Pulmonology Coding Alert

Hint: Get acquainted with your carriers' LCDs One of the biggest challenges coders face is deciphering individual carrier guidelines on how to code procedures and services. Review these expert tips that will keep you organized so you can choose the right pulmonology code and modifier regardless of payer differences.
 
Here's how to keep straight who wants what. 1. Chart Those Choices Best bet: Set up a spreadsheet to keep track of frequently applicable payer policies and quirky filing requirements. In this spreadsheet, you should also note which codes each payer accepts for common procedures, which codes they never accept, which diagnosis codes they allow for each procedure code, which modifiers the payer allows, and how you should report them. Keeping a spreadsheet means that you've got who wants what already ironed out.
 
"We have a notebook divided by payer with specifics for each. We use this information for discussions with providers," says Nancy Lynn Reading, RN, BS, CPC, a coding educator with University Medical Billing at the University of Utah in Draper.
 
Example: You may have one payer that wants you to place "2" in the units box if you use modifier 50 (Bilateral procedure) and another that wants you to place "1" in the units box for that modifier, so you should make sure this information is at hand in your spreadsheet.

2. Don't Let Your Guard Down To stay current on your payers' policies, you have to dig through their newsletters and Web sites. Because CMS has made a point of going paperless, you have to be doubly vigilant in checking for Medicare and Medicaid online bulletins.
 
Good practice: "I check our major local and national payers' as well as Medicare's newsletters and policies the first week of every month," says Anne Karl, RHIA, CCS-P, CPC, coding and compliance specialist at St. Paul Heart Clinic in Mendota Heights, Minn. "It's very beneficial to keep up on what new edits may be coming."
 
What to do: If your patient is covered by TrailBlazer Health in Texas, and you go to this Medicare carrier's Web site (www.trailblazerhealth.com), in the center of the page you'll see a "What's New" column to help you keep up with the latest information.
 
If you have a question about a specific policy, click on "Texas" under "Part B" on the left side of the screen. Then to find a policy for a particular procedure, click on "LCD (Local Coverage Determination)" in the left column. You can search by the name of the procedure or the CPT code.
 
Example: You have a report of a patient with documented asthma and shortness of breath, and the pulmonologist wants the patient to undergo spirometry testing before and after bronchodilator. You want to make sure [...]