ICD-10: Narrow Choice for Essential Hypertension to I10   (October 2011)

ICD-10 streamlines to single diagnosis.Many diagnoses will expand to multiple options with ICD-10 in October 2013, but that’s not always the case. Essential hypertension is one diagnosis your internist might report that will actually have fewer choices with ICD-10.Currently: ICD-9 2011 includes three diagnosis options for essential hypertension:401.0 – Essential hypertension; malignant401.1 – … benign401.9 – … unspecified.ICD-10, however, includes only a single code for essential hypertension: I10 (Essential [primary] hypertension).Bonus: Eliminating multiple diagnoses eliminates the problem of [...]

You Be the Coder: Report Arthrocentesis with HCPCS Code For Medicines   (October 2011)

Question: The physician used ultrasound guidance when performing arthrocentesis on the patient’s knee to withdraw fluid from a baker’s cyst; she then injected the area with Kenalog. Do we report the aspiration and injection separately and the ultrasound guidance for each, or do we consider everything a single procedure?Washington SubscriberAnswer: You should report 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) once. Most providers will not puncture [...]

Reader question: Choose Between 99213, 99214 for Pre-Op Examination   (October 2011)

Question: The local orthopedist requires clearance before scheduling patients for total knee replacement surgery, so we see a lot of Medicare patients for their pre-surgical exams. What is the best way to bill these visits?West Virginia SubscriberAnswer: Because your physician is not the surgeon scheduled to perform the procedure, you can code for a pre-op exam (a pre-op exam with the surgeon is considered part of the surgical global package). Choose the appropriate office or [...]

Reader question: 99078 vs. 98960-98962   (October 2011)

Question: Our physician wants to implement group patient education meetings, when he’ll bring together several patients with the same diagnoses for an educational lecture/meeting. He suggested we could bill with 99078. What’s your advice?Kansas SubscriberAnswer: The appropriate code choice depends on how your provider structures the meetings and how many patients are present.Option 1: If the physician plans and presents the information, you can submit 99078 (Physician educational services rendered to patients in a group [...]

Reader question: HCPCS code for Lidocaine During Block or Injection Not Separately Billable   (October 2011)

Question: Our physicians often use a local anesthetic or a mixture of triamcinolone and lidocaine when performing a nerve block or joint injection. I’ve always heard that we couldn’t bill separately for the anesthetic, but now a new provider in our group believes it’s billable. Can we code for the lidocaine?Arkansas SubscriberAnswer: Physicians commonly use lidocaine as an anesthetic during nerve blocks or joint or soft tissue injections, but that doesn’t make it billable. HCPCS [...]

Reader question: Claim Dermabond Supply With 12001-12007   (October 2011)

Question: An established patient visited our office because of severe hyperkeratosis affecting both feet. The physician asked the patient to return a week later because we didn’t have Dermabond supplies in stock. The patient returned, and the physician applied Dermabond to several skin cracks on her feet. How should we code the second encounter?Wisconsin SubscriberAnswer: You can report and bill for the closure and supplies. Because the physician treated the problem with only Dermabond, you’re [...]

Reader question: Avoid Confusion of Block Code With Simple Repair   (October 2011)

Question: If a physician performs a digital block on a finger and repairs a 2 cm laceration, would the correct codes for these procedures be 64450 (Injection, anesthetic agent; other peripheral nerve or branch) and 12001-51? Thanks for any help.Virginia SubscriberAnswer: CPT® states that the digital block is included in the simple laceration repair code. The following services are always included in addition to the operation per se:Local infiltration, metacarpal/metatarsal/digital block or topical anesthesiaSubsequent to [...]

Reader question: Follow-Up Visit: Fill In Two Of Three E/M Components   (October 2011)

Question: I am auditing some of my physician’s E/M visits, and discovered that he’s not dictating a “physical exam” on the patient. He gives reason for the visit (i.e., vitals, past history, assessment and plan), but no physician exam notes on any follow-up patient. I’m pretty sure we need some type of documented physical exam (e.g., general mental status, general appearance, and orientation). When I discussed it with him, he says documented physical exam is [...]

Reader question: Remove J0570 From Your Superbills   (October 2011)

Question: We’re receiving denials when we report codes J7610 and J0570. Can you advise regarding what the problem might be?Tennessee SubscriberAnswer: Code J0570 (Injection, penicillin G benzathine, up to 1,200,000 units) was deleted on January 1, 2011. It crosswalks to new code J0561 (Injection, penicillin G benzathine, 100,000 units), which you should report instead.Code J7610 (Albuterol, inhalation solution, compound product, administered through DME, concentrated form 1 mg) is still an active code, but Medicare coverage [...]

Reader question: Tinnitus Coding   (October 2011)

Question: The internist documented “ringing in head” for a new patient. What diagnosis code applies?Oklahoma SubscriberAnswer: Submit the best-fitting choice from 388.3x (Tinnitus). The fifth-digit options describe unspecified, subjective (when only the patient hears the ringing sound), and objective tinnitus (when the physician and patient can both hear the ringing sound). Include an additional code for the external cause, if applicable, to identify the reason for the ear condition (such as E928.1, Exposure to noise, [...]