Capture additional pay by separating wound care management codes 97597-97602 from the newly revised debridement codes.

Every year, just when you’re trying to get used to new CPT codes, the Correct Coding Initiative (CCI) comes along and limits how and when you can use the new codes you’ve been given. This year is no exception with CCI 17.0 adding edits involving new Renessa and posterior tibial neurostimulator (PTNS) codes, among others.

The CCI released version 17.0, revealing 19,822 new active pairs and 9,778 code pair deletions, said Frank D. Cohen, MPA, MBB, senior analyst with The Frank Cohen Group, LLC, in a Dec. 14 announcement.

Many of the new code pair additions involve CPT codes that debuted on Jan. 1, 2011 with CCI getting ready to halt payment if you report certain procedures together. Get a grip on the new bundles with this urology-focused rundown.

CPT 2011 deleted Category III code 0193T (Transurethral, radiofrequency microremodeling of the female bladder neck and proximal urethra for stress urinary incontinence), replacing it with a new Category I code 53860 with the same descriptor. CCI targets 53860 with several edits.

When your urologist performs the Renessa procedure, you’ll report 53860, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook.

As of Jan. 1, when 53860 became an active code, CCI 17.0 created edit pairs with the following column 2 codes that Medicare considers usual and necessary parts of any surgery:

• Venipuncture, IV, infusion, or arterial puncture services represented by codes 36000, 36400- 36440, 36600-36640, and 37202
• Naso- or oro-gastric tube placement (43752)
• Bladder catheterization (51701-51703).

“In general CPT code 53680 would include catheter placement for temporary postoperative urinary drainage at the conclusion of the procedure, and therefore, these latter...

Level-four and level-five office visits are not unusual in a urology practice, but failing to incorrectly match the history, exam, and medical decision-making (MDM) can make you miss out on the higher level codes you could report.

The third element for the historical portion of an E/M service, after the chief complaint (CC) and the history of the present illness (HPI), is the review of systems (ROS) — this portion of the E/M service trips up many coders because often they must select a lower code simply because the provider didn’t document pertinent negative responses or inappropriately used the statement “all systems negative.”

Ensure you’re properly counting your urologist’s ROS with this primer to guarantee you’re not overcoding or undercoding his E/M services.

“The review of systems is a subjective account of a patient’s current and or past experiences with illnesses and or injuries affecting any of the 14 applicable organ systems,” explains Nicole Martin, CPC, manager of the medical practice management section of the Medical Society in New Jersey in Lawrenceville.

You’ll need to know the differences between the three ROS levels to determining the proper level of history and therefore, E/M code level:

A problem-pertinent ROS occurs when the urologist reviews a single system during the encounter, presumably the system directly related to the problem identified in the patient’s history of present illness (HPI). For a urology practice, “pertinent” refers to the genitourinary system, says Becky Boone, CPC, CUC, certified reimbursement assistant for the University of Missouri Department of Surgery in Columbia, which means the urologist reviews at least one item within the GU system.

A problem-pertinent ROS supports a level two new patient E/M service (99202) or a level three established patient E/M service (99213).

When the physician conducts an extended ROS, he should review a “limited”...

...

Coding is all about applying standardized code sets to situations that don’t always qualify as “standard.” The good news is that authoritative coding resources sometimes address even those encounters you don’t handle on a daily basis. Test your skills with these two scenarios and see whether your responses match the official rules.

Challenge 1: Staff administers a non-chemotherapy therapeutic drug via one IV infusion site, and then following oncologist orders based on protocol, administers chemotherapy intravenously via a second IV site. Should you report the chemotherapy admin or the non-chemotherapy admin as the initial code?

Solution 1: Challenge 1 presents a trick question. You should report initial codes for both the chemotherapy and non-chemotherapy infusions.

CPT guidelines state, “When administering multiple infusions, injections or combinations, only one ‘initial’ service code should be reported, unless protocol requires that two separate IV sites must be used,” notes Gwen Davis, CPC, associate with Washington-based Derry, Nolan, and Associates.

Citing this same rule, Tracy Helget, CPC, in the business office of Medical Associates of Manhattan in Kansas, notes, “The easiest way to think of this is, if we are making more than one stick to the patient, we bill more than one initial code.”

Many payers indicate that when you report two initial codes because each requires a separate access site, you should append modifier 59 (Distinct procedural service). So you may need to append modifier 59 to the secondary “initial” code to indicate the separate IV sites for each infusion in this case. For example, your claim may include the following:

• 96413 – Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
• 96365-59 – Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour.

Challenge 2: Documentation indicates your oncologist participated in...