Reader Question: 38220-59 Is Best Bet in This Case (December 2011)
Question: We want to be sure we’re reporting 38220 correctly when the physician takes more than one aspiration. Should we report multiple units?Rhode Island SubscriberAnswer: When the physician aspirates more than one needle site (such as the iliac and the sternum), you should report 38220 (Bone marrow; aspiration only) for the first site and 38220-59 (Distinct procedural service) for the second site. This is the method advised by CPT® Assistant (January 2004).Caution: If the physician [...]
Case Study: J9265 and More Apply to This Ovarian Cancer Scenario (November 2011)
Test yourself by choosing the proper codes and units for this encounter.Finding the proper codes – even for well-documented visits – can require some detective work. Take a look at the sample scenario and make your choices for the appropriate ICD-9-CM, HCPCS, and CPT® codes.Scenario: Documentation shows the patient presents for her first day of chemotherapy, aimed at treating stage III epithelial ovarian cancer (primary).The tracking form for the patient shows the following infusions:0817-0833, dexamethasone sodium phosphate, [...]
Give your coding a boost by tying code digits to actual structures.Your ability to identify the body part described in your oncologist’s documentation can help sharpen your coding.Use the anatomic illustration below to locate the site described, and then match that site to the sampling of applicable ICD-9-CM codes in the table.Important: The above table indicates only sample codes for the anatomic structure. When coding a report, you should use the most specific code available [...]
E/M: 99224-99226 Are Reportable by Treating Physician Only, CMS Says (November 2011)
Not coding for the treating physician? Look to outpatient E/M codes.In effect for nearly a year now, CPT®’s subsequent observation care codes have been something of a mystery since they were released, but CMS finally ended that by issuing clarifications about how to report these codes.Pinpoint Services Included in 99224-99226The codes in focus are:99224, Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 [...]
ICD-10-CM: C50.- Range Will Replace Both 174.x and 175.x (November 2011)
Prepare for more specific codes for male breast cancer patients.ICD-9-CM codes for breast neoplasms are fairly specific, but your ICD-10-CM options kick the detail requirements up another notch. Here’s the lowdown on how ICD-10-CM incorporates additional anatomic information and increases the data needed when you code for male patients.ICD-9-CM coding rules: Using ICD-9-CM 2011, your coding options for primary breast neoplasms differ based on sex.For female patients you use 174.x (Malignant neoplasm of female breast), [...]
You Be the Coder: Knock Out This Nasopharyngeal Case (November 2011)
Question: How should I report the following case? A patient presented for chemotherapy to treat a primary malignant neoplasm of the nasopharyngeal floor. The patient complained of new onset of extreme fatigue, and the oncologist performed a level-3 office visit to evaluate her. The patient then received a 30-minute gemcitabine infusion followed by a 60-minute cisplatin infusion. We did not supply the drugs. Montana SubscriberAnswer: For the diagnoses indicated, you should report V58.11 (Encounter for [...]
Reader Question: 203.01 Is More Appropriate Than ‘History of’ Code (November 2011)
Question: Which “history of” code applies to myelomatosis in remission?Texas SubscriberAnswer: Rather than looking for a “history of” code, you should use 203.01 (Multiple myeloma; in remission).The fifth digit allows you to describe the disease as being in remission, which basically means that the disease is no longer observable in the patient. The disease is not considered “cured,” however.Your other fifth digit options for 203.0x include:0, … without mention of having achieved remission (also appropriate for [...]
Reader Question: 93005 Describes ECG Tech Component (November 2011)
Question: Techs employed by our center perform ECGs on certain patients to check for toxicity. A different group provides the interpretation and reports it. How should we report our service?Virginia SubscriberAnswer: For the services your center performs, you should report 93005 (Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report).Rationale: Although for many codes you would indicate performance of only a portion of the service by appending either modifier TC [...]
CCI Update: Q2043 Edits Abound in the Latest Round of CMS Bundles (October 2011)
Be sure to check the effective date for these edits.October 1, 2011, brings Correct Coding Initiative (CCI) 17.3 for physician coders. Be sure to check for Q2043 and 36xxx changes before you send in your next claim.Think Twice Before Pairing a Code With Q2043 The latest version of CCI adds 1,380 new edit pairs, according to Frank Cohen, principal and senior analyst for The Frank Cohen Group, LLC, in his NCCI 17.3 Update (available at [...]
CCI Basics: Refresh Your Knowledge of How to Legitimately Override Edits (October 2011)
Don’t forget the ’same provider’ aspect of CCI-bundled codes.Correct Coding Initiative (CCI) edits are a fact of life for coders, and they come with a rule book all their own. Here’s a quick reminder of when CCI says it’s OK to report two codes from an edit pair on the same claim.How it works: CCI edits are updated quarterly. They are created for Medicare, but many private payers apply the edits, as well. “All edits [...]
