Billing Best Practices: Useable Tips

Check with your carriers for specific recommendations. Keep in mind the way one carrier may request reporting is not necessarily the way another carrier does.

Let’s look at the common errors leading to lost revenue in facilities...

Gastroenterology

Confusion as to screening colonoscopy vs. diagnostic colonoscopy:

Screening colonoscopies are performed for early detection of colorectal cancer in high-risk and average-risk patients. The patient is not displaying any signs or symptoms. An example of a true screening diagnosis would be V76.51.

A diagnostic colonoscopy is performed to evaluate a patient displaying signs or symptoms. If during the course of a screening a lesion is identified that results in biopsy or removal, code V76.⁵¹ first, then the findings.

Incorrect polypectomy reporting. Polyp removal codes are intended to represent the technique used while removing the polyp. You may use the code only once, regardless of how many polyps were removed by that technique. Example: two polyps removed by snare, another one by biopsy: 45385, 45380-59.

Podiatry

Misuse of modifiers: metatarsal codes use –RT, or –LT. Phalange codes use the toe modifiers TA-T9. Remember a bunion can only be –RT, -LT or -50.

Bunionectomy unbundling: bunionectomy codes include capsulotomy, arthrotomy, synovial biopsy, synovectomy, Removal of bursa, neuroplasty, tendon release, tenotomy, tenolysis, articular shaving, excision of scar (revision), placement of internal fixation.

Hammertoe coding: CPT Code 28285, does not include a capsulotomy. If a capsulotomy of the metatarsophalangeal joint is performed, also code 28232. (see reader comment below)

Orthopedics

Knee arthroscopies: abrasion arthroplasty vs. chondroplasty. In order to use CPT code 29879 abrasion arthroplasty, look for terms like “detail drilling,” “microfracturing” or “debridement to bleeding bone.” If documentation does not support this narrative, code only a chondroplasty 29877. Per CCI edits 29877 bundles into other arthroscopy codes, be careful not to unbundle.

Miscoding of shoulder synovectomies: partial synovectomy CPT code 29820 is used to report when one quadrant is resected. When two or more quadrants are resected, use code 29821.

Incorrect reporting of hardware removal: CPT code 20680 should be reported once regardless of how many screws, pins, etc., are removed. Multiple reporting may be used when the hardware is removed from another fracture site. In this case, you may append a -59 to indicate a separate procedure.