Reader Question: ICD-10 Prep is Different for Paper Claims   (December 2011)

Question: If we file paper claims to Medicare, will the claims form change once we begin using ICD-10? Will the form be updated, and will there be any changes for filing paper claims?Louisiana SubscriberAnswer: No, there is no current change to the CMS-1500 form used for filing paper claims for Medicare beneficiaries. CMS may announce changes as we move closer to the Oct. 1, 2013 deadline for implementing ICD-10, but no revisions to the form [...]

Reader Question: Decide HPI Level Based on Element Number   (December 2011)

Question: A patient came to the surgeon’s office complaining of severe abdominal pain. The surgeon had performed two previous hernia repairs for the patient. The patient says the pain is occurring mostly in her umbilical and upper epigastric areas. Notes indicate that the sharp and nonradiating pains have been occurring “off and on” for two or three days; further the pains are getting worse each day. The notes also read that the pain gets worse [...]

Reader Question: Identify ‘Extremity’ to Find Correct Code   (December 2011)

Question: What is the correct diagnosis code for popliteal artery stenosis?North Carolina SubscriberAnswer: You should look to 440.2x (Atherosclerosis of native arteries of the extremities). The popliteal artery is an extension of the femoral artery and bifurcates into the tibial arteries. That places the popliteal arteries in the lower extremities. Code 440.2x applies to arteries in the extremities, so you know you’re on the right track.Look in the ICD-9 index under “Stenosis; artery; extremity,” and [...]

CPT^® 2012: 49082-49084 Separate Peritoneal Procedures for More Accurate Coding   (November 2011)

Get ready for vascular and skin changes, too. Have you ever been baffled trying to distinguish between an acellular dermal replacement and an acellular dermal allograft? You’ll wonder no more, now that CPT 2012 scraps six families of codes in favor of one new skin-substitute-graft family. We’ve got a look at these changes and more, so read on for tips on how to code your general surgery claims in 2012. Distinguish Paracentesis, Lavage Prior to [...]

ICD-10: Switch from 567.22 to K65.1 for Peritoneal Abscess   (November 2011)

Little changes from ICD-9 to ICD-10 for this condition.Your surgeon may diagnose a peritoneal abscess when a procedure such as abdominal paracentesis confirms a pocket of infected fluid and pus within the abdominal cavity. That’s when you’ll turn to 567.22 (Peritoneal abscess) to describe the diagnosis. But when ICD-9 shifts to ICD-10 on Oct. 1, 2013, you’ll need to report the condition with K65.1 (Peritoneal abscess).Code cause, if known: The condition is often caused by [...]

CPT® 2012: 99218-99220: Observation Time Guidelines Could Help You Gain Pay   (November 2011)

Also watch for modifier 33.When CPT® 2011 debuted the subsequent observation care codes 99224-99226, many coders were left scratching their heads. Those new codes featured typical times associated, even though the initial observation care codes 99218-99220 don’t have typical times. Get a New Outlook on E/M TimeThe new 2012 edition of your CPT® manual, which takes effect on Jan. 1, will remedy that problem, with the addition of the following typical time guidelines:99218 – …Physicians typically [...]

Medical Necessity: 3 Steps Focus Diagnosis Coding for Your Surgical Claims   (November 2011)

Add these tips to your ICD-9 toolbox.You won’t get paid for your surgeon’s work if you only focus on what he did; you also need to focus on why he did it. Choosing the right ICD-9 code tells the “why” story – and that’s the basis for demonstrating medical necessity for the procedure.Follow our experts’ tips to make sure you pick the right ICD-9 code to reflect your surgeon’s diagnosis documentation, and to make sure you [...]

Hone Your ICD-9 Coding Skills With This Example   (November 2011)

You just studied tips for accurate ICD-9 coding in “3 Steps Focus Diagnosis Coding for Your Surgical Claims.” Now you can practice those skills with the following example:Scenario: Your general surgeon excises an external thrombosed hemorrhoid (46320, Excision of thrombosed hemorrhoid, external) in a patient at 28 weeks gestation. What ICD-9 code should you use?Solution: If you selected 455.4 (External thrombosed hemorrhoids) because you checked only the alphabetic index, you would be wrong. Once you [...]

You Be the Coder: Anatomy Answers Cecectomy Question   (November 2011)

Question: The surgical note says that the surgeon performed a laparoscopic “partial cecectomy,” which involved stapling across the cecum. How should we code the procedure?Ohio SubscriberAnswer: You should use a laparoscopic partial colectomy code, because the cecum is a part of the colon. Based on the description of “stapling across the cecum,” the best code choice is probably 44204 (Laparoscopy, surgical; colectomy, partial, with anastomosis), unless the full op report provides additional information about the [...]

Reader Question: 49321: Stick to Anatomic Site for Code Selection   (November 2011)

Question: Can we use 49321 for a laparoscopic liver biopsy to avoid using an “unlisted” code? Tennessee SubscriberAnswer: No, you should not report a laparoscopic liver biopsy using 49321 (Laparoscopy, surgical; with biopsy [single or multiple]). Instead, you should report the service using 47379 (Unlisted laparoscopic procedure, liver). Here’s why: 49321 is in the CPT subsection for “Abdomen, peritoneum, and omentum” (49000-49999). Because CPT provides specific codes in the “Liver” subsection (47000-47399), you should use [...]