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AAPC May 2, 2007
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Issue #76

Top Stories

Get A Sneak Peek At the New ICD-9-CM Codes

Don't Let Synvisc Coding Rules Confuse You

Modifier 57 Helps You Demonstrate Decision for Surgery

The Edge Blast Wants Your Articles!


Test Yourself

UB-92 Use Ends May 22

The UB-92 will not be accepted by CMS after May 22, 2007.
The National Uniform Billing Committee (NUBC) is replacing the UB-92 with the UB-04 paper form. The Health Insurance Portability and Accountability Act (HIPAA) requires submission of National Provider Identifiers (NPIs) on claims effective May 23, 2007, and the UB-92 does not have a field for reporting of NPIs. During the period March 1, 2007 through May 22, 2007, providers that use paper forms for claim submission will be able to submit either the UB-92 or the UB-04 form.
More information about the transition is available from the NUBC Web site (http://www.nubc.org/). The UB-04 will retain the CMS-1450 designation.


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Torrey Kim Top News

by Torrey Kim, CPC

Get A Sneak Peek At the New ICD-9-CM Codes

If you're looking for new codes to describe lymphoma, hearing loss, dysphagia or several other conditions, your wish will be granted on Oct. 1, when the new batch of ICD-9-CM codes will go into effect.

CMS released a preliminary list of the new, revised and deleted diagnosis codes effective Oct. 1, and although CMS plans to add more codes to the lists, the sneak peak offers some great news for coders who felt their claims could use more specificity.

Many of the new codes describe various types of lymphoma. For example, ICD-9-CM will add an entire new subsection under the 200 series (Lymphosarcoma and reticulosarcoma). In the past, the codes jumped from 200.2x to 200.8x, but now you’ll find new codes to fill in the gaps.

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Don't Let Synvisc Coding Rules Confuse You

Coders who were surprised to find the Synvisc and Hyalgan code J7317 missing from HCPCS 2007, but were relieved to find the replacement code J7319 in its place, may have started noticing denials for these services. That’s because J7319 has already been deleted and replaced with four “Q” codes that describe various drugs that the physician may inject.

CMS retired J7317 (Sodium hyaluronate, per 20 to 25 mg dose for intra-articular injection) at the end of 2006, although you should still report J7317 for any dates of service through Dec. 31, 2006.

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Modifier 57 Helps You Demonstrate Decision for Surgery

Contrary to popular belief, modifier 25 doesn't fit the bill for all of your physician's E/M visits when performed with other procedures. Often, you'll find that modifier 57 more appropriately suits your claim.

You can make the most of modifier 57 by using it only if the E/M service occurs on the same day of, or the day before, the surgical procedure, and the E/M directly leads the physician to the decision to perform surgery.

If the physician schedules a surgery and then later performs an E/M service on the patient the day before surgery (for example, a preoperative clearance), you cannot append modifier 57 to the preop visit, because the physician decided to perform the surgery long before the patient presented for the preop visit.

CPT® states that a global period includes "one related E/M encounter on the date immediately prior to or on the date of procedure (including history and physical [H&P])." Therefore, the preoperative visit is bundled into the surgical code, unless the physician performs the E/M that leads him or her to the decision for surgery.

Most insurers only allow you to append modifier 57 to E/M codes when the surgery performed has a 90 day global period, although CPT® doesn't designate a specific time frame, so check with your insurer before you use modifier 57.

You should always append modifier 57 to the E/M service code, not the surgical procedure code.

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The EdgeBlast Wants Your Articles!

The EdgeBlast and the Cutting Edge are always looking for articles from our AAPC members. If you would like to contribute an article for either of these publications, please contact our editor, Torrey Kim, CPC at torrey.kim@aapc.com. We’re hoping to hear from you!

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Test Yourself

By answering the following questions you can earn .5 continuing education units to apply toward your annual AAPC certification renewal. Simply answer the questions and send in a copy of your work when submitting your CEU package. Include the number of each EdgeBlast on your submission (example: #76). The number is available at the top of the page.

Answers to the questions are not always found directly (word for word) in the EdgeBlast in which they appear. While often related to the EdgeBlast content, they require additional resources such as your ICD-9-CM, CPT® and HCPCS manuals.

1. Effective Oct. 1, 2007, which ICD-9-CM code should you report for "mixed hearing loss, bilateral"?

Answer:

2. Suppose the physician performs a skin biopsy and a level three consultation during the same visit. Which CPT® codes and modifier(s) should you report?

Answer:

3. Which HCPCS code should you report when the physician injects Orthovisc?

Answer:

4. The physician diagnoses a displaced distal radial fracture during an E/M visit, and reduces the fracture in the office during the same visit. Which modifier should you append to the E/M code?

Answer:

5. Effective Oct. 1, 2007, which ICD-9-CM code should you report for marginal zone lymphoma of the spleen?

Answer:

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Copyright ©2007 AAPC

CPT® codes copyright 2006 American Medical Association. All Rights Reserved.
CPT® is a trademark of the AMA.
No fee schedules, basic units, relative values or related listings are included in CPT®.
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