The Food and Drug Administration (FDA) approved the first fully-robotic surgery device, the da Vinci® surgical system, in early 2000. In recent years, robotic surgery—technically called laparoscopic robotic-assisted surgery—has revolutionized minimally invasive surgery (MIS).

Robotic-assistance has been adopted by several surgical specialties for complex procedures, such as mitral valve repair, Roux-en-Y, prostectomy, hysterectomy, sacral colpopexies, coronary anastomosis, nephrectomy, and others.

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AAPC member Mary LeGrand, RN, MA, CPC, CCS-P, provides orthopaedic specialists advice on injection coding in AAOS — the American Academy of Orthopaedic Surgeons’ online newsletter.

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The American Academy of Dermatology (AAD)  provides advice to avoid filing duplicate claims, which it says occurs in 6 percent of Medicare claim reporting. The common sense document includes the following tips, which help save Medicare and your practice money.

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A new proposal from the Centers for Medicare & Medicaid Services (CMS) to cut payments for radiation therapy treatments would cause many cancer centers to close, stop accepting Medicare patients, lay off support staff, and reduce services to cancer patients, according to a survey conducted by the American Society for Radiation Oncology (ASTRO).

On July 13, CMS announced in the Medicare Physician Fee Schedule (MPFS) proposed rule for 2010 proposed changes to Medicare policies and payment rates for physician services, including radiation oncology, that would cut payments to radiation therapy services by nearly 20 percent. Read more »

Accurate coding and claims payment start with dispelling four ovarian cyst removal coding myths, according to an article in Ob-Gyn Coding Alert 2009. It’s all in the approach, says Celia Hernandez, CPC.

Myth #1: Coding by documentation alone

For laparoscopic removal of an ovarian cyst, your code selection should be based on the procedure’s extent. “Always make sure to read your op note carefully,” says Hernanadez, “as sometimes the Ob/Gyn does more than what is noted under the beginning.”

“Coding based on documentation alone can cost you $58,” warns the Ob-Gyn Coding Alert editor.

CPT^® code 58662 Laparoscopy, surgical; with fulgration or excision of lesions of the ovary, pelvic viscera, or peritonial surface by any method is appropriate when no additional tissue is removed. When the cyst is large and difficult to remove, possibly requiring partial removal of the ovary, code 58661 Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectony).

Myth #2: Underestimating documentation requirements for common procedures

According to the American College of Obstetricians and Gynecologists (ACOG), the ob-gyn should document the following in the patient’s medical record:

1. Last menstrual period and contraceptive method and one or more of the following:

a) Pelvic examination or ultrasound demonstrating a cystic mass that is 8 cm or larger.
b) Persistence of a cystic mass of 6 cm or larger for two cycles.
c) Presence of a cystic mass that is multilocular (many-celled) or has solid components, as confirmed by ultrasound.

2. Pelvic examination in the operating room or within 24 hours prior to the procedure to confirm persistence or presence of mass.

Myth #3: Treating documented terms “aspiration” and “drainage” differently

These terms mean the same thing when an ob-gyn removes fluids from an ovarian cyst using a suction device. Base your code selection on the method:

58800 Drainage of ovarian cyst(s), unilateral or bilateral (separate procedure); vaginal approach
58805 Drainage of ovarian cyst(s), unilateral or bilateral (separate procedure); abdominal approach
49322 Laparascopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple)

Myth #4: Guidance is part of the main procedure and should not be reported separately

When the ob-gyn uses ultrasound guidance to place the needle she uses to aspirate the cyst, report 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation or 76998 Ultrasonic guidance, intraoperative if the physician performs the actual aspiration under ultrasound guidance.

Remember to append modifier 26 Professional component to codes for services the physician performs in a hospital.

Orthopedists who treat pediatric patients for fractures have three new ICD-9-CM codes to use come Oct. 1.

Report ICD-9-CM code 813.46 Torus fractures of ulna [alone] when the patient fractures only the ulna; and 813.47 Torus fracture of radius and ulna when the patient fractures both.

Don’t confuse these codes with 813.45 Torus fracture of radius and other radius and ulnar fracture codes specified in the 813.xx Fracture of radius and ulna range, warns Coding News.

And for a dislocated elbow or “radial head subluxation,” report  832.2 Nursemaid’s elbow for services rendered on or after Oct. 1.

As for now, ICD-9-CM directs you to 832.0x Dislocation of elbow; closed dislocation for this condition, says Leslie A. Follebout, CPC, COSC, PCS, coding manager at Peninsula Orthopaedic Associates in Salisbury, Md.

A proposed rule that addresses Part B payment policies paid under the Medicare Physician Fee Schedule (MPFS) went on display today in the Federal Register. The proposed rule with comment period includes several policy changes intended to help offset a much-anticipated payment cut in 2010.

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Allergies and asthma often go hand-in-hand, so a patient suffering from both conditions may need to see more than one specialist. With the allergy season in full swing, now is a good time for allergy and pulmonology practices to familiarize themselves with Medicare policy to ensure concurrent care reimbursement.

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Not sure if you should bill Part B or Part D for a drug regimen of aprepitant when used to alleviate chemotherapy induced nausea-vomiting (CINV)? You’re not alone. To answer an influx of questions pertaining to anti-emetic drugs, the Centers for Medicare & Medicaid Services (CMS) recently issued MLN Matters SE0910.

In MM SE0910, you will find guidance for billing aprepitant when used as a complete replacement for intravenous therapy or as a completion of a 48-hour regimen where IV aprepitant is given the day of chemotherapy and the oral medication is given days 2-3 of therapy.

Senator Edward Kennedy (D-Mass.) and four additional sponsors introduced legislation (S.717) on March 26 that seeks to “modernize cancer research, increase access to preventative cancer services, provide cancer treatment and survivorship initiatives,” and more.

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