GI Coding Updates for 2012 Top 10 Errors to Avoid in 2012

Transcription

1 GI Coding Updates for 2012 Top 10 Errors to Avoid in 2012 Shelly Cronin, CPC, CPMA, CGSC, CGIC, CANPC 1 CPT copyright 2010 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association

2 Agenda GI Coding Updates for 2012 New Acronyms/Abbreviations ICD-9-CM Diagnosis Code Changes Current Procedural Terminology (CPT) Top 10 Errors to Avoid in New Acronyms/Abbreviations AIP (Acute Interstitial Pneumonia) ASD s (Autism Spectrum Disorders) AVM (Arteriovenous Malformation) CBD (Corticobasal Degeneration) CLABSI (Central line-associated bloodstream infections) DD (Developmental Disabilities) G-CSF (Granulocyte colony-stimulating factor) GM-CSF (Granulocyte-macrophage colony-stimulating factor) hcg (Human Chorionic Gonadotropin) HUS (Hemolytic Uremic Syndrome) 4 2

3 New Acronyms/Abbreviations IGRAs (Interferon Gamma Release Assays) IPF (Idiopathic Pulmonary Fibrosis) LEMS (Lambert-Eaton Myasthenic Syndrome) PBA (Pseudobulbar Affect) POAG (Primary Open Angle Glaucoma) SPN (Solitary Pulmonary Nodule) STEC (Shiga Toxin-Producing Escherichia Coli) TST (Tuberculin Skin Test) VMA (Vitreomacular Adhesions) ICD-9-CM CODE CHANGES 6 3

4 ICD-9-CM Diagnosis Code Changes E. Coli Deleted code Escherichia coli (E. coli) infection in conditions classified elsewhere and of unspecified site Added Shiga toxin-producing Escherichia coli [E. coli] (STEC) O Other specified Shiga toxin-producing Escherichia coli [E. coli] (STEC) Shiga toxin-producing Escherichia coli [E. coli] (STEC), unspecified Other and unspecified Escherichia coli [E. coli] 7 ICD-9-CM Diagnosis Code Changes Revised Encephalitis codes Other encephalitis, myelitis, and encephalomyelitis due (to other) infections classified elsewhere Other myelitis due (to other) infections classified elsewhere Changes do not change how these codes are applied New Code Nervous System & Sense Organs Brain Death 8 4

5 ICD-9-CM Diagnosis Code Changes New Code Complications of Bariatric Surgery and Gastric Band Procedures 539.0x - Complications of gastric band procedure Infection due to gastric band procedure Use additional code to specify type of infection, such as:» abscess or cellulitis of abdomen (682.2)» septicemia ( )» Use additional code to identify organism ( ) Other complications of gastric band procedure Use additional code(s) to further specify complication 9 ICD-9-CM Diagnosis Code Changes Complications of other bariatric procedure Excludes: complications of gastric band surgery ( ) 539.8x - Complications of other bariatric procedure Use additional code to specify type of infection, such as: abscess or cellulitis of abdomen (682.2) septicemia ( ) Use additional code to identify organism ( ) Other complications of other bariatric procedure Use additional code(s) to further specify complication 10 5

6 ICD-9-CM Diagnosis Code Changes New Code Injury and Poisoning: Postoperative Shock Postoperative shock, unspecified Collapse, not otherwise specified, during or resulting from a surgical procedure Failure of peripheral circulation, postoperative Postoperative shock, cardiogenic Postoperative shock, septic Postoperative endotoxic shock Postoperative gram-negative shock Code first underlying infection» Use additional code, to identify severe sepsis and any associated acute organ dysfunction, if applicable (995.92) Postoperative shock, other Postoperative hypovolemic shock 11 ICD-9-CM Diagnosis Code Changes Revised Code Other and unspecified infection due to central venous catheter New Code Bloodstream infection due to central venous catheter Local infection due to central venous catheter Acute infection following transfusion, infusion, or injection of blood and blood products 12 6

7 ICD-9-CM Diagnosis Code Changes Deleted Code Anaphylactic reaction due to serum Expanded to three new codes New Code Anaphylactic reaction due to administration of blood and blood products Anaphylactic reaction due to vaccination Anaphylactic reaction due to other serum 13 ICD-9-CM Diagnosis Code Changes Deleted Code Other serum reaction Expanded to three new codes New Code Anaphylactic reaction due to administration of blood and blood products Other serum reaction due to vaccination Other serum reaction 14 7

8 2012 CPT CODE CHANGES 15 CPT Procedure Code Changes Section headings and parenthetical instructions throughout the CPT manual have undergone significant revisions. This guide covers code changes only, and is not an exhaustive accounting of all new text and instruction within CPT. You must review the CPT manual for new instructions added for Within the CPT manual, new and/or revised section headings and parenthetical instructions are identified by green text enclosed within two opposing, green triangles ( ) Modifiers: 33 Preventive Services 16 8

9 CPT Procedure Code Changes Guideline Changes/Revisions Evaluation/Management Revised information regarding new patient s A new patient is one who has not received professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years. 17 CPT Procedure Code Changes Guideline Changes/Revisions Evaluation/Management Revised information regarding established patient s An established patient is one who has received professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years. 18 9

10 CPT Procedure Code Changes Revised Code Descriptions for Initial Observation Care codes typically 30 minutes at the bedside and on the patient s hospital floor or unit typically 50 minutes at the bedside and on the patient s hospital floor or unit typically 70 minutes at the bedside and on the patient s hospital floor or unit Change to include the time typically spent for each encounter 19 CPT Procedure Code Changes Revised Code Descriptions for Prolonged Service codes removed text physician and face-to-face removed text physician removed text physician and added the text or observation removed text physician removed text face-to-face removed text physician 20 10

11 CPT Procedure Code Changes Revised Parenthetical notes Laparoscopy, surgical; revision or removal of gastric neurostimulator electrodes, antrum (For laparoscopic implantation, revision, or removal of gastric neurostimulator electrodes, lesser curvature [morbid obesity], use 43659) Revision or removal of gastric neurostimulator electrodes, antrum, open (For open implantation, revision, or removal of gastric neurostimulator electrodes, lesser curvature [morbid obesity], use 43999) 21 CPT Procedure Code Changes Revised Parenthetical notes Anoscopy; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (For delivery of thermal energy to the muscle of the anal canal, use 0288T) 22 11

12 CPT Procedure Code Changes Biopsy of liver, needle; percutaneous Added conscious sedation symbol Moderate sedation is inherently included as part of the percutaneous needle liver biopsy 23 CPT Procedure Code Changes Deleted Codes Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); initial Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); subsequent New Codes Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance with imaging guidance Peritoneal lavage, including imaging guidance, when performed (Do not report or in conjunction with 76942, 77002, 77012, 77021) 24 12

13 Example Diagnosis: Malignant ascites Procedure: Therapeutic paracentesis The patient is explained the risks, benefits, and alternatives of the procedure abdominal paracentesis for treatment of her malignant ascites. She fully understood and wished to proceed. Pre-operative sonographic images of the abdomen show a large volume of ascites with a pocket free of bowel loops with the left lower quadrant, this will be our entry point. The overlying skin was prepped and draped 2% lidocaine was utilized for local anesthetic. A 7- french sheath needle was passed via a left lower quadrant approach into the ascitic fluid. Clear, straw-colored ascitic fluid was noted. A total of 7 liters was removed. The sheath was removed; sampling was not taken to pathology. The patient tolerated the procedure well with no apparent complications. Correct CPT code: Example Diagnosis: ascites Procedure: Ultrasound guided paracentesis Description: The patient was placed in a supine position; the abdomen was prepped and draped. The subcutaneous tissues were anesthetized with lidocaine solution. Using ultrasound to guide us, the centesis needle was advanced into the abdominal cavity. A total of 6.9 liters of clear yellow fluid was aspirated. The patient tolerated the procedure well with no immediate complications. The correct CPT code for this report would be code

14 CPT Procedure Code Changes Revised Parenthetical notes Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous Insertion of tunneled intraperitoneal catheter, with subcutaneous port (i.e., totally implantable) (49420 has been deleted. To report open placement of a tunneled intraperitoneal catheter for dialysis, use To report open or percutaneous peritoneal drainage or lavage, see 49020, 49021, 49040, 49041, , as appropriate. To report percutaneous insertion of a tunneled intraperitoneal catheter without subcutaneous port, use 49418) 27 CPT Procedure Code Changes New Code Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and imaging processing (Do not report in conjunction with 72191, 73706, 74175, 75635, 76376, 76377) (For CTA aorto-iliofemoral runoff, use 75635) Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing (Do not report in conjunction with or For CTA aortoiliofemoral runoff, use 75635) (Do not report in conjunction with For combined computed tomographic angiography abdomen and pelvis study, use ) 28 14

15 CPT Procedure Code Changes Revised Parenthetical notes Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation (For ultrasound and duplex Doppler of a transplanted kidney, do not report in conjunction with 93975, 93976) Note If the Doppler is performed on a different anatomical area or organ it would be appropriate to report the code with the codes and CPT Procedure Code Changes Revised Parenthetical notes Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; 2-dimensional data (91011, have been deleted. To report esophageal motility studies with stimulant or perfusion, use in conjunction with 91010) with stimulation or perfusion during 2- dimensional data study (eg, stimulant, acid or alkali perfusion) (List separately in addition to code for primary procedure) (To report esophageal motility studies with high resolution esophageal pressure topography, use 0240T and with stimulant or perfusion, use 0241T) 30 15

16 CPT Procedure Code Changes Category II New Codes 1031F Smoking status and exposure to second hand smoke in the home assessed (Asthma) 1032F Current tobacco smoker OR currently exposed to secondhand smoke (Asthma) 1033F Current tobacco smoker AND currently exposed to secondhand smoke (Asthma) 31 CPT Procedure Code Changes Category III New Codes 0240T - Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with 3-dimensional high resolution esophageal pressure topography (Do not report 0240T in conjunction with or 91013) +0241T - with stimulation or perfusion during 3-dimensional high resolution esophageal pressure topography study (eg, stimulant, acid or alkali perfusion) (List separately in addition to code for primary procedure) (Do not report 0241T in conjunction with or 91013) (Do not report 0241T more than once per session) (To report esophageal motility studies without high resolution esophageal pressure topography, use and with stimulant or perfusion, use 91013) 32 16

17 CPT Procedure Code Changes Category III New Codes 0288T Anoscopy, with delivery of thermal energy to the muscle of the anal canal (eg, for fecal incontinence) (Do not report 0288T in conjunction with ) 33 Example Diagnosis: Fecal Incontinence Procedure: Radiofrequency energy treatment of the anal canal Description: The patient was placed in lithotomy position; the perineum was anesthetized with lidocaine injected circumferentially. The anal canal was gently dilated and the treatment anoscope was inserted to begin the treatment 0.5cm from the dentate line in the posterior midline. The needles were deployed into the sphincter muscle, and the appropriate tissue temperature and electrical impedance were confirmed to be within normal range. Energy was administered according to the instrument based algorithm. The needles were withdrawn, the anoscope was advanced 0.5cm in the posterior midline, and the treatment was repeated for four more cycles. The entire process was repeated at the same four locations in the remaining three quadrants of the anal canal. The anal canal was inspected for any thermal injury with none noted, hemostasis was confirmed. The patient tolerated the procedure well with no immediate complications. The correct CPT code for this report would be code 0288T

18 CPT Procedure Code Changes New Modifier 33 Preventive Services When the primary purpose of the service is the delivery of an evidence based service in accordance with a US Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure. For separately reported services specifically identified as preventive, the modifier should not be used. 35 TOP 10 ERRORS TO AVOID IN 2012 FOR GI SERVICES 36 18

19 Top 10 Errors to Avoid in Incorrect coding due to misinterpretation of the documentation a) Thoroughly read the documentation b) Become familiar with your providers documentation style and the procedures performed in your office c) Talk to your providers, ask questions 37 Top 10 Errors to Avoid in Unbundling a) Update all 2011 codes to 2012 to avoid this b) Continued abuse will result in an audit a) Avoid this error, update all information, provide education and use NCCI edit tables properly 3. Not coding to the highest specificity a) Start now to prepare for ICD-10 b) Review documentation, educate providers about providing more detail c) Do not rely solely on cheat sheets 38 19

20 Top 10 Errors to Avoid in Not updating reference material a) Update superbills or charge tickets b) Review policies and procedures to account for new guidelines c) Education 5. Not reviewing payer policies a) Check for coverage and payment policy changes b) Prevent delays in reimbursement and denials 39 Top 10 Errors to Avoid in Not confirming benefits and eligibility prior to providing a service a) Allows you to inform patient of non-coverage or deductible responsibilities b) Prevent delays in reimbursement and denials 7. Not building a relationship with your providers a) Helps with communicating issues b) If not readily available develop the relationship via

21 Top 10 Errors to Avoid in Not collecting co-pays prior to providing a service a) Inform patient s prior to the appointment what payment will be expected at check-in 9. Not knowing your denial rates or top 5 denials a) If you don t know what has been denied you cannot provided education or simply correct the issue 41 Top 10 Errors to Avoid in Not continuing your education a) Strengthen your knowledge base I. Anatomy II. Pathophysiology III. medical terminology IV. Advanced coding b) Go beyond maintaining CEUs for renewal 42 21

22 THANK YOU 43 References 2012 ICD-9-CM Manual Complete 2012 ICD-9-CM Coding Updates & Rationales 2012 CPT Manual 2012 CPT : An insiders view Retina Today - July/August 2011 Supplement; Symptomatic Vitreomacular Adhesion (VMA): Diagnosis, Pathologic Implications, and Management PubMed Health U.S. National Library of Medicine 44 22