The Current Procedural Terminology (CPT) manual offers guidelines on how to code for a “problem” that is addressed during a preventive medicine service. The guidelines cover “insignificant or trivial” problems…
Alexander Miller, M.D., a dermatologist in Yorba Linda, Calif., has a simple message for colleagues grappling with the new ICD-10 codes: Don't panic! "It's just a matter of restructuring one's…
A new year means new codes and new revenue opportunities for medical practices—but also new challenges to ensure the codes are used correctly. Below is a brief summary of new…
Recent survey results from the Workgroup for Electronic Data Interchange (WEDI) seem dire for physician practices, but the numbers may not tell the whole story. The WEDI survey, released amid…
Medicare audits have revealed recurring errors in billing with add-on and place-of-service codes. In addition, Medicare continues to receive claims that appear to be duplicate because they lack an appropriate modifier. Here are some guidelines for correct billing.
As patients, we don't have the thousands of dollars it costs to tap into the extensive database information required for the entire body of CPT codes. But the AMA does offer us an easy way to look up one code at a time, for free.
Providers, suppliers, billing companies and clearinghouses can submit ICD-10 acknowledgement test claims anytime up to the new planned October 1, 2015 ICD-10 implementation date. However, the Centers for Medicare and…
Information regarding the ICD-10 delay continues to trickle out of the Centers for Medicare and Medicaid Services. CMS has announced that the partial code freeze for ICD-9-CM and ICD-10 will…
Health Revenue Assurance Holdings Inc. (otcqb:HRAA) ("HRAA") a leading provider of revenue integrity solutions for healthcare provider organizations, announced its response to the one year compliance deadline delay for converting…
The American Physical Therapy Association (APTA) reports that due to the magnitude of proposed changes to an entire family of physical medicine and rehabilitation codes, the editorial panel of the…
The new ICD-10 acupuncture insurance billing diagnosis codes are mandatory beginning October 2014. Here is a list of easy ICD-10 codes for insurance billing and reimbursement. This system is very…
The Center for Medicare and Medicaid Services (CMS) has proposed switching wound care reimbursement from the current pay-for-service model, in which the treating physician bills the government based on the…
The numbers are in! According to the American Medical Association (AMA), there will be 329 total code changes in 2014, to include 175 new codes, 107 revised codes, and 47…
Before 2011, hospitalists had only Centers for Medicare & Medicaid Services’ (CMS) specialty-specific CPT distribution data, and no hospitalist-specific data, available when looking for benchmarks against which to compare their…
Bill all three or get a denial: supply, injection, and illumination. Coding for photodynamic therapy (PDT) involves three key components, which means you should look into multiple CPT® codes to describe your claim appropriately. But this could jeopard...
Reporting modifier 78 for a staged procedure? Expect denials.
When it comes to appending CPT® modifiers to your codes, the rules can be daunting, and Medicare’s regulations only compound the confusion. But if you’re up to speed on these key modifier billing practices, you’ll be raking in deserved pay.
Check out the following five tips to ensure that you aren’t missing any opportunities.
1. Don’t Avoid Modifier 26.
If your physician provides an interpretation and report for an x-ray or other radiological service in the treatment of a patient, that’s not always just part of his E/M—in some cases, you can separately bill for the interpretation and report by appending modifier 26 (Professional component) to the CPT® code.
Typically, the technologist that performed the patient’s x-ray will bill the code — such as 71010 (Radiologic examination, chest; single view, frontal) — with modifier TC (Technical component) to indicate that he is billing for the equipment, room charge, film and radiologic technician, but not for the physician’s interpretation. If the physician who renders the interpretation is with a separate professional group and is not a hospital employee, you should report the service with modifier 26 to obtain his proper share of the reimbursement.
2. Know the Difference Between Modifiers 58 and 78.
Because both modifier 58 and 78 describe procedures performed during another surgery’s global period, it can be easy to confuse them. But differentiating between the two can mean the difference between collecting your due and filing endless appeals.
Key: You’ll report modifier 78 (Unplanned return to the operating room for a related procedure during the postoperative period) when conditions arising from the initial surgery (complications) rather than the patient’s condition...