You Be the Coder: HCPCS for Kenalog Injections   (November 2011)

Question: How should I report an intra-epidiymal injection of Kenalog?South Carolina SubscriberAnswer: Report 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the injection. Then, choose between J3300 (Injection, triamcinolone acetonide, preservative free, 1 mg) or J3301 (…not otherwise specified, 10 mg) for the Kenalog itself, based on your internist’s documentation.

Reader Question: Turn to 99214 to Give Credit for Extra Time   (November 2011)

Question: Our physician spends lot of time discussing treatment options, imaging results, and other issues with patients. How should she document these activities to support coding E/M based on time? Arizona Subscriber Answer: When counseling and/or coordination of care take up more than 50 percent of the encounter, and you choose to code based on time, CPT®’s E/M guidelines state, “the extent of counseling and/or coordination of care must be documented in the medical record.” [...]

Reader Question: For E/M Services, 3 ‘Vitals’ Equals 1 Exam Bullet   (November 2011)

Question: Would you please explain how taking the vital signs contributes to determining the E/M service’s physical exam?Georgia Subscriber Answer: Checking any three vital signs will count as one bullet in the physical exam, based on the current (1997) documentation guidelines for E/M services, which you can find at (www.cms.gov/MLNEdWebGuide/25_EMDOC.asp). Here’s how it works: Under the current 1997 documentation guidelines for E/M services, performing (and documenting) any three of the following seven vital signs will [...]

Reader Question: Glucose Monitoring with 95250, 95251   (November 2011)

Question: What is the best way to bill for continuous glucose monitoring? Do we bill for the initial visit and when the patient returns to the office after five days of monitoring, or report only one visit? Nevada Subscriber Answer: You can bill for both dates of service related to continuous glucose monitoring (CGM). The codes are: 95250 – Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 [...]

Reader Question: Add Lacerations Only If Found at Same Site and Level   (November 2011)

Question: A patient with a 1.5-cm laceration on his eyebrow presented to our practice. Our physician performed an intermediate repair. The patient also had a 3.6-cm forehead laceration that required a simple repair. Should we add these two wound lengths together and then code the intermediate repair, or does each get its own code?New York SubscriberAnswer: In this instance, you should report code 12051 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous [...]

Reader Question: E Code for Initial Fall Visit   (November 2011)

Question: An established patient came to the office complaining of back pain related to a fall three weeks ago. We aren’t sure of the allowable timeframe for coding falls. Can we still report an E code?New Hampshire Subscriber Answer: The HIPAA mandated ICD-9 Coding guidelines state that you should assign the appropriate E code for the initial encounter of an injury but not for subsequent treatment. Although you’re treating an established patient, this is the [...]

HCPCS Supplies: Medical Supply Claims Require Proper Modifiers Application   (October 2011)

Get acquainted with modifiers NU, KX. When a patient leaves your office with crutches, your automatic response might be to report an appropriate HCPCS code, such as E0110 (Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips). If you get denials from your DME (durable medical equipment) MAC in return, get a leg up on collecting for equipment by getting to know two important modifiers. Don’t Overlook Modifier [...]

CCI Edits Update: Latest CCI Edits 17.3 Target Annual Wellness Visit Codes   (October 2011)

New bundles for G0438 and G0439 shouldn’t hit your bottom line.The latest updates from the Correct Coding Initiative (CCI) went into effect Oct. 1, with more pairings affecting the new annual wellness visit (AWV) codes G0438 (Annual wellness visit; includes a personalized prevention plan of service [PPS], initial visit) and G0439 (Annual wellness visit, includes a personalized prevention plan of service [PPS], subsequent visit).Edits bundle both G0438 and G0439 into G0402 (Initial preventive physical examination; [...]

ICD-9 2012: 414.4 Lets You Get Specific About Calcified Coronary Lesions   (October 2011)

But 425.1 will bring instant denials as of October 1.Don’t consider your ICD-9 2012 update lists final until you’ve studies these late additions for coronary atherosclerosis and hypertrophic cardiomyopathy.Although coders get a sneak peek at ICD-9 changes each summer in CMS’s proposed Inpatient PPS rule, those changes aren’t the last word for updates. The codes below weren’t finalized in time to be included in the proposed rule, but they are effective Oct. 1, 2011, all [...]

ICD-10 Watch: Prepare for ICD-10 Conversion Following Easy Steps   (October 2011)

Analyze your practice’s mostly used diagnoses to familiarize withIt’s not too early to start educating yourself about ICD-10 implementation, but don’t spend your time trying to memorize code sets.That was the advice Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, shared 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 [...]