What Are the Medical Codes to Report Epilepsy?

What Are the Medical Codes to Report Epilepsy?

According to oxhp.com, epilepsy is commonly found and 10% of Americans have at least one seizure in their lifetime. This neurological condition is characterized by two or more unprovoked seizures. Seizures are unpredictable and it is difficult for health care providers to diagnose epilepsy. Neurologists are required to carefully understand the medical history of the patient and assess brain imaging results to analyze the abnormal patterns of electrical activity in the brain. It is essential to have specificity in the diagnosis for delivering excellent patient care and for accurate clinical documentation. Medical billing services can ensure that appropriate ICD-10 codes and CPT codes are compiled based on the clinical documentation.

CPT Codes To Report Epilepsy Treatment Procedures

The severity of the disease and its outcome have to be examined by neurologists to determine the treatment plan. Excellent patient care can be delivered only with accurate diagnosis. The CPT codes corresponding to each procedure have to be accurately assigned for successful reimbursement of the claims.

  • 95819- Routine EEG (Electroencephalogram)

Electroencephalogram or EEG is a diagnostic test that uses small electrodes attached to the scalp to measure the electrical activity of the brain. In this procedure, the provider performs the EEG during awake and asleep states of the patient.

  • 95709- Long-term EEG monitoring

The patient undergoes an electroencephalography, a study of the electrical activity of the brain, lasting 12 to 26 hours with intermittent monitoring and maintenance. No video recording is made, and an EEG technologist reviews the data and writes a technical description.

  • 70554 – MRI procedures of the Head and Neck

The provider performs a functional magnetic resonance imaging (fMRI) of the brain, which tracks brain activity by assessing the metabolic changes that occur in response to neural activity.

  • 78811-Positron Emission Tomography (PET)

In this diagnostic procedure, the provider performs PET, positron emission tomography, on a small, defined area of the body. PET is a type of nuclear imaging test that produces three-dimensional images of functional processes in the body, and is an effective method of detecting tumor cells in the body.

ICD-10 Codes to Report Epilepsy

The ICD-10 codes for epilepsy are mentioned under G00-G99 Diseases of the nervous system, G40-G47 Episodic and paroxysmal disorders.

  • G40- Epilepsy
    • G40.11: Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures or localized onset, intractable, with status epilepticus.
    • G40.019: Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, without status epilepticus.
    • G40.111: Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus.
    • G40.119: Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus.
    • G40.211: Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizure, intractable, with status epilepticus.
    • G40.219: Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus.
    • G40.3: Generalized idiopathic epilepsy and epileptic syndrome
    • G40.4: Other generalized epilepsy and epileptic syndromes
    • G40.5: Special epileptic syndromes
    • G40.6: Grand mal seizures, unspecified (with or without petit mal)
    • G40.7: Petit mal, unspecified, without grand mal seizures
    • G40.8: Other epilepsy
    • G40.9: Epilepsy, unspecified
  • G41: Status epilepticus
    • G41.0: Grand mal status epilepticus
    • G41.1: Petit mal status epilepticus
    • G41.2: Complex partial status epilepticus
    • G41.8: Other status epilepticus
    • G41.9: Status epilepticus, unspecified

Accurate neurology medical billing is essential for prompt reimbursement of medical claims. An expert team of coders can appropriately assign codes, eliminating the chances of claim denials.

Cardiac Surgery Coding for Transcatheter Aortic Valve Replacement (TAVR)

Cardiac Surgery Coding for Transcatheter Aortic Valve Replacement (TAVR)

Transcatheter Aortic Valve Replacement (TAVR) (also called Transcatheter Aortic Valve Implantation (TAVI) is a procedure which involves replacement of a thickened and narrowed aortic valve of the heart through the blood vessels. Located between the left lower heart chamber (left ventricle) and the body’s main artery (aorta), the aortic valve regulates the blood flow from the heart to the body. If the aortic valve doesn’t open correctly, blood flow from the heart to the body gets reduced. Billing and coding for this cardiac condition can be challenging. Outsourcing these tasks to a reputable cardiology medical coding company is a great option for cardiologists to document TAVR as well as other treatment options and get reimbursed on-time.

TAVR Procedure – How Is It Performed and What Does it Involve?

TAVR is generally an option for people who have aortic stenosis (that causes signs and symptoms), have an intermediate or high risk of complications from surgical aortic valve replacement, have an existing biological tissue valve (but it isn’t working well anymore) and who can’t undergo open-heart surgery. Potential risks of TAVR may include – blood vessel complications, problems with the replacement valve (such as the valve slipping out of place or leaking), severe bleeding and infections, stroke, heart rhythm problems (arrhythmias) or even death. There are two different approaches – Transfemoral approach and Transapical approach for TAVR procedure. Transfemoral approach does not require a surgical incision in the chest and therefore involves entering through the femoral artery (large artery in the groin). Transapical approach, on the other hand, is a minimally-surgical procedure wherein small incisions are made in the chest area. The incisions are made through a large artery in the chest or through the tip of the left ventricle (the apex). Physicians in certain cases may use other approaches to access the heart. Imaging techniques may be used to guide the catheter through the blood vessel, to the heart and into the aortic valve. Upon positioning the new valve, a balloon is inflated on to the catheter’s flip (to expand the replacement valve in to the correct position) and the catheter is removed. The procedure can cause infections (from bacteria in the mouth) and therefore it is extremely important to maintain adequate dental and personal hygiene.

Medicare Coverage for TAVR

Transcatheter Aortic Valve Replacement (TAVR) is covered for the treatment of symptomatic aortic valve stenosis. CMS offers coverage for TAVR under Coverage with Evidence Development. In 2012, CMS released a National Coverage Determination (NCD) that provides details of the qualifications of the physicians who perform TAVR and the patients who benefit from the procedure. Below listed are the top coverage criterions specified in the National Coverage Determination (NCD) –

  • The procedure is furnished with a complete aortic valve and implantation system that has received FDA premarket approval (PMA) for that system’s FDA-approved indication.
  • All TAVR cases must be enrolled in the national transcatheter valve therapy (TVT) registry.
  • The patient who is planning to undergo a TAVR must be under the care of a multi-disciplinary team of cardiologists both preoperatively and postoperatively.
  • Both a cardiac surgeon and an interventional cardiologist must independently examine the patient face-to-face and evaluate the patient’s suitability for surgical aortic valve replacement.
  • IVR cardiologists and cardiac surgeons must jointly participate in the intra-operative technical aspects of TAVR.
  • Hospitals must perform at least 50 TAVRs and more than 300 percutaneous coronary interventions per year

Applicable Medical Codes for TAVR

Billing and coding for cardiac procedures involves the use of procedure codes and diagnosis codes on the medical claims submitted to health insurers for reimbursement. Relying on the services of a professional and reputable medical coding company that is well-versed in the changing coding guidelines for the cardiology specialty can help in on-time reimbursement.

CPT Codes

  • 33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach
  • 33362 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach
  • 33363 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach
  • 33364 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach
  • 33365 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (e.g., median sternotomy, mediastinotomy)
  • 33367 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with percutaneous peripheral arterial and venous cannulation (e.g., femoral vessels) (List separately in addition to code for primary procedure)
  • 33368 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannulation (e.g., femoral, iliac, axillary vessels) (List separately in addition to code for primary procedure)
  • 33369 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with central arterial and venous cannulation (e.g., aorta, right atrium, pulmonary artery) (List separately in addition to code for primary procedure)

Diagnosis Code

  • Z00.6 Encounter for examination for normal comparison and control in clinical research program

ICD – 10 Procedure Codes

  • 02RF38Z Replacement of aortic valve with zooplastic tissue, percutaneous approach
  • 02RF38H Replacement of aortic valve with zooplastic tissue, transapical, percutaneous approach

In general, transcatheter aortic valve replacement (TAVR) may provide relief to the symptoms of aortic valve stenosis. However, adopting healthy lifestyle habits like – regular exercise, quitting the habit of smoking, making healthy diet choices, controlling stress and maintaining a healthy body weight can help prevent the reoccurrence of cardiac disorders in the long run. As mentioned above, cardiology medical billing and coding can be challenging. IVR cardiologists, cardiac surgeons and other specialists performing a TAVR procedure can consider the support of a reputable physician billing company to report their services accurately on the medical claims.

BC Advantage Magazine Publishes OSI’s Articles on Sun Heat-related Illnesses

BC Advantage Magazine Publishes OSI’s Articles on Sun Heat-related Illnesses

A leading medical billing and coding company in the U.S., Outsource Strategies International is proud to announce that our articles – “Here Comes the Sun: Know the Difference Between Heat Stroke and Heat Exhaustion” and “Summer Fun: Be Aware of Sunburns – ICD-10” have been published in the May / June 2022 issue of BC Advantage Magazine.

Heat illnesses range from mild to severe. The sun’s UV rays are strongest during summer months and over exposure to these rays can cause sun burn and other heat-related illnesses such as – heat rash, heat cramps, heat exhaustion or heat stroke. Heat-related illnesses are preventable, with proper prevention tips.

OSI’s article on sunburn is authored by Amber Darst, the company’s Solutions Manager in the Practice and Revenue Cycle Management Department. The article on the differences between heat stroke and heat exhaustion is authored by Meghann Drella, Senior Solutions Manager in the Healthcare Division of the same department.

Know the Difference Between Heat Stroke and Heat Exhaustion

Our article on sunburn, discusses the types of sunburn degrees, ICD-10 and CPT codes for sunburns, necessary steps to prevent excessive UV exposure, and some first aid tips. The other article discusses the signs, symptoms, diagnosis, treatment options of heat exhaustion and heat stroke. This article also lists the ICD-10 codes to report these heat-related illnesses.

BC Advantage Magazine is a highly acclaimed, CEU-approved national online healthcare publication and the largest independent resource provider in the industry for medical coders and billers, healthcare auditors, practice managers, compliance officers, and clinical documentation experts. It features articles written by industry professionals on a wide range of subjects such as billing/coding, legal issues, marketing, business building, career advantage, coders 20/20, news, reviews and more.

“As a company that has been providing medical billing, coding and other support functions such as insurance verifications and authorizations for medical offices in the USA for more than 17 years, we are proud of our accomplishments. Getting featured in BC Advantage Magazine validates our company’s culture of hard work and customer service,” says Rajeev Rajagopal, President of Managed Outsource Solutions.

OSI has years of experience in providing medical billing and coding services for all medical specialties, including dermatology. We serve a vast clientele – individual physicians, physician groups, free standing diagnostic facilities, multi-specialty groups, clinics, long-term care facilities, acute care facilities, and hospitals. Our coding and billing experts have a clear understanding of the changing coding standards and reimbursement policies of all major government and private insurance companies. Our experience and expertise in the industry have been continuously recognized and featured by BC Advantage Magazine.

For more information about Outsource Strategies International, please visit www.outsourcestrategies.com.

How to do a Comprehensive Physical Therapy Eligibility Verification

How to do a Comprehensive Physical Therapy Eligibility Verification

Physical therapists provide services for a wide range of conditions, from helping patients reduce chronic pain, restore physical mobility, and regain strength to managing hand, wrist, arm, elbow and shoulder injuries and conditions. Physical therapy focuses on getting people back to get back to daily life and activities, sports, office, and more.  While they provide specialized services to address each patient’s injury or condition, physical therapy practices need to have efficient processes in place for verification of patients’ insurance coverage eligibility. Reports say that eligibility issues are one of the key reasons for claim denials in this specialty. The solution is to perform comprehensive insurance eligibility verification before services are provided. Outsourcing the task to an experienced physical therapy medical billing company is the best way to prevent claim denials due errors made at patient registration and to also free up time for patients.

Why is physical therapy eligibility verification necessary?

Physical therapy eligibility is the process of confirming that the patient’s plan will cover the physical therapy services you provide and is in your network. Every patient’s insurance coverage and benefits has to be verified prior to the office visit – at the first appointment and periodically thereafter as information can change at any time. Prior authorization is also necessary to confirm whether a treatment, care or service will be approved.

Verifying insurance coverage will provide you with a clear idea about the patient’s financial responsibility, including co-payment, co-insurance and patient-specific remaining deductible.  This information can be used to estimate patient costs before treatment decisions are made, create claims, and collect deductibles and co-insurance before patients leave the office.

While Insurance verification confirms your patient’s coverage and benefits, insurance authorization enables you to provide specific services. Neglecting verification of patients’ insurance coverage eligibility will result in claims denials for physical therapy billing errors such as:

  • Missing information
  • Submission of duplicate forms, and
  • Provision of unauthorized treatment or services.

Not completing insurance verification before a patient receives medical services will also result in expensive surprise bills for the patient.

Accurate and timely insurance verification and authorization services minimize denied claims, maximize reimbursement, and boost patient satisfaction.

Physical Therapy Eligibility Verification Process

The insurance verification process involves collecting patient insurance information when scheduling appointments and verifying it with the insurer. Comprehensive physical therapy eligibility verification is done at many points in the revenue cycle, especially scheduling, and pre-registration.

  • Patient scheduling: The process of insurance verification begins with patient scheduling. Schedulers collect data needed to schedule a patient’s appointment. Patient scheduling can be done via phone text, fax or email or self-scheduling. Staff can also record insurance information and do a real-time eligibility verification on the phone. The required demographic and payment information is captured and entered in the registration software. Patients can be informed about co-pay collection policies and also reminded to obtain a referral if required by their plan requires this.
  • Pre-registration: Collecting patient information prior to the appointment wherever possible can streamline the onboarding process. Appointments may have been scheduled months in advance and insurance information may have changed. That’s why insurance verification is important3-7 days before the appointment date. A pre-visit eligibility check is crucial to ensure that data stored in the registration/billing system aligns with that obtained from the payer. If any data is found inaccurate, it should be corrected quickly for a clean claims process.

Leading providers of insurance verification and authorization services work with a standard preregistration script to ensure that nothing is left out.

Eligibility Verification for Physical Therapy – What is Covered

Most insurance plans pay for medically necessary health care services, but definition of medical necessity may vary among insurance companies. Some plans cover physical therapy in full while others cover physical therapy in part. Further, insurance companies that designate physical therapists as specialists will require a referral from the patient’s primary care provider before they will pay for any specialist’s services. Insurance verification specialists will determine these aspects and confirm all patients’ insurance coverage, including:

  • Patient name, date of birth, insurance ID and other demographic information
  • Claims mailing address
  • Copay
  • Coinsurance
  • Deductible
  • Benefits/therapy cap
  • Patient policy status
  • Effective date
  • Payable benefits
  • Plan exclusions
  • Health insurance caps
  • Type of plan and coverage details
  • Referrals and pre-authorizations
  • Out of network benefits
  • DME reimbursement
  • Limitations in terms of Visit
  • PCP/Specialist Co-pay
  • PCP Information where applicable
  • Other payer information
  • Requirements for additional documents, if any

Prior authorization:  Payers typically require pre-authorization for PT,OT, and ST – unless the payer will retroactively authorize services. If prior authorization is not obtained before performing a PT, OT or ST procedure, the claim for that service will be denied and the patient cannot be billed for it. Insurers authorize only a specific number of visits with referral from a primary care provider and further visits will require prior authorization.

Physical therapists require seamless and comprehensive verification of eligibility and benefits to prevent claim eligibility-related denials and boost cash flow. Partnering with a competent provider of insurance verification and authorization services is the best option.

With expert physical therapy medical billing support, providers and their staff can focus on delivering quality care and improving the patient experience.

CDT Coding for Gingivectomy

CDT Coding for Gingivectomy

Outsource Strategies International (OSI) is a competent provider of dental billing services. Our team helps practices submit clean claims with the correct CDT codes to meet payer guidelines. We also provide comprehensive dental eligibility verification services to confirm patient benefits before services are rendered.

In today’s podcast, Meghann Drella, a Senior Solutions Manager at Outsource Strategies International, discusses the dental codes for gingivectomy.

Podcast Highlights

00:11 Gingivectomy CDT Codes

00:54 CDT Coding Guidelines

Read Transcript

Hello and welcome to our podcast series. My name is Meghann Drella and I’m a Senior Solutions Manager here at Outsource Strategies International. Today I’ll be discussing the dental codes for gingivectomy.

00:11 Gingivectomy CDT Codes

The teeth in the mouth are divided into 4 quarters or sections. Let’s take a look at the CDT codes that describe your gingivectomy procedures and when each CDT code should be used.

  • D4210 for Gingivectomy or Gingivoplasty is four or more contiguous teeth or tooth bonded spaces per quadrant
  • D4211 is one or three contiguous teeth or tooth bounded space per quadrant

These procedures are performed to eliminate suprabony pockets, orto restore normal architecture when gingival enlargements are asymmetrical or unaesthetic topographically is evident with normal body configuration.

00:54 CDT Coding Guidelines

D4210 is covered when 4 or more teeth within a section meet the allowable criteria. D4211 is covered when 1 to 3 teeth within a section with the allowable criteria. D7971 is used when inflammatory or hypertrophied tissue is being removed on a partially affected or impacted tooth. D4274 can also be used for this procedure. This code does not include any osseous recontouring or removal and is used when the procedure is performed in an edentulous area adjacent to a tooth allowing removal of a tissue wedge to gain access for debridement and to reduce pocket depth. However, any benefit for this procedure will be disallowed when performed in conjunction with another surgical procedure in the same area. For instance, if bone removal is indicated or performed, D4261 should be used instead of D4274.

As coding for dental procedures can be really complex, a comprehensive dental eligibility verification to verify your patience coverage before the procedures are performed is very important.

I hope this helps, but always remember the documentation as well as a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for joining me and stay tuned for my next podcast.