Coding Strategy

Double check POS 11 shouldn’t be 22 — or 24.

Entering your place-of-service (POS) number on your claim form may seem routine, but a recent OIG audit found that practices are not giving POS numbers the care they deserve.

Based on a review of 100 non-facility Part B claims from 2007, the OIG found that only 10 of the sampled claims had the correct POS code assigned to it, resulting in overpayments of over $4,700. Based on the sample, the OIG estimated that Medicare nationally overpaid physicians $13.8 million in POS coding errors, according to the report.

Physicians collect higher payments for services rendered in the physician’s office, a patient’s home, an ASC, a nursing facility, or another non-hospital facility versus those services performed in a facility setting (such as a hospital). The OIG review of 100 sample claims found that 90 of the services were coded as having been performed in a non-facility location, even though “60 were actually performed in hospital outpatient departments and 30 were ASC-approved procedures performed in ASCs,” the report notes.

As a result of the audit findings, CMS indicated that it would institute safeguards to ensure that POS errors are better identified. Therefore, practices should remember to focus just as clearly on POS coding as they do on procedure and diagnosis coding to avoid scrutiny and accusations of miscoding.

Written by Torrey Kim, MA, CPC, editor for Part B Insider: Keeps you up to date, compliant.

488.1x Cheat sheet makes fast work of snagging correct code.

Don’t let rumors of few ICD-9 changes in prep for ICD-10 blindside you to top diagnosis changes for 2011. Without the scoop on expansion to the 488, 784, and 787 categories, denials for invalid codes will derail your claims delaying your payments.

In ICD-9 2011, “Codes continue to become more and more specific necessitating a provider to document clearly and thoroughly to allow for selection of the most specific and accurate code,” says Jennifer Swindle, RHIT, CCS-P, CEMC, CFPC, CCP-P, PCS, Director Coding & Compliance Division, PivotHealth, LLC.

Good news: Updating your ICD-9 coding by the Oct. 1, 2010, effective date doesn’t have to be a chore. Start using your new choices in no time flat following these guidelines.

Look at Manifestation When Assigning “Swine Flu” Dx

This fall, when a patient has H1N1 (“swine flu”) pay attention to two details. The medical record will have to identify the correct influenza and you will have to capture the appropriate manifestation to select the codes to the degree of specificity now required, Swindle points out.

With the change “category 488 (Influenza due to certain identified influenza viruses) would mirror the structure of category 487 (Influenza),” according to the Summary of March 2010 ICD-9-CM Coordination and Maintenance Committee Meeting. The current 488.x sub-category didn’t provide the level of detail that category 487 (Influenza) does.

Change: There will be “tremendous expansion of the H1N1 category,” Swindle explains. ICD-9 2011 deletes 488.0 and 488.1 and adds six new five-digit codes. New codes 488.0x (Influenza due to identified avian influenza virus) and 488.1x (Influenza due to identified novel H1N1 influenza virus) allow you “to uniquely capture pneumonia, other respiratory manifestations, and other manifestations occurring with these types of influenza,” states the summary.

Starting Oct. 1, you’ll assign the correct 488.xx code based on the type of comorbid manifestation the avian or H1N1 influenza involves:
Comorbid Manifestation                        Avian         H1N1
Pneumonia                                                  488.01      488.11
Other respiratory manifestations      488.02      488.12
Other manifestations                               488.09      488.19

Don’t forget: As with 487.0, when you code 488.01 or 488.11, you’ll use an additional code to identify the type of pneumonia (480.0-480.9, 481, 482.0-482.9, 483.0-483.8, 485).

Focus on These Fecal Incontinence Symptoms

You’ll get to be a whole lot more specific when reporting fecal incontinence this fall. The single code 787.6 will give way to four new options that describe fecal incontinence problematic symptoms, such as fecal smearing, fecal urgency, and incomplete defecation.

When Oct. 1 rolls around, you’ll no longer be able to report 787.6 (Incontinence of feces). ICD-9 will delete it. Instead, you’ll use one of the following new codes:

• 787.60 — Full incontinence of feces
• 787.61 — Incomplete defecation
• 787.62 — Fecal smearing
• 787.63 — Fecal urgency.

Don’t miss: Incomplete defecation (787.61) is distinct from constipation and fecal impaction. Rectum and anal sphincter problems (including rectoceles) can cause these problems, but currently, you don’t have a way to specify these symptoms.  The 2011 ICD-9 includes a new code, 560.32, for fecal impaction.  Previously, this condition was included in 560.39, “Impaction of intestine; Other.”   

 “The new fecal incontinence code (787.60) is a change that we will have to remember,” says Lisa Selman-Holman, JD, BSN, RN, HCSD, COSC, consultant and principal of Selman- Holman & Associates and CoDR — Coding Done Right in Denton, Texas. The new code for fecal impaction excludes constipation, she says, which can still be reported using a code from the 564.0X series, “Constipation.”

Welcome More Specific Pain Dx in 2011

When the physician diagnoses jaw pain after Oct. 1, coders can choose 784.92 (Jaw pain) for the encounter. Previously, consideration included 526.9 (Unspecified diseases of the jaws), “which does not clearly illustrate the complaint,” relays Sarah Todt, RN,CPC, CEDC, director of education and compliance for Medical Reimbursement Systems, Inc., in Woburn, Mass.

Benefit: The more specific jaw pain code could help “support some complaints that may be related to dental problems,” says Todt.

For more coding changes, check out Family Practice Coding Alert, written by Jen Godreau, BA, CPC, CPEDC.

Code 276.6 denials will plague you unless you’ve got the code’s expansion details.

Come October 1, you must be ready to report the new and changed 2011 ICD-9 codes. Now that CMS has finalized the update, you can get a jump start on the changes.

Add Detail to Fluid Overload

Starting in October, you’ll need to code with a higher degree of specificity when it comes to reporting fluid overload.

2010’s 276.6 (Fluid overload) category will expand to include the following:

• 276.61 — Transfusion associated circulatory overload
• 276.69 — Other fluid overload.

Transfusion-associated circulatory overload (TACO), a heart-related condition, “is a circulatory overload following transfusion of blood or blood components,” said Mikhail Menis, PharmD, MS, of the FDA CBER, who presented the proposal for this change at the September 2009 ICD-9-CM Coordination and Maintenance Committee meeting.

The patient may experience “acute respiratory distress, increased blood pressure, pulmonary edema secondary to congestive heart failure, positive fluid balance, etc., during or within 6 hours of transfusion.”

The new code 276.69 includes fluid retention. Another related addition at 782.3 (Edema) excludes fluid retention.

Define Post-Traumatic Seizures

Post-traumatic seizures are acute, symptomatic seizures following a head injury. In a Centers for Disease Control & Prevention release, the ICD-9-CM Coordination and Maintenance Committee explains that “a unique code for this type of seizure is important because these patients need to be followed for treatment as well as prognostic and epidemiologic considerations.”

Result: The creation of 780.33 (Post traumatic seizures) will further specify this type of seizure. Currently, you must look to the 780.3x (Convulsions) subcategory in order to report a patient’s symptoms.

As with other kinds of seizures, post-traumatic seizures may not occur until weeks or months after the injury, when the seizure may be considered a late effect of the head injury. But before you code for a seizure as a late effect, you’ll need documentation that shows the causal relationship between the current condition/symptom/sign and the underlying etiology.

Bottom line: Rely on documentation to determine whether to also code one of the late effects ICD-9 codes, such as 907.0 (Late effect of intracranial injury without mention of skull fracture), as a secondary diagnosis.

By: Torrey Kim, MA, CPC. Stay up to date with Part B Insider.

Check out V13.65 for corrected congenital heart malformations.

Each October you’re faced with new ICD-9 codes to add to your diagnosis arsenal. 2011 is no exception, with new ectasia, congenital malformation, and body mass index (BMI) codes you’ll need to learn. Take a look at the proposed changes that will affect your cardiology practice, so that you’re ready when fall rolls around.

End Your Ectasia Hunt at 447.7x

The proposed changes to ICD-9 2011 add four codes specific to aortic ectasia, which could be among the most significant changes for cardiology coders.

“Ectasia” means dilation or enlargement, and aortic ectasia often refers to an enlargement that is milder than an aneurysm. But ICD-9 2010 does not distinguish ectasia from aneurysm, linking aortic ectasia to 441.9 (Aortic aneurysm of unspecified site without mention of rupture) and 441.5 (Aortic aneurysm of unspecified site, ruptured).

The proposed 2011 codes are specific to aortic ectasia and are based on anatomic site:

• 447.70 — Aortic ectasia, unspecified site
• 447.71 — Thoracic aortic ectasia
• 447.72 — Abdominal aortic ectasia
• 447.73 — Thoracoabdominal aortic ectasia.

New Corrected Congenital Malformations Code

A number of new codes deal with congenital malformations of the heart and circulatory system. Code V13.65 (Personal history of [corrected] congenital malformations of heart and circulatory system) will be “very useful to our practice,” says Janel C. Peterson, CPC, with Alegent Health Clinic Heart and Vascular Specialists in Omaha, Neb.

Add BMI V Codes to Your E/M Arsenal

The ICD-9 proposal has “expanded the body mass index (BMI) codes to demonstrate higher BMIs with five new codes,” notes Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, with CRN Healthcare Solutions in Tinton Falls, N.J.

You’ll need to stop using V85.4 (Body Mass Index 40 and over, adult) on Oct. 1 and start using one of the following new V codes in its place:

• V85.41 — Body Mass Index 40.0-44.9, adult
• V85.42 — Body Mass Index 45.0-49.9, adult
• V85.43 — Body Mass Index 50.0-59.9, adult
• V85.44 — Body Mass Index 60.0-69.9, adult
• V85.45 — Body Mass Index 70 and over, adult.

The benefit: “BMI has become an important health tool, and those codes [V85.41-V85.45] will also provide more data,” says Susan Vogelberger, CPC, CPC-H, CPCI, CMBS, CCP-P, CEO of Healthcare Consulting & Coding Education, LLC.

“There are seven vital signs that count for the constitutional bullet in the E/M physical exam coding, and there are those who are of the opinion that BMI should be an eighth option,” Vogelberger says. If that eighth bullet gains traction and comes into play for coders, the new V codes could help considerably.

Be ready for the ICD-9 2011 revisions you can’t live without. Join veteran Coding Institute editors for a speed run through of the top changes impacting more than 13 specialties. This quick prep FREE Webinar will highlight rehaul spots and training areas your practice needs for continued payments.

By: Deborah Dorton, JD, MA, CPC, editor of Cardiology Coding Alert, Volume 13, Number 6.

Say goodbye to form 4010A1 for ICD codes as well, starting in 2012.

Dig into your claim forms now to ensure that the beneficiary’s information is accurate to the letter, or you’ll face scores of denied claims on the new HIPAA 5010 forms.

Why it matters: CMS will deny claims on which the beneficiary’s name doesn’t perfectly match how it’s listed on his Medicare I.D. card when you begin using HIPAA 5010 form — the new Medicare universal claim form starting in 2012.

Include Jr. or Sr. Suffixes

“Whenever there is a name suffix, such as ‘Jr.’ or ‘Sr.’ abbreviations, etc., it must be included with the last name,” said Veronica Harshman of CMS’s Division of Medicare Billing Procedures during an April 28 Open Door Forum regarding the eligibility component of the HIPAA 5010 form.

You can include the suffix either with the patient’s last name or in the suffix field, specified CMS’s Chris Stahlecker during the call.

“The date of birth must also match exactly to what the Social Security Administration has on file,” Harshman said. CMS will use several new error codes on claims once the 5010 form goes into effect. “If you communicate with CMS through a third-party vendor (clearinghouse), it is strongly recommended that you discuss with them how these errors will be communicated to you and how these changes will impact you and your business,” Harshman advised.

Look for Production Systems Next Year

According to the HIPAA 5010 Final Rule, CMS will have a production 5010 system available as of Jan. 1, 2011, Harshman said.

The last day CMS will accept a 4010A1 form will be Dec. 31, 2011. As of Jan. 1, 2012, if you aren’t using the 5010 form, you’ll “lose the ability to receive eligibility data from Medicare,” Harshman said. In other words, she noted, mandatory compliance of the 5010 form will begin on Jan. 1, 2012.

Contact your software vendors soon to determine when you can expect your software to be upgraded so it’s 5010 ready, Harshman said.

Plus: “Don’t forget many of your business processes which may also need to be changed,” she noted. For instance, you may want to evaluate how the new form will impact patient registration, billing, appointment scheduling, claims reconciliation, etc., Harshman noted.

Resource: CMS developed several educational products that can help with your 5010 transition, including a side-by-side comparison of the current 4010 form versus the new 5010 form.

Watch For Diagnosis Input Changes, Too

You’ll also have to get used to using 5010 as a prerequisite to submitting ICD-10 codes, CMS says in MLN Matters article SE0904.

Roadblock: You won’t be able to submit ICD-10 codes without this new form, so start preparing. CMS advises practices that they “must be ready to submit claims electronically using the X12 version 5010” effective Jan. 1, 2012.

CMS published the final rule for implementing the 5010 transaction standard on Jan. 15, and the MLN Matters article lays out some of the crucial details you need to know to prepare.

While form 5010 will allow you to report your ICD-10 codes when they take effect on Oct. 1, 2013, you’ll also see other diagnosis reporting benefits as well.

Example: The new form “distinguishes between principal diagnosis, admitting diagnosis, external cause of injury, and patient reason for visit codes,” the MLN Matters article notes.

CMS hopes to use this data to monitor mortality rates for some illnesses, outcomes for specific treatment options, and hospital stay durations for some conditions. The new form also offers an indicator on institutional claims for “present on admission” conditions.

Watch for diagnosis input changes by subscribing to Medical Office Billing & Collections Alert.

Written by Leesa A. Israel, BA, CPC, CUC, CMBS, executive editor, Medical Office Billing & Collections Alert, 2010; Volume 10, Number 5.