Providers struggle to reconcile conflicts between recent CMS regulations and the CPT® Manual and other AMA publications. Jugna Shah, MPH , Valerie A. Rinkle, MPA , and Linda S. Dietz, RHIA, CCS, CCS-P , look at specific areas of confusion and how to code them accurately.
The ICD-10 implementation delay has impacted training timelines for many providers. Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC , talks about how this time can be used to improve physician documentation, easing the transition for both coders and providers.
Hyperbaric oxygen therapy is only covered for certain diagnoses after extensive prequalification. Gloria Miller, CPC, CPMA, reviews how HBO therapy can be used for wound care, as well as 2014 changes for wound care clinics.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, explains how reporting multiple gestations will change in ICD-10-CM, including greatly expanded specificity and replacements for V codes from ICD-9-CM.
On Monday, the Senate passed a House of Representatives bill on Medicare payments that included a provision to delay ICD-10 implementation until at least October 1, 2015.
Q: My question is about the time interval requirement of the CPT ® add-on code 96376 (each additional sequential intravenous push of the same substance/drug provided in a facility [list separately in addition to code primary procedure]), which says that more than 30 minutes must pass between administrations of same substances in order to report it. In our ED, cardiac patients are frequently started on heparin—a bolus given for less than 16 minutes and a drip given over several hours. These are frequently charted in the electronic record as having been given at the same time. In this case, is it still appropriate to report 96365 (intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour) for the first hour of drip and 96376 for the bolus, or must the administration be given greater than 30 minutes apart?
Changes implemented by the 2014 OPPS Final Rule resulted in the addition and deletion of many codes in the January I/OCE update. Dave Fee, MBA , reviews some of the most important modifications, including changes to evaluation and management services and device reporting.
Even though ICD-10-CM respiratory changes are relatively minor, coders will still have to learn the new guidelines and review anatomy and physiology in order to report them accurately. Tara L. Bell, RN, MSN, CCM, AHIMA-approved ICD-10-CM/PCS trainer, and Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CPC-I, CHA, AHIMA-approved ICD-10-CM/PCS trainer, highlight the changes and new guidelines.
Hierarchical Condition Category (HCC) coding may be a foreign concept for some coders, but making sure documentation for Medicare Advantage patients supports it can be critical. Holly J. Cassano, CPC , discusses what criteria needs to be met for complete documentation.
In the Medicare Quarterly Provider Compliance Newsletter , CMS writes about auditor findings for MRI scans that did not meet medical necessity and how to ensure documentation that supports it.
Q: When coding excision of a breast mass with needle localization using stereotactic guidance, we report CPT ® code 19125 (excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion) and new code 19283 (placement of breast localization devices, percutaneous; first lesion, including stereotactic guidance). The 3M system says Medicare NCCI edits consider this separate reporting of codes that are components of the comprehensive procedure if billed for services provided to the same beneficiary by the same physician on the same day. These codes will be rebundled by the Medicare payer and payment will be based on code 19125 only. Does that mean to only report 19125 for this kind of case? If there is an excision of a lesion by one surgeon and needle localization done by a radiologist, can we report 19125, with 19283 and modifier -59 (distinct procedural service)? We can’t find any official reference for this issue for 2014. How do we code excision of a breast mass with needle localization now?
Q: I am auditing a note for a fusion. The note lacks detail, therefore is hard to justify. The patient had a prior hardware placement. The note describes dissecting down, debridement of necrotic bone, and tissue work done. This is the entire note, after describing dissection, “Vigorous irrigation with 10 liters of saline and antibiotics was carried out. Hemostasis was maintained. The right S1 screw and rod portion was removed as it was notably loose. Additional decortication and onlay bone grafting was performed at L1-S1. Drains were placed…” They coded: 22612 (arthrodesis, posterior or posterolateral technique, single level; lumbar) Add-on code 22614 (each additional vertebral segment) x4 22852 (removal of posterior segmental instrumentation) In the procedures performed area of the note, they state: Hardware removal, lumbar Revision fusion L1-S1 with onlay bone graft Irrigation and debridement of lumbar spine wound Since there is nothing in the note regarding autografting, I assume this is an allograft? Should this be coded? Also is that documentation enough to justify arthrodesis? Modifier -GC (this service has been performed in part by a resident under the direction of a teaching physician) was appended, although the language was not added for this. I can only assume a resident dictated this.
The auditory system has its own code category in ICD-10-CM because of the number of new codes and specificity available. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I , reviews ear anatomy and how to report newly introduced diseases and conditions.
CMS Administrator Marilyn Tavenner reiterated last week that ICD-10 implementation would not be delayed again, as CMS prepares for end-to-end testing of providers this summer.
Not surprisingly, coders will have many more options to report how a patient was injured in ICD-10-CM. Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD , and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS , explain how the codes differ from ICD-9-CM E codes, when to report them, and why coders should not be too worried about the transition.
Coders will have many more options to report wrist and hand injuries in ICD-10-CM, with codes for individual fingers, wrist bones, and joints, as well as laterality. Review the anatomy of the wrists and hands in order to take advantage of the specificity available in ICD-10-CM.
Debbie Mackaman, RHIA, CPCO, and Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS, discuss the purpose of medically unlikely edits (MUEs) and how they are calculated by CMS.
While the 2014 CPT ® Manual features many new combination codes among its hundreds of changes this year, it was also updated to reflect newly recognized technologies and procedures . Denise Williams, RN, CPC-H, looks atsome of the changes made in the Radiology and Laboratory sections.
The added specificity of ICD-10 may require coders to learn more about disease processes and terminology in order to code accurately. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, reviews some medical terms coders should know and steps to take to improve communication between providers and coders.
