Here’s what you need to explain in your cover letter....
Even though Medicare no longer accepts consult codes, you can still apply modifier 57.
Question: In our ob-gyn office, we used to apply modifier 57 to inpatient consult codes. Now that Medicare doesn’t accept consult codes, how should we use...
If your radiologist performs adjustments during the bariatric surgery’s global period, do this.
Question: Our radiologists perform percutaneous LAP-BAND adjustments. We report S2083 for the service and 77002 for the fluoroscopy. Is this the correct fluoroscopy code?
Connecticut Subscriber
Answer:...
Did you factor in a foreign body removal code?
Question: During an open hernia repair for a reducible umbilical hernia, the surgeon finds a sizeable gallstone embedded in the omentum extending into the preperitoneal fat. The surgeon excises the...
Don’t code a closed fracture treatment code without more information.
Question: Our orthopedist saw a patient in the emergency department for a gunshot wound and diagnosed a metacarpal fracture. He irrigated the site and removed a foreign body. Can we...
Question: Our hospital billing and medical departments say that diagnoses we add to a claim for reimbursement must have a physician endorsement. We’ve researched our Local Coverage Determination (L26884) from National Government Services, the Ingenix Coding & Payment Guide for...
Tip: Bill for the exact units given per patient.
Question: My neurologist scheduled two patients back-to-back for botulinum type B injections. But he didn’t use all of the Botox and we disposed of it. Do I need to report the...
Decipher what column 1/column 2 means in this neurosurgery bundle example.
Question: Would you explain what the differences are between mutually exclusive and “column 1/column 2″ edits that come from the Correct Coding Initiative (CCI)?
Florida Subscriber
Answer: Mutually exclusive...
Find out what incident-to requirements you have to meet.
Question: Is there any circumstance in which a group can bill all services and all providers (including other physicians) under just the head doctor? I know we can bill NPP...
Examine Medicare’s coverage guidelines.
Question: My ob-gyn sees a patient who has breast implants or breast augmentation and orders a mammogram. Should I count the mammography as a screening or a diagnostic test?
Louisiana Subscriber
Answer: Implants and augmentation...
Discover why coding a myofascial flap twice is a big mistake.
Question: Our surgeon performs an abdominal closure using left and right myofascial advancement flaps. I believe we should code one unit of 15734 because flap codes refer to the...
Here’s why you should append modifier 25.
Question: A 47-year-old male reports to the ED complaining of a painful, swollen, and reddening right thumb. The physician performs an expanded problem focused history and examination, which uncovers two splinters. The ED...
The answer hinges on the urologist’s interpretation.
Question: A patient had a robotic prostatectomy for prostate cancer on Jan. 1. Then the patient started experiencing voiding problems in February. At that time my doctor did a cystoscopy to check for...
Relying on the physician’s encounter form could be a big mistake.
Question: I used 491.9 to report a patient’s bronchitis, but the payer denied my claim and requested additional information. What was wrong?
Vermont Subscriber
Answer: Your claim may have...
Find out where to report date of services on your claim form.
Question: Which date(s) of service should I report for 30-day cardiac event monitoring?
Washington Subscriber
Answer: For Noridian Medicare, your Part B administrator for Washington, you’ll need to...
Don’t separately report a cursory H&P from the sleep code.
Question: If a nurse practitioner (NP) performed an H&P (history and physical exam) or a subsequent visit with a patient prior to a sleep study, can you bill the H&P...