Posts Tagged ‘CPT’

National Government Services (NGS) says Error Code (EC) 31 Services incorrectly coded denials have been increasing in relation to CPT® 85025 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count.

“Review of the CERT data shows that the CERT contractor has been re-coding CPT 85025 to show the appropriate service rendered,” NGS writes in its November 2009 Medicare Monthly Review (MMR). So how should billing staff code this service?

NGS says, generally, CPT® 85027 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) is more appropriate.

Correct coding: If the physician has ordered only a CBC (with no mention of a differential), the correct code is 85027.

To prevent EC 31 denials, providers should review the medical records and the physician order/requisition before performing and coding the service to make sure what is being done and billed matches the order.

Cardiac computed tomography (CCT) professionals will see major changes in coding next year. CPT® 2010 adds four new Category I codes to report CCT and cardiac computed tomography angiography (CCTA) services and deletes four Category III codes.

In a statement posted on its Web site prior to the Oct. 30 release of the 2010 Outpatient Prospective Payment System (OPPS) final rule, the Society of Cardiovascular Computed Tomography (SCCT) said it did not foresee significant changes in payment for CCT/CCTA. They were singing another tune Nov. 2.

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The Centers for Medicare & Medicaid Services (CMS) has determined that its blanket of non-coverage for blood flow measurement using magnetic resonance imaging (MRI) technology contradicts its policies and magnetic resonance angiography (MRA). CMS has eliminated that from the national coverage determination (NCD), effective Sept. 28, and is allowing payers to choose to cover the services.  This will impact four codes in January’s outpatient code editor (OCE).

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Submitted by Rebecca Woodward, CPC, CEMC

In the past, there was some confusion on how to properly code Morton’s neuroma, but two newly-created CPT^® codes make coding this condition much less of a pain in the … foot.

A Morton’s neuroma is a benign growth on nerve tissue that occurs in the nerve of your foot, often between the third and fourth toes, although it also may occur at the second toe interspace. Symptoms can range from burning, numbness, and tingling, to sharp pains in the sole of your foot. A Morton’s neuroma can develop from tight fitting shoes, injuries, and other pressuring irritants.

Report unilateral CPT^® code 64455 Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton’s neuroma) for the steroidal and/or anesthetic agent injections used for pain relief, or 64632 Destruction by neurolytic agent; plantar common digital nerve for the nerve destruction by a neurolytic agent.

Report either 64455 or 64632 only once per foot, regardless of the number of injections provided. When either of these services is performed on both feet, you may append modifier 50 Bilateral procedure to either code.

CPT^® 28080 Excision, interdigital (Morton) neuroma, single, each describes the surgical excision of the Morton’s neuroma. Report this code for each neuroma excised.

CPT^® instructs you to use 77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedure (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint), including neurolytic agent destruction for fluoroscopic guidance and localization for needle placement and injection. Report this code only once per session, regardless of the number of injections.

The American Medical Association (AMA) posted several Category II code updates in recent weeks. The latest additions, deletions and revisions will affect how physicians report certain conditions in 2010, but you won’t find them listed in the CPT^® books until 2011. Read more »

If your practice can’t seem to successfully bill for the professional component lately, there could be a logical explanation. It could be something as simple as an incorrect modifier.

According to First Coast Service Options Inc. (FCSO), an excessive number of claims from providers are being denied because they request payment for the professional component using the wrong modifier with the CPT^® or HCPCS Level II code.

Prevent Delays and/or Denial

When billing for the professional component of a procedure, hospital outpatient departments, ambulatory surgical centers (ASCs), and other practitioners should properly identify the service by adding modifier 26 Professional component to the appropriate CPT^® or HCPCS Level II code — not the new modifier effective July 1,  PC Wrong surgery on patient.

Medicare automatically denies all lines related to an erroneous surgery with dates of service on or after Jan. 15, including claims for related hospitalizations.

Claims Appeal

FCSO advises providers appeal claims billed in error with modifier PC and subsequently denied for wrong surgery. Correcting and resubmitting these claims won’t work. Only an appeal will remove the edit logic that was installed for the beneficiary and date of service of the wrong surgery based on the initial claim.

The American Medical Association (AMA) has created a new CPT^® code specific to vaccine administration and revised an existing code to include the H1N1 vaccine. Read more »

Submitted by Anthony McCallum, CPC, CCS, CPC-I, CIRCC

Multiple fine needle aspirations (FNAs) performed on separate lesions or at separate body sites may be reported separately using 10022 Fine needle aspiration; with imaging guidance by appending the appropriate anatomic modifier or modifier 59 Distinct procedural service; however, the imaging guidance may be reported only once per patient encounter.

National Correct Coding Initiative (CCI) Policy Manual guidelines allow one unit of service for radiologic guidance codes 76942, 77002, 77003, 77012, and 77021. “The unit of service for these codes is the patient encounter, not the number of aspirations, number of biopsies, number of injections, or number of localizations,” according to CCI guidelines.

Accurate payment for seasonal influenza (flu) virus vaccines requires precise coding. And to accomplish that, coders have to pay attention to details.

“Make sure you code correct route, correct product, correct ICD-9,” says Cathy Gray, RHIT, CCS, CPC-I, CCC, CGIC, with Henry Ford Health System in Detroit, in a recent issue of Pediatric Coding Alert.

Ask yourself the following questions:

1. Is the flu product the patient receiving preservative-free?

Preservative-free products cost more and, as such, reimburse at a higher rate. Report the wrong product code and your office loses money.

2. How old is the patient?

You should also base your product code selection on the patient’s age. Vaccines administered to individuals 3 years of age and older pay more than those given to children 6-35 months.

3. What came first, the shot or the spray?

The order in which you code services can affect how much your practice is reimbursed. If a patient receives an intranasal flu vaccine at the same time as an injectable vaccine, for example, code the injectable first.

4. Which vaccine administration code set should I use?

You should use the administration code set that best represents the patient’s age and physician (or other health care professional) counseling, advises Pediatric Coding Alert. Consult your payer to confirm whether it pays more for 90465 – +90468 than for the comparable 90471 – +90474 code set.

Read the complete Pediatric Coding Alert article, entitled “4 Coding & Billing Steps Boost Your Flu Prevention Pay by $38.”

In the last EdgeBlast issue, we reported that HCPCS Level II codes for the H1N1 vaccine and Bevacizumab injection were recently added to the Medicare Physician Fee Schedule Database (MPFSDB), but you should also note other important changes this year’s October update holds in store. Read more »