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1 Wolters-Kluwer Auditing Your Interventional Radiology Reports to Insure Complete and Compliant Reimbursement Jeff Majchrzak, BA, RCC, CIRCC Vice President Radiology and Cardiology Consulting Services

2 Disclaimer Panacea Healthcare Solutions, Inc. has prepared this seminar using official Centers for Medicare and Medicaid Services (CMS) documents and other pertinent regulatory and industry resources. It is designed to provide accurate and authoritative information on the subject matter. Every reasonable effort has been made to ensure its accuracy. Nevertheless, the ultimate responsibility for correct use of the coding system and the publication lies with the user. Panacea Healthcare Solutions, Inc., its employees, agents and staff make no representation, warranty or guarantee that this information is error-free or that the use of this material will prevent differences of opinion or disputes with payers. The company will bear no responsibility or liability for the results or consequences of the use of this material. The publication is provided as is without warranty of any kind, either expressed or implied, including, but not limited to, implied warranties or merchantability and fitness for a particular purpose. The information presented is based on the experience and interpretation of the publisher. Though all of the information has been carefully researched and checked for accuracy and completeness, the publisher does not accept any responsibility or liability with regard to errors, omissions, misuse or misinterpretation. Current Procedural Terminology (CPT ) is copyright 2016 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT is a trademark of the American Medical Association. Copyright 2017 by Panacea Healthcare Solutions, Inc. All rights reserved. No part of this presentation may be reproduced in any form whatsoever without written permission from the publisher Published by Panacea Healthcare Solutions, Inc., 287 East Sixth Street, Suite 400, St. Paul, MN,

3 Agenda Identify key resources needed to succeed in IR coding Understand Best Practice documentation Increase your skills in identifying final report Learn common pitfalls in IR coding and how to correct them Review of sample reports 3

4 Tools that make you better prepared and more efficient CPT, HCPCS,CCI, Netters, CMS sites, MLM IR pubs You must read, know and understand what CPT says to correctly and compliantly assign codes. The CPT manual is turning into a true coding guide. See narrative text preceding codes 4

5 Tools that make you better prepared and more efficient To code correctly for IR services, you need an in-depth knowledge of anatomy and physiology, a thorough understanding of how to use the revised CPT codes, and a familiarity of some key terms. Remember, codes are not based upon who did the procedure, but what was done. Two helpful references for all anatomy are pictured below: 5

6 Tools that make you better prepared and more efficient Interventional Radiology Coder Basics of Interventional Radiology Coding by MedLearn Publishing (800)

7 Tools that make you better prepared and more efficient Interventional Radiology Coders Users Guide and Supplements, by SIR (703) or 7

8 Tools that make you better prepared and more efficient Procedural Coding Manuals and References CPT-4 Procedural Coding ICD-10-CM Diagnosis Coding 8

9 Tools that make you better prepared and more efficient American Medical Association CPT Assistant Authoritative Guidance CPT Changes An Insider s View 2017 Clinical Examples in Radiology 9

10 Tools that make you better prepared and more efficient (Correct Coding Initiative [CCI] Information) 10

11 Correct Coding Initiative (CCI) Information Sources of Information about NCCI and MUE The CMS website contains: 1. National Correct Coding Initiative Policy Manual for Medicare Services ( 2. NCCI PTP edits utilized for practitioner claims ( Edits.html) 3. NCCI PTP edits utilized for outpatient hospital claims in the Outpatient Code Editor (OCE) ( Edits.html) 4. NCCI and MUE Frequently Asked Questions (FAQ) ( 5. MUE Overview ( 11

12 Correct Coding Initiative (CCI) Information 6. HCPCS/CPT codes with published MUE values in the Practitioner Services MUE table ( 7. HCPCS/CPT codes with published MUE values in the Facility / Hospital Outpatient Services MUE table ( 8. HCPCS/CPT codes with published MUE values in the Durable Medical Equipment (DME) Supplier Services MUE table ( 9. Current quarterly version update changes for NCCI PTP edits and published MUEs Changes.html) 10. Add-on code edits utilized for practitioner claims ( Edits.html) 12

13 Correct Coding Initiative (CCI) Information 11. Current quarterly updates to add-on code edits ( Edits.html) 12. Medicare Learning Network Publication: Medicare Claim Review Programs: MR, NCCI Edits, MUEs, CERT, and Recovery Audit Program ( MLN/MLNProducts/downloads/MCRPBooklet.pdf) 13. Medicare Learning Network Publication: How to Use the National Correct Coding Initiative (NCCI) Tools ( 13

14 Tools that make you better prepared and more efficient Modifiers (CMS Info) Medicare Claims Processing Manual Chapter 23 - Fee Schedule Administration and Coding Requirements Guidance/Guidance/Manuals/downloads/clm104c23.pdf Guidance/Guidance/Manuals/Downloads/clm104c04.pdf 14

15 Tools that make you better prepared and more efficient (OPPS Modifier Info) 15

16 Tools that make you better prepared and more efficient (CMS Modifier Info) 16

17 Tools that make you better prepared and more efficient Modifiers A modifier provides a method by which the reporting entity (hospital or physician) can indicate a service or procedure which has been performed has been altered by some specific circumstance, yet not changed in its definition or code. Payers may require modifiers to allow specificity. While not all inclusive of every modifier that may be necessary in radiology, consider the following examples: -26 Professional component -LT/-RT The side on which the procedure was done -22 Procedure was more involved than what the code states -62 More than one surgeon was involved 17

18 Supporting what was performed Best Practice Use language that correlates to CPT CPT does not differentiate based upon who did the exam or what supply or device was used For example: See CPT language prior to lower extremity endovascular revascularization procedures These codes include balloon angioplasty (e.g., low-profile, cutting balloon, cryoplasty), atherectomy (e.g., directional, rotational, laser) and stenting (e.g., balloon-expandable, self-expanding, bare metal, covered, drug-eluting). Assume whoever is reading the report is not clinical Use language that anyone can match-up to what CPT says. 18

19 Supporting what was performed Best Practice Example: CPT describes differences between internal, external, catheter and stent regarding Biliary procedures. An external biliary drainage catheter is a catheter placed into a bile duct that does not terminate in bowel, and that drains bile externally only. An internal external biliary drainage catheter is a single, externally accessible catheter that terminates in the small intestine, and may drain bile into the small intestine and / or externally. A stent, as used in this code set, is a percutaneously placed device (e.g., self expanding metallic mesh stent, plastic tube) that is positioned within the biliary tree and is completely internal, with no portion extending outside the patient. First think about the procedure, then the definitions and how they fit relative to CPT. Another thought toto help choose and assign the correct code is: If you can see it with the naked eye or physically touch it, it is a catheter If you know its there, but cannot touch it or see it with the naked eye, it s a stent 19

20 Supporting what was performed- Best Practice Logically, these same terms apply to the GU world as well. Think of the terms: J-J stent Double -J stent Pigtail stent Nephroureteral catheter Nephroureteral stent Internal / external stent Universal stent Not all stents are coded as stents! 20

21 Increasing your coding skills What are key phrases Providers can assist you by using key language that correlates to what CPT says, not the vendor name, trade name or internal descriptions Simple terms help lead you to correct code(s) Non-selective Selective Vascular family Contralateral Ipsilateral Stent Catheter 21

22 Troublesome things Pitfalls in IR Coding Inherently, because of bundling there are problems One-size fits all approach CMS and 75% Bundling / Collapsing 3 main ways that one still may code for invasive / interventional radiology procedures Component coding Abdominal aortogram, bilateral lower extremity arteriogram, catheter in aorta (75625, 75716, 36200) Complete procedure code Carotid stent placement (37215 or 37216), TIPS (37182 or 37183) Hybrid bundling PTA of left anterior tibial and posterior tibial arteries after initial diagnostic imaging of the left lower extremity as well as additional selective diagnostic exams of the anterior tibial, posterior tibial and peroneal arteries (75710, x3, 37228, 37232) Diagnostic imaging of an upper extremity AV Circuit followed by thrombectomy of arterial anastomosis as well as embolization of three separate outflow veins. From a second approach, catheter placement upstream of the arterial anastomosis and into the native arterial system with flow of the forearm and hand to examine steal syndrome. (36904, 36909, 75710, 36215) 22

23 Sample Reports Abdominal aortography with bilateral lower extremity angiography Selective renal arteriography Antegrade pyelography with percutaneous nephrostomy catheter placement PTC with right and left internal / external biliary drainage catheters Dialysis circuit imaging with thrombectomy and central venous angioplasty 23

24 QUESTIONS? Thank you! Jeff Majchrzak, BA, RCC, CIRCC

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