Hot Coding Topics / modifier 26 / RAC

Audits: HDI RAC Targets TC, Modifier 26 & More

Want to know what RAC contractors will be looking for next? Here’s the link. Recovery audit contractors (RACs) are working hard to expand their lists of approved issues, and you should keep a close eye on your services in these areas as well. Health Data Insights (HDI), the RAC contractor for Region D, posted 66 new approved [...] Related articles:

  1. CMS COVERAGE DECISIONS: MACs Can Make Exceptions to LCDsRACs can make exceptions only to approve claims. Coders know local coverage...
  2. RAC Fact Did you know that those new RAC auditors out...
  3. RAC Fact: Watch Out For Medicare’s Once-in-a-Lifetime Services G0389 & the IPPE codes may be potential RAC...

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January 26, 2010
Coding Challenge

Ophthalmology Coding Challenge: Flashers & Floaters

How’s Your EO Coding & Billing? Test Yourself With This Scenario. Question: A patient reports flashes and floaters but the ophthalmologist does not find evidence of retinal pathology on routine ophthalmoscopy. Are we justified in billing for extended ophthalmoscopy (EO)? Answer: If the ophthalmoscopy is a routine part of a patient’s eye exam, do not [...] Related articles:

  1. Ophthalmology Coding: RT/LT or Modifier 50? Prevent Uni-Bi Reporting Errors With This Expert Insight Don’t...
  2. Ophthalmology Coding: GDX, VF, & Temp Plugs — How Many Modifiers?Question: A patient came in for a GDX and visual...
  3. Eye Surgery Coding Challenge: Denials for 15823 & 67904Question: I started receiving denials for 15823 and 67904. To...

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January 24, 2010
CCI / Hot Coding Topics / modifier 59 / mutually exclusive

Ob-Gyn CCI 16.0: Hysterectomy Coding

Here’s where you can bypass the edits with modifier 59. The Correct Coding Initiative (CCI) version 16.0 didn’t overlook the hysterectomy, vaginal graft, and colpopexy codes — nor should you. To make sense of the deletions, break these additions into mutually exclusive and non-mutually exclusive. Note: In all these cases — except those involving the anesthetic injection [...] Related articles:

  1. Hysterectomy Coding Simplified: Look at Weight, Removal Severing these ligaments clues you into whether ob-gyn removed...
  2. CCI 15.2 Retracts Neurostimulator Edits from 15.1Look for new edits that affect eye exam codes, anesthesia,...
  3. 3 Steps Take the Guesswork Out of Coding Vaginal Cuff Repairs Find out what colporrhaphy code you’ll use for an...

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January 22, 2010
Coder's Cranium / surgery

Time Your Surgical Collections Right by Referencing Payer Contracts

Find out if you’re legal in collecting patient portion before providing the surgical service. Don’t be too hasty in collecting a patient’s copay and deductible up front. “While in theory, the practice of collecting deductibles up front may sound good, you should check your carrier contracts to be sure you are allowed to do this before requesting [...] Related articles:

  1. Checklist: Collect Surgical Deductibles Up Front to Improve A/RThis 3-step checklist will boost your bottom line. With fewer...
  2. Medical Billers: Test Your Collections Know-How Here This nifty tool tells you if collections cluelessness is...
  3. 10 Carrier Contract Negotiation Tips Carrier contract negotiation is often a long, difficult process....

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January 21, 2010
Coding Challenge

Pulmonology Coding Challenge: Why Are My 94664 Claims Getting Denied?

Before coding 94664, check off these items. Question: Under the direction of my pulmonologist I recently submitted 94664 for reimbursement for training time, but the bill was rejected? Can I challenge this? Answer: You can challenge training denials, provided your documentation supports the education’s reason. However, “not all payers will pay for 94664,” notes Gary N. Gross, [...] Related articles:

  1. Surgery Coding Challenge: Master Microsurgery Units With This AdviceCheck your EOB to make sure payers don’t apply a...
  2. 52214 Coding Challenge: Fulguration, Then TUIBNCQuestion: If my physician went to do a TUIBNC and...
  3. Radiology Coding Challenge: Why is Medicare Denying a 38792, 78195 ClaimTip: Discover true meaning of 38792 note Question: The physician...

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January 21, 2010
E/M / Hot Coding Topics / modifier 25

Wound Closure Coding: Make the Simple, Intermediate Distinction

Accounting for depth is a tricky task when coding closure. Practices interested in ethically boosting their bottom line and getting $80 or more for the same closure repair need to walk the line that separates simple from intermediate. What Makes a Repair “Simple”? A wound closure is a simple repair if the procedure: is simple; is a single-layer closure involving [...] Related articles:

  1. Coding Education: Simple, Intermediate or Complex Closure?Correctly distinguish closure levels every time with this advice from...
  2. Simple Laceration Repair Code or E/M Code? Answer Could Cost Hundreds Not recognizing a laceration repair that’s included in an...
  3. Multi-Laceration Repair Coding Case StudiesDo you know when to code repairs that occur in...

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January 21, 2010
Coding Challenge / E/M / modifier 25 / modifier 50

How Do I Code a 2-Sided Nosebleed?

Heads up: 2 nosebleed codes are not the answer. Question: A patient reports to the ED after sustaining injuries during a soccer match; she was hit in the face with a ball, her nose is bleeding, and her right eye is blackened. The physician is not able to stop the bleeding with ice or pressure, so [...] Related articles:

  1. Is 30901 Your Nosebleed Code? Not So Fast?Hint: Look for these keywords in the note to select...
  2. Winter Laceration Repair: How Do I Code For Dermabond?Warning: Your coding will vary depending on who’s getting the...
  3. How Do I Code This Multiple Fracture Accident Patient?Question: A 30-year-old female presents to a rural ED with...

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January 19, 2010
Hot Coding Topics / modifier 58 / modifier 78 / modifier 79 / surgery

Second Surgery Coding: Tips for Modifier 58, 78 Success

Don’t let ‘unplanned’ lead to ‘unpaid.’ The next time a patient takes an extra trip to the operating room, don’t let the added service throw your coding off track. Keep these tips in mind to know when to assign modifier 78 – or something else. Check for Surprise Versus Planned Two modifiers pertain to follow-up trips to the [...] Related articles:

  1. Bone Up On ASC Orthopedic Coding With These Global Period, Modifier Tips 3 ways your physician claim better look different than...
  2. Global Billing: Document ‘Unrelated’ for Modifier 79 ServicesMACs are looking for ‘red flags’ to halt additional global period pay...
  3. Decision Chart: Modifier 78, 58, or 79?Simplify your post operative service claims with this nifty tool....

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January 19, 2010
CCI / Coder's Cranium / modifier 59

Cataract Surgery Coding Skill Builder

Determine ‘planned or unplanned’ before separately coding vitrectomy. With several possible surgical treatments for cataract procedures, which you probably code more often than any other surgery, there’s a lot of room for error – with over $890 at stake for complex cataract procedures in 2009. Use these tricky scenarios as a guide through some of the most [...] Related articles:

  1. Ophthalmology Coding: See Your Way to Clear Reimbursement for Eye Exams and Cataract SurgeryChoose the Right E/M or Eye Code to Optimize Reimbursement...
  2. Cataract Surgery Coding: When Optometrist Provides Postop CareWe’ve got the modifier you need when the ophthalmic surgeon...
  3. Optometry Coding: Eye Exams, Cataract Surgery and Co-ManagementE/M or Eye Code? Choose Wisely With These Documentation Tips...

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January 19, 2010
CCI / Hot Coding Topics / pathology

Pathology Billing: Calculate How MUE/CCI Restricts Your Outside Consult Pay

Don’t bank on accepted 88321-88323 unit of service. Your pathologist consults with an outside lab on slides taken from a 2006 lumpectomy and a 2009 lymph node fine needle aspiration (FNA). That’s 88321 x 2 — right? Maybe. Your payer determines the answer to that question. The problem: “Although the American Medical Association (AMA) says the unit of service for [...] Related articles:

  1. 5 Rules Pinpoint Date of Service for Laboratory ClaimsTip 3: Here’s DOS advice for archived samples. You can’t...
  2. Match Pathology Report Keywords to Uterus Codes Common descriptions and diagnoses lead the way. Never again...
  3. Zero In On Correct Nasal-Specimen Coding With This Quick Quiz Missing multiple 88304 specimens could cost your practice $125....

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January 17, 2010
Anesthesia / Coding Challenge

Anesthesia Coding Education: Combined Spinal Epidural

Question: Our anesthesiologists sometimes mark our C-section tickets as “combined spinal epidural,” but our billing system will only allow us to choose epidural or spinal. Where can I find information about spinal epidurals and how to correctly code them? Answer: From a coding perspective, whether your physician used spinal or epidural anesthesia doesn’t matter as long [...] Related articles:

  1. How Do I Code an Epidural Blood Patch on Same Day as L&DDon’t forget to double-check these 2 things to find the...
  2. Anesthesia Coding Education: Sciatic Nerve Block & Same-Day General AnesthesiaQuestion: My anesthesiologist performed a sciatic nerve block for a...
  3. Bust These Delivery Coding Myths to Streamline Your Ob Claims Warning: Ordering twin delivery codes incorrectly could cost you....

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January 17, 2010
Coding Challenge / modifier 25

Winter Laceration Repair: How Do I Code For Dermabond?

Warning: Your coding will vary depending on who’s getting the claim Question: A 60-year-old patient reports to the ED with a bandaged left hand. The patient says she was cleaning out the blades of her snow blower and cut her left index finger; the wound is wrapped in gauze, but it is reddening with blood. During [...] Related articles:

  1. Simple Laceration Repair Code or E/M Code? Answer Could Cost Hundreds Not recognizing a laceration repair that’s included in an...
  2. Coding Challenge: Dermabond for Laceration Repairs Question: The dermatologist treated an established patient with a...
  3. Does Dermabond Warrant Special Code? Question: A pediatrician uses Dermabond to close a patient’s...

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January 16, 2010
Toolkit

Checklist: Collect Surgical Deductibles Up Front to Improve A/R

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:

  1. Front Desk Data Tracking ChecklistClean data means more than just a healthy bottom line....
  2. Medical Billers: Test Your Collections Know-How Here This nifty tool tells you if collections cluelessness is...
  3. Time Your Surgical Collections Right by Referencing Payer Contracts Find out if you’re legal in collecting patient portion...

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January 16, 2010
Coding Challenge / modifier 25

10060 Won’t Wash for Some I&Ds

Careful: A pilonidal cyst I&D is a separate animal. Question: A patient presents to the ED reporting pain in her spine. During the exam portion of a level-three E/M, the physician discovers that the painful area is red, and slightly warm to the touch. The patient also has a low-grade fever that she says she noticed about [...] Related articles:

  1. Winter Laceration Repair: How Do I Code For Dermabond?Warning: Your coding will vary depending on who’s getting the...
  2. Know What Separates FBR From E/M or Lose $80 in Pay Here’s why ‘incision’ with non-scalpel instrument could be an...
  3. Wound Closure Coding: Make the Simple, Intermediate DistinctionAccounting for depth is a tricky task when coding closure....

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January 14, 2010
Hot Coding Topics / radiology

Radiology Coding: CPT 2010 Breathes New Life Into Your Respiratory Coding

Master 32561’s guidelines to prevent a major units gaffe. Flip through the Surgery/Respiratory System section of your CPT 2010 manual, and you’ll see the coding committee has been hard at work adding to and revising your options. Discover the added cath removal code, the all new fibrinolytic agent instillation code, and the reshaped bronchoscopy descriptors, so [...] Related articles:

  1. CCI 15.0 Update for Radiology Coders 76942 and 78808 on a single claim needs a...
  2. Capture Separate CV Access Radiological GuidanceDon’t miss out on $20 per procedure when your surgeon...
  3. Multiple Bronchoscopy Coding Crash Course Head off denials & ratchet up reimbursement with these...

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January 14, 2010
ICD-9 / Toolkit

ICD-9 Sequencing: Ace Late Effects Diagnosis Coding With This Flow Chart

Combination codes for stroke late effects won’t always cover all the details. Proper sequencing is essential when coding for late effects, so use this handy chart to sequence your codes correctly every time. Chart provided by Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates and CoDR — Coding Done Right in Denton, Texas. For easy [...] Related articles:

  1. Flow Chart: Tame the Diabetes Diagnosis Coding Beast When coding for diabetes (250.xx), the fourth and fifth...
  2. Our Flow Chart Does the Incident-To Decision Making for YouSuppose your nonphysician practitioner sees a patient on a day...
  3. Flow Chart: Select the Correct Pediatric Critical Care CodeThis flow chart solves location, transport, age dilemmas to land...

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January 13, 2010