Shelly Cronin, CPC, CPMA, CANPC, CGSC, CGIC, CEU vendor department manager for AAPC, discusses common mistakes made in GI ambulatory surgery center coding and what coders need to know about changes to GI coding in 2012.
Q: In your experience, what are the most common mistakes coders make with ASC GI procedures?
Shelly Cronin: The most common mistakes coders make with ASC GI procedures are similar to those made by other coders, which would be coding from superbills rather than the operative reports, misuse of modifiers, reporting the incorrect codes for procedures performed [and] not following Medicare LCDs when applying codes to a procedure. These mistakes cause more problems than most other things because of the amount of money that could be sitting in the chart and the compliance risks that they entail.
Q: Why do these mistakes happen, and what can coders do to correct them?
SC: There are several reasons for the mistakes. It can range from the need for more education to following old habits that are passed down year after year without correction. Coders can prevent these mistakes by being proactive. If you feel that you lack education in an area, then look for a way to educate yourself or request the education to be provided from your employer.
If you feel that something is being billed incorrectly, do your research about why your facility reports services that way. It may seem wrong, but if a payor states that they want that service reported a certain way in order for the facility to receive payment, then that is what you must do to fit their regulations. If it is wrong, then address the issue with your manager or compliance officer.
Q: Are there any changes to GI coding for 2012 that ASC coders should be aware of?
SC: There are several code changes that ASC GI coders should be aware of. The codes for abdominal paracentesis, initial (49080) and subsequent (49081) have both been deleted and replaced with three new codes: 49082, abdominal paracentesis (diagnostic or therapeutic); without imaging guidance; 49083, abdominal paracentesis (diagnostic or therapeutic); with imaging guidance; and 49084, peritoneal lavage, including imaging guidance, when performed.
Medicare has continued bundling radiologic procedures commonly reported at the same time. This year it is the code 74174, computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing. This code as a Z2 ASC payment indicator for the service provided is an integral aspect to a surgical procedure on the ASC list.
There are several revisions to the esophageal motility study codes, which indicate deleted codes 91011 and 91012 and how to report the services correctly. There is a new Category III code 0288T for anoscopy, thermal energy treatment of fecal incontinence.
Q: Do you have any advice for GI-driven surgery centers related to improving their coding and billing accuracy and getting claims paid on time?
SC: My advice is to evaluate your centers performance, either annually or quarterly, to find any money that may be left on the table from the mistakes mentioned above. The evaluation can find your other weak points as well trigger changes, such as implementing an education program to proactively identify issues and educate the coders on proper coding/billing for services.
Documentation changes by providers may be required to provide greater specificity, which is of utmost importance, as we get closer to ICD-10. My final piece of advice is to share your findings with the coders. As a coder, if I don't know what my top five denials or my mistakes are, I won't be able to fix or prevent them in the future.
Related Articles on Coding, Billing and Collections:
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Fredericksburg Ambulatory Surgery Center Back In-Network With Anthem
Q: In your experience, what are the most common mistakes coders make with ASC GI procedures?
Shelly Cronin: The most common mistakes coders make with ASC GI procedures are similar to those made by other coders, which would be coding from superbills rather than the operative reports, misuse of modifiers, reporting the incorrect codes for procedures performed [and] not following Medicare LCDs when applying codes to a procedure. These mistakes cause more problems than most other things because of the amount of money that could be sitting in the chart and the compliance risks that they entail.
Q: Why do these mistakes happen, and what can coders do to correct them?
SC: There are several reasons for the mistakes. It can range from the need for more education to following old habits that are passed down year after year without correction. Coders can prevent these mistakes by being proactive. If you feel that you lack education in an area, then look for a way to educate yourself or request the education to be provided from your employer.
If you feel that something is being billed incorrectly, do your research about why your facility reports services that way. It may seem wrong, but if a payor states that they want that service reported a certain way in order for the facility to receive payment, then that is what you must do to fit their regulations. If it is wrong, then address the issue with your manager or compliance officer.
Q: Are there any changes to GI coding for 2012 that ASC coders should be aware of?
SC: There are several code changes that ASC GI coders should be aware of. The codes for abdominal paracentesis, initial (49080) and subsequent (49081) have both been deleted and replaced with three new codes: 49082, abdominal paracentesis (diagnostic or therapeutic); without imaging guidance; 49083, abdominal paracentesis (diagnostic or therapeutic); with imaging guidance; and 49084, peritoneal lavage, including imaging guidance, when performed.
Medicare has continued bundling radiologic procedures commonly reported at the same time. This year it is the code 74174, computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing. This code as a Z2 ASC payment indicator for the service provided is an integral aspect to a surgical procedure on the ASC list.
There are several revisions to the esophageal motility study codes, which indicate deleted codes 91011 and 91012 and how to report the services correctly. There is a new Category III code 0288T for anoscopy, thermal energy treatment of fecal incontinence.
Q: Do you have any advice for GI-driven surgery centers related to improving their coding and billing accuracy and getting claims paid on time?
SC: My advice is to evaluate your centers performance, either annually or quarterly, to find any money that may be left on the table from the mistakes mentioned above. The evaluation can find your other weak points as well trigger changes, such as implementing an education program to proactively identify issues and educate the coders on proper coding/billing for services.
Documentation changes by providers may be required to provide greater specificity, which is of utmost importance, as we get closer to ICD-10. My final piece of advice is to share your findings with the coders. As a coder, if I don't know what my top five denials or my mistakes are, I won't be able to fix or prevent them in the future.
Related Articles on Coding, Billing and Collections:
Specialists Branching Into Lucrative Cosmetic Procedures to Offset Decreasing Reimbursement
Sen. Feinstein Announces Support for California Initiative to Control Insurance Rate Hikes
Fredericksburg Ambulatory Surgery Center Back In-Network With Anthem