Supercoder - Ask an Expert?: Recent Posts

Supercoder - Ask an Expert?: Recent Posts http://www.supercoder.com/forum/ Supercoder - Ask an Expert?: Recent Posts en Thu, 09 Feb 2012 18:34:28 +0000 Kathy Foss on "Mohs surgery & repairs" http://www.supercoder.com/forum/topic/mohs-surgery-repairs#post-11296 Thu, 09 Feb 2012 17:44:10 +0000 Kathy Foss 11296@http://www.supercoder.com/forum/ Do you know if reimbursement for a repair would reduced when it is reported with the Mohs surgery codes or if it is paid at the regular reimbursement rate? Thank you in advance for your assistance. Sue Bolton on "arthroscopic shoulder surgery coding" http://www.supercoder.com/forum/topic/arthroscopic-shoulder-surgery-coding#post-11295 Thu, 09 Feb 2012 17:36:57 +0000 Sue Bolton 11295@http://www.supercoder.com/forum/ <code>29819,29827,29824,29828,29826,29807,29823</code> I am beginner at coding shoulders & not sure if I have coded correctly? Massive rotator cuff tear. Rotator cuff was extesivley scarred down, esp anteriorly involving 3 tendons. Multiple releases anterior & mobilize of posterior cuff tear.Biceps tenodesis. Multiple margin convergence to reconnect anterior part of tear to posterior part of tear. Multiple anchors implanted. SLAP trephination repair superior glenoid after biceps release. Multiple piece of loose body debrided and removed from the joint. Decompression anterior & lateral aspects of acromion out to the AC joint & across the AC joint with modified Mumford with removal of distal inferior clavicle where it was impinging on the cuff. Jami Deerfield on "Laparoscopy cholecystectomy" http://www.supercoder.com/forum/topic/laparoscopy-cholecystectomy#post-11294 Thu, 09 Feb 2012 17:15:49 +0000 Jami Deerfield 11294@http://www.supercoder.com/forum/ If the doctor started laparoscopy cholecystectomy then after about 15 mins. decided this was not the best way to go and changed it to an open cholecystectomy. Would I just code 47600, or is there another code I need to have? Sanjit Mishra on "Nurse visit for Unna boot" http://www.supercoder.com/forum/topic/nurse-visit-for-unna-boot#post-11293 Thu, 09 Feb 2012 16:43:29 +0000 Sanjit Mishra 11293@http://www.supercoder.com/forum/ Just for dressing changes by a nurse can be billed with 99211 Jacquelin Underwood on "AV optimization echo for biV ICD" http://www.supercoder.com/forum/topic/av-optimization-echo-for-biv-icd#post-11292 Thu, 09 Feb 2012 16:23:33 +0000 Jacquelin Underwood 11292@http://www.supercoder.com/forum/ How do I code an echo done at the hospital by cardiologist as an AV optimization study for timing and synchronization of a biV ICD? I think I would need to code a limited echo and device interrogation? Thanks Deborah Marsh on "NEW PFT CODE FOR 2012" http://www.supercoder.com/forum/topic/new-pft-code-for-2012#post-11291 Thu, 09 Feb 2012 16:12:05 +0000 Deborah Marsh 11291@http://www.supercoder.com/forum/ The CPT manual states "94240 has been deleted. To report thoracic gas volumes, see 94726, 94727." You can also get an idea of how the codes cross from the slides in the AMA presentation: <a href="http://www.ama-assn.org/resources/doc/cpt/08-2011-pulmonary-manaker.pdf" rel="nofollow">http://www.ama-assn.org/resources/doc/cpt/08-2011-pulmonary-manaker.pdf</a>. For example, see slide 15. (No need to say 2012 coding will depend on what the documentation supports.) Regards, Deborah Marsh, JD, MA, CPC, CHONC The Coding Institute Deborah Marsh on "Venfor and Normal Saline" http://www.supercoder.com/forum/topic/venfor-and-normal-saline#post-11290 Thu, 09 Feb 2012 15:42:58 +0000 Deborah Marsh 11290@http://www.supercoder.com/forum/ Coding hydration with therapeutic infusion is a tricky area. Medicare’s Correct Coding Initiative (CCI) policy manual states, “Hydration concurrent with other drug administration services is not separately reportable” (chapter 11, section B.5). You also shouldn’t code the saline if it runs just to keep the line open, according to CPT guidelines. The guidelines also state not to report hydration if it runs 30 minutes or less. On the other hand, you may report hydration that has been ordered and has documentation of medical necessity. Also remember it needs to run 31 minutes or more, and you can’t count it if it’s running concurrent with a therapeutic infusion. To avoid confusion and promote documentation quality, ask physicians to document their clinical rationale when they include hydration as part of the medication therapy order. Deborah Marsh on "72110 vs 72114" http://www.supercoder.com/forum/topic/72110-vs-72114#post-11289 Thu, 09 Feb 2012 15:27:28 +0000 Deborah Marsh 11289@http://www.supercoder.com/forum/ 72114 should be appropriate for the views you describe. Regards, Deborah Marsh, JD, MA, CPC, CHONC The Coding Institute Leesa Israel on "take home injections" http://www.supercoder.com/forum/topic/take-home-injections#post-11288 Thu, 09 Feb 2012 15:19:17 +0000 Leesa Israel 11288@http://www.supercoder.com/forum/ Hi Dana. * I know this is a late reply to this question, but I just noticed the question and wanted to chime in with my two cents. :-) * Sanjit is absolutely correct. In fact, since there was no drug administration performed in the office, and these drugs will be self- administered by the patient himself out of the office at home, you cannot bill at all. You should not submit a claim for the injection of the drugs or for the drugs supplied by the physician. * For this clinical scenario the patient should purchase the drugs by prescription from a pharmacy, especially if he has a drug plan for reimbursement or payment for the drugs purchased. * I hope this helps. * Best, Leesa * Leesa A. Israel, BA, CPC, CUC, CMBS Executive Editor, The Coding Institute Manager, TCI Consulting & Revenue Cycle Solutions Email: <a href="mailto:leesai@codinginstitute.com">leesai@codinginstitute.com</a> <a href="http://www.codinginstitute.com" rel="nofollow">http://www.codinginstitute.com</a> Leesa Israel on "Multiple HCPCS 50398" http://www.supercoder.com/forum/topic/multiple-hcpcs-50398#post-11287 Thu, 09 Feb 2012 15:14:58 +0000 Leesa Israel 11287@http://www.supercoder.com/forum/ Hi Keven. * First, 50398 is a CPT code, not a HCPCS code. :-) * For Medicare and some private payers you should report 50398 (Change of nephrostomy or pyelostomy tube). * You should attach modifier 50 (Bilateral procedure). You should expect to receive the 150 percent payment adjustment for these bilateral procedures. Place a “1”in the unit column box 24G of the 1500 form. * Some commercial and most private payers require two line billing with 50398-LT (Left side) on one line and 50398-50-RT (Right side) on the second line. * Best bet: Check with the individual payer as to its coding preference for this clinical scenario. * I hope this helps. * Best, Leesa * Leesa A. Israel, BA, CPC, CUC, CMBS Executive Editor, The Coding Institute Manager, TCI Consulting & Revenue Cycle Solutions Email: <a href="mailto:leesai@codinginstitute.com">leesai@codinginstitute.com</a> <a href="http://www.codinginstitute.com" rel="nofollow">http://www.codinginstitute.com</a> yides fuchs on "Sleep Study Plus Oxygen" http://www.supercoder.com/forum/topic/sleep-study-plus-oxygen#post-11286 Thu, 09 Feb 2012 15:11:44 +0000 yides fuchs 11286@http://www.supercoder.com/forum/ I wonder if you can help me with this Question- -A Patient had to have Oxygen during a Sleep Study can the provider bill for the Oxygen? and if yes which code? Leesa Israel on "psoas hitch" http://www.supercoder.com/forum/topic/psoas-hitch#post-11285 Thu, 09 Feb 2012 15:11:41 +0000 Leesa Israel 11285@http://www.supercoder.com/forum/ Hi David. * Sorry for the delayed response here. I thought someone else had already answered you. * Report 51565 (Cystectomy, partial, with reimplantation of ureter[s] into bladder [ureteroneocystostomy]). * The psoas hitch is included (bundled) into 51565 and in this clinical scenario is not a separately billable service. * You should use 189.2 (Malignant neoplasm of kidney and other and unspecific urinary organs, ureter) as your diagnosis code for this case. * I hope this helps. * Best, Leesa * Leesa A. Israel, BA, CPC, CUC, CMBS Executive Editor, The Coding Institute Manager, TCI Consulting & Revenue Cycle Solutions Email: <a href="mailto:leesai@codinginstitute.com">leesai@codinginstitute.com</a> <a href="http://www.codinginstitute.com" rel="nofollow">http://www.codinginstitute.com</a> Lynn Pascoe on "Aortogram and removal of foreign body" http://www.supercoder.com/forum/topic/aortogram-and-removal-of-foreign-body#post-11284 Thu, 09 Feb 2012 14:33:59 +0000 Lynn Pascoe 11284@http://www.supercoder.com/forum/ 37193 is not the correct code for the removal of the "foreign body'. 37193 is specifically for the retrieval of a vena cava filter. I would look at CPT 37203 if the removal was done "transcatheter" Also, I would not code the 75630 without a modifier, as there is no interpretation of the "Aorta". You might consider using 75630 with a 52 modifier. Lynn Pascoe on "Hidradenitis of Infra-mammary fold" http://www.supercoder.com/forum/topic/hidradenitis-of-infra-mammary-fold#post-11283 Thu, 09 Feb 2012 13:04:39 +0000 Lynn Pascoe 11283@http://www.supercoder.com/forum/ Is it appropriate to use a benign lesion excision for the excision of hidradenitis in the area of the inframammary fold ? This is not really a "lesion" per se, but all the information I see resorts to this coding because there is no cpt code for this anatomical area. Please advise, Lynn apoorba ganguly on "CPT CODE SUTURE REMOVAL" http://www.supercoder.com/forum/topic/cpt-code-suture-removal#post-11282 Thu, 09 Feb 2012 08:48:41 +0000 apoorba ganguly 11282@http://www.supercoder.com/forum/ If the suture removal is done under anesthesia (other than local), then any of these 2 codes would be used, based on the factor whether the same or different surgeon is doing the suture removal process: 15850, 15851. If it's done under local or no anesthesia, these codes could not be used. Sanjit Mishra on "administering Lucentis injections with sample drug" http://www.supercoder.com/forum/topic/administering-lucentis-injections-with-sample-drug#post-11281 Thu, 09 Feb 2012 06:17:02 +0000 Sanjit Mishra 11281@http://www.supercoder.com/forum/ Great Info you shared Tanya! Actually, I handled some denials similarly long time back. When you raised this issue, it refreshed my mind of similar issues of those days. Thanks a Million. TANYA PEREZ on "administering Lucentis injections with sample drug" http://www.supercoder.com/forum/topic/administering-lucentis-injections-with-sample-drug#post-11280 Thu, 09 Feb 2012 00:08:52 +0000 TANYA PEREZ 11280@http://www.supercoder.com/forum/ Hello, butting in to your question, as working with a retina specialist for the past few years, I have come across this issue. Whereas the injection 67028 is not paying due to the fact that CMS guidelines have updated to reflect that any injection must be accompanied by a covered medication. Now in your case, you are not wanting to bill for the sample Lucentis, since it was no charge to the doctor. Logical, but since you performed the injection, Medicare should pay for 67028. What we had to end up doing, is billing the Lucentis charge not as a $0 charge, but just submitted the J2788 as $0.01 *1 cent), which then will forward the charge to Medicare, Medicare will pay the $0.01 as well as the injection, 67028. Even if you bill a valid medication, full charge, but accidentally submit with, let's say, an invalid modifier. Since the medication will deny to invalid mod, or medical necessity, etc, etc, the injection will not be paid either, until the medication is corrected. Amy Poche on "code for bilateral lumbar sympathetic block" http://www.supercoder.com/forum/topic/code-for-bilateral-lumbar-sympathetic-block#post-11279 Wed, 08 Feb 2012 23:32:19 +0000 Amy Poche 11279@http://www.supercoder.com/forum/ I would choose code 64520 but modifier 50 is not allowed with this code. Any idea how to code the procedure below? Using continuous fluoroscopic guidance, a #25-gauge, 4-11/16-inch Quincke tip needle was inserted just inferior to the L3transverse process and advanced superior and lateral to the exiting nerve root to come in contact with the posterolateral aspect of the L3 vertebral body. It was then advanced in contact with periosteum to lie in the anterolateral paravertebral space. Appropriate position was confirmed on AP and lateral projections as well as with the injection of 1 mL of Isovue-M 200 showing characteristic contrast dye spread in the paravertebral space. Following this, a solution of 3 mL of 0.75% Marcaine and 1 mL of betamethasone solution was injected without difficulty. Ssandra Herron on "Frontal Craniotomy with Menengial Biopsy" http://www.supercoder.com/forum/topic/frontal-craniotomy-with-menengial-biopsy#post-11278 Wed, 08 Feb 2012 23:09:36 +0000 Ssandra Herron 11278@http://www.supercoder.com/forum/ How to code: Frontal Craniotomy with Menengial Biopsy and Dural repair with a periosteal dural graft, Fibrin glue and Duragen plus sponge. Diagnosis of CNS inflammatory disease. Sanjit Mishra on "Aortogram and removal of foreign body" http://www.supercoder.com/forum/topic/aortogram-and-removal-of-foreign-body#post-11277 Wed, 08 Feb 2012 23:03:17 +0000 Sanjit Mishra 11277@http://www.supercoder.com/forum/ 37193 and 75630. Correctness: Not sure Sanjit Mishra on "Newborn visits in physician office" http://www.supercoder.com/forum/topic/newborn-visits-in-physician-office#post-11276 Wed, 08 Feb 2012 21:42:40 +0000 Sanjit Mishra 11276@http://www.supercoder.com/forum/ When the visit is in follow-up to an identified problem such as jaundice, infrequent stools, or infrequent feedings, and the physician, nurse practitioner, or physician assistant provides the service, an office visit (eg, 99212-99215) and problem specific diagnosis codes should be reported. * If no feeding or other health problem has been previously noted, this visit may be the first well child visit when provided by a physician, nurse practitioner or physician assistant. Code 99391 may be reported with diagnosis code V20.2 for this service. This service includes time spent addressing routine feeding issues. However, if significant time beyond that typical of the infant preventive service is spent in counseling, physicians may also report a problem-oriented service (99212-99215) with modifier -25 to indicate the significant and separately identifiable services provided on the same date. Documentation should include approximate time spent face-to-face with the family and patient, notation of time spent in counseling and context of counseling. (Codes may be selected based on time spent in counseling and coordination of care when documentation indicates more than 50% of face-to-face time was spent in these activities.) * If a nurse visit is provided (e.g., weight screen only), code 99211 may be reported. If the nurse visit results in a visit with the physician, only the physician services would be reported. LINDA HISCOCK on "NEW PFT CODE FOR 2012" http://www.supercoder.com/forum/topic/new-pft-code-for-2012#post-11275 Wed, 08 Feb 2012 20:45:41 +0000 LINDA HISCOCK 11275@http://www.supercoder.com/forum/ I'M LOOKING FOR THE CORRECT CODE FOR THE PFT FOR 2012 THAT REPLACE CODE 94240. I'VE BEEN READING IT'S JUST ONE CODE BUT FROM A FEW OF THE ANSWERS ON HERE IT LOOKS LIKE 3-4 CODES COULD BE USED. THX'S Sanjit Mishra on "what is the codes Laparoscopic transhiatal esophagectomy and placement of je" http://www.supercoder.com/forum/topic/what-would-be-the-correct-cpt-codes#post-11274 Wed, 08 Feb 2012 20:33:41 +0000 Sanjit Mishra 11274@http://www.supercoder.com/forum/ As you have mentioned 43107 is the open procedure for the said purpose, and 44015 is for jejunostomy placement. There is no code for laparoscopic procedure,so you can code 43999 here and file claim with complete documentation of reports and medical records. Teela Depena on "Alternative code for 97039" http://www.supercoder.com/forum/topic/alternative-code-for-97039#post-11273 Wed, 08 Feb 2012 20:22:23 +0000 Teela Depena 11273@http://www.supercoder.com/forum/ UHC is denying cpt 97039 as unlisted code & asking to resubmit with appropriate cpt code so can you help me? Sanjit Mishra on "Interest on clean claims" http://www.supercoder.com/forum/topic/interest-on-clean-claims#post-11272 Wed, 08 Feb 2012 20:05:28 +0000 Sanjit Mishra 11272@http://www.supercoder.com/forum/ Page#214 of <a href="https://www.cms.gov/manuals/downloads/clm104c01.pdf" rel="nofollow">https://www.cms.gov/manuals/downloads/clm104c01.pdf</a> ---------------------------------------------------------------- 80.2.2 - Interest Payment on Clean Non-PIP Claims Not Paid Timely (Rev. 1771, Issued: 07-17-09, Effective: 08-17-09, Implementation: 08-17-09) Interest must be paid on clean claims if payment is not made within the applicable number of calendar days (i.e., 30 days) after the date of receipt as described above. The applicable number of days is also known as the payment ceiling. For example, a clean claim received on March 1, 2009, must have been paid before the end of business on March 31, 2009. Interest is not paid on: • Claims requiring external investigation or development by the provider’s FI or carrier; • Claims on which no payment is due; • Full denials; • Claims for which the provider is receiving PIP; or • HH PPS RAPs Interest is paid at the rate used for §3902(a) of title 3l, U.S. Code (relating to interest penalties for failure to make prompt payments). The interest rate is determined by the applicable rate on the day of payment. This rate is determined by the Treasury Department on a 6-month basis, effective every January and July 1. Providers may access the Treasury Department Web page <a href="http://fms.treas.gov/prompt/rates.html" rel="nofollow">http://fms.treas.gov/prompt/rates.html</a> for the correct rate. Medicare contractors shall include notification to providers of any change to the Treasury Department interest rate in their routine educational materials and/or website for providers. Interest is calculated using the following formula: Payment amount x rate x days divided by 365 (366 in a leap year) = interest payment The interest period begins on the day after payment is due and ends on the day of payment. sandy lukert on "debridement and antegrade drilling code help" http://www.supercoder.com/forum/topic/debridement-and-antegrade-drilling-code-help#post-11271 Wed, 08 Feb 2012 19:58:14 +0000 sandy lukert 11271@http://www.supercoder.com/forum/ Can anyone help me with the code for debridement of the second metatarsophalangeal joint with debridement and antegrade drilling of the second metatarsal head? Diagnosis is avascular necrosis of the second metatarsal head. Jacquelin Underwood on "stress test interpretation only" http://www.supercoder.com/forum/topic/stress-test-interpretation-only#post-11270 Wed, 08 Feb 2012 19:35:20 +0000 Jacquelin Underwood 11270@http://www.supercoder.com/forum/ To bill for 93018, does the dr have to include diagnosis or reason for exam even if he is not the ordering physican? Can we use 93018 to bill for just his interpretation? Thanks Sanjit Mishra on "HCPCS '36569' and '71010' together" http://www.supercoder.com/forum/topic/hcpcs-36569-and-71010-together#post-11269 Wed, 08 Feb 2012 19:34:44 +0000 Sanjit Mishra 11269@http://www.supercoder.com/forum/ Here Chest x-ray was performed to confirm the position of the PICC line, not for any medical necessity, so is included in Picc line insertion. Tara Purdy on "CCI edit question ENT" http://www.supercoder.com/forum/topic/cci-edit-question-ent#post-11268 Wed, 08 Feb 2012 18:59:36 +0000 Tara Purdy 11268@http://www.supercoder.com/forum/ When is modifier 59 appropriate when billing 69440 and 69660 together? Sanjit Mishra on "administering Lucentis injections with sample drug" http://www.supercoder.com/forum/topic/administering-lucentis-injections-with-sample-drug#post-11267 Wed, 08 Feb 2012 18:42:13 +0000 Sanjit Mishra 11267@http://www.supercoder.com/forum/ You are right Theresa. Sanjit Mishra on "Allograft and Autograft?" http://www.supercoder.com/forum/topic/allograft-and-autograft#post-11266 Wed, 08 Feb 2012 18:34:27 +0000 Sanjit Mishra 11266@http://www.supercoder.com/forum/ No, CPT 29892 description and layterms doesn't include implantation of allograft. So, you can code from the codes: 20962: Bone graft with microvascular anastomosis; other than fibula, iliac crest, or metatarsal OR, 28103: Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with allograft OR, 27899 Unlisted procedure, leg or ankle Theresa Jane Davis on "administering Lucentis injections with sample drug" http://www.supercoder.com/forum/topic/administering-lucentis-injections-with-sample-drug#post-11265 Wed, 08 Feb 2012 18:27:23 +0000 Theresa Jane Davis 11265@http://www.supercoder.com/forum/ the diagnosis code 362.02 is not a stand alone diagnosis code. If you read the CPT under that code you have to use a primary dx code of 250.50 or 250.51 show the diabetic manifestation. I hope this helps. Donna Young on "Physicians assistants billing 99304-99306" http://www.supercoder.com/forum/topic/physicians-assistants-billing-99304-99306#post-11264 Wed, 08 Feb 2012 18:14:50 +0000 Donna Young 11264@http://www.supercoder.com/forum/ I am receiving denial C0-170 payment is denied when preformed/billed by this type of provider. Per Medicare PA's can not charge inital visit with pos 31 (SNF) provider type 38 (PA). Does anyone have any information on this denial? Sherry Olson on "Colonoscopy w/bougie dilation & biopsy" http://www.supercoder.com/forum/topic/colonoscopy-wbougie-dilation-biopsy#post-11263 Wed, 08 Feb 2012 18:05:30 +0000 Sherry Olson 11263@http://www.supercoder.com/forum/ How would you code this? My doctor did a complete colonoscopy and then pulled the colonoscope back into the rectum. Then he used a 42 French Maloney dilator, passed rectally and dilated the narrowing of the colonic lumen. A rectosigmoid biopsy was also obtained. Per CCI edits 45303 bundles into 45380. Is there another code that more reflects all procedures? Renita Bowman on "How do you code the reprogramming/maintance on a Baclofen pump?" http://www.supercoder.com/forum/topic/how-do-you-code-the-reprogrammingmaintance-on-a-baclofen-pump#post-11262 Wed, 08 Feb 2012 17:49:09 +0000 Renita Bowman 11262@http://www.supercoder.com/forum/ How do you code when a patient is seen by a physician and all he does is the reprogramming/maintance of the patients baclofen pump, which code do I use? Also how do you code if the physician does a reprogram and refill of the pump? Thanks for you help.