Think You Understand the New Consult Rules? Find Out Fast

Test your 2010 consultation coding understanding with these questions. Consultation coding has every practice on edge this year. Ensure that you’ve got a handle on this complicated coding and billing situation by trying your hand at this question. Question: When a visit with a Medicare inpatient that would normally have been coded as a consultation does not [...] Related articles:

  1. Think You Understand the New Consult Rules? Find Out FastCheck your 2010 consultation coding savvy. Find out if you’re...
  2. Ask 3 Questions to Head Off 2010 Consult Problems Before They Start Ever used an unlisted E/M code? Get ready. By...
  3. CMS Will Soon Issue Consult Code Replacement Advice, According to Open Door ForumPlus: You can now download a list of all practitioners...

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Give Your Radiosurgery or Gamma Knife Surgery Coding a Check-Up

Improve your reimbursement chances by applying modifier 58 in this situation. When your surgeon targets the brain or spine with stereotactic radiosurgery (also called gamma knife surgery) to treat multiple lesions over multiple sessions, you need to know two crucial things: what stereotactic radiosurgery codes to use and how many units to include. Take this three-question challenge [...] Related articles:

  1. Take Our Multi-Level Spinal Surgery Coding Challenge AUDIO TRAINING EVENT: Receive Optimum Reimbursement for Spinal Co-Surgeries,...
  2. Check Destruction Method Before Assuming 17110You could gain $30 if a shave is also performed....
  3. Second Surgery Coding: Tips for Modifier 58, 78 SuccessDon’t let ‘unplanned’ lead to ‘unpaid.’ The next time a...

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Ob-gyn Challenge: Take the Pressure Out of a 3D US Coding

No severe problems? You may have trouble with reimbursement. Question: The ob-gyn performed and OB ultrasound (US) on a patient. Can I bill 76376 in addition to the ultrasound if the ob-gyn used 3D? Montana Subscriber Answer: Yes. You can report a 3D procedure with 76805 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, [...] Related articles:

  1. Ob-gyn Coding Challenge: EM End-Result Tells You What ICD Code To Go ForCheck out these ICD-10 ob-gyn diagnosis coding equivalents. Question: A...
  2. Urology Coding Challenge: Gold Seed Marker Placement Plus TRUS Question: How should I report the placement of gold...
  3. Surgery Coding Challenge: Master Microsurgery Units With This AdviceCheck your EOB to make sure payers don’t apply a...

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Counseling Must Dominate Exception Claims For Seamless Payment

Choose the service level using the documented history, exam, and MDM. Question: A new patient with a chronic gastric ulcer meets the gastroenterologist for management of her condition. The gastroenterologist meets for 34 minutes with the patient, and performs an expanded problem focused history and exam and straightforward medical decision making. The note also indicate that [...] Related articles:

  1. E/M Challenge: Can I Report 99214 and +99354?Counseling representing more than 50 percent of E/M visit? Choose...
  2. E/M Coding: Don’t Sell Yourself Short on Problem Sports ExamsTip: Time-based E/M might be in line when managing diabetes,...
  3. How Do I Code Genetic Counseling By A PhysicianLimit 96040 to Trained Counselor Question: May we report 96040...

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Set the Record Straight: ICD Code Options for COPD

What your pulmonologist writes in the documentation matters. The pulmonologist’s documentation, along with the patient’s medical record can make or break your chronic obstructive pulmonary disease (COPD) reporting. One key is making sure that your coding accurately identifies the patient’s specific pulmonary condition and any other associated acute condition (if necessary). Background: According to the National Heart [...] Related articles:

  1. 3 Pulmonary Diagnosis Coding TipsRemember to focus on acute conditions & exacerbations. Correctly reporting...
  2. How Do You Code COPD With Acute Bronchitis?  Question: An established patient with chronic obstructive pulmonary disorder (COPD)...
  3. Should You Code Presenting Symptoms Along With Dx? Question: An established patient complains of trouble breathing and...

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Get Paid for EM Visits: How Much ROS Documentation Is Enough?

Caution: Keep enough paperwork on hand to back up EHR. Transitioning to the world of Electronic Health Records (EHR) can make your coding easier on many levels, but don’t take it for granted. Physicians often fall short in their review of systems (ROS) documentation whether you use paper charts or rely on EHR, but you can [...] Related articles:

  1. Bullet-Proof Level-4, Level-5 E/Ms with These ROS Documentation TipsROS documentation musts that most practices get wrong. Gastroenterology Coders:...
  2. E/M Coding Focus: Geriatric Patients & DementiaDetermine HPI or ROS during assessment for geriatric patients. Your...
  3. Bulletproof Your Doc’s PSA Documentation with This Form You’re just one click away from a code-focused order....

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Surgery Coding: Narrow Your Options for Birmingham Hip Procedure

Include this term in Box 19 to indicate the type of implant. Question: One of our surgeons says we should use a total hip code for Birmingham resurfacing even if he doesn’t complete a total hip procedure; another physician says to use an unlisted code . What’s the correct answer? Washington Subscriber Answer: Both of your physicians could [...] Related articles:

  1. Test Yourself: Total Knee Replacement (TKR) Coding Can you tackle an op note like this one...
  2. How Do I Code An Arthroscopic To Open Ankle Surgery?Question: Our surgeon attempted to remove a loose body in...
  3. Podiatry Coding Education: 28293 For Joint Replacement for Hallux LimitusQuestion: Our podiatrist performed a joint replacement for hallux limitus and...

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Red Alert, Cardiology Coders: Expect EP Study + Ablation Denials Until April 1

CMS won’t fix CCI blunder until version 16.1, to be released in the spring. If your heart skipped a beat when you saw that January’s Correct Coding Initiative (CCI) edits bundled catheter ablations with electrophysiology (EP) studies, you weren’t alone. Good news: CMS has decided to delete the edits retroactively because their addition was a mistake, according [...] Related articles:

  1. Take Heart, Cardiology Coders: CCI Deletions Overturn 93296 Denials Go back to the future. 3 months of denials...
  2. Nerve Conduction Study Coding TipDid you know that new medical devices are opening doors...
  3. Bundle of His Recording Coding ChallengeQuestion: How should I report right atrial pacing and recording...

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CMS Delays Ordering/Referring PECOS Regulation Until 2011

Take the extra time to get your practice registered in PECOS — don’t wait until the end of the year, CMS reps say. Practices that were busily struggling to find out whether their ordering/referring physicians’ national provider identifiers (NPIs) were in the PECOS system can relax a little bit — at least until next year. If your physician performs [...] Related articles:

  1. CMS: Billing Co. Can’t Fill Out PECOS Form on Doc’s BehalfIf you’ve grown accustomed to a designated credentialing specialist in...
  2. A Press Release Is Not a Legal Ruling, PECOS Pundits Point OutKeep an eye on the Federal Register as you use...
  3. CMS Changes Course: Physicians Need Not Personally Complete PECOS ApplicationWhat a difference three months makes, especially when it comes...

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OIG Hit List: Perfect Your 38220, 38221, and G0364 Usage

Don’t sweat reporting 38220-59 if you meet these Medicare-approved conditions. If your oncologist takes both a bone marrow biopsy and a bone marrow aspiration, whether you’ll see Medicare reimbursement depends on the two guidelines below. But watch out: With OIG scrutiny and a HCPCS twist, these guidelines will put your coding savvy to the test. Append 59 [...] Related articles:

  1. Coding Education: Bone Marrow Harvesting for Autologous TransplantQuestion: Is there a CPT code specific to harvesting bone...
  2. Use This Podiatry Scenario to Perfect Your Emerging Technology ClaimsHint: If you try to use an unlisted code, be...
  3. Multiple Bronchoscopy Coding Crash Course Head off denials & ratchet up reimbursement with these...

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ICD-9 Coding: Stop Asking ‘Which Diagnosis Code Will Get My Claim Paid?’

Assigning an ICD-9 code merely to get your claim paid could land you in legal hot water. Medical coders face a lot of questions each day in the course of their work, but one question you should not be asking is “which diagnosis code should I put on this claim if I want to collect?” When [...] Related articles:

  1. What’s the Correct Diagnosis Code for a Urine Drug Test?Question: What is the proper ICD-9 code when the lab...
  2. 3 Pulmonary Diagnosis Coding TipsRemember to focus on acute conditions & exacerbations. Correctly reporting...
  3. Dx Coding Moves That Stop Denials for Chronic Pain ClaimsTip: Code prior conditions in these cases. Imagine your pain...

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E/M Coding: Don’t Sell Yourself Short on Problem Sports Exams

Tip: Time-based E/M might be in line when managing diabetes, asthma, ADHD. Overlooking time as the key factor on a camp or sports exam in which the patient has a problem could cut $30 per claim. Opportunity: An office visit (99201-99215, Office or Other Outpatient Services) using time as the key factor might be appropriate, but keep [...] Related articles:

  1. Counseling Must Dominate Exception Claims For Seamless PaymentChoose the service level using the documented history, exam, and...
  2. Mid-Level E/M Coding BreakdownOur chart shows you how to choose among 99212, 99213 &...
  3. E/M Challenge: Can I Report 99214 and +99354?Counseling representing more than 50 percent of E/M visit? Choose...

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Optometry Coding: Stop 92081-92083 Denials in Their Tracks

Record visual fields interpretation and report the right way. Visual fields are a compliance hot spot. Optometrists should use the visual field interpretation and report (I&R) to record what their thinking process was at that moment by recording any changes noticed, how the field compares to other testing like OCT (92135, Scanning computerized ophthalmic diagnostic imaging, [...] Related articles:

  1. Ophthalmology Coding: GDX, VF, & Temp Plugs — How Many Modifiers?Question: A patient came in for a GDX and visual...
  2. Optometry Coding: Eye Exams, Cataract Surgery and Co-ManagementE/M or Eye Code? Choose Wisely With These Documentation Tips...
  3. Ophthalmology Coding: RT/LT or Modifier 50? Prevent Uni-Bi Reporting Errors With This Expert Insight Don’t...

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Migraine ICD-9 Codes: How Do I Get My 5th Digits Right?

Discover what the 5th digit represents and why you need it on your claim. Question: A presents to the ED with complaints of a headache that’s worsening daily. He is experiencing visual blurring and nausea but no vomiting. This is the third headache of this nature in three weeks, and it has lasted “four or five [...] Related articles:

  1. Ahhhhh: Relief for Your Migraine ICD-9 Coding Headaches Don’t let migraines’ five subcategories and 30 codes suck...
  2. Should You Code Presenting Symptoms Along With Dx? Question: An established patient complains of trouble breathing and...
  3. Winter Laceration Repair: How Do I Code For Dermabond?Warning: Your coding will vary depending on who’s getting the...

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Burn Coding: Calculate Total Body Surface Area (TBSA)

Investigate your physician’s documentation to determine the body area percentage actually debrided. Question: My anesthesiologist administered anesthesia for a burn excision on the leg of a middle-aged adult male, but he didn’t give clear notes on the patient’s affected body surface area. How do I code for this? Kansas Subscriber Answer: You will start by coding 01952 (Anesthesia [...] Related articles:

  1. Double Your Money When You Spot E/M and Burn Treatment on Same ED Claim The key component of 16000 puts burn coding questions...
  2. Test Yourself: Total Knee Replacement (TKR) Coding Can you tackle an op note like this one...
  3. Coding Challenge: Foot Foreign Body Removal Vs. Soft-Tissue FBRQuestion: Our physician performed a foreign-body removal (FBR) on a...

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Coding Compliance: OIG Targets Transforaminal Epidural Injections

Verify that you’re counting injections and levels correctly to keep claims clean. The Office of Inspector General (OIG) Work Plan for 2010 includes a closer look at Medicare payments for transforaminal epidural injections. The Work Plan specifically states, “We will review Medicare claims to determine the appropriateness of Medicare Part B payments for transforaminal epidural injections.” Stay [...] Related articles:

  1. Save Time Coding Facet Injections With This Coding Tool Hint: Location, number and substance are key. Several factors...
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  3. Trigger Point Injection Coding: Count Targets, Not Shots Become the top TPI gun in your coding department...

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