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
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
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
Coding Challenge / E/M / modifier 24

How Do I Bill For Follow-Up Visits After the Global?

Tip: Make sure the ICD-9 coding & documentation support follow-up visits after the global. Question: Code 19101 has a 10-day global period, which means you cannot bill an E/M for anything related to that procedure within that time frame. If the patient continues to have follow-up visits outside the global period, should we then report the [...] Related articles:

  1. Global Billing: Document ‘Unrelated’ for Modifier 79 ServicesMACs are looking for ‘red flags’ to halt additional global period pay...
  2. These 8 Services Are Not Part Of The Global Surgical PackageIf you’re not reporting these services separately, you’re losing money....
  3. Pregnancy Global Coding Guide: 59400, 59510, 59610 & 59618 TipsGood news: You can report a higher-level (and higher-paying) E/M...

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January 11, 2010
CPT 2010 / Pain Management / Toolkit

CPT 2010 Code Selection Chart for Paravertebral Facet Joint Injections

CPT 2010 introduces a slew of new codes for paravertebral facet injections, so why not consult our handy flow chart to help you select the correct code? © Neurology Coding Alert. To read the full article on the new facet joint injection codes for 2010, download your 2 FREE sample issues here. Was it painful for you to [...] Related articles:

  1. Pain Management Coding Update: Facet Joint Injection CPT Changes for 2010Pain management, anesthesia, orthopedic, physiatry & neurology coders get ready...
  2. Facet Joint Injection Coding for 2010Marvel Hammer’s Quick Start Guide to changes you’ll face in...
  3. Save Time Coding Facet Injections With This Coding Tool Hint: Location, number and substance are key. Several factors...

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December 10, 2009
Coding Challenge / modifier 77

Pain Management: 2 Providers, 2 Postop Pain Injections

Double 76942 OK for second provider? Question: Two providers from the same physician group performed two separate postoperative pain injections on the same patient, on the same day. Each provider used ultrasonic guidance during the procedure, but I’ve been told to report 76942 only once per day. How should we report both services? Answer: You can bill [...] Related articles:

  1. Pain Management Coding: Endoscopic Lumbar Nerve DecompressionHint: Think ‘unlisted procedure.’ Question: One of our physicians is...
  2. Pain Management Coding: TPI Do’s and Don’ts for Pay You Can KeepSample ICD-9 codes to support medical necessity for trigger point...
  3. Check New HCPCS Codes to Keep Pain Management Claims on TrackCatch the changes to botulinum toxin and neurostimulator electrode codes....

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December 8, 2009
CPT 2010 / Hot Coding Topics / Pain Management

Facet Joint Injection Coding for 2010

Marvel Hammer’s Quick Start Guide to changes you’ll face in 2010. Tons of pain management coders gathered at the Orlando conference this week, and everyone was abuzz about the coding changes the painful reimbursement cuts their practices are going to get next year. Some big news: Effective January 1, 2010 radiological imaging will be required and bundled [...] Related articles:

  1. MAC Auditors Will Stick It To Facet Joint Injection Claims We hook you up with CMS instructions for when...
  2. Pain Management Coding Update: Facet Joint Injection CPT Changes for 2010Pain management, anesthesia, orthopedic, physiatry & neurology coders get ready...
  3. Audit Hot Spot: Facet Joint Injection ClaimsHere’s why the OIG wants to stick it to facet...

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December 8, 2009
Coding Challenge / modifier 54 / modifier 55

Cataract Surgery Coding: When Optometrist Provides Postop Care

We’ve got the modifier you need when the ophthalmic surgeon passes the baton. Question: An ophthalmic surgeon performs cataract surgery, and then turns the patient over to the optometrist for postoperative management only. How should I code between the two providers? Do I need a modifier? Answer: If the ophthalmic surgeon turns the patient over to the [...] Related articles:

  1. Optometry Coding: Eye Exams, Cataract Surgery and Co-ManagementE/M or Eye Code? Choose Wisely With These Documentation Tips...
  2. Ophthalmology Coding: See Your Way to Clear Reimbursement for Eye Exams and Cataract SurgeryChoose the Right E/M or Eye Code to Optimize Reimbursement...
  3. Cataract Removal Eye-Opener: 66984CPT 66984 is the number-one procedure performed in ASCs, according...

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December 7, 2009
Provider News

Coding News Travels to Florida for 2010 Updates

Do you have a question about how you should code in 2010? Write us and we’ll ask the experts. Princesses have their castles, but the big news in Orlando this weekend is that the Coding Queens are coming to town! This week in Orlando, nationally known coding & billing experts like Marvel Hammer, Melanie Witt, Leslie Johnson [...] Related articles:

  1. CCI 15.2 News: 3,500 New Code Pairs, Plus Modifier Status Changes CPT continues to add new codes, and the Correct Coding...
  2. News Flash: Over 300,000 New Code Pair Edits from CCIExtra! CCI also creates a few welcome deletions. If you...
  3. AboutCoding News is the essential digest of updates and advice...

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December 4, 2009
Coding Challenge / Pain Management

How Do I Code an Epidural Blood Patch on Same Day as L&D

Don’t forget to double-check these 2 things to find the correct code. Question: How do I code an epidural blood patch procedure on the same day as labor and delivery? Should I include a modifier? Answer: Administering a blood patch on the same day as labor and delivery is unusual because most physicians try to manage spinal [...] Related articles:

  1. 64450 or 64421: Which Code to Tap for TAP Block?Question: What exactly is a “tap block,” and what code...
  2. How Do I Code Blood Draw Plus E/M?Question: An established type II diabetic patient comes in for...
  3. Will S Code Pay Off for Cord Blood Collection?Question: My ob-gyn did cord blood collection. I have these...

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December 2, 2009
Coding Challenge

Coding News Coding News – News about Coding 2009-11-30 23:00:02

Split Postoperative Cataract Care Question: An ophthalmic surgeon performs cataract surgery, and then turns the patient over to the optometrist for postoperative management only. How should I code between the two providers? Do I need a modifier? Washington Subscriber Answer: If the ophthalmic surgeon turns the patient over to the optometrist for all 90 days of postoperative care, the optometrist will report 66984 [...] Related articles:

  1. Optometry Coding: Eye Exams, Cataract Surgery and Co-ManagementE/M or Eye Code? Choose Wisely With These Documentation Tips...
  2. Bone Up On ASC Orthopedic Coding With These Global Period, Modifier Tips 3 ways your physician claim better look different than...
  3. Medical Coder’s Modifier 25 Checklist Append 25 with the greatest of ease … Appending...

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November 30, 2009
Coding Challenge / modifier 52 / multiple wake test

Can a Sleep Study Code Describe an Awake Test?

Question: A sleep study was ordered for a patient diagnosed with hypersomnolence. The neurologistincluded a multiple wake test in the sleep study. What CPT code should I use for the multiple wake test? Answer: You should use 95805 (Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during [...] Related articles:

  1. Protect Sleep Study Pay With These Documentation Essentials How to keep your polysomnography claims off Medicare’s hit...
  2. Sleep Study Reimbursement: How to Claim Your Piece of the Pie Medicare promises to cover facility and home-based testing —...
  3. CMS: Apnea is Key for Sleep Testing Coverage Medicare benes who suffer from obstructive sleep apnea (OSA)...

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November 29, 2009
Provider News

CMS Makes Key Changes to ABN Modifiers

We’ve got the new instructions you’ll need to follow. CMS will update the ABN modifiers effective April 1, according to MLN Matters article MM6563, dated Oct. 29. The ABN descriptors will read as follows: Modifier GA — Revised to read, “Waiver of liability statement issued as required by payer policy.” You’ll use this when a required ABN was issued. Modifier GX — [...] Related articles:

  1. CIGNA Opens Black Box: Get Paid With Modifiers 25 & 59 You now have clear-cut policies to apply, including 1...
  2. Still Using the Old ABN, NEMB Forms? Stop Now Surprise! Here’s when the new form puts you on...
  3. Got Multiple Modifiers? How To Sequence Them on the Claim Coders like to say that modifiers help them tell...

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November 10, 2009
Coding Challenge / radiology

Radiology Coding Education: Is 76705 OK for Back?

Question: For a lower back ultrasound of a soft tissue mass, which CPT code is appropriate? Answer: Code 76705 (Ultrasound, abdominal, real time with image documentation; limited [e.g., single organ, quadrant, follow-up]) is appropriate for this lower back ultrasound. Although the code descriptor states “abdominal” and not “back,” CPT Assistant (May 2009) clarifies that 76705 is appropriate [...] Related articles:

  1. New From CPT Assistant: Help with Trunk Ultrasound Coding Do you know exactly what’s in the mediastinum? Your US...
  2. Double Ultrasound Codes Spell Double Trouble With AuditorsAuthorities scrutinize medical necessity for 76830 & 76856. The OIG...
  3. 5 Lessons Radiology Coders Should Learn From CCI 15.3Wonder if there’s a method to the 76001 madness? Here’s...

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November 2, 2009
Coder's Cranium

Nonphysician Providers & Incident To Checklist

Check state laws PLUS this crucial document. In last week’s Coder’s Cranium, we started a checklist of 3 things you should know to correctly bill for a nonphysician practitioner’s services — and stay compliant. This week, we complete the checklist with advice for items 4, 5 & 6. 4. Have You Distinguished Auxiliary Personnel From NPP Services? NPPs can [...] Related articles:

  1. Nonphysician Providers and Incident-To: Your Coding Questions AnsweredHere’s why you should keep your physicians’ work schedules on...
  2. Use This Incident-To Checklist to Breathe Easy During an Audit You don’t need to second-guess the way you bill...
  3. Steer Your Incident-To Coding Using These 4 Questions 100 percent pay possible if NPP follows internist’s care...

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November 1, 2009