E/M: Compare 1995 and 1997 Exam Level Guidelines With At-A-Glance Tool (September 2011)
Be sure you choose the single set that’s most advantageous to your code choice.With two sets of guidelines – 1995 and 1997 – for assigning an E/M physical examination level, you may have a hard time keeping the requirements for each level straight. Clip this chart from Suzan Berman, CPC, CEMC, CEDC, senior manager of coding education and documentation compliance with UPMC in Pittsburgh, Pa., and keep it near your desk for quick access to the exam [...]
You Be the Coder: Capture Codes for Rituxan Infusion (September 2011)
Question: How should I code the following case?IV Rituxan, 7:30 AM to 10:30 AM IV Aloxi and Decadron (mixed in one bag), 10:30 AM to 10:50 AM IV Benadryl and Zantac (mixed in one bag), 10:50 AM to 11:10 AMNew Mexico SubscriberAnswer: Your first step is to verify the primary reason for the visit. CPT® guidelines specify that for physician coding you should choose the “initial” code based on the primary reason for the visit. [...]
Reader Question: Specialty Code 95 No Longer Identifies ADI (September 2011)
Question: Can you clarify whether we’ll need to use specialty code 95 for ADI?
Illinois SubscriberAnswer: Specialty code 95 will not be available for use to indicate advanced diagnostic imaging (ADI) accreditation. ADI includes diagnostic MRI, CT, and nuclear medicine imaging such as PET, and excludes X-ray, ultrasound, and fluoroscopy.History: In April 2011, CMS issued Transmittal 2192, indicating new specialty code 95 would apply to ADI accreditation.But on June 24, CMS issued Transmittal 2248 (www.cms.gov/transmittals/downloads/R2248CP.pdf) eliminating [...]
Reader Question: 79005 and More Saw CCI 17.1 Changes (September 2011)
Question: I’ve been hearing that a lot of the April CCI nuclear medicine updates changed modifier indicators retroactive to January. Does that mean we can resubmit the claims for payment?
Maryland SubscriberAnswer: When Correct Coding Initiative (CCI) edits are modified or deleted retroactive to a specific date, you may resubmit claims denied because of the edit when the date of service is on or after that specific date.Regarding version 17.1’s retroactive changes to modifier indicators for [...]
Reader Question: ‘Seen and Agree’ Won’t Withstand Audit (September 2011)
Question: Our physician works with residents each year. It’s very time consuming, but he does review their documentation and indicates whether he agrees with their findings. He doesn’t use a rubber stamp. Instead, he actually writes “Seen and agreed” on the chart before he signs it. A consultant told us during an audit that documenting this way is unacceptable. Can you explain the problem?
California SubscriberAnswer: The consultant is correct. Although you’re correct that a “seen [...]
Reader Question: Modifier QW Clues Are Available at CMS Site (September 2011)
Question: We are a CLIA waived lab. How can we find out if a specific test kit is something we’re approved to use in our lab?
Kansas SubscriberAnswer: You can find a complete online list of approved tests for waived labs under the Clinical Laboratory Improvement Amendments (CLIA). The Food and Drug Administration (FDA) categorizes tests and makes available a quarterly update of any new tests approved for waived-status labs.CMS posts the CLIA waived list, which you [...]
Clarify the limits of ‘anemia in neoplastic disease,’ or risk misrepresenting patient’s condition.
Scenario: Suppose documentation shows a diagnosis of anemia. The cause of the anemia is documented as cancer (primary overlapping sites in the colon) and not treatment (chemotherapy). The patient presents solely for treatment of the anemia. You need to choose which diagnosis codes you apply to the case and what order they go in. Follow along to see where to turn for the [...]
ICD-10: 198.5’s Combination Approach Sees a Change Under ICD-10 (August 2011)
Be sure documentation clearly distinguishes bone from bone marrow metastases.
ICD-10 will double your coding options for secondary neoplasms of bone and bone marrow.
ICD-9: Under ICD-9 2011, you report 198.5 (Secondary malignant neoplasm of other specified sites; bone and bone marrow) to indicate the confirmed presence of cancer that has spread from a different (primary) site to the bones or bone marrow.
ICD-10: The new code set, planned to take effect Oct. 1, 2013, instead may offer [...]
CMS Update: Q2043 Covers More Services Than You May Expect, Says CMS (August 2011)
You’ll also want to highlight the need for a second ICD-9 code.
A recent Medicare announcement revealed the limits of Provenge coverage. Here are the specifics.
Resist Urge to Report Q2043 With Admin Code
CMS announced coverage for Provenge use, finding the immunotherapy reasonable and necessary for beneficiaries with \asymptomatic or minimally symptomatic metastatic castrate-resistant (hormone refractory) prostate cancer.” The effective date is June 30, 2011, and the implementation date is Aug. 8, 2011.
HCPCS: As of July 1, [...]
E/M Coding: 3 Questions Get to the Heart of Physical Exam Guideline Options (August 2011)
1995 vs. 1997 guidelines: Limit yourself to one set per claim.
Whether you need a quick link to 1995 and 1997 E/M guidelines or a refresher on how the guidelines differ for the exam component, the answers to three FAQs can help keep your physical exam selection on track.
1. Where Do I Find Exam Level Guidelines?
There are two sets of guidelines you should be familiar with before trying to determine the level of the physicalexamination key [...]
