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AAPC’s coding expert, Raemarie Jimenez, gives you the scoop on next year’s updates. Code update season is always an exciting time of year. With it brings new, revised, and deleted CPT® codes and coding guidelines that become effective Jan. 1. There are always a lot of changes to learn about: CPT® 2022 includes 249 new […]
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Understand the coding mechanics behind some of the most common obstetrical US examinations. An outsider looking in might think diagnostic radiology coding is as simple as knowing the number of views of an X-ray or whether contrast was used on a computed tomography (CT) or magnetic resonance imaging (MRI) scan. But to say that’s even […]
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AAPC’s coding expert Raemarie Jimenez gives you the scoop on next year’s updates. Code update season is always an exciting time of year. With it brings new, revised, and deleted CPT® codes and coding guidelines that are effective Jan. 1, 2020. There are a lot of CPT changes to learn about: The CPT® 2020 code book […]
The post Master 2020 CPT Changes With This Expert Overview appeared first on AAPC Knowledge Center.
Can someone please share a master list of all existing chronic conditions ICD-10 codes in CSV or excel format, or share a source from where I can download this info. I greatly appropriate your all help and time.
Kind Regards,
Muhammad Imran
If your orthopedist carries out several procedures during a knee arthroscopy on the same patient on the same day, you will need to understand the multiple-scope rule to determine which procedures you can actually claim and get the payments too.
Vital orthopedic exception: Remember that the multiple-scope rule applies mainly to shoulder and knee procedures in the orthopedic practice; however it also affects those of the elbow, wrist and hip. On the contrary, it doesn’t apply to ankle or metacarpophalangeal (MCP) arthroscopy, and it does not affect arthroscopically aided procedures (29851, 29855-29856, 29888-29889 and 29892).
Follow these expert-approved tips to clinch your coding every time
1. Look to CPT for scope ‘families’
Prior to worrying about how to apply the multiple-endoscopy rule, you should first know why and when it applies.
The multiple-endoscopy rule is Medicare’s method to avoid paying twice (or more) for ‘inclusive’ services by reimbursing only a portion of any scope carried out at the same time as another scope of the same basic type.
2. Always include the ‘base’ procedure
Let us assume that the doctor has carried out a diagnostic shoulder arthroscopy (29805) plus shoulder arthroscopy for repair of SLAP lesion (29807). How does the multiple-scope rule apply?
Remember that family codes always include the work involved in the base code, and a surgical scope always includes the diagnostic scope of the same type. As such, you would report only 29807 in this case.
What about diagnostic shoulder arthroscopy followed by arthroscopic limited debridement? Once more, you should report only the more extensive procedure – in this case, 29822 (Arthroscopy, shoulder, surgical; debridement, limited).
3. Bill both scopes if there’s no base procedure
If the surgeon carries out two scopes in the same family, neither of which is the base procedure, you should go for both codes. As such, if your orthopedist carries out shoulder arthroscopy with foreign-body removal (29819) followed by shoulder arthroscopy for complete synovectomy, you would submit both 29819 and 29821 (… synovectomy, complete).
4. Watch your reimbursement
Under the multiple-scope rule, Medicare will pay the entire fee schedule amount only for the highest-valued scope in a given code family during the same operative session. Medicare carriers will reimburse any additional scopes in the same family by subtracting the value of the base scope in that family and paying the difference.
For more details on this and for other orthopedic coding updates, sign up for an audio conference and stay informed.
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A modifier in the right place at the right time is likely to get you a prompt and good reimbursement. You use one of the most key modifiers – modifier 59 so often that you think you know everything there is to know about it. Evaluate essential facts about modifier 59 and avoid hitting a blank wall before it is too late.
Guideline 1: Know modifier 59’s criteria when you see it
The right combination of a podiatrist’s procedure and a modifier can make or break your claim. If you want to be able to interpret a modifier correctly, read it like a story. Through modifiers, payers know what transpired during a procedure without having to read every operative report.
In this case of modifier 59, it indicates that a significant, separately identifiable procedure has been carried out on the same day as another procedure and often times during the same operative session. This modifier encompasses treatment for primary, unrelated problems and may represent session or a different procedure site.
Guideline 2: Do not overuse modifier 59
You should use caution when using modifier 59 and be sure another modifier is not more apt. In CMS memo A-00- 35, you will discover that anatomical or bilateral modifiers may be more apt than 59. In those examples where an anatomic or bilateral modifiers is not apt, modifier 59 may be apt. Go for the most comprehensive code on the first claim line without a modifier. On subsequent lines, report the code with modifier 59 and the unit of service equal to one.
Guideline 3: Draw the line between modifiers 59, 51
Do not confuse modifier 59 with 51, which is used to identify secondary ‘allowable’ procedures or services provided along with the primary procedure.
Some coders think of modifier 51 as an indicator to payers that multiple procedures were done during one operative session, while modifier 59 as more of a bundling/unbundling modifier, which is typically used to indicate that procedures normally consider components of another are in certain cases to be looked at ‘individually’.
For more Podiatry coding update, sign up for an audio conference. Such a site comes stocked with all podiatry coding information to help you code right for your practice.
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