Reader Question: Boil This Procedure Note Down to What MD Actually Performed   (December 2011)

Question: My ob-gyn documented the following note:Procedures: Administered injection. Patient given one dose of Atropine. Site - Left Upper Quadrant Lot # 0211317 Expiration: 2/2013 Patient given 60mg of Tordol. Site - Left Upper Quadrant Lot@ DK 12011 Expiration: 11/2012. Thermachoice Ablation: Betadine was used to cleanse vaginal vault and cervix. Superficial anterior cervix was injected with 2cc 0.05% Carbocaine (20cc mixed with 20cc Saline=40cc total volume) using a 10cc control syringe with a 22 [...]

You Be the Coder: Repeat Pap Plus Urinary Tract Infection   (November 2011)

Question:  A Medicare patient who is high risk due to sexual behavior came in for her annual wellness visit. The ob-gyn did a Pap, and the office reported G0438/V70.0 with Q0091/V76.2. He ordered a repeat Pap six months later, due to insufficient cells. The patient came back to have the repeat Pap, but she did complain at the visit that she had urinary frequency and pain. The ob-gyn evaluated her for a urinary tract infection [...]

CPT^® 2012: These Deletions Will Impact How You Report Implanon Insertions in 2012   (November 2011)

Check out new pathology codes that reflect the tests your ob-gyn can order. If you were concerned that 2012 might be a heavy year for ob-gyn code additions, then you can breathe easy – but not too easy. You still need to check out these new skin substitute graft codes and potential gyn oncology services. Getting to know these five CPT 2012 changes now means that you won’t be scratching your head when that ob-gyn claim [...]

Don’t Forget Printed Additions of 90654, Mod 33   (November 2011)

Remember how 90654 (Influenza virus vaccine, split virus, preservative-free, for intradermal use) went into effect Jan. 1, 2011? Now you can see it in your CPT manual. Also, you’ll see modifier 33 (Preventive services) printed in your CPT manual. It, too, went into effect Jan. 1, 2011. This modifier allows you to tell your payer that you performed a preventive service and that the patient’s deductible and coinsurance do not apply under the new Patient [...]

ICD-10: Your Leukorrhea Code Will Become a General One in 2013   (November 2011)

Don’t overlook these Excludes1 notes. If a patient has leukorrhea, she has whitish, yellowish, or greenish discharge from the vagina. The discharge can be normal or the sign of an infection.Right now, you should report this condition with 623.5 (Leukorrhea not specified as infective). When you switch to ICD-10 in October 2013, you should report N98.8 (Other specified noninflammatory disorders of vagina) instead. These two codes have a one-to-one correlation, but you should examine how [...]

OIG Report: Pay Attention to E/M Levels, G Modifiers, and More, OIG Warns   (November 2011)

Check your compliance on the areas in the 2012 Work Plan before OIG does.Every practice knows that with payer audits and recoupment requests coming in, now is the time to step up your compliance but where do you start? The HHS Office of Inspector General (OIG)’s 2012 Work Plan, released on Oct. 5 can point you in the right direction.The OIG has some big plans next year for reviewing Part B claims, and they span [...]

Reader Question: Take This Vaginal Cuff Dehiscence Challenge   (November 2011)

Question: My ob-gyn performed a Da Vinci assisted abdominal sacrocolpopexy, and I asked her if code 57425 was correct.. After looking at it, she replied, “This surgery also included a repair of vaginal cuff dehiscence.” What should I report? Virginia SubscriberAnswer: You won’t find a separate code to reflect vaginal cuff dehiscence. If the ob-gyn repaired it via the laparoscope, you could report an unlisted procedure code, but you have no close comparisons to submit [...]

Reader Question: Examine 57410 vs. 49000 for Exploratory Vaginal Surgery   (November 2011)

Question: My ob-gyn performed an exploratory vaginal surgery. The patient was status post normal spontaneous vaginal delivery with continuous vaginal bleeding after a vaginal repair of laceration. The vaginal packing was in place. Should I report 57410 or 49000? New Mexico SubscriberAnswer: This depends on the approach. You should report 57410 (Female pelvic examination under anesthesia) if the ob-gyn looked only at the vagina, and of course this procedure means it was a vaginal approach. [...]

Reader Question: You Won’t Find CPT^® Guidelines For This 59850 Issue   (November 2011)

Question: I know to bill 59850 for the delivery of twins (both nonviable) 19-4/7 weeks, but should I bill this once or twice with modifier 51 for twin “B?”California SubscriberAnswer: You won’t find any specific guidelines in CPT for this issue, because at that age, each fetus is very small. Your best bet may be to add modifier 22 (Increased procedural services) to 59850 (Induced abortion, by one or more intra-amniotic injections [amniocentesis-injections], including hospital [...]

Reader Question: Retained IUD Diagnosis Changes Based On This Factor   (November 2011)

Question: Can I use 996.32 for a retained intrauterine device (IUD)?Nevada SubscriberAnswer: Yes, you can use 996.32 (Mechanical complicaion due to intrauterine contraceptive device) so long as the patient is not pregnant.ICD-10: This code will become T83.39xA (Other mechanical complication of intrauterine contraceptive device, initial encounter), T83.39xD (…subsequent encounter), or T83.39xS (… sequela).If a pregnant patient has a retained IUD and this condition alters the management of the pregnancy because the ob-gyn suspects this has [...]