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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 […]

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  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 […]

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  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 […]

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  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 […]

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  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 […]

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  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 […]

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  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 […]

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  3. OK to Code Debridement With Consult?Question: Can you charge for an inpatient consult and a bedside…
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Santa brings gifts; CCI brings bundles

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 […]

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  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 […]

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  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 […]

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Ophthalmology Coding: GDX, VF, & Temp Plugs — How Many Modifiers?

Question: A patient came in for a GDX and visual field (VF) tests. During the same visit, the ophthalmologist put in temporary plugs. Can we get paid for all services on the same day? I know the office visit needs a modifier. Do I need to put one on the GDX & VF, too?
Answer: Provided the […]

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  3. Ophthalmology Coding: See Your Way to Clear Reimbursement for Eye Exams and Cataract SurgeryChoose the Right E/M or Eye Code to Optimize Reimbursement…
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Does My E/M Coding Have to Match Hospital’s E/M Coding?

Question: My physician removed a catheter in an outpatient hospital exam room. Should I include this removal as part of the E/M? If E/M is appropriate, will the hospital also report an E/M? And, if so, do the physician and hospital E/M codes need to match?
Answer: You should include simple Foley catheter removal as part […]

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  3. Capture ‘Patient Limbo’ Period With These Observation Coding Steps Internist deciding on admission? That’s your signal to look…
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E/M Coding Education: Does ‘No SOB’ Fall Under HPI or ROS?

Question: For a chart with a chief complaint of resolving pneumonia, a note indicates, “No coughing, SOB.” Should I give the pediatrician credit for this ‘no coughing & no shortness of breath’ statement under history of present illness (HPI) or as a review of systems (ROS)?
Answer: This is a gray area of E/M coding that […]

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Watch Out for 3 Telephone Service Coding Pitfalls

Caution: You may need to incorporate the call into an in-office E/M service.
If you’re reporting services your physician provides over the phone, but you’re not getting paid, the reason might be one of two things — you’re not following the coding rules surrounding the codes or your payer just isn’t paying for those services. Check out these […]

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