Coding Challenge / E/M / modifier 25

Gastroenterology Coding Challenge: Repositioning a G Tube

Reading 44373’s code descriptor is key to getting your G Tube claim right. Question: The gastroenterologist goes to the hospital to treat a patient that had recently been admitted because his gastrojejunostomy tube had migrated to his stomach. After performing a problem focused interval history and exam, the gastroenterologist decides to perform an EGD to reposition the [...] Related articles:

  1. Gastroenterology Coding Education: Bravo Cap Placements Question: A new patient reports to the gastroenterologist with complaints...
  2. How Should I Code a Fibrinolytic Agent Instillation Via Chest Tube?Different calendar dates matter, but multiple instillations the same day...
  3. Winter Laceration Repair: How Do I Code For Dermabond?Warning: Your coding will vary depending on who’s getting the...

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February 7, 2010
Medicare / Oncology / Provider News

Oncology Coding: Update Your PET Claims With This New Guidance

Here are the requirements the exam must meet, according to Medicare. If your PET claim meets certain requirements, you don’t need to append modifier Q0 (Investigational clinical service provided in a clinical research study that is in an approved clinical research study), according to MLN Matters article MM6753. Effective for dates of service on or after Nov. [...] Related articles:

  1. Which PET Code Is Best for Brain Images? Question: Which CPT code is appropriate for PET performed...
  2. Oncology Coding 2010 Update: 3 New Lab Services CodesWatch for your chance to replace 86316 with more specific...
  3. ICD-9 Update: Take Your Oncology Coding Specificity Up a Notch With 7 2010 Changes Tumor lysis syndrome is getting its own code —...

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February 7, 2010
Coding Challenge

Why Is the Co-Pay I Collected Short By $20?

Verify co-pay early to save time, money Question: A patient came to our office for a routine exam with the same insurance card she’s had for years. We charged her the standard copay of record. Then I found out her employer changed the terms of the insurance, so the copay she paid was short by $20. [...] Related articles:

  1. Your New Patient Packet ToolkitHow to use technology to speed up new patient check-in....
  2. Medical Office Billing: Benefits Verification, Copayment and Consolidated BillingIs Lack of Verification Costing Your Practice? Stop the Bleeding...
  3. Front Desk Data Tracking ChecklistClean data means more than just a healthy bottom line....

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February 6, 2010
Hot Coding Topics / modifier 25

Newborn Status Change Means Deciding Between Hospital Care Codes

Sort your normal, sick and intensive care options. Choosing the appropriate codes for initial newborn services can be difficult due to the large number of available codes and gray areas between the spectrum of illnesses. If you find yourself getting tripped up by the multiple categories, read on for expert tips and real-world examples that [...] Related articles:

  1. Must Hospital Admit Codes and Admission Show Same DOS? Overlook this rule, and risk leaving rightful E/M dollars on...
  2. Give Your Newborn Coding Skills a Checkup This directive stops the sending physician from committing an...
  3. Answers To Your Hospital Admission, Subsequent Care Coding Questions Revenue Booster: Here’s when you can claim a consult...

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February 4, 2010
CMS / Provider News

AMA Chimes In On How to Report Consults for Non-Medicare Patients

Beware: Don’t use the CMS consult crosswalk for billing purposes. You may be seeing light at the end of the tunnel. The AMA just published an article to clarify the use of the consultation codes for non-Medicare patients, and talks about their efforts to get CMS to delay their new policy. You can find the article [...] Related articles:

  1. CMS Will Offer New Modifier to Denote Admitting Physician on ClaimsPop the champagne cork & get ready for brand new...
  2. CMS’s Refusal to Pay Consults Makes MSP Claims a HeadacheIf you bill consults to private payers, good luck collecting...
  3. Proposed 2010 MPFS: $26 More for ‘Welcome to Medicare’ ExamCMS welcomed health care providers to an July 9 open...

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February 4, 2010
Coding Challenge / E/M

Is E/M Possible Pre-Colonoscopy?

Question: A local family physician refers a patient to our gastroenterologist for a diagnostic colonoscopy. The patient reports to the practice and meets the gastroenterologist for the first time. After answering some patient questions during a brief introduction, the gastroenterologist performs a diagnostic colonoscopy with brushing. The patient had never met the gastroenterologist before. Is the time he spent with the patient [...] Related articles:

  1. Are These Colonoscopy Codes Bundled?Challenge: Can you report codes 45380 and 44388 together? Answer:...
  2. Don’t Wait for CPT: Maximize Virtual Colonoscopy Payment Now Learn whether to file an ABN with 0066T, 0067T....
  3. Gastroenterology Coding Education: Bravo Cap Placements Question: A new patient reports to the gastroenterologist with complaints...

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February 3, 2010
Hot Coding Topics / Oncology

Oncology Coding 2010 Update: 3 New Lab Services Codes

Watch for your chance to replace 86316 with more specific 86305. If your oncology practice has its own lab, heads up. You’re sure to find a few new lab codes “in CPT 2010 that you need to know,” says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha. Get started with a [...] Related articles:

  1. CPT 2010 Update: Laboratory & Pathology CodingStop using general codes for analyte-specific tests. Here’s why. You...
  2. ICD-9 Update: Take Your Oncology Coding Specificity Up a Notch With 7 2010 Changes Tumor lysis syndrome is getting its own code —...
  3. Oncology Coding: Update Your PET Claims With This New GuidanceHere are the requirements the exam must meet, according to...

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February 2, 2010
E/M / Provider News

E/M Audits: MAC Sets Up Pre-Pay Edit for Code 99310

87 percent error rate leads to drastic measures. If you think CMS is only watching your E/M codes when it comes to the office or hospital, think again. One MAC recently reviewed nursing facility care claims and was stunned at the findings. NGS Medicare, a Part B payer in four states, announced on Jan. 26 that it [...] Related articles:

  1. The Truth About Self-AuditsAnd one crucial step you should never miss. How many...
  2. E/M Challenge: Can I Report 99214 and +99354?Counseling representing more than 50 percent of E/M visit? Choose...
  3. CMS Will Offer New Modifier to Denote Admitting Physician on ClaimsPop the champagne cork & get ready for brand new...

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February 2, 2010
Hot Coding Topics / modifier 59

What Lab Coders Need to Know About CCI 16.0

Look for transcutaneous hemoglobin limitations, and bundling for those new 2010 culture codes. Think you’re ready to use all those brand new CPT lab codes? Not so fast. You better learn Correct Coding Initiative (CCI) restrictions first, before you start billing Medicare for services using new CPT 2010 codes. CCI released version 16.0, effective Jan. 1, which includes 24,060 [...] Related articles:

  1. CCI 15.3 Update: You Can Resubmit Dozens of Previously-Bundled 22526 ClaimsNewsflash: CCI 15.3 retroactively deletes hundreds of edit pairs, but...
  2. What Interventional Radiology Coders Should Know About CCI 15.1 EXTRA–Radiology Reimbursement WEBINAR: Do you know the difference between...
  3. Can’t Locate an H. Pylori Lab Test Code? 2 Clues Point the Way Solve CLO test culture code dilemma and other mysteries....

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January 31, 2010
CMS / Coding Challenge / E/M

E/M Challenge: Can I Report 99214 and +99354?

Counseling representing more than 50 percent of E/M visit? Choose level based on time. Question: I have a family physician who documented 60 minutes on an established patient’s office visit. The FP diagnosed the patient with morbid obesity (278.01). Since the patient was newly diagnosed and had some difficulty understanding the doctor’s orders, the FP spent [...] Related articles:

  1. Asthma Attack Coding: When To Use Prolonged or High-Level E/M     Checklist deters payback requests for insufficient +99354...
  2. Does CNS Count as NP for Time-Based Coding? CNS = NP = PA for CPT, but Check...
  3. CPT 2010 Update: Non-Face-to-Face Prolonged ServicesNew Year’s hats & horns for looser guidelines that let...

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January 31, 2010
Hot Coding Topics

Orthopedic Coding Clinic: Labral Tears

10-2:00 in the op note signals SLAP lesion repair. Even experts can land on the wrong ICD-9 code for SLAP lesion repair, but visualizing the injury region as a clock will help you distinguish one type of SLAP (superior labral anterior posterior) tear from another. Research Patient History for Accurate Diagnosis Having a solid understanding of anatomy and [...] Related articles:

  1. Orthopedic Coding Clinic: Complete the ICD-9 Picture with These Tips Code the condition your ortho treats first, followed by...
  2. Orthopedic Coding Clinic: Pull the Plug on PRP Injection Denials Here’s where 86999 comes in. If your orthopedist is...
  3. Orthopedic Coding Quick Start Guide: ASC Shoulder ProceduresShoulder ICD-9 and CPT codes you’ll most likely see in...

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January 28, 2010
CCI / Coding Challenge / surgery

Surgery Coding Challenge: Master Microsurgery Units With This Advice

Check your EOB to make sure payers don’t apply a multiple-procedure reduction to +69990. Question: When my ENT uses a microscope during a procedure, what guidelines can I use for choosing between 92504 and +69990? Is there a rule governing how many times you can report the add-on code 69990? Answer… You can use 92504 (Binocular microscopy [separate [...] Related articles:

  1. Spinal Surgery Coding Challenge: Tethered Cord Release & Dural Tag RemovalQuestion: My neurosurgeon released a tethered cord under the microscope,...
  2. Know Your Magnifiers for Microscope Coding Success Your ENT has invested training time and money in...
  3. Take Our Multi-Level Spinal Surgery Coding Challenge AUDIO TRAINING EVENT: Receive Optimum Reimbursement for Spinal Co-Surgeries,...

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January 28, 2010
CMS / Toolkit

Want to Integrate PQRI Measures Into Your Practice? Look Here.

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:

  1. PQRI 2010: Tips That Boost Your Practice’s RevenueFollow our links and advice to put more plusses in...
  2. New PQRI, E-Prescribe Tool from CMS If your head is spinning with all of the...
  3. Keep These 2009 PQRI Eye Care Measures HandyOphthalmologists and optometrists who want to recoup a bonus from...

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January 28, 2010
Coding Challenge

How Should I Code a Fibrinolytic Agent Instillation Via Chest Tube?

Different calendar dates matter, but multiple instillations the same day do not. Question: My pulmonologist inserted a chest tube and then instilled a fibrinolytic agent to break up multiloculations to free up an entrapped lung. Usually, I use 32560 for this procedure, which is for pleurodesis, not fibrinolysis. What code should I use for fibrinolytic agent [...] Related articles:

  1. Radiology Coding: CPT 2010 Breathes New Life Into Your Respiratory CodingMaster 32561’s guidelines to prevent a major units gaffe. Flip...
  2. Signs & Symptoms Coding Coach: Chest Pain 786.50-786.59: One of the most common symptoms that cardiovascular...
  3. PFS Treasure Chest: Read Medicare’s MindIt seems like dry reading, but the physician fee schedule...

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January 27, 2010
Coder's Cranium / ICD-10 / ICD-9

Pick the Right ICD-9, ICD-10 Code for Postmenopausal Abnormalities

Do N95.0 and N95.2 look foreign? Get your ob-gyn ICD-10 equivalents now. Spare yourself denial hot flashes by taking this three-part postmenopausal abnormality scenario challenge. Fill In These Blanks Using Your ICD-9 Book Question 1: Your ob-gyn sees a post menopausal patient with an inflamed vagina because the tissues are thinning and shrinking. The ob-gyn notes decreased vaginal [...] Related articles:

  1. Coder’s Anatomy: Cardiac Cath & Congenital AbnormalitiesTime Saver: Before you start assigning cardiac catherization codes, make...
  2. Nuclear Medicine Code Crosswalk: Bone Scans If your practice has trouble following which bone scan...
  3. What Diagnosis Code Do I Use for a Fern Test?Ob-Gyn Coding Tip: Scan for leukorrhea signs when fluid is...

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January 26, 2010