Continuing with our look at areas of coding confusion, let’s today examine pain. According to Medline Plus Magazine from the National Institutes of Health (NIH), pain is the most common…
Pay attention to dates associated with the new COVID--19 codes, Z20.822 and Z20.828, to avoid billing errors. In December 2020, the Centers for Disease Control and Prevention (CDC) announced six…
For many providers, the end of the pandemic is in sight with the recent emergency use authorization of a COVID-19 vaccine. And while this may be true, it is just…
On July 20, the Office of Inspector General (OIG) released a report that found that hospitals are overbilling or upcoding hospitals to the tune of $1 billion. OIG reviewed 200…
Just like our patients, proper coding and billing for obstetric patients can be…complicated. As a coding instructor and compliance auditor, I field a lot of questions from new students and…
Incident to billing allows non-physician providers (NPPs) to report services “as if” they were performed by a physician. The advantage is that, under Medicare rules, covered services provided by NPPs…
In most markets, when a buyer and a seller can't settle on a price, they walk away. Medicine is different. Doctors and insurance companies often sort out who owes what…
Accurate, efficient revenue cycle management is essential to maintaining positive cash flow in a healthcare facility. Maintaining positive health care finances requires that claims processing and payments are effectively managed…
Radiology, as a business, has become increasingly complex as regulatory demands grow and revenues, both on the hospital and physician side decrease. Doing more with less has become a common…
How can medical practices work effectively with payers to receive payment? Business News Daily sought answers from healthcare experts. Here are six tips: 1. Fill out claims, well. Make sure…
The U.S. health care system began using the International Classification of Diseases 10th edition on Oct. 1. ICD-10 replaces the decades-old 9th edition, and it represents the largest change in…
As we move towards building a universal patient-centered data platform in health IT, several sources of data are useful. Data coming from transitions of care, clinical summary documents (C-CDAs) which…
When two surgeons work together to perform one procedure, each physician’s individual documentation requirements can get jumbled up. Make sure your physician isn’t passing the documentation buck and that he or she knows to follow these four tips when you submit claims with modifier 62.
Tip 1: Each physician should identify the other as a co-surgeon. Also make sure that the other physician is billing with modifier 62. A lot of confusion can arise when physicians from different practices are reporting the same procedure.
You may find yourself in a situation where one physician may report the other physician’s work as that of an assistant surgeon, in which case the claims would not correspond. This means a denial will hit your desk. One surgeon cannot simply indicate the other as the co-surgeon. Both physicians must submit claims for the same procedure, both with modifier 62. To accomplish this all you only need to call with a simple courtesy to the other physician’s billing or coding department.
Tip 2: Each physician should document her own operative notes. When surgeons are acting as “co-surgeons,” it is implied that they are each performing a distinct part of the procedure, which means they can’t “share” the same documentation. Each physician should provide a note detailing what portion of the procedure he or she performed, how much work was involved, and how long the procedure took. Including a brief explanation of the need for co-surgeons will help to avoid denials and reimbursement delays.
Tip 3: Each physician must link the same diagnosis code to the common procedure code. Though this requirement may seem obvious, if two physicians serve as co-surgeons to perform one procedure, the diagnosis code(s) they link to the CPT® code should be the same. Before submitting a claim with modifier 62, someone...
When two surgeons work together to perform one procedure, each physician’s individual documentation requirements can get jumbled up. Make sure your physician isn’t passing the documentation buck and that he or she knows to follow these four tips when you submit claims with modifier 62.
Tip 1: Each physician should identify the other as a co-surgeon. Also make sure that the other physician is billing with modifier 62. A lot of confusion can arise when physicians from different practices are reporting the same procedure.
You may find yourself in a situation where one physician may report the other physician’s work as that of an assistant surgeon, in which case the claims would not correspond. This means a denial will hit your desk. One surgeon cannot simply indicate the other as the co-surgeon. Both physicians must submit claims for the same procedure, both with modifier 62. To accomplish this all you only need to call with a simple courtesy to the other physician’s billing or coding department.
Tip 2: Each physician should document her own operative notes. When surgeons are acting as “co-surgeons,” it is implied that they are each performing a distinct part of the procedure, which means they can’t “share” the same documentation. Each physician should provide a note detailing what portion of the procedure he or she performed, how much work was involved, and how long the procedure took. Including a brief explanation of the need for co-surgeons will help to avoid denials and reimbursement delays.
Tip 3: Each physician must link the same diagnosis code to the common procedure code. Though this requirement may seem obvious, if two physicians serve as co-surgeons to perform one procedure, the diagnosis code(s) they link to the CPT® code should be the same. Before submitting a claim with modifier 62, someone...
Do you ever meet with parents before their baby is even born? In these cases, you might be hesitant to charge for the visits because the patient isn’t present yet—but can you collect anything for the physician’s time? Check out the following 4 options, along with our expert advice before billing to insurance.
1. Consider an Office Visit
Some practices think of meet-and-greets, in which they tell the parents about the way they run their practice, more as an office visit, such as 99201. However, this would need to be billed based on time to the mother’s insurance company and would likely be questioned by the insurance company. For practices that do charge for these services, there’s a diagnosis code you can use: V65.11. ICD-9 guidelines allow you to list the code as a first or additional diagnosis.
2. Ensure You Meet Criteria Before Using 99401-99404
As an alternative to use a problem-oriented office visit code, the American Academy of Pediatrics (AAP) suggests the pediatrician may deem an appropriate counseling or risk factor reduction code. You may report these codes for prenatal counseling “if a family comes to the pediatrician/neonatologist either self-referred or sent by another provider to discuss a risk-reduction intervention (i.e., seeking advice to avoid a future problem or complication),” according to the AAP’s Coding for Pediatrics 2009.
You would report the service under the mother’s insurance, according to the AAP. Make sure you don’t use 99401-99404 if the mother or her fetus has any existing symptoms, an identified problem, or a specific illness. As per CPT®’s Counseling Risk Factor Reduction and Behavior Change Intervention guidelines, “these codes are used to report services for the purpose of promoting health and preventing illness or injury.”
Codes 99401-99404 aren’t necessarily shoo-ins for typical meet and greets. The AAP gives...
Question: Our state’s Medicaid carrier denies our claims when we submit 62311 with modifier 59 for postoperative pain management. They say the 62311 is bundled with the anesthesia procedure code. How should we handle this? -Ohio Subscriber Answer: ...