Quick & Easy Quarterly
Fall 1997
Contents:
1998 Code Changes
As you probably know, on October 1, 1997, the changes for 1998 diagnostic codes
became effective. After December 31, 1997, you may start getting rejected claims.
Of the hundreds of changes, we mention these few here because they had the biggest
changes. We recommend that you review your superbill (encounter form) against the 1998
version of InstaCode ICD-9 Software to make sure you are in compliance with the changes.
For example, under the following categories, there are new codes:
Staphylococcal septicemia (038.1)
Disorders of calcium metabolism (275.4)
Late effects of cerebrovascular disease (438)
Hypotension (458)
Convulsions (780.3)
Remember, these are not all inclusive. Many other small changes were made.
Lab & X-ray Coding
Here's a little reminder from the Health Care Financing Administration (HCFA)
guidelines about correctly coding outpatient services.
"Do not code diagnoses documented as 'probable,' 'suspected,' 'questionable,'
'rule out,' or 'working diagnosis.' Rather code the condition(s) to the highest degree of
certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or
other reason for the visit." -[HCFA Diagnostic Coding and
Reporting Guidelines for Outpatient Services (Hospital-Based and Physician Office)]
Until an actual diagnosis has been confirmed, use ONLY codes that
describe the symptoms and signs.
Please note that this is opposite the guidelines and practices of hospitals.
Oddly enough, there are a few instances when some of the words which their guidelines
state should NOT be used, should be used. For example, the word "suspected" is
valid when coding for 'suspected carrier of' specific diseases or for possible problems
with a fetus.
Another acceptable example is the word "questionable". It is used in the
Neoplasm section of the Alphabetic index to describe the morphology of the neoplasm.
X-ray Codes and Modifiers
Most doctor's offices with an x-ray unit perform both
the technical and professional components (taking and interpreting) of the service. A CPT
code for x-rays includes both components. Billing without a modifier is the standard.
One of the most common problems in coding x-ray services happens when
the service is unbundled. The following are the most commonly used modifiers for x-rays or
radiographic services when this happens.
Technical Component - 90
When a facility ONLY takes the
x-ray, they use this modifier.They do NO interpretation and do NOT bill for the
interpretation component. The film goes to another party for the interpretation and
report.
Professional Component -26
This represents ONLY the
reading or inter-pretation portion. Bill ONLY the professional component if you do not
take the x-ray.
Bundled Fees
Both
components equal a single global fee. If the facility does the technical (-90) and the
interpretation with a report (-26), it is inappropriate to bill for the latter component
again. (This is also known as "double dipping" and/or fraud.)
E & M Code Usage
After the x-ray has been taken
(-90) and interpreted (-26), there is a need to consider its relevance in the clinical
setting with the patient. From a CPT coding perspective, evaluating the x-ray and its
report are a part of the "data" considered during the "Clinical Decision
Making" process in the patient-doctor encounter. According to E/M coding guidelines,
as a component of the E/M encounter, it could affect the actual E/M code level assigned.
Modifer (-22) Unusual Service
Occasionally, there
could be a need for more detailed service over and above the routine initial
interpretation. Perhaps further development and analysis is required. In such cases, it
would be appropriate to append -22 to the code and attach a report documenting the need
for the unusual, extended review or analysis beyond the routine service.
Other -22 Applications
For some offices, it may be of interest
to note that the AMA-CPT editorial panel for 1999 is considering the variable costs of
film in future relative value updates. It is an accepted fact that large film can be a
significant factor in actual practice overhead x-ray costs. If you are currently carrying
an abnormal burden for 1998, you might want to consider the use of modifier (-22) in such
cases. If you determine that the propriety of this practice is applicable to your office,
be sure to attach a report of explanation to your claim.
InstaCode's Quick & Easy Quarterly Newsletter is published for the exclusive use of InstaCode Institute friends and clients. Any decisions based upon this information are the sole responsibility of the reader and users.
© Copyright 1997, InstaCode Institute, LC - All rights reserved.
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