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Topic: Common coding mistakes by specialty-Avoid errors in pain management and lesion removal

Ambulatory Surgery Reimbursement Update, March 11, 2008

Many common coding mistakes are rooted in both insufficient physician documentation and coders' inadequate knowledge of the anatomy involved in various specialties. To rectify common errors, make it a priority to provide communication between coders and physicians about the procedures themselves and the CPT guidelines for coding those procedures.

Pain management

Medicare has bundled fluoroscopy payment for this year; however, some carriers will allow for separate reimbursement. But coders often fail to capture all the vertebral levels physicians inject and overlook opportunities for reporting fluoroscopy to commercial carriers.

This may be the case because coders are not always familiar with the anatomy of the spine or the rationale behind the procedure, says Cristina Bentin, CCS-P, CPC-H, CMA, founder of Coding Compliance Management in Baton Rouge, LA. Physicians are not always diligent in detailing their descriptions of the procedures.

"More importantly, [physicians'] diagnosis information indicated on the operative report is sometimes lacking in specificity and simply states 'pain.' While 'pain' is a working diagnosis, this doesn't by itself warrant the injection or meet medical necessity requirements as specified by some carriers' local coverage determinations," Bentin says. "The physician should give us the specific condition or diagnosis on the operative note rather than simply stating that the patient has pain."

Delays can occur when coders have to query the physician.

Likewise, carriers could deny the claim if they determine that, given the vague or unspecified diagnosis provided, the procedure was not medically necessary.

Editor's note: This article is an excerpt from the March 2008 issue of Ambulatory Surgery Coding and Reimbursement Insider. For more information on how to avoid common coding mistakes at your ASC, visit www.hcpro.com/content/205505.cfm.

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