Download - 2011 CODING & DOCUMENTATION UPDATE Healthcare Services Group October 2010.

2011 CODING & DOCUMENTATION

UPDATE

Healthcare Services Group

October 2010

Overview of Topics

• Coding Changes Reminder

• 2011 Diagnosis Code Changes

• 2011 ICD-9-CM Procedure Code Changes

• 2011 CPT Code Changes

• RAC Audits – Physician & Hospital

• 2011 OIG Work Plan – Physician & Hospital

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Coding Changes Reminder

• Remember to change the following to reflect the new diagnosis and procedure codes for 2011:– Superbill / Encounter Form– Practice Management Software

• Update ICD-9-CM and CPT Books

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2011 Diagnosis Code Changes

Effective 10/1/10

New Diagnosis Codes

Additional Digits Required

Deleted Diagnosis Codes

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• Neoplasms – Schwannomatosis - 237.73

• One form of a genetic disorder called neurofibromatosis (NF) that has only been recently recognized

– Neurofibromatosis, NEC - 237.79

• Endocrine, Nutritional & Metabolic, Immunity– Deleted

• Disorders of Iron Metabolism – 275.0

– Additional 5th Digit Required

» Hereditary Hemochromatosis – 275.01

» Hemochromatos – RBC transfusions – 275.02

» Hemochromatosis NEC - 275.03

» Other Disorders of Iron Metabolism – 275.09

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• Endocrine, Nutritional & Metabolic, Immunity– Deleted

• Fluid Overload 276.6


» Transfusion associated circulatory overload – 276.61

» Other fluid overload – 276.69

– New Code• Obesity hypoventilation syndrome – 278.03

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• Blood and Blood-Forming Organs– Deleted

• Secondary Thrombocytopenia - 287.4


» Post-transfusion purpura - 278.41

» Other secondary thrombocytopenia – 278.49

• Mental Disorders– New Code

• Childhood onset fluency disorder – 315.35

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• Circulatory System– New Codes

• Other disorders of arteries and arterioles - 447.7

• Aortic Ectasia - 447.71 – 447.73

• Respiratory System– Deleted

• Influenza due to identified avian influenza virus – 488.0


» Influenza due to identified avian influenza virus with:

» Pneumonia – 488.01

» Other Respiratory Manifestations – 488.02

» Other Manifestations – 488.09

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• Respiratory System– Deleted

• Influenza due to identified novel H1N1 influenza virus – 488.1


» Influenza due to identified novel H1N1 influenza virus with:

» Other Respiratory Manifestations – 488.12

» Other Manifestations – 488.19

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• Digestive System– New Code

• Fecal impaction – 560.32

• Musculoskeletal System – New Code

• Spinal stenosis, lumbar region, with neurogenic claudication – 724.03

• Congenital Anomalies– Deleted

• Other anomalies of uterus – 752.3

– Additional 5th Digit Required:

» 752.31 – 752.47

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• Symptoms, Signs and Ill-Defined Conditions– New Codes

• Post traumatic seizures – 780.33

• Febrile non-hemolytic transfusion reaction – 780.66

• Fluency disorder in conditions classified elsewhere – 784.52

• Jaw pain – 784.92

• Signs and Symptoms involving cognition

– Attention or concentration deficit – 799.51

– Cognitive communication deficit – 799.52

– Visuospatial deficit – 799.53

– Psychomotor deficit – 799.54

– Frontal lobe and executive function deficit – 799.55

– Other signs and symptoms involving cognition – 799.59

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• Symptoms, Signs and Ill-Defined Conditions– Deleted Codes

• Hemoptysis – 786.3


» Acute idiopathic pulmonary hemorrhage in infants – 786.31

» Other hemoptysis – 786.39

• Incontinence of Feces – 787.6


» Incomplete defecation – 787.61

» Fecal smearing – 787.62

» Fecal urgency – 787.63

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• Injury and Poisoning– Deleted

• Poisoning by other specified central nervous system stimulants – 970.8


» Poisoning by cocaine – 970.81

» Poisoning by other central nervous system stimulants – 970.89

• ABO incompatibility reaction – 999.6


» ABO incompatibility with hemolytic transfusion reaction not specified as acute or delayed – 999.61

» Acute – 999.62 Delayed – 999.63

» Other ABO incompatibility reaction - 999.69

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• Injury and Poisoning– Deleted

• Rh incompatibility reaction – 999.7


» Rh incompatibility with hemolytic transfusion reaction not specified as acute or delayed – 999.71

» Acute – 999.72 Delayed – 999.73

» Other Rh incompatibility reaction – 999.74

– Non-ABO Incompatibility

» Non-ABO incompatibility reaction, unspecified – 999.75

» Not specified as acute or delayed – 999.76

» Acute – 999.77 Delayed – 999.78

» Other non-ABO incompatibility reaction – 999.79

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• Injury and Poisoning– New Codes

• Transfusion reaction, unspecified – 999.8

• Hemolytic transfusion reaction, incompatibility unspecified – 999.83

• Acute hemolytic transfusion reaction, incompatibility unspecified - 999.84

• Delayed hemolytic transfusion reaction, incompatibility unspecified – 999.85

• External Causes of Injury and Poisoning – New Codes

• Volunteer Activity – E000.2

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• Factors Influencing Health Status (V Codes)– New Codes –

• Personal History of:

– Combat & operational stress reaction – V11.4

– Vaginal dysplasia – V13.23

– Vulvar dysplasia – V13.24

– Other (corrected) congential malformations of:

» Genitourinary system – V13.62

» Nervous system – V13.63

» Eye, ear, face and neck – V13.64

» Heart and circulatory system – V13.65

» Respiratory system – V13.66

» Digestive system – V13.67

» Integument, limbs and musculoskeletal – V13.6816



• Personal History of:

– Retained foreign body fully removed – V15.53

• Do not resuscitate status – V49.86

• Physical restraints status – V49.87

• Homicidal ideation – V62.85

• Acquired absence of pancreas – V88.1

– Total – V88.11 Partial – V88.12

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• Retained:

– Foreign body – V90

» Radioactive fragment – V90.0

» Depleted uranium fragments – V90.01

» Other radioactive fragments – V90.09

– Metal fragments – V91

» Metal fragments, unspecified – V90.10

» Magnetic metal fragments – V90.11

» Non-magnetic metal fragments – V90.12

– Plastic fragments – V90.2

– Organic fragments – V90.3

– Animal quills or spines – V90.31

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• Retained:

– Tooth – V90.32

– Wood fragments – V90.33

– Other organic fragments – V90.39

– Other specified foreign body – V90.8

– Glass fragments – V90.81

– Stone or crystalline fragments – V90.83

– Other specified foreign body, NEC – V90.89

– Foreign body, unspecified material – V90.9

• Multiple Gestation Placenta Status

– Codes V91.0 – V91.99

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• Factors Influencing Health Status (V Codes)– Deleted

• Encounter for insertion of intrauterine contraceptive device (IUD) – V25.1

– Insertion of IUD – V25.11

– Removal of IUD – V25.12

– Removal and re-insertion of IUD – V25.13

• Body Mass Index (BMI) 40 and over, adult – V85.4

– BMI 40.0 – 44.9, adult – V85.41

– BMI 45.0 – 49.9, adult – V85.42

– BMI 50.0 – 59.9, adult – V85.43

– BMI 60.0 – 69.9, adult – V85.44

– BMI 70 and over, adult – V85.45

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2011 ICD-9-CM Volume 3Procedure Code Changes

• ICD-9-CM Volume 3 Procedure Code Changes– 22 New Codes & 1 Deleted Code

• Insertion of drug-eluting stent(s) of superficial femoral artery – 00.60

• Cranial implantation or replacement of neurostimulator pulse generator – 01.20

• Removal of cranial neurostimulator pulse generator – 01.29

• Non-coronary intra-operative fluorescence vascular angiography (IFVA) – 17.71

• Bronchoscopic bronchial thermoplasty, ablation of airway smooth muscle – 32.27

• Percutaneous mitral valve repair with implant – 35.97

• Excision or destruction of other lesion or tissue of heart, thoracoscopic approach – 37.37

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• Central venous catheter placement with guidance – 38.97

• Implantation or replacement of carotid sinus stimulation device

– Total system – 39.81

– Lead(s) only – 39.82

– Pulse generator only – 39.83

• Revision of carotid sinus stimulation


– Pulse generator – 39.85

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• Removal of carotid sinus stimulation

– Total system – 39.86


– Pulse generator – 39.88

• Other operations on carotid body, carotid sinus and other vascular bodies – 39.89 (Deleted 39.8)

• Reverse total shoulder replacement – 81.88

• Insertion of sternal fixation device with rigid plates – 84.94

• Fat graft to breast – 85.55

• Fat graft of skin & subcutaneous tissue – 86.97

• Extraction of fat for graft or banking – 86.90

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2011 CPT Code Changes

Effective 1/1/11

New Codes

Deleted Codes

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• Evaluation and Management – 3 New Codes– Code added and resequenced

• Subsequent Observation Care, Low Severity - 99224• Subsequent Observation Care, Mod. Severity - 99225• Subsequent Observation Care, High Severity - 99226

• Integumentary System – 3 New & 2 Deleted – Code added and resequenced – (Add-on Codes)

• Debridement, each additional 20 sq cm– Subcutaneous Tissue - 11045– Muscle/Fascia - 11046– Bone – 11047

– Deleted• Debridement; skin; partial & full thickness – 11040 & 11041

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• Musculoskeletal System – 5 New Codes– Neck & Spine Fusion, Additional – 22551– Add’l Neck & Spine Fusion (Add-On Code) - 22552– Code added and resequenced

• Hip Arthroscopy with– Femoroplasty – 22914– Labral Repair – 22915– Acetabuloplasty - 22916

• Respiratory System – 4 New Codes– Nasal Sinus Endoscopy with Dilation of:

• Maxillary Sinus – 31295• Frontal Sinus – 31296• Sphenoid Sinus – 31297

– Bronchoscopy with Balloon Occlusion - 31634

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• Cardiovascular System – 20 New & 23 Deleted– New Codes

• Application of Pulmonary Artery Bands - 33620

• Transthoracic Insertion of Catheter or Stent - 33621

• Reconstruction Complex Cardiac Anomaly - 33622

• Revascularization with Stent

– Iliac, Femoral/Popliteal Artery, Tibial/Peroneal Artery

» 37220 - 37235• Intraoperative Identification of Sentinel Lymph Nodes - 38900

– Deleted Codes• Transluminal balloon angioplasty - 35454 – 35474

• Transluminal peripheral atherectomy – 35480 - 35495

• Repair, diaphragmatic hernia – 39520 - 39531

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• Digestive System – 18 New & 4 Deleted– New

• Laparoscopy, Esophageal Lengthening (Add-On) - 43283• Esophagogastric Fundoplasty - 43327 – 43328• Hiatal Hernia Repair - 43332 – 43338• Gastric Intubation & Aspiration, Necessitating Physician Skill - 43753 • Gastric/Duodenal Intubation & Aspiration- 43754 - 43754• Laparoscopy Placement of Interstitial Device - 49327• Placement of Interstitial Device (Add-On) - 49412• Insertion of Tunneled Intraperitoneal Catheter – 49418

– Deleted • Esophagogastric fundoplasty – 43324 & 43326• Biopsy of Stomach - 43600

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• Urinary System – 1 New Code– Transurethral Radiofrequency Treatment for Stress Incontinence -

53860

• Female Genitourinary System – 1 New Code– Insertion of Vaginal Brachytherapy Device - 57156

• Nervous System – 8 New & 2 Deleted– Stereotactic Computer Assisted Cranial Procedures –

• 61781 -61783

– Posterior Tibial Neurostimulator - 64566

– Cranial Nerve Neurostimulator Electrodes - 64568 – 64570

– Chemodenervation of Parotid & Submandibular Glands - 64611

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• Eye and Ocular Adnexa – 4 New Codes– Placement of Amniotic Membrane on Ocular Surface –

• 65778 – 65779

– Transluminal Dilation of Eye Canal - 66174 - 66175

• Radiology – 5 New Codes– CT Angioplasty Abdomen/Pelvis

• Without Contrast – 74176• With Contrast – 74177• Without Contrast 1+ Body Regions – 74178

– Ultrasound Extremity Non-Vascular• Complete - 76881 • Limited – 76882

• Pathology & Laboratory–15 New & 13 Deleted

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• Medicine – 40 New & 41 Deleted– New Codes

• Immunization Administration thru 18 years

– First Vaccine/Toxoid – 90460

– Each Additional – 90461

• H1N1 Immunization Administration, including counseling - 90470

• Meningococcal Vaccine, 2-15 months - 90644

• Influenza Virus Vaccine

– Intranasal – 90664

– Intramuscular, Preservative Free – 90666

– Intramuscular, Split Virus, Adjuvanted – 90667

– Intramuscular, Split Virus – 90668

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• Medicine – 40 New & 41 Deleted– New Codes

• Therapeutic repetitive transcranial magnetic stimulation treatment; planning – 90867

– Delivery and management, per session - 90868• Esophageal Motility (Add-On Code) – 91013• Sleep Study 95800 - 95801

– Deleted Codes• Immunization Administration – 90465 – 90468• Esophageal/Gastric Intubation/Motility – 91000-91105• Telephonic Transmission of Post-Symptom EKG strips

– 93012 & 93014• Holter Monitors

– 93230 - 93233– 93235 - 93237

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• Medicine – 40 New & 41 Deleted– New & Deleted Heart Catheterization Codes

• New

– 93451 - 93464

– 93563 - 93568

• Deleted

– 93501

– 93508 - 93511

– 93514

– 93524

– 93526 - 93529

– 93539 - 93545

– 93555 - 93556

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• Category II Codes (F Codes) – 31 New Codes– Major Depressive Disorder– Parkinson’s Disease– Epilepsy– Body Mass Index– Cervical Cancer Screening– BloodTyping– ClinicalTumor Staging– Anesthesia – Tobacco Use & Cessation Counseling

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• Category III Codes (T Codes) – 52 New Codes & 13 Deleted Codes– Cryopreservation Ovary Tissue / Oocyte – 0058T & 0059T

– Audiometry and Speech Audiometry – 0208T – 0212T

– Injection Paravertebral Facet Joint – 0213T – 0218T

– Placement Posterior Intrafacet Implants – 0219T – 0222T

– Transluminal Peripheral Atherectomy – 0234T – 0239T

– Esophageal Motility – 0240T – 0242T

– Measurement of Wheeze Rate for Bronchodilator • 0243T & 0244T

– Open Treatment of Rib Fractures – 0245T – 0248T

– Ligation Hemorrhoid with Ultrasound – 0249T

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• Category III Codes (T Codes) – 52 New Codes– 52 New Codes & 13 Deleted Codes– Bronchial Valve Procedures – 0250T – 0252T

– Endovascular Repair – 0254T – 0256T

– Aortic Heart Valve Replacement with and without Cardiac Bypass – 0258T & 0259T

– Hypothermia, Neonate, 28 days or less – 0260T & 0261T

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RAC Audits – Region AOutpatient Hospital - Physician

• Untimed Codes– Certain untimed codes are billed for more than one unit

• i.e. Physical Therapy

• Newborn/Pediatric Codes– Patients that exceed the age limit defined by CPT code

• Global Surgery– Pre- and Post-Operative visits

• New Patient Visits– Guidelines for a new patient

• New to practice

• Has not been seen in practice for 3 years

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• Technical Component of Radiology• Neulasta

– Drug that reduces risk of infection in cancer patients• Commonly reported with a chemotherapy drug administration code

rather than a therapeutic administration code which creates an overpayment

• Global Billing of Radiology or Diagnostic Tests in Facility Setting

• Add-On Codes– Add-on code reimbursed when primary procedure either

was not billed or not paid• NCCI Edits

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• Duplicate Claims• IV Hydration

– When billed for more than one unit per date of service

• Once in a Lifetime– i.e. Removal of organs; genetic testing; dialysis training etc.

• Bronchoscopy Services– When billed for more than one unit per date of service

• Global vs. TC/PC Split Reimbursements– Reimbursement for global and then additional

reimbursement for TC or PC

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RAC Audits – Region AInpatient Hospital

• MS-DRG Validation – – Currently Medical Necessity Excluded

• Tracheostomy

• Coronary Bypass, Cardiac & Cardiac Valve Procedures

• Extensive & Non-Extensive OR Procedures

• Joint Disorders

• Major Chest Procedures

• Major Large & Small Bowel Procedures

• Hip & Femur Procedures

• Intracranial Hemorrhage or Cerebral Infarction

• Pulmonary Edema & Respiratory Failure

• Ventilator Support of 96+ Hours

• Craniotomy & Endovascular Intracranial Procedures

• Excisional Debridement40


• MS-DRG Validation – Currently Medical Necessity Excluded

• Severe Sepsis

• Complications of Cholecystectomy

• Seizures

• Lysis of Adhesions

• Pathological Fractures

• Cardiac Defibrillator– Diagnostic and procedural information and the discharge status

of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record

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• DRG Coding and Medical Necessity Validation– Diseases of Blood, Blood Forming Organs & Immunological

Disorders• Currently for MS-DRG 811

– Red Blood Cell Disorders with MCC

– Endocrine, Nutritional & Metabolic Disorders• Currently for MS-DRG 640

– Nutritional & Miscellaneous Metabolic Disorders with MCC

– Nervous System Disorders• Currently for MS-DRG’s 056 & 057

– Degenerative Nervous System Disorders with MCC

– Degenerative Nervous System Disorders w/o MCC

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• DRG Coding and Medical Necessity Validation– Musculoskeletal Disorders

• Currently for MS-DRG’s 551 & 552

– Medical Back Problems with MCC

– Medical Back Problems w/o MCC

– Gastrointestinal Disorders• Currently for MS-DRG’s 391 & 393

– Esophagitis, Gastroenterology & Miscellaneous Digestive Disorders with MCC

– Other Digestive System Diagnoses with MCC

– Kidney and Urinary Tract Disorders• Currently for MS-DRG’s 683 & 684

– Renal Failure with CC

– Renal Failure w/o MCC

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• DRG Coding and Medical Necessity Validation– Respiratory

• Currently for MS-DRG’s 190, 191 & 192

– COPD with MCC

– COPD with CC

– COPD w/o CC and MCC

– Cardiovascular Procedures• Currently for MS-DRG 249

– Percutaneous Cardiovascular Procedure with Non-Drug Eluting Stent w/o MCC

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• IPPS Hospital to Hospital Transfers– Per diem rate should be paid for transferring hospital– Full MS-DRG payment to final discharge hospital– Validating that both hospitals don’t receive full MS-DRG

payments

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2011 OIG Work PlanPhysician

• Evaluation and Management (E/M) Coding and Electronic Health Record (EHR) Bonuses– Review E/M utilization to identify trends in the level of services

• Certain providers billing lower or higher-level codes

– Review documentation for E/M Services• To determine if identical or very similar documentation was used for

different E/M codes

– OIG believes the reliance on EHR systems’ automated documentation features may be causing improper payments based on identical documentation

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• EHR Bonuses and Attestation– OIG will check that those receiving bonuses have met

meaningful use standards

• Error-Prone Providers– Providers with high claims denial rates over the last four years

• Will be singled out for medical claims review

• Will receive overpayment demand letters

• Coding of E/M Services– Providers are responsible for ensuring that the codes they

submit accurately reflect the services they provide

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• Place of Service Errors– Physician’s Office vs. Ambulatory Surgical Center (ASC) /

Hospital Outpatient Departments

• E/M Services Billed During Global Surgery Periods

• Part B Imaging Services– Review whether the utilization rates reflect industry standards

• Excessive Payments for Diagnostic Tests– Determine if testing was medically necessary

• Trends in Laboratory Utilization– Will review types of lab tests ordered and number of lab tests

ordered

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2011 OIG Work Plan Hospital

• Medicare Excessive Payments– Hospitals required to report units of service as the number of

times that a service or procedure was performed• Review outpatient claims in which payments exceeded charges and

selected HCPCS codes for billings that appear aberrant

• Medicare Disproportionate Share (DSH) Payments– Determine if payments were in accordance with Medicare

methodology

• Medicare Outlier Payments– Verify that outlier payments are based on the most recent cost-

to-charge ratio from the cost report to properly determine outlier payments

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• Reliability of Hospital-Reported Quality Measure Data– Review hospitals’ controls for ensuring the accuracy of data

related to quality of care

• Hospital Readmissions– Readmitted to hospital less than 31 days after being

discharged– Determine trends in the number of hospital readmission

cases– Determine if the hospital services met professional

standards of care

• Payments for Diagnostic Radiology Services in Hospital Emergency Departments

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• Hospital Admissions with Conditions Coded Present-on-Admission (POA)– Determine which types of facilities and specific providers are

most frequently transferring patients with certain diagnoses that were coded POA

• Responses to Adverse Events in Hospitals– Determine whether hospitals have taken corrective actions

and are in compliance with Medicare standards– Will identify and analyze potential overlaps, conflicts and gaps

in responses

• Hospital Reporting for Adverse Events– Review type of information hospitals’ internal incident-reporting

systems capture

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Contact Information

– Contact Information

• Michael McLafferty CPA, MBA, FACMPE, CHFP EisnerAmper, LLP Partner, Healthcare Services Group [email protected]

• Steven Bisciello, MBA EisnerAmper, LLP Supervising Consultant, Healthcare Services Group [email protected]

• Maureen Doherty, CPC, CPC-H EisnerAmper, LLP Supervising Consultant, Healthcare Services Group [email protected]

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