september 2015 medical coding q&a webinar

Certification Coaching Q & A Webinar

September 2015

This Month’s Q & A Webinar Agenda: 90-120 min

II: Q&A from our Instructors ● JoAnne: Radiology Coding● JoAnne: Back to Basics: CPC Coding/

payment policy

● Alicia: ICD-10 Code of myocardial infarction

● Alicia: Back to Basics: Practicode Case● Alicia: Lesions 10,000 Series● Alicia: Wound Care

● Laureen: Apligraf skin graft

I: Introduction● Why stay?● Where is everyone from?● Recent CCO Graduates/ You Too?● Announcements and Course Updates

IV: Your Questions in the Chat

III: Close - @ 90 min-’ish’● Wrapup● Drawing● CEU Certificate Download Link

Ask Along the way in the Questions box.

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Alicia Espinosa 9/14/2015 Passed CPC

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Cindi Duran 8/26/2015 Passed ICD-10 Assessment

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Katherine Jade Martinez 9/14/2015 Passed ICD-10 Assessment

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Anna Burnham 9/15/2015 Passed ICD-10 Assessment

Anna Burnham 9/15/2015 Completed FBC Course

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Alicia ScottCPC, CPC-I, CRC

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MODIFIERS

Risk Adjustment/HCC

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Risk Adjustment presented by Alicia Scott, CPC, CPC-I, CCO Education Director

with Content contribution by Subject Matter Expert:

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CCO Helpdesk

helpdesk.cco.us(You can search the knowledge base,

create a ticket and check up on existing tickets)

Poll - What region of the country are you from?

Poll

● JoAnne: Back to Basics - Radiology Coding● JoAnne: Back to Basics - Applying Coding to

Payment Policy

● Alicia: Back to Basics - Practicode Case ● Alicia: ICD-10 Coding of subsequent acute

myocardial infarction● Alicia: Lesions 10,000 Series ● Alicia: Wound Care

● Laureen: Apligraf skin graft

Coding Q and A Topics

Alicia ScottCPC, CPC-I, CRC

Jo-Anne SheehanCPC, CPC-I, CPPM

Laureen Jandroep CPC, CPC-I, COC, CMSCS,CHIC, CPPM

Back to Basics - Radiology Coding

Question: Can you elaborate and give tips on Radiology Coding?

ANSWER

Back to Basics - Applying Coding to Payment Policy

Question: Please explain CPC coding and payment policy.

ANSWER

Back to Basics - Practicode Case

Alicia presents a Practicode case

ANSWER

Poll

What AAPC coding credential do you HAVE?

ICD-10 Subsequent Acute Myocardial Infarction

This example comes from AAPC Quick Reference. I want to know why we need 2 codes. Is this only a ICD-10 rule? A patient suffers an acute MI of the inferior wall 2 weeks after suffering an acute MI of the left anterior descending coronary artery. He is admitted for the new MI. I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall I21.02 ST elevation (STEMI) myocardial infarction of left anterior descending coronary artery In this example, the second MI occurs within four weeks of the first, so it is a subsequent MI coded from category I22. The patient is admitted for the new MI, so the subsequent MI is the first listed ‐code, followed by the initial MI.

ANSWER

Poll

What coding credential do you WANT?

Wound Care

Question: Can you elaborate on wound care coding?

ANSWER

Lesions 10,000 Series

Question: I get confused when it comes to report per lesion and report number of lesions in the 10,000 series.

Please help!

ANSWER

Apligraf skin graft

Question: Can you go over coding for Apligraf skin graft procedures?

ANSWER

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Questions In The Chat

ANSWERS

Your Webinar Chat Team

Chat Q & AWebinar- Sept 2015

Modifier 33 and Vaccine

Can you shed any light on the modifier 33 and the Affordable Care Act and vaccine coding with a preventative visit?

Modifier 33 and Vaccine-Answer

A HCPCS Code G0121 is a colorectal screening colonoscopy on individual NOT MEETING criteria for high risk-DX V76.51 Screening colon cancer. If you use 45378 which is also a colonoscopy but it is a screening with V76.51, you would add modifier 33 to indicate it was a preventive.

G0179

What should I do for a patient with Medicare primary and BCBS of SC secondary and the physician office bills G0179. Medicare processes and pays, secondary is denying for invalid code?

G0179 - Answer

G0179 is a physician re-certification for MEDICARE-COVERED home health services under a home health plan of care. There is no CPT code that matches the exact description of this Medicare code so a secondary payment is highly unlikely.

Unspecified Codes

I have heard if you use unspecified codes the insurance companies are going to "PIN" the claims and request for additional documentation?? Is this true?

Unspecified Codes -Answer

Unspecified diagnosis codes are not typically queried unless a high level office visit (ex: 99215) is associated with an unspecified diagnosis not qualifying for such a high level of service. THEN you get flagged and documentation must be provided in order to get paid.

1995 or 1997 Guidelines

Q: Which guidelines do you suggest to use for E/M?1995 or 97?

A: I find that 1997 is the most common guidelines that physicians use. More comprehensive.

Modifiers Change

I'm trying to get an answer on how modifiers will change since ICD10 is so much more specific now. Like we will still be using modifiers in coding after ICD10 is implemented?

Modifiers Change-Answer

Modifiers are still required on CPT codes and must match the diagnosis code. Example, cerumen removal, bilateral 69210-50 and diagnosis code for impacted cerumen, bilateral is H61.23. The last character 3 indicates bilateral. If it ends in 0, it is unspecified, 1 is right ear, 2 is left ear.

Newborn 92586

Any insight on newborn hearing cpt 92586? Certain payers are denying inclusive to facility but we own the equipment and are providing tc and pc so not being billed with a 26 modifier.

Newborn 92586 - Answer

92586 seems to be listed strictly as global while 92585 and 92587 use 26 and TC. 92586 seems to just present as global.

Different kinds of coding

What is the difference between the different kinds of coding (CCA, CCS, RHIT, etc)

Hospital Follow-up

Can you have hosp follow-up as a chief complaint without any further details but follow-up?

Transition Care Management

Wouldn't a hospital follow up be a TCM? Transition Care Management? The patient has to be contacted by a certain time as well as other guidelines pertaining to TCM?

Code G83.23

Code G83.23 patient is left handed, for code G83.24 Monoplegia of upper limb affecting left non-dominant side, is patient left handed or right handed?

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