CCI Update: Watch for New Edits Hitting Brachytherapy and Heparin Codes   (July 2010)

Pay close attention to modifier indicators — and when modifier 59 is safe to use.
Effective July 1, you have more than 16,000 new edit pairs to comply with, thanks to Correct Coding Initiative (CCI) Version 16.2.
The update brings “the total number of active edit pairs to 653,718,” said senior analyst Frank Cohen, MPA, MBB, of MIT Solutions, in a June 17 announcement about the CCI changes. Save yourself some time by homing in on the [...]

ICD-9 Coding: Follow These Tips to Feel Certain About Coding Uncertain Neoplasms   (July 2010)

Mastering uncertain vs. unspecified is an oncology coding essential.
Unless you’ve got the terms “uncertain” and “unspecified” down pat, you’re setting yourself up for miscoded claims. Take a look at our experts’ explanations and examples to make sure you know the difference.
Know How the Neoplasm Table Can Help
To understand the uncertain/unspecified distinction, you need to comprehend the overall neoplasm diagnostic classification scheme. The ICD-9 neoplasm table distinguishes cancers as malignant, benign, uncertain, or unspecified. Starting with [...]

CCI Update: Don’t Overlook Hospital Visit/Radiation CCI News   (July 2010)

When you’re reviewing the Correct Coding Initiative (CCI) version 16.2 changes, remember there’s more to consider than additions and deletions. With each of the quarterly CCI updates, practices tend to focus primarily on the new CCI edits. “They may not even consider that there’s a potential swap in the columns, and the need to change which code should have the modifier appended,” says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACSPM, CHCO, owner of MJH [...]

You Be the Coder: Take the Chemotherapy Coding Challenge   (July 2010)

Question:
How should I report the following case?
Primary diagnosis is lung cancer, primary neoplasm in upper lobe
500 NS (saline), 10:15-12:05 for the diagnosis of dehydration
Avastin, 10:30-11:00
Kytril, 11:00-11:25
Decadron, 11:00-11:25 (mixed with Kytril)
Gemzar, 11:25-12:05
Pennsylvania Subscriber
As a starting point, assuming chemotherapy is the primary reason for the encounter, you should report the administration of chemotherapy drugs Avastin and Gemzar using 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for one and +96417 [...]

Reader Questions: Pick 233.4 for PIN III   (July 2010)

Question:
The oncologist notes that a prostate biopsy reveals “high-grade prostatic intraepithelial neoplasia (PIN-III).” I can’t find this in the neoplasm table. What is the correct diagnosis code?
New York Subscriber
Answer:
For high-grade PIN III you should use 233.4 (Carcinoma in situ of breast and genitourinary system; Prostate).
Although the neoplasm table in the ICD-9 manual’s index does not offer enough information to help you choose 233.4 for PIN III, you will find a “PIN III” entry [...]

Reader Questions: Nix Reporting NS Concurrent With Chemo   (July 2010)

Question:
If the patient receives saline (NS) concurrently with chemotherapy for hydration, may we report +96361 along with the chemotherapy administration code?
Pennsylvania Subscriber
Answer:
You should not report 96360-+96361 (Intravenous infusion, hydration …) for saline administered concurrently with chemotherapy, according to Medicare.
Rule: “Medicare currently permits separate payment of HYDRATION therapy provided sequentially (but not concurrently) to CHEMOTHERAPY infusion,” states your Pennsylvania Part B MAC, Highmark, in article A47797. (Search for the article here: www.cms.gov/mcd/search.asp.)
In addition, Medicare’s [...]

Reader Questions: 2 Modalities Still Equal 77263 x 1   (July 2010)

Question:
When a course of therapy involves both brachytherapy and external beam therapy, should I report two separate treatment planning codes?
New Jersey Subscriber
Answer:
No. If you check CPT’s “Clinical Treatment Planning (External and Internal Sources)” guidelines, the definition of complex planning includes “combination of therapeutic modalities.”
Your New Jersey Medicare Part B contractor, Highmark, specifies that “Treatment planning is a one-time charge per course of therapy. Billing for multiple treatment plans for a single course of [...]

Reader Questions: Match J9303 to Chemo Admin Codes   (July 2010)

Question:
I had a claim for J9303, 96413, and +96367 rejected. Are these the correct administration codes for this drug?
Wisconsin Subscriber
Answer:
The most likely problem is the pairing of J9303 (Injection, panitumumab, 10 mg) with non-chemotherapy additional sequential infusion code +96367 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; additional sequential infusion, up to 1 hour [List separately in addition to code for primary procedure]).
Here’s why: Code J9303 represents panitumumab (sold as [...]

Reader Questions: Take Care When Choosing NDC   (July 2010)

Question:
Where can I find an NDC number for J0881?
New York Subscriber
Answer:
You’ll need to take the NDC (National Drug Code) from the package or purchase invoice to be sure you’re using the proper code for the specific drug (and strength, package type, dosage form, etc.) administered.
The U.S. Food and Drug Administration (FDA) offers an online searchable database (www.fda.gov/Drugs/InformationOnDrugs/ucm142438.htm). But you will need a lot of information in the documentation to be able to choose the [...]

Estrogen Receptor Status: 3 Questions Clarify V86.0 Use for Current Breast Cancer Coding Success   (June 2010)

Learn which code you should add for patients on tamoxifen therapy.
Skipping secondary ICD-9 codes can be tempting, but properly reporting estrogen receptor status is a quick way to add support to your breast cancer patients’ claims. Shore up your V86.x coding skills with the answers to three key questions.
Important: These questions and answers relate to patients being treated for breast cancer that is currently present, not for patients on prophylactic regimens.
1. What Do ER+ and [...]