Coding Laboratory Services

Transcription

1 Audio Seminar/Webinar June 4, 2009 Practical Tools for Seminar Learning Copyright 2009 American Health Information Management Association. All rights reserved.

2 Disclaimer The American Health Information Management Association makes no representation or guarantee with respect to the contents herein and specifically disclaims any implied guarantee of suitability for any specific purpose. AHIMA has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this audio seminar, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this program. AHIMA makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service. CPT five digit codes, nomenclature, and other data are copyright 2009 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. As a provider of continuing education the American Health Information Management Association (AHIMA) must assure balance, independence, objectivity and scientific rigor in all of its endeavors. AHIMA is solely responsible for control of program objectives and content and the selection of presenters. All speakers and planning committee members are expected to disclose to the audience: (1) any significant financial interest or other relationships with the manufacturer(s) or provider(s) of any commercial product(s) or services(s) discussed in an educational presentation; (2) any significant financial interest or other relationship with any companies providing commercial support for the activity; and (3) if the presentation will include discussion of investigational or unlabeled uses of a product. The intent of this requirement is not to prevent a speaker with commercial affiliations from presenting, but rather to provide the participants with information from which they may make their own judgments. The faculty has reported no vested interests or disclosures regarding this presentation. AHIMA 2009 Audio Seminar Series American Health Information Management Association 233 N. Michigan Ave., 21 st Floor, Chicago, Illinois i

3 Faculty Betty Hatten, MHS, MT Betty Hatten is a manager in Huron Consulting Group s Clinical Research Solutions and Healthcare Compliance practice. Ms Hatten is a 40 year veteran of the healthcare industry, including the past 11 as a healthcare consultant focusing on coding and compliance, charge capture, performance improvement, and chargemaster development and maintenance. A medical technologist for 28 years, her experience includes clinical laboratories, genetics and transplant labs, in vitro fertilization labs, educator, and laboratory administrative director. Diana Medal, MA, RHIA, CCS, CPC, CCS-P Diana Medal is a compliance practice leader in the care delivery section of Kaiser Permanente s national Compliance, Ethics, and Integrity team, where she is responsible for coordinating coding compliance training and supporting coding compliance audits. Ms Medal was previously assistant professor of health information administration at Loma Linda University. She also participated in global distance instruction for Loma Linda, as medical terminology instructor for physical and occupational therapy students in Yokkaichi, Japan. AHIMA 2009 Audio Seminar Series ii

4 Table of Contents Disclaimer... i Faculty... ii The Objectives... 1 The Agenda... 1 Comparison of Organ & Disease Panels... 2 Lab Coding Tips... 3 Online, Free, Lab Coding Reference... 4 Using the Reference Lab Website... 4 Coding Tip: Always Validate Testing Methods: Labs Vary CPT Codes HCPCS Code Selection... 7 Polling Question #1 Source of Diagnostic Information... 8 Official Coding Guidelines... 8 Official Coding Guidelines Diagnostic Services Only Coding for Physician Billing Pathologist Proposed New Codes for FY Proposed Invalid Codes for FY Pathologist s Interpretation of a Pap Smear Papanicolaou Test Reconfirmation V Abnormal Cytologic Smear of Anus Other Codes Associated with Anal Pap Smear Diagnosis from Ordering Physician vs. Pathologist for Pathologist Claim Diagnosis for Urine Culture Diagnosis for Complete Blood Count (CBC) Diagnosis for Monitoring Effects of Long-term Use of Drugs Clinical Laboratory Fee Schedule Physician Fee Schedule Reimbursement for OPPS Hospital Lab Tests that are Assigned APCs Reimbursement for OPPS Hospital Labs Addendum B: OPPS Reimbursement Status Indicator Definitions Billing for End Stage Renal Disease (ESRD) Related Laboratory Tests Composite Rate Tests Polling Question #2 The Semicolon and Modifiers National Correct Coding Initiative Do these 2 Indented Codes Need a Modifier? Modifier -59 Distinct Procedural Service Polling Question #3 Use of Modifier Modifier -91 Repeat Clinical Diagnostic Test or -91 Case Study Modifier -90 Reference (Outside) Laboratory AHIMA 2009 Audio Seminar Series (CONTINUED)

5 Table of Contents ESRD Modifiers: CD, CE, CF OIG Work Plan (FY 2009) Why Doctors Order Lab Tests? Information Available for Each Reason The Need for ABNs: Variable Screening Tests: Legislative Provisions Beneficiary Notices Initiative (BNI) The CMSR ABN Instructions and Options Guidelines for Coding Blood Transfusions Complete Billing of the Blood Transfusion Transfusion Medicine Case: The Facts Transfusion Medicine Case: The Answer NCCI Edits for Crossmatching Transfusion Medicine Case: The Answer Most Common Missed CPT Codes in Lab: Microbiology Aerobic and Anaerobic Cultures with Blood Cultures Most Common Missed CPT Codes in Lab: Microbiology For More Information on Laboratory Coding from CPT Assistant Resource/Reference List Supplemental Material Other References : Lab Websites Audience Questions Audio Seminar Discussion Become an AHIMA Member Today! Audio Seminar Information Online Upcoming Audio Seminars Thank You/Evaluation Form and CE Certificate (Web Address) Appendix Resource/Reference List CE Certificate Instructions AHIMA 2009 Audio Seminar Series

6 The Objectives At the conclusion of today s program, the participants will be able to: 1. Select the most accurate lab CPT/HCPCS code; 2. Locate internet resources for coding esoteric lab procedures and profiles; 3. Identify the appropriate payment programs for OP lab services including ESRD composite rate, Clinical Lab Fee schedule and OPPS APCs; 4. Discuss CPT coding guidelines for laboratory services; 5. Summarize the ICD-9 CM Diagnostic Coding and Reporting Guidelines for Outpatient Services; and 6. Demonstrate the correct use of modifiers 59 and The Agenda 1. CPT & HCPCS Coding Overview with Coding TIPS and CAUTIONS 2. ICD-9 Diagnosis & Procedure Coding 3. The Fee Schedules and Addendum B 4. Lab Modifier Maze and the NCCI 5. OIG & the Clinical Lab: Compliance Guidelines and the 2009 Work Plan 6. Deep Dive into Real Life Lab Coding Cases 2 AHIMA 2009 Audio Seminar Series 1

7 Comparison of Organ & Disease Panels 3 Comparison of Organ & Disease Panels 4 AHIMA 2009 Audio Seminar Series 2

8 Lab Coding Tips Select Accurate Codes Adjectives and other important words Specimen, Method, Total or Free, With or W/out Manual or automated, Qual or Quant, initial, Each, first, 2-8 or 9-15 Antibody codes start with 86xxx; Antigens start with 87xxx 5 Lab Coding Tips When you need more than one code Charge explosions Panels, Profiles and Reflex Tests: Maintaining Compliance When there isn t a code Avoid the unlisted procedure code: Use Method Codes How to find esoteric testing codes 6 AHIMA 2009 Audio Seminar Series 3

9 Online, Free, Lab Coding Reference Type your Query or select from the alphabet 7 Using the Reference Lab Website Queried Drug Screen 8 AHIMA 2009 Audio Seminar Series 4

10 CODING TIP: Always Validate Testing Methods: Labs Vary CPT Codes Myeloperoxidase (MPO) A biomarker used in conjunction with troponin, CK or CKMB and BNP. ID s patients w/chest pain who are at risk for MI but have a negative troponin or ECG Oncoprotein (DCP) Oncoprotein biomarker intended for F/U of patients w/chronic liver disease at risk for Hepatocellular carcinoma. (Associated w/a 4.8 increase of HCC w/in next 21 months) 10 AHIMA 2009 Audio Seminar Series 5

11 2009 CPT Codes Coagulation & Fibrinolysis, functional activity, NOS, each analyte Used in Dx of thrombotic thrombocytopenic purpura & hemolytic uremic syndrome (examples of assays i.e., Disintegrin and metalloproteinase) Infectious agent enzymatic activity other than virus (e.g., sialidase activity in vaginal fluid) The test is for bacterial vaginosis with results in approx 10 minutes. Has a reported sensitivity of 90% CPT Changes The old subheading following Transcutaneous Procedures was deleted in 2009 and replaced with the new subheading In Vivo (e.g. transcutaneous) Laboratory Procedures. The new codes are: Bilirubin, total transcutaneous Hemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin Methemoglobin 12 AHIMA 2009 Audio Seminar Series 6

12 2009 CPT Changes Molecular diagnostics codes were revised in These codes represent molecular diagnostic techniques for analysis of nucleic acids. Code separately each procedure used in the analysis. Additional descriptions were added, for example, each nucleic acid type (i.e., DNA or RNA), each enzyme treatment, and each nucleic acid preparation. 13 HCPCS Code Selection Select Accurate HCPCS Codes The Blood Products P P9060; J J2792 Adding on a Code to a blood product CAUTION: Do not unbundle or double bill 14 AHIMA 2009 Audio Seminar Series 7

13 Polling Question #1 Source of Diagnostic Information A diagnosis was not on the lab order. Can the lab staff accept the patient s reason for why the test has been ordered? [*1] Yes [*2] No 15 Official Coding Guidelines Diagnostic Coding and Reporting Guidelines for Outpatient Services Coding guidelines for inconclusive diagnoses (probable, suspected, rule out, etc.) were developed for inpatient reporting and do not apply to outpatients. 16 AHIMA 2009 Audio Seminar Series 8

14 Official Coding Guidelines Diagnostic Services Only Patients receiving diagnostic services only For patients receiving diagnostic services only during an encounter/visit, sequence first the diagnosis, condition, problem, or other reason for encounter/ visit shown in the medical record to be chiefly responsible for the outpatient services provided. Codes for other diagnoses may be sequenced as additional diagnoses. 17 Official Coding Guidelines Diagnostic Services Only For encounters for routine laboratory testing in the absence of signs, symptoms, or associated diagnosis, assign V72.6. If routine testing is performed during the same encounter as a test to evaluate a sign, symptom, or diagnosis, it is appropriate to assign both the V code and the code describing the reason for the non-routine test. 18 AHIMA 2009 Audio Seminar Series 9

15 Official Coding Guidelines Diagnostic Services Only For outpatient encounters for diagnostic tests that have been interpreted by a physician, and the final report is available at the time of coding, code any confirmed or definitive diagnosis(es) documented in the interpretation. Do not code related signs and symptoms as additional diagnoses. Note: This differs from the coding practice in the hospital inpatient setting regarding abnormal findings on tests. 19 Coding for Physician Billing Pathologist Coding Clinic First Quarter 1990 Page: When patients receive only ancillary diagnostic services during an encounter, the appropriate V code for the examination is sequenced first. The diagnosis/problem for which the services are being performed is sequenced second. V72.6 Laboratory examination is used often by pathologists to describe the reason for the encounter (e.g. study biopsy specimen). When the bill is submitted, if there is an established diagnosis (e.g. malignant neoplasm) then an additional code can be submitted for the diagnosis. 20 AHIMA 2009 Audio Seminar Series 10

16 Proposed New Codes for FY 2010 V72.60 Laboratory examination, unspecified V72.61 Antibody response examination V72.62 V72.63 Laboratory examination ordered as part of a general medical examination Pre-procedural laboratory examination V72.69 Other laboratory examination 21 Proposed Invalid Codes for FY 2010 V72.6 Laboratory examination 22 AHIMA 2009 Audio Seminar Series 11

17 Pathologist s Interpretation of a Pap Smear Scenario: Physician performed a routine gynecological examination with a pap smear. The specimen was sent to an external lab. Conclusion: The pathologist s interpretation of the pap smear revealed abnormal cells and bacterial vaginosis. Code Assignment: V72.6 as the first listed diagnosis followed by Rationale: Pathology claims should start with V72.6. The secondary diagnosis code represents any definitive diagnostic information. 23 Papanicolaou Test Reconfirmation V72.32 V72.32 Encounter for Papanicolaou Cervical Smear to Confirm Findings of Recent Normal Smear Following Initial Abnormal Smear This code is assigned by the gynecologist and not the pathologist. It is routine for patients to return for several Pap tests following an initial abnormal Pap smear. 1 st Pap as part of routine GYN Exam V If abnormal, 2 nd pap 795.0x. When result of 2 nd Pap is normal, Third pap test is V72.32, and 4 th pap test is V AHIMA 2009 Audio Seminar Series 12

18 Abnormal Cytologic Smear of Anus x may be assigned as a secondary diagnosis code by the pathologist for abnormal cytologic smear of anus and anal HPV. V72.6 is principal diagnosis for pathologist. Human papillomavirus (HPV) can occur in the anus and is associated with a higher incidence of anal cancer in HIV patients compared to the general population. Pap smears are also performed for cytologic evaluation of the anus, and similar to cervical cytology, anal cytology uses the Bethesda 2001 system to categorize the abnormalities by severity. 25 Other Codes Associated with Anal Pap Smear V76.49 Screening for malignant neoplasm of other sites Satisfactory anal smear but lacking transformation zone Unsatisfactory anal cytology smear 26 AHIMA 2009 Audio Seminar Series 13

19 Diagnosis from Ordering Physician vs. Pathologist for Pathologist Claim Scenario: A physician surgically removed a skin lesion. The specimen was sent to the pathologist to determine the nature of the lesion. Conclusion: The pathologist confirmed the lesion to be malignant. Code Assignment: The pathologist would report the appropriate malignancy code dependent on the anatomical site and the morphology of the neoplasm on his claim. Rationale: The pathologist is a physician. 27 Diagnosis for Urine Culture (Note: See Supplemental Materials for Urine Culture Flow Chart) Scenario: A physician ordered a urinary culture for a patient experiencing sharp pelvic pains, a burning sensation in the urethra, and urine tinged with blood. The physician sent the urine sample to the lab. Conclusion: The culture was positive for a urinary tract infection (UTI). Code Assignment: The lab would report the code(s) to describe the symptoms. Rationale: The urine culture did not have physician interpretation. 28 AHIMA 2009 Audio Seminar Series 14

20 Diagnosis for Complete Blood Count (CBC) Scenario: A physician orders a CBC for a patient c/o frequent headaches and lethargy. The blood sample was sent to an external lab. Conclusion: The findings were low hemoglobin and hematocrit. Code Assignment: the lab would report the code(s) to describe the symptoms. Rationale: The blood sample did not have physician interpretation. 29 Diagnosis for Monitoring Effects of Long-term Use of Drugs Assign a code from category V58.6x for patients requiring laboratory monitoring to asses the effects of Long-term (current) drug use Monitoring for Long-term (current) use of other medications (i.e., chemotherapy, digitalis) V58.69 as the principal diagnosis Monitoring for Long-term (current) use of warfarin/coumadin V58.61 Monitoring for Long-term (current) use of aspirin V58.66 Monitoring for Long-term (current) use of steroids V AHIMA 2009 Audio Seminar Series 15

21 Clinical Laboratory Fee Schedule Log on to the CMS website at: Then click Medicare Scroll down, on the right hand side click Medicare Fee for Service Payment Then click Clinical Laboratory Fee Schedule In the left hand column, click Fee Schedule Clinical Laboratory Fee Schedule Home 31 Clinical Laboratory Fee Schedule 32 AHIMA 2009 Audio Seminar Series 16

22 Clinical Laboratory Fee Schedule 33 Physician Fee Schedule Log on to the CMS website at: Then click Medicare Scroll down, on the right hand side click Medicare Fee for Service Payment Then click Physician Fee Schedule In the left hand column, click Fee Schedule Physician Fee Schedule Home Physician Fee Schedule Physician Fee Schedule Overview 34 AHIMA 2009 Audio Seminar Series 17

23 Physician Fee Schedule 35 Reimbursement for OPPS Hospital Lab Tests that are Assigned APCs Log on to the CMS website at: Then click Medicare Scroll down, on the right hand side click Medicare Fee for Service Payment Then cllick Hospital Outpatient PPS In the left hand column, click Addendum A and Addendum B Updates Addendum B April 2009 Hospital Outpatient PPS Addendum A and Addendum B Updates 36 AHIMA 2009 Audio Seminar Series 18

24 Reimbursement for OPPS Hospital Labs 37 Addendum B: OPPS Reimbursement Status Indicator identifies reimbursement method 38 AHIMA 2009 Audio Seminar Series 19

25 Status Indicator Definitions Click Tab and Scroll 39 Billing for End Stage Renal Disease (ESRD) Related Laboratory Tests Medicare Publication Chapter 16 (Rev. 1, ) PM AB-98-7, PRM , B Hemodialysis, Intermittent Peritoneal Dialysis (IPD), and Continuous Cycling Peritoneal Dialysis (CCPD) Tests 40 AHIMA 2009 Audio Seminar Series 20

26 Billing for End Stage Renal Disease (ESRD) Related Laboratory Tests With some exceptions, laboratory tests for hemodialysis, intermittent peritoneal dialysis (IPD), and continuous cycling peritoneal dialysis (CCPD) are included in the ESRD composite rate. For a particular date of service to a beneficiary, if 50 percent or more of the covered laboratory tests are noncomposite rate tests Medicare allows separate payment beyond that included in the composite rate. 41 Billing for End Stage Renal Disease (ESRD) Related Laboratory Tests For a description of what laboratory tests and other tests are included in the composite rate and under what conditions such tests may qualify for additional payment in addition to the composite rate, see the Medicare Benefit Policy Manual Chapter 11, End Stage Renal Disease (ESRD), and Chapter 8 of this manual. Clinical diagnostic laboratory tests included under the composite rate payment are paid through the composite rate paid by the FI. 42 AHIMA 2009 Audio Seminar Series 21

27 Composite Rate Tests 43 Polling Question #2 The Semicolon and Modifiers The placement of the semicolon in the CPT description is an indication for the need of a modifier? [*1] True [*2] False 44 AHIMA 2009 Audio Seminar Series 22

28 National Correct Coding Initiative The CMS National Correct Coding Initiative (NCCI) edits provide many specific instructions for use of CPT modifiers used for laboratory services. If an NCCI flag is reported on a claim, consider that modifiers may be added to remove the NCCI edit if the procedure is distinct or unrelated to other procedures performed on the same date. 45 Do these 2 Indented Codes Need a Modifier? 46 AHIMA 2009 Audio Seminar Series 23

29 Do these 2 Indented Codes Need a Modifier? 2 common methods for susceptibility testing 47 Do these 2 Indented Codes Need a Modifier? 48 AHIMA 2009 Audio Seminar Series 24

30 Modifier -59 Distinct Procedural Service -59 is used to identify procedures/services that are not normally reported together, but are appropriate under certain circumstances. -59 is used to designate instances when distinct and separate multiple services are provided to a patient on a single date of service. 49 Modifier -59 Distinct Procedural Service -59 is only to be used if no more descriptive modifier is available -59 is used for separate sessions or patient encounters, or different procedures. -59 is used if the same procedure using the same procedure code is used for testing a different specimen (e.g. aerobic culture of two independent wound site specimens). 50 AHIMA 2009 Audio Seminar Series 25

31 Modifier -59 Distinct Procedural Service -59 is NOT used when a test is ordered and performed and additional related procedures are necessary to provide or confirm the result. These would be considered part of the ordered test. Example A patient has an abnormal test result and repeat performance of the test is done to verify the result. Only one unit of service of the test may be reported. 51 Polling Question #3 Use of Modifier -59 Is modifier -59 used with flow cytometry involving and x 3? [*1] Yes [*2] No 52 AHIMA 2009 Audio Seminar Series 26

32 Modifier -91 Repeat Clinical Diagnostic Test -91 is used to identify repeat performance of the same laboratory test on the same day to obtain subsequent (multiple) test results. For example, if a second culture was performed from the same wound site on the same day, -91 is appended. 53 Modifier -91 Repeat Clinical Diagnostic Test -91 is NOT used when tests are re-run to confirm initial results due to testing problems when a normal, one-time reportable result is all that is required. -91 is NOT used when other CPT codes are available to describe series of results (e.g. glucose tolerance tests, evocative/suppression testing). 54 AHIMA 2009 Audio Seminar Series 27

33 -59 or -91 Case Study A female patient is seen in the outpatient laboratory for aerobic culture of two sites of a single wound of the left arm. The lab technologist obtains independent specimens, one from the proximal, and one from the distal wound site is coded x 2 for quantitative aerobic bacterial culture. What modifier is appended to the second code? or -91 Case Study A male patient with hypokalemia had multiple blood tests performed to check potassium following potassium replacement therapy. After the initial potassium value, three subsequent blood tests were performed on the same date following the administration of potassium to correct the patient s hypokalemic state x 2 is coded for serum potassium. What modifier is appended to the second code? 56 AHIMA 2009 Audio Seminar Series 28

34 Modifier -90 Reference (Outside) Laboratory When laboratory procedures are performed by a party other than the treating or reporting physician, the procedure may be identified by adding modifier -90 to the usual procedure number. Although the physician is reporting the performance of the test, the actual testing component was a service from a laboratory. 57 ESRD Modifiers: CD, CE, CF Three pricing modifiers discreetly identify the different payment situations for ESRD AMCC services. The physician that orders the tests is responsible for identifying the appropriate modifier when ordering the test as follows: CD AMCC test has been ordered by an ESRD facility or MCP physician that is part of the composite rate and is not separately billable CE AMCC tests has been ordered by an ESRD facility or MCP physician that is a composite rate test but is beyond the normal frequency covered under the rate and is separately reimbursable based on medical necessity 58 AHIMA 2009 Audio Seminar Series 29

35 ESRD Modifiers: CD, CE, CF CF AMCC tests has been ordered by an ESRD facility or MCP physician that is not part of the composite rate and is separately billable The ESRD clinical laboratory test identified with modifiers CD, CE or CF may not be billed as organ or disease panels. Upon the effective date of this business requirement, all ESRD clinical laboratory test must be billed individually. 59 OIG Work Plan (FY 2009) Compare pricing of individual tests vs. profiles Look for inappropriate unbundling of profile tests Analyze laboratory pricing policies for End Stage Renal Disease services Analyze Medicare/Medicaid laboratory services for appropriate payments 60 AHIMA 2009 Audio Seminar Series 30

36 Why Doctors Order Lab Tests? 1. To Screen for Disease 2. To Diagnose a Disease/Condition 3. To Monitor an existing Disease 4. To Monitor a Therapeutic Drug 61 Information Available for Each Reason Screening No established diagnosis No signs or symptoms Diagnosing There are signs and symptoms Monitoring There is a diagnosis There is a treatment, care plan or medication 62 AHIMA 2009 Audio Seminar Series 31

37 The Need for ABNs: Variable To Screen for Disease ABN not necessary unless criteria not met To Diagnose a Disease/Condition ABN not necessary if Signs/Symptoms given To Monitor an existing Disease ABN not necessary if reason for test is provided To Monitor a Therapeutic Drug ABN not necessary w/v58.6x (V58.61 V58.69) 63 Screening Tests: Legislative Provisions See HCPCS Level II Book Lab PSA G0103 PAP Smears G0123, G Fecal Occult G0328 Blood, Immunoassay Radiology Vaccines 64 AHIMA 2009 Audio Seminar Series 32

38 Beneficiary Notices Initiative (BNI) 65 The CMSR AHIMA 2009 Audio Seminar Series 33

39 The CMSR ABN Instructions and Options 68 AHIMA 2009 Audio Seminar Series 34

40 Guidelines for Coding Blood Transfusions Medicare Publication Section 250. The Order The Product The Cross-match and other testing The Transfusion Transfusion Reactions and Exceptions 69 Complete Billing of the Blood Transfusion In Lab Testing ABO, Rh, Antibody Screen (only 1 of each the above) When Antibody Screens are positive multiple identification tests and procedures are required Crossmatch depending on the product ordered, bill a crossmatch (select method) for each unit tested whether transfused of not Revenue codes for lab may be 300 or 302. Follow FI instructions. The Blood Product Enter appropriate P code and # of units actually transfused On occasion there is not a P code that completely describes the product. Add irradiation, splitting, vol reduction as necessary. (CAUTION: Do not double bill! Revenue Code 390 for most labs. Revenue Code X is for purchased products or when a hospital has its own donor center. Administration of the Product Bill once per date of service (NOT per unit given) CPT code includes all supplies, nursing time, room fees (for OP). Revenue Code AHIMA 2009 Audio Seminar Series 35

41 Transfusion Medicine Case: The Facts The patient was admitted to Short Stay unit for transfusion of 2 units of packed red blood cells. The lab had a difficult time finding compatible blood - identifying an antibody and screening 10 units of blood to find 2 units that were ultimately given. What services and units of service can be billed? 71 Transfusion Medicine Case: The Answer ABO (86900), RH (86901), Antibody Screen (86850) 1 time for each CPT code (Rev Code 300/302) Antibody Identification (86870) or Pretreatment methods ( ) for each panel and for each technique (Rev Code 300/302) Screening for Compatible Units (86903 or 86904) for all units screened (Rev Code 300/302) Complete crossmatch (check with lab, could be 86920, 86921, and/or 86922) for each unit crossmatched (not just the ones given). (Rev Code 300/302) 72 AHIMA 2009 Audio Seminar Series 36

42 NCCI Edits for Crossmatching 73 Transfusion Medicine Case: The Answer PRBC (P9016 if leukoreduced or P9021 if not) for each unit given (Rev Code 390) Blood Administration (36430) 1/Day (Rev Code 391) Routine supplies are included in the blood administration APC E&M code is not used with if that is the sole service 74 AHIMA 2009 Audio Seminar Series 37

43 Most Common Missed CPT Codes in Lab: Microbiology Stool Cultures: and Most Labs use one plate for Salmonella and Shigella which is coded with Many Labs (esp in the South) test for multiple other pathogens which require additional plates, such as Vibrio, Yersinia, E. coli 0157, Campy, and more Wound Cultures: Many orders for wound cultures include Anaerobic and Aerobic initial cultures as well as gram stains Urine Cultures: Best Practice = Every Urine culture (87088) has a Colony Count (87086). Many labs only bill for one. 75 Aerobic and Anaerobic Cultures with Blood Cultures 76 AHIMA 2009 Audio Seminar Series 38

44 Aerobic and Anaerobic Cultures with Blood Cultures 77 Most Common Missed CPT Codes in Lab: Microbiology Serotyping colonies (87147) Many labs do not bill for negative testing Many labs do not bill for each antisera used Identification tests (87077) Often a technologist suspects a pathogen but the testing identifies a non-pathogen and the charge is not submitted When multiple isolates are tested for identification, the charge is only submitted for one ID E tests should be billed for each strip (87181) 78 AHIMA 2009 Audio Seminar Series 39

45 Most Common Missed CPT Codes in Lab: Microbiology When doctors add on drugs for susceptibility testing beyond the MIC, often the Kirby Bauer test is not billed. (A modifier is required.) (87184 for KB, for MIC) Many body fluid cultures require a concentration step (i.e., centrifugation, millipore filters). Often CPT code is missed. There are numerous CCI edits for the various types of cultures. Frequently, patients (think nursing home patients or bronchial washings as an OP) have more than one culture on the same date of service. Without a modifier, only one culture will pass CCI edits. 79 For More Information on Laboratory Coding from CPT Assistant See supplemental materials in the Appendix for further CPT Assistant citations on: Basic metabolic panel Chromosome studies Mohs Occult blood by peroxidase activity Drug Testing for opiates and barbituates H. pylori antibody rapid qualitative test 80 AHIMA 2009 Audio Seminar Series 40

46 For More Information on Laboratory Coding from CPT Assistant Immunology Irradiation of blood products Lactoferrin, fecal Reproductive medicine procedures Strep group B detection Surgical pathology microdissection Transfusion medicine Microbiology for a variety of cultures 81 Resource/Reference List American Hospital Association ( AHA ), Coding Clinic. Chicago, Illinois Coding Clinic, Second Quarter 2006 Page: 4 Effective with discharges: July 15, 2006 Coding Clinic, Fourth Quarter 2008 Page: 117 to 119 Effective with discharges: October 1,2008 CC, 1 st QTR 1990 Page 22 CC, 3 rd QTR 1999 Page CC, 1 st QTR 2000 Page 3, 5-6 CC, 2 nd QTR 2006 Page 4 82 AHIMA 2009 Audio Seminar Series 41

47 Resource/Reference List American Medical Association, CPT Assistant. Chicago, Illinois CPT Assistant September 2003 Page: 5-7 CPT Assistant, May 1997 Pages: CPT Assistant June 2008 Page: 157 CPT Assistant, February 2006, Volume 16, Issue 2, pages 7-8, and page 16: Changes to Pathology and Laboratory Part I CPT Assistant, March 2006, Volume 16, Issue 3, pages 9 and 16: Changes to Pathology and Laboratory Part II 83 Resource/Reference List Center for Disease Control/National Center for Disease Statistics. ICD-9-CM Official Guidelines for Coding and Reporting, Effective October 1, Retrieved May from: Centers for Medicare and Medicaid Services. National Correct Coding Initiative Edits. Retrieved May 6, 2009 from: U. S. Department of Health and Human Services, Office of Inspector General. Work Plan Fiscal Year Retrieved May 5, 2009 from: 84 AHIMA 2009 Audio Seminar Series 42

48 Supplemental Material CMS Internet Only Manuals Publication 100 Chapter 4 section 230 for Transfusion Medicine Chapter 8 for ESRD Guidelines Chapter 16 for Lab Services 85 Other References: Lab Websites AHIMA 2009 Audio Seminar Series 43

49 Audience Questions Audio Seminar Discussion Following today s live seminar Available to AHIMA members at Click on Communities of Practice (CoP) icon on top right AHIMA Member ID number and password required for members only Join the Coding Community from your Personal Page under Community Discussions, choose the Audio Seminar Forum You will be able to: Discuss seminar topics Network with other AHIMA members Enhance your learning experience AHIMA 2009 Audio Seminar Series 44

50 Become an AHIMA Member Today! To learn more about becoming a member of AHIMA, please visit our website at ahima.org/membership to Join Now! AHIMA Audio Seminars Visit our Web site for information on the 2009 seminar schedule. While online, you can also register for seminars or order CDs, pre-recorded Webcasts, and *MP3s of past seminars. *Select audio seminars only AHIMA 2009 Audio Seminar Series 45

51 Upcoming Seminars/Webinars Coding for Respiratory Services June 18, 2009 Physician Practice E&M Auditing July 16, 2009 APC Revenue Cycle: Tips for Success July 23, 2009 Thank you for joining us today! Remember sign on to the AHIMA Audio Seminars Web site to complete your evaluation form and receive your CE Certificate online at: Each person seeking CE credit must complete the sign-in form and evaluation in order to view and print their CE certificate Certificates will be awarded for AHIMA Continuing Education Credit AHIMA 2009 Audio Seminar Series 46

52 Appendix Resource/Reference List CE Certificate Instructions AHIMA 2009 Audio Seminar Series 47

53 Appendix Resource/Reference List AHIMA 2009 Audio Seminar Series 48

54 To receive your CE Certificate Please go to the AHIMA Web site click on the link to Sign In and Complete Online Evaluation listed for this seminar. You will be automatically linked to the CE certificate for this seminar after completing the evaluation. Each participant expecting to receive continuing education credit must complete the online evaluation and sign-in information after the seminar, in order to view and print the CE certificate.