Coding Strategy

Plus, experts at the AMA meeting in Chicago tell you what to do if you can’t get H1N1 vaccine for PQRI Measure 110 or other vaccine measures.

Question: My internist decided not to put a patient on Coumadin because the patient has a higher risk of falling than from having a stroke. Our group participates in PQRI easure 33 for risk of clotting. How can I indicate performing the measure wasn’t appropriate so that the physician isn’t penalized for not prescribing the anti-blood clotting medication?

Answer: You should report the measure and append the denominator exclusion indicator 1p. This indicator shows the physician chose not to prescribe the drug due to the art of medicine, or factors that make performing the measure not clinically appropriate.

If, however, the internist prescribed Coumadin but the patient isn’t taking it because she can’t afford the medication, you instead would use 2P. Your group can then have the patient referred to a social worker to help the patient figure out her financial hardship and find a way to obtain the medically necessary drug.

The third denominator exclusion in this group is 3p, which shows the medication was not available. Read on to learn what to do when you can’t get H1N1 vaccine supply …

For instance, if you’re reporting on giving H1N1 vaccine, but no product was available since delivery mechanisms sent the vaccine to clinics, not your practice, you could use the universal vaccine measure 110 with 3P for no vaccine available.

These three exclusion denominators show why things like art of medicine, education, or economic reason prevented the physician from performing a given measure, explained Susan Nedza, MD, MBA, FACECP, at the final session of the AMA CPT 2010 symposium. The patients who fall under these reasons do not effect physician’s quality of care percentage as shown in a registry for an individual’s or group’s measure.

“Physicians for the most part are receptive to using these now,” reported Ronald A. Gable, MD, CPT Performance Measures Advisory Group, in the PQRI presentation in Chicago. Denominator exclusions used to be a negative allowing physician to say why opted out of a measure. Now they are a positive that indicates why performing the measure was not appropriate so that quality of care percentage not negatively impacted.

—by Jennifer Godreau

AUDIO TRAINING EVENT: 2010 Primary Care Coding & Reimbursement Update. With Jill Young.

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Here’s where you can find a full list of resequenced codes.

Notice that new sign in your CPT book? No, that hash mark’s not to delete a message or to sign into a conference; it’s to alert you to an out of order code.

The “#” works like a flashing yellow light: Slow down, there might be something unexpected. Rather than moving groups of codes to new sections, the AMA has created another option. “Resequencing makes a lot of sense to avoid renumbering the codes,” explained William T. Thorwarth, Jr., MD, in “CPT 2010 Overview” at the CPT and RBRVS 2010 Annual Symposium’s opening session in Chicago.

Watch for the Out of Order Placard

When you’re coding a lesion excision, you usually assume the code increases by one as the excision’s size class goes up. But that truism will no longer hold true. Fortunately, watching for # will alert you to these inconsistencies. Read more for examples …

Example: The AMA wanted to break up the soft tissue neck excision parent code 21566 into two different size based codes. Since 21566 is right next to 21567, there’s no space for another code using numerical sequencing. Instead, the AMA chose available numbers that were close to those used so that the section reads:

21555 — Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm

#21552 — … 3 cm or less

21556 — Excision, tumor, soft tissue of neck or anterior thorax, deep, subfascial, (e.g., less than 5 cm)

#21554 — … 5 cm or greater

21557 — Radical resection of tumor (e.g., malignant neoplasm), soft tissue of neck or anterior thorax; less than 5 cm.

“Before the new code symbol, we added a new symbol so you readily identify out of number codes,” Peter A. Hollmann, MD, said in the symposium’s final session of the day: “CPT 2010 Resequencing Principles”.

The new system will save you lots of headaches. When CPT 2009 deleted numerous pediatric codes and cross walked them to nearly identical new codes, many insurers incorrectly applied “new” code payment reductions to the old codes.

Follow the Road Signs to Relocated Code

The AMA’s also got a new method of relocating an existing out of order code. Rather than deleting the code and creating a new number, the AMA will move the code to its more appropriate location and leave a road sign for you. “Where you would expect the code to be, we added references referring to the code’s new place,” Hollmann said.

Example: Urinary code +51797 (Voiding pressure studies …) did not change in meaning, but due to the bundling project for all urodynamics typically performed in the same day, it fit better after the urodynamics codes 51727-51729. So, the AMA put +51797 after 51729 and added road signs including:

• The # sign in front of +51797 to designate the code as out of order
• A reference placed where +51797 would have been found numerically.

Relocate or Renumber? What’s the Rationale?

The new system will allow for more consistency; “it’ll just take some time to get used to,” Hollmann maintains. The AMA uses these principles to decide what actions to take when moving or renumbering codes:
• When a code’s meaning and/or intent changes, the code should be deleted and renumbered.
• When large groups of new concepts are added, there’s no need to delete and renumber existing codes.

The AMA, however, will allow renumbering for placement of related codes to an appropriate location.

Resource: For a full list of resequenced codes, check out Appendix N or Hollmann’s Webinar on Dec. 9. And for pediatric codes, check out Appendix M.

By Jennifer Godreau, who’s at the AMA CPT conference in Chicago this week. Stay tuned to Coding News for her updates.

And don’t miss Jennifer’s “CPT Remodel - A Practical look at the 2010 CPT Updates.” An audio training event on Monday, December 14.

Related articles:

1. 2010 Tumor Excision Coding: Lesion Vs. Chunk SizeStraight from the AMA in Chicago — answers to your lesion...
2. Lesion Excision Coding Challenge: 2 Lesions, 1 CutQuestion: Our nonphysician practitioner (NPP) discovers a pair of benign...
3. Radiology Billing Checklist: Rules for Additional Tests without Treating Physician’s OrderKeep these additional test rules at your fingertips if your...

Here’s where you can find a full list of resequenced codes.

Notice that new sign in your CPT book? No, that hash mark’s not to delete a message or to sign into a conference; it’s to alert you to an out of order code.

The “#” works like a flashing yellow light: Slow down, there might be something unexpected. Rather than moving groups of codes to new sections, the AMA has created another option. “Resequencing makes a lot of sense to avoid renumbering the codes,” explained William T. Thorwarth, Jr., MD, in “CPT 2010 Overview” at the CPT and RBRVS 2010 Annual Symposium’s opening session in Chicago.

Watch for the Out of Order Placard

When you’re coding a lesion excision, you usually assume the code increases by one as the excision’s size class goes up. But that truism will no longer hold true. Fortunately, watching for # will alert you to these inconsistencies. Read more for examples …

Example: The AMA wanted to break up the soft tissue neck excision parent code 21566 into two different size based codes. Since 21566 is right next to 21567, there’s no space for another code using numerical sequencing. Instead, the AMA chose available numbers that were close to those used so that the section reads:

21555 — Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm

#21552 — … 3 cm or less

21556 — Excision, tumor, soft tissue of neck or anterior thorax, deep, subfascial, (e.g., less than 5 cm)

#21554 — … 5 cm or greater

21557 — Radical resection of tumor (e.g., malignant neoplasm), soft tissue of neck or anterior thorax; less than 5 cm.

“Before the new code symbol, we added a new symbol so you readily identify out of number codes,” Peter A. Hollmann, MD, said in the symposium’s final session of the day: “CPT 2010 Resequencing Principles”.

The new system will save you lots of headaches. When CPT 2009 deleted numerous pediatric codes and cross walked them to nearly identical new codes, many insurers incorrectly applied “new” code payment reductions to the old codes.

Follow the Road Signs to Relocated Code

The AMA’s also got a new method of relocating an existing out of order code. Rather than deleting the code and creating a new number, the AMA will move the code to its more appropriate location and leave a road sign for you. “Where you would expect the code to be, we added references referring to the code’s new place,” Hollmann said.

Example: Urinary code +51797 (Voiding pressure studies …) did not change in meaning, but due to the bundling project for all urodynamics typically performed in the same day, it fit better after the urodynamics codes 51727-51729. So, the AMA put +51797 after 51729 and added road signs including:

• The # sign in front of +51797 to designate the code as out of order
• A reference placed where +51797 would have been found numerically.

Relocate or Renumber? What’s the Rationale?

The new system will allow for more consistency; “it’ll just take some time to get used to,” Hollmann maintains. The AMA uses these principles to decide what actions to take when moving or renumbering codes:
• When a code’s meaning and/or intent changes, the code should be deleted and renumbered.
• When large groups of new concepts are added, there’s no need to delete and renumber existing codes.

The AMA, however, will allow renumbering for placement of related codes to an appropriate location.

Resource: For a full list of resequenced codes, check out Appendix N or Hollmann’s Webinar on Dec. 9. And for pediatric codes, check out Appendix M.

By Jennifer Godreau, who’s at the AMA CPT conference in Chicago this week. Stay tuned to Coding News for her updates.

And don’t miss Jennifer’s “CPT Remodel - A Practical look at the 2010 CPT Updates.” An audio training event on Monday, December 14.

Related articles:

1. 2010 Tumor Excision Coding: Lesion Vs. Chunk SizeStraight from the AMA in Chicago — answers to your lesion...
2. Lesion Excision Coding Challenge: 2 Lesions, 1 CutQuestion: Our nonphysician practitioner (NPP) discovers a pair of benign...
3. Radiology Billing Checklist: Rules for Additional Tests without Treating Physician’s OrderKeep these additional test rules at your fingertips if your...