Provider News

Big Insurers Underspend On Medical Care, Senate Probe Finds

Which big health insurance company did lawmakers single out? Is it the one that gives you the most denials trouble? A US Senate probe confirms what many coders and billers have been suspecting all along — that six major medical insurers aren’t spending as much as they should providing actual health care. Insurance industry officials say that [...] Related articles:

  1. Insurers Offer to Charge Sick People Less …… and healthy people more. In an unexpected move last...
  2. $12,910 More Per Year For Health Insurance?Imagine a world where insured patients pay DOUBLE the health...
  3. Stimulus Package Crash Course for Health Care ProvidersIf your head is swimming trying to figure out what...

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November 3, 2009
Coding Challenge / radiology

Radiology Coding Education: Is 76705 OK for Back?

Question: For a lower back ultrasound of a soft tissue mass, which CPT code is appropriate? Answer: Code 76705 (Ultrasound, abdominal, real time with image documentation; limited [e.g., single organ, quadrant, follow-up]) is appropriate for this lower back ultrasound. Although the code descriptor states “abdominal” and not “back,” CPT Assistant (May 2009) clarifies that 76705 is appropriate [...] Related articles:

  1. New From CPT Assistant: Help with Trunk Ultrasound Coding Do you know exactly what’s in the mediastinum? Your US...
  2. Double Ultrasound Codes Spell Double Trouble With AuditorsAuthorities scrutinize medical necessity for 76830 & 76856. The OIG...
  3. 5 Lessons Radiology Coders Should Learn From CCI 15.3Wonder if there’s a method to the 76001 madness? Here’s...

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November 2, 2009
Coder's Cranium

Nonphysician Providers & Incident To Checklist

Check state laws PLUS this crucial document. In last week’s Coder’s Cranium, we started a checklist of 3 things you should know to correctly bill for a nonphysician practitioner’s services — and stay compliant. This week, we complete the checklist with advice for items 4, 5 & 6. 4. Have You Distinguished Auxiliary Personnel From NPP Services? NPPs can [...] Related articles:

  1. Nonphysician Providers and Incident-To: Your Coding Questions AnsweredHere’s why you should keep your physicians’ work schedules on...
  2. Use This Incident-To Checklist to Breathe Easy During an Audit You don’t need to second-guess the way you bill...
  3. Steer Your Incident-To Coding Using These 4 Questions 100 percent pay possible if NPP follows internist’s care...

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November 1, 2009
Hot Coding Topics

Neurosugery Coding: 3 Easy Steps Distinguish Between 61790 & 61791

Anatomy know-how points you in the right direction every time. How do you tell the difference between 61790 (Creation of lesion by stereotactic method, percutaneous, by neurolytic agent [e.g., alcohol, thermal, electrical, radiofrequency]; gasserian ganglion) and 61791 (… trigeminal medullary tract)? That’s the question a Neurosurgery Coding Alert reader posed when she wrote, “What is the difference [...] Related articles:

  1. Add $36 to This Excision Claim in 3 StepsPatience is a virtue, particularly when it comes to coding...
  2. 5 Lessons Radiology Coders Should Learn From CCI 15.3Wonder if there’s a method to the 76001 madness? Here’s...
  3. Skull Biopsy, No Burr Hole: 61500 or 61563?Question: Our surgeon biopsied a lesion from the skull, but...

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November 1, 2009
Coding Challenge / E/M / modifier 25

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 [...] Related articles:

  1. Ophthalmology Coding: RT/LT or Modifier 50? Prevent Uni-Bi Reporting Errors With This Expert Insight Don’t...
  2. CIGNA Opens Black Box: Get Paid With Modifiers 25 & 59 You now have clear-cut policies to apply, including 1...
  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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October 31, 2009
Anesthesia / Hot Coding Topics / ICD-10 / Pain Management

Pain Management Coding Update: Facet Joint Injection CPT Changes for 2010

Pain management, anesthesia, orthopedic, physiatry & neurology coders get ready for a facet joint codes shift that preps for ICD-10. The 2010 version of CPT attempts to organize the facet joint injection codes by deleting 64470-64476 and debuting 64490- 64495 in their place, as follows: • 64490 — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves [...] Related articles:

  1. MAC Auditors Will Stick It To Facet Joint Injection Claims We hook you up with CMS instructions for when...
  2. Audit Hot Spot: Facet Joint Injection ClaimsHere’s why the OIG wants to stick it to facet...
  3. Save Time Coding Facet Injections With This Coding Tool Hint: Location, number and substance are key. Several factors...

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October 28, 2009
Coding Challenge / E/M

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 [...] Related articles:

  1. Must Hospital Admit Codes and Admission Show Same DOS? Overlook this rule, and risk leaving rightful E/M dollars on...
  2. Answers To Your Hospital Admission, Subsequent Care Coding Questions Revenue Booster: Here’s when you can claim a consult...
  3. Capture ‘Patient Limbo’ Period With These Observation Coding Steps Internist deciding on admission? That’s your signal to look...

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October 28, 2009
Toolkit

Your New Patient Packet Toolkit

How to use technology to speed up new patient check-in. Not enough hours in the day? Are you always looking for ways to save time? Many medical offices report that sending out new patient packets in advance of the patient’s visit greatly reduces the number of incidents at patient check-in and saves time. “Normally, it would take [...] Related articles:

  1. Front Desk Data Tracking ChecklistClean data means more than just a healthy bottom line....
  2. Dependent-Child Billing & the Birthday Rule Our easy key tells you when the birthday rule...
  3. Checklist Gets You Clean Claims Boost accuracy and payup. Has your office ever received...

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October 28, 2009
Tips

Get a Free Medical Coding Practice Exam

http://www.medicalcodingpro.com Medical Coding Pro is the coders destination for information. Get a Free Medical Coding Certification Practice Exam. Go to our website and click on the scroll bar to enter your information!

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October 27, 2009
Coding Challenge

Closed Treatment of Hip Dislocation – Codes 27250 – 27252

http://www.medicalcodingpro.com/join-us-elite-group.html Medical Coding Pro - Coders Destination for Information. Get a Free 7 Day Trial to Medical Coding Pro's Membership Site with over 300+ coding video's just like this one!

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October 27, 2009
Coding Challenge

Closed Treatment of Fracture Great Toe – Codes 28490

http://www.medicalcodingpro.com/join-us-elite-group.html Medical Coding Pro - Coders Destination for Information. Get a Free 7 Day Trial to Medical Coding Pro's Membership Site with over 300+ coding video's just like this one!

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October 27, 2009
CPT / Hot Coding Topics

New CPT Codes for Cardiac CT, Imaging Appear for 2010

Plus: Say goodbye to two perfusion codes. If you’ve ever wondered whether Medicare actually pays attention to CPT’s Category III codes, the AMA offers an answer with the release of the new codes included in CPT 2010. First and foremost, CPT will delete the Category III cardiac computed tomography (CT) imaging codes 0144T-0151T and replace them with [...] Related articles:

  1. Cardiac Anesthesia Workshop: Coding for TEE Discover if your transesophageal echocardiography (TEE) anesthesia is payable...
  2. 2010 CPT Category II & III Codes You Might Miss Yes, our CPT books are fountains of knowledge, but...
  3. Break Down Outpatient ESRD Into These G-Code Mirroring Cat I Codes We tell you the inpatient dialysis codes that trigger...

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October 27, 2009
CPT / modifier 22 / Provider News

Surgical Coding Update: 21930, 21931 & More Debut for CPT 2010

Tumor excision codes get specific. Will surgical oncology practices take a reimbursement hit? We’re starting to learn what new CPT codes we’ll be using come January 1, 2010. Coding News will keep you posted over the coming weeks, along with analysis from coding experts around the country so that you know what to expect for your practice’s [...] Related articles:

  1. Pain Management Coding Update: Facet Joint Injection CPT Changes for 2010Pain management, anesthesia, orthopedic, physiatry & neurology coders get ready...
  2. 141 New ICD-9 Codes Debut for 2010 Like a passel of fresh-faced debutantes, the new ICD-9...
  3. Surgical Coding: Modifiers 58, 78, and 79SURGICAL MODIFIER CHOICES Surgery Modifier Choices are Key to Surgery...

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October 27, 2009
Coding Challenge

Does CNS Count as NP for Time-Based Coding?

CNS = NP = PA for CPT, but Check State Law Question: Does a certified nurse specialist (CNS) count as a nurse practitioner (NP) for reporting 99213 based on time? Answer: Yes, for CPT purposes, a certified nurse specialist billing under his own provider number counts the same as a nurse practitioner or physician assistant. So if [...] Related articles:

  1. Asthma Attack Coding: When To Use Prolonged or High-Level E/M     Checklist deters payback requests for insufficient +99354...
  2. E/M Coding Basics: MDM Maximizes Payup for Hepatitis Diagnosis4 ways to get what your practice really deserves for...
  3. Mid-Level E/M Coding BreakdownOur chart shows you how to choose among 99212, 99213 &...

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October 26, 2009