Reader Question: Established Patients Last 3 Years   (January 2012)

Question: We saw a patient over a year ago for a cystectomy, and now the patient came back with extreme lower right quadrant pain and our surgeon performed a hysterectomy. Should we bill the hysterectomy as a new patient since she’s coming back for a different reason?Idaho SubscriberAnswer: No, you should not bill this case as a new patient. You should bill this as an established patient for several reasons.If your ob-gyn sees a patient [...]

Gynecology: Fine Tune Your Fibroid Claims By Studying These Removal Methods   (December 2011)

Check out this minimally invasive, nonsurgical option. To accurately report uterine fibroid removals, you must know what method the ob-gyn used to take care of the growth. Learning more about each method of fibroid treatment, you will be prepared for whatever your ob-gyn chooses to perform. Method 1: Count Hysterectomy As Most Common Procedure First, if the ob-gyn removes the uterus entirely, he performed a hysterectomy. This is the most common option, but only when [...]

Diagnosis coding: Confused by Fibroids Vs. Polyps? Here’s How to Make the Distinction   (December 2011)

You may have to wait for the pathology report.Fibroids and polyps are similar because they’re both growths, but one occurs in the endometrial lining while the other occurs in the muscle. Can you guess which one is which? Here’s the answer.Polyps are small growths on the surface of the uterine wall that are easy for the ob-gyn to remove. In other words, they are an overgrowth of the endometrial lining. They’re intracavitary lesions.Fibroids (or myomas) [...]

Obstetrics: Consider 3 Options For Reporting Only Antepartum Care   (December 2011)

Abandon global ob codes and count the number of visits.Did your ob-gyn perform antepartum care but not the delivery? If so, that means you may need to abandon global codes 59400, 59510, 59610, and 59618 (Routine obstetric care including antepartum care …) and go for three alternative options. But one thing is certain, however: you need to count the number of visits.Note: CPT® states that antepartum care includes monthly visits up to 28 weeks gestation, [...]

Coding refresher: Look Sharp at New Vaccine Codes For The 2011 Flu Season   (December 2011)

Double check your code assignments to make sure you comply with payer instructions.Flu season can be a busy time in the emergency department, especially if an epidemic hits the area. Although ideally not the place for preventive care, your ob-gyn may provide flu shots for certain patient populations that seek treatment there. To better recoup deserved reimbursement for these services, take note of the differences between CPT® and Medicare for flu vaccine codes.CPT® has several [...]

ICD-10: Orient Yourself To These New ICD-10 Ovarian Cyst Codes   (December 2011)

Your 620 codes become N83 ones in 2013.An ovarian cyst consists of a fluid filled closed sac or cavity in the ovary. The cyst is usually lined by epithelium. They can be normal, abnormal, non-neoplastic, or neoplastic tissues.Here’s how you report these codes right now:620.0 – Follicular cyst of ovary620.1 – Corpus luteum cyst or hematoma620.2 – Other and unspecified ovarian cyst.When your diagnosis coding system changes in 2013, you’ll report ovarian cysts like this:N83.0 – Follicular cyst of [...]

You Be the Coder: Process This CPT® 2012 Prolonged Care Revision   (December 2011)

Question: I know the E/M codes for observation services changed, but I heard the prolonged services did too. Is that true?Virginia SubscriberAnswer: Yes. CPT® 2012 E/M code revisions clarify timeframes and providers for both observation services and prolonged care.Prolonged service: Codes +99354-+99359 delete “physician” and substitute “direct patient contact” for “face-to-face” requirements from the descriptors, which opens the door for other qualified health care professionals who have billing privileges in your practice to submit the [...]

Reader Question: Refer to 628.8 for Couple’s Infertility Diagnosis   (December 2011)

Question: What diagnosis code should I use for an office visit where a patient and her husband cannot get pregnant due to the husband’s oligospermia? Ohio SubscriberAnswer: If you’re billing the female patient’s insurance, you should report 628.8 (Infertility, female; of other specified origin). This is a “couple” diagnosis, so this is appropriate.ICD-10: When your diagnosis coding system changes in 2013, you will report N97.8 (Female infertility of other origin).

Reader Question: Try This Different Day, Different Delivery Twin Scenario   (December 2011)

Question: A patient admitted at 24 weeks with twin pregnancy for rescue cerclage that the ob-gyn was unable to perform. So the ob-gyn admitted the patient for management of incompetent cervix. Fifteen days later, she vaginally delivered one twin, and the ob-gyn placed an emergent cerclage to retain the second twin. Six days later, she delivered second twin by cesarean section for rupture of membranes. First, should I use a global care code (59400) for [...]

Reader Question: Code 99051 is Not an Automatic Weekend Add-On   (December 2011)

Question: Can you report 99051 in addition to an E/M code for a Saturday visit? The description states adjunct to basic services rendered for services provided during posted evening, weekend, or holiday office hours. Wyoming SubscriberAnswer: No. Ask yourself, what exactly is the additional special service? Code 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service) is not an automatic add-on code for seeing [...]