E/M / Provider News

E/M Audits: MAC Sets Up Pre-Pay Edit for Code 99310

87 percent error rate leads to drastic measures. If you think CMS is only watching your E/M codes when it comes to the office or hospital, think again. One MAC recently reviewed nursing facility care claims and was stunned at the findings. NGS Medicare, a Part B payer in four states, announced on Jan. 26 that it [...] Related articles:

  1. The Truth About Self-AuditsAnd one crucial step you should never miss. How many...
  2. E/M Challenge: Can I Report 99214 and +99354?Counseling representing more than 50 percent of E/M visit? Choose...
  3. CMS Will Offer New Modifier to Denote Admitting Physician on ClaimsPop the champagne cork & get ready for brand new...

Comments Off on E/M Audits: MAC Sets Up Pre-Pay Edit for Code 99310
February 2, 2010
CMS / Coding Challenge / E/M

E/M Challenge: Can I Report 99214 and +99354?

Counseling representing more than 50 percent of E/M visit? Choose level based on time. Question: I have a family physician who documented 60 minutes on an established patient’s office visit. The FP diagnosed the patient with morbid obesity (278.01). Since the patient was newly diagnosed and had some difficulty understanding the doctor’s orders, the FP spent [...] Related articles:

  1. Asthma Attack Coding: When To Use Prolonged or High-Level E/M     Checklist deters payback requests for insufficient +99354...
  2. Does CNS Count as NP for Time-Based Coding? CNS = NP = PA for CPT, but Check...
  3. CPT 2010 Update: Non-Face-to-Face Prolonged ServicesNew Year’s hats & horns for looser guidelines that let...

Comments Off on E/M Challenge: Can I Report 99214 and +99354?
January 31, 2010
Coding Challenge / E/M / modifier 25 / modifier 50

How Do I Code a 2-Sided Nosebleed?

Heads up: 2 nosebleed codes are not the answer. Question: A patient reports to the ED after sustaining injuries during a soccer match; she was hit in the face with a ball, her nose is bleeding, and her right eye is blackened. The physician is not able to stop the bleeding with ice or pressure, so [...] Related articles:

  1. Is 30901 Your Nosebleed Code? Not So Fast?Hint: Look for these keywords in the note to select...
  2. Winter Laceration Repair: How Do I Code For Dermabond?Warning: Your coding will vary depending on who’s getting the...
  3. How Do I Code This Multiple Fracture Accident Patient?Question: A 30-year-old female presents to a rural ED with...

Comments Off on How Do I Code a 2-Sided Nosebleed?
January 19, 2010
Coding Challenge / modifier 25

Winter Laceration Repair: How Do I Code For Dermabond?

Warning: Your coding will vary depending on who’s getting the claim Question: A 60-year-old patient reports to the ED with a bandaged left hand. The patient says she was cleaning out the blades of her snow blower and cut her left index finger; the wound is wrapped in gauze, but it is reddening with blood. During [...] Related articles:

  1. Simple Laceration Repair Code or E/M Code? Answer Could Cost Hundreds Not recognizing a laceration repair that’s included in an...
  2. Coding Challenge: Dermabond for Laceration Repairs Question: The dermatologist treated an established patient with a...
  3. Does Dermabond Warrant Special Code? Question: A pediatrician uses Dermabond to close a patient’s...

Comments Off on Winter Laceration Repair: How Do I Code For Dermabond?
January 16, 2010
Coding Challenge / modifier 25

10060 Won’t Wash for Some I&Ds

Careful: A pilonidal cyst I&D is a separate animal. Question: A patient presents to the ED reporting pain in her spine. During the exam portion of a level-three E/M, the physician discovers that the painful area is red, and slightly warm to the touch. The patient also has a low-grade fever that she says she noticed about [...] Related articles:

  1. Winter Laceration Repair: How Do I Code For Dermabond?Warning: Your coding will vary depending on who’s getting the...
  2. Know What Separates FBR From E/M or Lose $80 in Pay Here’s why ‘incision’ with non-scalpel instrument could be an...
  3. Wound Closure Coding: Make the Simple, Intermediate DistinctionAccounting for depth is a tricky task when coding closure....

Comments Off on 10060 Won’t Wash for Some I&Ds
January 14, 2010
Coding Challenge / E/M

ED Coding Question: Observation or Other E/M Code?

Question: A 42-year-old patient reports to the ED early on Tuesday morning for evaluation of uncontrollable shaking in her extremities and severe pain in her neck. The EP admits the patient to observation at 7 a.m. and orders blood tests and a CT scan — however, the shaking continues to worsen. The EP consults with a [...] Related articles:

  1. Capture ‘Patient Limbo’ Period With These Observation Coding Steps Internist deciding on admission? That’s your signal to look...
  2. 5 Steps Ensure Correct Observation Care Coding To prevent ED denials, code service only when doc...
  3. Observation Coding Do’s and Don’ts What’s the POS for an ED hallway? Answers to...

Comments Off on ED Coding Question: Observation or Other E/M Code?
November 16, 2009
Coding Challenge / modifier 50

Is 30901 Your Nosebleed Code? Not So Fast?

Hint: Look for these keywords in the note to select the correct nosebleed code. Question: The internist stops a patient’s nosebleed. Is this always a procedure? Answer: No, if a patient reports with a nosebleed and the physician stops the bleeding with basic methods, you’ll typically opt for the appropriate-level E/M code. E/M methods: Code minimal attempts at [...] Related articles:

  1. Can You Code ‘Buddy Taping’ Separately? Question: An established patient complains of pain in her...
  2. Should You Code Presenting Symptoms Along With Dx? Question: An established patient complains of trouble breathing and...
  3. How Do I Code Blood Draw Plus E/M?Question: An established type II diabetic patient comes in for...

Comments Off on Is 30901 Your Nosebleed Code? Not So Fast?
November 11, 2009
Coder's Cranium / Medicare / Oig

Nonphysician Providers and Incident-To: Your Coding Questions Answered

Here’s why you should keep your physicians’ work schedules on file. Correctly billing your nonphysician practitioners (NPPs) incident-to services means the difference between 85 and 100 percent reimbursement. But if you bill incident-to haphazardly, you’re just waving a red flag at auditors. And those auditors are jonesin’ to find incident to billing problems. Just check out this [...] Related articles:

  1. Nonphysician Providers & Incident To ChecklistCheck state laws PLUS this crucial document. In last week’s...
  2. Steer Your Incident-To Coding Using These 4 Questions 100 percent pay possible if NPP follows internist’s care...
  3. Use This Incident-To Checklist to Breathe Easy During an Audit You don’t need to second-guess the way you bill...

Comments Off on Nonphysician Providers and Incident-To: Your Coding Questions Answered
October 25, 2009