After two years of following a doctor around the office as a medical assistant, Raina Diaz was ready for a change. “I wanted to be part of the back end…
Outpatient coders achieved higher average accuracy scores for the second consecutive year in Central Learning's nationwide ICD-10 coding contest. Contest participants coded a total of 4,471 medical record cases using…
Communication was the theme at the Code It Right conference last week as medical coders prepare for a massive transition to a new medical coding system known as ICD-10. “I…
Here are the pros and cons to help guide your decision.
Question: Our practice is considering accepting patients with PFFS plans. We’re heard that some patients are starting to have them, but we’re not sure whether we’re going to accept them or not. Are PFFS plans beneficial for us?
Answer: PFFS are Private Fee-for-Service plans, which are non-network plans. These plans let members receive care from any doctor or hospital that accepts the plan’s payment terms and conditions.
If your practice decides to accept these terms, you would become a “deemed” provider. Plan members can receive covered services from any deemed provider in the U.S. However, member patients must confirm that the provider is deemed every time a service is provided.
PFFS plans are different from Medicare Advantage plans because they do not require a doctor or hospital to contract with a health plan to provide services. This means that doctors or hospitals that do not agree to the PFFS plans’ terms and conditions may choose not to provide health care services to a plan member, except in emergencies.
Coming soon: Starting in 2011, PFFS plans will have to measure and report on their providers’ quality of care. But the catch is that they’ll also have to form provider networks with contracts.
In counties where there are two or more non-PFFS plans, PFFS plans will no longer be able to simply “deem” providers into the plan without a contract. Under current law, PFFS plans don’t have to prove they can meet access standards if they allow any willing qualified Medicare provider to participate, and they pay as traditional Medicare would pay.
One argument is that the network requirement would provide better access to care because there would be contracts between the providers of services and the plan. On the...
Understand what FHR involves and when patients benefit.
An initial femoral head resurfacing (FHR) procedure involves only the femoral head and not the acetabular socket of the hip joint. The surgeon mills the femoral head and implants a metal hemisphere over the bone that exactly matches the size of the original femoral head.
FHR helps “buy time” for patients whose disease or degree of progression doesn’t merit total hip replacement (27130, Arthroplasty, acetabular and proximal femoral prosthetic replacement [total hip arthroplasty], with or without autograft or allograft).
This is especially true for younger patients because femoral head resurfacing preserves more bone stock for possible later revisions.
Judy Larson, CPC, billing manager for Rockford Orthopedic Associates in Rockford, Ill., shares a few advantages of choosing FHR:
The metal head used during FHR will wear out the socket over time, however, and the patient will need total hip replacement.
Once the patient reaches the point of total hip replacement you’ll code the new procedure as a conversion with 27132 (Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft), says Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network.
@ Orthopedic Coding Alert. Editor: Leigh DeLozier, CPC
Sign up for the upcoming live audio conference, Coding Tips for Hip Procedures, or order the CD/transcripts.
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If you have a question, be sure to ask your physician.
Question: A patient reports to the ER at 8 a.m. on a Sunday morning. He reports a horrible toothache that started on Friday; he says he planned to “tough it out” over the weekend and see his dentist Monday, but the pain was too severe; he reports 10 on a 10-point pain scale. The ER physician performs an “inf. Aveo block,” according to the notes. What condition do the notes reflect, and how should I code this scenario?
Massachusetts Subscriber
Answer: You should double-check with the physician before filing...
Technical and professional components hold your clues.
What do insurers expect for documentation of tympanometry or other diagnostic tests? That’s the question Pediatric Coding Alert subscriber Paula Escobar with Riverside Pediatric Group asked, so we went looking for answers.
Starting...
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