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Tag Archives: Code

2018 ICD-10-PCS Code Changes

The U.S. Department of Health & Human Services (HHS) has released the code changes for ICD-10-PCS coding system. ICD-10-PCS codes were adopted under HIPAA for hospital inpatient healthcare settings to use for reporting procedures. Their guidelines help healthcare providers and coders to accurately identify procedures to be reported on healthcare claims.

The 2018 updates will reflect services from Oct. 1, 2017 through Sept. 30, 2018, so be sure to update your medical records to account for the changes.

There were 75,789 codes in 2017. In 2018, the number jumps to 78,705…

 

Continue reading this article

 

The post 2018 ICD-10-PCS Code Changes appeared first on Outsource Management Group, LLC..

ICD-10 – Outsource Management Group, LLC.

Do we need to code venogram separately?

ULTRASOUND GUIDANCE FOR VENOUS ACCESS

SUPERIOR VENA CAVAGRAM

TUNNELLED CVC INSERTION

DESCRIPTION OF PROCEDURE:

Realtime ultrasonography of the right neck was performend demonstrating
patency of the internal jugular vein which was then chosen for access;
ultrasound images were archived.

A large area of the right neck and upper chest was prepped and draped in
sterile fashion.

Using 1% lidocaine for local anesthesia and under real-time ultrasonic
guidance, a 21ga. micropuncture set was used to access the right internal
jugular vein at the base of the neck. Ultrasound images were archived.

A small incision was made at the puncture site. The wire could not be
advanced much into the vessel and for this reason a 4 French catheter was
advanced over the wire. Contrast material was injected and digital
angiograms were obtained demonstrating occlusion of the superior vena cava
just beyond the confluence of the azygos vein. Flow in the azygos vein is
retrograde.

Over a wire, the tract was dilated and an introducer sheath was advanced into
the vein.

A tract of subcutaneous tissue, leading from the incision at the puncture
site to the anterior right chest below the clavicle, was then infiltrated
with local anesthetic. A small incision was made at the chest end of the
tract. A flexible tunneler was then used to pull an 8 cm long dual-lumen
catheter through the subcutaneous tunnel. The tunneler was disconnected and
the catheter was then advanced through the sheath until its tip reached the
central portion of the patent superior vena cava ; as mentioned above the
catheter could not advance be advanced into the right atrium since the cava
is occluded more centrally.

Fluoroscopy of the air at demonstrated a kink in the catheter as it entered
the internal jugular vein. We were unable to resolve the kink and for this
reason the catheter had to be removed and the procedure restarted after re-
prepping and draping of the area.

Using sterile technique under real-time ultrasonic guidance a 21 gauge needle
was placed in the right internal jugular vein. An introducer sheath was
advanced into the vein.

A 6 French dual-lumen central venous catheter was then advanced through the
subcutaneous tunnel and into the internal jugular vein until its tip reached
the central portion of the patent superior vena cava. This time no kinks
were identified along the course of the catheter.

Both ports were capped and heparinized and the catheter was then secured to
the skin with 2-0 nylon sutures. The incision at the base of the neck was
closed with tissue glue and SteriStrips.

There were no complications.

CAN ANYBODY SUGGEST CORRECT CODING FOR THIS?

Medical Billing and Coding Forum – Interventional Radiology

36415 venipuncture code bcbsil

So we bill 36415 with modifier 59 to bcbs and it always gets paid. But now its being rejected as incidental to other labs. PEr bcbs agent, new guidelines since may 2017. Any idea how I can get the 36415 to get paid? Is anyone going thru the same problem. I work for two providers and both of them have the same issue.

Medical Billing and Coding Forum – Auditing General Discussion

I don’t want to live in a world where Ebola is sold out at the Giant Microbe store – and there’s no code for it

There is a super cute little toy shop in Coeur d’Alene, ID called Shenanigan’s Toy Emporium that sells vintage toys and other unique items.  When traveling there on business, we usually make a stop in to shop from their wall of amazing salt water taffy and check out their selection of toys that don’t come with a power button.  You know, the kind of toys we had prior to the Atari and Game Boy era!

Shenanigan’s also has a great display of giant microbes – small plush renderings of everything from the common cold to diarrhea.  I am still marveling at how they could create a plush toy out of liquid stool!  I’m sure it’s just the geeky coder in me (and my colleagues), but we decided to buy a few and put them out during our training sessions along with our baskets of Play Dough, pipe cleaners, and candy (we like to have FUN in our training sessions!).  Needless to say, they were a big hit with our clients and we noticed on one of the tags that there was a website where we could order more.  By now your interest is surely piqued, so be sure to check out the online Giant Microbes store.

You’re probably thinking what I’m thinking right about now, which is, wouldn’t these giant microbes make great white elephant gifts for Christmas?  My thoughts immediately went to what would be appropriate for my family’s white elephant gift exchange.  Don’t worry, my family has a great sense of humor – there’s still a copy of Pamela Anderson’s novel (yes, she wrote one) complete with the “naughty” pages clipped together courtesy of my grandmother who was sheltering her daughter from the filthy parts.  And what better gift for someone in 2014 than the Ebola virus?  There’s just one problem.

Sold out.

Apparently I am not the only person who thinks that Ebola would make a great Christmas gift.  It’s a sign of recent headlines that this virus, which is actually kind of cute in plush form, is unavailable.  What’s even more worrisome given that this was the year Ebola came to the US, is that we don’t have an ICD-9-CM code to report it.  Here’s the best we can do in ICD-9:

  • 065.8, Other specified arthropod-borne hemorrhagic fever
  • 078.89, Other specified diseases due to virus

What about ICD-10-CM?  How about this?

  • A98.4, Ebola virus disease

YESSSSSS!  Way more specific!

In previous years as we’ve prepped for ICD-10 implementation, the opponents have given a laundry list of extensive and admittedly ridiculous (yet fun!) ICD-10 codes that begged the question, why do we really need this?  And this year, Ebola was delivered to our health system and we have nonspecific codes to report it.  But in ICD-10, we have a very specific code.  Hmm.  Perhaps this ICD-10 thing really could help with reporting and impact patient care.  Just a thought.

So Santa, if I can’t have Ebola for Christmas this year, could I please have ICD-10 so that I can code it for those people who did get it?

Author’s Note: I am not affiliated with Shenanigan’s Toy Emporium or giantmicrobes.com in any way. I am just a really big fan!
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2016 CPT Code Changes


2016 Newly Added Lab Codes List

80081 Obstetric panel (includes HIV testing)

This new code is identical to the 80055 code (Obstetric panel) except the HIV testing was added. In order to bill this code all components of the panel must be performed. The added service for this new panel includes HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result (87389).

MOLECULAR PATHOLOGY TIER 1 MOLECULAR PATHOLOGY PROCEDURES

The following are the new codes for 2016 for gene-specific and genomic procedures. Molecular pathology codes include all analytical services performed in the test. This includes cell lysis, nucleic acid stabilization, extraction, digestion, amplification, and detection. Any procedures required prior to cell lysis such as microdissection (88380, 88381) are reported separately. AMA instructs coders to use 87149-87153, 87470-87801, and 87900-87904 for any molecular testing done for microbial identification. This means molecular testing for infectious agents, such as HPV are NOT reported in the molecular pathology section of the code book. You should look to the Microbiology section for those codes.

For in situ hybridization, use the 88271-88275 (when interpreted by scientist instead of pathologist) and 88365-88368 when interpreted by a pathologist.

81170 ABL1 (ABL proto-oncogene 1, non-receptor tyrosine kinase) (eg, acquired imatinib tyrosine kinase inhibitor resistance), gene analysis, variants in the kinase domain

81162 BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis. Do not report 81162 in conjunction with 81211, 81213, 81214, 81216)

81218 CEBPA (CCAAT/enhancer binding protein [C/EBP], alpha) (eg, acute myeloid leukemia), gene analysis, full gene sequence

81219 CALR (calreticulin) (eg, myeloproliferative disorders), gene analysis, common variants in exon 9

81272 KIT (v-kit Hardy-Zukerman 4 feline sarcoma viral oncogene homolog) (eg, gastrointestinal stromal tumor [GIST], acute myeloid leukemia, melanoma), gene analysis, targeted sequence analysis (eg, exons 8, 11, 13, 17, 18)

81273 KIT (v-kit Hardy-Zukerman 4 feline sarcoma viral oncogene homolog) (eg, mastocytosis), gene analysis, D816 variants(s)

81276 KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma gene analysis; additional variants(s) (eg, codon 61, codon 146)

81311 NRAS (neuroblastoma RAS viral [v-ras] oncogene homolog) (eg, colorectal carcinoma), gene analysis, variants in exon 2 (eg, codons 12 and 13) and exon 3 (eg, codon 61)

81314 PDGFRA (platelet-derived growth factor receptor, alpha polypeptide) (eg, gastrointestinal stromal tumor [GIST]), gene analysis, targeted sequence analysis (eg, exons 12, 18)

GENOMIC SEQUENCING PROCEDURES AND OTHER MOLECULAR MULTIANALYTE ASSAYS

This new section of genomic sequencing procedures (GSPs) are DNA or RNA sequence analysis methods that simultaneously assay multiple genes or genetic regions relevant 

to a clinical situation. Most commonly referred to a “Next Gen Sequencing” (NGS) or “Massively Parallel Sequencing” (MPS) in the laboratory, are tests intended to 

evaluate the genetic material in totality or near totality.

The codes in this section should be used when the components of the descriptor(s) are met regardless of the technique used, unless specifically noted in the code descriptor. 

If all the components are NOT performed, then you must assign code(s) in the Tier 1 or Tier 2 section or if they aren’t listed in the Tier codes, use the unlisted code 

81479. AMA provides two parenthetical statements after this introduction section:

• For cytogenomic microarray analyses, see 81228, 81229, 81405, 81406.
• For long QT syndrome gene analyses, see 81280, 81282 

81412 Ashkenazi Jewish associated disorders (eg, Bloom syndrome, Canavan disease, cystic fibrosis, familial dysautonomia, Fanconi anemia group C, Gaucher disease, Tay-Sachs disease), genomic sequence analysis panel, must include sequencing of at least 9 genes, including ASPA, BLM, CFTR, FANCC, GA, HEXA, IKBKAP, MCOLN1, and SMPD1

81432 Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); genomic sequence analysis panel, must include sequencing of at least 14 genes, include ATM, BRCA1, BRIP1, CHD1, MLH1, MSH2, MSH6, NBN, PALB2, PTEN, RAD51C, STK11, and TP53

81433 Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); duplication/deletion analysis panel, must include analyses for BRCA1, BRCA2, MLH1, MSH2, and STK11

81434 Hereditary retinal disorders (eg, retinitis pigmentosa, Leber congenital amaurosis, cone-rod dystrophy), genomic sequence analysis panel, must include sequencing of at least 15 genes, including ABCA4, CNGA1, CRB1, EYS, PDE6A, PDE6B, PRPF31, PRPH2, RDH12, RHO, RP1, RP2, RPE65, RPGR, and USH2A

81437 Hereditary neuroendocrine tumor disorders (eg, medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma; genomic sequence analysis panel, must include sequencing of at least 6 genes, including MAX, SDHB, SDHC, SDHD, TMEM127, and VHL

81438 Hereditary neuroendocrine tumor disorders (eg, medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma; duplication/deletion analysis panel, must include analyses for SDHB, SDHC, SDHD, and VHL

81442 Noonan spectrum disorders (eg, Noonan syndrome, cardio-facio-cutaneous syndrome, Costello syndrome, LEOPARD syndrome, Noonan-like syndrome), genomic sequence
analysis panel, must include sequencing of at least 12 genes, including BRAF, CBL, HRAS, KRAS, MAP2K1, MAP2K2, NRAS, PTPN11, RAF1, RIT1, SHOC2, and SOS1

The CPT codes listed above in this section are panels associated with various disorders where the testing is performed by genomic sequence analysis. In each of the CPT panel codes the code descriptors define specifically what genes must be tested in that panel as well as the minimum number of genes that must be tested in order to assign that given CPT code.

MULTIANALYTE ASSAYS WITH ALGORITHMIC ANALYSES

Multianalyte Assays with Algorithmic Analyses (MAAAs) are procedures that utilize multiple results derived from assays of various types, including molecular pathology assays, fluorescent in situ hybridization assays and nonnucleic acid based assays (eg, proteins, polypeptides, lipids, carbohydrates). Algorithmic analysis using the results of these assays as well as other patient information, if used, is then performed and reported typically as a numeric score(s) or as a probability.

MAAAs are typically unique to a single clinical laboratory or manufacturer. The results of individual component procedure(s) that are inputs to the MAAAs may be provided on the associated laboratory report; however, these assays are not reported separately using additional codes. For more information on these codes, please see the MAAA section of the 2016 CPT code book and Appendix O in your 2016 Code book

81490 Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers using immunoassays, utilizing serum, prognostic algorithm reported as a disease activity score. Do not report 81490 in conjunction with 86140

81493 Coronary artery disease, mRNA, gene expression profiling by real-time RT-PCR of 23 genes, utilizing whole peripheral blood, algorithm reported as a risk score

81525 Oncology (colon), mRNA, gene expression profiling by real-time RT-PCR of 12 genes (7 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence score

81528 Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or negative result. Do not report 81528 in conjunction with 81275, 82274

81535 Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by DAPI stain and morphology, predictive algorithm reported as a drug response score; first single drug or drug combination

+81536 Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by DAPI stain and morphology, predictive algorithm reported as a drug response score; each additional single drug or drug combination (List separately in addition to code for primary procedure) Do not report 81536 in conjunction with 81535

81538 Oncology (lung), mass spectrometric 8-protein signature, including amyloid A, utilizing serum, prognostic and predictive algorithm reported as good versus poor overall survival

81540 Oncology (tumor of unknown origin), mRNA, gene expression profiling by real-time RT-PCR of 92 genes (87 content and 5 housekeeping) to classify tumor into main cancer type and subtype, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a probability of a predicted main cancer type and subtype

81545 Oncology (thyroid), gene expression analysis of 142 genes, utilizing fine needle aspirate, algorithm reported as a categorical result (eg, benign or suspicious)

81595 Cardiology (heart transplant), mRNA, gene expression profiling by real-time quantitative PCR of 20 genes (11 content and 9 housekeeping), utilizing subfraction of peripheral blood, algorithm reported as a rejection risk score

0009M Fetal aneuploidy (trisomy 21, and 18) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy

0010M Oncology (High-Grade Prostate Cancer), biochemical assay of four proteins (Total PSA, Free PSA, Intact PSA and human kallikrein 2 [hK2]) plus patient age, digital rectal examination status, and no history of positive prostate biopsy, utilizing plasma, prognostic algorithm reported as a probability score

SURGICAL PATHOLOGY

Immunofluorescence Stains

AMA has added one code for 2016, an add-on code for immunofluorescence stains. This code represents any additional stains that are performed above the initial first stain which is assigned CPT 88346. The “unit of service” is defined as each additional “single antibody stain procedure” from that designated specimen. It is not solely each additional stain performed, it has to be a separate stain procedure for that given stain, hence the descriptor “single antibody stain procedure.”

Also please note in the parenthetical that the AMA specifically states to not report 88346 and 88350 when the stain performed is a multiplex immunofluorescence stain(s)… it directs to the coder to assign the miscellaneous code 88399.

NOTE that 88350 has a + sign denoting an add-on code and can only be billed when 88346 is also billed. 

+88350 Immunofluoroscence, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure) Report 88350 in conjunction with 88346. Do not report 88346 and 88350 for fluorescent in situ hybridization studies, see 88364, 88365, 88366, 88367, 88368, 88369, 88373, 88374, and 

88377. Do not report 88346 and 88350 for multiplex immunofluorescence analysis, use 88399

CMS newly added codes

G0475 Hiv antigen/antibody, combination assay, screening

G0476 Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test.


Coding Ahead

Code for the Day: There’s Even a Code for One of My New Year’s Resolutions! (Y93.E9)

How do people start New Year’s resolutions on January 1?  Am I the only person in the world who bakes, entertains, gift wraps, and parties myself into oblivion until the point where I don’t want to do a darn thing come New Year’s Day?  Here we are on January 14 and I am finally getting things organized enough to focus on how to better myself in 2013. 

Oh sure, I had lofty goals.  Last year, we took an awesome New Year’s day hike at Red Rocks Park near Denver.  And we were going to do it again.  But this year 2013 hit us in a sleep deprived state so we decided to forgo the hike and head to a late breakfast instead.  We did end up at Ikea, though, so I suppose a few hours there could technically be classified as a hike.

In general, I hate New Year’s resolutions.  I think they are incredibly cliche and what’s even more cliche is the fact that they never last.  I think the number 1 New Year’s resolution should be to make your New Year’s resolution last longer than a few weeks – maybe even the whole year. 

I try to start out every year with a general plan to get organized and unload myself of unnecessary clutter. I am, after all a super organized coder and that carries over into my home and daily life. So I’ve spent the last couple of weeks organizing my kitchen, planning menus, organizing closets, cutting back on what I eat (duh, who doesn’t have that resolution!), and decluttering my physical space.  And I was so delighted to find that there is, in fact, a code for that:

  • Y93.E9, Activity, other interior property and clothing maintenance

If only there was a companion code specific to shoe shopping – then I could code the before and the after!

What’s in Store for 2013?

Happy New Year to all of you!  I am not sure what is in store for my blog in 2013, but I continue to look around for inspiration. For now I am still inspired by the Code for the Day, even though it doesn’t seem to come every day. Look for an FAQs page coming some time in the next couple of months for people interested in a coding career.  And best wishes for keeping your New Year’s resolution past first quarter!
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