Amazing Tips for coding Thoracentesis and Paracentesis


CPT 2013: 32420-32422 Are Out -- Prep 4 New Thoracentesis and Drainage Codes

Clear up old aspiration questions with new codes.

If your general surgeons provide chest tube services, you’ve got some changes coming your way that you won’t want to miss. Get familiar with deleted and added codes to make sure you code your chest cases properly effective on Jan. 1, 2013.

Look at Lung Additions, Deletions, and Revisions, Too

Coding for removal of fluid from the chest cavity  looks a little different in this Year.


Deleted:  CPT 2013 deleted these codes:
·         32420 -- Pneumocentesis, puncture of lung for aspiration
·         32421 -- Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent
·         32422 -- Thoracentesis with insertion of tube, includes water seal (e.g., for pneumothorax), when performed (separate procedure).

Amazing Tips for coding Thoracentesis and Paracentesis

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


Added: In their place, you can see four new codes:
·         32554 -- Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance
·         32555 -- …with imaging guidance
·         32556 -- Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance
·         32557 -- … with imaging guidance.

Revised: Code 32551 has some wording changes you should be sure to note. Text that has been deleted is crossed through and text that has been added is underlined: Tube thoracostomy, includes water seal connection to drainage system (e.g., for abscess, hemothorax, empyema water seal), when performed, open (separate procedure).
These tips are really important for Certification exams like CPC, you can go through sample CPC questions here which is surely help in clearing CPC exam.


Matching Codes to Procedures Should Be Simpler


Good news: These changes should help clarify proper coding.


In the past, this set of codes has seemed to be somewhat of a challenge to coders. A common area for confusion is aspiration versus the drainage tube, and the new codes explained it better. Eliminating the pneumocentesis aspiration code can further reduce confusion.


Aspiration vs. indwelling catheter: Based on the new code definitions, 32554 and 32555 apply to aspiration, and 32556 and 32557 apply when the physician places an indwelling catheter as part of the fluid removal service.


An indwelling catheter is a small flexible tube placed with one end in the chest and the other end outside the skin. The catheter is left in place to allow for drainage.


Needle/catheter aspiration: Another typical troublemaker with the 2012 codes is how to code when the physician uses a catheter rather than a needle for aspiration. Codes 32554 and 32555 will help clarify this by specifying "needle or catheter."


Imaging guidance: The 2013 codes continue the CPT trend of bundling imaging guidance into surgical procedure codes Codes 32555 and 32557 specify "with imaging guidance."


The bottom line is that you should not report imaging separately for 32554-32557 in 2013. This marks a change from 2012 codes 32421 and 32422, which instruct you to report guidance separately (76942, 77002, or 77012).


Don’t forget 32551 revision: In 2013, the definition of chest tube insertion code 32551 specifies that the service is an open procedure. Physicians perform tube thoracostomy to remove fluid from between the chest cavity and lungs.


CPTupdate u 2013: Make the Most of ‘Other Qualified Healthcare Professionals’ Billing


Don’t limit E/M services to general surgeons in your practice.


If you’ve been losing pay when a physician assistant (PA) or other appropriate caregiver performs E/M services in your surgical practice, recent changes could come to your rescue.


You’ll find revisions to more than 80 E/M codes in CPT® 2013 that allow you to bill services for certain "qualified healthcare professionals" other than physicians. We’ll show you what you need to know now to take advantage of the change.


Get Familiar With Code Modifications


Throughout the revised code definitions, CPT 2013 makes certain additions and deletions to clarify who can bill for the E/M service.


For example: The explanation with many E/M codes for settings from office to hospital now read, "Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. … Typically, XX minutes are spent face-to-face with the patient and/or family."


Differences: Previous descriptors stated that the counseling and/or coordination of care took place with "other providers or agencies." The face-to-face time associated with each code also was attributed to the physician instead of being open to physicians or other qualified providers.


Look to Table 1 to see a list of revised CPT 2013 codes that has been  included "other qualified healthcare professionals."


Know the ‘Qualified Healthcare Professional’ Definition


Although you won’t see code-definition changes until 2013, the AMA actually released the definition of "other qualified healthcare professionals" in CPT 2012 errata, as follows:


"A ‘physician or other qualified health care professional’ is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service.


These professionals are distinct from ‘clinical staff.’ A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service. Other policies may also affect who may report specified services."


The definition was in response to questions that the AMA received related to immunization administration codes that used the terminology (e.g., 90460-90461, Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional …). The definition helps to "clarify healthcare professionals as distinct from clinical staff,".


Result: RNs and LPNs aren’t included in the definition because they cannot independently report the professional services that they provide. RNs and LPNs fit the CPT® definition of "clinical staff," since their professional services are typically reported under a physician or other qualified health care professional’s identification number (e.g., under Medicare’s "incident to" rule). "This means that when certain CPT codes refer to ‘other qualified health care professionals’ they are excluding RNs and LPNs.


Tip: PAs (with various certification designations such as PA-C) and Advanced Registered Nurse Practitioners (ARNP) qualify as "other qualified healthcare professional," in most cases.

  

News Brief: Get Ready for Medicare Pay Cuts -- Yet Again -- in 2013


Watch for final rule and Congressional changes.


There may be some winners and losers this year under the Medicare Physician Fee Schedule (PFS) proposed rule, but it won’t general surgeons.


Here’s the low-down on what you can expect if CMS makes no changes in the final rule, and if Congress fails to avert the sustainable growth rate (SGR) update for 2013.


Surgeons Lose to Primary Care Physicians


To offset a pay increase to some physicians under the primary care initiative, CMS proposes to hold steady or decrease pay for all non-primary care physicians, including general surgeons. Although some specialties face extreme fee reductions (up to 14 percent), general surgeons can expect to hold steady with a 0 percent pay change, according to CMS.


Here’s why: CMS is proposing a 7 percent pay increase for family practitioners, and between 3 and 5 percent increases for other primary care practitioners. "Helping primary care doctors will help improve patient care and lower health care costs long term.


That’s not all: As it has every year since CY 2002, CMS projects a significant reduction in PFS payment rates under the SGR methodology. For CY 2013, CMS projects a reduction of 27 percent. Congress has acted to avert the cuts every year since 2003, however. That means the waiting begins now to see if the 27 percent reduction materializes.


Keep an eye on future issues of General Surgery Coding Alert to see if any changes in the final rule or Congressional action will impact your bottom line.

38240-38243 Q&A Helps You Apply Updated Hematopoietic Progenitor Cell Codes

Stay alert for limited opportunities to report distinct E/M.

When it comes to applying codes correctly, veteran coders know that coding guidelines can be as important as code definitions. Review this Q&A -- and the guidelines in your manual -- to ensure you apply stem cell transplant and lymphocyte infusion codes correctly in 2013.

Background: CPT 2013 revised and added to the list of stem cell transplant codes, as explained in "38243 that has brought a New Option for HPC Boost Starting January 1.

Effective Jan. 1, 2013, CPT deleted the crossed out text and added the underlined text shown below:
·         Revised: 38240, Bone marrow or blood-derived peripheral stem Hematopoietic progenitor cell transplantation(HPC); allogeneic transplantation per donor

·         Revised: 38241, … autologous transplantation

·         New: 38243, … HPC boost

·         Revised: 38242, Bone marrow or blood-derived peripheral stem cell transplantation Allogeneic lymphocyte infusions; allogeneic donor lymphocyte infusions

1. What’s the Timeframe for an HPC Boost?


An HPC boost can take place days, months, or years after the original transplant, state CPT® 2013 guidelines for "Transplantation and Post-Transplantation Cellular Infusions." The same holds true for lymphocyte infusions.


An HPC boost is an infusion of HPCs from the original donor. The physician orders the boost to treat a relapse or post-transplant cytopenia (reduction in number of blood cells). You’ll report this service using new-for-2013 code 38243 (Hematopoietic progenitor cell [HPC]; HPC boost).


A lymphocyte (type of white blood cell) infusion is ordered to treat relapse, infection, or post-transplant lymphoproliferative syndrome. You should report this service in 2013 using revised code 38242 (Allogeneic lymphocyte infusions).


2. What’s Included in 38240-38243?
Bone, Bone marrow, Bone marrow examination, Braydon, Cancer,

According to CPT guidelines, you should not report the following services in conjunction with 38240-38243:


·         Physician monitoring of physiologic parameters
·         Physician verification of cell processing
·         Patient evaluation immediately before, during, and after HPC/lymphocyte infusion
·         Physician presence and direct supervision of clinical staff during infusion
·         Management of uncomplicated adverse events, such as nausea and urticaria (hives)
·         Incidental hydration and fluids used for administration
·         Concurrent infusions of medications.



3. Which Services Are Separately Reportable?


CPT guidelines also provide information on which services you may report in addition to 38240-38243.


You may report E/M codes on the same date as 38240-38243 if that E/M is separately identifiable and supported by the progress note documentation. Guidelines instruct you to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code to identify the separate visit service performed.


The guidelines also state that "post-transplant infusion management of adverse reactions is reported separately using the appropriate E/M, prolonged service or critical care code(s)." Keep in mind, however, that guidelines instruct you to not separately report treatment of uncomplicated adverse events during the infusion.


Finally, CPT guidelines for the new code specify that you may separately report hydration and medication administration unrelated to the transplant. Append modifier 59 (Distinct procedural service) to show the service was properly ordered and provided beyond what is normally an inclusive, necessary component of an HPC or lymphocyte service.


2013 ICD-9 Changes
Clinical Scenario:

Question: We always prepare for ICD-9 changes in the fall of each year, but I haven’t heard anything this year. Are there updates planned for 2013 that I’ve somehow missed?
Answer: There are no ICD-9-CM diagnosis code updates planned for 2013 (effective Oct. 1, 2012). There’s a freeze in place until ICD-10-CM replaces ICD-9-CM, and that means no new codes.

The ICD-9-CM Coordination Committee can make other changes, however. The committee has resisted making any changes to the alphabetical index and tabular list for ICD-9-CM, but they have made changes to ICD-10-CM. Plus, there may or may not be changes to the coding guidelines.

Potential changes for the annual ICD-9-CM update usually appear at this time of year in CMS’s Inpatient Prospective Payment System (IPPS) proposed rule, but this year’s IPPS indicated you won’t have to deal with any changes. Instead, your general surgery practice can focus on ICD-10 preparation.

CPT 2013: 32420-32422 Are Out -- Prep 4 New Thoracentesis and Drainage Codes

Clear up old aspiration questions with new codes.

If your general surgeons provide chest tube services, you’ve got some changes coming your way that you won’t want to miss. Get familiar with deleted and added codes to make sure you code your chest cases properly effective on Jan. 1, 2013.
Look at Lung Additions, Deletions, and Revisions, Too
Coding for removal of fluid from the chest cavity  looks a little different in this Year.
Deleted:  CPT 2013 deleted these codes:
·        
32420 -- Pneumocentesis, puncture of lung for aspiration
·        
32421 -- Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent
·        
32422 -- Thoracentesis with insertion of tube, includes water seal (e.g., for pneumothorax), when performed (separate procedure).

Added: In their place, you can see four new codes:


·        
32554 -- Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance
·        
32555 -- …with imaging guidance
·        
32556 -- Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance
·        
32557 -- … with imaging guidance.

Revised: Code 32551 has some wording changes you should be sure to note. Text that has been deleted is crossed through and text that has been added is underlined: Tube thoracostomy, includes water seal connection to drainage system (e.g., for abscess, hemothorax, empyema water seal), when performed, open (separate procedure).


Matching Codes to Procedures Should Be Simpler


Good news: These changes should help clarify proper coding.


In the past, this set of codes has seemed to be somewhat of a challenge to coders. A common area for confusion is aspiration versus the drainage tube, and the new codes explained it better. Eliminating the pneumocentesis aspiration code can further reduce confusion.


Aspiration vs. indwelling catheter: Based on the new code definitions, 32554 and 32555 apply to aspiration, and 32556 and 32557 apply when the physician places an indwelling catheter as part of the fluid removal service.


An indwelling catheter is a small flexible tube placed with one end in the chest and the other end outside the skin. The catheter is left in place to allow for drainage.


Needle/catheter aspiration: Another typical troublemaker with the 2012 codes is how to code when the physician uses a catheter rather than a needle for aspiration. Codes 32554 and 32555 will help clarify this by specifying "needle or catheter."


Imaging guidance: The 2013 codes continue the CPT trend of bundling imaging guidance into surgical procedure codes Codes 32555 and 32557 specify "with imaging guidance."


The bottom line is that you should not report imaging separately for 32554-32557 in 2013. This marks a change from 2012 codes 32421 and 32422, which instruct you to report guidance separately (76942, 77002, or 77012).

Don’t forget 32551 revision: In 2013, the definition of chest tube insertion code 32551 specifies that the service is an open procedure. Physicians perform tube thoracostomy to remove fluid from between the chest cavity and lungs.

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