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Coding Tips
CODING UPDATES
FLUOROSCOPY GUIDANCE - HOW MANY UNITS CAN I BILL?
NEW RENAL DISEASE CODES EFFECTIVE OCTOBER 1
CODING CHANGES FOR 2005-ANESTHESIA AND PAIN MEDICINE
2005 HCPCS CODES AVAILABLE
CCI SI JOINT INJECTION EDIT & 10.2 VERSION
FLUORO EDIT REVERSAL
2004 INCIDENT-TO SERVICES SUBMITTED ON CMS-1500 CLAIM FORM
CCI EDITS VERSION 10.0
2004 CHANGES TO HCPCS-DRUG CODES
NATIONAL CORRECT CODING INITIATIVES POSTED
ICD-9-CM UPDATES POSTED
WRITING SUMMARY LETTERS
TEE REVERSAL
NEW K CODES
PAYER INFORMATION
TEE CODES BUNDLED
CLAIMS STATUS CODES UPDATE REQUEST
TEMPORARY "K" CODES
CORRECT CODING EDITS
SACRAL NERVE STIMULATION
AMBULATORY SURGICAL CENTER CODES
ADD-ON CODES FOR ANESTHESIA
FLUOROSCOPY GUIDANCE - HOW MANY UNITS CAN I BILL?
HGS Administrators has conducted medical review of claims submitted for services rendered regarding the use of fluoroscopy guidance, procedure code 76005, to verify appropriate billing practice.
The use of fluoroscopy guidance is utilized for localization of a needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint), including neurolytic agent destruction. During these reviews it was identified that some of the medical records reviewed did not support the correct number of units that were billed for procedure code 76005.
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NEW RENAL DISEASE CODES EFFECTIVE OCTOBER 1
(posted 7/05)
The code for chronic renal failure (585) will be replaced with seven new codes that describe the stage of the kidney disease (585.1?585.9) on October 1. To review these and other revisions to the ICD-9-CM diagnosis codes, visit the NCHS Web Site.
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CODING CHANGES FOR 2005-ANESTHESIA AND PAIN MEDICINE
(posted 12/04)
Current Procedural Terminology (CPT®) 2005 contains one new anesthesia code. Two of the pain codes reported by anesthesiologists have been revised. The 2005 ASA Relative Value Guide (RVG) reflects these changes.
New Code – 00561 – Anesthesia for procedures on heart, pericardial sac and great vessels of chest, with pump oxygenator, under one year of age.
ASA Base unit value – 25 + time
It is not appropriate to report code 99100, 99116, 99135 with this new code as these qualifying, circumstances are accounted for in the base unit value.
Revised Code – 63685 – Insertion or replacement of spinal neurostrimulator pulse generator or receiver, direct or inductive coupling
ASA Base unit value – 23
According to CPT do not report this code with 63688 for the same pulse generator or receiver
Revised Code – 95971 – Electronic analysis of implanted neurostimulator pulse generator system (e.g. rate, pulse amplitude and duration configuration of wave form, battery status, electrode selectability, out modulation, cycling, impedance and patient compliance measurements); simple spinal cord, or peripheral (i.e. nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator transmitter, with Intraoperative or subsequent programming.
ASA Base unit value – 3
Check the new codes for deep brain stimulators.
In Appendix G of the CPT 2005 is a summary of CPT codes which include conscious sedation. There are CPT codes for which conscious sedation is considered an inherent part of the procedure (e.g., endoscopy) and these are identified by a symbol ( ) in the body of the book.
From the ASA web site “Anesthesiologists and payers should note that CPT distinguishes between conscious sedation performed by the physician doing the invasive procedure (e.g., the gastroenterologist) and anesthesia provided by a second clinician. The introductory text to the appendix states, “The inclusion of a procedure on this list does not prevent separate reporting of an associated anesthesia procedures/service (CPT codes 00100-01999) when performed by a physician other than the operating physician or a qualified professional under the responsible supervision of a physician other than the operating physician.” When an anesthesiologist or “qualified anesthesia provider” performs an anesthesia service for an endoscopy or other procedure listed in the appendix, the anesthesia service is payable as long as it is medically necessary. The addition of Appendix G to CPT has not changed that fact.
The ASA RVG and the ASA CROSSWALK™ and Reverse CROSSWALK™ have been revised and updated for 2005. The CROSSWALK Editorial Panel, a subgroup of ASA Committee on Economics members, assigned anesthesia codes to the new 2005 CPT codes, analyzed the revisions made to existing CPT codes to determine whether they had any effect on the CROSSWALK and conducted an in-depth review of the radiology and colectomy sections. The 2005 RVG includes several new coding comments or notes to clarify the use of specific codes.
ASA published the print and electronic versions of the RVG, CROSSWALK and Reverse CROSSWALK (CD only) in early November 2004 in order to give practices sufficient time to update their systems. Anesthesiology practices should be prepared to implement the new codes on January 1, 2005.”
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2005 HCPCS CODES AVAILABLE
(posted 11/15/04)
The 2005 Healthcare Common Procedure Coding System (HCPCS) codes were released November 8. The Level II alpha-numeric codes, alphabetic index, and table of drugs are available at the CMS Web Site. These codes, which are established by CMS's Alpha-Numeric Editorial Panel, primarily represent items and supplies and non-physician services not covered by the American Medical Association's CPT-4 codes. The files do not contain the American Medical Association's CPT-4 codes.
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CCI SI JOINT INJECTION EDIT & 10.2 VERSION
(posted 5/04)
Version 10.1 bundles all fluoroscopic guidance codes into the SI Joint Injection (27096). This is a bundling change due to the AMA CPT-4 description requiring radiology guidance. Hopefully this will not become a trend. Take a look at the latest - Version 10.2 of the CCI Edits which will become effective July 1, 2004
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FLUORO EDIT REVERSAL
(posted 7/04)
Effective 8/15/04, Aetna will start paying 76005 with injections. Please go to www.asipp.org for a copy of the letter from Aetna stating their decision to reverse their fluoro edits.
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2004 INCIDENT-TO SERVICES SUBMITTED ON CMS-1500 CLAIM FORM
(posted 5/04)
CMS instructions to clarify and standardize the method of indicating the ordering and supervising professionals on CMS-1500 claim form. Physician and Non-Physician Practitioners should pay particular attention to Item 17; Item 24K and Item 31 when a service is provided incident to a Medicare covered service and/or item. For additional details, see Medlearn Matters at CMS.
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CCI EDITS VERSION 10.0
(posted 1/04)
This past January 1 - 7,904 changes went into effect that CMS inserted into National Correct Coding Initiative version 10.0, which includes 7,263 new comprehensive component code edits and 244 mutually exclusive edits. The majority of code pair additions are in Anesthesia, 00000-09999 as well as the 30000-39999 (respiratory, cardiovascular, hemic and lymphatic systems and the HCPCS range. CPT code edits include new anesthesia code 00529 which bundles many codes for E&M services and EEG services and is itself bundled into about 2 dozen endoscopy codes that cannot be overridden with a modifier. Check out the newest CCI Edit version at the Center for Medicare and Medicaid at its web site.
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2004 CHANGES TO HCPCS-DRUG CODES
(posted 1/04)
Lidocaine J2000 has been deleted in 2004. The only J code for lidocaine is for an intravenous infusion J2001. MED-MCM 2049 Code A4645 Omnipacque 300 iodine has also been deleted. The only codes for radiopharmaceutical imagining agents are in the C codes, which can only be used for outpatient pass through payments. Please make sure to change your superbills/charge tickets.
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NATIONAL CORRECT CODING INITIATIVES POSTED ONLINE
(posted 9/03)
Effective September 2, 2003, the Center for Medicare and Medicaid began posting it National Correct Coding Initiatives (NCCI) edits on its web site. These edits are used to identify claims that reflect combinations of codes not normally attributable to the same patient on the same day, or that likely represents redundant services. The edits also adjust payments to reflect what is viewed as appropriate amounts by Medicare. Click here to locate the edits.
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ICD-9-CM UPDATES POSTED
(posted 9/03)
Discover the ICD-9-CM updates just released from the coordination and Maintenance Committee.
Posted are the actual diagnostic and surgical codes used for Version 21, along with a summary of the updates to ICD-9-CM. A conversion table is also available to show the date the new codes became effective and their previously assigned code equivalent. Below is the link to the CMS website on ICD-9, from the coordination and maintenance committee.
Click here for all of the information.
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WRITING SUMMARY LETTERS TO AVERT APPEALS
(posted 7/03)
Trying to convince Medicare and third-party payers that a procedure deserves extra payment with modifier 22 (unusual procedure services) means you need to write a procedure summary that is separate from the operative report. Normally it is in a cover letter, attached to the claim form and note, explaining clearly why the procedure was unusual. You need to do this up front, otherwise you will find appealing modifier 22 denials tough going.
Here are some pointers that may assist in writing your summaries:
- Two to three simple short statements that direct payers to the part of the procedure that is unusual. Documentation.
- Key phrases and terms – “new technique”, “procedure was complicated due to….”
- Submit CPT Code description for the procedure in your summary and explain why it is unusual.
- Show that the problem is worth what you are asking for.
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TEE REVERSAL
(posted 6/03)
You will once again be able to bill for intraoperative transesophageal echocardiography (TEE) codes effective July 1, provided the service is diagnostic and not monitoring. There are strict new documentation requirements for this procedure.
You will now be able to bill for codes 93312, 93313, 03315 and 93316 intraoperatively with anesthesia with a modifier, since the National Correct Coding Initiative officials reversed themselves.
The changes will be retroactive to April 1, this is the date CCI changed the modifier indicator that bars anesthesia providers from billing them separately.
If you have been stacking up denials, you can resubmit them on or after July 1 when the new version takes effect.
Providers will also be allowed to bill for the probe placement when a diagnostic TEE is performed during anesthesia. CMS has realized that when a provider inserts a TEE probe they don’t know whether it is solely for monitoring or also for diagnostic. If the probe is used only for monitoring, its placement is not reported separately. However, if a patient requires a diagnostic TEE by an anesthesiologist, both the placement and the probe along with the interpretation may be reported.
This decision will cause TEE providers to determine after performing the procedure if it was for diagnosis information or purely just for monitoring.
Being paid for TEE has never been easy, according to a study of Medicare code utilization in 2001, the most popular codes were 93312 and 93313, and these codes had denial rates of 63% and 75%. There are about 100,000 TEE claims a year filed by anesthesiologist, which is a small number compared with invasive line claims. In recent years, the physicians have had to battle individual Medicare carriers to retain coverage of the probe procedure.
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NEW K CODES
(posted 6/03)
New K codes for billing will be established on July 1, 2003, these include:
- Surgical dressing
- Thoracic lumbar sacral othosis
- Dialysis supplies
- speech generating devices
- automatic defibrillators and supplies This will be added to the (DMERC) Durable Medical Equipment Regional Carrier system.
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PAYER INFORMATION
(posted 5/03)
When determining the amount that Medicare should pay a secondary payer, it is critical that the Medicare Claim correctly capture the following information:
- the actual charge
- the obligated to accept payment in full amount
- the amount a primary payer allowed
- the amount a primary payer paid
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TEE CODES BUNDLED
(posted 4/03)
A major Medicare policy shift stipulates that, beginning April 1, 2003, anesthesia providers will no longer be paid separately for intraoperative transesophageal echocardiography (TEE). The new CCI Version 9.1 edit bundels 93312 (probe placement+ image acquisition and interpretation and report) into the 0XXXX code so that anesthesologists can't bill separately for the TEE.
The TEE codes involved are:
- 93312 (echocardiography, transesophageal)
- 93313 (placement of trahsesophageal probe only)
- 93315 (transesophageal echocardiography, congenital cardiac anomalies)
- 93316 (placement of transesophageal probe only)
The change could affect cardiology-related pain specialists the most. ASA officials are working to convince CMS to keep the TEE codes unbundled from anesthesia service codes or other CPT codes.
"This fragmentation of the procedure is not the result we expected following our last set of discussions with the CMS regarding TEE and the CCI," said Karin Bierstein, JD, MPH, Assistant Director of the Office of Governmental Affairs for the ASA. "We are talking to CMS about the need for a fast correction. Wish us luck."
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CLAIMS STATUS CODES UPDATE REQUEST
(posted 4/03)
CMS is asking carriers and intermediaries to update their claims system with the most current health care claims status category codes and health care claim status codes for use with the Health Care Claim Status Request and Response ASC X12N 276/277. These codes can be found at www.wpc-edi.com and shows whether certain codes have been added, changed, or deleted.
CMS is requiring a July 1, 2003 deadline for these groups to meet all applicable code changes and new codes.
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TEMPORARY "K" CODES
(posted 4/03)
Effective April 1, 2003, a new "K" code will be established for billing supplies for external infusion pumps. Code K0455 verbiage will change to include the medication treprostinil. Code A4232 will become invalid for claim submission to the durable medical equipment regional carriers (DMERC's).
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CORRECT CODING EDITS
(posted 4/03)
The CMS data center will have the latest test package of CCI edits, Version 9.2 available on or about May 1, 2003 and the final file available on or about May 16th. Version 9.2 will include all previous versions and updates from January 1, 1996 through the present.
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SACRAL NERVE STIMULATION
(posted 4/03)
The discard date for the Program Memoranda on "Coverage and Billing of Sacral Nerve Stimulation" has been extended through January 1, 2004. The 22x and 23x bill types have been liminated. All other information remains the same.
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AMBULATORY SURGICAL CENTER CODES
(posted 4/03)
ASC Healthcare Common Procedure Coding System (HCPCS) code changes have been released with instructions and applicable payment groups. The changes will be effective April 1, 2003.
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ADD-ON CODES FOR ANESTHESIA
(posted 4/03)
New add-on codes have been released involving burn excisions or debridement and obstetrical anesthesia. Carriers have also been instructed on how to price anesthesia add-on codes. The add-on code is billed as an addition to the primary anesthesia code. Add-on codes for anesthesia are priced dfferently than multiple anesthesia codes. Carriers should generally allow only the base unti of the add-on code with the exception for obstetrical anesthesia.
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