Diagnosis for Open Wounds as a Result of Cancer Resection December 15, 2016 What diagnosis code do we use when we are reconstructing a defect after the Moh s surgeon, or someone else removed the cancer? When I try to crosswalk the ICD-9-CM open wound code I used to something in ICD-10-CM, it takes me to an S code which is strange because the open wound is not the result of an injury or trauma. Good question! Technically, you would not use a cancer diagnosis code since you are not treating cancer (the Moh s surgeon treated the cancer by excising it). Your diagnosis codes, as the surgeon treating an open wound/resulting defect resulting from cancer resection are: 1. Z48.1 Encounter for planned postprocedural wound closure, and 2. Z42.8 Encounter for other plastic and reconstructive surgery following medical procedure, and 3. Personal history of neoplasm code (e.g., skin Z85.82-, melanoma Z85.820). If the reconstruction occurs on the same day as the cancer removal, then the C code for malignant neoplasm can be substituted for the Z85.- code. of 12/15/16.
An Office Visit and an Injection. Can I Bill Both with a Modifier 25? December 15, 2016 A colleague informed me that billing an office visit every time I give a patient an injection can lead to an audit. I also read a recent article where an orthopedic practice had to pay back millions of dollars partially for this reason. I typically bill an established patient visit with an injection, but I always add a 25 modifier on the visit. Does that mean I am safe from an audit? Unfortunately, no. It is true that an evaluation and management code, an E/M or office visit, can be reported with a minor procedure such as an injection, but only if the E/M is significant and separate and exceeds the pre-service evaluation that is inherent to the injection. Every minor procedure has time for pre-service evaluation included in the value of the procedure code. Medicare and other payors have become concerned that E/M s are being routinely reported with minor procedures without considering if the extent of the visit was truly more than the pre-service evaluation already included in the procedure. WEBINAR ALERT! To hear more about how to determine when a visit is significant and separate and how to document that preservice evaluation has been exceeded, join Teri Romano for a webinar on January 9, 2017.
of 12/15/16. Treatment of Vasospam During Intracranial Aneurysm Coiling December 15, 2016 Thank you for the discussion yesterday! You are very insightful and a great educator on a complex topic. I have a question for you regarding treating vasospasm extracranially (not intracranially). Can I also use 61650 for a catheter that causes vasospasm on the way up to coil an aneurysm? There are a few issues with using 61650 in the situation you describe. First, 61650 is for treating intracranial vasospasm in your example below the vasospasm is extracranial so 61650 cannot be used. Also, there is no longer a peripheral code for treating vasospasm. That code 37202, non-thrombolytic infusion, was deleted in 2015. There was no replacement code because it is rarely appropriate to separately code the vasospasm treatment in the peripheral vascular system. Lastly, if the catheter to treat an aneurysm causes the vasospasm, then we would not separately code for treating the vasospasm because you re billing for the aneurysm coiling (61624).
of 12/15/16. G Code Use for Moderate Sedation December 13, 2016 I heard there is a new G code for moderate sedation but I don t see it in the 2017 CPT manual. Is it not a 2017 code? The G code you are referring to, G0500, is a Medicaredeveloped code intended for Medicare patients only so you will not find it in the CPT manual. While some private payers may choose to use this code, it is intended for Medicare patients. It is reported for the first 15 minutes of moderate sedation. For more information on the use of this G code, tune in for a webinar on December 14 to learn why these codes changed, how they are reported in 2017 and how this change will impact your reimbursement. Webinar Alert! For more detailed information about Medicare and private payer billing under these new guidelines, please join Teri Romano for a thirty minute Zipinar on December 15, 2017, focusing on the coding and reimbursement changes for endoscopy procedures. of 12/13/16.
Coding Changes in Angioplasty for 2017 December 13, 2016 I see the new transluminal angioplasty codes include all radiological supervision and interpretation necessary to perform the angioplasty. Does that include diagnostic angiograms? No, it does not. The radiological supervision and interpretation (S&I) codes in the code description refer to the guidance radiological S&I for guidance, not diagnostic angiograms. If the rules are followed for reporting diagnostic angiograms at the same session as an intervention, a diagnostic angiogram may be reported with the angioplasty. Make sure to append a 59 modifier to the diagnostic study. Webinar Alert! The codes for AV access/dialysis circuit imaging and interventions all change on January 1, 2017. Join Teri Romano for a webinar on these and other new vascular codes on December 14, 2016. of 12/13/16.
PRP Injection? How Is It Reported? December 1, 2016 How is an injection of PRP reported? Code 0232T, Injection(s) platelet rich plasma, any site, with image guidance, harvesting and preparation when performed, is used to report this procedure. A PRP injection is bundled into tendon sheath, trigger point, and joint injections. It is only reported when it is the only procedure performed. As a Category III code, it is not valued by Medicare (has 0 RVUs assigned), so payment is problematic. Most Medicare carriers do not pay for PRP. of 12/01/16. Reimbursement: Co-surgery December 1, 2016 What is the reimbursement for co-surgery using modifier 62? Is it different for the primary and co-surgeon?
For Medicare, co-surgery requires two different specialties performing separate parts of a single CPT code. Private payers may have different policies regarding the specialties involved. For both surgeons, a 62 modifier is appended to the appropriate CPT code(s). Medicare multiples the allowable fee by 125% and splits the reimbursement exactly in half, resulting in a payment of 62.5% to each surgeon. Both surgeons dictate an operative note describing their work and both have post-operative responsibilities. of 12/01/16. Acute Blood Loss Diagnosis Codes December 1, 2016 Our hospital tells us they are developing guidelines for the application of diagnosis codes for acute blood loss anemia post-operatively. They propose the use of lab values pre- and post-op to allow the hospital coders to assign these codes. Is this correct coding? No, this is not an acceptable practice. The official Coding Guidelines state that abnormal findings (lab, x-ray, pathologic, and other diagnostic results) are not coded unless the physician indicates the clinical significance. This means
the provider would need to document that the blood loss was clinically significant, required intervention, abnormal, or a complication of the procedure to assign a diagnosis indicating any of the preceding circumstances. of 12/01/16. Dialysis Access Creation in Lower Extremity December 1, 2016 I created an AV access in the leg. What code do I use for this? The CPT codes for AV graft or fistula creation apply to the lower extremity as well as the upper extremity. Take a look at codes 36281-36830 for the most appropriate code for the procedure you performed. WEBINAR ALERT! The codes for AV access/dialysis circuit imaging and interventions all change on January 1, 2017. Join Teri Romano for a webinar on these and other new vascular codes on December 14, 2016. Click here for more information and
registration. of 12/01/16. Moderate Sedation Coding in 2017 December 1, 2016 I see there are new moderate sedation codes in the 2017 CPT manual. Why were these changed? Moderate sedation codes, 99143-99145 codes have been deleted and replaced by codes, 99151-99157. These are part of a Medicare-initiated revision regarding the use of moderate sedation. All codes that previously included moderate sedation as an inherent part of the codes, such as EGD and colonoscopy, have now been revalued to exclude the sedation. As a result, if you personally supervise moderate sedation, you will now report the sedation separately. Tune in for a webinar on December 15th to hear what prompted that change. WEBINAR ALERT: For more detailed information about Medicare and private payer
billing under these new guidelines, please join Teri Romano for a thirty minute Zipinar on December 15, 2016, focusing on the coding and reimbursement changes for endoscopy procedures. Click here for more information and registration. of 12/01/16.