Are your coders equipped with the latest coding information? Every year there are changes to the diagnoses and procedure codes, whether this is deletion or newly created codes. Along with coding updates, insurance carriers frequently adjust, delete, or create medical policies to reflect updates to procedures or diagnose codes.
Coders must be equipped with the latest Current Procedural Terminology (CPT); International Classification of Diseases, 9th Revision (ICD-9); and the Healthcare Common Procedure Coding System (HCPCS ) guides. Coders at any level should participate in continuing education to ensure that they are aware of all changes. By investing in coders’ educations, physicians are ensuring that their practices are compliant with coding and billing guidelines.
Each October, ICD-9 diagnosis codes are updated. In the past, Medicare and private carriers allowed a grace period before the code changes would take effect, but this is no longer the case. All diagnosis code updates go into effect October 1 of each year, and claims made on or after that date will be rejected if the correct diagnosis code is not used. An example of an ICD-9 code change that affected rheumatology this year was the diagnosis code for gout:
- 2009: 274.0–Gouty arthropathy (There was only one four-digit code to identify this diagnosis.)
- 2010: 274.0–Gouty arthropathy (Now a fifth digit is needed for more specificity of the diagnosis.)
- 274.00–Gouty arthropathy, unspecified
- 274.01–Acute gouty arthropathy
- 274.02–Chronic gouty arthropathy without mention of tophus (tophi)
- 274.03–Chronic gouty arthropathy with tophus (tophi)
Each January, the CPT and HCPCS codes are updated. Many practices think it is acceptable to use outdated coding books because it saves a little money. In the end, however, this could cost a practice far more than what was saved. Below are examples of CPT and HCPCS changes that affected rheumatology practices this year:
- 2009: 64470-64472–Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic.
- 2009: 64475-64476–Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral.
- For fluoroscopic guidance and localization for needle placement and injection in conjunction with 64470– 64476, use 77003.
- 2010: 64490-64492–Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic.
- 2010: 64493-64495–Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral.
- Image guidance (fluoroscopy or CT) are inclusive components of 64490– 64495. Imaging guidance and localization are required for the performance of paravertebral facet joints injections. If imaging is not used, then report 20550–20553. If ultrasound guidance (76492) is used, then 64999 must be reported.
- 2009: J7322–Hyaluronan or derivative, Synvisc, for intra-articular injection, per dose.
- 2010: J7325–Hyaluronan or derivative, Synvisc or Synvisc-One, for intra-articular.
- Synvisc and Synvisc-One is under the same code because it is per 1 mg now instead of per dose.
As you can see, there were significant changes to rheumatology coding in 2010. It is extremely important to have the correct coding materials available to coders and billers—it can make a difference in your reimbursement. Rheumatology practices should take advantage of the coding resources available on the ACR website. If you have any questions or need additional information, contact Melesia Tillman, CPC, CRHC, CHA, at firstname.lastname@example.org or (404) 633-3777, ext 820.