Hot Coding Topics / MAC / modifier

Think You Understand the New Consult Rules? Find Out Fast

Check your 2010 consultation coding savvy.

Find out if you’re set to properly code your physician’s consultation services this year by tackling three problems and their solutions.

Check With Your MAC for Guidance

When…

Related articles:
  1. Think You Understand the New Consult Rules? Find Out FastTest your 2010 consultation coding understanding with these questions. Consultation...
  2. Ask 3 Questions to Head Off 2010 Consult Problems Before They Start Ever used an unlisted E/M code? Get ready. By...
  3. CMS Will Offer New Modifier to Denote Admitting Physician on ClaimsPop the champagne cork & get ready for brand new...

Comments Off on Think You Understand the New Consult Rules? Find Out Fast
March 4, 2010
Medicare / Provider News

Medicare Physician Pay Cut Update

On Tuesday evening, the Senate passed H.R. 4691, which freezes the Medicare conversion factor at current levels through March 31.

Because of this vote, you will not face the 21% pay cut until April 1, explains Part B Insider editor,…

Related articles:
  1. Physician Fee Schedule Update: An Extension for the Temporary Conversion Fix?Fear not: The CF may stay until autumn, but the...
  2. SGR Update: What’s Up With That 21 Percent Physician Pay Cut? Here’s what you should be watching on Capitol Hill....
  3. How Obama’s Medicare Cuts Hit Physician Reimbursement  The budget released Thursday suggests we cut $300 billion from...

Comments Off on Medicare Physician Pay Cut Update
March 3, 2010
MAC / Provider News

CMS Tells MACs to Hold Claims For 10 Days

The latest on the 21 percent Medicare pay cut.

If your practice leans heavily on Medicare for reimbursement, expect your cash flow to taper off a bit.

CMS has instructed the MACs to hold claims for the first ten business…

Comments Off on CMS Tells MACs to Hold Claims For 10 Days
March 2, 2010
Hot Coding Topics / surgery

Stay in the Game With the Correct Ligament Repair, Reconstruction Codes

Remember ligament repair abbreviations to simplify elbow ligament surgeries.

Baseball players are gearing up for the season, which means your orthopedist could see a sudden increase in elbow ligament injuries. If conservative therapies fail to help torn medial (841.1) or…

Comments Off on Stay in the Game With the Correct Ligament Repair, Reconstruction Codes
March 2, 2010
Coder's Cranium

Think You Understand the New Consult Rules? Find Out Fast

Test your 2010 consultation coding understanding with these questions. Consultation coding has every practice on edge this year. Ensure that you’ve got a handle on this complicated coding and billing situation by trying your hand at this question. Question: When a visit with a Medicare inpatient that would normally have been coded as a consultation does not [...] Related articles:

  1. Think You Understand the New Consult Rules? Find Out FastCheck your 2010 consultation coding savvy. Find out if you’re...
  2. Ask 3 Questions to Head Off 2010 Consult Problems Before They Start Ever used an unlisted E/M code? Get ready. By...
  3. CMS Will Soon Issue Consult Code Replacement Advice, According to Open Door ForumPlus: You can now download a list of all practitioners...

Comments Off on Think You Understand the New Consult Rules? Find Out Fast
February 28, 2010
Hot Coding Topics / modifier 22

Give Your Radiosurgery or Gamma Knife Surgery Coding a Check-Up

Improve your reimbursement chances by applying modifier 58 in this situation. When your surgeon targets the brain or spine with stereotactic radiosurgery (also called gamma knife surgery) to treat multiple lesions over multiple sessions, you need to know two crucial things: what stereotactic radiosurgery codes to use and how many units to include. Take this three-question challenge [...] Related articles:

  1. Take Our Multi-Level Spinal Surgery Coding Challenge AUDIO TRAINING EVENT: Receive Optimum Reimbursement for Spinal Co-Surgeries,...
  2. Check Destruction Method Before Assuming 17110You could gain $30 if a shave is also performed....
  3. Second Surgery Coding: Tips for Modifier 58, 78 SuccessDon’t let ‘unplanned’ lead to ‘unpaid.’ The next time a...

Comments Off on Give Your Radiosurgery or Gamma Knife Surgery Coding a Check-Up
February 28, 2010
Coding Challenge

Ob-gyn Challenge: Take the Pressure Out of a 3D US Coding

No severe problems? You may have trouble with reimbursement. Question: The ob-gyn performed and OB ultrasound (US) on a patient. Can I bill 76376 in addition to the ultrasound if the ob-gyn used 3D? Montana Subscriber Answer: Yes. You can report a 3D procedure with 76805 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, [...] Related articles:

  1. Ob-gyn Coding Challenge: EM End-Result Tells You What ICD Code To Go ForCheck out these ICD-10 ob-gyn diagnosis coding equivalents. Question: A...
  2. Urology Coding Challenge: Gold Seed Marker Placement Plus TRUS Question: How should I report the placement of gold...
  3. Surgery Coding Challenge: Master Microsurgery Units With This AdviceCheck your EOB to make sure payers don’t apply a...

Comments Off on Ob-gyn Challenge: Take the Pressure Out of a 3D US Coding
February 28, 2010
Coding Challenge

Counseling Must Dominate Exception Claims For Seamless Payment

Choose the service level using the documented history, exam, and MDM. Question: A new patient with a chronic gastric ulcer meets the gastroenterologist for management of her condition. The gastroenterologist meets for 34 minutes with the patient, and performs an expanded problem focused history and exam and straightforward medical decision making. The note also indicate that [...] Related articles:

  1. E/M Challenge: Can I Report 99214 and +99354?Counseling representing more than 50 percent of E/M visit? Choose...
  2. E/M Coding: Don’t Sell Yourself Short on Problem Sports ExamsTip: Time-based E/M might be in line when managing diabetes,...
  3. How Do I Code Genetic Counseling By A PhysicianLimit 96040 to Trained Counselor Question: May we report 96040...

Comments Off on Counseling Must Dominate Exception Claims For Seamless Payment
February 25, 2010
Coder's Cranium

Set the Record Straight: ICD Code Options for COPD

What your pulmonologist writes in the documentation matters. The pulmonologist’s documentation, along with the patient’s medical record can make or break your chronic obstructive pulmonary disease (COPD) reporting. One key is making sure that your coding accurately identifies the patient’s specific pulmonary condition and any other associated acute condition (if necessary). Background: According to the National Heart [...] Related articles:

  1. 3 Pulmonary Diagnosis Coding TipsRemember to focus on acute conditions & exacerbations. Correctly reporting...
  2. How Do You Code COPD With Acute Bronchitis?  Question: An established patient with chronic obstructive pulmonary disorder (COPD)...
  3. Should You Code Presenting Symptoms Along With Dx? Question: An established patient complains of trouble breathing and...

Comments Off on Set the Record Straight: ICD Code Options for COPD
February 25, 2010
CMS / E/M / Hot Coding Topics

Get Paid for EM Visits: How Much ROS Documentation Is Enough?

Caution: Keep enough paperwork on hand to back up EHR. Transitioning to the world of Electronic Health Records (EHR) can make your coding easier on many levels, but don’t take it for granted. Physicians often fall short in their review of systems (ROS) documentation whether you use paper charts or rely on EHR, but you can [...] Related articles:

  1. Bullet-Proof Level-4, Level-5 E/Ms with These ROS Documentation TipsROS documentation musts that most practices get wrong. Gastroenterology Coders:...
  2. E/M Coding Focus: Geriatric Patients & DementiaDetermine HPI or ROS during assessment for geriatric patients. Your...
  3. Bulletproof Your Doc’s PSA Documentation with This Form You’re just one click away from a code-focused order....

Comments Off on Get Paid for EM Visits: How Much ROS Documentation Is Enough?
February 25, 2010
BCBS / Coding Challenge

Surgery Coding: Narrow Your Options for Birmingham Hip Procedure

Include this term in Box 19 to indicate the type of implant. Question: One of our surgeons says we should use a total hip code for Birmingham resurfacing even if he doesn’t complete a total hip procedure; another physician says to use an unlisted code . What’s the correct answer? Washington Subscriber Answer: Both of your physicians could [...] Related articles:

  1. Test Yourself: Total Knee Replacement (TKR) Coding Can you tackle an op note like this one...
  2. How Do I Code An Arthroscopic To Open Ankle Surgery?Question: Our surgeon attempted to remove a loose body in...
  3. Podiatry Coding Education: 28293 For Joint Replacement for Hallux LimitusQuestion: Our podiatrist performed a joint replacement for hallux limitus and...

Comments Off on Surgery Coding: Narrow Your Options for Birmingham Hip Procedure
February 23, 2010
CCI / CMS / Hot Coding Topics

Red Alert, Cardiology Coders: Expect EP Study + Ablation Denials Until April 1

CMS won’t fix CCI blunder until version 16.1, to be released in the spring. If your heart skipped a beat when you saw that January’s Correct Coding Initiative (CCI) edits bundled catheter ablations with electrophysiology (EP) studies, you weren’t alone. Good news: CMS has decided to delete the edits retroactively because their addition was a mistake, according [...] Related articles:

  1. Take Heart, Cardiology Coders: CCI Deletions Overturn 93296 Denials Go back to the future. 3 months of denials...
  2. Nerve Conduction Study Coding TipDid you know that new medical devices are opening doors...
  3. Bundle of His Recording Coding ChallengeQuestion: How should I report right atrial pacing and recording...

Comments Off on Red Alert, Cardiology Coders: Expect EP Study + Ablation Denials Until April 1
February 23, 2010
CMS / MAC / Provider News

CMS Delays Ordering/Referring PECOS Regulation Until 2011

Take the extra time to get your practice registered in PECOS — don’t wait until the end of the year, CMS reps say. Practices that were busily struggling to find out whether their ordering/referring physicians’ national provider identifiers (NPIs) were in the PECOS system can relax a little bit — at least until next year. If your physician performs [...] Related articles:

  1. CMS: Billing Co. Can’t Fill Out PECOS Form on Doc’s BehalfIf you’ve grown accustomed to a designated credentialing specialist in...
  2. A Press Release Is Not a Legal Ruling, PECOS Pundits Point OutKeep an eye on the Federal Register as you use...
  3. CMS Changes Course: Physicians Need Not Personally Complete PECOS ApplicationWhat a difference three months makes, especially when it comes...

Comments Off on CMS Delays Ordering/Referring PECOS Regulation Until 2011
February 23, 2010
CCI / HCPCS / Hot Coding Topics / Medicare / modifier 59 / NCCI / Oig / Oncology

OIG Hit List: Perfect Your 38220, 38221, and G0364 Usage

Don’t sweat reporting 38220-59 if you meet these Medicare-approved conditions. If your oncologist takes both a bone marrow biopsy and a bone marrow aspiration, whether you’ll see Medicare reimbursement depends on the two guidelines below. But watch out: With OIG scrutiny and a HCPCS twist, these guidelines will put your coding savvy to the test. Append 59 [...] Related articles:

  1. Coding Education: Bone Marrow Harvesting for Autologous TransplantQuestion: Is there a CPT code specific to harvesting bone...
  2. Use This Podiatry Scenario to Perfect Your Emerging Technology ClaimsHint: If you try to use an unlisted code, be...
  3. Multiple Bronchoscopy Coding Crash Course Head off denials & ratchet up reimbursement with these...

Comments Off on OIG Hit List: Perfect Your 38220, 38221, and G0364 Usage
February 21, 2010
Coder's Cranium / ICD-9 / MAC

ICD-9 Coding: Stop Asking ‘Which Diagnosis Code Will Get My Claim Paid?’

Assigning an ICD-9 code merely to get your claim paid could land you in legal hot water. Medical coders face a lot of questions each day in the course of their work, but one question you should not be asking is “which diagnosis code should I put on this claim if I want to collect?” When [...] Related articles:

  1. What’s the Correct Diagnosis Code for a Urine Drug Test?Question: What is the proper ICD-9 code when the lab...
  2. 3 Pulmonary Diagnosis Coding TipsRemember to focus on acute conditions & exacerbations. Correctly reporting...
  3. Dx Coding Moves That Stop Denials for Chronic Pain ClaimsTip: Code prior conditions in these cases. Imagine your pain...

Comments Off on ICD-9 Coding: Stop Asking ‘Which Diagnosis Code Will Get My Claim Paid?’
February 21, 2010