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Paul Cadorette, director of education for mdStrategies in Houston, cites 10 ways coders for ambulatory surgery centers can stay up-to-date on changes in CPT codes, even on a small budget.
1. Consult the ASCA website. "The Ambulatory Surgery Center Association website is a great resource for ASC coders," Mr. Cadorette says. The site provides a number of different lists of approved procedures in an ASC. For example, the association offers a list of "device-intensive" procedures, based on their HCPCS codes, in which payment for the devices is packaged into the facility payment, and a list of ASC Medicare payment rates for 399 surgical procedures.
2. Read all the instructions. Coders need to read all the instructions in the CPT book. "Read everything from the chapter or section guidelines down to all the parenthetical notes under each code," Mr. Cadorette says. Sometimes the codes will have four to five parenthetical notes. Under balloon sinuplasty, for example, the parenthetical notes explain that if you do the older surgical endoscopy procedure, using cutting instruments, combined with the new balloon dilation, sometimes called a hybrid procedure, you can only report the surgical endoscopy code and not the balloon code.
3. Get updates from CMS website. Updates on the CMS site are published quarterly, so at this time the April 2011 updates are the most current. Mr. Cadorette recommends checking the CMS website at least once each quarter for the latest information. The Medicare site lists addenda AA and BB of the hospital outpatient prospective payment system/ASC final rule. Medicare-covered ASC procedures and associated payment rates are published in addenda AA and covered ancillary services are in addenda BB.
For example, Category III codes for new technology are released in January and July. In July 2010, a new Category III code for platelet rich plasma injection procedures was introduced before the yearly publication of new codes in the CPT book, so this new code was listed in addenda AA with the July update, alerting coders to its existence. On the other hand, code Q1003, intraocular lens (reduced spherical aberration) was deleted in April 1, 2011 and now maintains a D5 status indicator (deleted/discontinued code). Facilities that used this code after the expiration date will not be reimbursed.
4. Consult local coverage determinations. Coders should frequently consult LCDs for specific services on the website of the local fiscal intermediary or Medicare Administrative Contractor. Each of these carriers has discretion on coverage matters, so policies may differ. Coders can Google the link for their local carrier and its LCDs. For instance, a determination may identify GI and pain procedures along with the diagnosis codes used for establishing medical necessity. Other procedures, like excision of benign lesions, will have certain terms and guidelines that must be followed to receive payment.
5. Sign up for listserv with your carrier. Coding rules can vary by Medicare carrier. In the listservs, which anyone can sign up for at no cost, the local MAC or fiscal intermediary regularly updates changes. For example, TrailBlazer, the carrier for Colorado, New Mexico, Oklahoma and Texas, e-mails necessary updates as often as several times a week. "If they are going change or modify any of their guidelines they will send you an e-mail," Mr. Cadorette says.
6. Stay away from coding forums. In a coding forum, anyone can answer your question, and the answer may be incorrect. Mr. Cadorette says he has seen incorrect information quite often on coding forums, and sometimes one answer to a question contradicts another. "How would you know which is right?" he asks.
7. Research inconsistencies. Sometimes reputable sources may contradict each other, requiring deeper research. For example, Mr. Cadorette found that information in an old CPT Assistant conflicted with a global billing guide from the American Academy of Orthopedic Surgeons. "It was 'rip your hair out' day," he says. To resolve the issue, he contacted the AMA CPT office, which involves a charge. In this case, the AMA agreed with the AAOS information. The AMA CPT office warns that answers may take a couple of weeks, but Mr. Cadorette says he usually hears back within four or five days.
8. Vendor information can be incorrect. Vendors' coding instructions for their products can overlook some of the nuances of coding, such as material in the parenthetical notes. If coders have any doubts, they should consult a second source, Mr. Cadorette says.
9. Network with other coders. Even ASCs with a small budget may allow their coders to attend nearby meetings, such as those of the statewide ASC association. Establish contacts with coders. "When consulting with a coder, verify that the information is from a reputable source and accurate," Mr. Cadorette says. If you are not sure the information is correct, he advises researching it more deeply.
10. Consult a coding company. Although there is a charge, coders can consult mdStrategies or another coding company for advice on a particular issue for a minimal fee. The coder submits an operative report and the company provides an educational review. Getting a thorough review, with explanations, is useful for procedures that are done repeatedly by the same physician. "You're paying for an educational service, not a case review," Mr. Cadorette says. "What we want is for the coder to gain experience that will be useful in the future."
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
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