Provider News

CMS Changes Conversion Factor Yet Again

Plus: Look for an increase in your DEXA scan reimbursement.

The bad news: Your carrier won’t be paying your claims using the conversion factor of $36.0846 anymore.

The good news: CMS is only changing the conversion factor by less than a penny, making it $36.0791, according to CMS Transmittal 700, issued on May 10. MACs will use this 2010 conversion factor to calculate your payments, but keep in mind that after May 31, you’re still due to face a 21 percent pay cut unless Congress intervenes. Keep an eye on the Insider for more information on whether Congress steps in...

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May 16, 2010
Audit / Provider News

Auditors Review Your Notes Based on the Regs as of the Service Date

auditorIf you performed a consult in 2006, the auditor will use 2006 guidelines — not today’s rules.

Most Part B practices have grown accustomed to tucking consult regulations into the backs of their minds, since Medicare no longer pays for...

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May 12, 2010
Anesthesia / Hot Coding Topics / ICD-9 / MAC

Unlock Pay With Anesthesia V Code Advice

Don’t be caught asleep: Patient history is one element of proper Dx coding.

Many coders hesitate to report V codes, or simply use them incorrectly, but sometimes this section of ICD-9 most accurately describes the reason for the patient’s condition....

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May 6, 2010
Coding Challenge / E/M / modifier 90

Medical Coders: Use 36415 for Lab Draws

You have two options depending on the next step.

Question: Our vascular office performs blooddraws and analysis for a local hospital. Can we bill for a lab draw in an office setting, and if so, what codes should we use?...

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May 5, 2010
Coding Challenge / Medicare / modifier

Append Modifier Q6 for Fill-In Physician

Before using modifier Q6 for a non-Medicare patient, check with the commercial payer — here’s why.

Question: We hired a locum tenens for two weeks. Do we code the same for the replacement physician as for a full-time...

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May 2, 2010
Coding Challenge / E/M / radiology

Radiology Medical Coders – Tighten Up Your LAP-BAND Coding

If your radiologist performs adjustments during the bariatric surgery’s global period, do this.

Question: Our radiologists perform percutaneous LAP-BAND adjustments. We report S2083 for the service and 77002 for the fluoroscopy. Is this the correct fluoroscopy code?

Connecticut Subscriber

Answer:...

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April 26, 2010
Coding Challenge / modifier 22

Surgical Coding: Follow Hernia Bundling Rules

Did you factor in a foreign body removal code?

Question: During an open hernia repair for a reducible umbilical hernia, the surgeon finds a sizeable gallstone embedded in the omentum extending into the preperitoneal fat. The surgeon excises the...

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April 22, 2010
Coding Challenge

Check for Fracture Diagnosis Before Coding Repair

Don’t code a closed fracture treatment code without more information.

Question: Our orthopedist saw a patient in the emergency department for a gunshot wound and diagnosed a metacarpal fracture. He irrigated the site and removed a foreign body. Can we...

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April 22, 2010
CCI / Hot Coding Topics

CCI 16.1: This Electrophysiology Edit Deletion Is Official

If you’ve been holding study claims, the time to send them in is here.

Correct Coding Initiative (CCI) version 16.1 has the news you’ve been waiting for.

The latest version, effective April 1, deletes 142 edit pairs, Frank D. Cohen,...

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April 22, 2010
Coder's Cranium / modifier 22

2 Tips Lead to Modifier 22 Success Every Time

Watch frequency and provide documentation to rationalize extra pay.

Applying modifier 22 (Increased procedural services) can help increase reimbursement if your neurosurgeon documents a greater-than-usual effort during a surgical service. To ensure your claims’ success, surgeons and coders must also...

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April 15, 2010
E/M / Hot Coding Topics / modifier 25

Follow 3 Steps on the Path to Paid Cerumen Removal

Medicare won’t pay 69210 alone, so here’s how to unlock payment.

Impacted cerumen removal is a fairly straightforward procedure, but billing for the procedure is not always so simple.

The problem: Most payers, including Medicare,consider 69210 (Removal impacted cerumen [separate...

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April 15, 2010