More good news - COBGC, AAPC National Conference and the 2011 code changes - keep up we're moving quickly....

COBGC? I have new letters after my name!

Whew!!!After stressing over whether or not I would pass the AAPC specialty exam for OB/GYN I have officially received the good news. I passed the test, and can now add another credential to my name. However, passing the test just reaffirms my drive to keep pursuing excellence in the coding realm. The test was very challenging, and it really made me “step out of the box” to view surgery and different scenario’s for the OB/GYN setting. Now, I just have to figure out what my next 'educational' goal will be.....

More good news… I was picked up by the AAPC to present at the National Convention in Long Beach, CA this year in April. I will be bringing my presentation on robotic assists in the operating room highlighting the daVinici device, and how it is used in a multitude of surgical applications and surgical specialties. I'll be presenting on the last day of the conference. We will have a lot of good presenters, and educational information for coders. If you can attend, it's a good time and lots of good info to go around.

But…back to the "big stuff" ... Since this is the beginning of 2011, be sure to crack open your new CPT & HCPCS books, and really take a look at all the changes within. There are a lot of changes to be had in the 2011 books. In my last post, I discussed the changes to debridement codes. , below, I've touched on the new subsequent daily codes for observation services in the hospital.

Evaluation and Management

New CPT codes for Observation Subsequent Care codes. These codes are used for all subsequent days following an admission to Observation status prior to discharge

99224- Subsequent observation care- per day- requires 2 out of 3 components

-problem focused history

-problem focused exam

-Medical decision making straightforward or low complexity

99225- Subsequent observation care- per day- requires 2 out of 3 components

- expanded problem focused history

- expanded problem focused exam

- Medical decision making moderate complexity

99226- Subsequent observation care- per day- requires 2 out of 3 components

- detailed history

- detailed exam

- Medical decision making high complexity

The other hot-button changes you will want to be looking at is the Medicare changes for the “welcome to Medicare” physical (wellness benefits) and the new annual wellness visit. Be sure to review the codes in your HCPCS book for specific documentation requirements that are pertinent for Medicare.

G0438- Annual wellness visit (AWV) First AWF (billable 1 year after Welcome to Medicare exam if performed on first year of Medicare)

G0439- Annual wellness visit (AWV) Subsequent years AWF

Then last, but not least -- keep an eye on the “consultation” codes for your private payers. Even though the Government payers such as Medicare/Medicaid/Tricare no longer recognize them or pay for consultation codes, does not mean consultation codes are not valid or cannot be used for private payers.

If you are receiving denials for usage of the consultation codes, you will want to appeal. Be sure to verify if you have a contract with that payer stating they no longer recognize those codes.

till next time.... Happy coding…

Debridement -Integumentary vs/Medicine Codes

Debridement & 2011 Coding advice..

Debridement codes can be confusing for coders…. Especially when you can/should/could use the integumentary codes such as 11042 (11040&11041 have been deleted for 2011) OR the Medicine codes of 97597/97598. I found this article that was posted in “Hot Coding Topics” that helps clarify which to use… Check it out below…. If you’re still confused.. shoot me an e-mail and I’ll try to help clear it up for you.

Happy Coding…. L : )

Clear The Smoke On Debridement And Active Wound Care Codes

by dchandhok in Hot Coding Topics

Confused about when to choose a debridement code and an active wound code? CPT 2011 is here to your rescue with revised debridement code guidelines that clarify how to choose between the two code groups — and the key word that will tighten up your coding is depth.

“Depth is the only documentation item you need to determine the correct code,” explained Chad Rubin, MD, FACS, AMA Specialty Society Relative Value Scale Update Committee (RUC) Alternate Member with Albert E. Bothe, Jr. MD, FACS, American College of Surgeons, AMA CPT Editorial Panel Member at their joint presentation “General Surgery” at last month’s CPT Symposium in Chicago.

Active wound care, which has a 0 day global period, is for active wound care of the skin, dermis, or epidermis. For deeper wound care, use debridement codes in the appropriate location.

Example: Codes 11040 (Debridement; skin, partial thickness) and 11041 (…full thickness) have been deleted. The parenthetical note under the codes’ deletion reads, “For debridement of skin, i.e., epidermis and/or dermis only, see 97597, 97598.” The codes are revised for 2011 to reflect this change. For instance, the revision for code 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less) removes “Skin, and” and adds after subcutaneous tissue “includes epidermis and dermis, if performed.”

Code 97597 is revised to (Debridement [e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], open wound, [e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm], including topical application[s], wound assessment, use of a whirlpool, when performed and instruction[s] for ongoing care, per session, total wound[s] surface area; first 20 sq cm or less]).

Code 97597’s revision involves “mainly rewording to make clear how active wound care is separate from integumentary wound care,” Bothe explained.

CPT 2011 also includes guidelines that indicate two requirements for active wound care management. These guidelines stress the following, which you should look for in the documentation to support billing these procedures:

Intent: “Active wound care procedures are performed to remove devitalized and/ or necrotic tissue and promote healing.” Contact: “Direct patient contact is required.”

BIG NEWS for me & a Podiatry coding issue....

Big news I want to share… (and education too!)

I have received good news from the AAPC this week. I just have to share with all of my blog followers. I have been chosen to speak at the national AAPC conference in April of 2011. It will be held in Long Beach, CA. I will be presenting on the daVinici robotic assist device utilized in a variety of surgeries. This is a presentation that is near and dear to my heart, as the surgeons that I work with, show me what successes they have every day utilizing this incredible robotic system.

I presented this educational session at our local chapter meeting in Boise, and had some GREAT feedback. If you would like to have the opportunity to see my presentation in Long Beach, here’s a quick link to see what the AAPC has out on the website regarding the conference.
http://www.aapc.com/medical-coding-education/conferences/national/longbeach/index.aspx

I have also submitted this presentation to AHIMA, and am hopeful that I will get the opportunity to bring this to the AHIMA national conference in Salt Lake City in October 2011. I’ve got my fingers crossed that they’ll pick it up too.

And now….. back to our educational blog……..

Tenotomy – Toe: Percutaneous vs/Open procedure codes.

I was coding podiatry op reports, and came across an issue from the podiatrist. He wanted me to code/bill for an “open” hammer toe tenotomy (code 28232) that was performed in the office.

When I reviewed the documentation, it was really a “percutaneous” hammer toe tenotomy (code 28010) that he performed and he noted it as such. He did the release of the tendon with a needle.

The key CPT notation between these two procedures is the “percutaneous” vs/the “incisional” modality in the provider’s documentation. Because the podiatrist stated he did this procedure “percutaneously” I was able to code/bill this correctly. If you are unable to determine how the procedure was performed, do not “guess” or “assume”. Query your provider, then have them amend or update the documentation to clarify the procedure prior to the billing of your claim.

Definition of both procedures are:

Code 28010 Tenotomy, percutaneous, toe; single tendon

“This procedure is performed to correct mallet or hammer toe. The physician makes a small percutaneous incision at the crease of the toe where the tendon is restricted. The tendon is released from the bone and the toe is straightened. The incision is sutured and dressing applied. “

Code 28232 Tenotomy, open, tendon flexor; toe, single tendon (separate procedure)

“This procedure is often done for repair of hammer toe. A small incision is made on the crease of the toe on the bottom of the foot. The skin is reflected and the tendon is exposed. The tendon is released from its attachment site allowing the toe to extend. This is usually is accompanied by other procedures. The incision is closed with sutures and a soft dressing is applied. Report 28234 if the incision is made on the dorsal toe and the extensor tendon is released”

Thanks again for allowing me to share my experiences with you, and I hope that I get the opportunity to meet you in person in Long Beach! HAPPY CODING!