May I report 76098 for specimen review during stereotactic biopsy?

Yes, you may report 76098 (Radiological examination, surgical specimen) when the radiologist examines a tissue specimen removed during surgery, regardless of which body part the specimen originated from.
The radiologist uses X-ray technology to examine the specimen, looking for evidence that the physician removed the complete area of interest for pathologic examination.


Always Keep in mind: Like many radiology codes, 76098 has a professional and technical component. If you're reporting only the professional component (because the service took place in a facility), append modifier 26 (Professional component) to 76098 to ensure the proper reimbursement level. 

AMA forecasts busy 2014 with Stage 2 Meaningful Use, ICD-10

The American Medical Association is gearing up for an action-packed year, says AMA President Ardis Dee Hoven, MD in a blog post.  Between the implementation of ICD-10, the beginning of Stage 2 Meaningful Use, and several big federal changes, the top five biggest national issues to affect providers in the coming year are all hefty challenges.

The repeal of the Medicare sustainable growth rate (SGR) will be one major issue to affect providers already strapped for cash and uncertain about the financial viability of hospitals and small, independent practices.  While the temporary repeal, giving Congress three more months to come up with a permanent solution, will further the goals of accountable care and provide some stability for physicians in the future, not everyone is satisfied with the “significant improvements” over the current system Hoven praises.

The most significant change to healthcare law in several decades is, of course, the Affordable Care Act.  “While aspects of this roll-out have been rocky, we must not lose sight of the ultimate goal of health care reform: Millions of previously uninsured Americans will gain access to care, and millions more no longer will be at risk of losing their coverage when they need it most,” Hoven says. “This is a chief goal for us as physicians—helping patients become healthy and stay healthy.” In addition to the changes inherent in the ACA, providers will also be facing new rules under the Sunshine Act, which will make financial transactions with drug and medical device manufacturers public.

Rounding out the list are two momentous health IT projects that have been in the works for years: the EHR Incentive Programs and ICD-10.  2014 will see the beginning of Stage 2 of Meaningful Use, and will also be the last year to avoid Medicare penalties for non-participation.  “While we have been successful in delaying Stage 3 for a year,” Hoven says, “we continue to urge CMS to make Stage 2 requirements more reasonable, address usability issues and break down barriers preventing communication among EHR systems rather than placing the responsibility on physicians to achieve the impractical.”

The AMA also continues to protest the upcoming transition to ICD-10.  “The AMA has been working for years to prevent the roll-out of ICD-10,” says Hoven.  “Two bills were introduced in 2013 to this end, and we continue to stress to the Centers for Medicare & Medicaid Services (CMS) that the new code set will place an immense burden on physicians.”  Despite the Association’s disapproval, ICD-10 is slated to go ahead at the beginning of October, whether or not the industry is entirely ready to make the change.    

Where you'll see important ICD-10 developments in 2014

I hate making predictions. Mostly because I'm not very good at it. So this is not the post full of predictions on ICD-10 deadline changes or how the ICD-10 implementation will go.
That's not going to be useful even if those guesses are accurate.
The key to 2014 will be knowledge. With only nine months left to implement ICD-10 coding, that doesn't leave a lot of room for trial and error. Healthcare organizations are going to have to make very smart decisions this year. And the best way to do that is to learn from the organizations that have completed a lot of the ICD-10 transition.
Here's what you need to pay attention to:

Centers for Medicare and Medicaid Services (CMS)

CMS will keep promising Oct. 1 is the deadline. Unless someone changes their minds.
They're not going to hint about any deadline or requirement changes until the decision is firmly made.  That's not saying they will make any decisions like that. The CMS doesn't make announcements like that until everything is figured out.
And the timetable for figuring out and implementing deadline changes is shrinking. There isn't much time to make major moves. So each day that goes by only allows minor changes.
Instead of watching CMS for deadline changes, it's going to be more productive to plan for an Oct. 1 implementation. CMS is going to be sharing a wealth of tutorials and information for procrastinating providers. If we're going to need to know something, CMS is going to be a source.

Clearinghouses

Clearinghouses exist to help healthcare providers navigate the medical billing process. ICD-10 implementation will be a major detour. Because clearinghouses deal in so much volume, they're going to see problems quickly. And each solution will be applied to many transactions.
The good ones will share information on how to file proper ICD-10 claims and preserve reimbursement revenue.
They will know where the mistakes are being made. Learn from them so you can avoid making costly mistakes.

Tests

There will be major end-to-end testing efforts this year. And you may not  be able to participate in them because of procrastination, unprepared partners or homework-eating dogs. At least you can look for takeaways and lessons learned during the tests.
This is going to help you prepare and perhaps make up for testing deficiencies.

Affordable Care Act (ACA)

I can't say this enough. The fate of ICD-10 implementation is tied to the ACA in Washington. Any problem with healthcare reform makes it harder for the CMS to persuade anyone that ICD-10 implementation will be worth doing.
So watch the debate carefully. The worse the ACA looks, the more likely ICD-10 coding will get thrown under the bus.

• Remember, it won't depend on facts. Soundbites will rule.
• Fear will trump intellectual reasoning.
• Any language that mimics what was used to explain or implement HealthCare.gov will be used as evidence that ICD-10 implementation will be a disaster.

It's not hard to imagine the Obama administration using ICD-10 compliance as a bargaining chip to keep the ACA.
But don't spend too much time reading the political tea leaves. Focus on the useful knowledge, and we can survive 2014.
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Stop Using These Transcatheter Stent Placement and Category III Codes

Brace up for new AAA codes, Category I codes, and Retrograde Stent Placement Code.

January 2014 is here and like every year, it’s time for general surgery coders to get their coding acts together. CPT® 2014 brings eight new codes for reporting abdominal aortic aneurysm (AAA) repair using fenestrated endoprosthesis. Your general and vascular surgeons will see deleted and added codes that you need to know about to code these procedures correctly.

Read on to get the scoop so you know how to code correctly this year:

• Category III Codes Make Their Way Out

In 2013, you used separate Category III codes to report the surgical component and the radiological component of FEVAR procedures. The primary codes were used for the initial prosthesis placement and the add-on codes for the extension prosthesis in each visceral branch as follows: 0078T, +0079T, 0080T, and +0081T. However, this year you’ll not find these codes in the CPT® 2014 manual.

• Welcome New Category 1 Codes

The Category 1 Codes have a different structure than Category III codes. This year you will have to use these codes: 34841, 34842, 34843, 34844, 34846, 34847, and 34848. Moreover, you’ll also have new guidelines and instructions to help you code these services.

• Forget These Transcatheter Stent Placement Codes

These five transcatherer stent placement codes 37205, +37206, 37207, +37208, and 75960 have been deleted this year and in their place, you will have to use these codes: 37236, +37237 (use with 37236), 37238, +37239 (use with 37238).

• Welcome Retrograde Stent Placement

 You’ll find a new code – 37217 – to report transcatheter stent placement in either the intrathoracic common carotid artery or innominate artery using an open cervical carotid approach. A key feature of this code is that it is specific to retrograde treatment, meaning going against the flow of blood in the vessel. Any angioplasty or radiological guidance required for the service is also covered.

• Count Aorta Sections and Visceral Endoprostheses

In order to use the new codes correctly, make sure there are two important pieces of information in the surgical report. You’ll need to identify the aorta section involved in the procedure as well as the number of endoprostheses from the op report.

Visceral Aorta: Codes 34841-34844 refer to only the visceral portion of the aorta.

Visceral Aorta and Infrarenal Abdominal Aorta:  When both the visceral and infrarenal abdominal areas of the aorta are involved, use codes 34845-34848.

Source: http://blog.supercoder.com/career-coach/cpt-2014-updates-for-general-surgery-stop-using-these-transcatheter-stent-placement-and-category-iii-codes/

Gastroenterology CPT® 2014 Updates : Codes for Esophagoscopy, Upper EGDs, ERCP, Consultations

Stay alert to big changes for endoscopy, ablation, stent placement, ERCP and E/M

As we enter the new year, gastroenterology practices will have to really prepare well to report all the CPT® 2014 codes affecting their specialty. This will be even more challenging as 25% of the CPT® changes will impact gastroenterology practices this year!

Read through some of the major CPT® updates affecting gastroenterology: 

• Prepare the Ground for New Codes for Esophagoscopy and Upper EGDs

Descriptor change: The word ‘rigid’ was removed from the existing code range 43200-43232 (Esophagoscopy, rigid or flexible…) to introduce the word ‘transoral’ making this range specific for esophagoscopy procedures employing a flexible scope.

You’ll also have to be prepared for new codes for endoscopic mucosal resection, dilation, ablation, stent placement that includes:

43211: Esophagoscopy, flexible, transoral; with endoscopic mucosal resection

43212: Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)

43213: Esophagoscopy, flexible, transoral; with dilation of esophagus, by balloon or dilator, retrograde (includes fluoroscopic guidance, when performed)

43214: Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed)

• Check Out These Four New Interpersonal Codes

 CPT® 2014 introduces four new consultation codes that you’ll have to report when your gastroenterologist reviews and discuses a patient’s condition with a referring physician over telephone or online. The four new codes are:

•   99446 (Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review)
• 99447 (… 11-20 minutes of medical consultative discussion and review)
• 99448 (… 21-30 minutes of medical consultative discussion and review)
• 99449 (… 31 minutes or more of medical consultative discussion and review).

Don’t assume ICD-10 diagnosis codes -- 424.1 will split under the new cardiology codes next year

 The coming year there will be major code changes when ICD-10 comes into effect. Like any other practice there will be major changes for cardiology codes. For instance, there will be new code set divides for diagnosis code 424.1 under ICD 9-CM that is used to report aortic valve disorders, and you need to ensure that you are updated with all the code changes to keep your practice compliant and profitable. A disorder of the aortic valve refers to a problem with the valve between the aorta and the left ventricle.

When ICD-10 becomes effective then there will be a range of codes specifying 424.1 that will be from 135.0 – 135.9. There will be a range of codes to choose from for multiple aortic valve disorder codes in the I35. – range under ICD-10. ICD-10 will have separate codes for stenosis, insufficiency, stenosis with insufficiency, other, and unspecified.

To ensure correct coding you need to ensure that you document correctly if the aortic valve disease is rheumatic or not. You also need to ensure that you have adequate knowledge regarding whether the condition is congenital because it will affect the choice of codes that will be used. Since there will be multiple code options for aortic valve disorders under ICD-10, documentation needs to be specific about the type of disorder to identify the most specific code.

There are some tips that can be followed to code correctly. If the documentation shows stenosis and insufficiency then only the code 135.2 should be used instead of I35.0 and I35.1 together. Insufficiency can also be documented by using incompetence or regurgitation. When 135.8 is used the term “other” specifies that the physician documented the type, but ICD-10 will not have any code that will specify the documented type. The “unspecified” in I35.9 would mean that the physician did not document the type.

How to Code Cosmetic Ptosis Repair

There is this Medicare patient of ours who'll be having a leva to resection on his right eye for ptosis. The ophthalmologist wants to do this as a bilateral procedure; however the patient's left eye is a non-seeing eye. As the operation on the right side may be medically necessary, but the left side would likely be considered cosmetic, how should I go about coding this surgery?

Well, you should report each side of the bilateral procedure on a separate line, appending modifiers LT (left side) and RT (Right side), linking each side to the appropriate diagnosis code explaining the necessity for the surgery.

In this situation, one side will be medically necessary, while the other will be cosmetic – the procedure will not benefit the vision on the non-seeing eye.

Here's what you need to do: Before the surgery, have the patient sign an advance beneficiary notice of non-coverage (ABN) prior to surgery, stating that he's aware that Medicare will not cover the procedure carried out on the left eye. Ensure your ABN is in layman's terms and specifies the specific reasons for non-coverage. (you shouldn't use CPT Code, ICD 9 codes on the ABN form).

You must also specify the estimated cost of the service on the ABN. The original signed ABN indicating the patients decision ( be sure the patient has chosen one of the options) to accept financial responsibility, is maintained by the practice and a fully executed copy must be provided to the patient. Append modifier (Waiver of liability statement on file) to the procedure done on the non-seeing eye to indicate that the patient was informed before and has selected the option to be responsible for the non-covered service and unpaid amount.

For instance: The patient has congenital ptosis (743.61), and his left eye is non-seeing. The ophthalmologist carries out levator resection (67904, Repair of blepharoptosis; [tarso] levator resection or advancement, external approach) bilaterally. Code as follows:

Line 1: 67904-RT linked to 743.61

Line 2: 67904-LT-GA linked to V50.1 (Elective surgery for purposes other than remedying health states; other plastic surgery for unacceptable cosmetic appearance).

If your documentation shows that the procedure was medically necessary on the right side, Medicare will reimburse the full amount for 67904-RT. The cosmetic diagnosis linked to 67904-LT-GA will prompt the carrier to deny the specific service due to the diagnosis and non-coverage of cosmetic services, and the explanation of benefits (EOB) received by the patient will confirm that the patient is responsible for payment.