This information is provided by our billing and coding consultant, Joy Newby who is with Newby Consulting, Inc.  Her contact information is below if you would like to become a client of hers!

Joy Newby, LPN, CPC, PCS

Newby Consulting, Inc.

A New Beginning

5725 Park Plaza Court

Indianapolis, IN 46220

Voice   317-573-3960

FAX     317-705-0131

E-mail  help@joynewby.net

CMS Clarifies Signature Requirements for Medicare Participating Docs

AAFP Responds With New Resources for FPs

By Sheri Porter
6/2/2010

 Most physicians would prefer to avoid being targeted in the cross hairs of a Medicare auditor. The key to doing so, according to Cynthia Hughes, C.P.C., an AAFP coding specialist, is to understand and follow CMS’ recently updated signature guidelines, which are outlined in the March 16 MLN Matters .

Stock photo of physician filling out paperwork
“Physicians need to make sure everything is signed and legible and will support the service that was rendered to the patient,” said Hughes. That’s the best way to avoid claims denials and attempted recovery of previously paid benefits by CMS auditors, she added.

Hughes and other staff members of AAFP’s Practice Support Division recently created new content for the coding resources area of the Academy’s website in response to CMS’ new guidelines. The information there spells out CMS directives on such issues as

  • handwritten signatures and acceptable signature formats,
  • valid electronic signatures,
  • attestation statements on unsigned documentation, and
  • signature logs.
Physicians must understand that the clinician’s signature serves as authentication of services rendered or ordered, said Hughes. Furthermore, CMS will not accept signature stamps for Medicare or Medicaid claims.

Physicians also will want to pay close attention to the CMS guidelines because the agency has created a small army of auditors to review Medicare claims, said Hughes.

Those auditors include recovery audit contractors, or RACs; zone program integrity contractors; program safeguard contractors; and comprehensive error rate testing contractors, according to the article in MLN Matters.

All of the above entities are responsible for “measuring, detecting and correcting improper payments, as well as identifying potential fraud in the fee-for-service Medicare program,” said the article.

What physicians may not know is that the auditors share information, said Hughes. If physicians are not following all the prescribed rules — for example, if patient records are going unsigned or physicians scribble an illegible signature — then physicians could end up under the microscope of more than one of the audit contractor groups, she said.

Furthermore, said Hughes, issues that are under review — as well as the percentage of errors found — are published by Medicare administrative contractors and may be the basis for further review by an RAC or even a Medicaid integrity contractor.

In addition, Hughes said, other staff members in the medical practice need to stay current on CMS regulations, too. It’s critical that physicians train all staff members who respond to a CMS contractor’s requests for records, she said. Staff members must learn to thoroughly review all paperwork, including signature lines, before any documents are released to CMS auditors for scrutiny.

 

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URGENT UPDATE –Are Your Physicians Enrolled in Medicare’s PECOS???

By: Connie Woods, CPC, CPC-I, CGSC, OCS

Newby Consulting, Inc.

Although only affecting DME suppliers now, failure to ensure your physicians are enrolled in Medicare’s Provider Enrollment Chain Ownership System (PECOS) will have far reaching consequences in the future. PECOS is an electronic system in which Medicare contractors enter the Medicare enrollment information you provided on the Medicare enrollment application. Regardless of whether you are a supplier or not and whether your physicians write prescriptions for any Durable Medical Equipment, Prosthetics, Orthotics, Supplies (DMEPOS), please read the rest of this article.

 

If you enrolled in Medicare or updated your Medicare enrollment information within the past five (5) years, your Medicare enrollment information is stored in PECOS. If you enrolled more than five (5) years ago and have not submitted any updates to your Medicare enrollment information, you need to update your Medicare enrollment information and may actually need to revalidate your provider information. Physicians should use the following web site to obtain information in relation to PECOS. This website can be used to access and/or enroll in the PECOS system.

http://www.cms.hhs.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS.asp

For now, physicians with supplier numbers need to look at the remark codes included at the end of the remittance advice. If you find one of the following remark codes C200, C201 and C202 (“the referring or ordering provider is not authorized”), you are receiving warning messages telling you that there are ordering/referring physicians for at least one of the patients not currently enrolled in PECOS. These warning messages started appearing on Medicare remittance advice statements in early October. Newby Consulting, Inc. (NCI) has started receiving help forms and questions about what they mean.

DO NOT ignore these messages. If a supplier receives one of these warning messages on a claim, they should contact the ordering/referring physician on the claim and have them verify their eligibility with PECOS. This problem cannot be “fixed” by the supplier, only the ordering/referring physician can resolve the issue. Effective January 1, 2010 suppliers will get an immediate denial on each DME claim filed with a name and NPI of a referring or ordering physician who is not in PECOS.

At this time, the rule does not apply to physicians who order tests or refer patients to another physician. Physicians not enrolled in PECOS will not lose their billing privileges even after January 1, 2010. The Centers for Medicare & Medicaid Services (CMS) started with DMEPOS to get physicians enrolled in PECOS. By targeting DMEPOS, a huge number of physicians and providers will be affected. Currently, this effort only affects physicians who order DMEPOS items, e.g., glucose strips for diabetic patients, oxygen, etc.; however, NCI believes in the future, CMS will expand the claims editing to all services requiring an ordering/referring name and NPI on any claim.

ACT QUICKLY – If you access the Internet-based PECOS and are find you are not listed or do not have access to any data, you must revalidate your enrollment with Medicare. In order to revalidate, the physician must complete an 855I enrollment application with all the information necessary to initially enroll in Medicare. This will get the provider or supplier into PECOS and will ensure that their enrollment information, which may have changed over the years, is current.

Physicians can revalidate their enrollment via Internet-based PECOS or they can fill out the appropriate paper CMS-855I Medicare provider enrollment forms and mail them to the appropriate enrollment contractor.

Instructions on Internet-based PECOS can be found on the CMS website at http://www.cms.hhs.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS.asp#TopOfPage

MLN Matters article SE0914 also has guidance on using internet-based PECOS and can be found on the CMS website at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0914.pdf

Currently, this revalidation only affects individual physicians; however, NCI believes that eventually group practices and physicians who are incorporated or have an LLC, will have to verify the entity’s enrollment in PECOS.  This is clearly stated in the transmittal.

Physicians Who Also Have Medicare DME Supplier Numbers

The Common Electronic Data Interchange (CEDI) has front end edits in place to validate the data submitted conforms to HIPAA and Medicare requirements. As part of these edits, CEDI utilizes external code sources to validate the data on inbound transactions. The PECOS file used to verify eligibility for ordering/referring providers is one of the external data code sources utilized by CEDI.

Information from PECOS is provided to CEDI using only upper case characters (capital letters). In order to validate the name against the PECOS file, the alpha character data on the claim for the ordering/referring provider must be in upper case. If a lower case character is submitted in the ordering/referring provider field, right now you will receive the message “the referring or ordering provider is not authorized.” Effective with dates of service on or after January 1, 2010, claims submitted with an ordering/referring provider name and NPI not enrolled in will be rejected.

CMS Announces DMEPOS Competitive Bidding Payment Amounts

The Centers for Medicare & Medicaid Services (CMS) has announced the single payment amounts for the Round 1 Rebid of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program.To view the Press Release, please click: http://www.cms.hhs.gov/apps/media/press_releases.asp

 To view the Fact Sheet, please click: http://www.cms.hhs.gov/apps/media/fact_sheets.asp

Visit the CMS web site at:  http://www.cms.gov/DMEPOSCompetitiveBid/01A1_Announcements_and_Communications.asp#TopOfPage  to view additional information.

Questions can be directed to rosfofm@cms.hhs.gov or telephone number (415) 744-3658 who will distribute your questions accordingly.

Superbills…helpful or harmful?  Plus new diagnosis codes!

By Joy Newby, LPN, CPC, PCS

Newby Consulting, Inc.

It may seem like it was just yesterday that you updated the diagnosis and procedure codes in your practice management computer system and on your superbills, but for some practices it may have been several years since a thorough review was performed. We frequently find physicians are incorrectly coding their services because of outdated superbills.

Procedure Codes

CPT and HCPCS codes are updated every year and the revisions become effective with dates of service on or after January 1 of the current year. Some years very few and maybe no changes effect your practice, in other years, the change can be astounding!

Although the coding change was effective January 1, 2007, we found the most common mistake on primary care superbills in 2009 are the codes for destruction of skin lesions. Physicians are incorrectly continuing to report 17000, 17003, and 17004 for the destruction of benign skin lesions. These codes should only be used to support the destruction of premalignant lesions.

17000  Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion

17003         second through 14 lesions, each (List separately in addition to code for first lesion) (Use 17003 in conjunction with 17000)

17004         15 or more lesions

Physicians should report the following codes for destruction of benign skin lesions.

17110  Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions

17111         15 or more lesions

If your practice has been incorrectly using 17000, 17003, and 17004, you have been overpaid for your services. The 2009 Arizona Medicare Fee Schedule reveals the following participating approved amounts when the procedure is performed in the office setting:

CPT Code Approved Amount
17000 $63.31
17003 $6.13
17004 $143.30
17110 $87.08
17111 $104.03

If you destroyed 5 benign lesions your approved amount is $87.08. If you incorrectly coded the service you have been overpaid by 75¢ ($87.83 – 87.08). If you destroyed 15 benign skin lesions, you have been overpaid by $39.27. If you only destroyed 1 benign skin lesion, you have been UNDERPAID by $23.77

Physicians using the above codes should review their superbills and if necessary perform a self-audit and, if necessary, take the appropriate action, e.g., refund, redetermination, etc.

While we don’t know what the 2010 changes will be, we can guarantee there will be many changes. Be sure you have already ordered your CPT 2010 and HCPCS 2010. Verify that someone in your office is assigned to review the superbill for changes.

Revisions are easy if your practice management system generates the superbills for each patient. The person assigned to monitor changes should be able to make changes easily.

For those of you ordering pre-printed superbills, please do NOT think “it is only a small change, we will remember to use the correct code until we use up our current supply.” After a couple of days/weeks, no one remembers to make the changes. This means claims are incorrectly filed and no one changes the incorrect information when ordering a new supply of superbills!

©All current procedural terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

Diagnosis Codes

I can’t believe it is already time to think about implementing the diagnosis coding changes that take effect October 1, 2009. The changes are noted below.

New Diagnosis Codes

Diagnosis Code Description
209.31 Merkel cell carcinoma of the face
209.32 Merkel cell carcinoma of the scalp and neck
209.33 Merkel cell carcinoma of the upper limb
209.34 Merkel cell carcinoma of the lower limb
209.35 Merkel cell carcinoma of the trunk
209.36 Merkel cell carcinoma of other sites
209.70 Secondary neuroendocrine tumor, unspecified site
209.71 Secondary neuroendocrine tumor of distant lymph nodes
209.72 Secondary neuroendocrine tumor of liver
209.73 Secondary neuroendocrine tumor of bone
209.74 Secondary neuroendocrine tumor of peritoneum
209.75 Secondary Merkel cell carcinoma
209.79 Secondary neuroendocrine tumor of other sites
239.81 Neoplasms of unspecified nature, retina and choroid
239.89 Neoplasms of unspecified nature, other specified sites
274.00 Gouty arthropathy, unspecified
274.01 Acute gouty arthropathy
274.02 Chronic gouty arthropathy without mention of tophus (tophi)
274.03 Chronic gouty arthropathy with tophus (tophi)
277.88 Tumor lysis syndrome
279.41 Autoimmune lymphoproliferative syndrome
279.49 Autoimmune disease, not elsewhere classified
285.3 Antineoplastic chemotherapy induced anemia
348.81 Temporal sclerosis
348.89 Other conditions of brain
359.71 Inclusion body myositis
359.79 Other inflammatory and immune myopathies, NEC
372.06 Acute chemical conjunctivitis
416.2 Chronic pulmonary embolism
438.13 Late effects of cerebrovascular disease, dysarthria
438.14 Late effects of cerebrovascular disease, fluency disorder
453.50 Chronic venous embolism and thrombosis of unspecified deep vessels of lower extremity
453.51 Chronic venous embolism and thrombosis of deep vessels of proximal lower extremity
453.52 Chronic venous embolism and thrombosis of deep vessels of distal lower extremity
453.6 Venous embolism and thrombosis of superficial vessels of lower extremity
453.71 Chronic venous embolism and thrombosis of superficial veins of upper extremity
453.72 Chronic venous embolism and thrombosis of deep veins of upper extremity
453.73 Chronic venous embolism and thrombosis of upper extremity, unspecified
453.74 Chronic venous embolism and thrombosis of axillary veins
453.75 Chronic venous embolism and thrombosis of subclavian veins
453.76 Chronic venous embolism and thrombosis of internal jugular veins
453.77 Chronic venous embolism and thrombosis of other thoracic veins
453.79 Chronic venous embolism and thrombosis of other specified veins
453.81 Acute venous embolism and thrombosis of superficial veins of upper extremity
453.82 Acute venous embolism and thrombosis of deep veins of upper extremity
453.83 Acute venous embolism and thrombosis of upper extremity, unspecified
453.84 Acute venous embolism and thrombosis of axillary veins
453.85 Acute venous embolism and thrombosis of subclavian veins
453.86 Acute venous embolism and thrombosis of internal jugular veins
453.87 Acute venous embolism and thrombosis of other thoracic veins
453.89 Acute venous embolism and thrombosis of other specified veins
488.0 Influenza due to identified avian influenza virus
488.1 Influenza due to identified novel H1N1 influenza virus
569.71 Pouchitis
569.79 Other complications of intestinal pouch
569.87 Vomiting of fecal matter
621.34 Benign endometrial hyperplasia
621.35 Endometrial intraepithelial neoplasia [EIN]
670.10 Puerperal endometritis, unspecified as to episode of care or not applicable
670.12 Puerperal endometritis, delivered, with mention of postpartum complication
670.14 Puerperal endometritis, postpartum condition or complication
670.20 Puerperal sepsis, unspecified as to episode of care or not applicable
670.22 Puerperal sepsis, delivered, with mention of postpartum complication
670.24 Puerperal sepsis, postpartum condition or complication
670.30 Puerperal septic thrombophlebitis, unspecified as to episode of care or not applicable
670.32 Puerperal septic thrombophlebitis, delivered, with mention of postpartum complication
670.34 Puerperal septic thrombophlebitis, postpartum condition or complication
670.80 Other major puerperal infection, unspecified as to episode of care or not applicable
670.82 Other major puerperal infection, delivered, with mention of postpartum complication
670.84 Other major puerperal infection, postpartum condition or complication
756.72 Omphalocele
756.73 Gastroschisis
768.70 Hypoxic-ischemic encephalopathy, unspecified
768.71 Mild hypoxic-ischemic encephalopathy
768.72 Moderate hypoxic-ischemic encephalopathy
768.73 Severe hypoxic-ischemic encephalopathy
779.31 Feeding problems in newborn
779.32 Bilious vomiting in newborn
779.33 Other vomiting in newborn
779.34 Failure to thrive in newborn
784.42 Dysphonia
784.43 Hypernasality
784.44 Hyponasality
784.51 Dysarthria
784.59 Other speech disturbance
787.04 Bilious emesis
789.7 Colic
793.82 Inconclusive mammogram
799.21 Nervousness
799.22 Irritability
799.23 Impulsiveness
799.24 Emotional lability
799.25 Demoralization and apathy
799.29 Other signs and symptoms involving emotional state
799.82 Apparent life threatening event in infant
813.46 Torus fracture of ulna (alone)
813.47 Torus fracture of radius and ulna
832.2 Nursemaid’s elbow
969.00 Poisoning by antidepressant, unspecified
969.01 Poisoning by monoamine oxidase inhibitors
969.02 Poisoning by selective serotonin and norepinephrine reuptake inhibitors
969.03 Poisoning by selective serotonin reuptake inhibitors
969.04 Poisoning by tetracyclic antidepressants
969.05 Poisoning by tricyclic antidepressants
969.09 Poisoning by other antidepressants
969.70 Poisoning by psychostimulant, unspecified
969.71 Poisoning by caffeine
969.72 Poisoning by amphetamines
969.73 Poisoning by methylphenidate
969.79 Poisoning by other psychostimulants
995.24 Failed moderate sedation during procedure
V10.90 Personal history of unspecified malignant neoplasm
V10.91 Personal history of malignant neuroendocrine tumor
V15.52 Personal history of traumatic brain injury
V15.80 Personal history of failed moderate sedation
V15.83 Personal history of underimmunization status
V20.31 Health supervision for newborn under 8 days old
V20.32 Health supervision for newborn 8 to 28 days old
V26.42 Encounter for fertility preservation counseling
V26.82 Encounter for fertility preservation procedure
V53.50 Fitting and adjustment of intestinal appliance and device
V53.51 Fitting and adjustment of gastric lap band
V53.59 Fitting and adjustment of other gastrointestinal appliance and device
V60.81 Foster care (status)
V60.89 Other specified housing or economic circumstances
V61.07 Family disruption due to death of family member
V61.08 Family disruption due to other extended absence of family member
V61.23 Counseling for parent-biological child problem
V61.24 Counseling for parent-adopted child problem
V61.25 Counseling for parent (guardian)-foster child problem
V61.42 Substance abuse in family
V72.60 Laboratory examination, unspecified
V72.61 Antibody response examination
V72.62 Laboratory examination ordered as part of a routine general medical examination
V72.63 Pre-procedural laboratory examination
V72.69 Other laboratory examination
V80.01 Special screening for traumatic brain injury
V80.09 Special screening for other neurological conditions
V87.32 Contact with and (suspected) exposure to algae bloom
V87.43 Personal history of estrogen therapy
V87.44 Personal history of inhaled steroid therapy
V87.45 Personal history of systemic steroid therapy
V87.46 Personal history of immunosuppressive therapy

 

Revised Diagnosis Codes for 2010

Diagnosis Code Description
453.2 Other venous embolism and thrombosis of inferior vena cava
453.40 Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity
453.41 Acute venous embolism and thrombosis of deep vessels of proximal lower extremity
453.42 Acute venous embolism and thrombosis of deep vessels of distal lower extremity
572.2 Hepatic encephalopathy
584.5 Acute kidney failure with lesion of tubular necrosis
584.6 Acute kidney failure with lesion of renal cortical necrosis
584.7 Acute kidney failure with lesion of renal medullary [papillary] necrosis
584.8 Acute kidney failure with other specified pathological lesion in kidney
584.9 Acute kidney failure, unspecified
639.3 Kidney failure following abortion and ectopic and molar pregnancies
669.30 Acute kidney failure following labor and delivery, unspecified as to episode of care or not applicable
669.32 Acute kidney failure following labor and delivery, delivered, with mention of postpartum complication
669.34 Acute kidney failure following labor and delivery, postpartum condition or complication
670.00 Major puerperal infection, unspecified, unspecified as to episode of care or not applicable
670.02 Major puerperal infection, unspecified, delivered, with mention of postpartum complication
670.04 Major puerperal infection, unspecified, postpartum condition or complication
757.6 Specified congenital anomalies of breast
772.0 Fetal blood loss affecting newborn
776.9 Unspecified hematological disorder specific to newborn
784.40 Voice and resonance disorder, unspecified
784.49 Other voice and resonance disorders
793.0 Nonspecific (abnormal) findings on radiological and other examination of skull and head
793.1 Nonspecific (abnormal) findings on radiological and other examination of lung field
793.2 Nonspecific (abnormal) findings on radiological and other examination of other intrathoracic organs
793.3 Nonspecific (abnormal) findings on radiological and other examination of biliary tract
793.4 Nonspecific (abnormal) findings on radiological and other examination of gastrointestinal tract
793.5 Nonspecific (abnormal) findings on radiological and other examination of genitourinary organs
793.6 Nonspecific (abnormal) findings on radiological and other examination of abdominal area, including retroperitoneum
793.7 Nonspecific (abnormal) findings on radiological and other examination of musculoskeletal system
793.89 Other (abnormal) findings on radiological examination of breast
793.99 Other nonspecific (abnormal) findings on radiological and other examination of body structure
813.45 Torus fracture of radius (alone)
996.43 Broken prosthetic joint implant
E876.5 Performance of wrong operation (procedure) on correct patient
V15.06 Allergy to insects and arachnids
V15.84 Personal history of contact with and (suspected) exposure to asbestos
V15.85 Personal history of contact with and (suspected) exposure to potentially hazardous body fluids
V15.86 Personal history of contact with and (suspected) exposure to lead
V57.3 Care involving speech-language therapy
V61.29 Other parent-child problems
V65.11 Pediatric pre-birth visit for expectant parent(s)

Invalid Diagnosis Codes for 2010

Diagnosis Code Description
239.8 Neoplasm of unspecified nature of other specified sites
274.0 Gouty arthropathy
279.4 Autoimmune disease, not elsewhere classified
348.8 Other conditions of brain
453.8 Other venous embolism and thrombosis of other specified veins
488 Influenza due to identified avian influenza virus
768.7 Hypoxic-ischemic encephalopathy (HIE)
779.3 Feeding problems in newborn
784.5 Other speech disturbance
799.2 Nervousness
969.0 Poisoning by antidepressants
969.7 Poisoning by psychostimulants
V10.9 Unspecified personal history of malignant neoplasm
V53.5 Fitting and adjustment of other intestinal appliance
V60.8 Other specified housing or economic circumstances
V72.6 Laboratory examination
V80.0 Special screening for neurological conditionsBy Joy Newby, LPN, CPC, PCSNewby Consulting, Inc.It may seem like it was just yesterday that you updated the diagnosis and procedure codes in your practice management computer system and on your superbills, but for some practices it may have been several years since a thorough review was performed. We frequently find physicians are incorrectly coding their services because of outdated superbills.Procedure CodesCPT and HCPCS codes are updated every year and the revisions become effective with dates of service on or after January 1 of the current year. Some years very few and maybe no changes effect your practice, in other years, the change can be astounding!Although the coding change was effective January 1, 2007, we found the most common mistake on primary care superbills in 2009 are the codes for destruction of skin lesions. Physicians are incorrectly continuing to report 17000, 17003, and 17004 for the destruction of benign skin lesions. These codes should only be used to support the destruction of premalignant lesions.17000  Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion17003         second through 14 lesions, each (List separately in addition to code for first lesion) (Use 17003 in conjunction with 17000)17004         15 or more lesionsPhysicians should report the following codes for destruction of benign skin lesions.17110  Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions17111         15 or more lesions

If your practice has been incorrectly using 17000, 17003, and 17004, you have been overpaid for your services. The 2009 Arizona Medicare Fee Schedule reveals the following participating approved amounts when the procedure is performed in the office setting:

CPT Code Approved Amount
17000 $63.31
17003 $6.13
17004 $143.30
17110 $87.08
17111 $104.03

If you destroyed 5 benign lesions your approved amount is $87.08. If you incorrectly coded the service you have been overpaid by 75¢ ($87.83 – 87.08). If you destroyed 15 benign skin lesions, you have been overpaid by $39.27. If you only destroyed 1 benign skin lesion, you have been UNDERPAID by $23.77

Physicians using the above codes should review their superbills and if necessary perform a self-audit and, if necessary, take the appropriate action, e.g., refund, redetermination, etc.

While we don’t know what the 2010 changes will be, we can guarantee there will be many changes. Be sure you have already ordered your CPT 2010 and HCPCS 2010. Verify that someone in your office is assigned to review the superbill for changes.

Revisions are easy if your practice management system generates the superbills for each patient. The person assigned to monitor changes should be able to make changes easily.

For those of you ordering pre-printed superbills, please do NOT think “it is only a small change, we will remember to use the correct code until we use up our current supply.” After a couple of days/weeks, no one remembers to make the changes. This means claims are incorrectly filed and no one changes the incorrect information when ordering a new supply of superbills!

©All current procedural terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

Diagnosis Codes

I can’t believe it is already time to think about implementing the diagnosis coding changes that take effect October 1, 2009. The changes are noted below.

New Diagnosis Codes

Diagnosis Code Description
209.31 Merkel cell carcinoma of the face
209.32 Merkel cell carcinoma of the scalp and neck
209.33 Merkel cell carcinoma of the upper limb
209.34 Merkel cell carcinoma of the lower limb
209.35 Merkel cell carcinoma of the trunk
209.36 Merkel cell carcinoma of other sites
209.70 Secondary neuroendocrine tumor, unspecified site
209.71 Secondary neuroendocrine tumor of distant lymph nodes
209.72 Secondary neuroendocrine tumor of liver
209.73 Secondary neuroendocrine tumor of bone
209.74 Secondary neuroendocrine tumor of peritoneum
209.75 Secondary Merkel cell carcinoma
209.79 Secondary neuroendocrine tumor of other sites
239.81 Neoplasms of unspecified nature, retina and choroid
239.89 Neoplasms of unspecified nature, other specified sites
274.00 Gouty arthropathy, unspecified
274.01 Acute gouty arthropathy
274.02 Chronic gouty arthropathy without mention of tophus (tophi)
274.03 Chronic gouty arthropathy with tophus (tophi)
277.88 Tumor lysis syndrome
279.41 Autoimmune lymphoproliferative syndrome
279.49 Autoimmune disease, not elsewhere classified
285.3 Antineoplastic chemotherapy induced anemia
348.81 Temporal sclerosis
348.89 Other conditions of brain
359.71 Inclusion body myositis
359.79 Other inflammatory and immune myopathies, NEC
372.06 Acute chemical conjunctivitis
416.2 Chronic pulmonary embolism
438.13 Late effects of cerebrovascular disease, dysarthria
438.14 Late effects of cerebrovascular disease, fluency disorder
453.50 Chronic venous embolism and thrombosis of unspecified deep vessels of lower extremity
453.51 Chronic venous embolism and thrombosis of deep vessels of proximal lower extremity
453.52 Chronic venous embolism and thrombosis of deep vessels of distal lower extremity
453.6 Venous embolism and thrombosis of superficial vessels of lower extremity
453.71 Chronic venous embolism and thrombosis of superficial veins of upper extremity
453.72 Chronic venous embolism and thrombosis of deep veins of upper extremity
453.73 Chronic venous embolism and thrombosis of upper extremity, unspecified
453.74 Chronic venous embolism and thrombosis of axillary veins
453.75 Chronic venous embolism and thrombosis of subclavian veins
453.76 Chronic venous embolism and thrombosis of internal jugular veins
453.77 Chronic venous embolism and thrombosis of other thoracic veins
453.79 Chronic venous embolism and thrombosis of other specified veins
453.81 Acute venous embolism and thrombosis of superficial veins of upper extremity
453.82 Acute venous embolism and thrombosis of deep veins of upper extremity
453.83 Acute venous embolism and thrombosis of upper extremity, unspecified
453.84 Acute venous embolism and thrombosis of axillary veins
453.85 Acute venous embolism and thrombosis of subclavian veins
453.86 Acute venous embolism and thrombosis of internal jugular veins
453.87 Acute venous embolism and thrombosis of other thoracic veins
453.89 Acute venous embolism and thrombosis of other specified veins
488.0 Influenza due to identified avian influenza virus
488.1 Influenza due to identified novel H1N1 influenza virus
569.71 Pouchitis
569.79 Other complications of intestinal pouch
569.87 Vomiting of fecal matter
621.34 Benign endometrial hyperplasia
621.35 Endometrial intraepithelial neoplasia [EIN]
670.10 Puerperal endometritis, unspecified as to episode of care or not applicable
670.12 Puerperal endometritis, delivered, with mention of postpartum complication
670.14 Puerperal endometritis, postpartum condition or complication
670.20 Puerperal sepsis, unspecified as to episode of care or not applicable
670.22 Puerperal sepsis, delivered, with mention of postpartum complication
670.24 Puerperal sepsis, postpartum condition or complication
670.30 Puerperal septic thrombophlebitis, unspecified as to episode of care or not applicable
670.32 Puerperal septic thrombophlebitis, delivered, with mention of postpartum complication
670.34 Puerperal septic thrombophlebitis, postpartum condition or complication
670.80 Other major puerperal infection, unspecified as to episode of care or not applicable
670.82 Other major puerperal infection, delivered, with mention of postpartum complication
670.84 Other major puerperal infection, postpartum condition or complication
756.72 Omphalocele
756.73 Gastroschisis
768.70 Hypoxic-ischemic encephalopathy, unspecified
768.71 Mild hypoxic-ischemic encephalopathy
768.72 Moderate hypoxic-ischemic encephalopathy
768.73 Severe hypoxic-ischemic encephalopathy
779.31 Feeding problems in newborn
779.32 Bilious vomiting in newborn
779.33 Other vomiting in newborn
779.34 Failure to thrive in newborn
784.42 Dysphonia
784.43 Hypernasality
784.44 Hyponasality
784.51 Dysarthria
784.59 Other speech disturbance
787.04 Bilious emesis
789.7 Colic
793.82 Inconclusive mammogram
799.21 Nervousness
799.22 Irritability
799.23 Impulsiveness
799.24 Emotional lability
799.25 Demoralization and apathy
799.29 Other signs and symptoms involving emotional state
799.82 Apparent life threatening event in infant
813.46 Torus fracture of ulna (alone)
813.47 Torus fracture of radius and ulna
832.2 Nursemaid’s elbow
969.00 Poisoning by antidepressant, unspecified
969.01 Poisoning by monoamine oxidase inhibitors
969.02 Poisoning by selective serotonin and norepinephrine reuptake inhibitors
969.03 Poisoning by selective serotonin reuptake inhibitors
969.04 Poisoning by tetracyclic antidepressants
969.05 Poisoning by tricyclic antidepressants
969.09 Poisoning by other antidepressants
969.70 Poisoning by psychostimulant, unspecified
969.71 Poisoning by caffeine
969.72 Poisoning by amphetamines
969.73 Poisoning by methylphenidate
969.79 Poisoning by other psychostimulants
995.24 Failed moderate sedation during procedure
V10.90 Personal history of unspecified malignant neoplasm
V10.91 Personal history of malignant neuroendocrine tumor
V15.52 Personal history of traumatic brain injury
V15.80 Personal history of failed moderate sedation
V15.83 Personal history of underimmunization status
V20.31 Health supervision for newborn under 8 days old
V20.32 Health supervision for newborn 8 to 28 days old
V26.42 Encounter for fertility preservation counseling
V26.82 Encounter for fertility preservation procedure
V53.50 Fitting and adjustment of intestinal appliance and device
V53.51 Fitting and adjustment of gastric lap band
V53.59 Fitting and adjustment of other gastrointestinal appliance and device
V60.81 Foster care (status)
V60.89 Other specified housing or economic circumstances
V61.07 Family disruption due to death of family member
V61.08 Family disruption due to other extended absence of family member
V61.23 Counseling for parent-biological child problem
V61.24 Counseling for parent-adopted child problem
V61.25 Counseling for parent (guardian)-foster child problem
V61.42 Substance abuse in family
V72.60 Laboratory examination, unspecified
V72.61 Antibody response examination
V72.62 Laboratory examination ordered as part of a routine general medical examination
V72.63 Pre-procedural laboratory examination
V72.69 Other laboratory examination
V80.01 Special screening for traumatic brain injury
V80.09 Special screening for other neurological conditions
V87.32 Contact with and (suspected) exposure to algae bloom
V87.43 Personal history of estrogen therapy
V87.44 Personal history of inhaled steroid therapy
V87.45 Personal history of systemic steroid therapy
V87.46 Personal history of immunosuppressive therapy

 

Revised Diagnosis Codes for 2010

Diagnosis Code Description
453.2 Other venous embolism and thrombosis of inferior vena cava
453.40 Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity
453.41 Acute venous embolism and thrombosis of deep vessels of proximal lower extremity
453.42 Acute venous embolism and thrombosis of deep vessels of distal lower extremity
572.2 Hepatic encephalopathy
584.5 Acute kidney failure with lesion of tubular necrosis
584.6 Acute kidney failure with lesion of renal cortical necrosis
584.7 Acute kidney failure with lesion of renal medullary [papillary] necrosis
584.8 Acute kidney failure with other specified pathological lesion in kidney
584.9 Acute kidney failure, unspecified
639.3 Kidney failure following abortion and ectopic and molar pregnancies
669.30 Acute kidney failure following labor and delivery, unspecified as to episode of care or not applicable
669.32 Acute kidney failure following labor and delivery, delivered, with mention of postpartum complication
669.34 Acute kidney failure following labor and delivery, postpartum condition or complication
670.00 Major puerperal infection, unspecified, unspecified as to episode of care or not applicable
670.02 Major puerperal infection, unspecified, delivered, with mention of postpartum complication
670.04 Major puerperal infection, unspecified, postpartum condition or complication
757.6 Specified congenital anomalies of breast
772.0 Fetal blood loss affecting newborn
776.9 Unspecified hematological disorder specific to newborn
784.40 Voice and resonance disorder, unspecified
784.49 Other voice and resonance disorders
793.0 Nonspecific (abnormal) findings on radiological and other examination of skull and head
793.1 Nonspecific (abnormal) findings on radiological and other examination of lung field
793.2 Nonspecific (abnormal) findings on radiological and other examination of other intrathoracic organs
793.3 Nonspecific (abnormal) findings on radiological and other examination of biliary tract
793.4 Nonspecific (abnormal) findings on radiological and other examination of gastrointestinal tract
793.5 Nonspecific (abnormal) findings on radiological and other examination of genitourinary organs
793.6 Nonspecific (abnormal) findings on radiological and other examination of abdominal area, including retroperitoneum
793.7 Nonspecific (abnormal) findings on radiological and other examination of musculoskeletal system
793.89 Other (abnormal) findings on radiological examination of breast
793.99 Other nonspecific (abnormal) findings on radiological and other examination of body structure
813.45 Torus fracture of radius (alone)
996.43 Broken prosthetic joint implant
E876.5 Performance of wrong operation (procedure) on correct patient
V15.06 Allergy to insects and arachnids
V15.84 Personal history of contact with and (suspected) exposure to asbestos
V15.85 Personal history of contact with and (suspected) exposure to potentially hazardous body fluids
V15.86 Personal history of contact with and (suspected) exposure to lead
V57.3 Care involving speech-language therapy
V61.29 Other parent-child problems
V65.11 Pediatric pre-birth visit for expectant parent(s)

Invalid Diagnosis Codes for 2010

Diagnosis Code Description
239.8 Neoplasm of unspecified nature of other specified sites
274.0 Gouty arthropathy
279.4 Autoimmune disease, not elsewhere classified
348.8 Other conditions of brain
453.8 Other venous embolism and thrombosis of other specified veins
488 Influenza due to identified avian influenza virus
768.7 Hypoxic-ischemic encephalopathy (HIE)
779.3 Feeding problems in newborn
784.5 Other speech disturbance
799.2 Nervousness
969.0 Poisoning by antidepressants
969.7 Poisoning by psychostimulants
V10.9 Unspecified personal history of malignant neoplasm
V53.5 Fitting and adjustment of other intestinal appliance
V60.8 Other specified housing or economic circumstances
V72.6 Laboratory examination
V80.0 Special screening for neurological conditions