Q. I understand that the Centers for Medicare & Medicaid Services has added National Correct Coding Initiative (NCCI) edits that no longer allow the billing of debridement with hundreds of surgical codes. What is the impact? How do NCCI edits affect us in general? A. NCCI edits define when two procedure codes may not be reported together except under special circumstances. Medicare implemented NCCI to promote national correct coding methodologies and to control improper coding, …
Read MoreImaging: X-Rays and Computed Tomography
Q. I understand that there will be reductions for x-ray reimbursements from Medicare in 2017. Is this true? A. To give imaging providers an additional incentive to adopt more advanced x-ray technology, Medicare will reduce reimbursement, beginning in 2017, for the technical component (and the technical component of the global fee) in claims submitted for x-rays performed with analog equipment. The cuts will continue in future years for those using computed radiography equipment (Table 1). …
Read MoreHow to Talk About Billing Codes to Providers Who Don’t Know Them
Q. How do I talk to my providers about the documentation to support specific International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes when most of them do not really know the codes, but they know the terminology? A. Now that we are 1 year into using ICD-10-CM codes, most expect the Centers for Medicare & Medicaid Services (CMS) to lift the grace period for allowing providers to assign unspecified diagnosis codes. It is …
Read MoreICD-10-CM and ICD-10-PCS Changes Effective October 1, 2016
Because it has been 4 years since the last annual update of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and because 2016 is the first year for the Centers for Medicare & Medicaid Services (CMS) to make updates to ICD-10-CM, CMS made many edits to the classification’s code set. On October 1, 2016, International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) will include 3651 new codes and 487 revisedcodes,1 and …
Read MorePlantar Warts, Digital Nerve Block in Lacerations, and Established Patients
Q. We had a patient present with 12 plantar warts. The provider used liquid nitrogen to freeze all 12 of the warts. What code should I bill for this procedure? A. In this case, you would bill Current Procedural Terminology (CPT) code 17110, “Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement) of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions.” Use only code 17110 once because the …
Read MoreImpacted Cerumen
Q. When a patient comes in with ear pain due to impacted cerumen, the health-care provider would normally instruct the nurse to perform ear irrigation. If the irrigation successfully removed the impacted cerumen, the procedure would be considered part of any evaluation and management (E/M) service and we could not bill for the service separately. With new rules regarding cerumen removal this year, can we get reimbursed for the ear irrigation if it is not …
Read MoreFracture Care
Q. Will you please help me understand initial visit, subsequent visit, and sequelae related to fracture care? If the patient is treated elsewhere for a fracture and the provider just stabilizes the fracture and instructs the patient to then come to my office for reduction, is this a subsequent visit or an initial visit? A. International Classification of Diseases 10th Revision, ClinicalModification (ICD-10-CM) guidelines state that a seventh character, A, is used for the initial …
Read MoreProlonged-Service Codes
Q. The coding staff has relayed to me that we can now bill for times when my clinical staff must spend extra time with a patient. Is this true? What are the requirements for documentation? A. Yes, two new Current Procedural Terminology (CPT) codes added in 2016 by the American Medical Association allow you to bill for clinical staff members’ time spent with a patient above and beyond what is considered to be the usual amount of time. …
Read MoreExcludes Notations and Code Notes
Q. How do I use Excludes 1 and Excludes 2 instructions in International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10CM)? A. Put simply, the Excludes 1 notation means that you cannot code any excluded code with the main (listed) code. Conditions listed with Excludes 1 are mutually exclusive. For example, code E11 (type 2 diabetes mellitus) has an Excludes 1 notation with the following codes listed: Diabetes mellitus due to underlying condition (E08.-) Drug …
Read More2016 Current Procedural Terminology Changes Pertinent to Urgent Care
Evaluation and Management There were two revisions and two additions to the “Evaluation and Management” section. Add-on codes 99354, “Prolonged evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour,” and 99355, “. . . each additional 30 minutes,” were revised to add the term psychotherapy in the description. Some good news in …
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