Exact timing of EEG monitoring is crucial, frequency is not important.
While reporting EEG recording, the most vital factor is to time the procedure. In case your physician uses advanced methods, video and digital recordings; you may be faced with added medical coding challenges for these services. Read on to prepare yourself on how to accurately time the procedure along with code the routine, extended, and special monitoring.
Look For How Long the Diagnostic Study Continued
While reporting EEG, you must look for how long your neurologist took to perform the monitoring. Monitoring that lasts 20 to 40 minutes is taken as routine. You will report CPT codes for extended monitoring in case the procedure goes beyond 40 minutes in duration. For EEG recording that lasts 41 to 60 minutes, you must report 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes), and in case it lasts more than an hour, you would report 95813 (Electroencephalogram [EEG] extended monitoring; greater than 1 hour).
It is significant that your neurologist's report evidently documents the actual EEG recording time. Medical coding is based on the recording though it is underway and the neurologist or technician is collecting data. You do not involve the set-up and take-down time..
Exception: CPT® does not include EEG CPT codes 95824 (Electroencephalogram [EEG]; cerebral death evaluation only), 95827 (Electroencephalogram [EEG]; all night recording), and 95829 (Electrocorticogram at surgery [separate procedure]) from a time component as these are unique services rendered by the physician to monitor a certain pathological condition or diagnose one.
Important note: You can report CPT codes 95812 or 95813 instead of 95816 (Electroencephalogram [EEG]; including recording awake and drowsy), 95819 ( . . . including recording awake and asleep) or 95822 ( . . . recording in coma or sleep only), however you cannot report them together. There is a thin line between drowsy and asleep. You report 95819 when the patient in reality slept during the monitoring. In case the patient did not achieve sleep in a procedure that intended monitoring in sleep, you report 95816 as an alternative.
In case the neurology specialist carries out the global diagnostic service, i.e. owns the equipment, employs the technical staff as well as interprets the diagnostic findings, then the EEG code would be billed without any modifiers. On the other hand, you would append modifier 26 (Professional component) to the EEG CPT® code, in case your neurologist only carries out the professional interpretation of the diagnostic study.
Scan For Video and Channels in Extended Monitoring
For 24-hour EEG monitoring, you should assess CPT codes 95950 (Monitoring for identification and lateralization of cerebral seizure focus, electroencephalographic [e.g., 8 channel EEG] recording and interpretation, each 24 hours)-95953 (Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic [EEG] recording and interpretation, each 24 hours, unattended) or 95956 (Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, electroencephalographic [EEG] recording and interpretation, each 24 hours, attended by a technologist or nurse).
Friday, June 29, 2012
Accurate Sphenopalatine Artery Ligation Coding
Make the maximum of surgical procedure modifiers when looking for the correct code.
Where conservative treatment is unsuccessful, endoscopic transnasal tactic for ligation of the sphenopalatine artery might be the best surgical technique for control of a severe epistaxis. But did you know that there are no medical CPT codes that exist precisely for this operative procedure? Read this article for expert insight on accurate medical coding.
Let's assume a scenario where a patient with coagulopathy also has epistaxis which has not been controlled with nasal packing. The bleeding starts from the posterior nasal cavity of the posterior ethmoid artery or a branch of the sphenopalatine artery. In order to gain control over the nose bleed, the otolaryngologist chooses to conduct an endoscopic transnasal sphenopalatine artery ligation.
When you're left without a certain CPT® code to label the procedure, you should go for other similar medical CPT codes, and try to work around it. Let's explore your options with the following medical CPT codes.
31238: Improve Endoscopic Control of Nasal Hemorrhage With Modifier 22
Medical CPT® 2011 guidelines for modifier 22 maintain that when the work needed to provide a service is significantly greater than typically needed, it may be recognized by the addition of modifier 22 to the typical procedure code.
Documentation should support the substantial added work and the reason for the added work.
In case of an endoscopic transnasal sphenopalatine artery ligation, you might report 31238 (Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage) appended by modifier 22 (Increased procedural service). This particluare ligation procedure includes interrupting the nasal vasculature at a place distal enough to avoid direct, retrograde, and anastomotic blood move from the ipsilateral and contralateral carotid systems.
Disadvantage: Though 31238-22 is a practical and correct medical coding option, payer reimbursement may be lesser than what surgeons feel is regular with the related physician work: about $200.46 (5.9 facility RVU, multiplied by the 2011 conversion factor of 33.9764).
Remember: 31238 a surgical endoscopy code. Ensure that you pay close attention to how the operative note (OR) explains the endoscopic use.
31299: Go The Safe Way With Unlisted Medical CPT Codes
You may also choose to use unlisted procedure code 31299 (Unlisted procedure, accessory sinuses). Several coders would in fact commend this option; however you must be careful of the hitches:
A lot of the claims don't get paid the first time they are submitted and processed. They need appeal with documentation describing what was done.
Documentation necessities (paperwork) may prove to be demanding.
Some experts endorse to use an unlisted code when conducting a procedure that has a medical CPT code meant for an open method however does not have a CPT code for an endoscopic approach.
Where conservative treatment is unsuccessful, endoscopic transnasal tactic for ligation of the sphenopalatine artery might be the best surgical technique for control of a severe epistaxis. But did you know that there are no medical CPT codes that exist precisely for this operative procedure? Read this article for expert insight on accurate medical coding.
Let's assume a scenario where a patient with coagulopathy also has epistaxis which has not been controlled with nasal packing. The bleeding starts from the posterior nasal cavity of the posterior ethmoid artery or a branch of the sphenopalatine artery. In order to gain control over the nose bleed, the otolaryngologist chooses to conduct an endoscopic transnasal sphenopalatine artery ligation.
When you're left without a certain CPT® code to label the procedure, you should go for other similar medical CPT codes, and try to work around it. Let's explore your options with the following medical CPT codes.
31238: Improve Endoscopic Control of Nasal Hemorrhage With Modifier 22
Medical CPT® 2011 guidelines for modifier 22 maintain that when the work needed to provide a service is significantly greater than typically needed, it may be recognized by the addition of modifier 22 to the typical procedure code.
Documentation should support the substantial added work and the reason for the added work.
In case of an endoscopic transnasal sphenopalatine artery ligation, you might report 31238 (Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage) appended by modifier 22 (Increased procedural service). This particluare ligation procedure includes interrupting the nasal vasculature at a place distal enough to avoid direct, retrograde, and anastomotic blood move from the ipsilateral and contralateral carotid systems.
Disadvantage: Though 31238-22 is a practical and correct medical coding option, payer reimbursement may be lesser than what surgeons feel is regular with the related physician work: about $200.46 (5.9 facility RVU, multiplied by the 2011 conversion factor of 33.9764).
Remember: 31238 a surgical endoscopy code. Ensure that you pay close attention to how the operative note (OR) explains the endoscopic use.
31299: Go The Safe Way With Unlisted Medical CPT Codes
You may also choose to use unlisted procedure code 31299 (Unlisted procedure, accessory sinuses). Several coders would in fact commend this option; however you must be careful of the hitches:
A lot of the claims don't get paid the first time they are submitted and processed. They need appeal with documentation describing what was done.
Documentation necessities (paperwork) may prove to be demanding.
Some experts endorse to use an unlisted code when conducting a procedure that has a medical CPT code meant for an open method however does not have a CPT code for an endoscopic approach.
Accurate ICD-9 Codes for Follow-up and 368.10 Now Joins Palmetto LCD ICD-9 Choices
Read these two scenarios and see what ICD-9 codes apply.
410.31 or 410.32 applies to Follow-Up?
Question: The patient is there in the hospital for a 410.31, and after that is discharged. The patient is arranged to be seen in the office again for a follow-up visit. Concerning this follow-up visit, which is certainly less than 8 weeks from the myocardial infarction, is it suitable to use the fifth digit of "2" on the MI (410.32), or would you still use ICD-9 code 410.31?
Answer: You must use 410.32 (Acute myocardial infarction of inferoposterior wall; subsequent episode of care) for this particular follow-up visit. ICD-9 notes with the 410.xx fifth digit selections state that you must use fifth-digit 2 to specify an episode of care succeeding the initial episode when the patient is admitted for additional observation, evaluation or for treating a myocardial infarction that has been offered initial treatment, but is still less than 8 weeks old."
You must report 410.31 (Acute myocardial infarction of inferoposterior wall; initial episode of care) only in the initial episode of care. The fifth digit "1" is applicable until the patient is discharged, irrespective of where the cardiologist offers the care. Notes in the ICD-9 manual explain that you use "1" for the initial episode of care, irrespective of the number of times a patient may be transferred in the initial episode of care."
In case documentation doesn't mention the episode of care (initial or subsequent), you must use fifth digit "0" (Episode of care unspecified).
In case the patient returns more than eight weeks post infarction, you must use 414.8 (Other specified forms of chronic ischemic heart disease). Notes with this code agree it is suitable for any condition classifiable to 410 defined as chronic, or presenting with symptoms post 8 weeks from date of infarction."
368.10 Joins Palmetto LCD ICD-9 Options
Question: You see a notice that your LCD for Noninvasive Vascular Testing (L31712) was reviewed. How has it changed?
Answer: The Palmetto GBA local coverage determination (LCD) you talk about has had two revisions since September. Both add ICD-9 codes backing up coverage for a variety of services.
For example: The revision adds ICD-9 codes 454.8 (Varicose veins of lower extremities with other complications) and 586 (Renal failure unspecified) to the list of ICD9 codes supporting these particular procedure codes:
93965 (Noninvasive physiologic studies of extremity veins, complete bilateral study (e.g., Doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography)
93970 (Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study
93971 (Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study)
410.31 or 410.32 applies to Follow-Up?
Question: The patient is there in the hospital for a 410.31, and after that is discharged. The patient is arranged to be seen in the office again for a follow-up visit. Concerning this follow-up visit, which is certainly less than 8 weeks from the myocardial infarction, is it suitable to use the fifth digit of "2" on the MI (410.32), or would you still use ICD-9 code 410.31?
Answer: You must use 410.32 (Acute myocardial infarction of inferoposterior wall; subsequent episode of care) for this particular follow-up visit. ICD-9 notes with the 410.xx fifth digit selections state that you must use fifth-digit 2 to specify an episode of care succeeding the initial episode when the patient is admitted for additional observation, evaluation or for treating a myocardial infarction that has been offered initial treatment, but is still less than 8 weeks old."
You must report 410.31 (Acute myocardial infarction of inferoposterior wall; initial episode of care) only in the initial episode of care. The fifth digit "1" is applicable until the patient is discharged, irrespective of where the cardiologist offers the care. Notes in the ICD-9 manual explain that you use "1" for the initial episode of care, irrespective of the number of times a patient may be transferred in the initial episode of care."
In case documentation doesn't mention the episode of care (initial or subsequent), you must use fifth digit "0" (Episode of care unspecified).
In case the patient returns more than eight weeks post infarction, you must use 414.8 (Other specified forms of chronic ischemic heart disease). Notes with this code agree it is suitable for any condition classifiable to 410 defined as chronic, or presenting with symptoms post 8 weeks from date of infarction."
368.10 Joins Palmetto LCD ICD-9 Options
Question: You see a notice that your LCD for Noninvasive Vascular Testing (L31712) was reviewed. How has it changed?
Answer: The Palmetto GBA local coverage determination (LCD) you talk about has had two revisions since September. Both add ICD-9 codes backing up coverage for a variety of services.
For example: The revision adds ICD-9 codes 454.8 (Varicose veins of lower extremities with other complications) and 586 (Renal failure unspecified) to the list of ICD9 codes supporting these particular procedure codes:
93965 (Noninvasive physiologic studies of extremity veins, complete bilateral study (e.g., Doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography)
93970 (Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study
93971 (Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study)
Accelerate New Patient Data Capture With 5 Expert Tips
A smart registration process can avoid claim-submission headaches.
In case you're trying hard to grow your practice, you'll require having a logical, simple form to get data from your new patients. Notonly is a patient form valuable for collecting vital insurance information, however it can help you find patients who owe your practice money and carry out collection activities when the patient is present. Our medical coding and billing experts offer spot on advice.
In case it's been a while since your practice updated its new patient registration form or you're creating one for the first time, follow these expert medical billing suggestions to make sure you can find patient's medical billing information quickly and easily:
1. Keep the Form Simple
Ask vital questions on the patient information intake form that you need all new patients to fill out. Ensure you have basic demographic information for instance:
The policy name and number
The insured's name
Social Security number
Dates of coverage
Secondary-insurance information (Households with more than one income often have more than one insurer. The patient must designate which payer is primary and which is secondary.)
Guardian or responsible party name
The name of the person or physician who referred the patient.
It may look obvious, however in case your form does not ask patients for their fax, cell phone number, or e-mail address, you could be losing out on valuable information.
2. Copying the Insurance Card is a Necessity
Besides having the patient fill out the new patient form, ensure to ask for, and keep a copy of, his insurance card. You should always make a copy of the patient's insurance card, front and back. This has important information on where to send the claims correctly the first time, ensuring the medical coding and billing accuracy and obtaining revenue faster.
As you'll make a copy of the insurance card's front and back, you don't require to ask the patient to give that information (policy number, group number, phone numbers, etc.) on a form.
Medical Coding and Billing Tip: You must ask for the card upon each and every visit by the patient. Insurance information can change regularly, and the patient may not even be conscious of the change. Certain payers have dissimilar addresses for different specialty medical billing.
3. Get Referring Physician Details
Once a new patient arrives due to a referral, ensure you have clear info on the referring physician as well. When the patient arrives, a staff member must be examining referral data for Medical Coding and Billing accuracy.
In case you're trying hard to grow your practice, you'll require having a logical, simple form to get data from your new patients. Notonly is a patient form valuable for collecting vital insurance information, however it can help you find patients who owe your practice money and carry out collection activities when the patient is present. Our medical coding and billing experts offer spot on advice.
In case it's been a while since your practice updated its new patient registration form or you're creating one for the first time, follow these expert medical billing suggestions to make sure you can find patient's medical billing information quickly and easily:
1. Keep the Form Simple
Ask vital questions on the patient information intake form that you need all new patients to fill out. Ensure you have basic demographic information for instance:
The policy name and number
The insured's name
Social Security number
Dates of coverage
Secondary-insurance information (Households with more than one income often have more than one insurer. The patient must designate which payer is primary and which is secondary.)
Guardian or responsible party name
The name of the person or physician who referred the patient.
It may look obvious, however in case your form does not ask patients for their fax, cell phone number, or e-mail address, you could be losing out on valuable information.
2. Copying the Insurance Card is a Necessity
Besides having the patient fill out the new patient form, ensure to ask for, and keep a copy of, his insurance card. You should always make a copy of the patient's insurance card, front and back. This has important information on where to send the claims correctly the first time, ensuring the medical coding and billing accuracy and obtaining revenue faster.
As you'll make a copy of the insurance card's front and back, you don't require to ask the patient to give that information (policy number, group number, phone numbers, etc.) on a form.
Medical Coding and Billing Tip: You must ask for the card upon each and every visit by the patient. Insurance information can change regularly, and the patient may not even be conscious of the change. Certain payers have dissimilar addresses for different specialty medical billing.
3. Get Referring Physician Details
Once a new patient arrives due to a referral, ensure you have clear info on the referring physician as well. When the patient arrives, a staff member must be examining referral data for Medical Coding and Billing accuracy.
Abdominal Aortography Interp Might Be Payable With Heart Cath
Added payment may be gained for any abdominal aortography carried out during the same session for example a left heart cath with aortography of the aortic root however only if documentation specifies that the intent of the abdominal aortography was the treatment of a dissimilar problem. This expert medical coding article gives you CPT code lookup tips and more.
Procedure notes thus need to document clearly and accurately (by including, for example, a second diagnosis) that the additional aortography was separate from the heart cath.
When a left heart cath is done, aortography as well as the more distinctive angiography of the left coronary chambers as well as the coronary arteries may be carried out to get images of the aortic root (where the aorta joins the heart). For this particular procedure, once you execute CPT code lookup, 93544 (injection procedure during cardiac catheterization; for aortography) is reported with 93556 (imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; pulmonary angiography, aortography and/or selective coronary angiography including venous bypass grafts and arterial conduits [whether native or used in bypass]).
Any images gained from injections in the ascending aorta (the first section of the aorta, defined as the section from the left ventricle to the arch, or bend) are encompassed in CPT codes 93544/93556. 93544 includes positioning the catheter in the ascending aorta which is above the aortic valve. It does not, though, describe abdominal aortography.
Abdominal aortography may be carried out following a heart cath. For instance, the cardiologist may have trouble passing a guidewire plus catheter from the access site (the femoral artery) to the aorta as the patient has tortuous arteries (defined as twisted and full of turns).
In case the coronary problem needs urgent attention, the cardiologist may carry out the heart cath first. When the catheter is being removed via the aorta, another injection is done to image the abdominal aorta or other arteries (such as the renal, iliac and femoral arteries).
Abdominal aortography and heart cath may as well be carried out simultaneously in case the patient has a supplementary problem (such as hip pain or leg cramps) that the cardiologist wants to evaluate at the same time.
CPT Code Lookup tip: Even though aortography of the aortic root (or elsewhere in the ascending aorta) has already been carried out, and reported using CPT codes 93544/93556, the supervision as well as interpretation of the abdominal aortogram (which reflects the manipulation of the catheter as well as the interpretation of the images) must be distinctly payable using either 75625 (aortography, abdominal, by serialography, radiological supervision and interpretation) if only the aorta is imaged, or CPT code 75630 ( . . . plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation) in case images of the iliac and/or femoral arteries are also gained.
Procedure notes thus need to document clearly and accurately (by including, for example, a second diagnosis) that the additional aortography was separate from the heart cath.
When a left heart cath is done, aortography as well as the more distinctive angiography of the left coronary chambers as well as the coronary arteries may be carried out to get images of the aortic root (where the aorta joins the heart). For this particular procedure, once you execute CPT code lookup, 93544 (injection procedure during cardiac catheterization; for aortography) is reported with 93556 (imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; pulmonary angiography, aortography and/or selective coronary angiography including venous bypass grafts and arterial conduits [whether native or used in bypass]).
Any images gained from injections in the ascending aorta (the first section of the aorta, defined as the section from the left ventricle to the arch, or bend) are encompassed in CPT codes 93544/93556. 93544 includes positioning the catheter in the ascending aorta which is above the aortic valve. It does not, though, describe abdominal aortography.
Abdominal aortography may be carried out following a heart cath. For instance, the cardiologist may have trouble passing a guidewire plus catheter from the access site (the femoral artery) to the aorta as the patient has tortuous arteries (defined as twisted and full of turns).
In case the coronary problem needs urgent attention, the cardiologist may carry out the heart cath first. When the catheter is being removed via the aorta, another injection is done to image the abdominal aorta or other arteries (such as the renal, iliac and femoral arteries).
Abdominal aortography and heart cath may as well be carried out simultaneously in case the patient has a supplementary problem (such as hip pain or leg cramps) that the cardiologist wants to evaluate at the same time.
CPT Code Lookup tip: Even though aortography of the aortic root (or elsewhere in the ascending aorta) has already been carried out, and reported using CPT codes 93544/93556, the supervision as well as interpretation of the abdominal aortogram (which reflects the manipulation of the catheter as well as the interpretation of the images) must be distinctly payable using either 75625 (aortography, abdominal, by serialography, radiological supervision and interpretation) if only the aorta is imaged, or CPT code 75630 ( . . . plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation) in case images of the iliac and/or femoral arteries are also gained.
A/R process: Tips to get your Practice its Deserved Reimbursements
Here are some medical billing tips to refine your accounts receivable (A/R) process swiftly and easily to bring in the money more efficiently. For the uninitiated, AR is the money that is owed to the practice.
Don't be a code it, bill it and forget it company - keep a tab on each claim you send out
Don't follow the footsteps of other companies who don't take any step to bring in the money. Ensure that someone in your practice monitors closely all the claims you submit. Enquire whether the insurance company received the claim or try to find out whether the patient paid her copay portion of the bill. Also, make it a point to follow up early; doing so can save you time. If it gets delayed, find out why.
Follow up if you get unpaid and denied claim
Every practice meets with unpaid and denied claim. The best way to ensure your practice is among dollars is to follow up on denials and appeal as the situation demands. Review your explanations of benefits (EOB), focusing on your denials. You can pick up a lot of information from your EOBs such as how quickly insurers are paying you, whether your fee schedule is enough, whether coders are doing their job properly, why insurance companies are denying your claims and if you are being paid as per your contracted rates.
You should update your A/R process
You need to produce a variety of reports to help you evaluate your A/R process. You can invest in a good management system and learn all of its capabilities. You should pay special attention to the reporting abilities of the system you use to ensure you get the data you need to manage your practice's A/R. It could be the practice's gross collection rate, net collection rate and average days in A/R for claims. After this, you can use this information to assess the efficiency of your practice's A/R management.
For more on this and for other medical billing and coding updates, sign up for a good coding resource Coding Institute.
Don't be a code it, bill it and forget it company - keep a tab on each claim you send out
Don't follow the footsteps of other companies who don't take any step to bring in the money. Ensure that someone in your practice monitors closely all the claims you submit. Enquire whether the insurance company received the claim or try to find out whether the patient paid her copay portion of the bill. Also, make it a point to follow up early; doing so can save you time. If it gets delayed, find out why.
Follow up if you get unpaid and denied claim
Every practice meets with unpaid and denied claim. The best way to ensure your practice is among dollars is to follow up on denials and appeal as the situation demands. Review your explanations of benefits (EOB), focusing on your denials. You can pick up a lot of information from your EOBs such as how quickly insurers are paying you, whether your fee schedule is enough, whether coders are doing their job properly, why insurance companies are denying your claims and if you are being paid as per your contracted rates.
You should update your A/R process
You need to produce a variety of reports to help you evaluate your A/R process. You can invest in a good management system and learn all of its capabilities. You should pay special attention to the reporting abilities of the system you use to ensure you get the data you need to manage your practice's A/R. It could be the practice's gross collection rate, net collection rate and average days in A/R for claims. After this, you can use this information to assess the efficiency of your practice's A/R management.
For more on this and for other medical billing and coding updates, sign up for a good coding resource Coding Institute.
96413 + 96365: Is This Pairing Right?
Authoritative coding resources sometimes address even those encounters you do not handle on a daily basis. Here are two scenarios to test your skills and see whether your responses match the official rules.
Question 1: How many 'initial' codes are too many?
First challenge: Staff administers a non-chemotherapy therapeutic drug through one IV infusion site, and then following oncologist orders based on protocol, administers chemotherapy intravenously through a second IV site. In this scenario should you report the chemotherapy admin or the non-chemotherapy admin as the initial code?
Answer: Challenge 1 presents a trick question. You should code initial codes for both the chemotherapy and non-chemotherapy infusions.
According to CPT guidelines, while administering multiple infusions, injections or combinations, only one 'initial' service code should be reported, unless protocol requires that two separate IV sites must be used.
Many payers point out that when you code two initial code because each calls for a separate access site, you should add modifier 59 (Distinct procedural service). As such you may be required to add modifier 59 to the secondary 'initial' code to indicate the separate IV sites for each infusion in this case. For instance, your claim may cover the following:
96413 -- Chemotherapy administration, intravenous infusion technique; up to an hour, single or initial substance/drug
96365-59 -- Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to an hour.
Question 2: Does 96446 apply to this intraperitoneal case?
Second challenge: Documentation shows your oncologist took part in an operative encounter that involved providing intraperitoneal heated chemotherapy. As such, should you go for 96446 (Chemotherapy administration into the peritoneal cavity through indwelling port or catheter) for the chemotherapy administration?
Answer: Well, the answer is no. For intraoperative intraperitoneal heated chemotherapy (IPHC or HIPEC) that's a planned and integral part of the procedure, the most appropriate code is 96549 (Unlisted chemotherapy procedure), as per CPT Assistant (Dec. 2010).
IPHC takes place near the end of a surgical session in which a surgeon does away with tumors from the abdominal cavity. The doctor allows a warm chemotherapy solution to sit in the abdominal cavity and then drain.
But why 96549? According to CPT Assistant, IPHC doesn't have a specific CPT code, however since the hyperthermic chemotherapy solution administration adds time to the surgical and anesthesia time and needs physician/operating suite staff work above and beyond that of the surgical procedure," you may code it separately. As per CPT guidelines, you shouldn't select a CPT code that merely approximates the service provided. If no such specific code exists, then the service using the proper unlisted procedure or service code. As such 96549 is the most appropriate code.
And why not 96446? The temporary nature of the intraperitoneal catheter used for IPHC is what tells you 96446 is not proper for IPHC. Code 96446 is meant to report intraperitoneal chemotherapy administered through a permanently placed intraperitoneal catheter.
Question 1: How many 'initial' codes are too many?
First challenge: Staff administers a non-chemotherapy therapeutic drug through one IV infusion site, and then following oncologist orders based on protocol, administers chemotherapy intravenously through a second IV site. In this scenario should you report the chemotherapy admin or the non-chemotherapy admin as the initial code?
Answer: Challenge 1 presents a trick question. You should code initial codes for both the chemotherapy and non-chemotherapy infusions.
According to CPT guidelines, while administering multiple infusions, injections or combinations, only one 'initial' service code should be reported, unless protocol requires that two separate IV sites must be used.
Many payers point out that when you code two initial code because each calls for a separate access site, you should add modifier 59 (Distinct procedural service). As such you may be required to add modifier 59 to the secondary 'initial' code to indicate the separate IV sites for each infusion in this case. For instance, your claim may cover the following:
96413 -- Chemotherapy administration, intravenous infusion technique; up to an hour, single or initial substance/drug
96365-59 -- Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to an hour.
Question 2: Does 96446 apply to this intraperitoneal case?
Second challenge: Documentation shows your oncologist took part in an operative encounter that involved providing intraperitoneal heated chemotherapy. As such, should you go for 96446 (Chemotherapy administration into the peritoneal cavity through indwelling port or catheter) for the chemotherapy administration?
Answer: Well, the answer is no. For intraoperative intraperitoneal heated chemotherapy (IPHC or HIPEC) that's a planned and integral part of the procedure, the most appropriate code is 96549 (Unlisted chemotherapy procedure), as per CPT Assistant (Dec. 2010).
IPHC takes place near the end of a surgical session in which a surgeon does away with tumors from the abdominal cavity. The doctor allows a warm chemotherapy solution to sit in the abdominal cavity and then drain.
But why 96549? According to CPT Assistant, IPHC doesn't have a specific CPT code, however since the hyperthermic chemotherapy solution administration adds time to the surgical and anesthesia time and needs physician/operating suite staff work above and beyond that of the surgical procedure," you may code it separately. As per CPT guidelines, you shouldn't select a CPT code that merely approximates the service provided. If no such specific code exists, then the service using the proper unlisted procedure or service code. As such 96549 is the most appropriate code.
And why not 96446? The temporary nature of the intraperitoneal catheter used for IPHC is what tells you 96446 is not proper for IPHC. Code 96446 is meant to report intraperitoneal chemotherapy administered through a permanently placed intraperitoneal catheter.
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