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
Hot Coding Topics

PQRI 2010: Tips That Boost Your Practice’s Revenue

Follow our links and advice to put more plusses in your claims column 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 [...] Related articles:

  1. Smokin’ PQRI Pointers We’ve got the G codes you need to score...
  2. PQRI: No Coumadin Due to Fall RiskPlus, experts at the AMA meeting in Chicago tell you...
  3. Accurate Diabetes ICD-9 Coding = PQRI BonusInternal medicine providers interested in a year-end bonus from Medicare...

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January 9, 2010
Coding Challenge / radiology

Radiology Coding Challenge: Total Spine MRI Without Contrast

Question: Which CPT code should I use for a total spine MRI without contrast? Answer: You won’t find a single CPT code that describes a “total spine” MRI, but you may report a code for each region the radiologist examines: • 72141 — Magnetic resonance (e.g., proton) imaging, spinal canal and contents, cervical; without contrast material • 72146 — Magnetic resonance (e.g., [...] Related articles:

  1. Which HCPCS Code Should I Use for Eovist MRI contrast? Question: Which HCPCS code should I use to report...
  2. Radiology Coding Challenge: Rate Your Reformatting SkillsQuestion: My radiology report documents axial CT slices from the...
  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 5, 2010
Provider News

News from the Feds: Last-Minute MPFS Change & Proposed HITECH Rule

We’ve got the links you need to keep up with these bottom-line changers from HHS, CMS. While most of us were celebrating the last few days the Old Year and preparing to welcome the New Year, the federal regulators had one last, little rulemaking frenzy for 2009. The result is a 555-page proposed rule implementing the [...] Related articles:

  1. Proposed 2010 MPFS: $26 More for ‘Welcome to Medicare’ ExamCMS welcomed health care providers to an July 9 open...
  2. Proposed 2010 Physician Fee Schedule: A Closer Look21.5 percent cut looms for your services Last week, Coding...
  3. ARRA Sharpens HIPAA’s TeethSurprise! The stimulus package gave us new HIPAA requirements that...

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January 5, 2010
Coding Challenge

How Do I Code An Arthroscopic To Open Ankle Surgery?

Question: Our surgeon attempted to remove a loose body in the ankle arthroscopically, but it was too large so he had to perform an open removal. Do I bill only for the open procedure, or include the arthroscopic attempt as a discontinued procedure? Answer: Because your surgeon completed the procedure as an open case, you’ll report [...] Related articles:

  1. 4 Tips Position Your ‘Multiple Scope’ Codes PerfectlyOrtho coders: Here’s what you should do when there’s no...
  2. Coding Challenge: Foot Foreign Body Removal Vs. Soft-Tissue FBRQuestion: Our physician performed a foreign-body removal (FBR) on a...
  3. Medicare Coverage for Bariatric Surgery: Do You Know These BMI Guidelines?Question: I heard that Medicare made some changes about diabetic...

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January 3, 2010
Coding Challenge

Urology Reimbursement: Coding for MESA, TESA

Question: Could you please give me the most current coding guidelines for the MESA and TESA procedures? The last I was aware, we were to use unlisted procedure codes. Is that still correct? Answer: You should still use unlisted procedure codes to report microsurgical epididymal sperm aspiration (MESA) and testicular sperm aspiration (TESA, sometimes called TESE [...] Related articles:

  1. Urology Coding Challenge: Gold Seed Marker Placement Plus TRUS Question: How should I report the placement of gold...
  2. Urology CPT 2010: 3 New Codes, 2 Deletions Change Your Urodynamics CodingUrodynamics income will go down by half, experts calculate. You will...
  3. Wake Up Your Reimbursement By Capturing Sedation Pay Reporting CS with a ‘targeted’ service puts a denial...

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December 16, 2009
Medicare / Provider News

CMS Will Cover HIV Screening As Preventive Care Service

Bonus: Effective immediately! You’re probably accustomed to CMS taking away coverage for certain services, but in an early holiday gift to practices, CMS has actually added a preventive care service to its roster of covered screenings, effective immediately. CMS issued a final decision on Dec. 8 declaring that HIV testing will now be covered for Medicare beneficiaries [...] Related articles:

  1. Show Us the Money for Primary CareAlmost everyone agrees that federal and private insurers should reimburse...
  2. Colorectal Cancer Screening: A Medicare Coding & Billing FAQ Steer clear of G0121 denials with these tips. If...
  3. Good-Bye Fee-For-Service, Hello ‘Episodes of Care’It’s not like we’re going to go back to capitation...

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December 15, 2009
E/M / Hot Coding Topics / modifier 59

CCI 16.0: Now Allows a Modifier to Separate Hundreds of Edits

But other new bundles that 16.0 has in store might put a dent in your reimbursement. You may still be poring through your 2010 CPT manual, but the new edition of CCI, effective Jan. 1, is already looking to make some code pairings impossible. The Correct Coding Initiative (CCI) released version 16.0 earlier this week, revealing 24,060 [...] Related articles:

  1. CCI 15.1: Adhere to These Osteotomy, Laminectomy Edits You’ll need a modifier on this code pair to...
  2. CCI 15.2 Retracts Neurostimulator Edits from 15.1Look for new edits that affect eye exam codes, anesthesia,...
  3. CCI 15.3 Update: You Can Resubmit Dozens of Previously-Bundled 22526 ClaimsNewsflash: CCI 15.3 retroactively deletes hundreds of edit pairs, but...

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December 15, 2009
Coder's Cranium / CPT 2010

The ASC Coder’s Resource Guide for 2010

Here’s a quick, handy way to get to all of Medicare’s new rules and reimbursement rates Ambulatory surgery center coders have a lot to learn for 2010, stressed Joanne Schade-Boyce at the ASC 2010 Coding & Reimbursement Update in Orlando. It’s absolutely essential that ASC coders study the AMA’s CPT Changes this year, Schade-Boyce recommended. Why? [...] Related articles:

  1. Coder’s Anatomy: ‘Dorsal’Da Dum. Da Dum. DaDumDaDumDaDum. If you can’t always remember...
  2. A Coder’s Guide to Health Care ReformQuick way to show your practice you’re prepared for the...
  3. Op Note Decoder Ring: Red Flags for Multiple ProceduresNever rely on an op note’s “procedure performed” line for...

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December 12, 2009
CPT 2010 / Hot Coding Topics / Pain Management

Facet Joint Injection Coding for 2010

Marvel Hammer’s Quick Start Guide to changes you’ll face in 2010. Tons of pain management coders gathered at the Orlando conference this week, and everyone was abuzz about the coding changes the painful reimbursement cuts their practices are going to get next year. Some big news: Effective January 1, 2010 radiological imaging will be required and bundled [...] Related articles:

  1. MAC Auditors Will Stick It To Facet Joint Injection Claims We hook you up with CMS instructions for when...
  2. Pain Management Coding Update: Facet Joint Injection CPT Changes for 2010Pain management, anesthesia, orthopedic, physiatry & neurology coders get ready...
  3. Audit Hot Spot: Facet Joint Injection ClaimsHere’s why the OIG wants to stick it to facet...

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December 8, 2009
Coding Challenge / radiology

How to Code for Screening Mammogram When Radiologist Finds Problem?

Watch out: Results don’t turn screening into diagnostic Question: A patient presented for a screening mammogram, and the radiologist determined the patient needed an ultrasound for a closer look. The patient returned for that test at a later date. Should I code the original mammogram as 77056 instead of 77057 because the radiologist found a possible [...] Related articles:

  1. Radiology Billing Checklist: Rules for Additional Tests without Treating Physician’s OrderKeep these additional test rules at your fingertips if your...
  2. Diagnostic Radiology ICD-9 Code Update: New Mammo Code 793.82 New code 793.82 shakes up the whole 793.x range...
  3. Radiology Coding Tips: Mammograms, CTs, MRIs and MoreRadiology coding is multi-faceted. Here are some foolproof radiology coding...

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December 5, 2009
Coding Challenge / modifier 52 / multiple wake test

Can a Sleep Study Code Describe an Awake Test?

Question: A sleep study was ordered for a patient diagnosed with hypersomnolence. The neurologistincluded a multiple wake test in the sleep study. What CPT code should I use for the multiple wake test? Answer: You should use 95805 (Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during [...] Related articles:

  1. Protect Sleep Study Pay With These Documentation Essentials How to keep your polysomnography claims off Medicare’s hit...
  2. Sleep Study Reimbursement: How to Claim Your Piece of the Pie Medicare promises to cover facility and home-based testing —...
  3. CMS: Apnea is Key for Sleep Testing Coverage Medicare benes who suffer from obstructive sleep apnea (OSA)...

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November 29, 2009