Make the transition to new iliac revascularization codes a little simpler by using this chart. Be sure to read “37220 to +37223 Revamp Your Iliac Intervention Coding Options” on the cover to get more information on these new codes. Use the appropri...
March 21, 2007
Dear JCAAI Member:
We recently surveyed JCAAI members regarding reimbursement for an E&M service on the same day as a skin test or on the same day as an injection (95115 – 95117). Well over 80% are paid for an E&M service on the same day as a skin test. Far fewer are paid for an E&M service on the same day as an injection. In particular, the majority of allergists reported that they were not paid for an injection on the same day they billed a minimal office visit (99211).
Under Medicare policy, neither the injections codes nor the skin testing codes have global periods. Codes that have global periods (typically procedure codes) usually cannot be billed with an office visit because the E & M service is considered bundled into the procedure. Codes that do not have global periods do not include any bundling of E & M services; thus, coding policy generally permits them to be billed on the same day as an E & M without the use of modifier-25. However, as our survey results indicate, not all payers are aware of or are following this policy. This may be because, until January 1, 2006, the injection codes were classified as global period codes (which meant that they could not be billed with an E & M service without the use of modifier-25). JCAAI was successful in getting Medicare to change this so that you are allowed to bill an E & M service (including 99211) with allergy injection codes without meeting the requirements for modifier-25. The primary reason for this change was to allow a physician to bill 99211 when dealing with clinical issues surrounding allergy injection administration (e.g., directing a nurse giving injections as to what the nurse should do if...
Get used to using letters in your diagnosis coding. Take a look at some of the ways your urology diagnosis coding will change in 2013 by reviewing this chart of some common diagnoses you see in your urology practice. This rundown, based on the ICD-10 2...
Here’s how to differentiate the tiquetrum from the trapezium. Doctors dealing with hand procedures don’t only treat carpal tunnel syndrome, and it’s up to you to link the correct diagnosis to the upper-extremity repair codes. Use this anatomic dr...
Name: _____________________________________________ Date: _______________
1. A CPT code has ___5_____ digits and an ICD-9-CM code has ___3-5____ digits.
2. Explain the difference between a CPT code and an ICD-9-CM code.
CPT (Current Procedural Terminology), standardized numeric system (5 digits without modifiers) is used to report WHAT medical services and procedures are done to the patient.
ICD9 (International Classification of Diseases – Ninth Edition) a Universal coding system is used to describe WHY a service was performed. Codes range from 3-5 digits.
3. What is the purpose of a modifier?
To identify in certain circumstances that a service or procedure has been altered by some specific circumstance but it has not changed the basic definition or code (this is the literal CPT book definition, but anything remotely close to this is acceptable).
4. What are E&M codes?
Evaluation and Management Codes that describe different levels of physician “visits” in various healthcare settings.
5. What does “COB” stand for? Coordination of Benefits
6. What insurance information do you obtain when the patient contacts our office with new insurance?
Guarantor name, guarantor DOB, guarantor policy and group number, new insurance name, address for claims submission, effective date of new policy, and (if possible) termination date of previous policy.
7. If the patient has Medicare and Medicaid, which insurance would you bill first?
Medicare would always be billed first.
8. What does HIPAA stand for? And what does it mean to you? Health Insurance Portability and Accountability Act.
HIPAA designates certain standards and procedures that must be followed to keep secure PHI (protected Health Information). HIPAA also calls for standardization of transaction code sets and various privacy laws (looking for some level of knowledge about the general concept of HIPAA).
9. How would you handle each of the following EOB rejections?...
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Before you hire a biller, you need to make sure he or she is qualified for the position. The following test coupled with a math test will assess whether the candidate will be successful in the role — and an asset to your company.
Name: _____________________________________________ Date: _______________
Multiple Choice
1. A “crossover” claim is:
a. When Medicare forwards a claim electronically to a secondary insurance carrier
b. When duplicate claims are sent and the same claim is returned for more information. (essentially the two claims are “crossing” in the mail)
c. When a claim is sent that has more than one box “crossed out”
d. Sending the claim to the secondary insurance first for administrative purposes, “crossing” the normal procedural policies.
2. An EOB is:
a. End of Balance
b....
Treatment plans are a must, experts say.
You’ve treated your chiropractic patient, you’ve selected the correct codes, and you’ve submitted your claim. All set, right? Not quite. Check out this common mistake that chiropractors make.
“Many chiropractors do not create written chiropractic treatment plans for every new patient,” says Marty Kotlar, DC, CHCC, CBCS, president of Target Coding, a chiropractic coding and billing consulting firm. Use this checklist to ensure you send Medicare the information CMS most wants to see included “with every new patient plan of care,” Kotlar says:
__ The history
__ Present illness
__ Family history
__ The past health history
__ The physical examination
__ The diagnosis
__ The plan — This should include:
__ Signature/initials to authenticate the records.
@ Part B Insider (Editor: Torrey Kim, CPC).
Sign up for the upcoming live audio conference, Risk Management Strategies for Healthcare Providers, or order the CD/transcripts.
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Careful: Skip over codes for legs and zero in on foot codes.
With the many graft options — including those taken from cadavers, pigs, and newborns — correctly coding a skin graft procedure can leave you guessing. Use this chart to narrow down the grafting field by matching definitions, product names, and treatment applications to CPT codes. Then, you’ll be sure to sail through coding your next graft claim.
Don’t miss: Nothing will get your claim denied faster than using a CPT code not linked to the diagnosis code. Thus, take care to avoid CPT codes for other body areas, such as the legs, which are generally listed above the code for the feet for each type of graft. Below, you will find only CPT codes that you can use to report grafts performed on feet.
Note: Be sure to periodically review the payer’s local coverage determination to ensure your office is in compliance for your state or region.
Remember: Site preparation, lesion excision, and supply (HCPCS) codes may also apply for these services (in addition to the above listed CPT codes). Look in future issues for more on coding skin graft services by subscribing to Podiatry Coding & Billing Alert. Editor: Stacie Borrello.
Sign up for the upcoming live Webinar, Why That Wound Won’t Heal: Practical Tips to Get Wounds Moving, or order the CD/transcripts.
Be a hero. Sign up for Supercoder.com, and join the coding community at the Supercoder.com Facebook Fan Page.
RACs are just another tool in the government’s arsenal to collect improper payments.
You’ve got so many compliance acronyms flying at you every day that you may not be able to differentiate your RAC from the OIG. Know these quick facts about RACs to stay better informed.
For more on the RAC program, visit www.cms.gov/rac.
@ Part B Insider. Editor: Torrey Kim, CPC
Sign up for the upcoming live Webinar, You Can Use the Appeals Process Like a Pro, or order the CD/transcripts.
Be a hero. Sign up for Supercoder.com, and join the coding community at the Supercoder.com Facebook Fan Page.
Save this option for when other collection methods have failed.
You’ve offered discounts, payment plans, and more,but you still haven’t received payment from a patient. You may be forced to do a write-off at this point, says Steve Verno, CMMC,...
Keep this job aid nearby to keep your Hodgkin’s coding in the clear.
Speed your coding for ABVD chemotherapy coding with this handy summary of the codes most likely to appear on your claim.
But remember: Base your final code...
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…
Record visual fields interpretation and report the right way. Visual fields are a compliance hot spot. Optometrists should use the visual field interpretation and report (I&R) to record what their thinking process was at that moment by recording any changes noticed, how the field compares to other testing like OCT (92135, Scanning computerized ophthalmic diagnostic imaging, [...] Related articles:
This aspect of op note coding is the “horse that pulls the cart.” Stuck on how to tackle this op note or those sitting on your desk? Follow this advice, provided by Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M. and co-presenter of the “Ob-Gyn Op Notes” session at the [...] Related articles:
Participation can put extra bread in your basket. Back again for 2010 is Medicare’s incentive-driven physician quality reporting initiative (PQRI), aimed at tracking quality metric or patient care services that physicians provide. When the practice treats enough patients in the same category, some PQRI dollars might be only a few codes away. If you know the basics [...] Related articles:
This 3-step checklist will boost your bottom line. With fewer patients following through on procedures because of economic and financial struggles, and an increasing number of patients not paying their bills, your practice needs to find ways to improve your A/R and bring in deserved money. Adapting an up-front deductible collection policy is one proven way [...] Related articles: