Medicare: Debridement Services in the Shoulder

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1 Medicare: Debridement 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

2 debridement codes in addition to other arthroscopic shoulder procedures performed on the ipsilateral or same shoulder. One 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. ICD-10-CM for Otitis Media September 24, 2015 I am hoping that ICD-10-CM has codes for recurrent acute otitis media since this is one of the most common reasons why we put in tympanostomy tubes. Did this happen?

3 Yes someone must have heard you! Many of the otitis media codes now specify acute, acute recurrent, and chronic. Laterality is also a prominent issue with the ear codes. For example, serous otitis media has the following specific codes: H Acute serous otitis media (ASOM), right ear H65.02 ASOM, left ear H65.03 ASOM, bilateral ears H65.04 Acute recurrent serous otitis media (ARSOM), right ear H65.05 ARSOM, left ear H65.06 ARSOM, bilateral ears H65.21 Chronic serous otitis media (CSOM), right ear H65.22 CSOM, left ear H65.32 CSOM, bilateral ears of 09/24/15. Acellular Dermal Matrix Placement for Breast Reconstruction September 24, 2015 I m doing bilateral tissue expander breast reconstructions and will be using ADM. Is there a separate code for the ADM? Yes, there is. In addition to (Breast reconstruction, immediate or delayed, with tissue expander, including

4 subsequent expansion) you can report an add-on code, (Implantation of biologic implant (e.g., acellular dermal matrix) for soft tissue reinforcement (e.g., breast, trunk)) (List separately in addition to code for primary procedure). You can report both codes bilaterally, with modifier 50. of 09/24/15. ICD-10-CM for Bilateral Carpal Tunnel Syndrome September 10, 2015 I noticed that the ICD-10 carpal tunnel syndrome diagnosis codes are specific for right and left. What happens if the patient has bilateral carpal tunnel syndrome how should I code it? Good question, because many ICD-10-CM codes have right, left and bilateral codes; although the codes for carpal tunnel syndrome do not have a bilateral option. Here s what we ve got in ICD-10-CM for carpal tunnel syndrome: G56.01 Carpal tunnel syndrome, right upper limb G56.02 Carpal tunnel syndrome, left upper limb But there is not a code for bilateral carpal tunnel syndrome. So if the patient has bilateral carpal tunnel syndrome, you will use both ICD-10-CM codes: G56.01 and G56.02.

5 of 09/10/15. Dry Needling September 10, 2015 We are receiving conflicting information on the correct coding for a dry needling procedure. Is it possible that Mary LeGrand can answer this question for us? Thank you for reaching out to KZA for your coding needs. We are not surprised that confusion exists related to this procedure. The correct code for this procedure is an unlisted code: Unlisted procedure, musculoskeletal system, general. Remember to check payor policies and Medicare LCDs as this may be a non-covered service. of 09/10/15. ICD-10-CM for Bilateral Cerumen Impactions September 10, 2015

6 I noticed that the ICD-10 codes for many ear conditions are specific for right, left and bilateral. But what if I am billing for a bilateral procedure, such as tympanostomy tubes? Should I use the right and left codes, or should I use the bilateral code? Good question! If a bilateral code exists and the disorder is documented as bilateral, then the bilateral code should be used. You would not use the individual right and left codes just because you are billing bilateral procedures even if you are line-item billing the procedure (i.e., and ). of 09/10/15. ICD-10-CM for Bilateral Conditions September 10, 2015 I noticed that the ICD-10 codes for many conditions are specific for right and left. I also noticed that some conditions have a specific code for bilateral. But what if the patient has bilateral disease but there is not a diagnosis code for bilateral? Should I use an unspecified code? Good question! No, don t use an unspecified code. The

7 laterality is specified in your documentation, so an unspecified code is inaccurate. If a bilateral code exists and the disorder is documented as bilateral, then the bilateral diagnosis code should be used. But if the documentation states the condition is bilateral, and there is not a bilateral diagnosis code, then use both the right and left codes. Watch for Kim Pollock s upcoming webinars on ICD-10 coding for plastic surgery and breast procedures more information shortly! of 09/10/15. The Cure for Soaring Patient Receivables: 8 Best Practices for Point of Service Collections and Payment Plans

8 KarenZupko & Associates Inc. September 2015 by Cheryl Toth, MBA Patient deductibles and financial responsibilities are skyrocketing. According to a 2014 survey by the Kaiser Family Foundation, 80% of all workers now have annual deductibles, and the average deductible amount has doubled over the last eight years. The study showed that today s annual deductibles average $1,217 for employer-offered individual coverage. Deductibles for families are much higher, averaging $2,328 for HMOs and $1,947 for PPOs. And Affordable Care Act (ACA) plans could have deductibles of more than $2,500 for individual coverage and more than $5,000 for families. Read Full Article Reduce Medical Practice Embezzlement Risk by

9 Implementing Cash Controls Physicians Practice September 2013 by Karen Zupko and Cheryl Toth, MBA Several years ago, we visited a practice in which the receptionist drove a Jaguar. We were particularly intrigued about this after we learned that her husband had been in and out of work for several years. As part of our engagement, we observed the receptionist checking in and checking out patients, and noticed fairly quickly that the encounter forms for several patients who paid in cash had disappeared. The next day, the receptionist called in sick and within a few days had resigned. In the end it became clear she had been tossing encounter tickets and pocketing cash for years. But because the practice didn t require anyone to account for all the day s encounter forms, nor balance money co llected against what was posted to the computer system, no one was the wiser. Read Full Article

10 Financial Reports and Data Aesthetic Surgeons Need to See Aesthetic Society News Winter 2015 by Cheryl Toth, MBA We frequently find that aesthetic surgeons make expensive business decisions based on hunches or staff suggestions instead of data. And when we ask which reports the surgeon reviews each month, we are often told, the P&L, if anything. This is often followed by: I keep asking my manager for reports but I still don t receive them. The staff said the computer can t run that report/provide that information. I was told our report data isn t accurate. I m not sure which reports I m supposed to look at every month. Read Full Article