DecisionHealth's Coding Answers 2009 Updates

Updates by Month:

April 2009:

Chapter

Description of changes

Cardiology

Updated with new 2009 codes in sections:

  • "How to bill a full echo that's missing some elements"
  • "Cardiovascular stress tests"
  • "Don't leave money behind when billing stress echoes"

Deleted section "Use existing device codes for analysis of ICDs & pacemakers"
Added new sections:

  • "Stress echocardiography"
  • "Cardio device monitoring & programming codes"
  • "Code in-person services first by implant type, then by the type of service"
  • "Programming or interrogation: Some clues to help you tell the difference"
  • "Follow these tips to code device interrogations vs. programming"
  • "Peri-procedural programming codes"

Chemotherapy

Updated all sections with new 2009 codes for hydration/infusion/injection (96360-96379)
Added current link to Medicare manual chemotherapy citations in section "Medicare's chemotherapy manual citation"

CPT Codes

Deleted section analyzing 2008 CPT code changes
Added new section "Analysis of CPT 2009 code changes"

Diagnosis Codes – ICD-10

Deleted section "ICD-10 implementation officially proposed for 2011"
Added new section "Final ICD-10-CM implementation date set for Oct. 1, 2013"

Dialysis

Deleted sections:

  • "Medicare's G codes for ESRD treatments"
  • "Home dialysis G codes"
  • "Coding for patients who travel, move or miss a full month"

Added new section "Medicare's "G" codes for ESRD treatments disappear"
Updated section "Coverage & coding for EPO and darbepoetin alfa" by providing current links
Updated section "Where to find Medicare's ESRD regulations" with current links

Injections

Updated all sections with new 2009 codes for hydration/infusion/injection (96360-96379)
Deleted section "Medicare limitations of B-12 coverage"

Newborn Care

Updated all sections with new 2009 codes for newborn care/intensive care (99460-99480)

Pediatric Coding

Deleted sections"2006 CPT codes full of good things…"
Deleted section "Jaundice guidelines pose coding dilemmas"
Updated section "Don't fear critical care codes" with new 2009 codes and other revisions

Prolonged Services

Added new section "Unit/floor time added to inpatient prolonged services"
Updated all sections with new 2009 code descriptors
Deleted all references to deleted modifier 21

May 2009:

Chapter

Description of changes

Preventive Medicine

Updated codes and descriptions of the Initial Preventive Physical Exam (IPPE) services

Psychotherapy

Updated details about psychological testing codes 96101-96103 and neuropsychological testing codes 96118-96120

June 2009:

Chapter

Description of changes

Evaluation and Management Services

Added new section “Documentation crucial to proper use of 99211”
Deleted section “CMS permits higher-level services for NPPs, but urges caution”
Revised section:

  • “Medicare’s E/M code regulations” – provides a direct online link to the Medicare manual (re-titled “How to link to Medicare’s E/M code regulations”)
  • “Telephone E/M codes replaced, new code for online evaluations” – now re-titled “Reimbursement still across-the-board for telephone, online E/M services”

Injections

Added new sections:

  • “Follow outpatient – not facility – rules for infusion and injection coding”
  • “Use these definitions to distinguish among infusion, IV push and injection”

Injections: Vaccines

Added new section “Chart to aid your immunization administration coding”
Updated section “Filling out the claims form for vaccinations”
Adds link to official source in section “Roster billing – mass immunizers”
Deletes section “CMS’s IOM Pub. 100-4, Chapter 18, section 10.3:

Modifier 59

Updated sections:

  • “Overview”
  • “59 NOT a catch-all: Bill other modifiers first if they apply”

Added new section “Modifier 59: Use as last resort, despite payer policy”
Deleted sections:

  • “Coders report spike in denials on claims with modifier 59”
  • “Two visits in one day: Some private payers say bill both with modifier 59”
  • “Another example of appropriate use of 59”
  • “And more tips CCI tips”
  • “Take a look at the differences between 51 and 59 reimbursement”

Revised sections:

  • “2 examples where modifier 59 is the right choice” – now re-titled “Three examples where modifier 59 is the right choice”
  • “Once again, the -59 goes on the lesser of the 2 services” – now re-titled “Modifier 59 goes on the lesser of the 2 services”
  • “Tips for using -59 correctly” – now re-titled “Five tips for using 59 correctly”

Shared visits

Added new sections:

  • “Criteria for split/shared visit between physician and non-physician practitioner (NPP)”
  • “Know the rules for providers who share E/M services”

Revised sections:

  • “What Medicare says about shared E/M visits: Tips to help you sort through the rules”
  • “Don’t factor NPP into your critical care code choice”
  • “Questions still remain about shared visits and consultations” – now re-titled “Tips to bill shared visits”

July 2009:

Chapter

Description of changes

Attention Deficit/ Hyperactivity Disorder

Added new section “Physicians can get paid for treating ADD/ADHD”

Diagnosis Codes – E Codes

Added new section “E codes gain prominence”

Pay For Performance

Revised sections:

  • “PQRI primer: What you need to know about Medicare’s P4P program”
  • “Medicare’s PQRI provides extra financial incentive”
  • “Several ways to participate in PQRI”

Added new sections:

  • “How the various PQRI reporting options work”
  • “PQRI: Your non-physician providers can participate too”

August 2009:

Chapter

Description of changes

Diagnostic Testing

Deleted section “ICD-9-CM coding for diagnostic tests (MCM Section 15021)”

Added new sections:

  • “Test your knowledge of physician supervision for diagnostic tests”
  • “Diagnostic test rules: Check your payment arrangements”
  • “2 factors decide whether anti-markup rules apply to your diagnostic tests”
  • “Medicare regulatory links”

Injections: Surgical

Added new section “Be careful coding bilateral facet joint injection procedures”

Lesions

Added new section “Genital warts: E/M code is likely your best bet”

September 2009:

Chapter

Description of changes

Evaluation and Management Services

Added new section “Don’t code pulse oximetry with E/M or other services”

Neurology and Neurosurgery

Added new section “How to code a recurrent HNP”

Obstetrics and Gynecology

Added new section “Code once for gyn exam that spans two dates of service”

October 2009:

Chapter

Description of changes

Diagnosis Codes – Annual Updates

Added new section:

  • “H1N1, venous embolism and ‘never events’ among new diagnosis codes”
  • “New ICD-9-CM diagnosis codes for fiscal 2010 (effective 10/1/09)”
  • “Revised ICD-9-CM diagnosis codes for fiscal 2010 (effective 10/1/09)”
  • “Invalid ICD-9-CM diagnosis codes for fiscal 2010 (effective 10/1/09)”

Deleted sections:

  • “367 new ICD-9 codes in Oct. 2008 update”
  • “New ICD-9-CM diagnosis codes for fiscal 2009 (effective 10/1/08)”
  • “Revised ICD-9-CM diagnosis codes for fiscal 2009 (effective 10/1/08)”
  • “Invalid ICD-9-CM diagnosis codes for fiscal 2009 (effective 10/1/08)”

Evaluation and Management Documentation Guidelines

Added new section “Define ‘additional workup’ in medical decision-making”

Deleted sections:

  • “Respiratory system: An example of how you can qualify for the higher levels under 1997 guidelines”
  • “CMS clarifications on 1997 E/M guidelines”

Foreign Body Removal

Revised sections: “Check out three ways to code for foreign body removal” and “Coding examples”

Added new sections:

  • “How to code a ring removal”
  • “Use 10120 for tick, splinter removal if you have to go ‘digging’”
  • “Why don’t sutures qualify as foreign bodies”
  • “Foreign body sensation vs. removal: Match ICD-9 to CPT”

HCPCS Codes

Added new sections:

  • “S codes not payable by Medicare”
  • “HCPCS code for sign language interpreter not generally reimbursed”

Deleted section “New and deleted HCPCS codes for 2007”

Injections: Vaccines

Renamed section “Flu vaccinations” as “Traditional flu vaccinations”

Added new section “H1N1 (swine) flu vaccinations”

Nutrition Services

Added new section “Distinguish MNT from self-management education”

S Codes

Deleted entire chapter; transfers information into “HCPCS Codes” chapter

November 2009:

Chapter

Description of changes

Asthma

Deleted entire chapter; transfers information into Chronic Obstructive Pulmonary Disease and Respiratory Therapy chapters

Chronic Obstructive Pulmonary Disease

Added new sections:

  • “Asthma: precise diagnosis coding required”
  • “Emphysema diagnosis codes rove throughout the body”
  • “Take stock of these less-frequent emphysema diagnoses encountered in documentation”

Emphysema

Deleted entire chapter; transfers information into Chronic Obstructive Pulmonary Disease chapter

Ophthalmology Services

Added section “Select the correct modifier for eyelid lesion removal”

Respiratory Therapy

Updated entire chapter - changes include:

added new sections

  • “Medicare encourages you to bill inhaler training”
  • “Watch parenthetical notes when coding breathing treatments”

Deleted section “Fracture nasal turbinate”

December 2009:

Chapter

Description of changes

Botulinum Toxin

Added new section “Consider endoscopy code for Botox injections”

Endoscopy Coding

Added new section “'Pill cam' coding options”

Modifier 62: Co-Surgeons

Added new section “Coding co-surgeons on a PEG”

Surgery: Global

Added new section “Preop H&P not separately billable, CPT confirms”

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