CCI / Coder's Cranium / modifier 59

Cataract Surgery Coding Skill Builder

Determine ‘planned or unplanned’ before separately coding vitrectomy. With several possible surgical treatments for cataract procedures, which you probably code more often than any other surgery, there’s a lot of room for error – with over $890 at stake for complex cataract procedures in 2009. Use these tricky scenarios as a guide through some of the most [...] Related articles:

  1. Ophthalmology Coding: See Your Way to Clear Reimbursement for Eye Exams and Cataract SurgeryChoose the Right E/M or Eye Code to Optimize Reimbursement...
  2. Cataract Surgery Coding: When Optometrist Provides Postop CareWe’ve got the modifier you need when the ophthalmic surgeon...
  3. Optometry Coding: Eye Exams, Cataract Surgery and Co-ManagementE/M or Eye Code? Choose Wisely With These Documentation Tips...

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January 19, 2010
CCI / Hot Coding Topics / pathology

Pathology Billing: Calculate How MUE/CCI Restricts Your Outside Consult Pay

Don’t bank on accepted 88321-88323 unit of service. Your pathologist consults with an outside lab on slides taken from a 2006 lumpectomy and a 2009 lymph node fine needle aspiration (FNA). That’s 88321 x 2 — right? Maybe. Your payer determines the answer to that question. The problem: “Although the American Medical Association (AMA) says the unit of service for [...] Related articles:

  1. 5 Rules Pinpoint Date of Service for Laboratory ClaimsTip 3: Here’s DOS advice for archived samples. You can’t...
  2. Match Pathology Report Keywords to Uterus Codes Common descriptions and diagnoses lead the way. Never again...
  3. Zero In On Correct Nasal-Specimen Coding With This Quick Quiz Missing multiple 88304 specimens could cost your practice $125....

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January 17, 2010
Anesthesia / Coding Challenge

Anesthesia Coding Education: Combined Spinal Epidural

Question: Our anesthesiologists sometimes mark our C-section tickets as “combined spinal epidural,” but our billing system will only allow us to choose epidural or spinal. Where can I find information about spinal epidurals and how to correctly code them? Answer: From a coding perspective, whether your physician used spinal or epidural anesthesia doesn’t matter as long [...] Related articles:

  1. How Do I Code an Epidural Blood Patch on Same Day as L&DDon’t forget to double-check these 2 things to find the...
  2. Anesthesia Coding Education: Sciatic Nerve Block & Same-Day General AnesthesiaQuestion: My anesthesiologist performed a sciatic nerve block for a...
  3. Bust These Delivery Coding Myths to Streamline Your Ob Claims Warning: Ordering twin delivery codes incorrectly could cost you....

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January 17, 2010
Coding Challenge / modifier 25

Winter Laceration Repair: How Do I Code For Dermabond?

Warning: Your coding will vary depending on who’s getting the claim Question: A 60-year-old patient reports to the ED with a bandaged left hand. The patient says she was cleaning out the blades of her snow blower and cut her left index finger; the wound is wrapped in gauze, but it is reddening with blood. During [...] Related articles:

  1. Simple Laceration Repair Code or E/M Code? Answer Could Cost Hundreds Not recognizing a laceration repair that’s included in an...
  2. Coding Challenge: Dermabond for Laceration Repairs Question: The dermatologist treated an established patient with a...
  3. Does Dermabond Warrant Special Code? Question: A pediatrician uses Dermabond to close a patient’s...

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January 16, 2010
Toolkit

Checklist: Collect Surgical Deductibles Up Front to Improve A/R

This 3-step checklist will boost your bottom line. With fewer patients following through on procedures because of economic and financial struggles, and an increasing number of patients not paying their bills, your practice needs to find ways to improve your A/R and bring in deserved money. Adapting an up-front deductible collection policy is one proven way [...] Related articles:

  1. Front Desk Data Tracking ChecklistClean data means more than just a healthy bottom line....
  2. Medical Billers: Test Your Collections Know-How Here This nifty tool tells you if collections cluelessness is...
  3. Time Your Surgical Collections Right by Referencing Payer Contracts Find out if you’re legal in collecting patient portion...

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January 16, 2010
Coding Challenge / modifier 25

10060 Won’t Wash for Some I&Ds

Careful: A pilonidal cyst I&D is a separate animal. Question: A patient presents to the ED reporting pain in her spine. During the exam portion of a level-three E/M, the physician discovers that the painful area is red, and slightly warm to the touch. The patient also has a low-grade fever that she says she noticed about [...] Related articles:

  1. Winter Laceration Repair: How Do I Code For Dermabond?Warning: Your coding will vary depending on who’s getting the...
  2. Know What Separates FBR From E/M or Lose $80 in Pay Here’s why ‘incision’ with non-scalpel instrument could be an...
  3. Wound Closure Coding: Make the Simple, Intermediate DistinctionAccounting for depth is a tricky task when coding closure....

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January 14, 2010
Hot Coding Topics / radiology

Radiology Coding: CPT 2010 Breathes New Life Into Your Respiratory Coding

Master 32561’s guidelines to prevent a major units gaffe. Flip through the Surgery/Respiratory System section of your CPT 2010 manual, and you’ll see the coding committee has been hard at work adding to and revising your options. Discover the added cath removal code, the all new fibrinolytic agent instillation code, and the reshaped bronchoscopy descriptors, so [...] Related articles:

  1. CCI 15.0 Update for Radiology Coders 76942 and 78808 on a single claim needs a...
  2. Capture Separate CV Access Radiological GuidanceDon’t miss out on $20 per procedure when your surgeon...
  3. Multiple Bronchoscopy Coding Crash Course Head off denials & ratchet up reimbursement with these...

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January 14, 2010
ICD-9 / Toolkit

ICD-9 Sequencing: Ace Late Effects Diagnosis Coding With This Flow Chart

Combination codes for stroke late effects won’t always cover all the details. Proper sequencing is essential when coding for late effects, so use this handy chart to sequence your codes correctly every time. Chart provided by Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates and CoDR — Coding Done Right in Denton, Texas. For easy [...] Related articles:

  1. Flow Chart: Tame the Diabetes Diagnosis Coding Beast When coding for diabetes (250.xx), the fourth and fifth...
  2. Our Flow Chart Does the Incident-To Decision Making for YouSuppose your nonphysician practitioner sees a patient on a day...
  3. Flow Chart: Select the Correct Pediatric Critical Care CodeThis flow chart solves location, transport, age dilemmas to land...

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January 13, 2010
Medicaid / Provider News

Payer Update: UHC Sticks With Consult Codes

Check with Medicaid plans, insurer warns. You can breathe a sigh of relief — one major payer will stick with 99241-99255. UnitedHealthcare (UHC) commercial plans will make no change in payment for consultation codes (99241-99255) at this time, according to a UHC e-mail alert. “Physicians may continue to submit claims for these services, and will be reimbursed according to United-Healthcare payment policies”. Beware: One Medicaid [...] Related articles:

  1. Medicare’s Consult Rule Trickle Down Effect And what it means for pediatric practices. A report...
  2. Payer Update: NGS Directives Vs. Proper Skin Lesion CodingIgnore the LCD and stick with what you know about...
  3. Pssssssst. Payer Report Cards Are OutIf you know your payers’ strengths and weaknesses, you’re better...

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January 12, 2010
Hot Coding Topics

CMS’s Refusal to Pay Consults Makes MSP Claims a Headache

If you bill consults to private payers, good luck collecting the balance from Medicare secondary payers. Don’t even think about billing a consult to Medicare — even if it’s only a secondary payer claim. Medicare may have scratched consultations off of its list of payable services, but many other insurers did not follow suit. This leaves you in [...] Related articles:

  1. CMS Will Offer New Modifier to Denote Admitting Physician on ClaimsPop the champagne cork & get ready for brand new...
  2. Consultation 5 R’s Miss 1 element, and invite auditors to check out...
  3. VaVaVoom: V-Codes Give Your Claims a Smoother RideSo what’s the deal, exactly, with V codes? Here are...

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January 12, 2010
Coding Challenge / E/M / modifier 24

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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January 11, 2010
CCI / Coding Challenge

Radiology Coding Challenge: Why is Medicare Denying a 38792, 78195 Claim

Tip: Discover true meaning of 38792 note Question: The physician performed a sentinel node injection with lymphoscintigraphy. A note with 38792 states to report 78195 for imaging. So why did Medicare deny a claim that included both codes? Answer: You should report 78195 (Lymphatic and lymph nodes imaging) for this service and leave 38792 (Injection procedure; for [...] Related articles:

  1. CCI 15.0 Update for Radiology Coders 76942 and 78808 on a single claim needs a...
  2. Radiology Coding Challenge: Total Spine MRI Without Contrast Question: Which CPT code should I use for a...
  3. Radiology Coding Challenge: Rate Your Reformatting SkillsQuestion: My radiology report documents axial CT slices from the...

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January 10, 2010
Hot Coding Topics

PQRI 2010: Tips That Boost Your Practice’s Revenue

Follow our links and advice to put more plusses in your claims column Back again for 2010 is Medicare’s incentive-driven physician quality reporting initiative (PQRI), aimed at tracking quality metric or patient care services that physicians provide. When the practice treats enough patients in the same category, some PQRI dollars might be only a few codes [...] Related articles:

  1. Smokin’ PQRI Pointers We’ve got the G codes you need to score...
  2. PQRI: No Coumadin Due to Fall RiskPlus, experts at the AMA meeting in Chicago tell you...
  3. Accurate Diabetes ICD-9 Coding = PQRI BonusInternal medicine providers interested in a year-end bonus from Medicare...

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January 9, 2010
Toolkit

Keep All the Urodynamics Codes Straight With This Handy Cheat Sheet

Knowing the differences between the tests is your key to proper code choice. When your urologist says he performed urodynamics tests, you need to dig deeper into his documentation for clues about which code to report. Tack this overview up by your computer to help you quickly choose the right code every time. • In a simple [...] Related articles:

  1. Urology CPT 2010: 3 New Codes, 2 Deletions Change Your Urodynamics CodingUrodynamics income will go down by half, experts calculate. You will...
  2. CPT 2010 Update: Urogynecology CodingRemember, supervision requirements still apply to new codes. CPT 2010...
  3. Urology Coding: TURP, Urodynamics and Stone RemovalTURP 101: Use This Comprehensive Guide to Master TURP Coding...

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January 8, 2010
HCPCS / Oncology / Toolkit

Oncology Billing Toolkit: Factor 8 HCPCS Changes Into Your Superbill

Watch those Taxotere units, or kiss 95 percent of your reimbursement goodbye. A brand new list of HCPCS codes — including docetaxel and bevacizumab updates — goes into effect Jan. 1 and our 8-step superbill maintenance plan will stop denials in their tracks for 2010. Not using the proper codes will lead to claim rejection, which means “not receiving the proper [...] Related articles:

  1. 2 New HCPCS Codes for H1N1 Vaccine AdministrationPlus: New Bevacizumab code is effective Oct. 1. If you’re...
  2. Check New HCPCS Codes to Keep Pain Management Claims on TrackCatch the changes to botulinum toxin and neurostimulator electrode codes....
  3. Which HCPCS Code Should I Use for Eovist MRI contrast? Question: Which HCPCS code should I use to report...

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January 7, 2010
Audit / Hot Coding Topics / MAC / modifier 58 / modifier 78 / modifier 79

Global Billing: Document ‘Unrelated’ for Modifier 79 Services

MACs are looking for ‘red flags’ to halt additional global period pay Billing for additional services during a global surgery period is always tricky, but now you can expect special scrutiny for modifier 79 claims. After the OIG got wind of fraudulent surgery billing with modifier 79 (Unrelated procedure or service by the same physician during the postoperative period), CMS contractors have been on the hunt [...] Related articles:

  1. These 8 Services Are Not Part Of The Global Surgical PackageIf you’re not reporting these services separately, you’re losing money....
  2. Modifier Cheat Sheet: Banish Your E/M Modifier Phobias ForeverOnce you have this tool, you’ll never again wonder which...
  3. Bone Up On ASC Orthopedic Coding With These Global Period, Modifier Tips 3 ways your physician claim better look different than...

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January 7, 2010