QUESTION: Can you explain the difference between modifier -80 (assistant at surgery by another physician) and –AS (physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery)? Medicare requires us to use both modifiers for our physician assistants. We have been instructed to use -AS first and -80 second for all Medicare claims submissions. Is this correct?
CMS instructed fiscal intermediaries (FI) and Medicare Administrative Contractors (MAC) to hold claims containing CPT ® code 33249 (insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead[s], single or dual chamber) and HCPCS code C1882 (cardioverter-defibrillator, other than single or dual chamber [implantable]).
CMS did not discuss drug administration services in the 2012 OPPS final rule, but the AMA did make significant additions to the CPT ® coding guidelines in the 2012 CPT Manual . Jugna Shah, MPH, and Kimberly Anderwood Hoy, JD, CPC, review the guidelines and explain the nuances to keep coders up to date.
The Bishop’s Score is primarily a scoring system to assess the viability and/or success of an induction of labor, odds of a spontaneous pre-term delivery, or whether a cesarean section should be considered instead of a vaginal delivery. Lori-Lynne Webb, CPC, CCS-P, CCP , explains how physicians tally the Bishop’s Score and what coders should look for in the documentation.
As charges become more specific to provide additional concrete and transparent cost data, providers must consider what procedures they routinely provide to patients and what procedures are specifically related to the patient's condition. Denise Williams, RN, CPC-H, and Kimberly Anderwood Hoy, JD, CPC, reveal tips for determining when to separately bill for ancillary bedside services provided to inpatients.
QUESTION: I would like to know the correct codes to use when a patient comes into the ER after smoking synthetic marijuana and has symptoms of palpitations, seizure, or anxiety. Some physicians document ingestion, while others document abuse. What is the proper way to code considering we do not have a specific code for this new drug on the market?
To correctly assign codes for any surgical procedure, coders need to have an operative (OP) report. But simply having an OP report isn’t enough. Coders also must be able to read the OP report and pick out the important information. Lynn Pegram, CPC, CEMC,CPC-I, CGSC, breaks down the OP report to help coders find the information they need.
A physician or clinical provider of care may have a completely different understanding, interpretation, and definition of medical necessity than the patient or a third-party insurance. Lori-Lynne A. Webb, CPC, CCS-P, CCP, COBGC, CHDA, explains the differences in the definition and application of the term medical necessity.
The transition to ICD-10-CM is coming. The only question is when. Despite the possible delay, coders and other HIM professionals must continue to prepare for the transition. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, Sandy Nicholson, MA, RHIA, Robert S. Gold, MD, Jennifer Avery, CCS, CPC-H, CPC, CPC-I, and Kim Felix, RHIA, CCS, provide information on how ICD-10-CM will—and will not—differ from ICD-9-CM.
Knowing spinal anatomy provides the foundation necessary to assign codes both before and after the switch to ICD-10-CM. Shelley C. Safian, Kim Pollock, RN, MBA, CPC, and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, guide coders through the anatomy and common coding situations in ICD-9-CM and ICD-10-CM.
Just because a physician considers a service or procedure medically necessary doesn't mean insurance carriers will pay for it. When a service or procedure is not covered, facilities must provide patients with an Advanced Beneficiary Notice of Noncoverage (ABN). Judith Kares, JD, CPC, and Jacqueline Woeppel, MBA, RHIA, CCS, explain limits on liability and what modifiers to use with ABNs.
CMS continues to add more screening services to the list of covered preventative services. The newest additions involve screenings for sexually transmitted infections (STI).
Otolaryngology coding covers a wide range of procedures and four parts of the respiratory system—the ears, nose, sinuses, and throat (ENT). Stephanie Ellis, RN, CPC, and Kim Pollock, RN, MBA, CPC, explore some common ENT coding trouble spots.
The January update to the Integrated Outpatient Code editor generally includes a large number of changes and the January 2012 update is no exception. Dave Fee, MBA, highlights the most significant changes including the addition of modifier –PD, which he calls one of the real sleepers in this release.
Drug delivery implants are designed to provide active pharmaceuticals to a targeted area in into the patient’s body for a certain length of time site. Lori-Lynne Webb, CPC, CCS-P, CCP, COBGC, CHDA, provides what coders need to understand to correctly report drug delivery implant codes and what the physician must document.