DecisionHealth's Coding Answers 2011 Updates

Updates by Month:

December 2011:

Chapter

Description of changes

Chronic Obstructive Pulmonary Disease

Adds new section: "Diagnosis Coding of COPD with ICD-10."

Musculoskeletal System

Editorial revision to section "General section (codes 20005-20999)."

Integumentary System

Updates section: "Excision of pressure ulcers" to revise code range for debridement services.

Ophthalmology Services

Adds new section: "Billing for therapeutic contact lenses."

Physical/Occupational Therapy

Updates section: "PTs, OTs and other NPPs are the focus of wound care codes" to include updated debridement codes.

Ulcers

Updates section "Decubitus ulcers" to include updated debridement code range

November 2011:

Chapter

Description of changes

Observation Care

Updates section "Look for new E/M codes for subsequent observation in 2011"

Adds new sections:

Place of Service

Adds new section "Physicians' POS coding draws OIG scrutiny; use these 4 tips to get it right"

Deletes section "Warning: OIG audits uncover major problems with physicians' POS selection"

Psychotherapy

Adds new section "Billing time-based psychotherapy codes"

Updates sections:

October 2011:

Chapter

Description of changes

Diagnosis Codes – Annual Updates

Adds new sections:

Deletes sections:

  • "New flu series, V-codes, ObGyn conditions dominate FY 2011 ICD-9-CM dx changes"
  • "New ICD-9-CM diagnosis codes for fiscal year 2011 (effective 10/1/10)"
  • "Revised ICD-9-CM diagnosis codes for fiscal year 2011 (effective 10/1/10)"
  • "Invalid ICD-9-CM diagnosis codes for fiscal year 2011 (effective 10/1/10)"

Modifiers 76 and 77

Updates section "Modifier 76"

Pediatric Coding

Adds new section "Billing a same-day visit and circumcision"

September 2011:

Chapter

Description of changes

Lesions

Updates section "Benign lesion destruction"

Adds new section "Malignant lesion destruction measurement"

Ophthalmology Services

Adds new section "Fulfill the dx and tx requirement for comprehensive exams"

Updates section "Billing for placing punctal plugs"

Unlisted Procedures

Adds new section "Follow these steps to correctly bill unlisted codes – and get paid"

Updates section "How to choose between billing an unlisted code or adding modifier 52"

Folds section "6 tips to writing out operative reports" into renamed section "Unlisted procedures: Translate the report into layman's terms"

Deletes sections "Mystery procedures: What to do when your service doesn't have a code"

August 2011:

Chapter

Description of changes

Abscesses

Updates section "Overview"

Adds new section "Depth is key when choosing between integumentary and musculoskeletal abscess codes"

Modifier 25

Updates section "4 pointers to help get 25 paid" and renames it "6 pointers to help get 25 paid"

Folds sections "Remember modifier -25 for surgeries with 0 global period" and "Critical care during a global surgical period" together into new section "Critical care and modifier 25"

Updates section "Provide two types of E/M services on the same day for the same patient" and renames it "Coding two types of E/M services on the same day for the same patient"

Deletes section "Medicare regulations" – replacing it with specific official source citations throughout the chapter

Modifier 25 vs. 57

Updates section "Clear confusion with modifier 25 & 57 checklist"

Deletes sections "Critical care during a global surgical period" (see "Critical care and modifier 25") and "Correct coding and modifier 57"

July 2011:

Chapter

Description of changes

Advance Beneficiary
Notice of Noncoverage

Updates section "CMS revised ABN form"

Updates section "Correct modifiers for claims expected to be denied: GA, GX, GY, GZ" and renames it "Use G-modifiers for claims expected to be denied"

Folds section "Points to remember" into new section "More tips on how to use an ABN correctly"

Deletes section "Limitation of liability for payment"

Modifier 24

Updates section "Overview"

Folds sections "Medicare and CPT guidelines differ on use of -24," "How to bill an E/M during a global for unrelated care" and "Unrelated diagnosis eases use of -24" into new section "A checklist for using modifier 24 correctly"

Adds new section "Two more tips for properly using modifier 24"

Adds new section "Billing for counseling in a postoperative period"

Deletes section "Only use -24 with the same physician"

Teaching Physicians

Adds new sections:

Updates section "Teaching physician G-modifiers"

Splits out section "PATH audit results: The University of Pennsylvania" from deleted section "Supervising physicians in teaching settings"

Deletes section "Tips"

June 2011:

Chapter

Description of changes

Endoscopy Coding

Updates section "Colonoscopy coverage" and renames it "Coverage of an 'interrupted' colonoscopy"

Updates section "Coverage criteria for colorectal cancer screening"

Adds new section "Use new modifier PT when a colorectal screen becomes a diagnostic service"

Modifiers

Adds new section "PT, 33 modifiers address screenings that become diagnostic/therapeutic"

Folds sections "Modifier GE"into section "Teaching physician modifiers: Modifier GC" and renamed it "Teaching physician modifiers"

Deletes section "Use GY, GZ and GA to receive wanted denials"

Updates section "G-modifiers tell Medicare you're using ABN correctly"

Updates section "Modifier KX denotes documentation"

Preventive Medicine

Adds new section "Use modifier 33 for screenings that become diagnostic/ therapeutic"

May 2011:

Chapter

Description of changes

HIPAA

Updates section "Overview"

Adds new section "HIPAA: Coder FAQs"

Integumentary System

Updates sections:

Adds new sections:

Updates section "Use these top tips for integumentary codes" and renames it "Use these top tips for repair (closure) codes"

Updates section "Removal of selected benign skin lesions" and renames it "Medicare coverage of benign lesion destruction/removal"

Updates section "Other flaps and grafts" and renames it "Don't be misled by terminology for 'free' and other flaps"

Updates section "Other procedures" and renames it "Dermabrasion and abrasion procedures"

Updates section "Pressure ulcers" and renames it "Excision of pressure ulcers"

Folds chapter "Suture Removal" and its contents into section "Suture removal"

Wound Care

Updates section "Wound coding made simple" and renames it "Wound closure coding made simple"

Updates sections:

Adds new section "Intermediate wound repairs (codes 12031-12057)"

Folds section "What is a tissue adhesive?" and "" into section "Payer preference, extent of repairs determines coding for adhesives"

Updates section "Depth of debridement one key to correct code" and renames it "Depth, surface area of debridement keys to correct code"

Deletes section "Non-physician practitioners are the focus of medicine section wound care codes"

April 2011:

Chapter

Description of changes

Diagnosis Codes – ICD-10-CM

Adds new section "Prepare for 7th characters and 'x' placeholders"

Evaluation and Management Services

Adds new section "OIG 2011 Work Plan focuses on E/M services"

Prolonged Services

Folds sections "Summary" and "Time is money: Getting paid for prolonged visits" into section "Overview"

Adds new section "Coding prolonged service for two same-day visits"

Updates section "Non face-to-face codes (99358, 99359)"

March 2011:

Chapter

Description of changes

Chart Audits

Updates section "Outside auditors: Materials they'll want to see"

Emergency Department

Updates sections

Adds new section "Tips to correct your ED service coding"

Updates and renames section "10 do's and don'ts for emergency department visits" as "Dos and don'ts for emergency department visits"

Updates and renames section "Orthopaedic procedures in the Emergency Department" as "Orthopedic procedures in the emergency department"

Updates and renames section "ER physicians: Make good use of modifier -54" as "ED physicians: Make good use of modifier 54"

Updates and renames section "X-rays/EKGs Performed in the Emergency Department" as "X-rays/EKGs performed in the emergency department"

Deletes sections

  • "Get paid for non-ER services in the ER: Meet 3 rules"
  • "ER visits versus primary care"
  • "Check out modifier -57 for billing ED visits"

Deletes section "Medicare Carriers Manual rules" – Links to online manual chapters reprinted in these sections now are provided throughout the chapter

Evaluation and Management Documentation Guidelines

Adds new section "Medicare clarifies signature legibility standards"

February 2011:

Chapter

Description of changes

Cardiology

Adds new section "Report just one unit when billing 48-hour Holters"

Hernia Repair

Adds new sections

Preventive Medicine

Folds section "Sample IPPE coding scenarios" into section "'Welcome to Medicare' exam: The rules of the road"

Updates and renames section "Medicare's covered preventive medicine services" as "More on Medicare's covered preventive medicine services"

Splits out and updates section "Medicare preventive coverage at-a-glance"

Updates and renames section "Two codes available for Medicare's smoking-cessation benefit" as "Two sets of codes available for Medicare's smoking-cessation benefit"

Renames section "Same-day preventive and 'sick visits': How to code & bill" as "Same-day preventive and 'sick visits': How to code & bill to commercial payers"

Updates section "Preventive medicine questions and answers"

Deletes section "Medicare rules on preventive services" – Links to online manual chapters reprinted in these sections now are provided throughout the chapter

Deletes sections:

  • "General screening rules: Medicare"
  • "Exceptions to the statutory screening exclusions"
  • "Medicare retires G0107 to enhance clarity in FOBT codes"
  • "The 1-2-3s of Medicare preventive/problem visit carve-outs"
  • "Carving out the dollars for 'combined' visits"
  • "Preventive and covered services at the same visit: An equation"
  • "E/M or preventive codes: Which do you use when patients present with a chronic condition?"

January 2011:

Chapter

Description of changes

Evaluation and Management Services

Moves section "Prepare to provide annual wellness visits: what you need to know" under the Preventive Services chapter

Hernia Repair
(New chapter)

Adds new sections

Injections: Vaccines

Adds new section "New for 2011: Vaccine administration codes that allow separate reporting of components"

Updates sections

Updates and renames section "Traditional flu vaccinations" as "Seasonal flu vaccinations"

Updates and renames section "H1N1 (swine) flu vaccinations" as "H1N1 (swine) flu vaccinations – Archived"

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