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Medical Billing and Coding Healthcare Blog

June 7, 2012 - There was never any doubt that the healthcare industry would grow exponentially, but few people realized 15 or even 10 years ago how dramatic the changes were going to be. The American population has grown older at the same time medical technology has advanced. Treatments thought nearly impossible are now everyday occurrences. The demand for these new treatments combined with the growing number of elderly patients has placed its own unique strains on medical billing systems. These changes have resulted in the need for new a system of medical coding and it is the ICD – 10 codes that will be responding to the challenge.

The International Statistical Classification of Diseases and Related Health Problems, or ICD codes, are used to classify not only diseases but also a wide range of symptoms and procedures of healthcare. It is the basis for medical billing and the ICD – 9 has been the workhorse code for years. However, due to the advances in medical treatment and technology, not to mention legislative changes, there are more situations than the ICD – 9 codes can fully cover. The ICD – 10 code terminology has been in existence since the 1990s but was slow to be accepted by the healthcare industry in the United States. That is now about to change.

The United States Department of Health and Human Services is about to require that those healthcare entities that deal with the Health Insurance Portability and Accountability Act of 1996 (HIPPA) use the ICD – 10 in place of the older ICD – 9. There has been a recent delay announced of compliance until October 1, 2014 to allow for additional review, but unless something dramatic is uncovered it is likely that the ICD – 10 codes will be universally used in American healthcare. This will bring about a major change in the field of medical billing and records. The ICD – 10 code sets have over 150,000 different codes as opposed to the approximately 17,000 codes found in ICD – 9. The ICD – 10 takes into account the advances in medicine, treatment, and diagnosis that occurred in the past few decades. Moreover, the ICD – 10 has already been adopted by a number of countries, including Germany, France and Australia. It is most likely that more and more countries will adopt the ICD-10 codes in the coming years.

This new code will bring about sizable changes in how billing and recordkeeping are done. Career minded medical coders will have to become proficient in ICD – 10 code terminology and software, and medical billing and records keeping will have to be revised to reflect the ICD – 10 lexicon of terms and codes. This all may prove to be extremely expensive as the transition to the new codes runs its course. The possibility of some confusion and administrative difficulty is quite real, as this happens in the event of any major change. It does mean that institutions training medical coders will have to offer increasingly more courses in ICD – 10 and discard the ICD – 9 curriculums. Nevertheless, there is a sizable benefit to be derived from the new codes, including more precise labeling of treatments and symptoms among other things. The ICD – 10 codes will eventually make the pricing of various healthcare services easier and more accurate.

This article was provided by our friends at the Medical Coding Training & Certification Guide – a free resource for current and aspiring medical coders. From general industry information, to specific job opportunities, all the important aspects of the medical coding profession are covered.


The Current Procedural Terminology (CPT) code set for 2011 includes several changes of interest to ob-gyns. Additionally, CPT has added several features to the CPT-4 manual to help clarify coding in a variety of situations, including new guidelines, Coding Tips, and Evaluation and Management tables. These new features are in addition to new, revised and deleted CPT codes. These changes take effect January 1. Because of HIPAA requirements, insurers must accept new codes beginning January 1. The American Medical Association CPT Editorial Panel approved these changes for 2011.

Influenza Pandemic Vaccine Codes
CPT released four new CPT-4 codes this year to report the pandemic formulation of the combination flu vaccine (CPT-4 codes 90664, 90666, 90667 and 90668). These codes are only for pandemic use.

  • 90664 Influenza virus vaccine, pandemic formulation, live, preservative free, for intranasal use
  • 90666 Influenza virus vaccine, pandemic formulation, split virus, preservative free, for intramuscular use
  • 90667 Influenza virus vaccine, pandemic formulation, split virus, adjuvanted, for intramuscular use
  • 90668 Influenza virus vaccine, pandemic formulation, split virus, for intramuscular use

Recommended coding for flu vaccine for the 2010-2011 flu season is to report non-pandemic codes from CPT-4 code series 90655 – 90660.

Integumentary Codes
The guidelines and many of the codes in the wound debridement section, such as codes 11042 – 11047, have been revised and new add-on codes have been established to further delineate the work performed, by depth of tissue and surface area of the wound.

Intraperitoneal Catheters
Codes in the intraperitoneal catheters section have been revised and new codes have been added to provide more specific identification of placement procedures.

  • 49418 Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous
  • 49419 Insertion of a tunneled intraperitoneal catheter with subcutaneous port
  • 49422 Removal of a tunneled intraperitoneal catheter

CPT code 49420 (Insertion of intraperitoneal cannula or catheter for drainage or dialysis; temporary) has been deleted.

Intraperitoneal Chemotherapy Administration
96446 Chemotherapy administration into the peritoneal cavity via indwelling port or catheter
Code 96445 (Chemotherapy administration into peritoneal cavity, requiring and including peritoneocentesis) has been deleted.

Introduction: Brachytherapy
57155 Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy
57156 Insertion of vaginal radiation afterloading apparatus for clinical brachytherapy

Maternity Care and Delivery Guidelines
The guidelines for maternity care have been updated to clarify the proper reporting of E/M services when appropriate with delivery only codes and delivery with postpartum care codes. The new guidelines are as follows:

  • Postpartum care only services (59430) include office or other outpatient visits following vaginal or cesarean delivery.
  • When reporting delivery only services (59409, 59514, 59612, 59620), report inpatient post delivery management and discharge services using E/M codes. Delivery and postpartum services (59410, 59515, 59614, 59622) include delivery services and all inpatient and outpatient postpartum services.
  • Medical problems complicating labor and delivery management may require additional resources. These services should be identified by reporting codes from the Medicine and E/M sections of CPT in addition to the appropriate codes for maternity care."

Pathology and Laboratory/Chemistry
Code 84112 has been established for reporting placental alpha microglobulin-1 (PAMG-1), through cervicovaginal secretion.

  • 84112 Placental alpha microglobulin-1 (PAMG-1), cervicovaginal secretion, qualitative)

Subsequent Observation Care Codes (99224-99226)
Subsequent observation care codes have been established for reporting observation services that extend beyond the initial day of service. These codes include reviewing the medical record, the results of diagnostic studies and any changes in the patient's status since the last assessment by the physician.

  • 99224 Subsequent observation care, per day for the evaluation and management of a patient which requires 2 of these 3 requirements: problem focused interval history, problem focused exam, and straightforward or low medical decision-making. Typical time is 15 minutes.
  • 99225 Subsequent observation care, per day for the evaluation and management of a patient which requires 2 of these 3 requirements: expanded problem focused interval history, expanded problem focused exam, and moderate medical decision-making. Typical time is 25 minutes.
  • 99226 Subsequent observation care, per day for the evaluation and management of a patient which requires 2 of these 3 requirements: detailed interval history, detailed exam, and medical decision-making of high complexity. Typical time is 35 minutes.

The introduction section of CPT now includes new guidelines for time measurement for those codes with a time basis for code selection. Per the new guidelines:

  • Time is the face-to-face time with the patient
  • The "interpretation and report" in the code description is not intended to indicate that report writing is part of the reported time.
  • A unit of time is attained when the mid-point is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and sixty minutes). A second hour is attained when a total of 91 minutes have elapsed.
  • For codes ranked in sequential typical times, when the actual time for the service falls between two typical times, the code with a typical time closest to the actual time is reported.
  • When another service (such as a procedure) is performed concurrently with a time based service, the time associated with the concurrent service should not be included in the time used for reporting the time based service.
  • Times for services measured in units other than days are considered continuous times even if the service extends into another calendar date.

The descriptions of several modifiers have been revised for 2011 in order to clarify their usage.
Modifier 50 (Bilateral procedure) has been revised to delete the term (operative) when describing procedures.

Modifiers 76 -78 (repeat procedures and unplanned return to the operating/procedure room) have been revised to clarify that these modifiers may be reported by a physician "or other qualified healthcare professional." Additionally, CPT clarified that modifiers 76 and 77 should not be appended to an evaluation and management service.