CMS Clears up the Most Common ICD-10 Myths

Plus: MACs to increase minimum dollar amounts for appeals in 2015

You’ve heard there won’t be an ICD-10 book that you can keep on your desk because the abundance of codes would make a book too thick—but is that tale true? Actually, no—it’s one of many ICD-10 myths that CMS hopes to dispel with its latest publication, called ICD-10-CM/PCS Myths and Facts.
Indeed, hard copies of the ICD-10 code book are already available and don’t take up more space than your current coding books, CMS says in the document. If you prefer leafing through a book over checking codes online, you’ll still get to handle business as usual when ICD-10 takes effect next October.

Likewise, CMS dispels the myth that you’ll have to scrap your CPT® knowledge when ICD-10 kicks in, since many providers erroneously believe that ICD-10-PCS will replace CPT®. In actuality, however, ICD-10-PCS will only be used for facility reporting of inpatient procedures, and won’t impact Part B providers’ use of CPT®.

Resource: To read the complete document, visit www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD-10MythsandFacts.pdf.

How to Get Clarification on “Dilation” and 58100

Question: The Feb. 2012 issue of the Ob-gyn Coding Alert has an example of CPT® 58100-endometrial sampling (biopsy) as: “…plastic catheter into the uterus and suctions out a small amount of the endometrial lining.” Dilation is bundled with 58100. If a provider does some cervical dilation along with an endometrial sampling, at what point do we change from coding a 58100, 58120-52 or 58120? I spoke with a provider who uses the plastic catheter suction device and states he does a 360 degree endometrial curettage, after dilating the cervix slightly and sounding the uterus. Another provider uses the same tool and states he does a 360 degree endometrial biopsy, after sounding the uterus and dilating the cervix as needed. Is there a clear CPT® guideline on what is considered a sampling/biopsy and what is considered a curettage? Both of these providers do this procedure with out anesthesia for menorrhagia. 
Iowa Subscriber

Answer: You can use CPT® code 58120 (Dilation and curettage, diagnostic and/or therapeutic [nonobstetrical]) for a complete or fractional D&C.
Code 58100 (Endometrial sampling ([biopsy] with or without endocervical sampling ([biopsy)], without cervical dilation, any method ([separate procedure]) is intended to denote a procedure where a small section of tissue is removed for examination and no dilation of the cervix is required in the process. A physician who dilates the cervix and then does a complete 360 degree sampling of the uterus is performing what would be referred to as a “fractional” D&C, and the code 58120 would be the most appropriate code to use in this case. You cannot report code 58100 with the code for cervical dilation because when dilation is performed the most correct code would become 58120.

How to Code H1N1 Vaccinations ?

You’ll Report H1N1 as a Regular FLU Virus.

Influenza is a great topic of this season. As per  Centers for Disease Control and Prevention (CDC), flu activities are expected to continue in the coming weeks. Don’t be surprised if your practice witnesses an increase in queries for H1N1 vaccinations in the coming days. You may have various questions such as:

•  What are the coding choices for reporting H1N1 vaccination – and restrictions if any?
•  Is it a pandemic?
•  Can you submit codes for both type of vaccine and administration of vaccine?

Here are some helpful notes on how you should report H1N1 vaccination:

About H1N1: H1N1 flu, also called swine flu, is a respiratory infection caused by an influenza virus. As the name suggests, the flu shot is not spread from pigs — instead it spreads from person to person. According to CDC, the H1N1 virus that caused the pandemic is now a regular human flu virus.
You will report the codes that you use to report most types of flu injections:

• For the particular vaccine you use, report from within 90654-90688.
• For Medicare beneficiaries, use from within Q2033-Q2039.

For the administration of the injection, look to these choices:

• For single injection, use 90471
•  For subsequent injections, use 90472
• For single intranasal or intraoral application, use 90474
• For additional intranasal or intraoral applications, use for additional intranasal or intraoral applications

For Medicare-only patients, use administration code G0008.
Diagnosis: Use V04.81 as your diagnosis. Medicare has fixed the payment at same rates as the administration of the seasonal influenza vaccine.

Correct Use P Modifiers Also

P modifier recognizes the distinctive levels of unpredictability of anesthesia administration.

Physical status modifiers, likewise alluded to as P modifiers, are interesting to anesthesia coding. Despite the fact that not every payer will add to your repayment for these modifiers, they are useful for following purposes and help clarify why anesthesia suppliers may use longer on a case than expected.

Why are P modifiers utilized?

These modifiers were created by American Society of Anesthesiologists (ASA) to help recognize the diverse levels of many-sided quality – from nearby to general anesthesia – in giving anesthesia administrations focused around the understanding's wellbeing circumstances. In spite of the fact that ASA does not completely clarify the terms, the trap is to know how to recognize one level from an alternate. You ought to choose P modifiers focused around:

P1 for ordinary sound patients, P2 for those with mellow systemic illness, P3 for those with moderate systemic malady that can be life-undermining, P4 for those with serious systemic infection that is a consistent risk to life, P5 for Moribund patient with no shots of survival with/ without operation, and P6 for the individuals who are proclaimed mind dead.

A large portion of your anesthesiologist's administrations will justify P1, P2, P3 modifier; to utilize a modifier P4 or higher anyway, you'll have to give clear and robust documentation to backing its utilization.

Are P modifiers repaid?

Whether a P modifier is acknowledged or not relies on upon the payer runs; so its generally a decent thought to take after the particular payer's arrangement. A number of you have a tendency to disregard this modifier since Medicare does not pay for this modifier. Medicaid and other private safety net providers may perceive P modifiers yet it relies on upon the payer and the state. It is thusly key that you keep a tab on these every year on the grounds that if the P modifier is not reported, it won't be repaid.

A few payers that pay/don't pay for P modifier

Laborers recompense and no-shortcoming protection transporters in New York State pay for this modifier while Medicaid bearers in California, Virginia, and some different states pay for higher doctor status codes. Meridian declines repayment of extra cash for physical status or other qualifying anesthesia codes with Medicare patie

Medicare’s April Update to 2014 Physician Fee Schedule – Watch Out for These Changes

Medicare's April redesign to the 2014 Physician Fee Schedule , compelling April 1, spreads RVU changes, progressions to descriptors, redressed markers for supervision of demonstrative administrations and the presentation of a G-code to Medicare builders' frameworks.

As indicated by CMS, a portion of the overhauls to Change Request CR 8664 are powerful April 1, yet larger part of the progressions are successful April 1.

Progressions to Short Descriptors of Cpt® Codes G0416-G0419 

Powerful April 1, there are changes in prostate needle biopsy descriptors.  According to the American Urological Association, the redesign adjusts a lapse in the past short descriptors (discharged 2014) that portrayed the techniques as "Sat biopsy prostate." Post the April overhaul, you won't discover the expression "sat" in the descriptors.

Doctor Expense:  Rvus for Respirator Motion Management Get a Raise 

Does your practice give respiratory administration 3-D radiotherapy (IMRT) plans for patients? In the event that yes, you'll think about the presentation of extra-code +77293. In cases, for example, these, separated from a 3-D radiotherapy arrangement or IMRT plan, the patient has a breath-connected or 4-D CT reenactment study performed. A respiratory sensor is put on the patient's midsection or stomach zone in a 4-D CT.

The April Fee Schedule Update expands the Rvus for the code 77293 from 9.16 to 9.96.

Keep in mind this: Effective April 1, you ought to report +77293 with codes 77295 and 77301.

New G-Code Added to Your Medicare Contractor's System 

Successful April 1, find new G-code that reports therapeutic implication for right on time affectation: G9361 (Medical sign for instigation [documentation of reason(s) for elective conveyance or early incitement … ). Experts might report G9361 as a component of the PQRS Measure 335. CMS's PQRS rules depict this code as one of the three conceivable numerators for this measure, which portray the particular clinical activities called for by the measure for execution.  G9355 or G9356 are the other two probable numerators. You have to report this measure each one time a method is brought out for patients experiencing elective conveyance or early actuation throughout the reporting period.

Discover Changes in Diagnostic Imaging Supervision Levels 

Demonstrative radiology specialists may need to observe this: There are progressions to the Physician Supervision of Diagnostic Procedures pointers to the TC of a few symptomatic radiology methodology.

These progressions are stamped with a successful date of January 1, 2014.

More points of interest on CR 8664 here: http://go.cms.gov/1htkw

WINFertility CPT Codes

WINFertility CPT Codes

J0725 Injection, chorionic gonadotropin, per 1,000 USP units

J3355 Injection, urofollitropin, 75 IU

S0122 Injection, menotropins, 75 IU

S0126 Injection, follitropin alfa, 75 IU

S0128 Injection, follitropin beta, 75 IU

S0132 Injection, ganirelix acetate, 250 mcg

S4011 In vitro fertilization; including but not limited to identification and incubation of mature

oocytes, fertilization with sperm, incubation of embryo(s), and subseq

uent visualization for

determination of development

S4013 Complete cycle, gamete intrafallopian transfer (GIFT), case rate

S4014 Complete cycle, zygote intrafallopian transfer (ZIFT), case rate

S4015 Complete in vitro fertilization cycle, not otherwise

specified, case rate

S4016 Frozen in vitro fertilization cycle, case rate

S4017 Incomplete cycle, treatment cancelled prior to stimulation, case rate

S4018 Frozen embryo transfer procedure cancelled before transfer, case rate

S4020 In vitro fertilizati

on procedure cancelled before aspiration, case rate

S4021 In vitro fertilization procedure cancelled after aspiration, case rate

S4022 Assisted oocyte fertilization, case rate

S4028 Microsurgical epididymal sperm aspiration (MESA)

S4035 Stimulated intrauterine insemination (IUI), case rate

S4042 Management of ovulation induction (interpretation of diagnostic tests and studies, non

-

face

-

to

-

face medical management of the patient), per cycle

55870

Electroejaculation

58321

Artificial insemination; intra

-

cervical

5

8322

Artificial insemination; intra

-

uterine

5

8323

Sperm washing for artificial insemination

58970

Follicle puncture for oocyte retrieval, any method

58974

Embryo transfer, intrauterine

5

8976

Gamete, zygote, or embryo intrafallopian transfer, any method

76857

Echography, pelvic (nonobstetric), B

-

scan and/or real time with image documentation;

limited or follow

-

up (eg, for follicles)

76948

Ultrasonic guidance for aspiration of ova, radiological supervision and interpretation

89250

Culture and fertilization of oocyte(s);

89251

Culture and fertilization of oocyte(s); with co

-

culture of embryos

8

9253

Assisted embryo hatching, microtechniques (any method)

89254

Oocyte identification from follicular fluid

89255

Preparation of embryo for transfer (any method)

89268

Insemination of Oocytes

89272

Extended cultures of Oocytes (4

-

7 days)

89280

Assisted oocyte Fertilization, Microtechnique (Less than 10 oocytes)

89281

Assisted oocyte Fertilization, Microtechnique (Greater than 10 oocytes)

89290

Biopsy for PGD; less than or equal to 5 Embryos

89291

Biopsy for PGD; Greater than or equal to 5 Embryos

89398

UNLISTED REPRODUCTIVE MEDICINE LABORATORY PROCEDURE

58540

Hysteroplasty, repair of uterine anomaly (Strassman type)

5

8560

Hysteroscopy, surgical; with division or resection of intrauterine septum (any method)

5

8672

Laparoscopy, surgical; with fimbrioplasty

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross

and Blue

Shield Association, an association of independent Blue Cross and Blue Shield Plans.

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What is the CPT Code used for this Welch Allyn product?

Our Reimbursement Support page  has CPT code information for Welch Allyn products. Payment will vary by geographic locality. It is always the provider’s responsibility to determine coding, coverage and claim information for the services that were provided.