CCI Edits: Latest CCI Edits 18.0: Understand New Bundled Codes   (January 2012)

Plus: 94150 ’separate procedure’ doesn’t always mean separate coding. New codes aren’t the only things that affect your coding in 2012 – you also need to cull through the latest Correct Coding Initiative (CCI) edits to ensure you correctly report multiple procedures. CCI 18.0 goes into effect Jan. 1, 2012, with substantial changes to how you should code familiar injection or incision/drainage procedures. Report Injection Over Compression, Aspiration CCI 18.0 includes 15,530 new edit pairs, according [...]

Worker’s Compensation: Select the Most Advantageous Fee Schedule for Worker’s Comp (WC) Claims   (January 2012)

Make you filing hassle-free by checking schedules.Worker’s compensation (WC) cases raise ongoing questions when it’s time to code your physician’s services. Begin your journey toward reimbursement by collecting pertinent information before the patient arrives for his appointment, and by focusing on the state where the claim originated, even if it’s different from the state where your physician practices. (See “Make Your Workers’ Compensation Billing Smooth with These Tips” in Internal Medicine Coding Alert, Vol. 15, [...]

E/M Coding: Stop Downcoding E/M Visits, and Add Minimum of $56 to Your Bottom Line   (January 2012)

Trap: You might not only be losing revenue — you’re also drawing chance of audit.National insurer data shows that physicians undercode E/M claims to the tune of more than $1 billion annually. That’s money physicians could have collected based on their documentation but missed out on because they reported a lower-level E/M code than they should have. Read on for three reasons to always file claims based on the physician’s documentation instead of “playing it [...]

5010 Readiness: Medicare Extending 5010 Implementation Deadline till March 31, 2012   (January 2012)

Plus: Avoid PO boxes on 5010, despite what your MAC tells you.Sweating over the fact that your 5010 standard won’t be in place by the Jan. 1 deadline? CMS has an early holiday gift for your practice, with the Nov. 17 announcement that it will not initiate enforcement action regarding 5010 until March 31, 2012.Not a deadline shift: CMS stresses in its statement that the 5010 compliance date remains Jan. 1, 2012. However, the agency [...]

ICD-10: Watch for Product, Dependence Clues for Coding of Nicotine Dependence Scenarios   (January 2012)

Choices expand from 305.1 to F17.2– beginning Oct. 1, 2013.When the internal medicine specialist sees a patient who is nicotine dependent (to the detriment of the patient’s health or social functioning), you have one diagnosis choice: 305.1 (Nondependent abuse of drugs; tobacco use disorder). Once ICD-10 goes into effect on Oct. 1, 2013, however, you’ll modify your tobacco use disorder coding in several ways. You’ll start with code series F17.2 (Nicotine dependence). Because specificity is [...]

You Be the Coder: Differentiating a Self-Limited or Minor Problem in E/M Visit   (January 2012)

Question: An established patient saw the physician with a new complaint. Through the E/M, the physician discovered the patient had bronchitis and prescribed medication. Should we consider it “self limited/minor” or “new problem/no additional work-up” when coding?Indiana SubscriberAnswer: CPT defines a “self-limited or minor” problem as one “that runs a definite and prescribed course, is transient in nature, and is not likely to permanently alter health status OR has a good prognosis with management/compliance.” In [...]

Reader Question: Debridement Includes Dressings   (January 2012)

Question: Can our practice be reimbursed for the surgical dressing (supplies) of a partial-thickness burn?Georgia SubscriberAnswer: Medicare and most private payers already factor supplies such as surgical dressings into the value of debridement codes. In these cases, you cannot recoup additional reimbursement using any codes.Some commercial insurers might accept 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, [...]

Reader Question: Choose 23650 Over 23655 for Local Anesthesia Administration   (January 2012)

Question: One of our physicians administered a shot of meperidine HCL while treating a shoulder dislocation. I’m not sure whether “anesthesia” always means consious sedation with IVs and such. Should we consider this a manipulation with or without anesthesia when coding? North Dakota Subscriber Answer: Your coding choices are 23650 (Closed treatment of shoulder dislocation, with manipulation; without anesthesia) and 23655 (… with anesthesia). The “anesthesia” referenced in code 23655’s descriptor represents general anesthesia, which [...]

Reader Question: Inadequate Height Increase Could Lead to Dx Code 783.43   (January 2012)

Question: The physician documented that the patient has inadequate growth (in terms of his height, not his weight). What is the best diagnosis? California SubscriberAnswer: Look to 783.43 (Short stature). As noted in the guidelines, you can report diagnosis 783.43 for patients who experience growth failure, growth retardation, lack of growth, or physical retardation. The code would also be appropriate for inadequate growth such as you describe.

Reader Question: No Documented HPI Leads to No Coding for New Patient   (January 2012)

Question: A new patient visits the physician with a chief complaint. I don’t have a review of system (ROS) or full history because the doctor didn’t document a history of present illness (HPI). He did include a brief HPI in the medical assessment that I credited toward the chief complaint. The physician completed an extended, problem-focused exam and medical decision making of low complexity. Can we bill for this encounter? Minnesota Subscriber Answer: According to [...]