Coding your anesthesia provider’s service is never cut and dried, especially with intricate procedures such as retrobulbar block placement. Answer these three questions regarding your anesthesiologist’s involvement in the case to know how to correctly code her services every time.

Does The Anesthesiologist Handle Everything?

Because administering anesthesia for retrobulbar blocks is riskier than other ocular injections, some surgeons (or facilities) prefer to have the anesthesia team handle everything. If your anesthesiologist is involved throughout the case, she administers the initial block and then administers monitored anesthesia care (MAC) during the case.

Code it: Your anesthesiologist places the block in preparation for the procedure, not as a separate pain management service. Therefore, you only code for the eye procedure instead of the procedure and block. Choose the appropriate code from 00140-00148 (Anesthesia for procedures on eye …). Depending on carrier requirements, append modifier QS (Monitored anesthesia care service) to indicate MAC, says Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla.

Expect your anesthesiologist to report discontinuous time in this scenario. She will place the block, leave the room while the block takes effect, and return in time for the procedure. Because she won’t be with the patient from start to finish, watch your time units. Calculate the time she spends placing the block and with the patient during the procedure for the total minutes.

Caution: Patients needing retrobulbar blocks often are scheduled back to back, which can make tracking your anesthesia provider’s time tricky. Be careful to ensure that case times don’t overlap when calculating the number of cases your anesthesiologist medically directs or supervises. Some practices decide to avoid potential compliance risks by not trying to capture the discontinuous time.

Does the Anesthesiologist Only Monitor?

Some facilities — and many...

When ICD-10 goes into effect in 2013, high cholesterol will still be a challenge for your patients. Here’s a look at how coding for this, and similar diagnoses, compares between ICD-9 and ICD-10.

ICD-9-CM Codes:

• 272.0, Pure hypercholesterolemia
• 272.1, Pure hyperglyceridemia
• 272.2, Mixed hyperlipidemia
• 272.4, Other and unspecified hyperlipidemia

ICD-10 Codes:

• E78.0, Pure hypercholesterolemia
• E78.1, Pure hyperglyceridemia
• E78.2, Mixed hyperlipidemia
• E78.4, Other hyperlipidemia
• E78.5, Hyperlipidemia, unspecified

Change: ICD-10 offers a one-to-one code match with ICD-9 for pure hypercholesterolemia (272.0, E78.0), pure hyperglyceridemia (272.1, E78.1), and mixed hyperlipidemia (272.2, E78.2). But where ICD-9 offers one code for “other and unspecified hyperlipidemia” (272.4), ICD-10 offers one code for “other” (E78.4) and a different code for “unspecified” (E78.5).

Documentation: Your clinicians’ documentation shouldn’t need to change from its current form. All you need to do as a coder to capture this already present information is to format your superbill to capture the difference between “other” and “unspecified” hyperlipidemia. “Other” means the physician documented the type, but ICD-10 doesn’t offer a code specific to the documented type. “Unspecified” means the physician did not document the type of hyperlipidemia.

Bonus tip: The notes with the ICD-9 and ICD-10 codes for lipid metabolism disorders are very similar, but there are a few differences. For example, while 272.1 includes “hypertriglyceridemia, essential,” E78.1 includes “elevated fasting triglycerides.”

Under E78.2, ICD-10 adds “combined hyperlipidemia NOS,” “elevated cholesterol with elevated triglycerides NEC,” and “Hyperlipidemia, group C.” Code E78.2 also has an Excludes1 note, telling you instead to code E78.4 for “familial combined hyperlipidemia” and E78.5 for “cerebrotendinous cholesterosis [van Bogaert-Scherer- Epstein] (E75.5).”

Remember: When ICD-10 goes into effect on Oct. 1, 2013, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and...

Even if you don’t have prescribing privileges, you can rest assured now as CMS will not cut your pay as a penalty for failing to comply with the new e-prescribing incentive program.

As you are probably aware, starting in 2012, you may be subject to a one percent payment adjustment on your Part B pay if you don’t successfully participate in e-prescribing this year. In 2013, that payment adjustment will go up to 1.5 percent, and in 2014 it will rise to two percent, CMS’s Daniel Green, MD noted on a Feb. 15 CMS-sponsored call.

“To earn an incentive in 2011, an eligible professional must e-prescribe 25 times during the year, ten of which must be in the first six months,” Green said. “If they are a successful e-prescriber during the calendar year, they not only would avoid the 2012 payment adjustment, they would get a one percent 2011 payment incentive, and they would be exempt from the 2013 payment adjustment,” he explained.

“Earning an incentive in 2011 does not necessarily exempt the eligible professional or group practice from a payment adjustment in 2012,” Green explained.

How to Avoid the Adjustment

CMS reps said that they’ve been flooded with calls about the 2012 payment adjustment, and described ways that you can avoid the adjustment if you qualify.

Not eligible to prescribe: If you are not a physician, nurse practitioner, or physician assistant between Jan. 1 and June 30, 2011, you can avoid the e-prescribing penalty. In addition, if you don’t have prescribing privileges at least once on a claim between Jan. 1 and June 30, 2011, you should append G8644 (Eligible professional does not have prescribing privileges) at least once before June 30 to ensure that your MAC knows you are not subject to the penalty, said CMS’s Michelle...

Your practice is going to have more patients coming in for bone density screenings, thanks to new recommendations from the U.S. Preventive Services Task Force (USPSTF) that might lower the age at which family physicians could begin screening some women for osteoporosis. Act now to ensure you’re assigning the correct diagnosis codes and verifying medical necessity.

1. Know Osteoporosis, Osteopenia Differences

Many people think of osteoporosis when they hear the term “bone density screening.” Osteoporosis — which literally means “porous bone” — is a disease characterized by low bone mass and structural deterioration of bone tissue. The changes lead to bone fragility and an increased risk of hip, spine, and wrist fractures. The condition is essentially a bone disease caused by dropping estrogen levels in postmenopausal women.

When your physician diagnoses osteoporosis, you’ll select from code family 733.0x (Osteoporosis). Choose the diagnosis based on the patient’s specific type of osteoporosis (such as postmenopausal, idiopathic, etc.). A less-thought-of diagnosis related to bone density screenings is osteopenia (733.90, Disorder of bone and cartilage, unspecified). Patients with osteopenia have lower than normal bone density.

Although osteopenia can be a risk factor or precursor for osteoporosis, not every patient with osteopenia develops osteoporosis.

Screening: Your physician will most likely order a dual-energy x-ray absorptiometry (DXA), which measures bone density, to diagnose the condition. DXA is the gold standard for measuring bone density, coder Donna Richmond with CodeRyte taught in The Coding Institute’s audioconference “Surefire Bone Density Screening Strategies.” Your code choices include:

• 77080 — Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine)
• 77081 — … appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
• 77082 — … vertebral fracture assessment.

2. Check for Documented Necessity

Medicare guidelines dictate that your documentation must include an...

Not all patients who present to the office with colon polyps will be diagnosed with colon cancer. This second-leading cause of cancer-related deaths in the US usually begins as small, benign adenomatous lump, and becomes cancerous overtime.

Colon cancer, or colorectal cancer as it’s regularly known, is a cancer which starts in the large bowel portion of the gastrointestinal (GI) system. Because it comes in many forms and symptoms, coding the definitive diagnosis might be risky. Guard your practice’s deserved dollars with these 3 tips.

1. Don’t Go Looking For ‘Benign’, ‘Malignant’

Whether or not you’re dealing with a full-blown colorectal cancer, you should be looking at the different terms used to describe benign or malignant colonic polyps. Some of these include:

• Adenomas including tubular adenomas and tubulovillous adenomas
• Hyperplastic polyps
• Inflammatory polyps
• Familial adenomatous polyposis, a rare hereditary disorder that causes hundreds of polyps in the lining of the colon beginning in the teenage years. If this is left untreated, the patient becomes high risk to develop colon cancer.
• Hereditary nonpolyposis colorectal cancer, a hereditary disorder that causes an increased risk of developing colon cancer.

But first, you have to accomplish the task of determining — without a doubt — if a polyp is benign or malignant. If you think you would find the clues in the pathology report (PR), think again. Usually, the PR will not use the term “benign” or “malignant.” However, it will use a description that points to the usual behavior of the polyp. It’s up to you to interpret those descriptions into benign or malignant.

Experts advise that you always wait for the pathology report to come back before deciding on a particular ICD-9. Even the gastroenterologists, themselves, usually defer to the pathology report before making a recommendation.

2....

Until now, you could not code for the additional service — and hence not get the pay — when your general surgeon placed interstitial devices for radiation therapy guidance during a distinct open or laparoscopic abdominal procedure. But two new CPT 2011 codes for the procedure help you capture all the pay you deserve.

Open, Lap, or Percutaneous Approach Distinguish Placement

Last year, you had one code to use when your surgeon placed an abdominal interstitial device for radiation therapy guidance — 49411 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], percutaneous, intra-abdominal, intra-pelvic [except prostate], and/or retroperitoneum, single or multiple).

“If your surgeon performed the device placement during an open or laparoscopic procedure prior to 2011, you had no way to capture the service,” says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle.

Now CPT 2011 adds two new add-on codes to describe interstitial device placement during another procedure, as follows:

• +49327 — Laparoscopy, surgical; with placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple [List separately in addition to code for primary procedure])
• +49412 — Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], open, intra-abdominal, intrapelvic, and/or retroperitoneum, including image guidance, if performed, single or multiple [List separately in addition to code for primary procedure]).

Choose +49327 for a laparoscopic approach, and +49412 for an open procedure. “Note that these are add-on codes, which means you can report them only in addition to a primary procedure,” Bucknam advises.

Continue to report 49411 for percutaneous interstitial device placement as a stand-alone procedure.

Use codes 49411, +49412, and +49327...