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Prepare for ICD 10 / ICD-10 CODING / ICD-10 CODING FOR LACERATION REPAIR
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on: Jun 24, 2015, 04:08:03 am
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Below is an article from the publication "Part B Insider (Multispecialty) Coding Alert-2015; Volume 16, Number 22" which is self-explanatory. Part B Coding Coach: Don't Let Faulty Coding Cut Into Your Laceration Repair Reimbursement - Published on Fri, Jun 19, 2015 Find the right answers to these clinical scenarios. Laceration repairs are among the most common procedures performed in dermatology practices – and along with those common procedures come some common coding mishaps. How well do you have your laceration repair coding sewn up? Take a look at the questions below, then read on for our expert answers elsewhere in this issue. Question 1: Your dermatologist performs laceration repair for an 18-year-old male patient for a cut that he received from broken glass. The laceration was 4.5 cm long and present on the right thigh area. Since there was glass shards interspersed in the wound, your dermatologist had to spend a lot of time in removing all the pieces of embedded glass. After the debridement, the dermatologist closed the wound with a single layer of sutures. What CPT® code should you report? A. 12001 B. 12002 C. 12031 D. 12032 Question 2: Your dermatologist repairs a 2.0 cm laceration of the scalp (dermis and epidermis), and a 3.4 cm laceration of the scalp involving multi-layer closure. What CPT® code or codes should you report? A. 12002 B. 12001 and 12032 C. 12001 x 2 D. 12032 Question 3: The dermatologist performs simple repair of two lacerations: a 3.0 cm laceration of the left hand and a 2.1 cm laceration of the scalp. What CPT® code or codes should you report? A. 12002 B. 12002 x 2 C. 12001, 12002-59 D. 12002, 12001-59 Question 4: True or false: If a dermatologist performs a simple laceration repair, and the next day the patient returns with bleeding from the wound and the dermatologist has to repeat the repair, you cannot code for the repeat repair. Check Out How You Fared See if your answers from our coding quiz match with our answers below. Answer 1: C. If your dermatologist didn’t mention the extensive debridement that he performed, you’d be prompted to report 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.6 cm to 7.5 cm). But in this case, you can report 12032 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.6 cm to 7.5 cm). Reimbursement tip: If you look at the above example, the CPT® code 12002 has 3.09 non-facility total relative value units (RVUs), meaning that will fetch you reimbursement of $110.48 when calculated using the 2014 conversion factor of $35.7547. On the other hand, code 12032 has 8.54 RVUs that will pay out $305.35, which means that you will lose out on approximately $195 if you fail to identify the extensive debridement factor. Answer 2: B. Report the service as 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less) and 12032. If the repairs involve different depths (intermediate versus simple) and/or different anatomic sites represented by different codes, you should separately report the repairs. Alternate: If both closures in the prior example were simple, you should not report 12001 for the 2.0 cm laceration plus 12002 (…2.6 cm to 7.5 cm) for the 3.4 cm laceration. Instead, you should code for 2.0 cm + 3.4 cm = 5.4 cm simple repair, scalp, which is a single unit of 12002. Pointer: If the repairs involve anatomic sites that represent different CPT® codes (such as neck versus lip), you can’t add the repair length for a single code. Pay attention to code body groupings, because these may change according to the repair class. For instance, CPT® includes hands, feet, and/or extremities in the same anatomic site for simple repairs, but exclude hands and feet from intermediate repair codes for extremities. Answer 3: A. When the dermatologist performs a repair in the same classification (simple, intermediate, or complex) of two distinct lacerations in an anatomical grouping that is covered within one series of CPT® codes – e.g., 12001-12007 for simple repairs of the scalp, neck, axillae, external genitalia, trunk or extremities (including hands and feet), coders should add the lengths of the repair, rather than report the two repairs separately. In this case, you would add 3.0 cm to 2.1 cm and report 12002 for a 5.1 cm repair. Don’t miss: Note, however, that the anatomical groupings do not remain constant in the different repair levels. For example, while in the simple repair codes, repairs to the trunk are grouped with the scalp, neck, axillae, external genitalia and extremities, in the complex repair category the trunk has its own series of CPT® codes – 13100-13102 (Repair, complex, trunk…). Answer 4: False. The correct answer depends on the code used to report the initial closure, notes Pamela Biffle, CPC, CPC-P, CPC-I, CPCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas. You are allowed to report a second unit of the code for the procedure performed on the second day because the simple laceration repair codes, 12001-12021, have zero global days. This means that any procedure performed on the succeeding days of the first procedure can be claimed for separately. However: If the dermatologist had initially performed an intermediate repair (such as CPT® code 12031, Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.5 cm or less), the global period for that procedure is 10 days, and you would not be able to report the second procedure. Example: The dermatologist performed laceration repair on a patient’s scalp. The coder reported 12001 for the procedure performed. The patient returned on day two with bleeding from the wound. Upon examination, the dermatologist found that the wound was open and repeated the laceration repair. In this case, you would report the same CPT® code (12001) for the repeat repair that you reported for the initial repair. Because the procedure has zero global days, you do not have to append a modifier such as 76 (Repeat procedure or service by same physician or other qualified health care professional) or 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) to the second unit of 12001 that you are reporting for the laceration repair performed on the second day. Dx code: Consider assigning V58.31 (Encounter for change or removal of surgical wound dressing) to the second unit of 12001 to reflect that the service was intended to address a problem with the original dressing and sutures rather than initial treatment of a laceration. Tip: You can look up the global days of any procedure at supercoder.com or at https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspxDebra Farley Billing Director BILLPro Management Systems 6-15-15 |
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Prepare for ICD 10 / ICD-10 CODING / ICD-10 CODING: SIGNS/SYMPTOMS CODING RULES, ETC.
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on: Jun 24, 2015, 04:01:20 am
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Below is an article from the publication "Part B Insider (Multispecialty) Coding Alert-2015; Volume 16, Number 22" which is self-explanatory. ICD-10: Uncertainty is Okay Under ICD-10 - Published on Fri, Jun 19, 2015 When you look forward to Oct. 1, you’ll be looking back at your existing signs/symptoms coding rules. Although you may have heard that ICD-10 includes a code for every condition under the sun, that news may have been exaggerated. In reality, the new diagnosis coding system won’t always include the right codes for your patient’s conditions—particularly if the physician doesn’t reach a diagnosis at the visit. CMS aimed to eliminate confusion about this situation and other issues with its new MLN Matters article SE1518, which the agency issued on June 9. Fortunately for those readers who have the ICD-9 guidelines memorized, the rules won’t change considerably when it comes to signs and symptoms coding after Oct. 1. “In both ICD-9-CM and ICD-10-CM, sign/symptom and unspecified codes have acceptable, even necessary, uses,” the article said. “While you should report specific diagnosis codes when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, in some instances sign/symptoms or unspecified codes are the best choice to accurately reflect the health care encounter.” In short: As you did with ICD-9, if the physician makes a definitive diagnosis by the end of the encounter, you’ll report that code. But if not, you should report the signs and symptoms that prompted the visit—for instance, code a sore throat if strep throat is suspected but the test results aren’t in. You’d report a code from the “unspecified” range for situations such as a patient who is diagnosed with pneumonia but the test results indicating the specific type haven’t come in yet, the article said. Don’t Over-Code Symptoms Remember that if you do have a definitive diagnosis, you don’t need to report the signs and symptoms. For instance, if your patient has congestive heart failure with edema and shortness of breath, you would report 428.0 (Congestive heart failure, unspecified) or I50.9 (Heart failure, unspecified). You wouldn’t include symptom codes for the shortness of breath or edema because the conditions are integral to the definitive diagnosis (CHF). No Definitive Diagnosis? You’ll list symptom codes when the physician hasn’t identified a definitive diagnosis. Symptom codes describe problems a patient is experiencing, so they come in handy when the cause is uncertain. For example: You are providing physical therapy including gait training for a patient who is experiencing falls of unknown etiology. In ICD-9, you would list the following codes for this patient: M1020a: V57.1 (Other physical therapy); M1022b: 781.2 (Abnormality of gait); and M1022c: V15.88 (History of fall). In this case, you don’t have a more specific diagnosis and the symptom (abnormal gait) is the focus of your care. ICD-10 difference: In ICD-10, there’s no equivalent to the therapy V57.x codes, so you’ll report the code for the underlying condition therapy is treating as your primary diagnosis. In this scenario, you would list: M1021a: R29.6 (Repeated falls) and M1022b: Z91.81 (History of falling). ICD-10 code R29.6 is a welcome addition for patients experiencing repeated falls. You can report R29.6 if the patient has recently fallen and the reason for the falls is being investigated, she says. And you can add Z91.81 to indicate the patient has a history of falls. Resolved Condition? Another situation in which you’ll report a symptom code is when you need to avoid coding a disease or condition that has been resolved. For example, when providing aftercare for joint replacement surgery, you can’t code a disease process such as gangrene because the condition been corrected by the surgery. In ICD-9, a symptom code can help justify the aftercare V code to further describe the patient’s care. For example: You are providing physical therapy following a below-knee amputation of the patient’s right leg due to gangrene. The patient is receiving gait training as well as aftercare. Report the following ICD-9 codes: M1020a: V58.49 (Other specified aftercare following surgery); M1022b: V49.75 (Lower limb amputation status; below knee); and M1022c: 781.2 (Abnormality of gait). In ICD-10, for this patient, you would report: M1021a: Z47.81 (Encounter for orthopedic aftercare following surgical amputation); M1023b: Z89.511 (Acquired absence of right leg below knee); and M1023c: R26.89 (Other abnormalities of gait and mobility). Not Integral? Some diagnoses can have symptoms that aren’t always part of the condition. When that’s the case for your patient, you should add the code for the symptom along with the condition. Be sure to take note of the coding guidelines regarding symptom coding: “Sequence the definitive diagnosis first, followed by the symptom code.” For example: If your patient has Parkinson’s disease (332.0) and she is experiencing slurred speech (784.59) you would code both because not all Parkinson’s patients experience slurred speech. In ICD-10 you would list G20 (Parkinson’s disease) followed by R47.81 (Slurred speech). Read the Notes for This Caveat Occasionally, the coding manual will instruct you to also list codes for symptoms even when you know the definitive diagnosis. For example: Suppose your patient has benign hypertrophy of the prostate (BPH) with urinary obstruction. You’ll code for this with 600.01 (Hypertrophy [benign] of prostate without urinary obstruction and other lower urinary tract symptoms [LUTS]). When you turn to the tabular listing, there is a sequencing instruction in both ICD-9 and ICD-10 to “use an additional code to identify symptoms” even though all the listed symptoms are integral to BPH with lower urinary tract symptoms (LUTS). In ICD-10, you would list N40.1 (Enlarged prostate with lower urinary tract symptoms) and N13.8 (Other obstructive and reflux uropathy). Resource: To read more about how to code signs and symptoms under ICD-10, see the MLN Matters article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1518.pdfDebra Farley Billing Director BILLPro Management Systems 6-24-15 |
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Ohio Medicare (including managed care) / General Medicare Information / CMS NEWS: New Medicare data available to increase transparency on...physician...
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on: Jun 02, 2015, 04:02:29 am
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Please scroll down to a CMS e-mail received yesterday titled "New Medicare data available to increase transparency on hospital and physician utilization." It is self-explanatory. Debra Farley Billing Director BILLPro Management Systems 6-2-15 From: Centers for Medicare & Medicaid Services [mailto:cmslists@subscriptions.cms.hhs.gov] To: debra@billpro.net Sent: Mon, 01 Jun 2015 10:17:51 -0500 Subject: CMS NEWS: New Medicare data available to increase transparency on hospital and physician utilization CMS NEWS FOR IMMEDIATE RELEASE June 1, 2015 Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries New Medicare data available to increase transparency on hospital and physician utilization Data serves as a rich resource to clearer look into Parts A and B costs, services, and trends As part of the Administration’s efforts to promote better care, smarter spending, and healthier people, today CMS is posting the third annual release of the Medicare hospital utilization and payment data (both inpatient and outpatient) and the second annual release of the physician and other supplier utilization and payment data. The announcement was made at the annual Health Datapalooza conference in Washington, DC. “These data releases will give patients, researchers, and providers continued access to information to transform the health care delivery system,” said acting CMS Administrator Andy Slavitt. “It’s important for consumers, their providers, researchers and other stakeholders to understand the delivery of care and spending under the Medicare program.” The Medicare hospital utilization and payment data consists of information for 2013 about the average amount a hospital bills for services that may be provided in an inpatient stay or outpatient visit. The hospital data includes payment and utilization information for services that may be provided in connection with the 100 most common Medicare inpatient stays and 30 selected outpatient procedures at over 3,000 hospitals in all 50 states and the District of Columbia. The top 100 inpatient stays represented in the hospital inpatient data are associated with approximately $62 billion in Medicare payments and over 7 million hospital discharges. The Medicare Part B physician, practitioner, and other supplier utilization and payment data consists of information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The data also shows payment and submitted charges, or bills, for those services and procedures by provider. It allows for comparisons by physician, specialty, location, types of medical services and procedures delivered, Medicare payment, and submitted charges. The new 2013 dataset has information for over 950,000 distinct health care providers who collectively received $90 billion in Medicare payments. Hospitals, physicians, and other health care providers determine what they will charge for services and procedures provided to patients and these “charges” are the amount the hospital or provider generally bills for the service or procedure, but the amount paid is determined by Medicare’s physician fee schedule or other payment methodologies. CMS protects beneficiaries’ personal information in all its data releases. “Data transparency facilitates a vibrant health data ecosystem, promotes innovation, and leads to better informed and more engaged health care consumers,” said Niall Brennan, CMS chief data officer and director of the Office of Enterprise and Data Analytics. “CMS will continue to release the hospital and physician data on an annual basis so we can enable smarter decision making about care that is delivered in the health care system.” The Administration has set measurable goals and a timeline to move Medicare toward paying providers based on the quality, rather than the quantity, of care they give patients. These data releases are part of a wide set of initiatives to achieve better care, smarter spending, and healthier people through our health care system. Open sharing of data securely, timely, and more broadly supports insight and innovation in health care delivery. Today’s data release adds to the unprecedented information recently released on Medicare Part D prescription drugs prescribed by physicians and other health care providers. To view a fact sheet on the 2013 hospital charge data, visit: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-06-01.html. To view a fact sheet on the 2013 Medicare Part B physician data, visit: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-06-01-2.html. |
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Before you begin / Announcements / BILLPRO PASSED END-TO-END ICD-10 TESTING WITH CGS MEDICARE!
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on: May 01, 2015, 06:06:58 am
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I M P O R T A N T A N N O U N C E M E N T
BILLPro was one of fifty electronic submitters selected to participate in end-to end ICD-10 testing with the Ohio Medicare contractor, CGS. This involved submitting claims with a 10-1-15 date of service with ICD-10 codes.
We are extremely pleased to report that notice was received from CGS this morning that we were successful.
This helps to ensure a successful transition to ICD-10.
Debra Farley
Billing Director
BILLPro Management Systems
5-1-15
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Prepare for ICD 10 / ICD-10 CODING / ICD-10-CM: Continue to Report CPT/HCPCS Modifiers for Laterality per CMS
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on: May 01, 2015, 04:19:09 am
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CMS published the following article in "CMS MLN Connects Provider eNews for Thursday, April 30, 2015"
"Coding for ICD-10-CM: Continue to Report CPT/HCPCS Modifiers for Laterality
"On October 1, 2015, ICD-10-CM will replace the ICD-9-CM code set currently used by providers for reporting diagnosis codes. Implementation of ICD-10-CM will not change the reporting of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes, including CPT/HCPCS modifiers for physician services. While ICD-10-CM codes have expanded detail, including specification of laterality for some conditions, providers will continue to follow CPT and CMS guidance in reporting CPT/HCPCS modifiers for laterality."
Debra Farley
Billing Director
BILLPro Management Systems
5-1-15
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EHR/EMR/EPrescribe/PQRI / PQRI/EPrescribe / CMS SE1507 Physician Feedback, Quality & Resource Use Reports & Value Mod.....
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on: Apr 29, 2015, 04:46:05 am
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ATTENTION: MEDICARE PROVIDERS: MDs, DOs, DPMs, OPTOMETRISTS, CHIROPRACTORS, PAs, NPs, LISWs, CLINICAL PSYCHOLOGISTS, PHYSICAL/OCCUPATIONAL/SPEECH-LANGUAGE THERAPISTS, REGISTERED DIETICIANS, NUTRITION PROFESSIONALS, AUDIOLOGISTS Directly below is the link to the CMS Medicare Learning Network publication, SE1507, titled "Physician Feedback, Quality and Resource Use Reports (QRURs) and Value-Based Modifier Program-Overview & Implementation." This is important reading. http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2015-Transmittals-Items/SE1507.html > under "Downloads" click on "SE1507 {PDF, 97KB}" Also, for those who didn't participate in the 4-16-15 CMS National Provider Call on "How to Register for the PQRS Group Practice Reporting Option in 2015," following is the link to that information including a slide presentation, audio recording and written transcript: http://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2015-04-16-PQRS-Group-Practice-Presentation.PDFDebra Farley Billing Director BILLPro Management Systems 4-29-15 |
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Ohio Medicare (including managed care) / General Medicare Information / Part B Insider article "Part B Payment: Congress Votes to Overhaul Part B ...
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on: Apr 23, 2015, 03:56:39 am
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The publication, "Part B Insider," posted an article on 4-17-15 titled ""Part B Payment: Congress Votes to Overhaul Part B Payments." Please scroll down for the article. We thought this would be of interest to you. Debra Farley Billing Director BILLPro Management Systems 4-23-15 Part B Payment: Congress Votes to Overhaul Part B Payments - Published on Fri, Apr 17, 2015 You’ll no longer face potential payment drops at the beginning of each New Year. With almost no time to spare, Congress passed a new Medicare payment reform bill on April 14, which means you should never again have to worry about last-minute payment patches to keep your Part B payments flowing. Background: Part B practices were dealing with a looming 21 percent reimbursement cut that was expected to take effect on April 1 but was later delayed until April 15. Instead of temporarily halting the pay cut through the end of the year like Congress has done 17 times in the past, legislators decided to permanently fix the Medicare payment formula this year instead of continuing to offer temporary fixes to the Sustainable Growth Rate (SGR) issue. House and Senate support bill: The House of Representatives passed the bill by a large margin on March 26 and it moved into the Senate for confirmation, where it was approved on April 14. President Obama signed it into law on April 16. Increases Kick in July 1 The Medicare and CHIP Reauthorization Act gives 0.5 percent annual boosts to your Medicare pay for almost five years starting in July, after which practitioners will get bonuses based on quality of care rather than the number of procedures administered. As for your current payments, you’ll continue to collect based on the rates that were in effect from Jan. 1 through March 31, giving MACs and practices time to prepare their systems for the new payment formulas that will kick in on July 1. ICD-10: Although some practices were expecting legislators to include language that would push ICD-10 implementation back another year, there was no ICD-10 delay included in the bill. Therefore, practices are still fully on track to implement the new diagnosis coding system in October. Some Beneficiaries Pay More The cost of the new Medicare payment plan reportedly amounts to more than $200 billion over the next decade, and some of that cost will be passed on to higher-earning Medicare beneficiaries. An amendment to the bill included a proposal that would have ended therapy caps, but that amendment was rejected, meaning that physical, occupational and speech therapists will continue to face reimbursement caps for their services. Medical associations were very pleased with the outcome, allowing doctors to focus on offering patients care rather than continually worrying about payment patches. “Passage of this historic legislation finally brings an end to an era of uncertainty for Medicare beneficiaries and their physicians—facilitating the implementation of innovative care models that will improve care quality and lower costs,” said the AMA’s Executive Vice President and CEO, James L. Madara, MD, in a statement. “Patients will be able to get the care they need and deserve.” Resource: To read the complete text of the bill, visit www.congress.gov/bill/114th-congress/house-bill/2/text. |
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