ICD-10 Prep: Brush Up On A&P When Prepping for ICD-10 Conversion (October 2011)
Focus on your practice’s top 30 diagnoses to get a head start toward compliance.Education is an important part of preparing for 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 [...]
ICD-10: 719.4x Expands to More Joint Pain Options with M25.5- - (October 2011)
Get ready for 7-digit specificity explaining sites of pain.When your physician evaluates and treats patients for joint pain, you have numerous code choices under ICD-9 for diagnosis 719.4x (Pain in joint) based on anatomic site. Code specificity will move from five to seven digits when ICD-10 becomes effective in October 2013. ICD-10 basics: Currently, ICD-9-CM lists all anatomic sites for joint pain in the same fifth-digit category (719.4x). ICD-10 changes that by listing code options [...]
You Be the Coder: Wait for More Specific Diagnosis Than V80.09, If Possible (October 2011)
Question: Our neurologist sometimes completes a punch biopsy to look for small fiber neuropathy. The payer denied our claim with diagnosis V80.09. What should I change when we resubmit? Arkansas Subscriber Answer: Typically, neurologists perform skin punch biopsies as a diagnostic study to determine whether the patient has a small fiber neuropathy (or to rule out that possibility) rather than as a screening test. The patient usually has signs/symptoms that make the diagnostic study medically [...]
Reader Question: Add -59 for EEG on Same Day as Spinal Tap (October 2011)
Question: Medicare denied an EEG interpretation billed on the same day as an initial hospital admission and spinal tap. Is the interpretation included in the history and physical? Michigan Subscriber Answer: The interpretation isn’t part of your neurologist’s initial hospital care service, but it is a Column 2 code of the spinal tap. Append modifier 59 (Distinct procedural service) to indicate the EEG and spinal tap are separate services. Your claim should read as follows: [...]
Reader Question: Regular EMG Codes Apply to Free Running Test (October 2011)
Question: What are the correct codes for interpretation of an intraoperative, free running EMG and pedicle screw stimulation? Is there a code we can report for online monitoring when the neurologist monitored the patient from outside the operating room? North Dakota Subscriber Answer: For pedicle screw stimulation, the provider performing the intraoperative electrophysiologic monitoring is usually evaluating free-run and triggered electromyography. CPT® does not list separate codes for a free running EMG. Simply report one [...]
Reader Question: Keep 64612 or 64613 to Single Unit, Not Bilateral (October 2011)
Question: When our physicians administer Botox for chronic migraines, we bill the HCPCS J code for the drug with procedure code 64613 and modifier 50. Payers are sending multiple denials, stating that the procedure/modifier combination is invalid. What’s our best coding strategy? Texas Subscriber Answer: When billing injections of Botulinum toxins, aka chemodenervation, the key is to review the CPT® code terminology. The procedure code you’ll turn to is 64613 (Chemodenervation of muscle[s]; neck muscle[s] [...]
Reader Question: Intent Helps Distinguish SI Injection From Arthrogram (October 2011)
Question: What is the difference between a sacroiliac (SI) joint injection and an SI joint arthrogram? How do I know the difference when requesting authorization prior to the procedure being rendered?South Carolina SubscriberAnswer: An arthrogram requires a formal radiological interpretation and report that the physician uses for further diagnosis and treatment of the patient. It also requires that hard copies of multiple views of the arthrogram be obtained. In contrast, the fluoroscopic guidance used with [...]
Reader Question: Turn to Q5 for Vacation-Coverage Billing (October 2011)
Question: One physician from our group covered another physician’s days while he went on vacation. Whose name should appear on the claim?Florida SubscriberAnswer: You may submit the claim in the vacationing physician’s name and receive payment, according to section 30.2.10 of Chapter 1 of the Medicare Claims Processing Manual (www.cms.gov/manuals/downloads/clm104c01.pdf). There are, of course, several conditions the visit must meet, which you can read about in the manual. One condition you want to be sure [...]
Neurology: Keep 4 Points In Mind for Successful H-Reflex Test Coding (September 2011)
Hint: Start by distinguishing from F-wave studies. You might turn to Appendix J of the CPT® manual most often to review the maximum number of nerve conduction studies you typically report for specific indications. Don’t overlook the next column that addresses H-reflex (or Hoffmann’s reflex) studies, however, because these tests have specific considerations to keep in mind while avoiding denials.1. Learn Difference Between Tests H-reflex and F-wave studies both test the patient’s late response reflex [...]
Tip: Narrow anatomy options to simplify code selection. When your pain management specialist treats trigeminal neuralgia, verifying the site and structure approached makes all the difference in your coding. Read on for four simple steps toward coding success and deserved payment. Brush Up On Anatomy BasicsKnowing cranial nerve anatomy simplifies your code selection. The trigeminal nerve is the largest cranial nerve, and is a mixed nerve with a predominant sensory component. It mainly supplies innervations [...]
