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:

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February 6, 2010
Coding Challenge / E/M

Is E/M Possible Pre-Colonoscopy?

Question: A local family physician refers a patient to our gastroenterologist for a diagnostic colonoscopy. The patient reports to the practice and meets the gastroenterologist for the first time. After answering some patient questions during a brief introduction, the gastroenterologist performs a diagnostic colonoscopy with brushing. The patient had never met the gastroenterologist before. Is the time he spent with the patient [...] Related articles:

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February 3, 2010
CMS / Coding Challenge / E/M

E/M Challenge: Can I Report 99214 and +99354?

Counseling representing more than 50 percent of E/M visit? Choose level based on time. Question: I have a family physician who documented 60 minutes on an established patient’s office visit. The FP diagnosed the patient with morbid obesity (278.01). Since the patient was newly diagnosed and had some difficulty understanding the doctor’s orders, the FP spent [...] Related articles:

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January 31, 2010
CCI / Coding Challenge / surgery

Surgery Coding Challenge: Master Microsurgery Units With This Advice

Check your EOB to make sure payers don’t apply a multiple-procedure reduction to +69990. Question: When my ENT uses a microscope during a procedure, what guidelines can I use for choosing between 92504 and +69990? Is there a rule governing how many times you can report the add-on code 69990? Answer… You can use 92504 (Binocular microscopy [separate [...] Related articles:

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January 28, 2010
Coding Challenge

How Should I Code a Fibrinolytic Agent Instillation Via Chest Tube?

Different calendar dates matter, but multiple instillations the same day do not. Question: My pulmonologist inserted a chest tube and then instilled a fibrinolytic agent to break up multiloculations to free up an entrapped lung. Usually, I use 32560 for this procedure, which is for pleurodesis, not fibrinolysis. What code should I use for fibrinolytic agent [...] Related articles:

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January 27, 2010
Coding Challenge

Ophthalmology Coding Challenge: Flashers & Floaters

How’s Your EO Coding & Billing? Test Yourself With This Scenario. Question: A patient reports flashes and floaters but the ophthalmologist does not find evidence of retinal pathology on routine ophthalmoscopy. Are we justified in billing for extended ophthalmoscopy (EO)? Answer: If the ophthalmoscopy is a routine part of a patient’s eye exam, do not [...] Related articles:

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January 24, 2010
Coding Challenge

Pulmonology Coding Challenge: Why Are My 94664 Claims Getting Denied?

Before coding 94664, check off these items. Question: Under the direction of my pulmonologist I recently submitted 94664 for reimbursement for training time, but the bill was rejected? Can I challenge this? Answer: You can challenge training denials, provided your documentation supports the education’s reason. However, “not all payers will pay for 94664,” notes Gary N. Gross, [...] Related articles:

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January 21, 2010
Coding Challenge / E/M / modifier 25 / modifier 50

How Do I Code a 2-Sided Nosebleed?

Heads up: 2 nosebleed codes are not the answer. Question: A patient reports to the ED after sustaining injuries during a soccer match; she was hit in the face with a ball, her nose is bleeding, and her right eye is blackened. The physician is not able to stop the bleeding with ice or pressure, so [...] Related articles:

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January 19, 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:

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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:

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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:

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January 14, 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:

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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:

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January 10, 2010
Coding Challenge / radiology

Radiology Coding Challenge: Total Spine MRI Without Contrast

Question: Which CPT code should I use for a total spine MRI without contrast? Answer: You won’t find a single CPT code that describes a “total spine” MRI, but you may report a code for each region the radiologist examines: • 72141 — Magnetic resonance (e.g., proton) imaging, spinal canal and contents, cervical; without contrast material • 72146 — Magnetic resonance (e.g., [...] Related articles:

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January 5, 2010
Coding Challenge

How Do I Code An Arthroscopic To Open Ankle Surgery?

Question: Our surgeon attempted to remove a loose body in the ankle arthroscopically, but it was too large so he had to perform an open removal. Do I bill only for the open procedure, or include the arthroscopic attempt as a discontinued procedure? Answer: Because your surgeon completed the procedure as an open case, you’ll report [...] Related articles:

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  3. Medicare Coverage for Bariatric Surgery: Do You Know These BMI Guidelines?Question: I heard that Medicare made some changes about diabetic...

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January 3, 2010
Coding Challenge

How Do I Code Genetic Counseling By A Physician

Limit 96040 to Trained Counselor Question: May we report 96040 if our physician is performing genetic counseling? Answer: You should report 96040 (Medical genetics and genetic counseling services, each 30 minutes face-toface with patient/family) only for a trained genetic counselor’s services. (Currently, the American Board of Genetic Counselors [ABMG] certifies genetic counselors in the US and Canada.) [...] Related articles:

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December 20, 2009