Technical and professional components hold your clues.
What do insurers expect for documentation of tympanometry or other diagnostic tests? That’s the question Pediatric Coding Alert subscriber Paula Escobar with Riverside Pediatric Group asked, so we went looking for answers.
Starting...
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...
Pre-authorization snag may require ABN.
If your practice performs MR urograms, you need to be prepared to handle a few reimbursement roadblocks.
You may find conflicting information in researching how to code MR urograms. For example, you may come across...
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...
Help is here: One troublesome, confusing edit is no longer an issue.
You may still be getting to know your CPT 2010 manual, but the new edition of CCI, effective April1, is already looking to make some code pairings impossible....
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...
Keep tabs on details to help justify more extensive treatments later.
Plantar fasciitis — a condition in which the plantar fascia becomes inflamed and painful — is the most common form of heel pain and can be treated many different...
Forget about incident-to in the facility, but consider this similar billing technique.
ED coders that have never heard of “incident-to” billing have nothing to worry about, as you cannot code for “incident-to” services in the hospital. Coders that don’t understand...
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,...
Wrap your brain around using letters in your diagnosis codes.
If you aren’t curious about how the ICD-9 codes crosswalk to ICD-10, maybe you should be.
“The transition date for ICD-10 codes is Oct 1, 2013,” stressed CMS’s Stewart Streimer...
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...
Test your ob record skills with this four part challenge.
If your ob-gyn simply confirms a patient’s pregnancy during an office visit, you’ll be able to report V72.42 (Pregnancy, confirmed). But when should you start the ob record? Take this...
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...
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...
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...