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Are these considered central line placements?
1) R femoral vein introducer placed.
2) Placement of a dual lumen temporary R femoral hemodialysis catheter placed.
Is a central line placement, CPT 36556, appropriate for these procedures referenced above?
In order to report a central line placement, MUST the provider state where the tip resides? Many times I do not see any documentation indicating where the tip of the device terminates. I see that ultrasound is used quite a bit to locate the vein, but no doc indicating where the tip of the catheter terminates.
Please help!
Skip Prior Authorization for These 4 HCPCS Codes
Effective April 30, four HCPCS Level II codes for certain durable medical equipment (DME) will no longer require prior authorization. If your medical office or facility sells or rents DME, it’s time to update your list. Master List Agenda The Centers for Medicare & Medicaid Services (CMS) published a final rule in the March 30 Federal Register to […]
AAPC Knowledge Center
Can I bill for these services?
Hello,
I have a pediatric provider who’s patient ran away and the family presented with paperwork that needed to be completed and wanted to discuss the matter with the provider. Can I bill for the providers time that she spent completing the paperwork and meeting with the family?
Right Reimbursements for Postop Surgery with These Modifier Tips
You may be appending modifiers to your claims on a regular basis, but that doesn’t mean you are filing correctly and getting the most appropriate pay. Here are some modifier tips for three of the most confusing modifiers: 58, 78, and 79.
Choosing between these modifiers can be carrier-specific in some situations.
Remember all possible uses for modifier 58
The descriptor for modifier 58 ‘Staged or related procedure by the same physician during the postoperative period’ seems self-explanatory. Coders sometimes falter, however when they forget that modifier 58 actually applies to subsequent procedures that fall into one of these three categories:
Planned or anticipated (staged): A good instance might be an infected hand that has to be debrided many times over the course of a couple of weeks. You will not use a modifier on the first procedure, but will add modifier 58 on the subsequent procedures. More extensive than the original procedure: The physician manipulates a patient’s ulnar fracturel. An x-ray at the follow-up appointment shows that the reduction met with failure; as such the physician completes pinning or an open reduction with internal fixation (ORIF). Code the procedure as required and append modifier 58. Therapy or treatment post a surgical or diagnostic procedure: This could apply to a soft tissue biopsy followed at a later date by malignant tumor excision. You will only append modifier 58 to the second procedure if it takes place during the first procedure’s global period. The date of the second procedure resets the global period. You should expect 100 percent reimbursement for procedures you file with this particular modifier. Verify ‘surprise’ prior to reporting 78 If your physician completes a second but unplanned procedure related to the first, you might need modifier 78. Prior to appending modifier 78, confirm that the follow-up procedure was related to the original procedure but unplanned and that it occurred during the global period. Check all diagnoses to justify modifier 79 Sometimes a patient returns to the operating room for a procedure that is not related to the first surgery, however still within the first procedure’s global period. In that case, you will consider appending modifier 79. Keep your modifier options straight with medical coding updates from a medical coding guide like Supercoder!
We provide you simple, instant connection to official code descriptors & guidelines and other tools for 2010 CPT code, HCPCS lookup that help coders and billers to excel in the work they do every day.
Clear Every ER/PR Coding Snag with These Steps
The adage to ‘always report the most specifc CPT code’ could ensnare your estrogen receptor (ER) and progesterone receptor (PR) coding for breast cases. Here our experts help you sort out the difference between specific analyte and specific method to ensure you select the right code every time.
Reserve 84233 and 84234 for assays
If you are searching for specific codes when a surgical pathology report references estrogen and/or progesterone receptor testing, you should not miss 84233 and 84234. However are those always the correct choice?
The 84233 and 84234 definitions create a confusion for medical coders reporting ER/PR tests. The question is whether you must report 84233/84234 as the definitions specify ER/PR, or if you can in its place report a generic immunohistochemistry code such as 88342 for certain ER/PR testing.
Codes 84233 and 84234 describe laboratory tests for estrogen and progesterone receptors that use a biochemical ligand-binding assay method like dextran-coated charcoal assay. However most labs evaluate ER/PR using immunohistochemistry as clinical studies have consistently shown the superiority of immunohistochemistry over biochemical assay methods for ER/PR testing.
Watch out for immunohistochemistry (IHC)
When the lab method involves immunohistochemistry for tissue specimens like evaluating breast tumors for ER and PR status, you should look to the following codes to describe the service: 88342, 88360, 88361.
Although these code definitions are ‘generic’ in the sense that they do not specifically identify estrogen or progesterone receptors, you should report them for an ER or PR (or any other) immunohistochemistry antibody strain.
Differentiate qualitative/quantitative codes
Choosing among 88342, 88360, or 88361 calls for knowing whether the immunohistochemistry analysis is qualitative or quantitative and whether quantification uses computer-assisted technology or “manual” counting, including visual approximation. You might choose to go for any of these three codes for ER, PR, Her- 2/neu, Ki-67, or any of various other IHC analyses
Count antibodies
You should report one unit of the right code for each antibody stain, irrespective of which antibody you are coding.
For more information on this and other CPT codes, sign up for a one-stop medical coding website. Such a site comes stocked with CPT codesets among other things.
We provide you simple, instant connection to official code descriptors & guidelines and other tools for 2010 CPT code, HCPCS lookup that help coders and billers to excel in the work they do every day.
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MH & SUD Assessment, how often can these be billed?
Can mental health and substance use disorder assessments be billed more often than once per year? Let’s say there was an assessment done 10 months ago by a provider but they feel that another assessment is appropriate now due to the potential change in the patient’s diagnosis and health status. Would it be appropriate for the provider to bill another assessment (H0001 or H0031) before 1 year? Or is there a more appropriate re-assessment code specific to Behavioral Health?
Cardiology Coding Got You Down? Use These 5 Tips For Success!
Cardiology Coding Tips
With the rollout of ICD-10, documentation, coding, billing, auditing, and compliance, have become buzzwords in medical practices.
These can all impact the physician’s revenue cycle and expected outcomes such as mortality and morbidity rates, resource utilization, and length of stay. This is necessary to meet compliance standards set forth by private insurers, the Centers for Medicare and Medicaid Services (CMS), and state agencies. In this article, I will discuss the challenges to proper documentation and coding in a cardiology practice.
These challenges include human errors, lack of knowledge regarding current coding and documentation standards, working and charting in multiple care environments, and/or not coding to the highest degree of specificity. As in any specialty practice, clear and accurate, detailed documentation is the best way to ensure proper coding.
This is the “ugh…” side of practicing medicine. Specialty practices, such as cardiology, provide a variety of services including invasive procedures, radiology tests, blood work and interventions to patients in several settings. Charges for services, care, medications etc, are handled differently based on whether the patient was cared for in the hospital, as an outpatient in same day surgery centers, or in the physician’s office.
Challenge 1: Minimize Human Error
We all make mistakes, and when dealing with up to 7 numbers and letters per code it is easy to enter them incorrectly, especially when dealing with multiple codes with complex patients and procedures. Whether you outsource your billing or manage internally, double checking codes is imperative. As you become more accustomed to ICD-10 and CPT codes you will start to memorize frequently used ones and may quickly enter them into your system. This leaves room for careless errors and potential loss of specificity which can affect reimbursement.
Challenge 2: Stay Updated on Cardiology Coding!
Alway keep the most current ICD-10 CM and PCS, CPT, and HCPCS code books in the office. There are frequent changes and guidelines posted by CMS and various coding clinics. The AHA (American Heart Association) offers quarterly newsletters. Refer to the CMS website for updates and subscribe to any publications offered by CMS, OIG (Office of the Inspector General) and state and local agencies that regulate billing practices.
ALWAYS look up codes in the alphabetical AND tabular indexes. At times a code may appear to be the correct one in the alphabetic index, but once looking further at the tabular index you may find notes and disqualifiers such as “code first” or “excludes..”.
Challenge 3: Complete and Accurate Documentation is Key!
If documentation problems exist, it will slow down the revenue cycle, decrease billable expense reimbursements, as well as leave room for coding inconsistencies which may become a red flag for auditors.
This is particularly difficult for procedures. Documentation gaps for interventional cardiologists such as cardiac catheterization may lead to loss of potential codes and codable components. This includes bifurcation interventions versus branch interventions, supplies used, additional medications used outside of the “standard”, etc.
Changes in the anticipated procedure may arise, as you never know what you may find until you “get in there”; therefore complete and thorough documentation is a necessity.
Challenge 4: Always Code to the Highest Degree of Specificity
A great example that comes to mind is diabetes. Diabetes including any of its chronic manifestations carries 3 times the risk weight than that of an unspecified diabetes code.
Physicians should completely chart all relevant comorbid and chronic diseases so that risk-adjusted outcomes accurately reflect the quality of care delivered. Also, cardiologists need to remember some of the basics of coding and documentation. When appropriate, document the diagnosis rather than the symptom such as angina compared to chest pain. Also, chart to the highest degree of specificity such as systolic or diastolic CHF compared to CHF unspecified. They are different diagnoses and the different code may impact how care is reimbursed or graded. In other words, this impacts revenue and risk adjustment.
More complete and accurate documentation will leave less room for translation and coding errors such as mismatched diagnosis and procedure codes.
Challenge 5: Audit Frequently!
Regular internal or external audits are encouraged to track common coding and documentation errors and to identify needs for further education of staff. An open line of communication should exist between physicians, nurses, CDI, coders and billers. This will provide opportunities for questions regarding diagnosis, procedures, supplies used etc to properly reflect the acuity and care of the patient.
As in all areas of healthcare, multiple parties are involved in painting an accurate picture of the patient’s overall care and level of acuity. Frequent audits will ensure correct reimbursement and documentation.
Maintaining current education, documenting properly and utilizing good coding practices will result in a faster return in the revenue cycle, decrease external audits, and overall improved compliance.
For further reference, the following are excellent resources:
What challenges do you face in the coding and billing arena as a specialist? Do you outsource your billing or manage within your own practice? Join in the conversation below.
— This post Cardiology Coding Got You Down? Use These 5 Tips For Success! was written by Manny Oliverez and first appeared on Capture Billing. Capture Billing is a medical billing company helping medical practices get their insurance claims paid faster, easier and with less stress allowing doctors to focus on their patients.