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Tag Archives: manual

CR12377 Updates Coding in Medicare Claims Processing Manual

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Code updates prompted the release of Change Request (CR) 12377 by the Centers for Medicare & Medicaid Services (CMS) on Oct. 13. The updates to chapters 3, 18, and 32 of the Medicare Claims Processing Manual Pub. 100-04 are effective Nov. 17, 2021. CR12377 further clarifies that “Unless otherwise specified, the effective date is the […]

The post CR12377 Updates Coding in Medicare Claims Processing Manual appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

conjunctive words and sequencing in the CPT manual

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Hello,

I am looking for a reasonable short explanations of what the conjunctive words mean in CPT coding

IE, CHF and ESRD with hypertension.

I’m trying to ascertain the direction of the words "and", "but" "with", "due to" and any other verbal linkages. I am sitting for the second time for my CPC in 2 months and I feel my ignorance of these terms may have contributed to my poor score. I understand they are directional for sequencing, but I can not seem to find a simple list and explanation for any and all conjunctive words for CPT. I code ICD10 all day long but very little of my job deals with the CPT codes or books.

Thanks in Advance.
Shari

Medical Billing and Coding Forum

Manual Reduction of testicular dislocation

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Looking for a CPT code to use. The doctor tried to do it by bedside but was unable due to discomfort so they decided to do it under anesthesia.

I came to examine the patient and did find that his left testicle has been dislocated and was riding up into the inguinal canal. The right testicle was present without masses or defects. I then placed a significant amount of pressure to slowly milk the testicle down and it popped through the external ring and down into the scrotum. I palpated the testicle again and it appeared to be in good position and there was no swelling or immediate bruising appreciated. There was some ecchymosis at the base of the penis as well as the mons pubis region from his injury, but there was no complications during the reduction of the dislocation.

Would this just be a 99212? I don’t believe there is any CPT code that would go with this?

Medical Billing and Coding Forum

Medical Billing and Coding Manual

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Hello everyone,

I’m the Billing Manager for a rapidly growing medical agency and we currently do not have a Medical Billing Manual in place. I wanted to know does anyone have any information on how I can create one or could someone send me a sample that I can read over and pull ideas from. I think I kind of have an idea of somethings that need to be it such as: End of Month deadlines, Insurance Check writing schedules, how to properly bill a claim, etc.

Please Help!! I look forward to hearing your feedback.

Thanks,

Tamara C. McCloud, CPC
Billing Manager
Medical Advocacy and Outreach
2900 McGehee Rd,
Montgomery, Al, 36111
Direct line: 334-481-1599
[email protected]

Medical Billing and Coding Forum

Is 2015 cpt manual obsolete??

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PLEASE ADVISE!
I passed the exam and ICD-10 updates in 2015, however remained at my (current) medical billing job.
I remain with an "Apprentice Status" to date… never found coding work and sadly, lost hope of working as a coder…however,
A job opportunity has come up!!!
I must test and was advised to, "be strong on using modifier 24, 25 & 57; Inpatient, OBS, admits, D.C. and Critical Care. ICD10, Concurrent Care".
I only have 2015 CPT Manual and ICD-10 Complete Draft Code Set in my possession. I’ve dusted them off and am eager to "refresh" my memory.
I don’t know who to ask…Can I still use these books?
I feel lost and don’t know where to begin!
All input is welcome! Thanking you in advance!

Medical Billing and Coding Forum

NCCI Manual includes clarifications for modifier -59 usage, injections and infusions

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By Steven Andrews
With the latest edition of the NCCI Manual, effective January 1, CMS does not introduce any new guidance for recurring coding trouble areas including modifier -59 (distinct procedural service) usage and injection and infusion services, but some new clarifications could aid coding departments.
 
The manual now includes new information regarding modifier -59 use for procedures performed at the same patient encounter. The expanded example for timed services, with 2016 additions bolded, now says:
There is an appropriate use for modifier -59 that is applicable only to codes for which the unit of service is a measure of time (e.g., per 15 minutes, per hour). If two separate and distinct timed services are provided in separate and distinct time blocks, modifier -59 may be used to identify the services. The separate and distinct time blocks for the two services may be sequential to one another or split. When the two services are split, the time block for one service may be followed by a time block for the second service followed by another time block for the first service. All Medicare rules for reporting timed services are applicable. For example, the total time is calculated for all related timed services performed. The number of reportable units of service is based on the total time, and these units of service are allocated between the HCPCS/CPT codes for the individual services performed. The physician is not permitted to perform multiple services, each for the minimal reportable time, and report each of these as separate units of service. (e.g., A physician or therapist performs eight minutes of neuromuscular reeducation (CPT code 97112) and eight minutes of therapeutic exercises (CPT code 97110). Since the physician or therapist performed 16 minutes of related timed services, only one unit of service may be reported for one, not each, of these codes.)
 
CMS also added a new example for describing use of modifier -59 to report procedures performed on different anatomic sites:
The procedure-to-procedure edit with column one CPT code 11055 (paring or cutting of benign hyperkeratotic lesion …) and column two CPT code 11720 (debridement of nail[s] by any method; 1 to 5) may be bypassed with modifier -59 only if the paring/cutting of a benign hyperkeratotic lesion is performed on a different digit (e.g., toe) than one that has nail debridement. Modifier -59 should not be used to bypass the edit if the two procedures are performed on the same digit.
 
The manual also include a new example to explain proper coding for infusions involving double lumen catheters:
If both lumina of a double lumen catheter are utilized for infusions of different substances or drugs, only one “initial” infusion CPT code may be reported. The double lumen catheter permits intravenous access through a single vascular site. Thus, it would not be correct to report two “initial” infusion CPT codes, one for each lumen of the catheter.

 

For more information about changes to the NCCI Manual, see CMS’ website. 

HCPro.com – APCs Insider

The New Year Brings Changes to Shoulder Arthroscopy in the NCCI Manual

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The National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services is updated once a year. The 2017 updates have been released. Chapter IV Surgery: Musculoskeletal system contains revisions to clarify limited and extensive debridement of the shoulder when performed with other shoulder procedures on the same shoulder. Subsection 4 In 2016, Section E Arthroscopy […]
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