Supercoder Blog

For those new to facility coding can find the world completely different. But these professional side coding tips can transfer to assignment of your facility level choice as well.

Contributing to the complexity of managing the coding and billing for the technical (facility) component of an ED visit are a number of factors, including the difference in rules governing how services are described within the same code set, says Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, President of Edelberg Compliance Associates in Baton Rouge, LA.

1. Focus on clinical staff documentation.

It is important for clinical staff, particularly nursing staff, to understand the hospital’s coding requirements to assure that documentation meets compliance standards.

Timed services such as observation, critical care, infusions and injections require start and stop times to assure they are being reported correctly, says Edelberg. E/M levels must be billed consistent with the guidelines and descriptors established by the individual facility which demands that ED clinical thoroughly document all assessments, interventions, treatments, ED course and the patient’s response to treatment, she adds.

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Don’t stop with your ICD-10 preparations just because the implementation delay gives you a little breather. Read on to learn about an important melanoma coding distinction that you’ll be required to use starting Oct. 1, 2014.

Site Specific Code

ICD-9: Under the current system, you have one code family for melanoma of skin (excluding skin of genital organs or sites other than skin): 172.x (Malignant melanoma of skin). A fourth digit designates the melanoma site as follows:

• 172.0 — Lip
• 172.1 — Eyelid, including canthus
• 172.3 — Other and unspecified parts of face
• 172.4 — Scalp and neck
• 172.5 — Trunk, except scrotum
• 172.6 — Upper limb, including shoulder
• 172.7 — Lower limb, including hip
• 172.8 — Other specified sites of skin
• 172.9 — Site unspecified.

ICD-10 provides similar site-specific codes in the family C43 (Malignant melanoma of skin). You’ll have more site specificity with the new codes, however, because ICD-10 adds a fourth digit for the ear (C43.2_, Ear and external auricular canal).

What’s more: ICD-10 also adds a fifth digit that provides greater specificity. For instance, C43.1_ further defines the melanoma site as follows:

• C43.10 — Malignant melanoma of unspecified eyelid, including canthus
• C43.11 — Malignant melanoma of right eyelid, including canthus
• C43.12 — Malignant melanoma of left eyelid, including canthus.

The right/left distinction isn’t the only way the fifth digit increases site-specificity. For instance, 172.3 crosswalks to the following three codes for ICD-10:

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This year is only halfway through, and the CPT® Editorial Committee has already started to think which codes you’ll get to see in 2013. In a recently-posted online publication of the Committee’s February meeting notes, you can see which code changes were proposed for 2013 that may apply to your practice.

Remember: Even though the proposed changes have been posted online, there is no guarantee that these changes will be instituted in CPT® 2013. As the Editorial notes indicate, “Codes are not assigned, nor exact wording finalized, until just prior to publication.”

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Question: My ob-gyn performed a laparoscopy and irrigated a right ovarian cyst. Should I report 58662? How about if he performs a laparoscopy with the resection of bilateral endometriomas?

Answer: You need to refer to your physician’s notes. Did he aspirate or drain the right ovarian cyst? If so, you should report 49322 (Laparoscopy, surgical; with aspiration of cavity or cyst [e.g., ovarian cyst] [single or multiple]).

As for the resection of bilateral endometriomas, you would choose your code depending on whether the physician removed any part of the ovary with them. If so, you should report 58661 (… with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]). If not, then you should report 58662 (… with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method).

However, you may not bill for both the aspiration of the cyst and its removal. In that case, you would bill only the most extensive procedure, which would be the removal of the cyst.

Heads up: Per a CPT® Assistant clarification, the code 58661 does not take a modifier 50 for a bilateral procedure; however, per the Medicare database, they now allow a modifier 50 on this code. Be sure you know which rule your payer is following if the code 58661 is the one you are billing.