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March 2007
Hello 2007, goodbye 2006. Hopefully one of your New Year’s resolutions was to become an expert coder. So, let us talk about coding. First, get rid of your 2006 ICD-9 book because the 2007 codes went into effect on Oct. 1, 2006. Also, say goodbye to your 2006 CPT book because the new 2007 codes went into effect on Jan. 1. If you wanted to save money this year and not buy new books because you think you already have all the codes you need, you are making a big mistake. First of all, some of the CPT codes from 2006 are no longer valid and therefore will not be accepted by the Managed Care Organizations (MCO). Although physicians must use correct codes, the MCOs do not have to recognize them. If you do not use the new codes, MCOs will not pay you for the services you have rendered. Furthermore, there are many additional codes among the new ICD-9 codes, and if you are not specific enough with your diagnosis coding, those MCOs that have coding software can automatically downcode you. I find ICD-9 codes to be useful. Many patients who come into the office present with more than one diagnosis. A child with pharyngitis (462) might also have large cervical nodes (785.6). The patient might also have hyperpyrexia (780.6). A patient who came in complaining of an upper respiratory infection (465.9) might also have eczema (692.9) If you employ all of the diagnosis codes involved at the visit, you build stronger support for the CPT code you have chosen. It is imperative that physicians remember to document properly. Always cover enough points on the history of present illness, including family, social and past history, and do not forget the review of systems. I am confident that you will remember to examine the proper number of organ systems to sustain the CPT code that you are choosing. Remember to list your diagnoses in order of decreasing severity or risk. There is an appropriate code for almost anything. Two examples of codes that you may not have previously considered: V71.4 exam following an accident, or V71.3 exam related to school or work incident. There are many others that can be found in your ICD-9 book. Some of the new codes that have been added for 2007 and are particularly helpful to pediatricians:
Similarly, there are several new CPT codes that are of specific interest to pediatricians. A rather significant change involves the revision of the circumcision code. Previously, 54150 was used for circumcision, and if a nerve block was utilized, the physician also coded 64450. In 2007, these procedures are coded together as 54150, which is defined as: “circumcision using clamp or other device with regional dorsal penile or ring block.” If you are not performing either the ring block or the dorsal penile block, add the modifier 52. A circumcision, surgical excision other than clamp, device or dorsal slit, is reported by using 54160 for an infant 28 days old or less. In this case, do not also use the modifier 63 for an infant older than 28 days. Instead, report 54161. Physicians who are performing procedures in the office should be aware of the codes for destruction of benign or premalignant lesions. These are:
There have also been codes added for home apnea monitoring, surfactant administration and home ventilator management. Be sure to check these new codes if you provide these services. Most importantly, remember to document everything that you do. If you do not document it, it did not happen. If you do not bill for it, you will not get paid. If it is denied and you do not appeal, you did the work for nothing. For more information: |
