Tag Archives | Choices

3 Steps to Keep Discontinued Procedure Claims Moving

You often turn to modifier 53 (discontinued procedure) when your anesthesiologist or the surgeon sees some risk that could threaten the patient’s health if the procedure continues.   However, Payers do recoil when it comes to reimbursing these claims.  Here are three easy steps by the experts to help you to get on the right track for reimbursement.

1) Conquer Electronic Filing Challenges

Gone are the days when you were told to submit paper claims reporting modifier 53 so you can append a written explanation with the claim.  With HIPAA and electronic standards, you can do the billing electronically.  Once you have billed electronically with modifier 53, the payer might request more information.  Thus the note should contain all the information the carrier needs.  For failed procedure, the record should state the reasons for the failure.  If your physician discontinued the procedure due to the patient’s condition, the record should detail what factors prevented the procedure from going forward.

2) Verify the Timing of Cancellation

Knowing exactly when the case was canceled in terms of the physician’s work will help guide your code choices.  If the physician cancels the procedure after induction, the case technically became a surgical procedure.  Determine the correct surgical code, such as 45380 for a colonoscopy with biopsy.  Then cross to the correct anesthesia code, such as 00810.  If the cancelled procedure took place in an outpatient hospital or ambulatory surgical center, some payers require modifier 73 or modifier 74.  In those situations, append modifier 73 or 74 to the anesthesia code instead of modifier 53 as modifiers 73 and 74 are specifically for outpatient hospital use.

3) Include the Correct Diagnosis

Indicate the reason for cancellation by reporting the appropriate diagnosis code or codes.   For a patient who experiences syncope while still in the…

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ICD-10: Here’s How To Report Hiatal Hernia In 2013

When ICD-9 becomes ICD-10 in 2013, you’ll need to get familiar with different sections in the new diagnosis code system, even if the condition you’re reporting has a simple one-to-one crosswalk.
When your surgeon performs a hiatal hernia repair, yo…

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Modifier 58, 78, 79 Tips to Get Postop Surgery Paid Correctly

Don’t miss out on extra pay when global period resets.

Just because you routinely append modifiers to your claims doesn’t mean you’re filing correctly and getting the most appropriate pay. Brush up on your modifier know-how with these tips for three of the trickiest choices: modifiers 58, 78, and 79.

Selecting between these modifiers can be carrier-specific in some situations, says Jacqui Jones, office manager for Benjamin F. Balme, MD, PC in Klamath Falls, Ore.

Remember All Possible Uses for 58

The descriptor for modifier 58 seems self-explanatory: Staged or related procedure by the same physician during the postoperative period. Coders sometimes trip, however, when they forget that modifier 58 actually applies to subsequent procedures that fall into one of three categories:

Planned or anticipated (staged):  A good example might be an infected hand that has to be debrided several times over the course of a couple of weeks. You won’t use a modifier on the first procedure, but will add modifier 58 on the subsequent procedures.

More extensive than the original procedure: The physician manipulates a patient’s ulnar fracture. An x-ray at the follow-up appointment shows that the reduction failed, so the physician completes pinning or an open reduction with internal fixation (ORIF). Code the procedure as needed (with 25545, Open treatment of ulnar shaft fracture, includes internal fixation, when performed, for example) and append modifier 58.

Therapy or treatment following a surgical or diagnostic procedure: This could apply to a soft tissue biopsy followed at a later date by malignant tumor excision.

You’ll only append modifier 58 to the second procedure if it occurs during the first procedure’s global period. The date of the second procedure resets the global period. You should expect 100 percent reimbursement for procedures you file with modifier 58.

Verify ‘Surprise’ Before Reporting 78

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ICD-9 2011: 799.51 Answers Your PreADD Diagnosis Dilemma

Pediatric and family practice coders are all too familiar with ADD-like complaints minus a definitive diagnosis. ICD-9 2011 holds the key to alternative options until further testing is complete.
ICD-9 2011 adds the 799.5x family to the “Ill Defined …

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Diagnosis Coding: Here’s How To Decode Your Physician’s Notes

If the doctor does not circle a diagnosis, it may be up to you to find one.

Don’t let an incomplete superbill damage your chances of submitting an accurate claim. If the doctor in your office fails to indicate the ICD-9 code for the condition that he treated, you should read through his documentation to find which diagnoses you should report.

Open the Notes When You Have to — and Even When You Don’t

Suppose your physician hands you a superbill with the procedures circled and the diagnosis left blank.

You could ask the physician which diagnosis to report, or you could examine the documentation yourself. If your office has a policy that includes “coding by abstraction” by certified/qualified coders, then submitting charges based on what is supported (documented) in the note is appropriate, says Barbara J. Cobuzzi, MBA, CPC, CPCH,CPC-P, CENTC, CHCC, with CRN Healthcare Solutions in Tinton Falls, N.J. The physician should be signing off on these charges as part of your internal policy.

Some practices choose to review the documentation and compare it against any diagnoses recorded on the superbill, even when they aren’t required to. This ensures that the documentation matches the code selection every time.

When in Doubt, Confirm With the Physician

If you are new at coding diagnoses from the physician’s notes, you should doublecheck your code selections with the practitioners before submitting your claims.

“Until a coder feels comfortable with the ICD-9 books and the codes used more often in their office, it’s a good idea to run the choices by a clinician,” says Suzan Berman, CPC, CEMC, CEDC, senior manager of coding and compliance with the Physician Services Division of UPMC in Pittsburgh. “You never want to give a patient a disease or symptom they don’t have  ” or one more…

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Hodgkin’s Coding: Simplify ABVD Regimen Coding, Easy as 1-2-3

Keep this job aid nearby to keep your Hodgkin’s coding in the clear.

Speed your coding for ABVD chemotherapy coding with this handy summary of the codes most likely to appear on your claim.

But remember: Base your final code…

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Surgical Coding: Scar Revision on Previous Mastectomy Site

Tip: Find mastectomy scar revision in wound repair
Question: Our surgeon performed a scar revision on the site of a previous mastectomy. The procedure involved excising a 16.5 cm curved scar before performing a layered closure. How should we code this?
Answer: You should use complex wound repair codes for the scar revision procedure that you describe. [...]

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