Coder's Cranium

Think You Understand the New Consult Rules? Find Out Fast

Test your 2010 consultation coding understanding with these questions. Consultation coding has every practice on edge this year. Ensure that you’ve got a handle on this complicated coding and billing situation by trying your hand at this question. Question: When a visit with a Medicare inpatient that would normally have been coded as a consultation does not [...] Related articles:

  1. Think You Understand the New Consult Rules? Find Out FastCheck your 2010 consultation coding savvy. Find out if you’re...
  2. Ask 3 Questions to Head Off 2010 Consult Problems Before They Start Ever used an unlisted E/M code? Get ready. By...
  3. CMS Will Soon Issue Consult Code Replacement Advice, According to Open Door ForumPlus: You can now download a list of all practitioners...

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February 28, 2010
CMS / MAC / Provider News

CMS Delays Ordering/Referring PECOS Regulation Until 2011

Take the extra time to get your practice registered in PECOS — don’t wait until the end of the year, CMS reps say. Practices that were busily struggling to find out whether their ordering/referring physicians’ national provider identifiers (NPIs) were in the PECOS system can relax a little bit — at least until next year. If your physician performs [...] Related articles:

  1. CMS: Billing Co. Can’t Fill Out PECOS Form on Doc’s BehalfIf you’ve grown accustomed to a designated credentialing specialist in...
  2. A Press Release Is Not a Legal Ruling, PECOS Pundits Point OutKeep an eye on the Federal Register as you use...
  3. CMS Changes Course: Physicians Need Not Personally Complete PECOS ApplicationWhat a difference three months makes, especially when it comes...

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February 23, 2010
CCI / HCPCS / Hot Coding Topics / Medicare / modifier 59 / NCCI / Oig / Oncology

OIG Hit List: Perfect Your 38220, 38221, and G0364 Usage

Don’t sweat reporting 38220-59 if you meet these Medicare-approved conditions. If your oncologist takes both a bone marrow biopsy and a bone marrow aspiration, whether you’ll see Medicare reimbursement depends on the two guidelines below. But watch out: With OIG scrutiny and a HCPCS twist, these guidelines will put your coding savvy to the test. Append 59 [...] Related articles:

  1. Coding Education: Bone Marrow Harvesting for Autologous TransplantQuestion: Is there a CPT code specific to harvesting bone...
  2. Use This Podiatry Scenario to Perfect Your Emerging Technology ClaimsHint: If you try to use an unlisted code, be...
  3. Multiple Bronchoscopy Coding Crash Course Head off denials & ratchet up reimbursement with these...

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February 21, 2010
Coder's Cranium / ICD-9 / MAC

ICD-9 Coding: Stop Asking ‘Which Diagnosis Code Will Get My Claim Paid?’

Assigning an ICD-9 code merely to get your claim paid could land you in legal hot water. Medical coders face a lot of questions each day in the course of their work, but one question you should not be asking is “which diagnosis code should I put on this claim if I want to collect?” When [...] Related articles:

  1. What’s the Correct Diagnosis Code for a Urine Drug Test?Question: What is the proper ICD-9 code when the lab...
  2. 3 Pulmonary Diagnosis Coding TipsRemember to focus on acute conditions & exacerbations. Correctly reporting...
  3. Dx Coding Moves That Stop Denials for Chronic Pain ClaimsTip: Code prior conditions in these cases. Imagine your pain...

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February 21, 2010
CPT / ICD-9 / modifier 22 / modifier 52 / modifier 59 / Modifiers / surgery / Toolkit

8 Simple Steps Organize Your Op Note Coding

This aspect of op note coding is the “horse that pulls the cart.” Stuck on how to tackle this op note or those sitting on your desk? Follow this advice, provided by Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M. and co-presenter of the “Ob-Gyn Op Notes” session at the [...] Related articles:

  1. 3 Steps Take the Guesswork Out of Coding Vaginal Cuff Repairs Find out what colporrhaphy code you’ll use for an...
  2. Write an Appeals Letter That Works In 6 Simple Steps Transform the written word into reimbursement with these tips...
  3. Op Note Coding Clinic: Breast Reconstruction with AlloDermSurgeons now commonly use AlloDerm in a variety of surgeries,...

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February 11, 2010
CMS / E/M / MAC / Provider News

CMS Will Soon Issue Consult Code Replacement Advice, According to Open Door Forum

Plus: You can now download a list of all practitioners who can order/refer. If you’ve been confused about how to report low-level hospital visits now that consult codes are gone, you aren’t alone. CMS intends to tackle this problem by issuing more specific guidance on the topic in the near future. That’s according to a Feb. 2 [...] Related articles:

  1. CMS Open Door Forum: RACs Are BackPlus: Medicare officials clarify who can bill incident-to services and under...
  2. Proposed 2010 MPFS: $26 More for ‘Welcome to Medicare’ ExamCMS welcomed health care providers to an July 9 open...
  3. Ask 3 Questions to Head Off 2010 Consult Problems Before They Start Ever used an unlisted E/M code? Get ready. By...

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February 9, 2010
CMS / Provider News

AMA Chimes In On How to Report Consults for Non-Medicare Patients

Beware: Don’t use the CMS consult crosswalk for billing purposes. You may be seeing light at the end of the tunnel. The AMA just published an article to clarify the use of the consultation codes for non-Medicare patients, and talks about their efforts to get CMS to delay their new policy. You can find the article [...] Related articles:

  1. CMS Will Offer New Modifier to Denote Admitting Physician on ClaimsPop the champagne cork & get ready for brand new...
  2. CMS’s Refusal to Pay Consults Makes MSP Claims a HeadacheIf you bill consults to private payers, good luck collecting...
  3. Proposed 2010 MPFS: $26 More for ‘Welcome to Medicare’ ExamCMS welcomed health care providers to an July 9 open...

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February 4, 2010
Hot Coding Topics / modifier 59

What Lab Coders Need to Know About CCI 16.0

Look for transcutaneous hemoglobin limitations, and bundling for those new 2010 culture codes. Think you’re ready to use all those brand new CPT lab codes? Not so fast. You better learn Correct Coding Initiative (CCI) restrictions first, before you start billing Medicare for services using new CPT 2010 codes. CCI released version 16.0, effective Jan. 1, which includes 24,060 [...] Related articles:

  1. CCI 15.3 Update: You Can Resubmit Dozens of Previously-Bundled 22526 ClaimsNewsflash: CCI 15.3 retroactively deletes hundreds of edit pairs, but...
  2. What Interventional Radiology Coders Should Know About CCI 15.1 EXTRA–Radiology Reimbursement WEBINAR: Do you know the difference between...
  3. Can’t Locate an H. Pylori Lab Test Code? 2 Clues Point the Way Solve CLO test culture code dilemma and other mysteries....

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January 31, 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...

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January 31, 2010
CMS / Toolkit

Want to Integrate PQRI Measures Into Your Practice? Look Here.

Participation can put extra bread in your basket. Back again for 2010 is Medicare’s incentive-driven physician quality reporting initiative (PQRI), aimed at tracking quality metric or patient care services that physicians provide. When the practice treats enough patients in the same category, some PQRI dollars might be only a few codes away. If you know the basics [...] Related articles:

  1. PQRI 2010: Tips That Boost Your Practice’s RevenueFollow our links and advice to put more plusses in...
  2. New PQRI, E-Prescribe Tool from CMS If your head is spinning with all of the...
  3. Keep These 2009 PQRI Eye Care Measures HandyOphthalmologists and optometrists who want to recoup a bonus from...

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January 28, 2010
Hot Coding Topics / modifier 26 / RAC

Audits: HDI RAC Targets TC, Modifier 26 & More

Want to know what RAC contractors will be looking for next? Here’s the link. Recovery audit contractors (RACs) are working hard to expand their lists of approved issues, and you should keep a close eye on your services in these areas as well. Health Data Insights (HDI), the RAC contractor for Region D, posted 66 new approved [...] Related articles:

  1. CMS COVERAGE DECISIONS: MACs Can Make Exceptions to LCDsRACs can make exceptions only to approve claims. Coders know local coverage...
  2. RAC Fact Did you know that those new RAC auditors out...
  3. RAC Fact: Watch Out For Medicare’s Once-in-a-Lifetime Services G0389 & the IPPE codes may be potential RAC...

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January 26, 2010
Coding Challenge

Pulmonology Coding Challenge: Why Are My 94664 Claims Getting Denied?

Before coding 94664, check off these items. Question: Under the direction of my pulmonologist I recently submitted 94664 for reimbursement for training time, but the bill was rejected? Can I challenge this? Answer: You can challenge training denials, provided your documentation supports the education’s reason. However, “not all payers will pay for 94664,” notes Gary N. Gross, [...] Related articles:

  1. Surgery Coding Challenge: Master Microsurgery Units With This AdviceCheck your EOB to make sure payers don’t apply a...
  2. 52214 Coding Challenge: Fulguration, Then TUIBNCQuestion: If my physician went to do a TUIBNC and...
  3. Radiology Coding Challenge: Why is Medicare Denying a 38792, 78195 ClaimTip: Discover true meaning of 38792 note Question: The physician...

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January 21, 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...

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January 16, 2010
Medicaid / Provider News

Payer Update: UHC Sticks With Consult Codes

Check with Medicaid plans, insurer warns. You can breathe a sigh of relief — one major payer will stick with 99241-99255. UnitedHealthcare (UHC) commercial plans will make no change in payment for consultation codes (99241-99255) at this time, according to a UHC e-mail alert. “Physicians may continue to submit claims for these services, and will be reimbursed according to United-Healthcare payment policies”. Beware: One Medicaid [...] Related articles:

  1. Medicare’s Consult Rule Trickle Down Effect And what it means for pediatric practices. A report...
  2. Payer Update: NGS Directives Vs. Proper Skin Lesion CodingIgnore the LCD and stick with what you know about...
  3. Pssssssst. Payer Report Cards Are OutIf you know your payers’ strengths and weaknesses, you’re better...

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January 12, 2010
Hot Coding Topics

CMS’s Refusal to Pay Consults Makes MSP Claims a Headache

If you bill consults to private payers, good luck collecting the balance from Medicare secondary payers. Don’t even think about billing a consult to Medicare — even if it’s only a secondary payer claim. Medicare may have scratched consultations off of its list of payable services, but many other insurers did not follow suit. This leaves you in [...] Related articles:

  1. CMS Will Offer New Modifier to Denote Admitting Physician on ClaimsPop the champagne cork & get ready for brand new...
  2. Consultation 5 R’s Miss 1 element, and invite auditors to check out...
  3. VaVaVoom: V-Codes Give Your Claims a Smoother RideSo what’s the deal, exactly, with V codes? Here are...

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January 12, 2010
CCI / Coding Challenge

Radiology Coding Challenge: Why is Medicare Denying a 38792, 78195 Claim

Tip: Discover true meaning of 38792 note Question: The physician performed a sentinel node injection with lymphoscintigraphy. A note with 38792 states to report 78195 for imaging. So why did Medicare deny a claim that included both codes? Answer: You should report 78195 (Lymphatic and lymph nodes imaging) for this service and leave 38792 (Injection procedure; for [...] Related articles:

  1. CCI 15.0 Update for Radiology Coders 76942 and 78808 on a single claim needs a...
  2. Radiology Coding Challenge: Total Spine MRI Without Contrast Question: Which CPT code should I use for a...
  3. Radiology Coding Challenge: Rate Your Reformatting SkillsQuestion: My radiology report documents axial CT slices from the...

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January 10, 2010