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Chapters
Introduction - Objectives | Coding from an IR Technologist Perspective with 2017 Coding Updates
Introduction - Objectives | Coding from an IR Technologist Perspective with 2017 Coding Updates
2017AVIRbillingcodingcollegecompletedinterventionaljennifermedicalprogramradiologytechnologisttopicswisconsin
CPT - Current Procedural Terminology | Coding from an IR Technologist Perspective with 2017 Coding Updates
CPT - Current Procedural Terminology | Coding from an IR Technologist Perspective with 2017 Coding Updates
2017ablationAVIRbookcodeeditorialembolizationessentiallymedicareocclusionpanelproposedreimbursementrockrulespecialtyvaluesvendors
IR Coding Conventions - Coding Component | Coding from an IR Technologist Perspective with 2017 Coding Updates
IR Coding Conventions - Coding Component | Coding from an IR Technologist Perspective with 2017 Coding Updates
2017ablationangiogramangiogramsAVIRchaptercodecodedcodescodingcomponentdiagnosticeditorialexamexceptionsextremityfull videoimagingmodelpercutaneousperformperformedradiologistreportingspecialtysurgeonsurgicalvenousvisceralworlds
Bundled Codes | Coding from an IR Technologist Perspective with 2017 Coding Updates
Bundled Codes | Coding from an IR Technologist Perspective with 2017 Coding Updates
2017AVIRbiliarybundlecategorycodecodedcodescodingextremityfilterincludedlowerographyphysicianplacementreimbursementrevascularizationtipstypicallyultrasoundunlistedvertebralvertebroplasty
2017 Coding Updates | Coding from an IR Technologist Perspective with 2017 Coding Updates
2017 Coding Updates | Coding from an IR Technologist Perspective with 2017 Coding Updates
2017ablationangioplastyAVIRcategorychecklistcodescodingcryoablationDialysisepiduralguysinterventionalpercutaneousproceduresradiologysedationtalktransluminal
2017 Dialysis Circuit Coding | Coding from an IR Technologist Perspective with 2017 Coding Updates
2017 Dialysis Circuit Coding | Coding from an IR Technologist Perspective with 2017 Coding Updates
2017anastomosisangioplastyarterialAVIRcentralcephaliccirclecodecodescodingdiagnosticDialysisexamextremityhierarchyiliacincludedincludeslesionlessermoveoutflowperipheralregionrulessegmentsegmentsselectseparatestentsthrombectomyultrasoundveinveinsvena
Dialysis Circuit Case Study | Coding from an IR Technologist Perspective with 2017 Coding Updates
Dialysis Circuit Case Study | Coding from an IR Technologist Perspective with 2017 Coding Updates
2017accessarterialAVIRballoonchartchartscodeDialysisgramimageincludedinterventionmacerationperipheralpullbackrefluxstenosisthrombectomy
2017 Vascular Percutaneous Transluminal Angioplasty - PTA | Coding from an IR Technologist Perspective with 2017 Coding Updates
2017 Vascular Percutaneous Transluminal Angioplasty - PTA | Coding from an IR Technologist Perspective with 2017 Coding Updates
2017arteriesarteryAVIRcircuitcodeDialysisembolizationembolizeepiduralextremitypcapercutaneousstentingveinsvisceral
2017 Cryoablation Category III Codes and Conscious Sedation | Coding from an IR Technologist Perspective with 2017 Coding Updates
2017 Cryoablation Category III Codes and Conscious Sedation | Coding from an IR Technologist Perspective with 2017 Coding Updates
2017AVIRcodecodesdynamicimagesinitialminutesnurseobserverpatientperformingphysicianplexusprocedureprovidersedationtrained
Questions | Coding from an IR Technologist Perspective with 2017 Coding Updates
Questions | Coding from an IR Technologist Perspective with 2017 Coding Updates
2017AVIRcardiologycertificationchargechargescodescodingdiagnosticeventexamguysreconciliationsend
Transcript

imagine puffs all right well we have another insightful moderator coming up that's going to lead us through a probably not my most fascinating lee interesting topics but one of the most critical critical things that we do need to know so if you want to know how to

code and want to make happen you need to stick around to listen to part of this or to listen to all of this next talk so let me get everybody up here is as Michelle and her gang mmm make an earth make him their way this way I'd like to

point out that Michelle even though I have seen earlier I almost forgot that she did work at UVA and as my tramping around up at UVA and being a part of that program and watching it grow and be everything that it has been she is she

has been there graduated work there and done everything else that you know was part of that program as it went through but right now she's at the University of wins constant and she's working out there why I should say the Medical

College of Wisconsin and wow sorry about that and so if you get a chance please give a well warm hand to the show and show it thank you very much for giving me this opportunity to moderate the coding and update presentation so not

only drive the privilege to introduce these two fine ladies I also get to work alongside of them every day which is an awesome experience our first speaker is Stephanie diable Stephanie completed her x-ray technologist training at Fort

hospital in 2004 she recently completed her MBA program at the University of wisconsin-milwaukee in 2015 stephanie has had various roles throughout the organization but she is currently serving as a decision administrator for

interventional radiology at the Medical College of Wisconsin Stephanie not only has a vital role in our health system but also volunteers for time with us I are in multiple capacities relating to coding and

billing stephanie has also pioneered the practice way for the IR coding and billing excuse me pioneers away for the IR coding and billing practice at freighter in the Medical College of Wisconsin I respect our second speaker

Jennifer excellent completed her x-ray technologist training at st. Luke's Medical Center in 1996 she has worked in a multitude of imaging modality throughout her career currently Jennifer works as a technical billing specialist

in interventional radiology at Friedrich hospital and outside of the hospital setting she serves as a co-chair of the local saucer southeastern Wisconsin a dir chapter please help me welcome them [Applause]

everyone I am I think that we need to do double credit for everybody who stuck around obviously that was a very challenging act to follow so we'll try our best here to get through this late afternoon session with coding and

billing but dr. Haskell said super important topics so kudos for all of you who stays perfect so our objectives our first one we're going to talk about is essentially the basic principles of CPT coding I'm going to pass it over to Jen

after that and she's going to review the 2017 coding updates that have been in place since January and then we're going to talk at the end about kind of applying your procedural knowledge as I our text to iron coding so this stuff is

kind of dry I'll try my best to keep it as exciting as possible but I think it's very important for everybody to understand where all of this comes from in a little bit of the history so some of the basics about coding reimbursement

is that the coding system that we all use today is is called the Medicare resource-based relative value scale or r vr vs as we all love acronyms in medicine and this is a stylish about 25 years ago and essentially the at the

core of it is a cpt code which we'll talk a lot more about but those CPT codes are assigned what's called an RV do or relative value unit and essentially those relative value units help determine times the

conversion factor what the reimbursement will be for a specific procedure this

CPT process again so CPT again acronym stands for current procedural terminology there's an entire CPT book that's governed by the AMA is who puts

this out and in that book if I had one in front of me it's about that thick and it's every specialty in medicine it's not unique to radiology it's every specialty in medicine in theory is represented somewhere in this book these

are just a few snapshots of what some of the stuff looks in the cpt looks like in the cpt book and what has happened over the past few years is they're doing more and more guidance within the cpt book so you'll see here in the center this is

some of the language that exists about the coding and billing for vascular embolization and occlusion and so the cpt book has really become a very good resource if you don't have one in your lab I mean it's obviously a dry read but

I think it's an important thing to have and to be able to reference so how did the cpt code even become a CPT code the first step at the top here is the cpt editorial panel and just very quickly is essentially specialty societies that

have some sort of interest in the code so most commonly for us it's going to be the Society of an inventory algae is going to have some sort of interest in the code that needs to be created or revised or something and we have

representatives from SAR who sit and participate in the cpt editorial panel process and they sit in front of this larger panel again governed by the AMA who's going to adjudicate what that cpt code and that code family should look

like and it it gets very granular in terms of making sure this consistency within the cpt book and all of this is sometimes a CPT code can be brought to the panel because maybe vendor has a new product so a very good example of that

Jen's going to talk about a new cpt code for 2017 for a product called Claire vein which is a new technology for end Elina um ablation for varicose veins so something like that the mint the the

vendors is there a very I'm sorry of cleansing there's a lot of new products on the market right now of Claire vain you know work with the SI r and say hey we have this new technology there's not a cpt code can you help us create the

cpt code so it can be backed by the vendors or it can be something that's Medicare drives to say we need to address some of the reimbursement issues around a certain set of CPT codes in terms of OD over utilization and we'll

get into some of that in a little bit as well but once the cpt code is created and it passes through the editorial panel is going to go to the rock panel which stands for relative value update committee and at the ruck is where

you're going to get the value that's going to drive the reimbursement and similar to the cpt editorial panel you have society representatives who are going to represent their societies and work with the panel to adjudicate what

the value should be for a specific code so those values are then taken from the ruck panel and given to essentially CMS which is Medicare to say here's what we think the value should be and historically medicare has always taken

those values pretty much at face value and not that anything more with them but with the environment of health care right now CMS more recently has taken those valleys and says okay thank you rock panel for all of your hard work but

we disagree with this and we're going to mark it down just a little bit more so that's a little a little hurtful especially to those of us involved in the rock process but essentially CMS will put those values out and what's

called a proposed rule and that usually comes out in July and you're allowed anybody literally anybody in this room could comment to CMS during that proposed rule period to agree or disagree with some of the reimbursement

policy that's going to be within the proposed rule and they'll take that into consideration and then eventually usually around November the early November they'll publish what's called the final rule and then you have an idea

of what's going to be what the kind of payment policy will look like for the following calendar year

so that's kind of the basics of how a cpt code becomes a cpt code but let's start talking about I are coding and how

it relates to you guys the thing that I always say that we have to really be careful of in our world today is we really live in two different worlds two different coding conventions the older model is on the left here what we call

component coding and we'll get into the details behind that and then on the other side is bundled coding this newer one code to do everything so with component coding you have what we have call an exam code or from a CPT

perspective is sometimes called a radiological supervision and interpretation code but this really represents the imaging component of the procedure you're going to perform and that's a separate cpt code than the

surgical component to what you're going to perform the most important thing that if I can stress anything about component coding when you have that dynamic is it's not a one-to-one relationship you could have multiple exam codes the

possibly only one surgical code and that it can be a little bit challenging because in your head you probably think there should be a nice correlation but there's not always so component conan has its advantages when it was first

instituted it really allows for reporting of what services were actually performed by that provider so you could have had in an old old model maybe the radiologist comes into the o.r to do the imaging component of something that a

surgeon is performing and so that worked really well because the radiologist could build the exam code the surgeon would build a surgical code and there's no issues but CMS looked at that and really considered that duplicated

reporting of the same work performed once you started having physicians not necessarily doing that different specialty model and it's the same position providing the same work so you're willing to cpt codes that kind of

state the same thing so this is where CMS will drive a cpt code set to go to that editorial panel for revision because they look at that is billing the same kind of procedure exam twice some examples of things that are still

currently component coded that haven't gone to that cpt editorial process to be bundled yet our diagnostic extremity angiograms diagnostic sister angiogram and this is where I'll point out that there's exceptions and so we

live in this two different worlds that we have to to know which world were coding in and which one we're living in because I'm saying diagnostic visceral angiogram czar component coded but there's an exception to that because

renal angiograms got caught in a screen in a bundle by CMS in and they're now bundled coded so there's always exceptions currently venous access procedures are still component coded and some percutaneous ablation procedures

are component coded but again there's exceptions when we talk about bundled

codes this I always say this in air quotes one code does it all because it's really not true it's as more and more of our codes have gotten bundled it becomes

more and more challenging to use that one code does it all type mentality so a bundled code is going to include the imaging and the surgical component and it again is going to assume that it's one physician performing the entire

procedure which for the most part probably is the case today but there are some exceptions certainly the most important thing about bundle coding is you have to understand what is in that cpt book and what is included in that

bundle to really know what you can and can't deal with it and not give you some examples so the advantages of bundled coding in theory is easy what I'm saying well kind of because again if you don't know what's included in a certain cpt

code it's very easy to leave something on the table the disadvantage of bundled codes is in general it's going to be a lower to relative value once it goes through the ruck panel and that leads to lower reimbursement so some examples of

bundled coded cases as I said regal and geography or renal artery ography vertebroplasty last year we had a whole new set of a couple dozen codes between biliary and genital urinary interventions tips placement and

revisions IVC filter placement and removal and this is my asterisks here talk about or illustrate the example of having to understand and know what's included in the bundle because while tips placement is a bundled code

when that went through the rock for value what happens is they ask the physicians a bunch of questions during a survey and they say what tips what do you typically do when you perform this examined you typically use ultrasound to

guide your needle into the IJ and the tips code went through the system close to 10 years ago now and at the time physician said no i don't use i'll just fun to get into the IJ so that was kind of left out of the bundle and IVC filter

a little bit more recent with surveyed and they said yes i use ultrasound all the time to get into dij so when that went through the process it actually is bundled into the code so this is where i'm trying to demonstrate the fact that

you have to understand what is included in the bundle to really build these procedures appropriately in my last example of a Mundell coded case is lower extremity arterial revascularization procedures which is a complex case or we

won't get into that one but a few last notes just about cpt codes in general that i think everybody should know the first one is there's a whole set of codes in the cpt book that are there called unlisted codes because the

instructions within cpt say that you cannot select a cpt code that merely approximates the service performed so if the best example I can give is you guys met dr. Taunton earlier today he places alone he does a lot of cement in a lot

of weird places and well a lot of that is somewhat analogous to a vertebra plasti if it's not going in the vertebral body I don't really have a code for that so we can't just say well we charge / keepo classy we'd have to

use what's called an unlisted code and the last note that i want to talk is something called a category 3 code so there's a small section in the cpt book that stands are that is for category 3 coats which are new or emerging

technology codes so this is going to be something that possibly could be FDA approved but maybe doesn't have enough kind of really solid research to really vet that it's going to be a category one code and have good payment policy for it

yet so it kind of sits in this category 3 section for a little while and could possibly be moved to a category what we call category one code to have proper reimbursement and I mentioned that category because in

our 2017 updates which jen is going to go into next we do have some category three codes so I'm going to press it again Thank You Stephanie that's a great

background of how these codes come into production and all the thinking that

goes into them a lot of work so I want to thank the avi are for this opportunity to speak with you all and I want to ask you guys a few questions so who provides the codes for your procedures you do an exam who is coding

the procedures in your institutions is it the text is it regular billing coders that do not have interventional background is it may be a combination of both okay um and then often the technologists really is the first line

of reporting what happens in a case you guys see it first and if you're the one documenting the codes you're really telling the story of what happens during case how is the quarry coding reported do you guys use a checklist a charge

master maybe a program that produces symbols of synonyms to translate into cpt because maybe not all of you are familiar with cpt who knows what a cpt is and know what the numbers mean do you guys use those a lot of people maybe not

all of you we are going to talk about cpts for this talk as Stephanie said the AMA is kind of who's responsible the big book of all the codes that we need to look at so i will talk about code deletions that are relevant to

interventional radiology a lot of codes to look at you'll see how many were deleted soon I want to talk a lot about dialysis codes with rules in hierarchy because all those things come to play and how to select the proper codes

vascular percutaneous transluminal angioplasty interlaminar epidural injections we'll go over some new codes for that procedure Luke a no chemical ablation or mocha that's the device Clara vein that Stephanie had alluded to

previously and cryoablation category three codes that are new those are those temporary codes that sets we just talked to you about and a huge huge change in conscious sedation I don't know how many are aware of what a big change that was

okay so just to summarize that first slide component coated procedures that have gone into bundle Co procedures so a lot of the dialysis codes kind of got bundled in we lost a few things will go into that into more detail emergency to

emerging technology technology assigned category three codes and also interventional radiology procedures that unbundled conscious sedation and it is now billed separately it was all bundled with in the actual procedure of code but

now they took that away okay so very big slide all these codes no more if you have them in your charge master or a checklist get rid of them they're invalid by ok let's go into depth about

dialysis circuit coding there's rules

that we have to talk about we're going to go over the hierarchy the specific codes themselves and I'm going to go through a case and we can code it together ok so this is my dog also the bigger one she's looking freaked out

right and we introduced a new code so to speak or puppy and she's like oh my gosh he doesn't know what he's doing he's freaking me out he's been into my space so it's really tough if you don't know what the rules are right ok but once you

know the rules you can work it out better so rules first of all dialysis circuits have two separate regions this isn't a new role in even when we were doing component coding there is a peripheral segment in a central segment

that are considered separately for coding so the peripheral segments in upper extremity begins with the arterial anastomosis the peripheral veins the outflow veins which include the axillary

or cephalic and then through the common femoral vein for a lower extremity when we talk about the central segment it includes the subclavian and the innominate in the superior vena cava for the upper extremity and then the iliac

external iliac veins through the inferior vena cave and the lower extremity so here's a picture and you can see that small green circle it's the arterial anastomosis and the peripheral segments really includes the whole big

green circle with the artery anastomosis the central segments are those being central I feel like a lot of things I see that are miss documented when you're picking versus peripheral and central as people think the cephalic arch is part

of the central segment it is not is part of the peripheral segments and outflow vein that's essential segments okay so hierarchy so important thing to understand about the code sets for dialysis graphs that they have a

hierarchy and the higher service includes the lesser service below it so when we're talking about just the diagnostic exam and there's no plot within the patient we do our exam and that is that first little circle and

then they find a lesion and they're going to treat it with PTA so you're going to move up kind of snowball that diagnostic exam within it and select the peripheral PTA code if they do a stint same thing everything that beneath the

stents is included so you'll have your diagnostic exam in the peripheral PTA all in the sense if you PTA after the sun same thing all included okay so now the patient is clotted and we begin all over within a difference here of bundle

code so your exam and we do some from back to me that's including the exam move on to PTA that's including the thrombectomy andrew Sam and then you move on to spending the lesion in the peripheral region again

all included so I'll say it again a higher level service includes the lesser service and you'll select a separate different code you do not keep the other one okay so central region which again is separate these are add-on code so you

need to actually paired them with the first something that you did in the first two slides I showed you they do not live by themselves you can't just access a graph and PTA something essential reason without doing anything

else so they do live with other codes ok so you performed a SVC angioplasty and then you moved on just emptiness those two have their own separate higher grades you do PTA in the fence fence includes the PTA okay so here are the

number the first topless wide is just without thrombectomy so we have three 6901 which is your exam you move on to PTA you're going to select 3690 2 and a 3 6901 went away because it's already inherent into that 3690 to say my move

same thing moving on to a spence 3690 3 includes the PTA and all the rest ok let's move on to the second tier again just explain hierarchy of the thrombectomy codes 3690 for includes the diagnostic exam if you wanted to think

if you started from square one you could start with 3 6 9 19 01 again if you didn't do the front back to me yet and stop there right but you move on to the thrombectomy so there it turns into 3690 436 905 it's when you do a angioplasty

within the personal region and then spend teen is just 36 906 ok so the there are a few possible add-on codes there are three new ones but I kind of separated the third 3690 one on its own because it doesn't play it into the

hierarchy of the central segments so 36 907 is an add-on code doesn't with a loan you have to have it with maybe a 3690 one which is your Diagnostics am alone so if you enter the graft and take pictures as 3690 one

there's nothing in the peripheral region to treat oh but the FCC has a snow so we're going to angioplasty we're going to pick that 369 07 to add on to the 369 old one ok now oh it's not going to stay open we are going to stents that lesion

so we're going to move on to 3 6 9 08 along with the 3 6 9 01 ok so 3 6 9 09 that is another add-on code that you would add to anything else you did in the procedure it doesn't have its own hierarchy you can just add it on to any

of the other dialysis coats but it is specific for dialysis so it'd be with one of those new code sets so that is an embolization of a main circuit or accessory veins and then we did we also have ultrasound ultrasound is not a new

dialysis code we've had it since for a while not exactly sure the whole history of stuff you might know more but 769 37 it does have a lot of documentation requirements for it there really should be an indication you need to have an

image archive and within the report there needs to be talked of vessel patency and such things like that ok so

let's start coding a case I would like you guys to try to help me out with us if you could we've gotten access into a

graft official whatever a dialysis circuit and we took a central veena gram I'm going to bring in a chart for you I hope you guys can see this i'm sorry if you cannot what do you think we would select if we stopped here 3690 one right

pretty simple not successfully added yet ok so please pay attention to the first image on the left and this is just a pullback fina gram if we move on to another station and take another image that do anything to the codes no

here's your chart just for reference but nope that doesn't change anything so sorry move to desk ok so I apologize so next slide we see a thrombectomy device and we're going to do some de clotting as you can see our charts we need to

pick a different code so 3690 for is the one that we would pick off our charts and what would we do for the three 6901 do we keep it does it go away yeah it goes away ok I know I'm trying see that's why I do case study because then

we can keep it going all right dialysis so now there's a balloon and I can tell you this is in the peripheral segments and it's an interestin stenosis so sorry there's no waste on the picture but its peripheral PTA here's your chart and

this is still the same patient same case so what do we do now what code do we select 3 6 9 05 that's correct yep 3 6 9 05 and then 3690 for is no longer because we've moved up on this here ok so here is a picture of an arterial

reflex image anything change no there's your chart nope you're still at 360 95 the arterial of reflux shot is included now I want to ask you this if you were doing a patient and you introduce the balloon and you're using it for point

arterial plug but you didn't treat any other lesions how do you coat that would that be pta still because you've got a balloon in place I hear a lot of just brown vexing me right yes right that is only part of the maceration process you

can't charge PTA unless it's an office ok yep oh yes I'm sorry oh yes so kind of like what stephanie was seeing we lost a few things with the bundling so if you were familiar with cpt there was three six

one four seven which is first access and then for diagnosis or any access for diagnostic exam and then the 36 148 was an access for intervention so now that's bundled with in the intervention code smells so that's no longer good question

right and as many as it takes doesn't matter where when how why okay very good question so here is a follow-up and we I think we all can move on and say that that's not included because just a part of the procedure I'll follow ups are

included and oh now we have something essential region and you can see this notice a little bit there you can see ways so at least I have a waist picture for you there is a snow civ let's bring in the chart what code are we picking

for that yep seven right I heard some seven yep so that's the central region 3 6 9 07 it's still same patients and we are going to keep everything else we didn't approve peripheral region set as an add-on code okay so that's your

follow-up and we have those are final code 3 6 9 05 and 36 907 moving on so

thanks for holding that with me guys is great help we are going to talk about PTA codes stenting kind of oh sorry go ahead for the one about embolization is

that if you're examining like a non maturing official and your embolize in collateral to find out that would be appropriate okay go exactly the most important thing yes I don't know that our they are not that the

embolization code is just one for that entire circuit you wouldn't be charging on bullet that 3 6 9 09 you wouldn't charge it per branch that your perfect lateral that you're analyzing it would be one for the circuit if any or all

whatever you're doing that okay so any other questions about dialysis one more sorry one more thing I want to add about a sensation of things that change this year is you used to be able to change charge for those catheter placements

when you would go into those accessories veins and the new code set those are all inclusive in the 36 yeah so yeah so that was ready Sarah 909 is really a bundle one does it all so once and everything ok so then again just went through this

funneling i think it was left here and my expense insurance that is correct and wouldn't you lasted a year before two years ago okay pretending just went through this now we're moved on to include pta both open and percutaneous

pca of the arteries and veins so our primary posts are 37 to 46 i'm sorry i only have my plus sign on my aunt i suppose this is for initial artery the add-on code is 37 247 so that's for any additional artery it doesn't stand

alongside anti suppose you have to have the initial one first in order to report a 37 247 this took place of separate collini for lake holding up the aorta recording of visceral arteries or 14 for specific areas it's just kind of got

funnels into this arterial PTA and please note that it's not for or extremity or had a neck those all have specific coin that are relative it's pathetic and also including dialysis shunt got something to say good you're

bored nothing projects five years ago he had more hannah know how I appreciate to help okay so vain same thing 37 to 42 the primary code 37 to 49 is additional or add-on code you can't have 37 to 49 x by itself and

that be for like making in reacting and suppressing in eastern laminar epidural

injections 6232 wine that is for the cervical thoracic region and six two three two three it was a long reticulation some things to note about

these is it's appropriate for the epidural or two brass with expert subarachnoid space also injection agents must be either diagnostic or therapeutic neurolytic agents are not included in example for neural education with the

alcohol that is entirely different coding imaging includes guidance instruction of the middle and or catheter and here are a couple other codes that they also built I didn't want to have it on because we're anything

that's what we do these ones do not include imaging so here's a little lovely picture very artistic you can even see the spinal cord stenosis that is because I saw strawberry straight but anyway um the two layers of superficial

to the spinal cord are acceptable for these hoes and you can see the spinal cord is read the next player just for Vishal to data source of the records basement for specials that is the epidural here's some images of neo

placement and really sorry this is probably not showing up very well but the meals kind of in the middle with a blue circle around it connects to the lateral projection is just showing that if between the spinous processes of how

you would that's the approach position to for that procedure okay a canticle

chemical ablation 3647 three is the initial code for one thing one access and then its reach 647 for is an add-on code and that is for any other things we

get in the same extremity it could be many times in any access for those people's basis if you have more than one is usually sell for taxes but doesn't matter just one for that okay so that's what

the device replaced it has an indexer on it and that it usually injects a sclerosing agent like maybe filter festival or some other reasons that you might use it institution the device is kind of get a little lip on the edge and

it rotates around and it kind of messes up the endothelium clear of the thing just one thing to mention about that that code is specific to that Clara vein not only only that is right at the after so there's nothing else you can use that

code for so eventually make it easier

three coats Stephanie Ares policy about those 0440 tx4 upper extremity a year 0 for 4 1 T that for Laura meters in 0 for 4 2 T that foreigner feckless plexus or

crumple nerve kind of brachial plexus or pudendal all the images images done is the CUDA notes quotes of what i use alt on PC or fluoro it doesn't matter it's all white coat does it all purses reaching that you're treating let's talk

a little bit about kind of sedation real quickly so 9 many 1051 that for pediatrics um we would kind of look at 990 152 data for greater than 50 patients with an independent observer for your initial 15 minutes this is

provided by the same position who's giving you the treatment and in spanish trained observers like your nurse and there remain focus is the patient's they're not strictly for the procedure they're not stroked in the case they're

not leaving the room they are taking care of the patient the time of that initial tiny begins when the patient is given the mess that's when we start to time the time complete when the nurse is completed her or independent trained

observer maybe it's another type of in trained observer but usually a nurse in my experience complete the face of basic annotations patients ready for recovery that's when you stop your time so its intricacies your time you can add on the

99 153 at the add-on code so i don't think it's frequently 15 minutes to be able to form water basin so you add that adults hold its minute just to make up the total time and this is what we have our questions on yes go ahead I'm sorry

that I don't think so I mean no it is water is it kappa like that right yep yeah as long as it's properly documented enjoying oh yeah right of medicine yeah I know what Stephanie elaborate on that I mean I

think that this is something that maybe these codes are really brand new so there's going to be a lot of questions in the beginning but your head sucking their thumb this is where i'm saying i know that cpt book is very very dry but

they've done a really good job of putting a lot of language if you would go through and read it about the time definitions to all of this so the initial 15 minutes you have to you have to be sedating for at least 10 minutes

in order to charge the initial 15 yes exactly and then the add-on codes it has to be seven and a half minutes so it's a little bit of a weird dynamic but yeah ten minutes for the initial in some in half for the each additional know it

would be fine it's technically seven and a half hour nap on I don't know anybody who'd documents in seconds but it's everyone in a crowd an ad or a half minute yeah well this year the physicians can bill

separately on the professional side so as far as your hospital see the or you know the nursing it just have to be documenting in your EMR somehow so wherever you document your Q vital throughout the procedure is sufficient

one more question that is correct did everybody hear a question so she said what if I monitored for only 16 minutes can I charge only that 15 and that answer is yes you can only charge that first initial 15 in

order to get to the add-on code it would be a total of twenty two point five minutes total but if you know if you're going by the last twenty two point five minutes on a clock and you can go out and do that as it's called turn I think

the other thing to point out is the dynamic and we're starting to touch on this a little bit as that there's kind of the the nursing piece of sedation and the physician piece of sedation and those depending on your institution and

how your procedures go those may not match one to one so and I can tell you that at an SI our level this conversation has come up multiple times through economic committee meetings that have been a part of that we're

struggling on how do we document the physician side of this so just know there's a little bit of a different dynamic and this is all brand-new and we're still struggling to kind of figure out some of those pieces all right the

second choice that is the same same thing as I am the difference is that there's a formal position he's not responsible for the cast or moderate sedation of the patient there's another position that's responsible for that now

stuff is going to come back to wrap it all up for you yes yeah that's exactly what this flap oops that was for them so the distinction between the two code Senate where if it's the same provider who's performing

the procedure and overseeing the sedation's versus what's on the flight now is a different provider another one who's performing the procedure so this would be what anesthesia would be charging if they're doing it yeah we

wouldn't ask yet they just they just distinguish between the two concepts which mean when a different provider is performing for sustained survivor that's like that's the group of the changes here thank you for the question l yes we

love it so I'm just going to kind of wrap it up here and we're going to talk about applying this knowledge and I architect and really what it comes down to measure if everybody was at the post recently a statement this is what our

posters was still hanging out there and that is looking really great so go out into the hall and age-appropriate veins on this slide but essentially you know again we've created this team of technologists who turned I our quarters

at trader's medical college and we think it's been very valuable and so what we did put opposed to against the meeting was take a look at about a month's worth of codes that come in into our work through on a daily basis

with venous access for the purposes of this this study only because those are pretty straightforward but it looked at the rest of the codes which was about 350 and see the numbers about 350 patients that we reviewed the crows test

for and a tentative track in terms of what kind of changes that heal this team mainly Genesis includes the day-to-day person on us now we're making who broke it down into four different categories of supply chains with needed some sort

of change to the slides that were charged a change to the cpt and supply changes 5050 alone and then no changes at all and essentially what it comes down to about fifty two percent of the cases that is reviewed it is some sort

of change and really I mean release at our institutions we try really hard to educate our texts and he come across some coding changes and coding rules but it's really challenging in a very busy lab and where there's no way you can

expect a text to know everything we need to know about all the procedures and medallion device devices out there and then keep up with all of these coding losses that we just talked about so it's really the kind of that experts to our

text me the best they can at the first cast and then jenny is reviewing this and we that over half of our patients needed some sort of change based on what to Texas and we looked at this in two

different ways the first way we look at it was from a worker making impact yet work revenues are going to become give you some sort of idea of what the impacts reimbursement might be and I'm again this is a poster still up there

we'll leave it up for another day but on average be it's positive work rvu impact when something was maybe undercoated by our text was adult 5 work rvu which is pretty significant in this day of decreasing your versus trust me your

physicians will care about five work are we use on the other side of that if there was some sort of charge taking away like the technical and over quoted that was a negative impact of just over two hours so it shows that most often

texts are a machine thing leaving things on on the people I can't remember but either but either way both close the risk to an organization whether something that's over coated or undercoated fraudulent we don't like to

use that effort but it's fraudulent either way the other way we look at this kind of this data set was in the small set of again a ninety percent is the total that needed some sort of supply proteins which is a very small number in

your trunk an alternative education for 350 cases but in those two not in at nine percent this is the impact dictation charge if we would have have caught the things that she thought was over 120 thousand dollars worth of

purification charged in a month and if you would obviously annualized that out we're talking over a million dollars but a lot of money in patient chart that a department cookies maybe not a table and I think the most impactful thing is this

is where I have tech seven books down because if you have some be like a station I an encoder not really knowing I our procedures that's exactly the kind of stuff that they don't know to look for because they don't know that then if

you breed occasions he like you know the coil volume doesn't match with the report says and I'm going to go back in for inventory system and see maybe there was more coils so that was one of the common things that she would an

efficacious and so I think this through a lot of value and having the procedural mind of an iron text looking at these pieces on a regular basis to Joe is a question and then that boy yes you all thank you

for your report and yes my brother exactly we have we have a crazy system in our organization I kind of don't know Stevie to tell us those are completely foreign to them we have this weird spinnin as bait this is how links in our

chargemaster but at the end of the day they're dropping a cpt code that all the tool works you that jen is reviewing and we kind of review at exit passes we can review it before we have a final report I don't know if your eyes are anything

like I are our risk but you don't exactly have the quickest turnaround time I'm bigger better than is good but yeah one of that final report comes in jenison only through the final reports to make sure that you know whatever we

said you know we did is one second to check out the door and the thing I above asleep I recognize that limitation is that we didn't have a cohort group of nonionic coding to compare this to life but these are the

kinds of things that is again an IR tech has that procedural that clinical mounts that really can pay attention to the nuances and details and understand this stuff and you can talk to the three of us and we can tell you about and what

times we go to coding seminars and engineering the questions that people who aren't clinical and procedural they just really don't understand the procedure so there's certainly a trend to get IOS become closer ties but we got

us a very valuable yeah any questions

sharks out there yes so nicely spider thank you for asking a question the coding certification of the three of a cat is through the AAPC because the American cabinets professional coders

and they have most like impulsive to those different kind of coding specializations outside of their basic coding one and circles again can't reject slide is on our poster third stands for certified under virtual

reality and cardiology coder and it's one of the only Appa Appa chances support independently you don't have to have any prior coding certification for that exam and I'll tell you it's one of the most ABC doesn't publish their

caps gallery but it's known to be one of the most common example to happen to take and the three of us all casted on our first try somebody else in the audience was tested on her first high without even going to any sort of

educational course to be studying out at home we saw here so the point being that this is super complex stuff with people like up in and I'll tell you that you can end up with so much more value I mean you guys are already so valuable as

I attempt no matta to know so much then having that extra added value I mean your doctors will be your pin scratch because you're going to be helping them you're going to be helping your katana so it it is very moving a lot of go down

your name your canonical you're talking yourself you will become that expert that everybody goes to any other questions yes cardiology side of it is that cat louses that's it you learn that too and with it actually let one of

these girls speak steps they've taken exam or reach movies like that is part of the exam but i think the sentiment would probably be if you if you can learn ir cody to learn more yeah I tell business in January so it was pretty

recent for me and I can tell you that they give you five hours and 40 minutes to complete the test we if you go for the class they have four days and you go through the whole body and the heart safe leaves the heart for the end and I

feel like there's this um just a smattering of cardiac event to event yeah it's that loading with cardiology on collections but you can still the same rules if you know how to do the rules in other places

nicole there is yes and again it's different really to go about it the three of us there's a company this is just a company that we use this we want ledges of medical access management in Atlanta Georgia they do like a week-long

intensive course to kind of teach you the basics in the useless the DTM on Friday so that's not the only way to do it but that's the way that we've done it again Lisa here just kind of self-study and she has to completely Harold so

which crew don't that's awesome but yes there is there are going to be teased associated with it and then so saying the thing excretion is once you know if you want to keep that certification just like you guys talking at your you know

continue education for your RZR it's continuing education for keep that up as well which will tell you can be a little challenging but I think it's worth it our reconciliation classes are we whale oh she was just wondering if we could

share our reconciliation process Jen did you wanna okay are you mean as far as when attack enters the charge so what happens is Stephanie referred to so the text makes the first pass of putting both all the supplies in in all of the

procedure codes in it drops into a work queue that Jen work and we know obviously that a PICC line we use x y and z and there should be these three charges so based if we don't have a report will send out that the hospital

charges on that or the technical charge let's say we see a fenced and send top stand charge but we don't see a stent supply that's where we're going to do digging because we know that if you send out a claim without that sent on there

it's not going to get paid so that's when we'll go more into the chart will go talk to the text say what time did you use and then we'll go back and add that supply so when we send it out the first time it's good yes so we use epic

at our facility and that's what it's based off of we have to logically to make sure that every single exam goes into this work for you again and we also have kind of another process to review to make sure charges exist because this

charge doesn't exist at all on the record it doesn't forms of the work you so we kind of have a duplicate process to make sure that both of those things happen I

working no that was Fitz included so if you were able to do diagnostic angiography then beforehand and it was actually a legitimate reason to do diagnostic and geography and then therefore based on the diagnosis you

proceeded with intervention the catheter codes or access all gets bundled into the work of the intervention so wherever whatever segmental leg you end up all the work is included to get there the only exception that I lads that is let's

say you were doing you had to stick high and you can get through so you stuck low but you only did that stentor ballooning through the top you can charge for that distal aspect because it's a different site so there's some caveats to that but

yeah I guess the last thing I land in the middle equal we could do it I know it's gonna happen we're happy to keep here to build any more questions the last people get those i think is a very general pizza when code their fashion

event specific as with similar content for example things like that will tend to have that counter position what open but with bundles and me impractical jet engines talked about they're not fast to about specific so you would fill the

stuff of selective cackling separate so if you know the codes enough notices a slip at specific you can almost guarantee that you won't be charging the Catholic but think you guys know it's a video this is data

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