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...
Sicker patients may not always mean higher MDM.
If your physician bills a lot of high-level office visits, he may be at risk of an audit — which may not be cause for concern — if his documentation justifies his...
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?
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Plus: CMS reps cite current Medicare law and advise that practices should report just one inpatient care code per patient, per day.
Although CMS has eliminated payment for consult codes, it will continue to honor split/shared visits — as long...
Medicare won’t pay 69210 alone, so here’s how to unlock payment.
Impacted cerumen removal is a fairly straightforward procedure, but billing for the procedure is not always so simple.
The problem: Most payers, including Medicare,consider 69210 (Removal impacted cerumen [separate...
Test your 2010 consultation coding understanding with these questions and answers.
Consultation coding has every practice on edge this year. Ensure that you’ve got a handle on this complicated coding and billing situation by taking this three-question quiz and then...
Grasping 93010’s effect on new vs. established patient status could bring a $58 reward.
Whether you call them ECGs or EKGs, chances are you see a lot of electrocardiograms in your practice. That means that even the tiniest coding errors...
Upcoming policy change will slash your payments by half.
Big changes are on the horizon if you participate with insurance provider Horizon Blue Cross Blue Shield (BCBS) of New Jersey.
In a recent memo, BCBS states that effective May 17,...
Medicare clears up confusion surrounding ‘8-hour rule.’
Reporting your FP’s observation services can be tricky business, as there is confusion about how, when, and why to choose from one observation code set or another.
Add to that a common misconception...
In MSP cases, non-consult code for both payers may be best.
If you have payers who didn’t play follow-the-leader with Medicare in cutting out consult codes, you have a dilemma on your hands. You have to decide what to do...
Knowing how to use add-on codes can net you up to $258 in additional reimbursement.
CPT is full of “add-on” codes, additions to minor and major surgical procedures as well as to E/M services. Fortunately for urology there are not…
Attach your procedure notes and the OIG’s report to pack extra punch.
Even if you follow all of CMS’s rules in reporting modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the…
You may need to append modifier 25, depending on payer policies.
Question: Our physician billed 90634, 90710, and 90606 for vaccines given to a 5-year-old patient. The insurance company denied payment and said they required a modifier. What should we…
Understand ‘significant’ and ‘separate’ to earn a gold star.
Knowing when to report modifiers and choosing the best one for each situation can be an easy trip-up for coders. If you find yourself especially befuddled…
Insurers might want to see a clear explanation as to why the E/M was necessary.
Question: An established patient with a plan of care in place for her gastroesophageal reflux disease (GERD) reports to the gastroenterologist; two weeks ago, the…
Don’t forget to include the code for the arthrocentesis.
Question: A new patient sees the orthopedist because of shoulder problems. The physician schedules an MRI and the patient returns the following week to discuss the findings. The physician had already…
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