMS   (December 2011)

Question: If the physician documents: “Time spent in the evaluation of the patient with mostly medical decision making time (two thirds) is 75 min,” can I choose the E/M code based on time alone?Texas SubscriberAnswer: No, you cannot code based on time with just the documentation you have mentioned. Here’s why: You should only code an E/M service based on time alone if at least 50 percent of the visit was spent on counseling or [...]