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January 2008 (Issue 0)	view entire issue

Ensure E/M accuracy with a cycle of education and auditing
Joe Rivet, CPC, CCS-P, says that educating billers, developing an auditing process, and monitoring and following biller education will improve coding accuracy and E/M documentation guideline uniformity.

Enforcement
Sample policy on standardizing E/M audits

Audit results


OIG Figure 1


CMS updates the therapy list to add new code
On November 23, 2007 CMS released Transmittal 1377, which added one new code (96125; Standard cognitive performance testing per hour) to the 2008 therapy code list. This code is considered "always therapy" regardless of who performs it, and the code requires a therapy modifier (GN, GO, or GP).

Physician queries: Ask the right questions to improve coding accuracy, obtain detailed documentation
To keep the lines of communication with your physician smooth and tension-free, Alison Nicklas, and James S. Kennedy, MD, CCS, say it's important for coders to approach queries with tact and to be thoughtful to not lead the physician toward a certain diagnosis.

2008 CPT codes: Understand the digestive system changes
Although there were only 13 new digestive codes, 10 revised codes, and four deleted codes overall, in the 2008 CPT Manual the American Medical Association corrected the reporting gaps of the past. Shannon E. McCall, RHIA, CCS, CPC, director of coding and HIM for HCPro, in Glen Allen, VA, and Cindy Basham, MHA, BSN, CCS, CPC, regulatory specialist with HCPro, in Maryville, TN, summarized the digestive system changes during HCPro's November 24, 2007, audioconference, "2008 CPT: Major Coding Additions, Changes and Deletions."

Coding laminectomies


Identify common coding mistakes for pain management and lesion removal
In the first of a two-part series Cristina Bentin, CCS-P, CPC-H, CMA, and Joanne Schade-Boyce, RDH, MS, CPC, ACS, examine the many common mistakes that coders make when coding pain management and lesion removal. These mistakes are often the result of insufficient physician documentation and coder knowledge of anatomy.

Tackle the 2008 drug administration changes: New code brings controversy
In the first article in a two-part series about drug administration (injection and infusion services) coding, Jugna Shah, MPH, and Valerie A. Rinkle, MPA, cover the code changes in the 2008 CPT Manual. The 2008 CPT Manual features several new and revised codes, code descriptors, and an explicit code/service-specific hierarchy to use when selecting the initial service code. Reporting code 90776 (to capture additional IV pushes of the same substance or drug) caused confusion because how this code should be used has led to increased reimbursement denials.

HHS seeks communities to participate in EHR demonstration project
Health and Human Services (HHS) Secretary Michael Leavitt is inviting community leaders nationwide to apply for a new demonstration project that provides Medicare incentive payments to primary care physician practices for use of certified electronic health records to improve patient care, according to a February 20 HHS press release. Financial incentives paid to as many as 1,200 physician practices over five years may be as high as $58,000 per physician or $290,000 per practice.

Reporting modifier -59
If a physician performs two subcutaneous debridements (CPT code 11042) on two different anatomic sites-one on the right leg and one on the left hip-should these procedures be reported using modifier -59?

Increase reimbursement with modifier -22
Sharon Bolarakis, CPC, discusses the AMA's decision to replace the term "unusual procedural service" with "increased procedural service" in the description of modifier -22. This change clarifies how a provider can request additional reimbursement for a procedure that takes significantly more time than what is typically associated with the procedure. However, overusing modifier -22 could trigger an audit by Medicare or another private payer, must require a significant amount of additional work done during the procedure to justify appending this modifier.

Cover Letter Example


Alice in Wonderland Syndrome
Clinical Conditions Dictionary term for Alice in Wonderland Syndrome

Fifth disease
Clinical Conditions Dictionary term for Fifth disease

Audit injection and infusion coding and billing to ensure compliance, accuracy:
In the second article in a two-part series about drug administration (injection and infusion services) coding, Jugna Shah, MPH, and Valerie A. Rinkle, MPA, cover longstanding difficulties with injection and infusion coding and billing, and provide strategies for conducting an audit of drug administration coding and billing.

Know the new and revised CPT orthopedic codes
Stephanie Ellis, RN, CPC, discusses the changes the American Medical Association made to the orthopedic section of the 2008 CPT Manual. This article summarizes some of the new and revised codes for orthopedic procedures.

CMS issues clarification instructions regarding pediatric pneumococcal vaccine administration and nasal influenza virus payment
On February 22, CMS issued Transmittal 1461 announcing additional instructions regarding pediatric pneumococcal vaccine CPT code 90669, and an updated payment allowance for nasal influenza virus vaccine CPT code 90660. This clarification instructs payers to accept CPT code 90669 to report a pneumococcal vaccine. Carriers must submit the payment indicator of "1" and the deductible indicator of "1" in the record sent to the payer for code 90669.

E/M coding in a hospital-based outpatient clinic
Should a coder report an established or new office visit CPT code instead of a consult code if a patient is seen in a hospital-based outpatient clinic?

Care Plan at risk for Pressure Ulcers


Five steps to success: Coding from an operative report
Lori-Lynne A. Webb, CPC, CCS-P, CCP, says that coded directly from an operative report or record can be an intimidating experience for many physician coders. Webb says that following a five step coding procedure will help coders successfully bill for physicians' operative services.

Operative header example


Develop appropriate compliance strategies for physicians
According to Jessica A. Little, CPC-FP, CPC-INTMED, educating physicians about documentation guideline compliance is hard work. To make the task less daunting, recognize the guidelines to which your physicians must adhere for documentation compliance. Little also suggests that you determine the tools and resources to which your physicians respond best. And of course, be friendly and ready to help. Open communication will make the difficult task of teaching a bit easier.

2008 CPT changes: Understand Category II additions, revisions, and deletions
If you haven't already, get acquainted with the 2008 Category II CPT codes. Introduced by the American Medical Asociation as supplemental tracking codes for performance measurement, these codes are optional and should never take the place of Category I codes. Shannon McCall, RHIA, CCS, CPC, instructor for HCPro's Certified Coder Boot Camp-Inpatient and Original versions explains how the use of these codes will certainly decrease the need for record abstraction and chart review, thereby minimizing administrative burdens on physicians.

Test Your Knowledge Answer


Maintain compliance when coding from the medical record
Lori S. McGuire, CCS, EMT, James S. Kennedy, MD, CCS, and Shannon E. McCall, RHIA, CCS, CPC, discuss what parts of the medical record are appropriate when it comes to code assignment.

Legislative changes to the inpatient rehabilitation facility (IRF) prospective payment rates
Section 115 of the Medicare, Medicaid, and State Children's Health Insurance Program Extension Act of 2007 amended Section 1886 (j)(3)(C) of the Social Security Act to apply a zero percent increase to payment rates for inpatient rehabilitation facilities (IRF) for part of fiscal year (FY) 2008 and all of FY 2009. These new rates are effective for discharges occurring on or after April 1, 2008.

CPC exam VS CPC-H exam
Q:What is the difference between the CPC and CPC-H exam?

Chart
CPC exam vs. CPC-H exam

Productivity benchmarks for the POA indicator: An executive summary
Has the present-on-admission (POA) indicator affected coder productivity at your facility? Find out what your fellow coders have to say about their coding experiences since the implementation of POA reporting. Also learn about the benefits that coder/physician education and system preparation had on the transition to Medicare Severity DRGs.

How well do you know the 2008 complications and comorbidities?
Shannon McCall, RHIA, CCS, CPC, and Deborah Mange, BSN, RN, discuss the newest additions to the CC list for 2008. Find out why it's more important than ever to correctly identify CC and major CC (MCC) conditions and how inappropriate designations can drastically impact DRG assignment and payment. At the end of the article, put your knowledge to the test with a helpful coding scenario.

Test your knowledge answer


Know critical care billing, documentation requirements: Don't put your career on the line because of fraudulent reporting, overcoding
Robert S. Gold, MD, provides physicians with advice on how to avoid fraudulent reporting and overcoding. Learn how some clinicians get into hot water when they bill for critical care interventions when a patient is not truly critically ill. Dr. Gold also provides helpful hints for how to properly document for critical care cases.

Recovery audit contractors collect $371.5 million in improper payments
On February 28, the Centers for Medicare & Medicaid Services (CMS) announced that the recovery audit contractor (RAC) demonstration program had collected or repaid $371.5 million to healthcare providers during fiscal year 2007. The demonstration program began in California, Florida, and New York--the three states that process the largest number of Medicare claims. The goal of the demonstration project was to lower the Medicate payment error rate.

Hematochezia


Hemoptysis


Polycythemia vera


Charge appropriately for radiopharmaceuticals: Erase the notion that if you don't get paid, you shouldn't report
Three experts explain how your facility can develop a well-organized chargemaster to bill appropriately for radiopharmaceuticals. Duane Abbey, PhD, CFP, Leatrice A. Ford, RN, BSN, CCS, and Glenn Krauss, RHIA, CCS, CCS-P, CPUR, provide advice on how you can charge procedures so that you have enough room to absorb the cost of radiopharmaceuticals.

CMS to modify medically unlikely edit (MUE) for CPT code 90766 in April
CPT code 90766, for IV infusion, additional hours/units greater than eight, has been a topic of discussion among fiscal intermediaries (FI), Medicare Administrative Contractors (MAC), and the CMS staff. Find out why claims containing 90766 are wrongly returned to providers with a medically unlikely edit (MUE) and how insurers plan to remedy the situation after April 1.

OPPS packaging: Address CMS' expansion and assess the financial impact
Jugna Shah, MPH, and Valerie A. Rinkle, MPA, discuss the packaging of services as a result of the OPPS final rule. Find out why packaged codes might affect healthcare facility reimbursement for some services. At the end of the article, read about packaged composite APCs.

Radiation oncology certification
Q: Is there still a specialty course for radiation oncology? I am interested in getting this extra certification.

Treatment of new and deleted laboratory codes


CMS changes payment allowance for two influenza vaccines


Physician Presence Policy now applies to renal dialysis monthly capitation payment


CMS releases new instructions for observation vs. inpatient admission and discharge codes


Reporting subsequent hospital visits and hospital discharge day management services
CMS has modified the 2005 National Coverage Determination for a treatment of obstructive sleep apnea (OSA) to cover continuous positive airway pressure (CPAP). Coverage is limited to a 12-week evaluation period. If patients experience improvement during this 12-week period, they may have use of the machine covered for a longer period of time.

Take a closer look at expanded packaging for 2008
Jugna Shah, MPH, addresses expanded packaging under the OPPS with an up-close look at seven categories of packaged services, status indicator changes, and composite APCs. Shah also examines the financial effects of CMS' expanded packaging.

Ensure that your remote coding program's security is up to par with CMS guidance and HIPAA
Angela K. Dinh, MHA, RHIA, and Tom Walsh, president of Tom Walsh Consulting, LLC, discuss CMS' growing concern over devices and tools used to store and transmit electronic protected health information (ePHI). Both experts provide security policy tips for remote coders and highlight the recent CMS/PricewaterhouseCoopers audit contract.

Coverage now available for machine that treats sleep apnea without surgery
CMS has modified the 2005 National Coverage Determination for a treatment of obstructive sleep apnea (OSA) to cover continuous positive airway pressure (CPAP). Coverage is limited to a 12-week evaluation period. If patients experience improvement during this 12-week period, the machine may be covered for a longer period of time.

Report modifier -JW for discarded amounts of single-use drugs and biologicals
Providers should report new modifier -JW when processing certain types of drugs to receive payment for partial use of those drugs, according to Transmittal R1478CP, effective April 14. CMS hopes that modifier -JW will encourage providers to use biologicals and drugs as efficiently as possible.

Q&A: Use appropriate established or new patient codes for office consultation
If a patient presents to a hospital-based clinic for a consultation, should you report the established or new office visit codes 99211-99205 instead of the consultation codes?

POA form
Forms Stephanie Bland, CSS, lead coder at Provena United Samaritans Medical Center in Danville, IL, submitted this form, which serves as a tool to determine whether a condition is present on admission. Clinical documentation improvement (CDI) specialists and inpatient coders can use this form as a part of the CDI program. The form helps the hospital obtain appropriate physician documentation to determine whether a preventable condition occurred during an inpatient hospital stay. Using the form has helped to raise hospital awareness of potentially preventable conditions, says Bland. To view the form, click here.

Take my advice when preparing for the Certified Professional Coder--Hospital (CPC-H®) and other professional coding exams
The American Academy of Professional Coders (AAPC) awards the CPC-H designation to those who pass a national certification examination that is designed to confirm a professional coder's level of knowledge about hospital outpatient cases.

Identify manifestations, probable underlying causes for AMS to capture severity
In this article, James S. Kennedy, MD, CCS, addresses altered mental status (AMS), a commonly underdocumented condition. Coders often query their physicians regarding AMS to garner greater specificity regarding manifestations and probable underlying causes. Learn how more explicit documentation better substantiates patient severity of illness and leads to greater reimbursement.

Use these three steps to verify whether you need to add modifier -59 to an outpatient claim
Susan Garrison, PCS, FCS, CPC, CHC, CPC-H, CCS-P, CPAR, and Caral Edelberg, CPC, CCS-P, CHC, discuss the use of modifier -59 and offer three easy steps to help coders determine whether they should append it to outpatient claims.

Modifier -59: Consider these tips


Use modifier -25 with caution: Follow these three steps to identify appropriate clinical scenarios and ensure compliance
During HCPro's audioconference, "Mastering Modifier-25 When Reporting Professional Services," Robin B. Stickney, MD, JD, addresses the problems that physicians and coders face when determining whether use of modifier-25 is appropriate. Stickney also provides some documentation recommendations that should assist in the determination process.

Involve coders when making decisions to purchase pharmaceutical and medical supplies
Debra S. Ingersol, CPC, CCS-P, discusses why coders should be involved in the decision-making process when it comes to purchasing pharmaceutical and medical supplies. She describes why coders can provide critical knowledge regarding how to code these supplies. This information can lend greater insight into how much reimbursement hospitals can expect to receive prior to purchasing the supply.

RAC report casts spotlight on wrong patient settings
Glenn Krauss, RHIA, CCS, CCS-P, CPUR, FCS, PCS, and Marion Kruse, RN, MBA, explain the findings of the 2007 RAC status report. The report announced that CMS identified $371.5 million in improper Medicare payments collected from or repaid to healthcare providers and suppliers in California, Florida, and New York.

Coding homicidal ideations
Q: What is the correct code for homicidal ideations?

CMS announces MAC contracts for CT and NY
CMS awarded National Government Services a five-year Medicare Administrative Contractor (MAC) contract for the administration of both Part A and Part B claims in Connecticut and New York, according to a March 18 CMS press release.

Medical record coding queries: Consider this approach for return on investment
Glenn Krauss, RHIA, CCS, CCS-P, CPUR, describes why clinical specificity in medical record documentation is essential for coding accuracy under the Medicare Severity DRG system (MS-DRG). Generic documentation is no longer sufficient because the MS-DRG system is based on recognizing clinical acuity, complication/comorbidity (CC) status, and major CC (MCC) status. Additionally, because MS-DRGs affect hospital reimbursement, it’s important to properly designate acute clinical conditions, chronic conditions, and acute-on-chronic conditions.

Coders in high demand, according to new Department of Labor statistics
The demand for medical records and health information technicians will continue to increase by 18% through 2016, according to new information published by the U.S. Department of Labor (DOL).

New information for ED trauma coding and charge capture creates confusion
New CMS guidance regarding services included in critical care CPT codes—codes that were commonly believed to be separately billable by the facility—has brought uncertainty to emergency departments (ED) nationwide. William L. Malm, ND, RN, and Caral Edelberg, CPC, CCS-P, CHC, discuss how health information management directors and outpatient coding staff members must change their approaches to trauma and critical care coding and scrutinize more than seven years of potential noncompliance.

Alleviate discharge disposition confusion to ensure compliance
Sandy Nicholson, MA, RHIA, CCS-P, and Sheryl Spohn, RHIA, help you get acquainted with the ever-challenging discharge disposition codes. Learn what discharge disposition you should report when patients at your facility are discharged home or transferred elsewhere. You’ll also understand the impact proper discharge disposition reporting has on reimbursement as well as the serious compliance implications for assigning incorrect status codes.

Can you explain what each of the coding certification credentials stand for?
Q: Can you explain what each of the coding certification credentials stand for?

Executive summary of ACDIS survey results
HCPro distributed its clinical documentation improvement (CDI) survey in January 2008. This overwhelming response rate demonstrates the importance of this subject to health information management (HIM) managers and CDI specialists and managers, according to Colleen Garry, RN author of HCPro’s soon-to-be released book, The Clinical Documentation Improvement Specialists Handbook.

Body Mass Index (BMI)
Clinical coding term for body mass index

Malnutrition
Clinical coding term for malnutrition

CMS releases 2009 IPPS proposed rule: Hospitals can expect expanded quality measures and new HACs
James S. Kennedy, MD, CCS, and DeAnne W. Bloomquist, RHIT, CCS, discuss the details of the proposed rule, and explain how the rule may affect your facility.

MS-DRGs to see few changes; discussion of RAND report yet to come
As expected, CMS proposes to base 100% of the relative weights of Medicare Severity DRGs (MS-DRG) on costs. This marks the final step in a three-year transition to cost-based weights from charge-based weights. In fiscal year (FY) 2008, the relative weights consisted of a 50/50 blend of CMS-DRG and MS-DRG rates. Read the details in Healthcare Happenings.

Understand documentation requirements for coding heart failure under MS-DRGs
Hypertension, obesity, alcohol consumption, valvular damage, and genetic predisposition may contribute to heart failure, a serious and often life-threatening condition. Robert S. Gold, MD, and James Dunnick, MD, FACC, discuss documentation requirements for heart failure and the heart’s complex anatomy.

What you need to know to accurately code women's incontinence diagnoses, symptoms, and interventions
Urinary incontinence—also known as an involuntary loss of urine—affects nearly 95% of women during some point in their reproductive or post-menopausal years. Lori-Lynne Webb, CPC, CCS-P, CCP discusses the types of urinary incontinence women may experience, and how to code the treatment options.

What you need to know to accurately code women's incontinence diagnoses, symptoms, and interventions
Urinary incontinence—also known as an involuntary loss of urine—affects nearly 95% of women during some point in their reproductive or post-menopausal years. Lori-Lynne Webb, CPC, CCS-P, CCP, discusses the types of urinary incontinence women may experience, and how to code the treatment options.

Can you explain how to code intravenous piggy back antibiotics on two calendar dates?
Q: Can you explain how to code intravenous piggy back antibiotics on two calendar dates?

Can you explain how to code intravenous piggy back antibiotics on two calendar dates?
Q: Can you explain how to code intravenous piggyback antibiotics that span two calendar dates?

Don't 'grab and run' with diagnoses
If clinical documentation improvement specialists don't perform a thorough record review, they may fail to catch many DRG-changing complications/comorbidities (CC) and major CCs. Glenn Krauss, RHIA, CCS, CCS-P, CPUR, FCS, PCS, and Deborah Mange, RN, BSN, discuss ways to build a more complete clinical picture of the patient encounter in order to ensure correct documentation.

Understand guidelines for coding sleep studies
Chronic sleep disorders are common and widespread conditions from which approximately 40 million Americans suffer. Meera Mohanakrishnan, CPC, discusses the sleep studies physicians perform to diagnose sleep disorders.

Deleted and payable HCPCS codes
CMS recently issued their quarterly update for Level II HCPCS codes, in Transmittal R1492, which are effective immediately. Learn about the four deleted codes, and the eight new ones.

E/M code for burn dressing
Q: In the outpatient emergency room setting, which evaluation and management (E/M) level should I assign for wound care when the provider dresses a burn?

Consider these five tips to avoid common mistakes when assigning the POA indicator
The POA indicator differentiates between preexisting conditions that a patient has before his or her hospital admission and conditions or complications that develop over the course of the hospital stay. DeAnne Bloomquist RHIT, CCS, and Shannon McCall RHIA, CCS, CPC, offer tips to help coders assign the indicator correctly.

Platinum form: POA indicator query form
Use this form to conduct present on admission queries.

CMS to make modifier -GD available soon
Providers may soon be able to use modifier -GD to override medically unlikely edits (MUE), according to a CMS official who addressed the issue during the April 24 CMS Open Door Forum call. Read more about modifier -GD in Healthcare Happenings.

Determine number of patients when reporting codes for asthma education
Q: One of our clinic nurses recently became an asthma educator, and she would like to know how to charge for that service. Can you advise?

Five Q&A's about outpatient care
Read the questions and answers to five questions about outpatient care in this week’s Just Coding Platinum!

Understand Medicare's split/shared visit policy
With the permanent Recovery Audit Contractor (RAC) program right around the corner, facilities should review a few internal progress notes to see whether their coding complies with the split/shared visit policy rule. Elin Baklid-Kunz, MBA, CPC, CCS, discusses increased latitude in hospital and office billing for evaluation and management (E/M) services.

The newest on PEGJ: Understand what a percutaneous endoscopic gastrojejunostomy is, and also what it isn’t
Robert S. Gold, MD, discusses how to correctly code a percutaneous endoscopic gastrojejunostomy.

ASCs: Avoid coding mistakes for GI, orthopedics, and ENT procedures
Cristina Bentin, CCS-P, CPC-H, CMA, and Joanne Schade-Boyce, RDH, MS, CPC, ACS, PCS, offer tips to avoid ambulatory surgery center coding mistakes for gastrointestinal, orthopedic, and as ear/nose/throat procedures.

Stage pressure ulcers: Specify origin and location to reflect severity, and assign proper codes
Because stage 3 or 4 pressure ulcers are major complications/comorbidities (MCC) that add $8,400 to an average base surgical admission, no one can afford to mischaracterize them. Unfortunately, coding staff members cannot code these from the wound care nurse’s assessment; physician documentation and staging is mandatory. James S. Kennedy, MD, CCS, describes how to correctly code pressure ulcers.

Know inpatient and outpatient prolonged care documentation and coding guidelines
Coders rely on two factors in the medical record when coding for prolonged services. These factors, which need to be documented in the medical record, determine the level of billing in the course of a patient encounter. Jessica A. Little CPC-FP, CPC-INTMED, discusses strategies for correctly assigning these evaluation and management codes.

Inpatient blood deductible provision applies to whole blood cells, red blood cells
On May 2, CMS released Transmittal 1495, which updated billing instructions for blood and blood products.

Billing for services included in code 99291
Could you tell me about the specific guidelines for using code 99291?

Know when to append modifier -JW
Providers who participate in the Competitive Acquisition Program—the program that allows CMS to select vendors who fill physician orders for drugs and other pharmaceuticals—can no longer report modifier -JW to receive reimbursement for unused vials, according to Transmittal R1478CP, effective April 14. Susan Garrison, CPC, CPC-H, CCS-P, CPAR, explains the modifier.

Threshold time for prolonged visit codes 99354 and 99355 when billed with office/outpatient and consultation codes
Information contained is taken/adapted from the Medicare Claims Processing Manual Publication # 100-04, Chapter 12 - Physicians/Nonphysician Practitioners. See http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf for more information.

Threshold time for prolonged visit codes 99356 and 99357 billed with inpatient and consultation codes
Information contained is taken/adapted from the Medicare Claims Processing Manual Publication # 100-04, Chapter 12 - Physicians/Nonphysician Practitioners. See http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf for more information.

Diffused or disseminated intravascular coagulation syndrome


Coronary pulmonary fistula


Monoclonal gammopathy of undetermined significance


Build the right structure for your coding department
Joe Rivet, CPC, CCS-P, says that when it comes to organizational coding structures, a common question is, "How do others do it?" Any organizational coding model, be it centralized, decentralized, matrix, or monitored can work or fail, Rivet says. Organizational success depends on each department's leadership and accountability.

2008 CPT changes: Understand cardiovascular system changes
Cindy Basham, MHA, BSN, CCS, CPC, senior regulatory specialist for HCPro, Inc., in Maryville, TN, discusses the 2008 CPT Manual cardiovascular system changes. The American Medical Association (AMA) added nine codes to the cardiovascular system, and revised nine others.

Coding scenario answer


Coding scenario answer


Coding scenario answer


CMS issues billing for clinical research study modifier changes
On January 18, CMS issued Transmittal 1418, which changed the HCPCS modifiers used to differentiate between routine and investigational providers should implement them implemented no later than April 7.

Coding hemiplegia
Hemiplegia is a neurological complication and comorbidity (CC). Does the physician need to specify "hemiplegia" instead of "weakness" to capture this CC?

Diaphoresis
Clinical Coding Term for diaphoresis

Cyanosis
Clinical coding term for cyanosis

Hypercalcemia
Clinical Coding Term for hypercalcemia

ASC alert: Stay on top of 2008 modifier updates
Stephanie Ellis, RN, CPC discusses some guidelines for proper use of modifiers -50, -RT/-LT, -SG, -FB, and -FC. Ellis says that coders who don't use modifiers according to each payer's specifications can cause unnecessary denials or cause Medicare to not pay claims properly.

Study your modifiers
Stephanie Ellis, RN, CPC, of Ellis Medical Consulting, Inc., in Brentwood, TN, suggests studying the definitions of the following modifiers:

CMS issues update of various claims processing instructions
On January 25, CMS issued Transmittal 1421, which announced revisions to various chapters of the Medicare Claims Processing Manual. CMS updated six chapters of the manual to reflect changes in form locators and/or data elements for institutional provider claims processing and instructions.

Coding inpatient services


2008 CPT changes: Understand Category III additions, revisions, and deletions
Cindy Basham, MHA, BSN, CCS, CPC, senior regulatory specialist for HCPro, Inc., in Maryville, TN, discusses the 2008 CPT Manual category III changes. In 2008 the American Medical Association (AMA) added 13 codes, revised 11, and deleted 13 category III codes.

Coding scenario answer


Three ways to tackle inpatient charge captures for E/M services
Joe Rivet, CPC, CCS-P, says that there are three different ways to create an inpatient charge capture for evaluation and management services. No matter what charge capture structure and process a hospital has in place, the goal of any coder is to achieve compliant and optimal charge captures within a reasonable amount of time.

CMS releases CPT codes for smoking, tobacco-use cessation counseling services
On February 1, CMS issued Transmittal 1433 announcing that Medicare will begin requiring providers to use CPT codes 99406 and 99407 to report smoking and tobacco-use cessation counseling services. These codes replace the HCPCS Level II "G" codes previously used to report these services.

Medicare improper payment level at an all-time low: Stress medical necessity and coding compliance for continued success in 2008
Aggressive oversight efforts by CMS has resulted in the continued reduction of the improper Medicare claims payments rate, from 14.2% in 1996 to 4.4% in 2006 and 3.9% in 2007. Glenn Krauss, RHIA, CCS, CCS-P, CPUR, an independent consultant in Maryville, TN. says that the error rate will continue to decrease if coders identify hospital-setting errors, interpret hospital error rates correctly, analyze PEPPER reports, and define medical necessity.

Keep physicians in the loop when coding E/M services
Debra Ingersol, CPC, CCS-P, health information review specialist at Case Mix Analysis, Inc. says that identifying the number of coding elements needed to meet the evaluation and management (E/M) coding criteria for each level can be a difficult concept for physicians to learn.

MVR reporting
An echocardiogram reveals that a patient has mitral valve regurgitation (MVR). A physician administered the test four days postadmission after previous diagnostic testing did not detect the patient's condition. Should we report the MVR as being present on the admission (POA)?

2008 CPT changes: Understand the E/M code changes
Shannon McCall, RHIA, CCS, CPC, director of HIM/coding for HCPro, Inc., in Glen Allen, VA. discusses the 2008 CPT Manual evaluation and management (E/M) changes. The American Medical Association (AMA) added 12 codes, revised nine, and deleted three E/M codes.

Coding scenario answer


Present on Admission form
Leanne Sterling, coding coordinator for Cullman Regional Medical Center in Cullman, AL presents a Present on Admission form that allows coders and physicians to clarify if diagnosis were present on admission.

CMS announces changes for billing noncovered charges for astigmatism-correcting intraocular lenses
On February 1, CMS issued Transmittal 1430 requiring hospitals to use HCPCS code V2787 to report noncovered charges relating to the astigmatism-correcting functionality of astigmatism-correcting intraocular lens (ACIOL). Physicians and coders should now bill code V2787 when reporting the noncovered charges for the approved ACIOL functionality of the inserted intraocular lens when inserting the ACIOL in an ambulatory surgical center, hospital outpatient department, or physician office.

Coding surgery, maternity care, and delivery
If a physician performs a nonstress test in the labor and delivery department, and then later in the day sends the patient to the radiology department to get a biophysical profile ultrasound, should we report code 76818 or 59025-59 with 76819?

To code or not to code: That is the question
Robert S. Gold, MD, says that ICD-9-CM diagnostic and procedural code assignments usually follow certain patterns. Despite this familiarity, assigning diagnostic codes is sometimes muddy at best.

Pharmacists can benefit from medication therapy management coding
Meera Mohanakrishnan, CPC, says that a medication therapy management (MTM) system can help pharmacists reduce the risk of adverse drug events, improve patient health outcomes and cost reduction, and help optimize therapeutic outcomes through quality medication use.

Add these coding resources to your must-have list for 2008
The editors of JustCoding.com listed a few of the books, handbooks, Web sites, and newsletters that they use on a daily basis. Add these resources to your wish list for 2008.

CMS issues January 2008 Integrated Outpatient Code Editor specifications
On December 28, 2007, CMS released the January 2008 Integrated Outpatient Code Editor (IOCE) specifications. Many of the new changes relate to CMS' replacment of separately payable observation services with a new extended assessment and management composite APC. CMS also added a new IOCE edit (edit 78; claim lacks required radiopharmaceutical).

Don't shoot the messenger when it comes to quality documentation and reporting
Dr. Robert S. Gold, MD, says the only way that physicians can tell whether they've achieved their documentation and reporting goals is to provide all necessary information and respond to any queries. If a question isn't a good one, physicians must help coders understand what is important by educating them.

Coding subdural hematomas
Is it appropriate to code subdural hematoma (code 432.1) as a primary diagnosis, with brain compression (code 348.4) as a secondary diagnosis?

2008 CPT codes: Understand urinary, genital, obstetric, and path/lab changes
Shannon E. McCall, RHIA, CCS, CPC, director of coding and HIM for HCPro, in Glen Allen, VA, and Cindy Basham, MHA, BSN, CCS, CPC, regulatory specialist with HCPro, in Maryville, TN, discuss the 2008 CPT Manual urinary, genital, obstetric (UGO), and pathology and laboratory (path/lab) section changes. The American Medical Association (AMA) added 15 codes to the UGO section, and 11 codes to the path/lab section.

Counseling and/or coordination of care
When more than half of the face-to-face (office or other outpatient) or floor/unit time (hospital or nursing facility) is spent with the patient and/or family providing counseling or coordination of care, a CPT code is selected based on the total time of the face-to-face or floor/unit time of the encounter.

Unmask five myths about physician inpatient E/M coding
Joe Rivet, CPC, CCS-P, says that inpatient evaluation and management (E/M) services often take a back seat to outpatient E/M services when organizations conduct in-house audits. The lack of attention paid to these services could put organizations at risk for over-or undercoding, using inappropriate E/M codes, and billing inappropriately for services rendered.

Unmask five myths of inpatient E/M coding references


2008 Complete practice CPC exam


2008 Complete practice CPC exam
We've updated our practice exam with all new questions and answers for 2008. Test your knowledge with these 150 CPC exam questions in preparation for the big test day or to simply brush up on your coding skills.

Sample test questions for 2008 CPC exam
Studying for the CPC exam? Test your knowledge with 20 new practice exam questions for 2008, free for all JustCoding visitors. Sign up for the platinum membership and receive all 150 questions!

CMS issues updated National Uniform Billing Committee codes and Internet-Only Manual chapter 25 revisions
On December 14, 2007, CMS issued Transmittal 1395 announcing National Uniform Billing Committee code updates, and Internet-Only Manual, Chapter 25 revisions. These changes went into effect on January 1, 2008.

Coding seizures
Does a physician have to specify a seizure as petit mal or grand mal in a report, or can the term "seizure" stand alone to count as a major complication and comorbidity (MCC)?

Recovery audit contractor update: Review Statement of Work, and start preparations now to maintain compliance
The recovery audit contractor (RAC) demonstration program will end on March 28, but it does not mean the program is going away for good. In fact, the opposite is true. Section 302 of the Tax Relief and Health Care Act of 2006 instructs CMS to expand the program and use RACs to identify Medicare underpayments and overpayments across the country by 2010. Hospitals should begin preparations for the RAC expansion now.

Dictation application macro templates: Strategies for compliance and ease of use
Jessica A. Little, CPC-FP, says that dictation application macro-reporting template systems can help coders, coding educators, or compliance officers achieve compliant electronic medical records.

2008 CPT changes: Understand musculoskeletal system changes: Code additions, revisions, and deletions are not as daunting as they first appear
Shannon E. McCall, RHIA, CCS, CPC, director of coding and HIM for HCPro, in Glen Allen, VA, discusses the 2008 CPT Manual musculoskeletal system changes. The American Medical Association (AMA) added 25 codes to the musculoskeletal system, and revised 96.

Musculoskeletal system coding scenario


ASCRI's quarterly benchmarking report
In this new Ambulatory Surgery Coding & Reimbursement Insider (ASCRI) quarterly benchmarking report, we take a look at ASC coder compensation. This report is based on the results of a survey in which we asked coders to provide information about their salaries and discuss the importance of coder compensation in ASCs. To view the report click

Acute kidney disease: The crossroads of ICD-9-CM and medical literature
James S. Kennedy, MD, CCS, says that defining acute kidney disease, specifically acute renal failure (ARF), is a confounding issue for physicians, coders, and quality specialists under Medicare Severity DRGs (MS-DRG).

Wernicke-Korsakoff syndrome


Tetralogy of Fallot


Osgood-Shlatter's disease


Coding POA requirements


Familiarize yourself with the new CPT code chages
In part one of our month-long series, Shannon E. McCall, RHIA, CCS, CPC, and Cindy Basham, MHA, BSN, CCS, CPC, analyze changes made to anesthesia services, Integumentary system, Respiratory system, and Eye and auditory section of the 2008 CPT Manual. The American Medical Association released the manual on November 30, 2007.

CMS selects sites for demonstration of revised post acute care payment, and examination of post acute services for beneficiaries
On December 19, CMS announced the next phase in a demonstration program evaluating the care that Medicare beneficiaries receive after being discharged from a hospital, and how CMS pays for that care.

Meet the challenges of MS-DRGs and the POA head on
October 1, 2007, marked the beginning of the largest change in Medicare's DRG reimbursement system since its introduction in 1983. Add Medicare's present on admission (POA) reporting initiative, which took effect on January 1, 2008, and hospitals suddenly face substantial new challenges. However, Betty B. Bibbins, MD, CHC, CPEHR, CPHIT says that these initiatives are also an opportunity to bring organizational departments together toward common goals and objectives.

Regular Mission Statement
Regular Mission Statement

Quizlet Archive Information


Current Quizlet Information


Sample Policies and Forms Intro


Sample Policies and Forms Disclaimer


CE Credit Page Information


Platinum Mission Statement


Coding and Billing Intro


Coder Training Intro

Other recently-published articles from JustCoding.com:

Billing for services included in code 99291

Know when to append modifier -JW

Threshold time for prolonged visit codes 99354 and 99355 when billed with office/outpatient and consultation codes

Threshold time for prolonged visit codes 99356 and 99357 billed with inpatient and consultation codes

Diffused or disseminated intravascular coagulation syndrome

Coronary pulmonary fistula

Monoclonal gammopathy of undetermined significance

Stage pressure ulcers: Specify origin and location to reflect severity, and assign proper codes

Know inpatient and outpatient prolonged care documentation and coding guidelines

Inpatient blood deductible provision applies to whole blood cells, red blood cells

CMS to make modifier -GD available soon

Determine number of patients when reporting codes for asthma education

Five Q&A’s about outpatient care

Understand Medicare’s split/shared visit policy

The newest on PEGJ: Understand what a percutaneous endoscopic gastrojejunostomy is, and also what it isn’t

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