Provider News

Physician Fee Schedule Update: An Extension for the Temporary Conversion Fix?

Fear not: The CF may stay until autumn, but the current snow storm is delaying the official word. Practices that were looking for a permanent change to the sustainable growth rate (SGR) formula before March 1 may come up empty-handed. However, Congress appears to be planning to offer an extension of the pay cuts that you’re [...] Related articles:

  1. Proposed 2010 Physician Fee Schedule: A Closer Look21.5 percent cut looms for your services Last week, Coding...
  2. SGR Update: What’s Up With That 21 Percent Physician Pay Cut? Here’s what you should be watching on Capitol Hill....
  3. CMS Issues Corrections to 2009 Physician Fee Schedule Final RuleIt’s that time of year again — time to get...

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February 17, 2010
Coding Challenge

Neurosurgery Coding: Previous Injury Means Multiple Dx Options

Find out what additional information V codes provide to the payer. Question: We have a patient with previous spinal injury that is now causing neck pain. How should I code the diagnosis? North Carolina Subscriber Answer: Document and code prior conditions that contribute to a patient’s current complaint — if they affect the management of the current condition. Prior trauma, [...] Related articles:

  1. ICD-9 2010: More Coding Options for Brain Injury Check out V80.01 and V80.09 for special screenings. The...
  2. Dx Coding Moves That Stop Denials for Chronic Pain ClaimsTip: Code prior conditions in these cases. Imagine your pain...
  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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February 15, 2010
BCBS / Hot Coding Topics / Musculoskeletal

Use This Podiatry Scenario to Perfect Your Emerging Technology Claims

Hint: If you try to use an unlisted code, be sure your OP notes include this information. If you don’t know the ins-and-outs of coding cutting edge procedures, you risk getting left in the dust as medicine continues to evolve. A new techniques, however, doesn’t always mean a new, corresponding CPT code. Check out this podiatry [...] Related articles:

  1. Podiatry Coding Clinic: G0245 and G0246Here’s when you may need to get an ABN Medicare...
  2. Podiatry Coding Education: 28293 For Joint Replacement for Hallux LimitusQuestion: Our podiatrist performed a joint replacement for hallux limitus and...
  3. Finger Modifiers Give You a Grip on Hand Surgery Claims Get a Handle On Hand Surgery Claims By Fixating...

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February 15, 2010
Coder's Cranium / surgery

Factor Location and Depth into Foreign-Body Removals

Explore these three “what if” scenarios to perfect your FBR claims. Your foreign-body removal (FBR) coding can vary greatly depending on the type of foreign body, its anatomic location, and the depth from which the physician must remove it. Here are three case studies to help you find your way. Case 1: No Incision Means No Separate [...] Related articles:

  1. Coding Challenge: Foot Foreign Body Removal Vs. Soft-Tissue FBRQuestion: Our physician performed a foreign-body removal (FBR) on a...
  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. Burn Coding: Calculate Total Body Surface Area (TBSA)Investigate your physician’s documentation to determine the body area percentage...

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February 15, 2010
Hot Coding Topics / modifier GV / modifier GW

Avoid Hospice Coding Headaches With Modifiers GV and GW

Differentiating between GV and GW is your first step. If your urologist sees and treats hospice patients, you probably feel like you have to jump through hoops to get paid. The key to bringing in every hospice-related dollar your urologist deserves is ensuring you append the right modifier. Base Modifier GV or GW Choice on Diagnosis When reporting [...] Related articles:

  1. Understand and Avoid Costly Mistakes for Modifiers 51, 52, 53, 58, 59, 25, 78 and 22It’s important to understand modifier usage to avoid costly mistakes....
  2. Ophthalmology Coding: GDX, VF, & Temp Plugs — How Many Modifiers?Question: A patient came in for a GDX and visual...
  3. 4 Coding Rules for Multi-Provider ModifiersCheck the work, not dictation, to prevent 42% or more...

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February 11, 2010
Coding Challenge / Oncology

Oncology Coding: Day 1 of FOLFOX4 Regimen

Here’s the key to concurrent infusion coding. Question: What are the appropriate codes for the first day of the FOLFOX4 regimen? Answer: You should base your final coding decision on the documentation and the exact services your practice provides. But as a starting point, the FOLFOX4 regimen typically involves the patient receiving Oxaliplatin and folinic acid concurrently [...] Related articles:

  1. Oncology Coding Challenge: When Infusion Runs Long Question: The oncologist ordered a 90-minute chemotherapy infusion service,...
  2. Infusion Coding Education: Remicade Coding Hint: Watch for ‘add-ons’ during Remicade sessions Question:...
  3. Do I Use a Chemo Code for Zevalin Therapy?Question: When I looked up Zevalin, I found out it’s...

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February 11, 2010
CPT / ICD-9 / modifier 22 / modifier 52 / modifier 59 / Modifiers / surgery / Toolkit

8 Simple Steps Organize Your Op Note Coding

This aspect of op note coding is the “horse that pulls the cart.” Stuck on how to tackle this op note or those sitting on your desk? Follow this advice, provided by Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M. and co-presenter of the “Ob-Gyn Op Notes” session at the [...] Related articles:

  1. 3 Steps Take the Guesswork Out of Coding Vaginal Cuff Repairs Find out what colporrhaphy code you’ll use for an...
  2. Write an Appeals Letter That Works In 6 Simple Steps Transform the written word into reimbursement with these tips...
  3. Op Note Coding Clinic: Breast Reconstruction with AlloDermSurgeons now commonly use AlloDerm in a variety of surgeries,...

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February 11, 2010
Coding Challenge / modifier 22

Surgical Coding: Capture Extra Work for Choledochal Cyst

Discover these subsequent reconstruction codes. Question: The surgeon treated a patient with a large choledochal cyst. The procedure involved an open cholecystectomy with en bloc excision of extrahepatic bile ducts (roux-en-Y reconstruction) with hepaticojejunostomy. What are the correct CPT and ICD-9 codes? Answer: The correct ICD-9 code will depend on whether the patient has an acquired [...] Related articles:

  1. Quick Start Guide to Benign Ovarian Cyst Dx CodingTip: An endometrial cyst is also known as a chocolate...
  2. Coding Ovarian Cyst Removal: Are You Making These 4 Mistakes?Here’s how you could potentially add $184 to your bottom...
  3. Surgical Coding: Scar Revision on Previous Mastectomy SiteTip: Find mastectomy scar revision in wound repair Question: Our...

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February 9, 2010
CMS / E/M / MAC / Provider News

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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February 9, 2010
CPT / Hot Coding Topics / Medicare

Critical Care Coding FAQ: Become a Master of Time

Beware: CPT, CMS differ on ‘family discussion’ parameters. When the physician treats a patient with a critical illness or injury, you need to know when to start and stop the critical care clock in order to avoid miscoding. Check out this FAQ to find out what’s part of critical care, what’s not, and how to correctly [...] Related articles:

  1. Maximize 99291 Coding with This Critical Care FAQ Physician ‘preventing further deterioration’ keys valid critical care claims....
  2. Critical Care Coding Checklist Certain patient conditions could indicate 99291 service. Given the...
  3. Bust 4 Myths About Pediatric Critical Care Services MYTHBUSTER: Codes 99291, +99292 apply to infants, young pediatric...

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February 8, 2010
Hot Coding Topics

Collections: Banish Co-pay, A/R Problems

5 tips help you recover deserved pay. Collecting money from patients, especially during a recession, can be challenging. If your front desk is responsible for collecting copays and sometimes old balances, its success or failure has a dramatic impact on the practice’s bottom line. Check out five ways you can improve your front desk collection efforts: 1. When [...] Related articles:

  1. Medical Billers: Test Your Collections Know-How Here This nifty tool tells you if collections cluelessness is...
  2. Time Your Surgical Collections Right by Referencing Payer Contracts Find out if you’re legal in collecting patient portion...
  3. Overcome ‘Forgot the Checkbook’ Excuses With This Checklist   When you get the old “I forgot my...

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February 7, 2010
Coding Challenge / E/M / modifier 25

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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February 7, 2010
Medicare / Oncology / Provider News

Oncology Coding: Update Your PET Claims With This New Guidance

Here are the requirements the exam must meet, according to Medicare. If your PET claim meets certain requirements, you don’t need to append modifier Q0 (Investigational clinical service provided in a clinical research study that is in an approved clinical research study), according to MLN Matters article MM6753. Effective for dates of service on or after Nov. [...] Related articles:

  1. Which PET Code Is Best for Brain Images? Question: Which CPT code is appropriate for PET performed...
  2. Oncology Coding 2010 Update: 3 New Lab Services CodesWatch for your chance to replace 86316 with more specific...
  3. ICD-9 Update: Take Your Oncology Coding Specificity Up a Notch With 7 2010 Changes Tumor lysis syndrome is getting its own code —...

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February 7, 2010
Coding Challenge

Why Is the Co-Pay I Collected Short By $20?

Verify co-pay early to save time, money Question: A patient came to our office for a routine exam with the same insurance card she’s had for years. We charged her the standard copay of record. Then I found out her employer changed the terms of the insurance, so the copay she paid was short by $20. [...] Related articles:

  1. Your New Patient Packet ToolkitHow to use technology to speed up new patient check-in....
  2. Medical Office Billing: Benefits Verification, Copayment and Consolidated BillingIs Lack of Verification Costing Your Practice? Stop the Bleeding...
  3. Front Desk Data Tracking ChecklistClean data means more than just a healthy bottom line....

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February 6, 2010
Hot Coding Topics / modifier 25

Newborn Status Change Means Deciding Between Hospital Care Codes

Sort your normal, sick and intensive care options. Choosing the appropriate codes for initial newborn services can be difficult due to the large number of available codes and gray areas between the spectrum of illnesses. If you find yourself getting tripped up by the multiple categories, read on for expert tips and real-world examples that [...] Related articles:

  1. Must Hospital Admit Codes and Admission Show Same DOS? Overlook this rule, and risk leaving rightful E/M dollars on...
  2. Give Your Newborn Coding Skills a Checkup This directive stops the sending physician from committing an...
  3. Answers To Your Hospital Admission, Subsequent Care Coding Questions Revenue Booster: Here’s when you can claim a consult...

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February 4, 2010
CMS / Provider News

AMA Chimes In On How to Report Consults for Non-Medicare Patients

Beware: Don’t use the CMS consult crosswalk for billing purposes. You may be seeing light at the end of the tunnel. The AMA just published an article to clarify the use of the consultation codes for non-Medicare patients, and talks about their efforts to get CMS to delay their new policy. You can find the article [...] Related articles:

  1. CMS Will Offer New Modifier to Denote Admitting Physician on ClaimsPop the champagne cork & get ready for brand new...
  2. CMS’s Refusal to Pay Consults Makes MSP Claims a HeadacheIf you bill consults to private payers, good luck collecting...
  3. Proposed 2010 MPFS: $26 More for ‘Welcome to Medicare’ ExamCMS welcomed health care providers to an July 9 open...

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February 4, 2010