Coding Type 1 and Type 2 Diabetes

Coding Type 1 and Type 2 Diabetes

Outsource Strategies International (OSI) is an experienced medical billing outsourcing company providing medical billing and coding services for diverse specialties.

In today’s podcast, Loralee Kapp, one of our Solutions Managers discusses type 1 and type 2 diabetes and how partnering with a reliable coding company can help practices with accurate disease reporting, claim submission and prompt reimbursement.

Read Transcript

Hey all, this is Loralee Kapp, Solutions Manager with Managed Outsource Solutions. Today I want to talk to you about type 1 and type 2 diabetes and how utilizing to an outsourcing company such as Managed Outsourced Solutions can help with your prompt reimbursement and coding needs. For a full list of ICD 10 and CPT codes associated with this podcast, please see the attached article.

CPT and ICD-10 codes to report Type 1 Diabetes- and Type 2 Diabetes

82009-84999: Chemistry Procedures

  • 82947: The lab analyst performs a test to measure the amount of glucose in a patient’s blood using a method other than a reagent strip.
  • 82948: The clinician performs a test to measure the amount of glucose in a patient’s blood using a reagent strip test method.
  • 82950: The lab analyst tests a sample, typically blood, for glucose, also known as blood sugar. The collecting provider takes the sample at a set time after the patient has ingested an amount of liquid or a meal with a high glucose content. Clinicians commonly use this to test for diabetes.
  • 82951: The lab analyst performs a test to measure the amount of glucose in a patient’s blood at three different times: initially while fasting and two more times, each at a specific time after the patient takes an oral dose of glucose.
  • 82952: Following a glucose tolerance test with three specimens, the lab analyst performs an additional test to measure the amount of glucose in the patient’s blood, typically following an additional oral glucose dose.
  • 83036: This A1C test measures the amount of sugar sticking to the red blood cells, displaying the result as a percentage. This gives the physician an understanding about the blood sugar level of the patient for the preceding three months.
  • 83037: The analyst performs a test using a drop of blood obtained by finger stick or venipuncture from the patient to rapidly measure the level of glycoslylated hemoglobin, HgbA1c. The analyst uses a device the FDA has approved for home use. This test is an indication of glucose control over a three to four month period and results show as a percent of total hemoglobin.

ICD – 10 Codes

Type 1 Diabetes Mellitus

  • E10: Type 1 Diabetes Mellitus
  • E10.1: Type 1 diabetes mellitus with ketoacidosis
      • E10.10: Type 1 diabetes mellitus with ketoacidosis without coma.
      • E10.11: Type 1 diabetes mellitus with ketoacidosis with coma
    • E10.2: Type 1 diabetes mellitus with kidney complications.
      • E10.21:Type 1 diabetes mellitus with diabetic nephropathy
      • E10.22: Type 1 diabetes mellitus with diabetic chronic kidney disease
      • E10.29: Type 1 diabetes mellitus with other diabetic kidney complication.
    • E10.3: Type 1 diabetes mellitus with ophthalmic complications.
    • E10.4: Type 1 diabetes mellitus with neurological complications
    • E10.5: Type 1 diabetes mellitus with circulatory complications.
    • E10.6: Type 1 diabetes mellitus with other specified complications.

Type 2 Diabetes Mellitus

  • E11: Type 2 Diabetes Mellitus
    • E11.0: Type 2 diabetes with hyperosmolarity
      • E11.00: Type 2 diabetes with hyperosmolarity without nonketotic hyperglycemic – hyperosmolar coma
      • E11.01: Type 2 diabetes with hypersmolarity with coma.
    • E11.1: Type 2 diabetes mellitus with ketoacidosis.
    • E11.2: Type 2 diabetes mellitus with kidney complications.
      • E11.21: Type 2 diabetes mellitus with diabetic nephropathy
      • E11.22: Type 2 diabetes mellitus with diabetic chronic kidney disease.
      • E11.29: Type 2 diabetes mellitus with other diabetic kidney complication.

00:24 About Diabetes Types

Diabetes is considered as a serious health condition and if it is not managed properly, it can lead to life threatening conditions. Type 2 diabetes is more common than Type 1, but both require constant monitoring of blood sugar levels. In the backdrop of the increasing cases of diabetes, endocrinologists have to attend to a considerable number of patients on a daily basis and correspondingly, endocrinology medical billing has to be managed. As providing the best treatment is the number one objective for doctors, it is important to utilize an outsourcing medical coding service for prompt reimbursement and error free documentation and assure that complexities associated with coding are efficiently dealt with.

01:08 Diagnosing diabetes

In order to diagnose type one and type 2 diabetes, endocrinologists direct patients to undergo the GlycatedHemoglobin test or A1C test to analyze average blood sugar level tests of the past two to three months. As an additional measure, the family history of the patient is thoroughly examined. The patient might be told to take to take a Random Blood Sugar Test or a Fasting Blood Sugar Test, if the A1C test is unavailable or if the patient has some underlying condition that can makean A1C test inaccurate.

As a medical billing and coding company, Managed Outsourced Solutions is here to help endocrinologists extend the quality of their services by taking over their needs of billing and coding, to ensure prompt and accurate reimbursement without claim denials.

Transient Global Amnesia – CPT and ICD-10 Coding

Transient Global Amnesia – CPT and ICD-10 Coding

Outsource Strategies International (OSI) is a reliable provider of comprehensive medical billing and coding services for diverse specialties including neurology, orthopedics, physical therapy, chiropractic and more.

In today’s podcast, Loralee Kapp, one of our Solutions Managers, discusses about Transient Global Amnesia and how outsourcing coding benefits practices.

Read Transcript

Hi all, this is Loralee Kapp, a Solutions Manager with Managed Outsource Solutions. Today I want to talk to you about Transient Global Amnesia and how outsourcing your coding needs to a medical billing and coding service can help.

For a full list of ICD 10 and CPT codes associated with this podcast, please see the attached article.

CPT

70010-76499: Diagnostic Radiology (Diagnostic Imaging) Procedures

70010-70559: Diagnostic Radiology (Diagnostic Imaging) Procedures of the Head and Neck

  • 70450: The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.
  • 70460: The provider performs computed tomography, or CT scanning, of the head or brain, with contrast. He performs the procedure to diagnose any brain or intracranial abnormalities, such as cerebral aneurysm.
  • 70551: The provider uses magnetic resonance imaging, or MRI, to examine the brain and brain stem. The provider does not administer contrast for the exam.
  • 70552: The provider uses magnetic resonance imaging, or MRI, to examine the brain and brain stem using contrast.
  • 70553: In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows with contrast material and takes more images.

95700-96020: Neurology and Neuromuscular Procedures

95954-95962: Other EEG Testing procedures

  • 95954: In this procedure, the provider uses a drug or physical activity to stimulate a patient during electroencephalogram recording. This code requires provider attendance during activation.
  • 95957: In this procedure, the provider performs computer based analysis of an electroencephalogram, abbreviated as EEG.

95965-95967:MEG Testing Procedures

  • 95965: In this procedure, the provider records and analyzes the patient’s spontaneous brain magnetic activity by using magnetoencephalography, a neuroimaging technique that uses sensors to form images of the magnetic field produced within the brain.
  • 95966:In this procedure, the provider records and analyzes the patient’s evoked brain magnetic activity by using magnetoencephalography , a neuroimaging technique that uses sensors to form images of the magnetic field produced within the brain.
  • 95967: In this add-on procedure, the provider records and analyzes evoked brain magnetic activity by using magnetoencephalography, a neuroimaging technique that uses sensors to form images of the magnetic field produced within the brain. He examines an additional brain modality in this test like language, sensory, or motor function.

96116-96127: Neurobehavioral Status Examination

    • 96116: A physician or other qualified health care professional performs face-to-face assessment to analyze a patient’s thinking, reasoning and judgment. Report this code for the first hour of face-to-face clinical assessment as well as the time spent in interpreting the results and preparing a report.
    • 96121: A physician or other qualified health care professional performs face-to-face assessment of a patient’s thinking, reasoning and judgment. Report this code for each additional hour of face-to-face clinical assessment including the time spent interpreting the results and preparing a report.
    • 96125: Comes under Assessment of Aphasia and Cognitive Performance Testing. The health provider performs standardized cognitive performance, which is a functional assessment for a person with memory loss.

90791-90792: Psychiatric Diagnostic Evaluation Services

  • 90791: In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.

ICD-10

G45.4 Transient global amnesia

00:23 What is Transient Global Amnesia?

Although Transient Global Amnesia is not a life-threatening condition, its symptoms can be scary for patients and cause emotional distress. Medical practitioners analyze the symptoms as it is difficult to distinguish the symptoms of Transient Global Amnesia from other serious illnesses. Neurologists rely on medical billing and coding services to accurately code the diagnosis as well as the medical procedures provided to treat the condition.

00:49 Transient Global Amnesia – Diagnosis Tests

Patients are directed to undergo various tests to confirm that the memory loss is due to Transient Global Amnesia.

The tests required include:

  • A blood test to determine levels of Vitamin B1, Vitamin B12 and thyroid hormone
  • Imaging tests like MRI or CT scans to rule out brain damage
  • Electroencephalogram (EEG), and
  • A psychiatric evaluation

As coding these diagnoses and procedures can be complicated, medical coding outsourcing is adopted as a practical solution by health practitioners for ensuring efficient billing flow with quick reimbursement, meaning they can focus more on diagnosing the cause of the underlying condition without hiring expert in-house coders for these critical transactions.

With the AAPC and AHIMA certified coders, we at Managed Outsource Solutions are here to help with your medical billing and coding means, so please reach out to us for additional information on our services.

CPT Code Modifiers and How They are Used

CPT Code Modifiers and How They are Used

An experienced medical coding company in USA, Outsource Strategies International (OSI) provides quality medical billing and coding services for diverse medical specialties. Our medical coding services can ease the claim submission tasks for practices and ensure proper and timely reimbursement. Our AAPC / AHIMA certified coders and team of skilled billing specialists are well trained in assigning diagnostic and procedure codes and related modifiers. They are up to date with medical billing and coding rules.

In today’s podcast, Loralee Kapp, one of our Solutions Managers, discusses CPT Code modifiers and how are they used.

Read Transcript

Hi all, this is Loralee Kapp, the Solutions Manager with Managed Outsource Solutions. Today I want to talk to you about CPT code modifiers and how they are used. For a list of commonly used CPT code modifiers, please see the attached article at the end of this podcast.

00:18 What Are CPT Code Modifiers and Why They Matter

Modifiers are codes that provide additional information about a procedure. They are added to CPT or HCPCS codes to communicate certain circumstances regarding the performance of a procedure or service. Appending the correct modifier to provide more specificity to payers about the service or procedure rendered will facilitate appropriate reimbursement. Likewise, an incorrectly used medical billing modifier on a claim will lead to denials. Experienced providers of medical billing and medical coding services can help practices file clean claims by assigning the correct codes and modifiers to support the services rendered.

00:58 Role of Modifiers in CPT Coding

As we know, CPT codes are five-digit numbers and primarily used in office and outpatient settings to report medical procedures and services in claims submitted to insurance companies. These codes are assigned based upon the physician’s documentation in the medical record. Modifiers provide a way to convey specific circumstances related to the performance of a procedure or service.

01:21 Types of Modifiers

The two broad types of modifiers used in medical billing are:

  • Level I Modifiers consist of two digits and are maintained by the American Medical Association.
  • Level II Modifiers or HCPCS modifiers are alphanumeric or have two letters and maintained by the Centre for Medicare & Medicaid Services (CMS).

01:43 When are Modifiers Used?

Specifically, a modifier provides the mechanism to:

  • Report or indicate that a service or procedure has been performed and altered by some specific circumstance without changing the meaning of the CPT code.
  • Provide additional information about the service that has been performed more than one time or services that have occurred unusually.
  • Provide details not included in the code descriptor.
  • To report codes in connection with specific payer programs.

02:14 Additional Situations When a CPT Modifiers Should Be Used

CPT lists additional situations when a modifier may be appropriate:

  • The service or procedure has both professional and technical components
  • More than one provider performed the service or procedure
  • More than one location was involved
  • A service or procedure was increased or reduced in comparison to what the code typically requires
  • The procedure was bilateral
  • The service or procedure was provided to the patient more than once

02:41 Ensure Accurate Medical Billing and Coding with Professional Support

The AMA publishes CPT coding guidelines each year on coding specific procedures and services. Proper use of modifiers is crucial for accurate coding and also because many modifiers impact providers’ reimbursement. Not using a modifier or using the wrong modifier can result in claim denials and lead to rework, payment delays, and potential reimbursement loss. Incorrect use of a modifier can also result in excess of the amount payable for a service rendered or receiving payment when payment is not due, which if not reported by the practice, can lead to heavy fines and penalty.

Getting professional support can go a long way in ensuring that the billing and coding cycle runs smoothly. Top medical billing companies have expert coders who are knowledgeable about CPT codes and modifiers and can help physicians report their services with the utmost specificity. They will ensure that modifier codes are reported only when they are relevant and supported by specific documentation in the patient’s medical record.

 Commonly Used CPT Code Modifiers

  •  CPT Modifier 22 Increased Procedural Service – This modifier describes an increased workload associated with a procedure. Modifier 22 is used in unusual circumstances such as surgeries that took significantly more time than usually required to complete, which includes increased intensity, time, technical difficulty of procedure, severity of patient’s condition (such as unusual or excessive bleeding during a procedure).
  • CPT Modifier 25 Significant, Separately Identifiable Service – Modifier 25 is applied when there is a significant, separately identifiable evaluation and management (E/M) service done by the same physician or other qualified health care professional on the same day of the procedure or other service. It is used to report surgical procedures, labs, X-rays, and supply codes that are documented as a separately identified E&M service performed on the same day as another procedure. If the patient presents to the office and a procedure was not anticipated, modifier 25 can be reported with the E&M service.
  • Modifier 26 Professional Service – Modifier 26 indicates the professional component when a service has both professional & technical components. For e.g., in radiology services, the physician’s note on the scans is considered as the professional component while the machinery used is counted as a technical component. The professional component may include technician supervision, interpretation of results, and a written report. Append modifier 26 for the following:
    • To bill only the professional component portion of a test when the provider utilizes equipment owned by a hospital/facility.
    • To report the physician’s interpretation of a test, which is separate, distinct, written, and signed.
  • Modifier 50 Bilateral Procedure – Modifier 50 indicates that bilateral procedures were performed in the same session.  For e.g., when billing for a bilateral mastectomy, CPT code 19303 (Mastectomy, simple, complete) would be reported with this modifier. Before applying this modifier, it is important to check the CPT code definition to confirm that bilateral is not included in its descriptor.
  • Modifier 51 Multiple Procedures – Modifier 51 is used to denote multiple procedures (other than E/M services) performed by the same physician during the same session. Modifier 59 is used to indicate:
    • Additional or different procedures performed at same session
    • Same procedure performed multiple times at same site
    • Same procedure performed multiple times at different sites

The primary procedure may be reported first without the modifier. Additional procedure(s) may be identified by attaching modifier 51 to the code(s).

  • Modifier 52 Reduced Services – Modifier 52 indicates that the physician has elected to partially reduce or eliminate the service or procedure. The basic service described by the CPT code has been performed, but not all aspects of the service have been completed. When a physician performs a bilateral procedure on one side only, append modifier -52. For e.g., if a physician performs a unilateral tonsillectomy on a six-year old child, report CPT code 42820) and append modifier 52.However, if the CPT code description includes “unilateral or bilateral,” (e.g. unilateral nasal endoscopy CPT code 31231) do not append modifier 52.
  • Modifier 59 Distinct Procedural Service – This modifier indicates that a procedure is separate and distinct from another procedure on the same date of service. It identifies procedures or services that are not usually reported together. Indications for the use of modifier 59 are:
    • Different session or encounter on the same date of service
    • Different procedure distinct from the first procedure
    • Different anatomic site
    • Separate incision, excision, injury or body part

Both modifier 52 and 59 should not be applied to an E/M service.

  • Modifier 76 – Modifier 76 is used to report repeat procedure performed on the same day by the same physician and is also consequent to the original procedure. For instance, CPT code 94640 signifies treatment of acute airway obstruction with inhaled medication and/or the use of an inhalation treatment to induce sputum for diagnostic purposes. If more than one inhalation treatment is performed on the same date of service, code 94640 should be reported by appending modifier 76.)
ICD-10 Coding For Osteoporosis

ICD-10 Coding For Osteoporosis

Outsource Strategies International (OSI) is an experienced provider of rheumatology billing services. Our medical coding services can ease the claim submission tasks for practices and ensure proper and timely reimbursement.

Our AAPC or AHIMA certified coders are well trained in assigning accurate diagnostic and procedure codes and related modifiers. They are up to date with the changing medical billing and coding standards.

In today’s podcast, Loralee Kapp, one of our Solutions Managers, discusses the ICD-10 codes for osteoporosis.

Read Transcript

Hi this is Loralee Kapp, the Solutions Manager with Managed Outsource Solutions. Today, I want to talk to you about osteoporosis and their appropriate ICD 10 codes. It is important to remember that accurate coding is necessary for timely returns on claims. For a full list of ICD 10 codes associated with this podcast please see the attached document.

  • M80 Osteoporosis with current pathological fracture.
    • M80.0 Age-related osteoporosis with current pathological fracture
      • M80.00 Age-related osteoporosis with current pathological fracture, unspecified site
      • M80.01 Age-related osteoporosis with current pathological fracture, shoulder
      • M80.02 Age-related osteoporosis with current pathological fracture, humerus
      • M80.03 Age-related osteoporosis with current pathological fracture, forearm
      • M80.04 Age-related osteoporosis with current pathological fracture, hand
      • M80.05 Age-related osteoporosis with current pathological fracture, femur
      • M80.06 Age-related osteoporosis with current pathological fracture, lower leg
      • M80.07 Age-related osteoporosis with current pathological fracture, ankle and foot
      • M80.08 Age-related osteoporosis with current pathological fracture, vertebra(e)
      • M80.0A Age-related osteoporosis with current pathological fracture, other site
    • M80.8 Other osteoporosis with current pathological fracture
      • M80.81 Other osteoporosis with pathological fracture, shoulder
      • M80.82 Other osteoporosis with current pathological fracture, humerus
      • M80.83 Other osteoporosis with current pathological fracture, forearm
      • M80.84 Other osteoporosis with current pathological fracture, hand
      • M80.85 Other osteoporosis with current pathological fracture, femur
    • M81 Osteoporosis without current pathological fracture
      • M80.0 Age-related osteoporosis without current pathological fracture
      • M80.6 Localized osteoporosis [Lequesne]

M81.8 Other osteoporosis without current pathological fracture

00:24 Reporting Osteoporosis

Reporting osteoporosis on medical claims is a complex task. Experienced medical billing outsourcing companies will be up to date with coding standards. Osteoporosis is a bone thinning condition, which causes loss of bone mass, making bones more vulnerable to fractures. Diverse medical specialists such as endocrinologists, orthopedists and rheumatologists are involved in treating osteoporosis. Rheumatology medical coding involves reporting the condition using the right diagnosis and procedure codes. To assign the right codes, coders must know what type of osteoporosis the patient has been diagnosed with. Two categories of osteoporosis are: primary and secondary. While the primary osteoporosis is age-related, secondary condition is caused by any underlying condition. Primary osteoporosis can be further divided into “primary type I (postmenopausal osteoporosis)” and “primary type II (senile)” osteoporosis.

01:25 Causes and Treatment

Causes of secondary osteoporosis can be endocrine disorders, malnutrition issues, marrow, renal or collagen disorders. Common risk factors for osteoporosis can be osteomalacia, aging, vitamin D deficiency, or hypocalcemia.

Diagnosis tests recommended to identify the right type of osteoporosis include DEXA scan, vertebral fracture assessment, and blood tests. Treatment for osteoporosis may include orthopedic and medical treatment. Surgeries such as kyphoplasty and vertebroplasty may be recommended for patients experiencing painful vertebral compression fracture from the condition. Medications such as bisphosphonates are used to treat osteoporosis to reduce the risk of fracture. Other treatments may include estrogen/hormone replacement therapy, and thyroid and parathyroid hormone therapy.

02:23 Types

Osteoporosis can occur with or without pathological fracture. Age-related osteoporosis with current pathological fracture includes Involutional osteoporosis, Postmenopausal osteoporosis, Senile osteoporosis, and Osteoporosis not otherwise stated (NOS). Other osteoporosis with current pathological fracture includes Drug induced osteoporosis, Idiopathic osteoporosis, Osteoporosis of disuse, Post-oophorectomy osteoporosis, Postsurgical malabsorption osteoporosis, and Posttraumatic osteoporosis.

02:58 Coding and Documentation Tips

Age-related osteoporosis or other osteoporosis with current pathological fracture can be reported using the M80 series codes. Codes are selected based on the anatomical site of the fracture, not the location of the osteoporosis.

For osteoporosis without pathological fracture, codes from the M81 series can be used. While the sixth digit indicates laterality (right shoulder, left shoulder, unspecified shoulder), the seventh digit indicates the episode of care.

Osteoporosis fracture documentation involves definition of the episode of care (initial, routine, or delayed healing), specification of location and laterality (left or right), and precise classification for pathological fracture (senile osteoporosis, posttraumatic osteoporosis). Providers treating this condition can consider the services provided by experienced medical billing and coding companies to submit their claims with up-to-date codes. Submitting accurate claims can prevent claim denials and ensure optimal reimbursement.

Biopsy Services – Billing Guidelines

Biopsy Services – Billing Guidelines

An experienced dental billing outsourcing company in U.S., Outsource Strategies International (OSI) provides comprehensive dental eligibility verifications to support claims submission. Our team can work on your Dental Software as an extension to your practice.

In today’s podcast, Amber Darst, Solutions Manager, Managed Outsource Solutions, discusses the CDT codes to report dental restoration procedures.

Read Transcript

Hello and welcome to our podcast series. My name is Meghann Drella and I am a Senior Solutions Manager here at Outsource Strategies International. Today I will be discussing the billing guidelines for biopsy services.

Various types of biopsy procedures are used to make a cancer diagnosis such as bone marrow biopsy, endoscopic biopsy, needle biopsy, skin biopsy and surgical biopsy. Providers of biopsy services need to know how to properly bill and code for these procedures.

00:27 CPT codes for biopsy procedures

In 2019, a series of CPT codes for biopsy procedures were introduced which are specific to the method of removal – tangential, punch, and incisional. These codes will be attached to the document provided with this podcast.

  • 11102 Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette); single lesion
  • +11103 each separate/additional lesion (List separately in addition to code for primary procedure)
  • 11104 Punch biopsy of skin [including simple closure, when performed]; single lesion
  • +11105 each separate/additional lesion (List separately in addition to code for primary procedure)
  • 11106 Incisional biopsy of skin (e.g., wedge) (including simple closure, when performed); single lesion
  • +11107 each separate/additional lesion (List separately in addition to code for primary procedure)

00:43 Types of biopsy procedures

  • Tangential biopsies are performed with a sharp blade and shave, scoop or curette techniques are used to remove a sample of epidermal tissue, with or without a portion of the underlying dermis.
  • Punch biopsies involve using a punch tool to remove a full-thickness cylindrical sample of the skin.
  • In incisional biopsies, a sharp blade is used to make a vertical incision or wedge to remove a full-thickness sample of tissue, penetrating deep to the dermis and into the subcutaneous tissue.

01:13 Reports on increasing claim denials

Reports indicate improper billing and denials have increased. Medicare Administrative Contractor First Coast Service Options (FCSO) identifies the reasons for biopsy procedure claim denials as –

  • When biopsy codes are billed with other surgery codes on the same date of service, modifier 59 is being appended to the other surgery code instead of the biopsy code.
  • Biopsy codes exceed the CMS Medically Unlikely Edits (MUEs). An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.
  • The wrong primary code is being billed or no primary code is being billed at all.
  • Biopsy codes are billed with a screening diagnosis.

According to AAPC, CPT guidelines on coding biopsy services can throw light on why these codes are facing denials: use of the incisional, punch, and tangential biopsy codes indicates that the procedure was to obtain tissue for a “diagnostic histopathologic examination” and that the procedure was “performed independently or was unrelated or distinct from other procedures/services at that time.”

02:19 Tips to reduce claim denials

To obtain proper payment for biopsy services, follow these steps:

  • Report CPT codes 11102-11107 only for diagnostic biopsies and do not bill these codes with a screening diagnosis.
  • Apply the appropriate modifier for the appropriate code.
  • Report the appropriate primary code.
  • Know the rules for reporting multiple biopsies.
  • If multiple biopsies are performed using the same technique, report the primary code with the highest RVU.
  • When billing for biopsy services, document the method, the number of units, and the location.
  • Ensure that the maximum units of service that can be reported for a single patient on a single date of service is not exceeded.

I hope this helps but always remember that documentation as well as a thorough knowledge of the 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.

Coding and Billing For Anesthesia Services

Coding and Billing For Anesthesia Services

An experienced dental billing outsourcing company in U.S., Outsource Strategies International (OSI) provides comprehensive dental eligibility verifications to support claims submission. Our team can work on your Dental Software as an extension to your practice.

In today’s podcast, Amber Darst, Solutions Manager, Managed Outsource Solutions, discusses the CDT codes to report dental restoration procedures.

Read Transcript

Hello everyone and welcome to our podcast series. My name is Natalie Tornese and I’m the Senior Group Manager for Outsource Strategies International (OSI). I wanted to take this opportunity to go over coding and billing for anesthesia services.

00:17 Anesthesiology Coding Challenges

Knowing how to code and bill anesthesia services correctly along with the appropriate modifiers is critical to ensure optimal reimbursement. Anesthesiologists face specific coding challenges due to cancelled anesthesia, monitored anesthesia care, failed medical direction, invasive line placement rules, and start/stop times. Every January, new medical billing and coding guidelines and policies come into effect, including coding changes in terms of added, deleted or revised codes.

Let’s take a look at some important considerations for success in anesthesia billing and coding:

00:51 Anesthesia CPT codes

First is the point to know the Codes: As with every medical specialty, reporting the correct anesthesia CPT codes is crucial for proper reimbursement.

I’m going to include a transcript along with this podcast, outlining all CPT and ICD-10 coding.

CPT Codes for Anesthesia Procedures

  • Head 00100-00222
  • Neck 00300-00352
  • Thorax (chest wall and shoulder girdle) 00400-00474
  • Intrathoracic 00500-00580
  • Spine and Spinal Cord 00600-00670
  • Upper Abdomen 00700-00797
  • Lower Abdomen 00800-00882
  • Perineum 00902-00952
  • Pelvis (except hip) 01112-01173
  • Upper Leg (except knee) 01200-01274
  • Knee and Popliteal Area 01320-01444
  • Lower Leg (below knee, including ankle and foot) 01462-01522
  • Shoulder and Axilla 01610-01680
  • Upper Arm and Elbow 01710-01782
  • Forearm, Wrist and Hand 01810-01860
  • Radiological Procedure 01916-01936
  • Burn Excisions or Debridement 01951-01953
  • Obstetric 01958-01969
  • Other Procedure 01990-01999

CPT Codes for Bundled Services

  • Special anesthesia service 99100
  • Anesthesia with hypothermia 99116
  • Special anesthesia procedure 99135
  • Emergency anesthesia 99140

01:10 Anesthesia Modifiers

Anesthesia services should be billed with an appropriate anesthesia modifier. Modifiers provide additional information about the service or procedure. Not using modifiers correctly can result in denied claims and revenue loss. There are two broad categories of anesthesia modifiers – pricing modifiers and informational modifiers.

Pricing modifiers are assigned based on the number of providers and their roles in the anesthesia service. Pricing modifiers must be submitted in the first position to indicate whether the service was personally performed, medically directed, or medically supervised.

  • Anesthesia services performed personally by the anesthesiologist would have the modifier AA
  • Medical supervision by a physician, more than 4 concurrent anesthesia procedures would have the modifier AD
  • Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals would have the modifier QK
  • Qualified non-physician anesthesiologist service, with medical direction by a physician would have the modifier QX
  • Medical direction of one qualified non-physician anesthetist by an anesthesiologist would have the modifier QY
  • CRNA service, without medical direction by a physician would have the modifier QZ

Those are the pricing modifiers.

Then there are informational modifiers, which are placed in the second modifier position and are critical for the billing processes, though they do not directly have an effect on reimbursement. For e.g. QS, which is monitored anesthesia care services are reported with anesthesia CPT codes along with actual anesthesia time. Another set of informational modifiers are those used to indicate the patient’s physical status during the anesthesia procedure, for e.g. P1 would be a normal healthy patient and P2 would be a patient with mild systemic disease.

03:24 Anesthesia Billing Guidelines

Follow proper billing guidelines when billing anesthesia include the following for proper reimbursement:

  • You’ll select the correct CPT and HCPCS codes
  • The number of minutes of administration or time spent on the procedure.
  • The start and stop time of the procedure should be documented based on payer rules.
  • You’re assigning the appropriate modifier to identify the anesthesia provider.
  • Procedure anesthesia codes (00100-01999), those codes should be reported with the appropriate physical status modifier that corresponds to the status of the patient undergoing the surgical procedure.
  • If multiple surgical procedures are performed during a single anesthesia administration, you would report only the single anesthesia code with the highest Base Unit Value.
  • You would report the appropriate qualifying circumstances codes if applicable along with the anesthesia procedures can result in higher reimbursement.

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