The 5010 837I transaction implementation in January 2011 will allow providers, hospitals and skilled nursing facilities (SNFs) to report up to 25 ICD-9-CM diagnosis and 25 ICD-9-CM procedure codes when submitting claims to Parts A and B Medicare administrative contractors (A/B MACs) and/or fiscal intermediaries (FIs) for services to Medicare beneficiaries.

Current claim forms allow for only nine ICD-9-CM diagnosis codes and six ICD-9-CM procedure codes. Medical coding and billing staff should prepare for this change.

Source: MLN Matters MM7004, issued July 30

AAPC member Kerrin Draak, MS, WHNP-BC, CPC, CEMC, COBGC, discussed reimbursement issues surrounding some of the newer GYN procedures and the need for coders in this specialty to become familiar with these new procedures to accurately report and receive reimbursement for these cases.

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AAPC member Debrarose Toscano, CPC, PCS, CPC-I discusses the two types of dialysis and the specificity needed in order to accurately and effectively code these treatments for reimbursement.

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Coding a Mohs procedure can seem like a daunting task at first glance. AAPC member Debra Mitchell, MSPH, CPC-H discusses issues related to coding Mohs and shares a number of tips to help improve the overall coding accuracy related to Mohs. This article is not available online but can be found in the July/August issue of Executive Decisions in Dermatology on page 9.

AAPC member Betty Johnson, CPC, CPC-I, CPC, CPC-I, CCS-P, PCS, RMC, CIC, CCP, CPC-H, CDERC, shares in-depth advice on how to determine the proper codes for pressure ulcers or bed sores. This article is not available online but can be found on page 14 of the June/July issues of BC Advantage.

The National Committee for Health Statistics (NCHS), has updated its ICD-9-CM conversion table for 2010. The 64-page table allows coders to crosswalk old, discontinued codes with current codes, including those effective Oct. 1. The table presents the current code assignments, their effective dates, and previous code assignments back to 1986.

The NCHS develops and maintains the ICD-9-CM codes system for the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC).

Nicole Benjamin, CPC, CPC-I, CEDC, coding education specialist for the AAPC, shares key strategies for understanding the recent changes to consultation codes and how to effectively use them based on recent code revisions.

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How much H1N1 flu is out there, and where is it? What patients were kept in seclusion at your hospital last year? For health care organizations, knowing the answers is important. Jeanne Yoder, RHIA, CPC, CPC-I, CCS-P shares the importance of diagnosis codes, what they include and how to create one.

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Rhonda Buckholtz, CPC, CPC-I, CGSC, COBGC, CEPDC, CENTC, vice president of business and member development for the American Academy of Professional Coders, commented that physicians need to understand that correct coding and documentation are more important than ever due to Medicare’s pay-for-performance program. In addition, she shares a number of tips to help physicians clean up their coding.

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Think your physician knows what constitutes a high-level evaluation and management (E/M) service? If he has a record of mainly billing high-level office visits, he may not. One thing you can be sure of is that all those high-level E/M claims will eventually catch your payer’s attention.

Rather than hold your breath and hope for the best, Part B Insider suggests ways you can protect yourself in the event of an audit.

Perform an Internal Audit

The first thing you should do is make sure your physician is billing high-level codes correctly. Crystal S. Reeves, CPC, CPC-H, consultant with Coker Group in Alpharetta, Ga., advises coders to use all their resources to determine proper billing.

“The CPT manual outlines the requirements of the E/M codes, there are clinical examples in the back of CPT, and CMS publishes a Table of Risk that can help guide you, so use all of those resources to determine whether you’re billing properly,” Reeves advises.

To determine the level of medical decision making, “look for how many diagnoses or management options the doctor is treating,” Reeves says.

It’s time to act if you determine that your physician is improperly billing high-level E/M codes, such as 99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family.

Just showing the doctor CMS’ Table of Risk, “can be an eye opener for physicians,” Reeves says, and may be all you need to do to get things back on track.

Cover All Your Bases

Even if you determine that your physician is properly billing high-level E/M codes, you’ll still need to be able to prove it in an audit.

If your claim doesn’t convey the status or complexity of the condition, an auditor won’t be able to infer it, advises Stephanie L. Fiedler, CPC, ACS-EM, director of revenue management with YAI in New York, N.Y. “The best way to do this is to report your diagnosis codes to the highest level of specificity.”

This means not settling for the next best ICD-9-CM code on the superbill. If a diagnosis code isn’t listed on your superbill, research to find it rather than just using one that you do list on your encounter form, advises Part B Insider editor Torrey Kim, CPC.

“Without the more specific code, the physician isn’t conveying the acuity of what he’s doing, so the diagnosis may not support the claim,” Fiedler says.

Source: Part B Insider, as seen here.