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Hot Topics

AMA Coding Guidance

Hot Topics

Meaningful Use Terminology Uncoded

   By Kathy Lindstrom, RHIT

In the midst of instituting Meaningful Use, other terminologies and coding systems besides ICD and CPT are being discussed. While we’re all in the midst of learning ICD-10, its also important to keep these other terminology coding systems on your radar. Here’s a primer on the various terminologies.

ICD: International Classification of Diseases. The Ninth revision the US is currently using is based on the World Health Organization’s (WHO’s) Ninth revision. The Tenth revision that the US will begin using in 2013 is also based on the WHO’s ICD-10 coding system. These code sets are used for diagnosis and procedural coding. In the US, the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention, is the official keeper for the ICD code set. The home page for ICD-9 can be found here: http://www.cdc.gov/nchs/icd/icd9cm.htm and for ICD-10 here: http://www.cdc.gov/nchs/icd/icd10cm.htm. Remember ICD codes are updated in April and in October, however the code set will essentially freeze after this year’s October update.

CPT: Current Procedural Terminology is used for procedural coding and is created and maintained by the American Medical Association (AMA). Codes are updated once a year. More information can be found on the AMA website at http://www.ama-assn.org/ama/pub/physician-resources/

SNOMED-CT: Systematized Nomenclature of Medicine-Clinical Terms is a comprehensive clinical terminology. It was originally created by the College of American Pathologists and is now maintained by the International Health Terminology Standards Development Organization (IHTSDO). Unlike ICD, SNOMED is not hierarchical. The terms are instead linked using semantic relationships. An example of this from the IHTSDO website is “One type of link is the “IS_A” relationship. This is used to define a concept’s position within a hierarchy, e.g. Diabetes Mellitus IS_A disorder of glucose regulation.” There are more than 300,000 unique concepts and more than 1,300,000 relationships between those concepts. SNOMED-CT is updated twice a year and is available in multiple languages. More information can be found on the IHTSDO website at http://www.ihtsdo.org/snomed-ct/

LOINC: Logical Observation Identifiers Names and Codes. Maintained by The Regenstrief Institute. LOINC was developed to give a definitive standard for identifying clinical information in electronic reports, such as laboratory and other clinical tests and results, meaning it can be used for both the ordering of tests and for the results. LOINC, like SNOMED, is also available in multiple languages. LOINC fills in where CPT and SNOMED leave off, because it is much more specific. For example, one CPT may have many LOINC codes associated with it, because the specimen or exact type of test being run is further specified within the LOINC definition. LOINC has been mapped to CPT by the National Library of Medicine. Basically LOINC is expected to be used for ordering tests while CPT would be used for billing tests. LOINC is updated at least three times a year. More information can be found here: http://loinc.org/

RxNorm: RxNorm is a standardized nomenclature for clinical drugs and drug delivery devices. Its maintained by the National Library of Medicine as part of the Unified Medical Language System (UMLS). The NLM is part of the National Institutes of Health. RxNorm was created to bridge the other commercially available drug information systems, all of which follow different naming conventions. RxNorm is updated monthly and has links within it to other drug vocabularies like MediSpan, First Databank and Micromedex. More information can be found on the UMLS site: http://www.nlm.nih.gov/research/umls/rxnorm/

DSM: Diagnostic and Statistical Manual of Mental Disorders. While not part of meaningful use, it is worth mentioning the DMS is also being updated from the fourth edition to the fifth edition. Its due to be published in May of 2013. The release date was changed in late 2009 to better coincide with the US’s conversion to ICD-10. The APA has worked with CMS and CDC to develop a common structure for the mental disorders section of ICT-10-CM. More information on DMS-5 can be found here: http://www.dsm5.org/Pages/Default.aspx

More information on Meaningful Use can be found within MediReg’s suite of products by searching Health Care Reform Law (under Category or Hot Resources), then searching the term meaningful use.

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2010 Electronic Prescribing Feedback Reports, Now Available!

   By Marianne Russo, CPC, CMC

As anticipated, the Centers for Medicare and Medicaid Services (CMS) has issued the 2010 e-Prescribing (eRx) bonus payments along with the associated feedback reports. Eligible professionals who met the criteria and successfully reported the e-prescribing quality measure code on at least 25 applicable claims are eligible for the bonus payment of 2% of their total allowed Part B Fee Schedule charges. The data received from qualified registries and Electronic Health Records (EHR) was included in the analysis.

The feedback reports are available through one of the three following options:

    1. By download. Reports at the Tax Identification Number (TIN) level can be downloaded directly from the Individuals Authorized Access to CMS Computer Services (IACS) system. A report should be available for every practitioner who submitted at least one claim with a quality measure code during the 2010 reporting period. The reports contain a listing of all the National Provider Identifiers (NPI) that are reporting under the TIN. This makes it easy for each provider group practice, since only one report encompasses the activity of all providers within the group. The breakdown identifies the providers that received the bonus, the bonus amount, along with the providers who were ineligible. Those providers who reported through the Group Practice Reporting Option (GPRO) will receive a similar report, but the report is not broken down by NPI – only a summary is provided. In order to access CMS’ secure website, a provider needs to authorize a representative to perform the transactions. That representative needs to register for an IACS account by clicking on the IACS website at: https://applications.cms.hhs.gov/
    . It is important to note that all providers must be current in Medicare’s Provider Enrollment Chain and Ownership System (PECOS) to receive their downloadable reports. The feedback reports are available in either a PDF, Microsoft Excel or .csv file formats.

    2. By contacting the local Medicare Administrative Contractor (MAC) or carrier. Unlike the reports available through IACS, the MAC/Part B Carrier can provide an eligible professional with a copy of their individual report. Group practice reports are not available. Alternatively, a group practice can request a copy of each individual report by NPI. The eligible professional, or their representative, simply contacts the local MACs call center to request the feedback report. This option is not available for providers that submitted their claims through the GPRO, because the GPRO does not contain individual NPI data.

    3. A web-based support page. This is a new option this year. The Quality Reporting Communication Support Page is a direct link into the CMS website. Available through the QualityNet portal, a provider can simply complete and submit a form requesting a copy of either the eRx or PQRS Feedback Report at the NPI level. A copy of the report will be sent to the eligible professional. To utilize this option, the eligible professional should click on the following link https://www.qualitynet.org/portal/server.pt/
    . A three page report will be generated. Table 1 contains a complete summary by TIN of the provider’s group and bonus allocation, Table 2 contains a summary by individual provider, and Table 3 will be generated only for those professionals who may have had an error on one of the claims. It is not available if the measure code was submitted through a registry or EHR.

In summary, it is important for a provider to carefully review the feedback reports to ensure that the appropriate bonus payment was calculated by CMS; otherwise you could be leaving money on the table.

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Be Prepared for New Electronic Standards Starting January 1, 2012

   By Kim Charland, BA, RHIT, CCS

There are only a few months left until implementation of the X12 Version 5010 of the HIPAA electronic transaction standards. The implementation date—January 1, 2012—is a date that is not subject to change, according to the Centers for Medicare & Medicaid Services. By that date, healthcare providers, clearinghouses and vendors as well as payers must be prepared to use the updated electronic standards, which replace current version 4010/4010A1.

In addition to version 5010, Medicare fee-for-service (FFS) trading partners (as CMS calls the above) must be prepared to use the National Council for Prescription Drug Programs (NCPDP) telecommunications standard D.0, which is the new version for pharmacy transactions. It replaces version 5.1 (as explained at http://www.cms.gov/Versions5010andD0/01_overview.asp).

Electronic claims that do not use the updated standards may not be processed on and after January 1, 2012.

Start Testing Now

All HIPAA-covered entities should be taking steps now to get ready, including conducting external testing to ensure timely compliance. The goal, of course, is to get ready for the transition and be in compliance by the implementation date of January 2, 2012.

On its website, CMS provides several steps that must be taken to get ready for version 5010. Although this isn’t a comprehensive list, the points below are a good start.

  • Upgrade current transaction versions to Versions 5010 and D.0.
  • Modify software to produce and exchange the new formats. (For example: Trading partners must be able to read incoming claims’ acknowledgments from Medicare.)
  • Review business processes (such as patient registration, billing, and claims’ reconciliation) to determine whether changes are needed to capture additional data elements that were not previously required.
  • Contact your vendor and/or clearinghouse to ensure all necessary products and processes will be updated. (For example: Will the upgrade include Medicare’s acknowledgement transactions?)
  • Contact your local Medicare administrative contractors (MACs) and arrange times for testing. The goal is to ensure that trading partners pass all testing requirements for each electronic transaction and that they are all using the same program or software to generate the transaction.

As CMS reminds providers, “Do not wait to begin testing with your MAC because the MACs will not be able to accommodate large volumes of trading partners seeking production status all at once. … Be prepared.”

How Version 5010 Relates to ICD-10

Version 5010 supports the use of ICD-10 codes that will be implemented on October 1, 2013. As you know, the ICD-10 codes have a different format and length than the ICD-9 codes and, therefore, can’t be reported in the current version of the HIPAA electronic transaction standards (version 4010). So, Medicare must complete the 5010 upgrade before the ICD-10 codes can be reported.

Although there are still more than two years until implementation, CMS encourages providers to begin preparing now because the transition to ICD-10 is a major undertaking.

As CMS stated, “It will drive business and systems changes throughout the health care industry, from large national health plans to small provider offices, laboratories, medical testing centers, hospitals, and more. Plans need to devote staff time and financial resources to transition activities. The transition will go much more smoothly for organizations that plan ahead and prepare now. A successful transition to ICD-10 will be vital to transforming our nation's health care system and ensuring uninterrupted operations.”

Help for the Transition

At the following web site address, you can find most of what you need related to Version 5010: http://www.cms.gov/Versions5010andD0/

On the left-hand column of the above address, the link to Educational Resources includes readiness checklists and a resource card with helpful web links. You can also go there directly at http://www.cms.gov/Versions5010andD0/

According to CMS, it will continue to add new tools and information related to Version 5010 to the site through the course of the transition.

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AMA Coding Guidance

July 2011 CPT Assistant   

 By Jennifer Ridell, CPC

Coding Communication: Lower Extremity Revascularization (37220-37235) and Supra-Inguinal Atherectomy Reporting (0234T-0238T)


CPT 2011 now specifically covers endovascular lower extremity revascularization. New Category I codes 37220 - 37235 were added to replace existing Category I codes 35454, 35456, 35459, 35470, 35473, 35474, 35483, 35485, 35493, 35495, 75992, and 75993. In addition to the new Category I codes, five new Category III codes (0234T - 0238T) were added to cover atherectomy performed by any method in arteries above the inguinal ligaments. The July 2011 CPT Assistant provides an in depth look at the procedures covered by these new codes and specific coding guidelines for using these codes.

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Stereotactic Computer-Assisted (Navigational) Procedures

Three new add-on codes were introduced in CPT 2011 to cover specific uses for stereotactic computer-assisted (navigational) procedures. These new codes replace the existing CPT code 61795, which was a general code used for all stereotactic computer-assisted procedures. The new CPT codes, 61781 - 61783 are more specific based on the type of procedure being performed and whether it is intracranial, extracranial, or spinal. When using these codes a primary procedure code must also be present.

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Updated Reporting Instruction for Modifiers and Category III Codes

The American Medical Association (AMA) has updated a question and answer story regarding the use of modifiers with Category III codes that was originally printed in the February 2002 CPT Assistant. The original answer from 2002 states that modifiers cannot be reported with a Category III code. The updated answer for 2011 gives detailed information regarding the evolution of Category III codes and why in 2011 it is acceptable, when noted by the AMA, to include modifiers with Category III codes.

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CPT and RBRVS 2012 Annual Symposium

The CPT and RBRVS 2012 Annual Symposium and ICD-10-CM Chicago Workshop will be held November 16 - 18, 2011 at the Chicago Marriott Downtown Magnificent Mile located at 540 North Michigan Avenue, Chicago, IL 60611. The changes for CPT 2012 and 2012 payment policy and relative value unit changes for the Medicare Physician Fee payment schedule will be discussed. New in 2012 is an ICD-10-CM workshop which discusses hot topics related to the ICD-10 transition. Additional information regarding this annual meeting can be found here: www.ama-assn.org/go/symposia.

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Coding Consultation: Questions and Answers

An article by the CPT Editorial Panel answers questions posed to the panel regarding the subjects of evaluation and management services, surgery/cardiovascular and nervous systems, radiology/diagnostic radiology (diagnostic imaging), medicine/audiologic function tests and qualifying circumstances for anesthesia, and Category III codes. The responses answer multiple questions including: when reporting hospital discharge day management services (99238, 99239), is the final examination of the patient required, and may code 37221, Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within same vessel, when performed, be reported for therapeutic intervention(s) on the iliac vein (eg, insertion of a stent into the left common iliac vein)?

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To view these articles via CCH Coding Comply, search from the Search Code Sets tab in Coding Comply for any of the codes listed above, view the Related Documents by clicking on the paper icon next to the code, then select the article. To view these articles in The Coding Suite, go to the CPT Assistant Archives folder and in the Search field within this folder and enter “July 2011.”

NOTE: To follow the MediRegs links above, you will need to be a subscriber to the Coding Suite of products and if prompted, enter your username and password. If you cannot remember your user name or password go to: http://wk.mediregs.com/login_fs.html and the system will let you request a reminder. For the Internet Research Network or IntelliConnect links, you will need to be a subscriber to the CCH Coding Comply.

Requests for information about article submission and comments from readers are welcome and should be directed to at Nicole Stone at Nicole.Stone@wolterskluwer.com, Fax 847-267-2514. Customer service inquiries should be directed to 800-449-9525. CCH Coding Compliance Advisor is published monthly by CCH, a Wolters Kluwer business.

©2011 CCH. All rights reserved. No claim is made to original government works; however, the gathering, compilation, and arrangement of such materials, the historical, statutory and other notes and references, as well as commentary and materials in this Publication are subject to CCH copyright. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the publisher is not engaged in rendering legal, accounting or other professional service. If legal advice or other expert assistance is required, the services of a competent professional should be sought. For more information about the The Coding Suite or CCH Health Care Portfolio, please visit our online store at http://mediregs.com or http://health.cch.com.

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About the Authors

Kathy Lindstrom, RHIT, is a professional coder for Provation, a Wolters Kluwer Health company, where she primarily focuses on physician clinical coding, ICD-9, ICD-10, and CPT coding. Kathy also focuses on terminology coding, which involves analyzing data from SNOMED, RxNorm, LOINC and MEDCIN. Kathy is a board member of the 2011 CCH & MediRegs Coding Compliance Advisory Board.

Marianne Russo, CPC, CMC, is the Reimbursement Manager for Clinical Practice Management Plan, where she has been employed for over 25 years. She currently manages the regulatory guidelines of the Medicare and Medicaid programs for 18 multi-specialty clinical practices. Marianne is a board member of the 2011 CCH & MediRegs Coding Compliance Advisory Board.

Kim Charland, BA, RHIT, CCS, is the Vice President of Consulting for Medical Learning (MedLearn) and has more than 20 years of experience in health information and reimbursement management for hospitals and physician offices. Her responsibilities include overseeing MedLearn’s Consulting division to ensure the delivery of up-to-date and compliant consulting products while also overseeing the development of new consulting products. Kim is a board member of the 2011 CCH & MediRegs Coding Compliance Advisory Board.

Jennifer Ridell, CPC, is the Data Application Coordinator for CCH Coding comply, CCH Reimbursement Toolkit, CCH Health Reform Toolkit and creates all value-add content in the CCH and MediRegs Coding Suite product line. She is the lead editor for the weekly Coding Comply newsletter and also writes for the CCH Medicare and Medicaid Guide weekly report letter where she serves as a coding and billing expert contributor.


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