Wound Care Coding Guidelines In 2013

With immense coding and billing changes this year, wound care codes are no exception. In fact, there are considerable changes to CPT codes and coding guideline changes every year. Some of the important changes in wound care coding guidelines are as follows:

• Degree specific codes have been removed. So now all appropriately trained and licensed healthcare practitioners or in a more professional term “Qualified Healthcare Professional” can use all CPT codes. This means that there will be no PT codes or RN specific codes including surgical codes which are also not physician specific. Qualified healthcare professional can also use a code that describes a procedure appropriately specifying providers training and scope of practice.
• At present, the only thing that will be taken into consideration is that if the code describes adequately the procedure that was performed. So, the use of code 97597 used to describe debriding necrotic tissue from a wound will be taken into consideration which was previously only used as a PT code. Also the once superficial codes, 1104x have undergone revision and at present will be used to bill only for debridement of muscle, fascia and bone.
• There are some terminology changes as well which are as follows:

1. The term provider has been changed to “professionals”
2. The term practitioners has been revised to “individuals”
3. Physicians can now be termed as “qualified healthcare professionals” or “individuals”

Ensure Compliant Documentation through HIPAA Training To Survive HIPAA Audits

A number of trials have been conducted in a year for HIPAA Compliance Audit program and these audits were also a trial for the entities where they were conducted. Now plans are being made to revive this new HIPAA audit program in Fiscal Year 2014, after the US Department of Health and Human Services has evaluated it.

The set of rules used for the 2012 HIPAA audits by the HHS contractors have been published by USDHHS, making it easier to understand the exact way to prepare for the audits and implement HIPAA Compliance Training at AudioEducator. Audits are applicable for any health care covered entity as they need to understand the adequate information that they are required to provide and ways to avoid compliance related issues resulting in penalty.

2013 CPT Code changes for Molecular Pathology

This year there has been considerable code changes in every practice that has taken the healthcare industry by storm. Molecular pathology too underwent significant changes and new CPT codes. But many payers as well as CMS did not have fee schedule payments. This will be done April onwards and failing to meet the terms of the new changes can lead to delay in claim processing and claim rejection.

Some of the 2013 CPT code changes include medical lab procedures that deal with analysis of nucleic acids that detects variants in genes that indicates germline or somatic disease or tests for histocompatibility antigens. It does not include diseases causing infections or in situ hybridization analyses that are only found in Microbiology and anatomic pathology section.

Some of the deleted codes include stacking codes 83890 – 83914, 88384-88386 that are array based evaluation codes, a few genetic testing modifiers.  A new code 81479 is to be used for unlisted molecular pathology procedure. Some Tier 1 molecular pathology codes like 81200-81383 are relevant to few biomarkers. Tier 2 molecular pathology codes in the range 81400-81408 are used to refer groups of biomarkers that will need the same level of interpretive and technical resources that is necessary to finish the test.

If one is reporting a particular biomarker and not providing the complete descriptor that is there in the parenthetical CPT examples will be considered to be sufficient. But sometimes it will be important to provide the abbreviated information that will be essential to identify the service that has been provided.

For instance, The CPT code 81404 indicates “level 5” biomarker tests. CPT has identified an huge list of biomarkers that needs to be reported using code 81404. While billing for “frataxin” reporting it as FXN will be sufficient.

When a particular biomarker that has been tested is not represented by a Tier 1 code as well as not listed in Tier 2 codes, then it is best to report the test as “unlisted” using molecular pathology code 81479.  However, it needs to have a description in the narrative or remarks section when this code is used.

If descriptions are provided for Tier 2 and unlisted codes it will immensely affect in claims being processed on time and failing this will only result in claim denial or delay in processing of claim.

If you are looking for online medical coding guideline and training conferences, AudioEducator is the place where you can choose a wide range webinars that provide training on 2013 CPT code changes, OIG work plan and you can get familiar with the 2013 ICD 9 code changes and stay compliant.

Dermatology Coding Guidelines under ICD-10

With the introduction of ICD-10, that will have revised dermatology coding guidelines, dermatology billing will be more accurate and it will be easier to file clean claims. The procedure that is performed in the office determines the amount that needs to be charged by an outpatient dermatology practice. All the charges are related to specific procedure codes as complex procedures draw high reimbursement. This again is related to the practice and professional resources that are used to provide the service. The ICD-9 codes for dermatology are matched to the corresponding procedure code that implies medical necessity under the present reimbursement system.

But it has been seen for a long time that the required specificity to accurately report medical necessity lacks in ICD-9. Often, physicians assign Volume 2 codes without referring to the volume 1 codes, which usually happens to be an unspecified code, and the claim gets paid without any obstacles. But this doesn’t mean that it is a clean claim.