Coding Laboratory Services - AHIMA

[Pages:54]Coding Laboratory Services

Audio Seminar/Webinar

June 4, 2009 Practical Tools for Seminar Learning

? Copyright 2009 American Health Information Management Association. All rights reserved.

Disclaimer

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.

AHIMA 2009 Audio Seminar Series ?

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American Health Information Management Association ? 233 N. Michigan Ave., 21st Floor, Chicago, Illinois

Faculty

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.

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Table of Contents

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

AHIMA 2009 Audio Seminar Series

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Table of Contents

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 ......................................................................................................... 33-34 ABN Instructions and Options.........................................................................................34 Guidelines for Coding Blood Transfusions ........................................................................35 Complete Billing of the Blood Transfusion........................................................................35 Transfusion Medicine Case: The Facts.............................................................................36 Transfusion Medicine Case: The Answer..........................................................................36 NCCI Edits for Crossmatching.........................................................................................37 Transfusion Medicine Case: The Answer..........................................................................37 Most Common "Missed" CPT Codes in Lab: Microbiology...................................................38 Aerobic and Anaerobic Cultures with Blood Cultures .................................................... 38-39 Most Common "Missed" CPT Codes in Lab: Microbiology.............................................. 39-40 For More Information on Laboratory Coding from CPT Assistant ................................... 40-41 Resource/Reference List ........................................................................................... 41-42 Supplemental Material ...................................................................................................43 Other References : Lab Websites....................................................................................43

Audience Questions.......................................................................................................44 Audio Seminar Discussion ..............................................................................................44 Become an AHIMA Member Today!.................................................................................45 Audio Seminar Information Online ..................................................................................45 Upcoming Audio Seminars ............................................................................................46 Thank You/Evaluation Form and CE Certificate (Web Address) ..........................................46

Appendix ..................................................................................................................47 Resource/Reference List .......................................................................................48 CE Certificate Instructions

AHIMA 2009 Audio Seminar Series

Coding Laboratory Services

Notes/Comments/Questions

The Objectives

At the conclusion of today's program, the participants will be able to:

1. Select the most accurate lab CPT/HCPCS code; 2. Locate internet resources for coding esoteric lab

procedures and profiles; 3. Identify the appropriate payment programs for OP

lab services including ESRD composite rate, Clinical Lab Fee schedule and OPPS APCs; 4. Discuss CPT coding guidelines for laboratory services; 5. Summarize the ICD-9 CM Diagnostic Coding and Reporting Guidelines for Outpatient Services; and 6. Demonstrate the correct use of modifiers 59 and 91.

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The Agenda

1. CPT & HCPCS Coding Overview with Coding TIPS and CAUTIONS

2. ICD-9 Diagnosis & Procedure Coding 3. The Fee Schedules and Addendum B 4. Lab Modifier Maze and the NCCI 5. OIG & the Clinical Lab: Compliance

Guidelines and the 2009 Work Plan 6. Deep Dive into Real Life Lab Coding

Cases

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Coding Laboratory Services

Comparison of Organ & Disease Panels

Notes/Comments/Questions

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Comparison of Organ & Disease Panels

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Coding Laboratory Services

Notes/Comments/Questions

Lab Coding Tips

Select Accurate 80000 Codes

? Adjectives and other important words

? Specimen , Method, Total or Free, With or W/out

? Manual or automated, Qual or Quant, initial, ? Each, first, "2-8" or "9-15" ? Antibody codes start with 86xxx; Antigens

start with 87xxx

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Lab Coding Tips

? When you need more than one code

? Charge explosions ? Panels , Profiles and Reflex Tests:

Maintaining Compliance

? When there isn't a code

? Avoid the unlisted procedure code: Use Method Codes

? How to find esoteric testing codes

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