Risk Managers and workers’ compensation claim managers normally know the purpose of medical bill review is to reduce medical bills to the state fee schedule or to the previously agreed…
Healthcare vendors are reassuring providers that they can improve medical coding productivity with computer-assisted coding (CAC) systems. But can hospitals and medical practices rely on those claims? What CAC does…
The health care industry is “not progressing at a suitable pace” to be ready for tens of thousands of new government-mandated “ICD-10” codes used to describe diseases and hospital procedures…
In a video statement issued late Tuesday afternoon Medical Coding Pro denied that any "hidden messages" are used in Laureen Jandroep's Blitz Videos to increase the pass rate of the…
As U.S. health care providers continue the march toward implementing the ICD-10 — a standardized set of medical diagnoses used by medical professionals across the world — the code set…
There should be a Medical Biller and Coder in every doctor's office, medical facility, nursing home or hospital.
EHRs may reduce medical liability for some errors, but could create new forms of medical liability and expose existing liability issues, says report.
While many innovative technologies, policies and procedures for managing patient data will be on display at the 83rd AHIMA Convention & Exhibit in Salt Lake City, the most pressing topic will be International…
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It is only two years until the compliance date for the ICD-10 code sets and yet not enough hospitals have yet begun readiness assessments and impact analyses, said Jim Jacobs,…
Healthcare Providers to Learn Best Practices for Achieving Financial Neutrality through ICD-10 Transition Bellevue, Washington (PRWEB) September 14, 2011 The transition from ICD-9 to ICD-10 represents one of the most…
Bill all three or get a denial: supply, injection, and illumination. Coding for photodynamic therapy (PDT) involves three key components, which means you should look into multiple CPT® codes to describe your claim appropriately. But this could jeopard...
New options replace 49420 for tunneled catheter. Choosing an intraperitoneal catheter insertion used to mean deciding between “permanent” and “temporary” — but CPT 2011 changes all that. Now you’ll need to know if the procedure is open, lap...
Posted on 07. Jul, 2011 by rpandit in Hot Coding Topics, Provider News Check whether your group might fall into one of four new categories. The push toward e-prescribing is in full swing, with physicians possibly being subjected to a one percent paym...
Reporting modifier 78 for a staged procedure? Expect denials.
When it comes to appending CPT® modifiers to your codes, the rules can be daunting, and Medicare’s regulations only compound the confusion. But if you’re up to speed on these key modifier billing practices, you’ll be raking in deserved pay.
Check out the following five tips to ensure that you aren’t missing any opportunities.
1. Don’t Avoid Modifier 26.
If your physician provides an interpretation and report for an x-ray or other radiological service in the treatment of a patient, that’s not always just part of his E/M—in some cases, you can separately bill for the interpretation and report by appending modifier 26 (Professional component) to the CPT® code.
Typically, the technologist that performed the patient’s x-ray will bill the code — such as 71010 (Radiologic examination, chest; single view, frontal) — with modifier TC (Technical component) to indicate that he is billing for the equipment, room charge, film and radiologic technician, but not for the physician’s interpretation. If the physician who renders the interpretation is with a separate professional group and is not a hospital employee, you should report the service with modifier 26 to obtain his proper share of the reimbursement.
2. Know the Difference Between Modifiers 58 and 78.
Because both modifier 58 and 78 describe procedures performed during another surgery’s global period, it can be easy to confuse them. But differentiating between the two can mean the difference between collecting your due and filing endless appeals.
Key: You’ll report modifier 78 (Unplanned return to the operating room for a related procedure during the postoperative period) when conditions arising from the initial surgery (complications) rather than the patient’s condition...
Modifiers and test results are among the ‘instant denial’ triggers for these codes.
Whether you search under medical oncology, hematology, or hematology/oncology, J0881 and J0885 rank first and third on the lists of the top 10 codes reported to the CMS database (2009). These J-codes for erythropoiesis stimulating agents (ESAs) carry a heavy load of very specific reporting requirements and volatile reimbursement rates. To be sure your claims for these frequently reported codes are as clean and accurate as possible, apply the tips below.
Learn more: These recently available top 10 rankings are listed in a file posted by Frank Cohen, MPA, principal and Senior Analyst for The Frank Cohen Group. Choose the link for “Top 10 procedure codes by frequency for all specialties” at www.frankcohen.com/html/access.html.
Warm Up With Code and ESA Definitions
The HCPCS codes in focus are as follows:
Code J0881 is appropriate to report the supply of Aranesp. Code J0885 applies instead to supply of Epogen or Procrit. Keep in mind that the J codes represent only the supply. You should report the ESA administration separately using 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for intramuscular (IM) administration, says Janae Ballard, CPC, CPC-H, CPMA, CEMC, PCS, FCS, coding manager for The Coding Source, based in Los Angeles.
Both codes indicate they are specific to “non-ESRD use.” ESRD is short for end stage renal disease. Consequently, these codes are appropriate when the injection is connected to oncologic use.
What ESAs do: ESAs stimulate bone marrow to produce more red blood cells, according to...