Coding Alert

Correct Coding Reminders

The most common coding and billing error is the unbundling of services, which cause denials and delay with payments.

Unbundling occurs when multiple procedure codes are billed for a group of procedures that are covered by a single comprehensive code.

coding-alert

For Example:

93000
93000 represents an ECG with interpretation and report.  Because this code represents the complete procedure, it is inappropriate to submit codes:

  • 93005 (ECG tracing only) and
  • 93010 (ECG, interpretation and report only). 

80061
Another common example of unbundling is found in lab panels.  80061 (lipid panel) includes:

  • 82465 (total cholesterol),
  • 83718 (lipoprotein) and
  • 84478 (triglycerides). 

It would be inappropriate to bill the three individual codes to represent the panel.

Following the AMA CPT and National Correct Coding Initiative (NCCI) guidelines will ensure that claims are coded and processed correctly

Another common coding and billing error is the correct reporting of a service unit. Always remember to verify units allowed based on CPT and NCCI guidelines.  A unit is a single instance of a service.

For Example:

CPT 90471

The correct reporting of an immunization administration, CPT 90471 (includes percutaneous, intradermal, subcutaneous, or intramuscular injections);

  • 1 vaccine (single or combination vaccine / toxoid) and
  • code 90473 (Immunization administration by intranasal or oral route; 1 vaccine).

These service(s) are only allowed once per the code description. 

If you have more immunizations to code on the same claim, use code:

  • 90472 or
  • 90474

for each additional immunization administration given.

CPT ​11100

Another example is CPT 11100 (Biopsy of skin, subcutaneous tissue and / or mucous membrane (including simple closure), unless otherwise listed; single lesion). 

The code indicates this can only be used for one biopsy.  If additional biopsies are performed:

  • use code 11101 (Biopsy of skin, subcutaneous tissue and / or mucous membrane (including simple closure), unless otherwise listed;
  • each separate / additional lesion (List separately in addition to code for primary procedure).  

Notice Regarding Billing Related to Adaptive Behavior

Codes have been deleted and added:

  • Code was deleted effective 12/31/17: 
    • 97532 Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes
  • New Code that replaced 97532 effective 1/1/18: 
    • 97127 Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact
      • The new code is an untimed code and will only be allowed once per day, regardless of the amount of time spent with the patient. There are no RVUs assigned to this code and is not accepted by Medicare.

CMS:  Medicare will not accept new CPT code 97127 (Cognitive function intervention). 

  • Medicare has created G0515 to report cognitive treatment instead.
    • G0515 mirrors former CPT code 97532 and should be reported on the claim form exactly as 97532 would have been, and in 15-minute units. 
    • Like 97532, G0515 should not be billed with CPT code 92507 (speech, language, voice, communication treatment).

At this time, providers should report the G0515 code for all lines of business.