Simple Easy steps to Clear CPC exam in 2017


Medical coding is one the best career option for all the life science graduates. But, to sustain in this field for long time medical coders need to work really hard. I myself have finished 7 years in medical coding and I really enjoyed this journey. One thing you should always remember, whatever you do in life always enjoy it to the fullest. Initially I was very scared that how I will be able to make a career in medical coding. My first year as Medical coder was full of struggle. Since, I was new to this field I have to learn everything about it. But, later I learnt about ICD, CPT, HCPCS codes and got familiar with these medical codes. Few years later I cleared CPC (Certified Professional Coder) exam and I am still trying to learn the other facilities in medical coding. This was in short I told my story. But, today I will share all the tricks I followed for clearing CPC exam and what new things should be followed for 2017 CPC exam.

Simple Easy steps to Clear CPC exam in 2017

CPC Practice Exam - Medical Coding Study Guide Please Click Here!


Be Updated with ICD 10 and CPT codes


From 2017, we have lot of changes in ICD 10 and CPT codes. The diagnosis codes have again increased in number. Since, ICD 10 codes are little difficult to learn, it is very important to focus more on diagnosis coding. Always remember to follow ICD 10 coding guidelines before answering any question in CPC exam. Same goes with the CPT codes, you should always follow the codebook. The CPT codebook will always guide you to the correct CPT codes. Do not forget to read the notes below CPT codes, many answers will be hidden in these sections. Try to highlight all the important section in ICD 10 and CPT codebook, so that you should be easily find them during CPC exam. Time is very important during CPC exam, which needs to be used very carefully. If you give proper time to each question you can easily find answers for most of the questions.


Be Confident with ICD 10 codes


If you want to clear CPC exam in 2017, you should be thoroughly prepared with ICD 10 coding guidelines. For examples, coding for Sepsis, pregnancy complication, use of Z codes, external Cause of injury codes etc. needs to be taken care. These topics generally requires two or more than two ICD 10 codes, hence one should not waste time during exam to find the multiple codes. Hence, be prepared with tough topics of ICD 10 and save your time in exam. Even CPT surgery questions requires lot of time, so divide your time among ICD 10 and CPT codes, to answer each question correctly. Also, in ICD 10 the initial, subsequent and sequela encounter codes need to be taken care. These section of ICD 10 codes might confuse you during CPC exam, hence be prepared with all these chapters in ICD 10.  


Be Prepared with CPT section


The main section for CPT codes in the surgery section. The question paper of CPC exam starts with surgery questions. I always suggest medical coders not to attempt the surgery questions in the beginning. These questions eat lot of time and hence should be attempted at the end. First try to solve the one or two liner questions which will take less than a minute to solve. Once, you have finished answers all the short questions, then go an attempt the big surgery question. Always remember, you have to finish the entire question paper and attempt all the question. Since there is no negative marking, you should be able to answer all the CPC exam questions.


Avoid silly Errors



Most of the time we do not focus on silly errors and these errors decreases our CPC exam score. First of all, finish your question paper before 30 minutes so that you can check your entire answer sheet for any unanswered question. Most of time, coders leave some questions to attempt them in the end, but in the end they might forget to answer those questions. Hence, try to check your answer sheet once before submitting to the invigilator. Secondly, do not waste time on single question, since we have to attempt all the question divide you time in such a way that, you should be able to answer all the questions. CPC exam has no negative marking; hence coders should always attempt all the questions in the question paper. Finally, be focused during CPC exam, if you are scared you will not find the answer but if you concentrate and read the question correctly you can easily find the correct answer. The more stable you are during CPC exam, the more the chances you have to pass CPC exam in 2017.

When to use CPT code 50432 and 50389

Coding for diagnostic nephrostogram can be little complicated sometimes. For example, when there is no clear documentation of new access or existing access, codingfor antegrade nephrostogram for CPT code 50430 and 50431 will be very complicated. This complication will be more when there is an interventional procedure is performed along with antegrade or diagnostic nephrostogram. So, today I am just trying to clear your doubt about how we can use these CPT code together with or without modifier in CPT coding.

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Read also: New CPT codes for 2017 for Spinal Epidural Injection

CPC Practice Exam - Medical Coding Study Guide Please Click Here!


Code description for CPT code 50430, 50432 and 50389


If you see the below description of these codes, you can see the imaging guidance and the radiological supervision and interpretation (RS&I) are included with the main procedure codes.

CPT 50430 : Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; new access 

CPT 50431 : existing access 

50389 Removal of nephrostomy tube, requiring fluoroscopic guidance



Sample coded report for CPT code 50430, 50432 and 50389



VAS/SP GENITOURINARY INTERVENTION
INDICATION:
Bilateral ureteral obstruction, status post bilateral internal
ureteral stents. Left external nephrostomy catheter remains.

EXAM:
GENITOURINARY INTERVENTION

MEDICATIONS:
None.

ANESTHESIA/SEDATION:
None.

CONTRAST:  20 cc Visipaque 320 - administered into the collecting
system(s)

FLUOROSCOPY TIME:  Fluoroscopy Time: 24 seconds

COMPLICATIONS:
None immediate.

PROCEDURE:
Informed written consent was obtained from the patient after a thorough discussion of the procedural risks, benefits and alternatives. All questions were addressed. Maximal Sterile Barrier Technique was utilized including caps, mask, sterile gowns, sterile gloves, sterile drape, hand hygiene and skin antiseptic. A timeout was performed prior to the initiation of the procedure.

Under sterile conditions, the existing left nephrostomy catheter was injected for antegrade nephrostogram. This demonstrates mild left hydroureteronephrosis. Left ureteral stent is patent and in good position. Ureteral jets demonstrated. Bladder is visualized with contrast.

Under sterile conditions, the existing left nephrostomy catheter was cut and removed over a guidewire under fluoroscopy. Sterile dressing applied. No immediate complication.

IMPRESSION:
Antegrade nephrostogram confirms patency of the left internal ureteral stent. Mild residual left hydroureteronephrosis noted.
                                                                                           
Uncomplicated left nephrostomy removal under fluoroscopy.

CPT code: 50431-59
                    50389


Rationale: The above report has some highlighted section. In the first section, you can see clearly an antegrade nephrostogram is performed with the existing access. Also, after the exam the physician has mentioned the finding, hence this will be coded as CPT code 50431.

The second highlighted section, removal of the nephrostomy tube under fluoroscopy, which is coded as CPT code 50489.

When we check for NCCI edit, it is seen that both codes cannot be coded together without a modifier. Hence, 59 modifier is assigned to CPT code 50431-59 to bypass the edit.


Amazing tips for CPT code 62320, 62321, 62322, 62323 in 2017


There are lot of changes in cpt codes in 2017. For example, the old codes for screening and diagnostic mammogram have been deleted and the new CPT code 77065, 77066and 77067 have been added. Also these new codes are bundled codes which includes the Computer aided detection (CAD). Similarly, we have new CPT codes 62320, 62321, 62322, 62323, 62324, 62325, 62326 and 62327 for coding Spinal injection procedures. Earlier we used procedure codes 62310, 62311, 62318, 62319 for coding spinal injection exam till 2016. But from 2017 we will be using new CPT codes for these exams. Let us check when these CPT codes should be used for these exams.
 
Amazing tips for CPT code 62320, 62321, 62322, 62323 in 2017
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Read also: When to use Modifier 47, 50 and 51

CPC Practice Exam - Medical Coding Study Guide Please Click Here!


Coding tips for CPT code 62320 and 62321


If you read the code description, the first basic difference between CPT code 62320 and 62321 is the used of imaging guidance. So, when a spinal steroid injection is performed percutaneously into interlaminar epidural or subarachnoid, cervical or thoracic region, and if it is performed without imaging guidance report CPT code 62320. But when the same exam is performed using imaging guidance like fluoroscopy or CT, use CPT code 62321. Below is the full code description for both these procedure codes.

62320 - Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance

62321- Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT)

Coding tips for CPT codes 62322 and 62323


These CPT codes should be reported only when the spinal steroid injection is performed in the interlaminar epidural or subarachnoid, lumbar or lumbosacral region. Here also, use CPT code 62322 when the exam is performed without imaging guidance and for exam with imaging guidance use CPT code 62323. Below is the full code description for both the procedures codes.

62322 - Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance

62323 - Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)


Sample coded Report for CPT code 62320, 62321, 62322 & 62323


RAD/DG NONSEL EPI INJ LUM/SAC EA
CLINICAL DATA:  Lumbosacral spondylosis without myelopathy. RIGHT
leg radicular symptoms.

FLUOROSCOPY TIME:  13 seconds corresponding to a dose of 10.5 mGy.

PROCEDURE:
The procedure, risks, benefits, and alternatives were explained to
the patient. Questions regarding the procedure were encouraged and
answered. The patient understands and consents to the procedure.
Time-out performed.

LUMBAR EPIDURAL INJECTION:

An interlaminar approach was performed on RIGHT at L5-S1. The
overlying skin was cleansed and anesthetized. A 20 gauge Crawford
epidural needle was advanced using loss-of-resistance technique.

DIAGNOSTIC EPIDURAL INJECTION:

Injection of Omnipaque 180 shows a good epidural pattern with spread
above and below the level of needle placement, primarily on the
RIGHT; no vascular opacification is seen.

THERAPEUTIC EPIDURAL INJECTION:

120.0 Mg of Depo-Medrol mixed with 2 mL 1% lidocaine were instilled.
The procedure was well-tolerated, and the patient was discharged
thirty minutes following the injection in good condition.

COMPLICATIONS:
None.

IMPRESSION:
Technically successful epidural injection on the RIGHT L5-S1 # 1.

CPT code – 62323

Since the above epidural steroid injection exam is performed in the lumbosacral region percutaneously in the presence of fluoroscopic guidance, CPT code 62323 has been reported for this exam.


Superb coding tips for Hydration CPT code 96360 & 96361


In Emergency department (ED) coding, use of hydration codes is required in facility coding. CPT code 96360 and 96361 are used in coding hydration infusion. In this procedure a physician or an assistant under direct physician supervision infuses a hydration solution such as prepackaged fluid and electrolytes for 31 minutes to one hour through an intravenous catheter inserted by needle into a patient’s vein or by infusion through an existing indwelling intravascular access catheter or port. For initial 31 minutes to 1-hour hydration, we should report CPT code 96360 and for each additional hour, use CPT code 96361.

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Description of CPT code 96360 and 96361


The hydration CPT codes should be used following the ED coding guidelines. The ED coders should follow the hierarchy      96365>96374>96372>96360. The CPT codes for IV infusion, IV pushes, IV injection and hydration should be based on this hierarchy. Below is the full code description for CPT code 96360 and 96361.

96360- Intravenous infusion, hydration; initial, 31 minutes to 1 hour

96361- each additional hour (list separately in addition to code for primary procedure)

Do and Don’t with CPT code 96360 and 96361


Do not report CPT code 96360 when performed as a concurrent infusion service

Do not report intravenous infusion for hydration of 30 minutes of less

Always use CPT code 96361 along with or in conjunction with CPT code 96360

Report CPT code 96361 for hydration infusion intervals of greater than 30 minutes beyond 1 hour increments.

Use CPT code 96361 to report hydration if provided as a secondary or subsequent service after the different initial service like CPT code 96360, 96365, 96374, 96409, 96413 when administer through same IV access.


The CPT code 96360 or 96361 are not intended to be reported by the physician or other qualified healthcare professional in the facility setting.

When to use Modifier 47, 50 and 51


Modifiers are very important in medical coding. We have already discussed previously about 25 and 27 modifier. It is quite complicated to choose the correct modifier and use them with CPT code. Today again we will discuss about modifier 47, 50 and 51.  These modifiers are very common to use during surgery coding. Also, if you want to clear CPC exam or CCS exam, you should be perfect in using modifiers with procedure codes. Let us learn each modifier one by one.
When to use Modifier 47, 50 and 51


Read also: Coding tips for Thoracentesis and Paracentesis

CPC Practice Exam - Medical Coding Study Guide Please Click Here!


When to use Modifier -47

Modifier -47 is used to report a surgical procedure in which the surgeon administers anesthesia (regional or general anesthesia) in addition to performing the surgery. Modifier 47 should not be used when a local anesthesia is used. The payment through a third party payer for modifier 47 should be based on the time spent administering the anesthesia. The surgery CPT code will be reported with modifier 47 by the surgeon who is acting as an anesthelogist. Modifier 47 should always be used with surgery CPT codes and never with the anesthesia codes.

When to use Modifier -50


Modifier -50 is used if the same procedure is performed on a mirror-image part of the body, using the same CPT procedure code to indicate a bilateral procedure. There are different methods the payer wants bilateral procedures to be submitted on the claim form.  Modifier 50 is the coding practice of choice when reporting bilateral procedures. The Medicare bilateral indicator is 1 or 3. 50 modifier is used when an identical procedure performed on both sides of the paired organ. Do not use RT or LT modifier in place of 50 modifier. RT and LT modifier should be used only when a procedure is performed on one side of the paired organ.
The physician performs a surgical sinus endoscopy with total ethmoidectomy, 31255, on the left and right ethmoid sinuses (bilateral).
1.       Using modifier -50, the service would usually be reported as 31255 and 31255-50.
2.      Using the Medicare modifiers for sides (-LT, left side and -RT, right side), the service would be reported as 31255-LT and 31255-RT.
3.      Using the one-line format, the service would be reported as 31255-50.
The most specific method of reporting is the second format, as it indicates not only the number of procedures, but also the side of the body.

When to use Modifier -51

Multiple Procedures

Modifier -51 is indicated when multiple procedures are performed at the same session by the same provider. This modifier should not be appended to designated add-on codes. Assign modifier -51 when multiple procedures, other than the E/M services, are performed on the same day or at the same session by the same provider. When reporting multiple surgeries, the primary procedure (procedure with the highest relative value unit) should be listed first on the claim. Use of modifier 51 should be done carefully because many procedure or CPT codes include many different procedures bundled together in one code. It would be incorrect to report services separately if they are included (bundled) in the description for a code. Unbundling is assigning multiple codes when one code would fully describe the service or procedure. The assigning of multiple codes in such a case results in increased reimbursement and is considered fraud by a third-party payer.
However, if one code does not describe all of the procedures performed, and the secondary procedure is not considered a minor procedure that is incidental to the major procedure (and therefore bundled into the major procedure), each additional procedure may be reported by using modifier -51.


Multiple procedures are reported in the following three significant circumstances:

·         The same operation is performed on different sites.

For example:  When an excision is 1 cm benign lesion done for patient of forearm and at the same time an excision of 2 cm benign lesion is done in the neck region. In such a case we will be coding two procedure codes for excision for forearm and neck with a modifier 51 to the second CPT code.
·         Multiple operations are performed at the same operative session.
There is multiple procedure performed at the same operative session. Always code the primary procedure which is more extensive or major procedure and then followed by the minor procedures of decreasing order of complexity with 51 modifier. The primary procedure should be paid full, second procedure during the same session should be paid 50% and the third procedure should be paid 25% of the fee, if there are 3 procedures performed at the same time.
·         The procedure is performed multiple times

Multiple procedures are also reported when the same procedure code is used to identify a  service performed more than once during a single operative session. There are two ways to report procedures performed multiple times, depending on the requirements of the third-party payer.

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