Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I

Common Medical Coding Missteps and Remedies

Header WHY PATIENT PORTALS?

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Common Medical Coding Missteps and Remedies

Header WHY PATIENT PORTALS?

Objectives

• Review common mistakes with modifiers 25 and 59 • Review documentation needed to support a separately identifiable E&M with a minor procedure on the same date of service • Review NCCI edits • Discuss medical necessity

Common Medical Coding Missteps and Remedies

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Modifier 25

Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service • Appended to the E&M code • Used to indicate a minor procedure or additional E&M performed on the same date of service • E&M must be separately identifiable

Common Medical Coding Missteps and Remedies

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Documentation Example #1

SUBJECTIVE: Mrs. X, a 43-year-old Caucasian female, arrives for a follow-up visit. She presents with knee pain and swelling. She is here for arthrocentesis of the left knee.

Common Medical Coding Missteps and Remedies

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Documentation Example #1

OBJECTIVE: Procedures: Joint pain, lower leg Procedure Note: Arthrocentesis/injection Arthrocentesis of left knee joint is performed. Written informed consent was obtained. The site is prepped with Betadine and sterile drape is placed. The site is anesthetized with 4 cc of 2% lidocaine. The needle is carefully introduced into the joint space. Aspiration of 20 cc of amber fluid is obtained. No complications. Estimated blood loss: 2 cc. The specimen is sent for routine path plus special studies ( acid fast bacilli, cell count and differential, bacterial culture, and fungal culture).

Common Medical Coding Missteps and Remedies

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Documentation Example #1

• Correct coding for this case: 20610-LT • The E&M for this case is not reported. The documentation does not support a significant and separately identifiable E&M.

Common Medical Coding Missteps and Remedies

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Documentation Example #2

S. continues to have achiness in her knees. Her current meds include ALEVE, only as needed, a few days a week as before. She is on LEXAPRO at night, XANAX, and CLONAZEPAM as needed. She is on a B12 injection once a month. We had given her a prescription for VICODIN but she lost the prescription. O: Weight is 188 pounds. Blood pressure is 112/74. Pulse is 60. There is some crepitus at the knees without tenderness elicited. There is no active synovitis noted at this time. There is no alopecia noted on exam.

Common Medical Coding Missteps and Remedies

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Documentation Example #2

Review of lab work from April 29, 2013, revealed a negative ANA. Urinalysis had no blood or protein. Normal liver and renal function tests. Uric acid was normal with normal CRP, rheumatoid factor, anti-CCP, and TSH. Hemoglobin was 10.8 with MCV of 79.6 and normal white count and platelets. A: Osteoarthritis of knees, anemia

Common Medical Coding Missteps and Remedies

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Documentation Example #2

• Correct coding for this case: 99213-25, 20610-LT • The E&M for this case is supported. • Wrong reporting: 99213, 20610-25 99213-25, 20610-59

Common Medical Coding Missteps and Remedies

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Modifier 59

Distinct Procedural Service • Procedures not normally reported together • Different session or patient encounter • Different procedure or surgery • Different site or organ system • Separate incision/excision • Separate lesion

Common Medical Coding Missteps and Remedies

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National Correct Coding Initiative (NCCI)

• Implemented by CMS • Promotes correct coding methodologies • Controls the improper assignment of codes that result in inappropriate reimbursement Medicare publishes NCCI: http://www.cms.hhs.gov/NationalCorrectCodInitEd/

Common Medical Coding Missteps and Remedies

Header WHY PATIENT PORTALS? Common Medical Coding Missteps and Remedies

Column 1

Column 2

* = In existence prior to

1996Effective

Date

Deletion Date*=no data

Modifier0=not

allowed1=allowed

9=not applicable

11042 0213T 20100701 * 011042 0216T 20100701 * 011042 0228T 20101001 * 011042 0230T 20101001 * 011042 10060 19960101 * 111042 11000 19960101 * 111042 11001 19960101 19960101 911042 11040 * 19960101 * 111042 11041 * 19960101 * 111042 11100 19970101 * 1

Column 1 / Column 2 Edits

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Documentation Example #3

ASSESSMENT and PLAN 1. Likely basal cell carcinoma, left forehead; biopsy performed. Procedure Note: Informed consent obtained. Area cleaned with alcohol and then injected with 1% lidocaine with epinephrine. The area was then cleansed with Hibiclens. A biopsy was performed with a flexible Gillette blade. Hemostasis was achieved with aluminum chloride. Dressed with antibiotic ointment and Band-Aid. Wound care was discussed with patient. 2. Actinic keratosis, left helix; Treated with cryotherapy freeze-thaw-freeze. Wound care discussed.

Common Medical Coding Missteps and Remedies

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Documentation Example #3

ASSESSMENT and PLAN 1. Likely basal cell carcinoma, left forehead; biopsy performed. Procedure Note: Informed consent obtained. Area cleaned with alcohol and then injected with 1% lidocaine with epinephrine. The area was then cleansed with Hibiclens. A biopsy was performed with a flexible Gillette blade. Hemostasis was achieved with aluminum chloride. Dressed with antibiotic ointment and Band-Aid. Wound care was discussed with patient. 2. Actinic keratosis, left helix; Treated with cryotherapy freeze-thaw-freeze. Wound care discussed. • Correct coding for this case 17000, 11000-59

Common Medical Coding Missteps and Remedies

Header WHY PATIENT PORTALS?

Medical Necessity

• Diagnosis must be indicated to support all services provided and tests performed • If ruling out a diagnosis, report the signs and symptoms unless there is a finding • Follow payment policies for private insurance and Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) for Medicare

Common Medical Coding Missteps and Remedies

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Your Questions • Colonoscopy screening / polyp removal • 211.4 vs. 235.2 • Bronchoscopy coding • Transitional codes, emergency codes • “Detailed” level of exam

Common Medical Coding Missteps and Remedies

Header WHY PATIENT PORTALS? Common Medical Coding Missteps and Remedies

For more information:

Raemarie Jimenez raemarie.jimenez@aapc.com

AAPC

http://www.aapc.com/

Physicians Practice http://www.physicianspractice.com/coding