Coding Strategy

Don’t let 2006 DXA code references lead you to use wrong codes.

Which codes should you use to reap the benefit of CMS’s new calculations for bone scan payment? During an April 13 CMS Open Door Forum, that’s what one caller wanted to know.

Good news: He was delighted that, thanks to the new healthcare reform legislation, CMS will be raising payment for  bone density tests, but noted that the legislation listed old bone density test codes 76075 and 76077. The caller asked whether MACs will be requesting those old codes going forward, or whether practices should continue reporting current codes 77080-77082 (Dual-energy X-ray absorptiometry [DXA] …).

Advice: You should use current codes 77080-77082, not the old codes, said CMS’s Amy Bassano.

Added support: CMS transmittal 700, effective Jan. 1 and implemented June 1, announces increased payment for DXA scan imaging, making the new non-facility total relative value units (RVUs) 2.70. The original 2010 fee schedule listed the transitioned non-facility total RVUs for this code as 1.71.

When combined with the conversion factor of $36.0791, that makes DXA pay about $97.00, a $36.00 increase over the previous payment of approximately $61.00. The calculation for the new rates depended on 2006 values, which is why the now-deleted codes are referenced. The transmittal notes that 77080 and 77082 replaced the 2006 codes.

@ Optometry Coding Alert (Editor: Jerry Salley, CPC).

Sign up for the upcoming live audio conference, Risk Management Strategies for Healthcare Providers, or order the CD/transcripts.

Be a hero. Sign up for Supercoder.com, and join the coding community at the Supercoder.com Facebook Fan Page.

The reason your patient is visiting is key.

Question: We have a patient who came in for a routine eye exam, but reported retinal damage from a BB-gun incident six years ago. What would be the best way to code this? This is a new patient, and I do not have any old records.

Answer: Unless the BB-gun injury six years ago has something to do with why the patient is there, it may not have any bearing on your coding. The diagnosis code always depends on the reason for the visit. If the patient decided to see an optometrist because of eye pain, eye pain (379.91, Pain in or around eye) — or whatever the optometrist found that was causing the pain — would be the diagnosis. If the eye pain is indeed the late effect of the BB-gun injury, you could report 906.0 (Late effect of open wound of head, neck and trunk) as a secondary diagnosis.

“When reporting late effects of an acute injury,” instruct the ICD-9 guidelines, “code the residual problem/condition as the primary diagnosis and record the appropriate late effects code as a secondary diagnosis.” In the above example, 379.91 would be the primary diagnosis, and 906.0 would be the secondary diagnosis.

However: If this was truly a routine exam, and the patient denies any current complaints, you would have to use V72.0 (Examination of eyes and vision) as the diagnosis. Unless the patient has vision insurance that covers routine exams, most carriers won’t reimburse you for this visit.

@ Ophthalmology Coding Alert (Editor: Jerry Salley, CPC).

Sign up for the upcoming live audio conference, Risk Management Strategies for Healthcare Providers, or order the CD/transcripts.

Be a hero. Sign up for Supercoder.com, and join the coding community at the Supercoder.com Facebook Fan Page.

Treatment plans are a must, experts say.

You’ve treated your chiropractic patient, you’ve selected the correct codes, and you’ve submitted your claim. All set, right? Not quite. Check out this common mistake that chiropractors make.

“Many chiropractors do not create written chiropractic treatment plans for every new patient,” says Marty Kotlar, DC, CHCC, CBCS, president of Target Coding, a chiropractic coding and billing consulting firm. Use this checklist to ensure you send Medicare the information CMS most wants to see included “with every new patient plan of care,” Kotlar says:

__ The history
__ Present illness
__ Family history
__ The past health history
__ The physical examination
__ The diagnosis
__ The plan — This should include:

• Therapeutic modalities to effect cure or relief (patient education and exercise training)
• The level of care that is recommended (the duration and frequency of visits)
• Specific goals that are to be achieved with treatment
• The objective measures that will be used to evaluate the effectiveness of treatment
• Date of initial treatment.

__ Signature/initials to authenticate the records.

@ Part B Insider (Editor: Torrey Kim, CPC).

Sign up for the upcoming live audio conference, Risk Management Strategies for Healthcare Providers, or order the CD/transcripts.

Be a hero. Sign up for Supercoder.com, and join the coding community at the Supercoder.com Facebook Fan Page.

Careful: Skip over codes for legs and zero in on foot codes.

With the many graft options — including those taken from cadavers, pigs, and newborns — correctly coding a skin graft procedure can leave you guessing. Use this chart to narrow down the grafting field by matching definitions, product names, and treatment applications to CPT codes. Then, you’ll be sure to sail through coding your next graft claim.

Don’t miss: Nothing will get your claim denied faster than using a CPT code not linked to the diagnosis code. Thus, take care to avoid CPT codes for other body areas, such as the legs, which are generally listed above the code for the feet for each type of graft. Below, you will find only CPT codes that you can use to report grafts performed on feet.

Note: Be sure to periodically review the payer’s local coverage determination to ensure your office is in compliance for your state or region.

Remember: Site preparation, lesion excision, and supply (HCPCS) codes may also apply for these services (in addition to the above listed CPT codes). Look in future issues for more on coding skin graft services by subscribing to Podiatry Coding & Billing Alert. Editor: Stacie Borrello.

Sign up for the upcoming live Webinar, Why That Wound Won’t Heal: Practical Tips to Get Wounds Moving, or order the CD/transcripts.

Be a hero. Sign up for Supercoder.com, and join the coding community at the Supercoder.com Facebook Fan Page.

Don’t look for a raise just yet, in most cases.

CMS may talk, but MACs don’t always listen — at least not quickly.

As we told you in last week’s Insider, CMS recently corrected several “technical errors” published in the 2010 Fee Schedule, and thanks to these corrections, Medicare will increase payment for several cardiology-related testing codes, including codes 75571-75574 (Heart CT) and 78451-78454 (Heart muscle SPECT imaging).

Although many practices are eager to see the payment boosts in their next Medicare payments, that may be an overly ambitious goal at this point.

“I inquired with a few MAC carriers such as Trailblazer, Noridian, and Palmetto, and was told different things by different Medicare payers,” says Terry Fletcher, BS, CPC, CCS-P, CCS, CMSCS, CCC, CEMS, CMS, CEO of Terry Fletcher Consulting Inc.

“One did not even know there was a change,” she says. “Next, Noridian said that they will be making the adjustments when they get the directive from CMS. And Palmetto said they would need the provider to contact them and then batch retroactive to January the myocardial perfusion imaging claims and send a letter to request the increase,” she says.

Bottom line: Until CMS provides a clear answer to the MACs regarding when they must implement the changes, you may not see your pay increases, but keep an eye on your carrier’s Web site for information on when it intends to reprocess claims using the new rates.

@ Part B Insider. Editor: Torrey Kim, CPC

Sign up for the upcoming live Webinar, You Can Use the Appeals Process Like a Pro, or order the CD/transcripts.

Be a hero. Sign up for Supercoder.com, and join the coding community at the Supercoder.com Facebook Fan Page.