Coding Laboratory Services Coding Laboratory Services AHIMA 2009 Audio Seminar Series 1...

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Transcript of Coding Laboratory Services Coding Laboratory Services AHIMA 2009 Audio Seminar Series 1...

  • © Copyright 2009 American Health Information Management Association. All rights reserved.

    Coding Laboratory Services

    Audio Seminar/Webinar June 4, 2009

    Practical Tools for Seminar Learning

  • Disclaimer

    AHIMA 2009 Audio Seminar Series • http://campus.ahima.org/audio American Health Information Management Association • 233 N. Michigan Ave., 21st Floor, Chicago, Illinois

    i

    The American Health Information Management Association makes no representation or guarantee with respect to the contents herein and specifically disclaims any implied guarantee of suitability for any specific purpose. AHIMA has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this audio seminar, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this program. AHIMA makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service.

    CPT® five digit codes, nomenclature, and other data are copyright 2009 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT®. The AMA assumes no liability for the data contained herein.

    As a provider of continuing education the American Health Information Management Association (AHIMA) must assure balance, independence, objectivity and scientific rigor in all of its endeavors. AHIMA is solely responsible for control of program objectives and content and the selection of presenters. All speakers and planning committee members are expected to disclose to the audience: (1) any significant financial interest or other relationships with the manufacturer(s) or provider(s) of any commercial product(s) or services(s) discussed in an educational presentation; (2) any significant financial interest or other relationship with any companies providing commercial support for the activity; and (3) if the presentation will include discussion of investigational or unlabeled uses of a product. The intent of this requirement is not to prevent a speaker with commercial affiliations from presenting, but rather to provide the participants with information from which they may make their own judgments.

    The faculty has reported no vested interests or disclosures regarding this presentation.

  • Faculty

    AHIMA 2009 Audio Seminar Series ii

    Betty Hatten, MHS, MT

    Betty Hatten is a manager in Huron Consulting Group’s Clinical Research Solutions and Healthcare Compliance practice. Ms Hatten is a 40 year veteran of the healthcare industry, including the past 11 as a healthcare consultant focusing on coding and compliance, charge capture, performance improvement, and chargemaster development and maintenance. A medical technologist for 28 years, her experience includes clinical laboratories, genetics and transplant labs, in vitro fertilization labs, educator, and laboratory administrative director.

    Diana Medal, MA, RHIA, CCS, CPC, CCS-P

    Diana Medal is a compliance practice leader in the care delivery section of Kaiser Permanente’s national Compliance, Ethics, and Integrity team, where she is responsible for coordinating coding compliance training and supporting coding compliance audits. Ms Medal was previously assistant professor of health information administration at Loma Linda University. She also participated in global distance instruction for Loma Linda, as medical terminology instructor for physical and occupational therapy students in Yokkaichi, Japan.

  • Table of Contents

    AHIMA 2009 Audio Seminar Series

    Disclaimer ..................................................................................................................... i Faculty ......................................................................................................................... ii The Objectives ............................................................................................................... 1 The Agenda ................................................................................................................... 1 Comparison of Organ & Disease Panels ............................................................................ 2 Lab Coding Tips ............................................................................................................. 3 Online, Free, Lab Coding Reference ................................................................................. 4 Using the Reference Lab Website .................................................................................... 4 Coding Tip: Always Validate Testing Methods: Labs Vary ................................................... 5 2009 CPT Codes .......................................................................................................... 5-7 HCPCS Code Selection .................................................................................................... 7 Polling Question #1 “Source of Diagnostic Information” ..................................................... 8 Official Coding Guidelines ................................................................................................ 8 Official Coding Guidelines Diagnostic Services Only ....................................................... 9-10 Coding for Physician Billing Pathologist ............................................................................ 10 Proposed New Codes for FY 2010 ................................................................................... 11 Proposed Invalid Codes for FY 2010 ................................................................................ 11 Pathologist’s Interpretation of a Pap Smear ..................................................................... 12 Papanicolaou Test Reconfirmation V72.32 ....................................................................... 12 Abnormal Cytologic Smear of Anus 796.7 ........................................................................ 13 Other Codes Associated with Anal Pap Smear .................................................................. 13 Diagnosis from Ordering Physician vs. Pathologist for Pathologist Claim ............................. 14 Diagnosis for Urine Culture ............................................................................................ 14 Diagnosis for Complete Blood Count (CBC) ...................................................................... 15 Diagnosis for Monitoring Effects of Long-term Use of Drugs .............................................. 15 Clinical Laboratory Fee Schedule ............................................................................... 16-17 Physician Fee Schedule ............................................................................................. 17-18 Reimbursement for OPPS Hospital Lab Tests that are Assigned APCs ................................. 18 Reimbursement for OPPS Hospital Labs ........................................................................... 19 Addendum B: OPPS Reimbursement ............................................................................... 19 Status Indicator Definitions ............................................................................................ 20 Billing for End Stage Renal Disease (ESRD) Related Laboratory Tests ........................... 20-21 Composite Rate Tests .................................................................................................... 22 Polling Question #2 “The Semicolon and Modifiers” .......................................................... 22 National Correct Coding Initiative ................................................................................... 23 Do these 2 Indented Codes Need a Modifier? ............................................................. 23-24 Modifier -59 Distinct Procedural Service ...................................................................... 25-26 Polling Question #3 “Use of Modifier -59” ........................................................................ 26 Modifier -91 Repeat Clinical Diagnostic Test ..................................................................... 27 -59 or -91 Case Study .................................................................................................... 28 Modifier -90 Reference (Outside) Laboratory ................................................................... 29

    (CONTINUED)

  • Table of Contents

    AHIMA 2009 Audio Seminar Series

    ESRD Modifiers: CD, CE, CF ...................................................................................... 29-30 OIG Work Plan (FY 2009)............................................................................................... 30 Why Doctors Order Lab Tests? ....................................................................................... 31 Information Available for Each “Reason” ......................................................................... 31 The Need for ABNs: Variable .......................................................................................... 32 Screening Tests: Legislative Provisions ............................................................................ 32 Beneficiary Notices Initiative (BNI) ................................................................................. 33 The CMSR 131 ................................................................................