Correct coding of surgical debridement (11042-11047) requires documentation of both the measurement of the wound surface area after debridement and the depth of tissue that is removed. To avoid claims submission errors, denials for insufficient documentation, and potential overpayments, educate your clinicians to document these measurements as standard operating procedures for surgical debridement.
Codes describing excision debridements deeper than skin only are organized by depth:
- subcutaneous tissue (includes epidermis and dermis, if performed); 11042 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less and 11045 … each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
- muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); 11043 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less and 11046 … each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
- bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); 11044 Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less and 11047 … each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
The deepest level of tissue removed from the wound determines the correct code. For example, don’t report 11044 when bone is visible, but not documented as being part of the surgical debridement procedure. When reporting add-on codes for additional areas (e.g., 11045-11047), documentation should specify the exact areas where tissue was removed.
March 3rd, 2014
The Centers for Medicare & Medicaid Services (CMS) covers either standard or FDA-approved HIV rapid screening tests, using the following HCPCS G codes:
- G0432 Infectious agent antibody detection by enzyme immunoassay (EIA) technique, HIV-1 and/or HIV-2, screening
- G0433 Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique, HIV-1 and/or HIV-2, screening
- G0435 Infectious agent antibody detection by rapid antibody test, HIV-1 and/or HIV-2, screening
Screenings are covered a maximum of three times per term of pregnancy for pregnant Medicare beneficiaries:
- When the diagnosis of pregnancy is known;
- During the third trimester; and
- At labor, if ordered by the woman’s clinician
HIV screening for pregnant women must be reported with a primary diagnosis code of V73.89 Special screening for other specified viral disease, plus a secondary diagnosis of either V22.0 Supervision of normal first pregnancy, V22.1 Supervision of other normal pregnancy, or V23.9 Supervision of unspecified high-risk pregnancy.
Screenings are covered once per year for beneficiaries at increased risk for HIV infection (11 full months must elapse between tests). Indicate increased risk for HIV on the claim with V73.89 as primary and V69.8 Other problems related to lifestyle as secondary.
For beneficiaries without increased risk factors, report HCPCS Level II code G0432, G0433, or G0435 with diagnosis code V73.89 only. Patients with any known prior diagnosis of HIV-related illness are not eligible for the HIV screening benefit.
The above guidelines apply to all physicians, providers, and clinical diagnostic laboratories submitting claims to Medicare contractors (Fiscal Intermediaries (FI), carriers, and Parts A/B Medicare administrative contractors (A/B MACs)) for services to Medicare beneficiaries.
You can find complete instructions in MLN Matters® Number: MM6786 Revised.
The Centers for Medicare & Medicaid Services (CMS) has removed the coverage of evidence (CED) requirement in the national coverage determination (NCD) for fluorodeoxyglucose (FDG) positron emission tomography (PET) for solid tumors, effective June 11, 2013.
CMS will cover three FDG PET scans (without the CED requirement) when used to guide subsequent management of anti-tumor treatment strategy after completion of initial anti-cancer therapy for the same cancer diagnosis. Coverage beyond three scans for the same cancer diagnosis is up to the discretion of your local Medicare administrative contractor (MAC).
What this means for coders is that you no longer need to use modifiers Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study and Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study, along with condition code 30 Qualifying clinical trial or ICD-9-CM code V70.7 Examination of participant in clinical research on claims for these services.
Continue to report FDG PET or PET/computed tomography (CT) scans with CPT® codes 78608, 78811, 78812, 78813, 78814, 78815, 78816, with either modifier PI PET or PET/CT to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing for an initial scan or modifier PS PET or PET/CT to inform the subsequent treatment strategy of cancerous tumors when the beneficiary’s treating physician determines that the PET study is needed to inform subsequent anti-tumor strategy for subsequent scans.
Report also the associated supply with HCPCS Level II code A9552 Fluorodeoxyglucose f-10 FDG, diagnostic, per study dose, up to 45 millicuries and the same cancer diagnosis code.
Each different cancer diagnosis is also allowed an initial treatment strategy (modifier PI) scan and three subsequent treatment strategy scans (modifier PS).
For additional scans for the same cancer diagnosis, append modifier KX Requirements specified in the medical policy have been met.
Remember: To use modifier KX, additional documentation must be available to support the medical necessity of the service being performed in accordance with medical policy.
Source: MLN Matters® Number: MM8468
There will be no delay in the Oct. 1 implementation of ICD-10-CM and ICD-10-PCS, the Centers for Medicare & Medicaid Services (CMS) head Marilyn Tavenner told attendees at the Healthcare Information and Management Systems Society (HIMSS) convention in Orlando, Fla. “Let’s face it guys, we’ve delayed this several times and it’s time to move on,” she said, according to Modern Healthcare.
Some case-by-case exemptions will be made for providers having a tough time meeting Stage 2 meaningful use targets she said. However, there will be no delay in compliance dates for stage 2, Tavenner told the crowd. Tavenner said that meeting Stage 2 deadlines was key to interoperability, quality measures, and ICD-10. Providers in dire need of an extension can file for “hardship exemptions” allowing them to comply in 2015, but Tavenner warned that without that approval providers must meet this year’s deadlines.
February 27th, 2014
The transition from ICD-9 to ICD-10, shifting from 14,000 codes to nearly 70,000, will require adequate training to be familiar with the more granular and detailed terms. The Washington Post recently published an article on this progression, after sending a reporter to AAPC’s ICD-10 Conference in San Francisco. Featuring quotes from AAPC members Luisa Realubin, CPC, and Angela Boynton, CPC, CPC-H, CPCO, CPC-P, CPC-I, the article explains the background of ICD-9, the reasons for ICD-10 implementation, and concerns that have been raised about the transition.
Two things are certain: ICD-10 is rapidly approaching, and the effects of its implementation will be best managed by those who started preparing early. Read the full article or find out which ICD-10 training is best for you.
February 15th, 2014
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