SuperCoder Blog

A lot of information is appearing very fast about COVID-19 (coronavirus disease 2019), and medical coders have the extra challenge of sorting through the onslaught to find the bits relevant to coding claims related to testing and treatment. This Q&A brings together the latest authoritative news about coding for COVID-19.

Term tip: COVID-19, a respiratory disease, is caused by a virus named SARS-CoV-2. Be alert for references to both terms in coding news updates.

Diagnosis coding brings the unique challenge of knowing when to use a 7^th character on your ICD-10-CM code and then determining which character applies. These tips will help you refine your diagnosis coding skills.

Tip 1: Don’t Ignore 7^th Character Requirements

If ICD-10-CM indicates a code requires a 7^th character, you must report a seven-character code. Payers will not accept incomplete codes. This tip is an obvious one, but as Tip 2 and Tip 3 reveal, getting that 7^th character on your code isn’t always simple.’

The Medicare Physician Fee Schedule (MPFS) includes special pricing for four colonoscopy codes when you append modifier 53 (Discontinued procedure). Here’s what you need to know about appending modifier 53 to these codes and the payment you can expect.

Compare Rates for Total and Discontinued Colonoscopies

Below are the four codes on the 2020 first quarter MPFS that have specific pricing when you append modifier 53. The rates shown are national rates. These rates are subject to quarterly changes, so always confirm the pricing for your date of service and for your specific geographic location.

Diagnosis coding for vaping-related disorders has been a hot topic lately. It’s so hot, that you’re getting a new ICD-10-CM code to be implemented on the unusual date of April 1, 2020, instead of with the usual Oct. 1 update. Start preparing with these tips.

Where Can You Find a U Code in ICD-10-CM?

Let’s jump right in by looking at the new code: U07.0 (Vaping-related disorder).

One of the more interesting aspects of this code may be that it starts with the letter U. ICD-10-CM does not currently include any other codes starting with U. The

ICD-10-CM 2020 added dozens of new codes for orbital fractures, which are breaks in the bones surrounding the eye. To help you get to the correct code faster, follow these steps for orbital fracture coding.

1. Check the Orbital Fracture Location

Your new ICD-10-CM 2020 options for orbital fractures allows you to identify the location more specifically when you assign your code. You’ll choose from the subcategories below based on the location information you have. Of all these subcategories, only S02.3- is not new for 2020.

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Evaluation and management (E/M) code descriptors for office and other outpatient visits will look a lot different in the 2021 CPT^® code set. One of the first steps in preparing for this major overhaul is understanding how medical decision making (MDM) and time will affect 99202-99215 in 2021.

Quick background: The American Medical Association (AMA), which maintains the CPT^® code set, has announced that the 2021 code set will not include level-one new patient code 99201, and codes

The clinical setting may not be the best place to get an accurate blood pressure reading, and two new CPT^® 2020 codes are here to help. Medical codes 99473 and 99474 apply to self-measured blood pressure services. Here’s what you need to know.

1. Review the Codes and Descriptors

Getting to know any new codes starts with a careful review of their descriptors. The two new codes represent different services:

• Training/calibration: 99473 (Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration)
• Data collection/report: 99474 (… separate self-measurements …
  

Medicare has posted the 2020 National Correct Coding Initiative (NCCI) manual, with the updates helpfully marked in red, as usual. Here are some hints on what you’ll find in the latest version.

Review Radiology Section’s SPECT/Planar and Oncology Updates

First up are changes in the radiology services section of the NCCI manual, which you’ll find in Chapter 9.

SPECT/planar combo codes: Subsection E covers nuclear medicine and includes an update about proper coding when there are both SPECT and planar studies. In short, if there’s a single code that covers …

January 1 is bringing roughly 400 CPT^® code changes. See if you’re ready with this quick medical coding quiz, including links to previous SuperCoder blog posts where you can find the answers.

Start Here With the Questions for 2020 Code Changes

Question 1: CPT^® 2020 is introducing new online digital evaluation and management (E/M) codes for established patients. Which code will apply to 11-20 minutes of cumulative time over seven days?

A. 99421

B. 99422

C. 99423

D. 99444

If denial prevention is one of your New Year’s resolutions, we’ve got some ideas to help you achieve your goal. Make 2020 your best year yet by watching the little details that matter for your medical claims, including changes for Appropriate Use Criteria, Medicare Beneficiary Identifiers, and global billing address requirements.

1. Remember That Code Updates Affect Policies

One of the most important actions you can take to help your claims is to ensure your medical codes are up to date. The 2020 ICD-10-CM code set was effective for dates of service on and after Oct. 1, 2019. The 2020 CPT^® and HCPCS …