New CPT® codes that go into effect Jan. 1, 2009 will allow your lab to code more accurately for advancing diagnostic tests, according to the Coding Institute’s Pathology/Lab Coding Alert (Vol. 9, No. 11).

Let’s say, for example, that a patient presents with chest pain but shows a normal EKG and tropinin-negative test results. The physician orders serum myloperoxidase (MPO). You would have to settle for a generic code, such as 83516 Immunoassay for analyte other than infectious agent antibody or infectious agent antogen, qualitative or semiquantitative; multiple step method to describe the test. In 2009, however, you’ll code this sort of test with total clarity using CPT® code 83876 Myeloperoxidase [MPO]. Read more »

Getting paid for unlisted procedure codes can be tricky, especially if a procedure is experimental or investigational.

“It’s not unheard of to get paid for unlisted procedures, but it’s not always easy,” says Joanne Mehmert, CPC, CCS-P, in Kansas City, Mo. “The insurance company has its own definition of medical necessity.” Read more »

Working with physicians to specify what constitutes as an emergency, and correctly coding emergency room visits with +99140 Anesthesia complicated by emergency conditions (specify) (List separately in addition to code for primary anesthesia procedure) is enough to frazzle any coder’s nerves. 

Anesthesia & Pain Management Coding Alert (Vol. 10, No. 10) takes a closer look at 99140, and clarifies how you should (or shouldn’t) use it with qualifying circumstances (QC).

The Centers for Medicare & Medicaid Services (CMS) updated the therapy services chapter of the Medicare Claims Processing manual to reflect the extension of the therapy caps exceptions process to Dec. 31, 2009, mandated by the Medicare Improvements for Patients and Providers Act (MIPAA) of 2008. CMS also added HCPCS Level II coding requirements. Read more »

The Centers for Medicare & Medicaid Services (CMS) has named four personal health record (PHR) companies to participate in the Medicare PHR Choice Pilot, according to a Nov. 12 press release. The pilot will be conducted in Arizona and Utah, and is slated to begin early 2009.

The four PHR companies are: Google Health, HealthTrio, NoMoreClipboard.com, and PassportMD. Read more »

The Outpatient Prospective Payment System/Ambulatory Surgical Center Payment System (OPPS/ASC) 2009 final rule includes a 3.6 percent annual inflation update for hospital outpatient departments (HOPDs), but sets the ASC update at 0 percent. The Centers for Medicare & Medicaid Services (CMS) projects final 2009 payment rates under the OPPS will result in a 3.9 percent increase in Medicare payments for providers paid under the OPPS. CMS issued the OPPS/ASC 2009 final rule Oct. 30. Read more »

Physicians and non-physician practitioners (NPPs) who provide health care to people with Medicare can expect a pay hike next year, but just how much depends on their willingness to accept the conditions put forth in the 2009 Medicare Physician Fee Schedule (MPFS) final rule. Read more »

New Study Finds ICD-10 Mandate Hardship for Health Care Providers
Typical 10-physician practice to spend $285,240 to comply with new federal mandate

(Washington, DC)— A controversial proposed rule from the US Department of Health & Human Services (HHS) requiring all physician practices and other providers to adopt a new coding set – the ICD-10 code set – by 2011 would dramatically increase costs for physician practices and clinical laboratories, according to a new cost study initiated by a broad group of provider organizations and conducted by Nachimson Advisors. Armed with this new information, these groups call on HHS to carefully reassess its plan to rapidly adopt ICD-10 and extend the implementation time frame. The costs associated with implementing ICD-10 in such a short timeframe, are markedly higher than what CMS has estimated and will place a major burden on providers, taking valuable time away from their patients and straining other resources needed to invest in health information technology. Read more »

By John Verhovshek

The most recent CPT Assistant (vol. 18, issue 9, Sept. 2008) now clarifies that when a surgeon performs partial mastectomy with complete axillary dissection, you should report 19302 Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy.

Partial mastectomy with anything less than a complete axillary dissection, however, will call for 19301 Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy) and the appropriate lymph node biopsy code 38500 Biopsy or excision of lymph node(s); open, superficial or 38525 Biopsy or excision of lymph node(s); open, deep axillary node(s). Read more »

Scurvy, the vitamin C deficiency disease most often associated with toothless sailors, is popping up around the country among the elderly and other vulnerable patients, according to a recent article in the American Medical Association’s (AMA) AMedNews, and you may find yourself coding it. Read more »