Reader Question: Avoid 99211 With 96372 at All Costs   (November 2011)

Question: If a patient pays for her medicine and goes to the clinic for the nurse to give the injection, we can bill 96372 (Therapeutic, prophylactic or diagnostic injection …). But CPT says we should bill 99211 (Office or other outpatient visit …) if this visit takes place without physician supervision. We used to bill an E/M code but stopped when we were told at a coding seminar a few years ago that we could [...]

Reader Question: Count Oocytes for 89280-89281   (November 2011)

Question: Codes 89280 and 89281 don’t have a Correct Coding Initiative (CCI) edit, but payers are denying these codes as “mutually exclusive.” Can we bill both codes and why?Rhode Island SubscriberAnswer: You should report 89280 (Assisted oocyte fertilization, microtechnique; less than or equal to 10 oocytes) or 89281 (… greater than 10 oocytes) based on the number of oocytes undergoing assisted fertilization under CPT guidelines, but not both. CCI would not have this edit because [...]

Reader Question: Simplify This Ectopic Pregnancy Scenario   (November 2011)

Question: The patient had a ruptured ectopic pregnancy. The ob-gyn did a laparoscopy. The ectopic pregnancy had blown through the isthmus tube and was at the junction of the cornua. He cauterized the surface of the uterus with a Kleppinger for hemostasis. She did not actually lose the tube. The op report reads diagnostic laparoscopy, cauterization of ectopic site. What CPT code(s) should I report? Should I code 49320 for lap and find another for [...]

Gynecology: Take 5 Steps to Make Myomectomy Mistakes a Thing of the Past   (October 2011)

Find out how the weight of myomas can trump the number of them. Deciding which myomectomy code you’ll report depends on three factors: the approach the ob-gyn uses, the number of the myomas, and their weight. Here’s how to translate this information into the correct CPT® code every time. Watch out: If your ob-gyn performs a hysterectomy, you won’t report the myomectomy separately. Step 1: Investigate Myomas and Their Types When your ob-gyn performs a [...]

Modifiers: Bust 5 Common Modifier 24 Myths to Ensure Deserved Reimbursement   (October 2011)

Hint: Focus on the documentation, not the diagnosis codes.To ensure payment for E/M services your physician performs within the global period of a surgical procedure, you must know the ins and outs of modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period). At times even seasoned billers struggle with this modifier.Overcome modifier 24 claim challenges by busting five myths that will lead to denial after denial if you fall [...]

ICD-10: Decipher How Dysuria’s 788.1 Becomes 2 Codes in 2013   (October 2011)

You won’t be reporting this condition with F45.8 – here’s why.Dysuria refers to difficulty or pain during urination. Currently, you report this condition with 788.1 (Dysuria), but this code expands into two options as of October 1, 2013:R30.0, DysuriaR30.9, Painful micturition, unspecifiedDocumentation tip: While not completely synonymous, the term dysuria can also be documented as ’strangury,” a term that refers to difficulty in micturition, with straining to void; urine may be passed intermittently with pain and [...]

Coding Quiz: How Much Do You Know About V Codes? Find Out Fast   (October 2011)

Learn when you can use V codes as primary diagnosesThe V codes are not only for providing supplemental information on your ob-gyn claims, and you could be facing denials or lower payments because you’re avoiding V codes. They are, in fact, key elements to correct coding practices.You don’t have to be wary of using your V codes. Take this quiz and see how you score when it comes to V codes.Challenge Yourself to These 7 [...]

You Be the Coder: Apply Either Modifier 51 or 59 In This Essure Scenario   (October 2011)

Question: The doctor stopped the Essure procedure he was performing in our office. According to his documentation, he couldn’t visualize due to uterine distention. He said that he did a diagnostic hysteroscopy and then ended up inserting a ParaGuard. He also said that nothing he did for the Essure procedure would be included in the ParaGuard. I’ve checked the Correct Coding Initiative (CCI) edits, and they are not bundled. How should I report this? Should [...]

Reader Question: Don’t Forget New ICD-9 2012 Codes Start Oct. 1   (October 2011)

Question: I know October 1, 2011 is the start date for the latest ICD-9 codes, but I don’t remember the ob-gyn codes. Could you remind me?California SubscriberAnswer: First of all, the following new codes for ICD-9-2012 reflect early spontaneous labor with a planned cesarean delivery:649.81 (Onset [spontaneous] of labor after 37 completed weeks of gestation but before 39 completed weeks gestation, with delivery by [planned] cesarean section, delivered, with or without mention of antepartum condition)649.82 [...]

Reader Question: Highlight This Appendectomy CCI 17.3 Addition   (October 2011)

Question: I noticed the Correct Coding Initiative (CCI) version 17.3 came out. Do any of these edits affect ob-gyn practices?Florida SubscriberAnswer: The only edit impacting ob-gyn practices is the addition of appendectomy codes 44950 (Appendectomy) and 49970 (Laparoscopy, surgical, appendectomy) into most codes. These edits have a modifier indicator of “0,” meaning you cannot separate these edit with a modifier (such as 59, Distinct procedural service) for any reason.To be exact, you’ll find 44950 to [...]