Vaccine CPT updates 2013 by AMA

The American Medical Association has been releasing and updating CPT codes since 2006, and recently the CPT updates 2013 codes for vaccines has been published.
Some of the codes that have been accepted and will be included in the 2013 codes are:

• Code 90653
• Code 90739
• Code 90672

The codes that are accepted to be included in the 2014 codebook are:

• Code 90685
• Code 90686
• Code  90687
• Code 90688

There are codes with the description “trivalent”, meaning “conferring immunity to three different pathogenic strains or species”:

• Code 90655
• Code 90656
• Code 90657
• Code 90658
• Code 90660

The newsletter of CPT® Assistant is published every month. Apart from the Coding Consultation section, it also contains detailed articles, commentaries, updates, and other timely facts to help keep your claims system running smoothly.
One can also look-up for reference articles online with Supercoder’s Code Connect, an online tool that has all the AMA’s CPT® Assistant denial busting — and accuracy boosting — reference articles. Easily refer to thousands of archived articles from the AMA to improve your accuracy and overturn denials.
Some unique features of Supercoder’s Code Connect featuring CPT Assistant are:

• CPT® Assistant 2012 & 1990-2011 Archives help to save time and increase efficiency.
• Every month receive the scoop on hot topics featured in the just released issue of CPT® Assistant.
• Get a better understanding of codes to file cleaner claims.

With Supercoder’s Code Connect featuring CPT® Assistant, one only needs to enter a CPT® code and instantly connect with all of the CPT® Assistant articles that the AMA has published on the code since 1990.
Supercoder’s Code Connect featuring CPT® Assistant, helps you get the updated and official guidance from the AMA to verify if you are coding correctly and let your practice become compliant and profitable.

Avoid These Common Coding Mistakes To Get The Reimbursement You Deserve

We all want to do a perfect job, report accurate claims, and get the complete reimbursement for the services that are performed in our services. And denial, of course, is something that we would never want to see. But if you have been receiving denials on your Part B codes lately, there could be a number of reasons. One important thing that could be doing wrong is inaccurately linking the diagnoses listed on the encounter form with the procedure codes. The codes you use to report the services your physician rendered decide the payment your practice will get, and sometimes you could be over- or under-coding, thus inviting denials or, in worst cases, audit attacks.
Have a look at these top five sources of claims denials that you should avoid:

1. Inaccurate reporting of diagnosis codes
Coders often incorrectly link ICD-9 codes with corresponding medical procedures. Several coders have complained of rejections when they report the CPT® code 15823.
Medicare will often reject this service as cosmetic surgery unless you tie it to an appropriate diagnosis code that proves medical necessity, such as 374.30 (Ptosis of eyelid, unspecified) and 374.34 (Blepharochalasis).

2. Improper reporting of bilateral services
Errors related to unilateral versus bilateral can also cause problems in processing your claims. Reporting the procedure code 92235 (Fluorescein angiography [includes multiframe imaging] with interpretation and report) is especially problematic.

3. Misuse of alpha modifier
Coders are found to often misuse–or not use–the eye modifiers (-LT, Left side; and -RT, Right side). But these modifiers can be the key to making sure that you get the reimbursement you deserve, especially when your physician performs similar procedures on both the eyes of the patient.
If, during the postoperative period for cataract surgery on a patient’s left eye, the physician notices that the right eye also has a cataract, and so he provides the service for the other eye. In this case you would report the code 66830 for the first eye. You should report the surgery for the other eye (right) using one of the eye modifiers.

 4. Overlooking Eyelid-Modifier Opportunities
Occasionally, the eyelid modifiers (-E1–-E4) are preferable to the eye modifiers -RT and -LT. Consider for example, your ophthalmologist performs 67904 (Repair of blepharoptosis; [tarso] levator resection or advancement, external approach) on the patient’s both upper eye lids. When the procedure is performed bilaterally, you should use the codes 67904–50 for Medicare. In this case, you should not use the eye modifiers or the eyelid modifiers.

5. Using Outdated Manuals
Use of an old, obsolete, or deleted procedure or diagnosis codes is a very common error. Practices are often found to be submitting codes that have been removed from the CPT® manual or they use some specific codes in error, particularly the age-specific codes.
Keep these common errors in mind to prevent them from happening the next time, and to ensure that you submit slick claims.

You Be the Coder: Coding Inpatient E/M

Question: When the ED physician is called to the floor to evaluate an inpatient and the visit does not qualify for critical care, what evaluation and management (E/M) code would be correct to use for the encounter?

Michigan Subscriber

Answer: There are three general groups of E/M codes the ED physician can use depending upon the service provided beyond the critical care codes.

1. If the ED physician was formally asked by the patients attending physician to assess the patient for a particular reason and that request was recorded in the patients chart either by the attending physician or by a nurse who recorded the order, then this could be considered a consultation and billed using consultation codes 99251-99255.

2. If no formal request was made and recorded in the chart, then the ED physician must use the subsequent inpatient visit codes 99231-99233. This is probably the most common situation.

3. If a procedure is performed, such as CPR, the appropriate service code would be used. Depending upon the circumstance, an E/M code could be used in addition to a procedure code, but the documentation must be complete to support the visit code in addition to the procedure code.

In all of these instances, the ED coder should take care to record the appropriate place of service (21, inpatient hospital) on the HCFA-1500, rather than the place of service for the ED (23, emergency room, hospital).

HCFA Delays Launch of APC/OPPS to August 1

The Health Care Financing Administration (HCFA) has moved back the start date of the new Outpatient Prospective Payment System (OPPS) until Aug. 1, 2000. Unfortunately, even an extra months delay will not help the medical industry if coders do not now gain knowledge on the Ambulatory Payment Classification rules.

HCFA published the official rules in the Federal Register on April 17, but the register can be hard to navigate.

ED outpatient coders and clinicians, who will be directly affected by the new rules, should visit HCFAs Web site at http://www.hcfa.gov/regs/hopps/default.htm to find a much simpler presentation of the new APC regulations. There is a chart that will help direct coders to the section of rules that apply to their specialty.

If you have questions about any of the data HCFA provides on their Web page, send them to outpatientPPS@hcfa.gov. Use of this e-mail address is limited to specific questions regarding the new payment system data outlined on the Web site.

As always, ED Coding Alert welcomes your feedback and aims to address your issues in upcoming publications. E-mail us your questions at questions@medville.com.

Understanding the Terminology: Open vs. Closed Fracture

Some coders confuse the indication of an open or closed fracture to mean that the treatment of that injury was open or closed, when, in fact, these terms mean two different things.

An open fracture is one where the skin overlying the fracture has been violated through the subcutaneous tissue, explains John Stimler, DO, FACEP, a practicing emergency physician in Jacksonville, FL, and a past president of the Florida chapter of the American College of Emergency Physicians. Often, this is because one end of a fractured bone has punctured the skin. However, a laceration or puncture wound over the fracture would also constitute an open fracture, he adds.

A closed fracture is one in which the skin overlying the broken bone is not violated through the subcutaneous tissue.

A superficial contusion or abrasion that is not into the subcutaneous area would be considered a closed fracture, Stimler notes. Open treatment of a fracture indicates that the physician had to surgically open the skin and go in to repair the injury, says Kenneth DeHart, MD, FACEP, president of Care First Health Specialists, an emergency physician group in Myrtle Beach, SC, and chairman of the American College of Emergency Physicians advisory committee on coding and nomenclature.

A good example would be a bone that is fractured in several places, he explains. The physician would have to make an incision and go in and set each of the pieces. Injuries that are this complicated are almost always managed by a consulting physician and not by the ED doctor, notes DeHart.

To be clear, it is possible to have open treatment of a closed injury, though you almost never have closed treatment of an open fracture.

Because of the high risk of infection, open fractures are rarely repaired in the ED. In most cases, the ED physician would stabilize the patient and he or she would be sent to the operating room to have the injury repaired by a specialist, who would assume treatment for the patient and use the orthopedic codes. (See article, Use Orthopedic Codes Plus Modifier -54 to Get Paid for ED Fracture Care, page 3, ECA December 1998 issue.)

Codes indicating open treatment and manipulation are rarely used for the ED physicians service, notes DeHart.

Generally, ED physicians dont manipulate unless there is acute neurovascular compromise, DeHart notes. You may have a closed fracture with a one-degree bend to it, and the physician would put it in traction before putting on a castthat would be manipulation.

Four Quick Documentation Strategies to Satisfy E/M Guidelines

Despite the confusion over the implementation of the 1997 Evaluation and Management (E/M) Guidelines, EDs must still adhere to either the 1995 or 1997 version. The 1995 guidelines are considered most beneficial to emergency medicine. Here are some key tips to ensure ED physicians are providing the right documentation to justify the appropriate level of service.

Remind ED physicians to document vital signs, orders, ED course, critical care time in dictations. (Coders dont always get the nurses notes.) For templated records, review for consistency and accuracy in how templates are used. Routinely communicate problems to physicians until resolved. Provide copies of records that indicate inconsistency between stated problems or RN/MD notes.

Encourage physicians to discontinue use of term non-contributory, when documenting the history. Recommend, reviewed and negative. Ask them to indicate whether nurses notes have been reviewed, and include references to pertinent information.

Remind the MDs to always record their review of system(s) identified in the history of present illness, plus other related systems. Remind them also that they must have a review of systems for all E/M levels but the lowest (99281).

If patient information is unobtainable or unreliable, the physician must record the reason for this in order to satisfy stated requirements.

G0105, 45378: Use This Coding Combination For Your High-Risk Patients

Irrespective of findings, stick to V10.05 to define condition.

Correctly reporting colorectal cancer screenings on patients at high risk for the disease can depend on fine points like allocating the right V code. Read this expert medical coding article and know what ICD-9 codes apply in this scenario.

Examine the following given scenario and the medical coding advice that follows to ace these claims -- and recover your deserved reimbursement for these services:

Scenario: A patient has a personal history of colon cancer, went through treatment for colon cancer six years before, however she is presently facing no symptoms. Her 2006 colonoscopy came out clear, as well as her recent one carried out about a month ago. You billed 45378 for the procedure, and then you selected V10.05, from the ICD-9 codes, for the diagnosis. Though, the patient called complaining you should've billed the procedure as routine as her last two colonoscopies were clean. How would you resolve this?

Choose G0105 Or 45378, But Get The History Diagnosis Right

In case you're billing Medicare, you smust report the procedure as a high risk screening with code G0105 (Colorectal cancer screening; colonoscopy on individual at high risk). Then, from ICD-9 codes, report V code V10.05 (Personal history of malignant neoplasm of large intestine) as the primary diagnosis.

Code V10.05 fits the bill for primary diagnosis as the patient presents to the office for a screening exam and not precisely for follow-up assessment of the cancer. In case the encounter's purpose is for cancer surveillance and follow-up at an interval close by the surgical treatment, you could, as an alternative, code V67.09 (Follow-up examination following other surgery) as your primary diagnosis. Though, keep in mind that this ICD-9 code is seldom used.

On the contrary, certain commercial carriers would need the code 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) with modifier 33 (Preventive services) appended to signify that the service was preventive, and the V code V10.05 as diagnosis.

Don't forget: From ICD-9 codes, you must list V10.05 as your primary diagnosis for both circumstances (Medicare and commercial payers), irrespective of the fact that the results were clear or not. Use this ICD-9 code if all treatment focused toward the cancer is complete and there are no symptoms of current disease . Don't make the error of reporting a cancer code (153.3, Malignant neoplasm of sigmoid colon) or the family history code (V16.0, Family history of malignant neoplasm of gastrointestinal tract).

Draw On Diplomacy To Confer With Patients

Complaints like this from patients on a screening colonoscopy are common in the gastroenterology practice. The best guidance is to talk it out with your patient, and make clear how their cancer history influences the medical coding.