G0105, 45378: Use This Coding Combination For Your High-Risk Patients

Irrespective of findings, stick to V10.05 to define condition.

Correctly reporting colorectal cancer screenings on patients at high risk for the disease can depend on fine points like allocating the right V code. Read this expert medical coding article and know what ICD-9 codes apply in this scenario.

Examine the following given scenario and the medical coding advice that follows to ace these claims -- and recover your deserved reimbursement for these services:

Scenario: A patient has a personal history of colon cancer, went through treatment for colon cancer six years before, however she is presently facing no symptoms. Her 2006 colonoscopy came out clear, as well as her recent one carried out about a month ago. You billed 45378 for the procedure, and then you selected V10.05, from the ICD-9 codes, for the diagnosis. Though, the patient called complaining you should've billed the procedure as routine as her last two colonoscopies were clean. How would you resolve this?

Choose G0105 Or 45378, But Get The History Diagnosis Right

In case you're billing Medicare, you smust report the procedure as a high risk screening with code G0105 (Colorectal cancer screening; colonoscopy on individual at high risk). Then, from ICD-9 codes, report V code V10.05 (Personal history of malignant neoplasm of large intestine) as the primary diagnosis.

Code V10.05 fits the bill for primary diagnosis as the patient presents to the office for a screening exam and not precisely for follow-up assessment of the cancer. In case the encounter's purpose is for cancer surveillance and follow-up at an interval close by the surgical treatment, you could, as an alternative, code V67.09 (Follow-up examination following other surgery) as your primary diagnosis. Though, keep in mind that this ICD-9 code is seldom used.

On the contrary, certain commercial carriers would need the code 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) with modifier 33 (Preventive services) appended to signify that the service was preventive, and the V code V10.05 as diagnosis.

Don't forget: From ICD-9 codes, you must list V10.05 as your primary diagnosis for both circumstances (Medicare and commercial payers), irrespective of the fact that the results were clear or not. Use this ICD-9 code if all treatment focused toward the cancer is complete and there are no symptoms of current disease . Don't make the error of reporting a cancer code (153.3, Malignant neoplasm of sigmoid colon) or the family history code (V16.0, Family history of malignant neoplasm of gastrointestinal tract).

Draw On Diplomacy To Confer With Patients

Complaints like this from patients on a screening colonoscopy are common in the gastroenterology practice. The best guidance is to talk it out with your patient, and make clear how their cancer history influences the medical coding.

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Ace Routine And Extended EEG Coding With These Pointers

Exact timing of EEG monitoring is crucial, frequency is not important.

While reporting EEG recording, the most vital factor is to time the procedure. In case your physician uses advanced methods, video and digital recordings; you may be faced with added medical coding challenges for these services. Read on to prepare yourself on how to accurately time the procedure along with code the routine, extended, and special monitoring.

Look For How Long the Diagnostic Study Continued

While reporting EEG, you must look for how long your neurologist took to perform the monitoring. Monitoring that lasts 20 to 40 minutes is taken as routine. You will report CPT codes for extended monitoring in case the procedure goes beyond 40 minutes in duration. For EEG recording that lasts 41 to 60 minutes, you must report 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes), and in case it lasts more than an hour, you would report 95813 (Electroencephalogram [EEG] extended monitoring; greater than 1 hour).

It is significant that your neurologist's report evidently documents the actual EEG recording time. Medical coding is based on the recording though it is underway and the neurologist or technician is collecting data. You do not involve the set-up and take-down time..

Exception: CPT® does not include EEG CPT codes 95824 (Electroencephalogram [EEG]; cerebral death evaluation only), 95827 (Electroencephalogram [EEG]; all night recording), and 95829 (Electrocorticogram at surgery [separate procedure]) from a time component as these are unique services rendered by the physician to monitor a certain pathological condition or diagnose one.

Important note: You can report CPT codes 95812 or 95813 instead of 95816 (Electroencephalogram [EEG]; including recording awake and drowsy), 95819 (… including recording awake and asleep) or 95822 (… recording in coma or sleep only), however you cannot report them together. There is a thin line between drowsy and asleep. You report 95819 when the patient in reality slept during the monitoring. In case the patient did not achieve sleep in a procedure that intended monitoring in sleep, you report 95816 as an alternative.

In case the neurology specialist carries out the global diagnostic service, i.e. owns the equipment, employs the technical staff as well as interprets the diagnostic findings, then the EEG code would be billed without any modifiers. On the other hand, you would append modifier 26 (Professional component) to the EEG CPT® code, in case your neurologist only carries out the professional interpretation of the diagnostic study.

Scan For Video and Channels in Extended Monitoring

For 24-hour EEG monitoring, you should assess CPT codes 95950 (Monitoring for identification and lateralization of cerebral seizure focus, electroencephalographic [e.g., 8 channel EEG] recording and interpretation, each 24 hours)-95953 (Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic [EEG] recording and interpretation, each 24 hours, unattended) or 95956 (Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, electroencephalographic [EEG] recording and interpretation, each 24 hours, attended by a technologist or nurse).

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CPT 2012: Don't Skip These Explanations About New Patients plus 'Qualified Healthcare Professional'

Learn how changes influence your use of 99201-99205, 99460-99461, and more.

Medical coding guidelines can at times seem puzzling when you're trying to decide whether to categorize a patient as new or established. For instance when an established patient comes to your practice to see a new physician, would you report a new patient office visit code?

CPT 2012 tries to clarify this question and one other E/M question: Who counts as a "qualified healthcare professional" to administer that vaccine or deliver prolonged service?

'New Patient' Classification Goes to a New Level

At present, CPT® indicates that a "new patient" refers to a patient who has not received any professional services, for instance an E/M or other face-to-face service, from the physician or another physician of the same specialty in the similar group practice in the past three years.

Clarification: CPT 2012 takes that definition a step further, by stating, "A new patient is one who has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years." The parts of the description that are novel for 2012 are underlined.

What it means: In case your practice employs several subspecialists, CPT® now clarifies that claims for patients who see dissimilar doctors with different subspecialties can be billed using a novel patient code (such as 99201-99205).

RN Doesn't Fit 'Other Qualified Healthcare Professional'

In case your payer follows CPT® rules, you can now eliminate registered nurses from the list of professionals who can administer vaccinations or offer prolonged services for patients.

At the demand of many physicians, CPT 2012 now describes the term "other qualified healthcare professional." Although this definition didn't make it into the 2012 manual, the AMA lists it as part of the "CPT 2012 Errata" on its Web site.

The definition("A 'physician or other qualified health care professional' is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service. These professionals are distinct from 'clinical staff.' A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service. Other policies may also affect who may report specified services.)

Result: RNs and LPNs are excluded in the definition, as they cannot individually report the professional services that they offer. RNs and LPNs suit the CPT® definition of "clinical staff," as their professional services are normally reported under a physician or other qualified health care professional's identification number (e.g., under Medicare's "incident to" rule). This implies that when certain CPT codes refer to 'other qualified health care professionals' they are not including RNs and LPNs.

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Prepare Yourself With Novel Codes To Report Neurolysis in 2012

While reporting the paravertebral facet joint nerve injections in 2012, you will no more be counting nerves that your surgeon targeted. Till now, you have been reporting injections for each nerve at a distinct vertebral level. Effective Jan. 1, you'll require adjusting your technique to look for the particular anatomical site involved along with the work that your surgeon did. Read this expert medical coding article for more on what changes does CPT 2012 brings for these injections in: what goes obsolete and what new comes in.



CPT 2012: Know the Deletions



Here are four CPT codes that will be deleted in 2012:

64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level)

+64623 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level [List separately in addition to code for primary procedure])

64626 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level)

+64627 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level [List separately in addition to code for primary procedure])

CPT 2102: Look at Novel Codes

You will find four new CPT codes in 2012. These include the following:

64633 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; cervical or thoracic, single facet joint)

+64634 (Destruction by neurolytic agent, paravertebral facet joint nerve [s], with imaging guidance [fluoroscopy or CT]; cervical or thoracic, each additional facet joint [List separately in addition to code for primary procedure])

64635 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single facet joint)

+64636 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, each additional facet joint [List separately in addition to code for primary procedure])

Don't Distinctly Report Image Guidance

When reporting neurolysis described by new CPT codes 64633-64636, ensure that your surgeon has used and documented the image guidance used to carry out the paravertebral facet joint nerve destruction. The CPT 2012 codes are inclusive of the image guidance, so you do not individually report the fluoroscopy or CT guidance used for the paravertebral nerve localization. Keep in mind that image guidance with either fluoroscopy or CT is both required and is bundled into the new CPT codes.CPT 2012 Tip: You do not report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, subarachnoid, or sacroiliac joint], including neurolytic agent destruction) for fluoroscopic guidance and 77012 (Computed tomography guidance for needle placement [eg, biopsy, aspiration, injection, localization device], radiological supervision and interpretation) for CT guidance with 64633-64636.





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33202-33211 Get Numerous Guidelines in 2012

Hint: Understanding RS&I coding is the important for denial prevention.

The enormous changes to CPT®'s pacemaker (PM) along with implantable cardioverter-defibrillator (ICD) section are challenging even to expert coders. You can streamline the switch by breaking the changes into convenient chunks and mastering one group before going to the next. This expert medical coding article will focus on changes to CPT codes 33202-33211.

Confirm Provider Before Reporting 33202-33203

When reviewing CPT codes 33202-33211 in the 2012 manual, the first change you'll find is a revision to the parenthetical note following 33202-33203 (Insertion of epicardial electrode[s] ...). Compare the 2011 and 2012 descriptions of the note:

2011: ("When epicardial lead placement is performed by the same physician at the same session as insertion of the generator, report 33202, 33203 in conjunction with 33212, 33213, as appropriate.")

2012: ("When epicardial lead placement is performed with insertion of the generator, report 33202, 33203 in conjunction with 33212, 33213, 33221, 33230, 33231, 33240.")

The major change to the instruction is the list of CPT codes you may report along with epicardial lead placement CPT codes 33202 and 33203. The longer list is the outcome of CPT® 2012 adding and revising a number of codes for the insertion of a PM pulse generator (33212, 33213, 33221) or the insertion of a pacing ICD pulse generator (33230, 33231, 33240).

33206-33208 Join Other Codes for Full Replacement

The subsequent change you'll notice for this code range is a revision to 33206-33208. CPT® 2012 includes the following bold text to the definitions: "Insertion of new or replacement of permanent pacemaker with transvenous electrode(s) ..."

What does not change: As in 2011, the codes vary based on the electrode location:

33207, ... ventricular

33208, ... atrial and ventricular.

Similarly just as in 2011, 33206-33208 comprise subcutaneous insertion of the pulse generator as well as a transvenous placement of electrode[s], as per a parenthetical note with the codes.

Scratch 71090 Off Your Medical Coding Aids

One code you may have noticed absent from the above discussion is 71090 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation). The reason behind that is in 2012, radiological supervision as well as interpretation associated with the pacemaker or pacing cardioverter-defibrillator procedure is included in 33206-33249, as per CPT® guidelines. In fact, 71090 is no longer in the list if valid CPT codes in 2012.

Example: In 2011, you would have reported dual lead pacemaker insertion in fluoroscopy by the means of CPT codes 33208 and 71090. In 2012, you'll report that similar service using only 33208.

The removal of fluoroscopy while placing devices is another instance of addition for routine services. Fluoro is required to place the PM or ICD so CPT® may have streamlined that it is a component part of the service and not distinctly billable.

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CPT® 2012: You'll Get Closure With Novel Skin Repair Guidelines

Also, don't overlook separate debridement opportunity.

Feeling dazed by all the changes in the CPT 2012 integumentary section? Read this expert medical coding article to keep your skin repair claims clean and earn all the pay you deserve.

Note New Modifier Advice for Repairs

CPT 2012 proposes new introductory notes that offer guidance on how to report skin closures (12001-13160). Though the guidelines earlier advised the use of modifier 51 (Multiple procedures) when reporting dissimilar wound repair classifications together, that guidance is old news as of Jan. 1.

In black and white: The 2012 CPT® manual reads, "When more than one classification of wounds is repaired, list the more complicated as the primary procedure and the less complicated as the secondary procedure, using modifier 59."

What's "complicated? As CPT 2012 proposes simple, intermediate, and complex repairs, you'd think through the "simple" repair the minimum complicated, and the "complex" repair the maximum complicated. Consequently, in case the surgeon closes a leg wound with a simple repair for instance 12001(Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less) and an intermediate repair, for instance 12032 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm), you'll report the intermediate repair first, which should be followed by the simple repair with the modifier: 12032, 12001-59.

Know When Debridement is ‘Separate'

When surgeons carries out skin grafting, it's normal for coders to spend a lot of time and work trying to decide whether they can bill debridement distinctly, as a lot of physicians request.

Debridement is taken as a distinct procedure only when gross contamination needs a prolonged cleansing, when considerable amounts of devitalized or contaminated tissue are removed, or when debridement is performed separately without immediate primary closure.

CPT 2012 Tip: Your documentation must fully explain the surgeon's work cleansing the contamination and eliminating the devitalized tissue prior to you distinctly bill your insurer for debridement.

Skin Substitute Coding Renovation Simplifies Processes

Even though you may have been surprised when you saw that CPT 2012 made enormous changes to the skin substitute coding section (15271-15278, Application of skin substitute graft …), you must know that the AMA's goal was to make your life stress-free, not more difficult,

For wounds that are lesser than 100 square centimeters, you'll follow one code structure – in case your wound is 100 square centimeters or greater, you'll follow a different code structure. It has been felt that about 80 percent of the wounds would fit into the ‘less than 100 sq. cm' description.

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