Jessica Edmiston, coding manager, and Tamara Wagner, coding audit manager, with National Medical Billing Services, discuss eight common coding errors that create compliance problems and decrease revenue for surgery centers.
Coders must read the entirety of an operative note to determine whether a procedure was open or arthroscopic, Ms. Edmiston says. “Coders make mistakes because the doctor will state that he’s going to do an open procedure in the procedure heading, but when he gets down to the procedure detail, he mentions scopes or vice versa,” she says. If the operative note seems to contradict itself as to whether the procedure was open or arthroscopic, the coder should query the physician.
Physicians may list certain procedures in the procedure heading of the op note but will actually document different (fewer or more) procedures in the body of the operative report, states Ms. Edmiston. You can tell the coders who don’t read the entire op note because the coding will match the procedure heading. She says coding from the procedure heading alone is incorrect. Coders must always read the entire operative report and question and discrepancies.
In pain management procedures, coders may make mistakes when coding radiofrequency ablation of lesions. If the physician is performing radiofrequency ablation of lesions on three levels (for example, L2, L3 and L4), the coder would report three levels, not two levels as with facet joint injections. “You have to understand that you can code out for all three nerves, not just two levels,” Ms. Wagner states. “It’s really important to understand the way the doctor documents the levels in the body of the op note. If coders report fewer levels than appropriate, the ASC will miss capturing revenue, Ms. Wagner says.
According to Ms. Wagner, when coding destruction of premalignant lesions, there are three separate codes that distinguish the first lesion from the second through 14 lesions and 15 or more lesions. Coders should use CPT 17000 to report the first lesion, then 17003 for each additional lesion up until the 14th lesion. If the patient has more than 15 lesions, the coder should use CPT 17004 alone, rather than using CPTs 17000 and 17003.
If a procedure begins arthroscopically and then converts to an open procedure, the coder should only report the open procedure, Ms. Edmiston says.” If the physician starts doing a rotator cuff repair arthroscopically and then converts it to open, you only report the open repair,” she says. She says this rule does not apply if the physician does one procedure arthroscopically and then the next procedure with the open technique. “If they’re different procedures, then you can report both procedures,” she says. “Sometimes that rule is misinterpreted.”
Ms.Wagner says she has seen coders mix up their anatomy when coding for phalanx or metatarsal surgery in the foot. “It’s important to know the anatomy before choosing the code,” she says. “For example, sometimes people forget there’s actually a code specific to the metatarsal head and instead choose a phalanx code.” She says because the bones are close in proximity, coders must read the operative note carefully and brush up on their anatomy knowledge to make sure they are coding the procedure correctly.
Ms. Edmiston says arthroscopic debridement should be reported with unlisted code 29999, but coders commonly use CPT 29877 instead. “29877 should be used for debridement of cartilage, and the ACL is a ligament, not cartilage,” she says. “For this procedure, unlisted code 29999 would have to be used.” Similarly, she says coders often use CPT 29828 to code arthroscopic biceps tenotomy, rather than using unlisted code 29999 as appropriate.
For GI procedures, coders can code separately for each different technique that is used to remove a polyp. For instance, the physician might use a cold biopsy, a hot biopsy or a snare biopsy to remove three different polyps. In this case, the coder would use three different CPT codes to demonstrate that three techniques were used. If the physician used a hot biopsy to remove two polyps and cold biopsy to remove one polyp, the coder would only report two techniques for all three polyps. “As long as they’re doing different techniques on different polyps, you can use up to three codes,” Ms. Wagner says. “You report each technique only once per session, no matter how many polyps are removed.”
Ref. Becker’s Healthcare