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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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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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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CMS Will Soon Issue Consult Code Replacement Advice, According to Open Door Forum

Plus: You can now download a list of all practitioners who can order/refer. If you’ve been confused about how to report low-level hospital visits now that consult codes are gone, you aren’t alone. CMS intends to tackle this problem by issuing more specific guidance on the topic in the near future. That’s according to a Feb. 2 [...] Related articles:

  1. CMS Open Door Forum: RACs Are BackPlus: Medicare officials clarify who can bill incident-to services and under...
  2. Proposed 2010 MPFS: $26 More for ‘Welcome to Medicare’ ExamCMS welcomed health care providers to an July 9 open...
  3. Ask 3 Questions to Head Off 2010 Consult Problems Before They Start Ever used an unlisted E/M code? Get ready. By...

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Gastroenterology Coding Challenge: Repositioning a G Tube

Reading 44373’s code descriptor is key to getting your G Tube claim right. Question: The gastroenterologist goes to the hospital to treat a patient that had recently been admitted because his gastrojejunostomy tube had migrated to his stomach. After performing a problem focused interval history and exam, the gastroenterologist decides to perform an EGD to reposition the [...] Related articles:

  1. Gastroenterology Coding Education: Bravo Cap Placements Question: A new patient reports to the gastroenterologist with complaints...
  2. How Should I Code a Fibrinolytic Agent Instillation Via Chest Tube?Different calendar dates matter, but multiple instillations the same day...
  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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Is E/M Possible Pre-Colonoscopy?

Question: A local family physician refers a patient to our gastroenterologist for a diagnostic colonoscopy. The patient reports to the practice and meets the gastroenterologist for the first time. After answering some patient questions during a brief introduction, the gastroenterologist performs a diagnostic colonoscopy with brushing. The patient had never met the gastroenterologist before. Is the time he spent with the patient [...] Related articles:

  1. Are These Colonoscopy Codes Bundled?Challenge: Can you report codes 45380 and 44388 together? Answer:...
  2. Don’t Wait for CPT: Maximize Virtual Colonoscopy Payment Now Learn whether to file an ABN with 0066T, 0067T....
  3. Gastroenterology Coding Education: Bravo Cap Placements Question: A new patient reports to the gastroenterologist with complaints...

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E/M Audits: MAC Sets Up Pre-Pay Edit for Code 99310

87 percent error rate leads to drastic measures. If you think CMS is only watching your E/M codes when it comes to the office or hospital, think again. One MAC recently reviewed nursing facility care claims and was stunned at the findings. NGS Medicare, a Part B payer in four states, announced on Jan. 26 that it [...] Related articles:

  1. The Truth About Self-AuditsAnd one crucial step you should never miss. How many...
  2. E/M Challenge: Can I Report 99214 and +99354?Counseling representing more than 50 percent of E/M visit? Choose...
  3. CMS Will Offer New Modifier to Denote Admitting Physician on ClaimsPop the champagne cork & get ready for brand new...

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E/M Challenge: Can I Report 99214 and +99354?

Counseling representing more than 50 percent of E/M visit? Choose level based on time. Question: I have a family physician who documented 60 minutes on an established patient’s office visit. The FP diagnosed the patient with morbid obesity (278.01). Since the patient was newly diagnosed and had some difficulty understanding the doctor’s orders, the FP spent [...] Related articles:

  1. Asthma Attack Coding: When To Use Prolonged or High-Level E/M     Checklist deters payback requests for insufficient +99354...
  2. Does CNS Count as NP for Time-Based Coding? CNS = NP = PA for CPT, but Check...
  3. CPT 2010 Update: Non-Face-to-Face Prolonged ServicesNew Year’s hats & horns for looser guidelines that let...

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Wound Closure Coding: Make the Simple, Intermediate Distinction

Accounting for depth is a tricky task when coding closure. Practices interested in ethically boosting their bottom line and getting $80 or more for the same closure repair need to walk the line that separates simple from intermediate. What Makes a Repair “Simple”? A wound closure is a simple repair if the procedure: is simple; is a single-layer closure involving [...] Related articles:

  1. Coding Education: Simple, Intermediate or Complex Closure?Correctly distinguish closure levels every time with this advice from...
  2. Simple Laceration Repair Code or E/M Code? Answer Could Cost Hundreds Not recognizing a laceration repair that’s included in an...
  3. Multi-Laceration Repair Coding Case StudiesDo you know when to code repairs that occur in...

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How Do I Code a 2-Sided Nosebleed?

Heads up: 2 nosebleed codes are not the answer. Question: A patient reports to the ED after sustaining injuries during a soccer match; she was hit in the face with a ball, her nose is bleeding, and her right eye is blackened. The physician is not able to stop the bleeding with ice or pressure, so [...] Related articles:

  1. Is 30901 Your Nosebleed Code? Not So Fast?Hint: Look for these keywords in the note to select...
  2. Winter Laceration Repair: How Do I Code For Dermabond?Warning: Your coding will vary depending on who’s getting the...
  3. How Do I Code This Multiple Fracture Accident Patient?Question: A 30-year-old female presents to a rural ED with...

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How Do I Bill For Follow-Up Visits After the Global?

Tip: Make sure the ICD-9 coding & documentation support follow-up visits after the global. Question: Code 19101 has a 10-day global period, which means you cannot bill an E/M for anything related to that procedure within that time frame. If the patient continues to have follow-up visits outside the global period, should we then report the [...] Related articles:

  1. Global Billing: Document ‘Unrelated’ for Modifier 79 ServicesMACs are looking for ‘red flags’ to halt additional global period pay...
  2. These 8 Services Are Not Part Of The Global Surgical PackageIf you’re not reporting these services separately, you’re losing money....
  3. Pregnancy Global Coding Guide: 59400, 59510, 59610 & 59618 TipsGood news: You can report a higher-level (and higher-paying) E/M...

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Ask 3 Questions to Head Off 2010 Consult Problems Before They Start

Ever used an unlisted E/M code? Get ready. By now, you’ve heard that CMS is doing away with all inpatient (99251-99255) and outpatient (99241- 99245) consultation codes in 2010 — but are you prepared for the issues this may cause, starting Jan. 1? Ask these three questions of your practice and payers, and you’ll fend off [...] Related articles:

  1. Answers To Your Hospital Admission, Subsequent Care Coding Questions Revenue Booster: Here’s when you can claim a consult...
  2. CMS Will Offer New Modifier to Denote Admitting Physician on ClaimsPop the champagne cork & get ready for brand new...
  3. OK to Code Debridement With Consult?Question: Can you charge for an inpatient consult and a bedside...

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CCI 16.0: Now Allows a Modifier to Separate Hundreds of Edits

But other new bundles that 16.0 has in store might put a dent in your reimbursement. You may still be poring through your 2010 CPT manual, but the new edition of CCI, effective Jan. 1, is already looking to make some code pairings impossible. The Correct Coding Initiative (CCI) released version 16.0 earlier this week, revealing 24,060 [...] Related articles:

  1. CCI 15.1: Adhere to These Osteotomy, Laminectomy Edits You’ll need a modifier on this code pair to...
  2. CCI 15.2 Retracts Neurostimulator Edits from 15.1Look for new edits that affect eye exam codes, anesthesia,...
  3. CCI 15.3 Update: You Can Resubmit Dozens of Previously-Bundled 22526 ClaimsNewsflash: CCI 15.3 retroactively deletes hundreds of edit pairs, but...

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ED Coding Education: FAST Exams

Watch It: If you fly through FAST exam coding, you could miss vital info When your physician performs a FAST (focused assessment by sonography for trauma) examination, be sure to go through the notes slowly or you could miss one of the three common codes. FAST exam patients are almost always in some physical trauma, which requires [...] Related articles:

  1. Coding for OB Ultrasounds and Annual ExamsCoding for OB Ultrasounds Are you confused about ultrasound coding?...
  2. Radiology Coding Education: Is 76705 OK for Back?Question: For a lower back ultrasound of a soft tissue...
  3. Pediatric PE Coding: Look Out for These Documentation Misses Here’s why oral thrush could be a major issue....

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ED Coding Question: Observation or Other E/M Code?

Question: A 42-year-old patient reports to the ED early on Tuesday morning for evaluation of uncontrollable shaking in her extremities and severe pain in her neck. The EP admits the patient to observation at 7 a.m. and orders blood tests and a CT scan — however, the shaking continues to worsen. The EP consults with a [...] Related articles:

  1. Capture ‘Patient Limbo’ Period With These Observation Coding Steps Internist deciding on admission? That’s your signal to look...
  2. 5 Steps Ensure Correct Observation Care Coding To prevent ED denials, code service only when doc...
  3. Observation Coding Do’s and Don’ts What’s the POS for an ED hallway? Answers to...

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