Is Unspecified Sometimes the Correct Option?

Transcription

1 Corpectomy or ACDF? March 3, 2016 Our orthopaedic spine surgeon recently attended a presentation sponsored by a vendor other than your firm. The surgeon returned to the office and was told that he could bill a corpectomy code in the anterior spine if he documented, scraping or smoothing of vertebral endplates. He told me we had missed out on a lot of reimbursement because I was only coding these as a traditional ACDF procedure. Was I wrong in how I coded these procedures, and if yes, should I go back and submit a corrected claim? No, you were absolutely correct in not interpreting this work as a corpectomy. This work is included as you correctly stated in the ACDF procedure assuming all other appropriate work is performed and documented. of 03/03/16. Is Unspecified Sometimes the Correct Option? February 18, 2016 If a patient presented with symptoms of a meniscal tear in the right knee, but the type and location were not known without an MRI, would it be correct to report an unspecified code

2 for right meniscal tear? Yes, it is correct to report the unspecified code (S83.206A Unspecified tear of unspecified meniscus, current injury, right knee, initial encounter). The ICD-10-CM guidelines state, unspecified codes should be reported when they are the codes that most accurately reflects what is known about the patient s condition at the time of that particular encounter. It would be inappropriate to select a specific code that is not supported by the medical record documentation. of 02/18/16. ICD 10: Aftercare Z Codes or 7th Character Code? UPDATED February 4, 2016 Patient has been seen in office during the global period after a rotator cuff repair for a sprain. No X-rays were taken. Internally we will record Would we assign Z47.89 or the sprain code to 99024? Thanks for your inquiry as your question gives us an opportunity to address documentation requirements and how sprains and strains are delineated in ICD-10-CM.

3 First, under ICD-10-CM descriptions, an acute injury to the rotator cuff muscle or tendon is described as a strain, under the subcategory S46,01-, not as a sprain. Although there is also an ICD code for sprain of the rotator cuff capsule, S43.42-, that is not the structure that typically injured. If you ve determined that the problem is an injury, you will look to the S codes; if it is a chronic or recurrent problem, you will look to the M codes. The ICD-10-CM options for a rotator cuff strain are: S Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder S Strain of muscle(s) and tendon(s) of the rotator cuff of left shoulder S Strain of muscle(s) and tendon(s) of the rotator cuff of unspecified shoulder Ideally the physician will document whether the strain affects the right or left shoulder; use of the unspecified code is reserved for cases when the laterality is not described. If the patient is seen in the global period for the injury, then the 7th character D is applied to indicate routine healing following active treatment of an injury. If the surgery was done to treat a chronic or degenerative condition coded from the M chapter, you will report Z47.89, Encounter for other orthopedic aftercare, provided the followup is uncomplicated. of 02/4/16.

4 Lysis of Adhesions In the Shoulder January 14, 2016 We are having a debate in our office we hope you can help unravel. We want to report CPT code and together but our Coding Companion states that they are inclusive to each other and are bundled. Our surgeon is questioning the accuracy of this information. Your surgeon is correct to question this information. CPT code describes arthroscopic lysis of adhesions; CPT code describes an arthroscopic rotator cuff repair. According to the AAOS Global Service Data Guide, these two procedures are exclusive to each other. Each procedure is supported by the medical necessity of two separate conditions and have separately identifiable diagnosis codes. If your Coding Companion is based on Medicare payment rules, you will see the two services as bundled together. This is where it is important to understand the differences between CPT coding rules and Medicare payment rules. For Medicare Part B carriers, you would not report the two codes together as there is an NCCI edit in place; CMS considers shoulders procedures on the ipsilateral procedure inclusive to each other when an edit exists thus, a modifier may not be applied (e.g. 59, XU) to the code combination. In your scenario, only the rotator cuff repair is reportable to Medicare Part B (remember, NCCI edits are for Medicare Part B and may apply to Medicaid also). For private payors who follow CPT rules, the code combination is reportable together and represents correct coding.

5 of 01/14/16. Are Cast Re-Applications Included in the Global Period? December 17, 2015 We are hospital employed and are being told that we cannot bill for cast re-applications in the global period. An article posted in the AAOS coding column tells us that cast reapplications are separately reportable and to append a modifier 58. We also understand that modifier 58 restarts the global period. In my old job, I was told by a billing company that post-op casting was included in the global period and was not payable unless there was a complication with the cast. Is a cast re-application billable in the global period when medically necessary and will the global period re-start? Thanks for your inquiry. For some readers this will be a very mundane question, but we are hearing this question more and more frequently so this is a good time to re-address how to report the services and why the services are reportable. Let s answer the first question first. Are cast reapplications billing during the global period? Yes! The first cast is inclusive to the global surgical CPT code, but reapplications are billable, assuming of course, that medical necessity is present. The following is the CPT citation: The

6 very first sentence in the Application of Casts and Strapping section of CPT states, The listed procedures apply when the cast application or strapping is a replacement procedure used during or after the period of follow-up care, or when the cast application or strapping is an initial service performed without a restorative treatment or procedure(s) to stabilize or protect a fracture, injury, or dislocation and/or to afford comfort to a patient. The answer to the second question is no, the global period will not re-start because splints and cast CPT codes have zero global days; as such, the global days cannot be reset or restarted. of 12/17/15. Therapy Services 12/03/15 We have a massage therapist employed in our office who is being supervised by our physical therapist. Our question: when we bill to Medicare, does the supervising therapist have to sign the massage therapist s notes agreeing with the care provided that day and the plan of care? Therapy services performed by a massage therapist are not reportable by the therapist Incident-To. A therapist may supervise a PTA for Medicare and bill if all rules are met; a massage therapist does not meet the qualified provider rules

7 for therapy according to Medicare. of 12/03/15. Incident-To or Not? November 5, 2015 A physician assistant sees a Medicare patient in the emergency room independently. Can this visit be billed under the name and NPI of her supervising physician who did not see the patient? No, Incident-To services do not apply to hospital-based services, nor do they apply to new patients or patients with new problems. This service must be reported under the NPI of the physician assistant who performed the service in the emergency room. of 11/05/15. Meniscectomy vs. Meniscal Repair October 22, 2015

8 Can you please clarify how to report the following procedure: The surgeon documented medial meniscal repair followed by a medial meniscectomy, both performed in the right leg. There are NCCI edits between the two codes showing payable and with a Column 2 edit. Do we code the repair or the meniscectomy since both were performed? The surgeon will be paid more if I report the if I can only report one code. I am not sure if I can report both codes for the same leg or not? Based on your scenario, both the repair and the meniscectomy were performed in the medial compartment. What is missing in your question is the actual documentation. Based on experience, we assume the surgeon attempted a medial meniscal repair that would not hold and converted to a medial meniscectomy. Both procedures were performed in the same compartment, same knee, making CPT code the most appropriate code. of 10/22/15. Infected Knee October 8, 2015 Will you please direct this question to Mary LeGrand? I was consulted to evaluate a patient to rule out a septic knee. I saw the patient in the morning and aspirated the joint; the fluid was cloudy and sent to pathology. Later that day I was notified of an increased cell count and decided to take the

9 patient to the OR later that day for an arthrotomy with lavage. My coder is telling me that I cannot bill CPT code with the arthrotomy because of a Medicare payment edit. This makes no sense to me. Can you advise if I am able to report this aspiration or not? Thanks for your inquiry. Yes, the aspiration is reportable with CPT code as you note. You may also report the arthrotomy with knee lavage; for example, CPT code Your coder is correct in that an NCCI edit is present between the two codes when performed on the same knee, same session. However, in your scenario, they are performed same day, different sessions. Append a modifier 59 (distinct procedure) to CPT code to indicate the aspiration occurred at a different session on the same day. If your Medicare carrier has instructed to use the new X modifiers instead of modifier 59 to indicate the separate encounter, you would report XE instead of Your service will be reported one of two ways: Or XE of 10/08/15. Medicare: Debridement

10 Services in the Shoulder September 24, 2015 We attend courses and receive education from KZA consistently on orthopaedic coding. Our practice recently hired a new billing manager and she states that the information we have been given is incorrect for Medicare related to arthroscopic debridement services. The billing managers external resource told her that or can be reported with other arthroscopic shoulder services as long there is no NCCI edit in place. We are telling the new manager that this is incorrect for Medicare. Can you please help validate what we perceived we heard from KZA is correct? To re-state, our question evolves around reporting debridement services (CPT codes and 29823) to Medicare when the patient has other arthroscopic shoulder procedures on the same shoulder. We understood, and have told the new billing manager, that the debridement services are considered inclusive to other arthroscopic procedures performed and reported on the same day if the debridement services are performed on the same shoulder. Our manager is telling us that if there is no edit in place, for example with CPT code and 29822, that we can report both to Medicare. Again, for clarification, she cites a non-kza resource person. Thanks for your loyalty and reaching out. Based on the information provided, you accurately perceived the instructions for reporting arthroscopic shoulder procedures to Medicare. While there are no NCCI edits between some of the arthroscopic procedures and either CPT code or 29823, it is considered incorrect coding to report one of these debridement codes in addition to other arthroscopic shoulder procedures performed on the ipsilateral or same shoulder. One

11 common error in coding according to Column 1 and Column 2 code edits is assuming if there is no edit, that the code combination may be reported together. The following source information used by KZA in all orthopaedic instructions is found in the January 2015 NCCI Musculoskeletal Chapter 4: 4. With the exception of the knee joint, arthroscopic debridement should not be reported separately with a surgical arthroscopy procedure when performed on the same joint at the same patient encounter. For knee joint arthroscopic debridement see the following paragraph. While a Column 1 or Column 2 edit may not exist in the Excel database, these written guidelines provide additional coding information in addition to the Column 1 and Column 2 edit. CPT codes or are not reportable with other arthroscopic shoulder procedures on the same shoulder, same session. of 09/24/15.