Question: I’m receiving contradictory guidance on which modifier to use when a gastroenterologist does an incomplete colonoscopy. Should I use modifier 52 or 53? Answer: CPT 2011 ends the days of arguing over whether to use modifier 52 or 53 for ...
Get ready to change your flu vaccine product code 90658 to one of four Q codes. For 2010, report 90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use) to signify that your physici...
Medicare beneficiaries will be thrilled that Medicare will cover annual well checks. The Center for Medicare introduces a new benefit of wellness visits for beneficiaries annually, except during the year of their Welcome to Medicare exam. You’ll use ...
Medically unlikely edits ignorance could be causing you medical coding claim denials.
Ensure you’re not letting medically unlikely edits (MUEs) wreak havoc on your urology practice’s coding and reimbursement by uncovering the truth about four aspects of these edits.
Myth 1: MUE Edits Don’t Affect Your Practice
Some practices feel that they don’t need to worry about MUEs.
Reality: “They limit the frequency a CPT code can be used,” says Chandra L. Hines, business office manager at Capital Urological Associates in Raleigh, N.C. “With our specialty of urology, we need to become aware of the denials and not let every denial go because the insurance company said it was an MUE. We should all be aware of MUEs as they occur, and we cannot always control whether or not we will receive payment.”
The MUE list includes specific CPT or HCPCS codes, followed by the number of units that CMS will pay. CMS developed the MUEs to reduce paid claims error rates in the Medicare Program. The first edits were implemented in January 2007, although some of the edits themselves became public in October 2008.
Some MUEs deal with anatomical impossibilities while others edit automatically the number of units of service you can bill for a service in any 24-hour period. Still others limit codes according to CMS policy. For example, excision of a hydrocele, bilateral (55041) has a bilateral indicator of “2,” so you should never bill two or more units of this code. Additional edits focus on the nature of the equipment for testing, the study or procedure, or pathology specimen.
Anatomical example: The MUEs edit out and deny an erroneously coded claim for a circumcision (54161, Circumcision, surgical excision other than clamp, device or dorsal slit; older than 28 days of age) for a patient...
You can sit back and enjoy the fall foliage spectacle — SuperCoder.com’s got your ICD-9-CM 2011, National Correct Coding Initiative 16.3, and October Medicare Physician Fee Schedule medical coding updates covered. Go ahead and search for th...
Study frequency guidelines before you bill for counseling services.
Question: A 60-year-old established Medicare patient with a confirmed diagnosis of vanishing lung (emphysema) reports to the family physician (FP) for a medication check and blood work; the patient is a moderate smoker. During the medication check and blood work, which took about 5 minutes, the patient tells the practice’s non-physician practitioner (NPP) “I think I’m ready to quit smoking; can you help?” The NPP spends the next 7 minutes providing smoking cessation counseling for the patient. Can I report a cessation code and an E/M?
Answer: Provided the patient meets Medicare’s requirements for cessation counseling, you can report the following:
Know the rules: According to Medicare, its patients are entitled to smoking and tobacco use cessation counseling provided the patient is either:
Additionally, note these two frequency guidelines for spot-on 99406 and 99407 (… intensive, greater than 10 minutes) claims:
...
Don’t lose 19342 pay for delayed insertion.
Your general surgeon may perform breast reconstruction following cancer, infection, trauma, or burns, or in some cases, strictly for cosmetic reasons. Make sure you capture appropriate implant pay, when that’s part of the surgical scheme, by following our experts’ tips.
Tip 1: Prosthesis’ Purpose Drives Coding
Breast implants commonly serve two functions — cosmetic breast enhancement or breast reconstruction following a disfiguring event such as mastectomy for cancer or a traumatic injury.
CPT divides implant codes based on the function, so that’s the first distinction you need to make when selecting the proper code.
Differentiate augmentation: Use 19325 (Mammoplasty, augmentation; with prosthetic implant) when the surgeon implants a breast prosthesis for breast enlargement. “Code 19325 describes cosmetic implants only,” emphasizes John F. Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop and Associates.
When the surgeon implants a prosthesis to reconstruct the breast following mastectomy, you need to look elsewhere for a code. For silicone or saline implants involved in reconstruction, CPT provides the following two codes:
Tip 2: Timing is Everything for Implant Placement
CPT provides 19340 and 19342 for breast prosthesis associated with mastectomy or mastopexy. You’ll decide between those two codes based on when your surgeon performs the implant procedure.
How it works: For patients whose physiology will accommodate a full-size saline- or silicone-filled prosthesis, your surgeon may place the implant immediately following the mastectomy. “If the surgeon inserts a breast implant at the same operative session as the mastectomy, you should report 19340,” Bishop says. “For our mastectomy patients who opt for reconstruction, immediate treatment is the most common...
Discover why coding a myofascial flap twice is a big mistake.
Question: Our surgeon performs an abdominal closure using left and right myofascial advancement flaps. I believe we should code one unit of 15734 because flap codes refer to the...
On Tuesday evening, the Senate passed H.R. 4691, which freezes the Medicare conversion factor at current levels through March 31.
Because of this vote, you will not face the 21% pay cut until April 1, explains Part B Insider editor,…
Related articles:AdreView gets its own ‘A’ code, too. You can leave confusing “not otherwise classified” codes behind for a few more of the contrast agents that you use. For services on or after Jan. 1, be sure you’re using the product-specific codes detailed below. Not using the proper codes will lead to claim rejection, which means “not receiving [...] Related articles:
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