Don’t separately report a cursory H&P from the sleep code.
Question: If a nurse practitioner (NP) performed an H&P (history and physical exam) or a subsequent visit with a patient prior to a sleep study, can you bill the H&P...
Knowing how to use add-on codes can net you up to $258 in additional reimbursement.
CPT is full of “add-on” codes, additions to minor and major surgical procedures as well as to E/M services. Fortunately for urology there are not…
You may need to append modifier 25, depending on payer policies.
Question: Our physician billed 90634, 90710, and 90606 for vaccines given to a 5-year-old patient. The insurance company denied payment and said they required a modifier. What should we…
Insurers might want to see a clear explanation as to why the E/M was necessary.
Question: An established patient with a plan of care in place for her gastroesophageal reflux disease (GERD) reports to the gastroenterologist; two weeks ago, the…
Don’t forget to include the code for the arthrocentesis.
Question: A new patient sees the orthopedist because of shoulder problems. The physician schedules an MRI and the patient returns the following week to discuss the findings. The physician had already…
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Check out these ICD-10 ob-gyn diagnosis coding equivalents.
Question: A patient presented for an initial OB visit. Another clinic confirmed her pregnancy, but she has never received prenatal care. The patient got her usual initial OB service (i.e. lab orders),…
Choose the service level using the documented history, exam, and MDM. Question: A new patient with a chronic gastric ulcer meets the gastroenterologist for management of her condition. The gastroenterologist meets for 34 minutes with the patient, and performs an expanded problem focused history and exam and straightforward medical decision making. The note also indicate that [...] Related articles:
Explore these three “what if” scenarios to perfect your FBR claims. Your foreign-body removal (FBR) coding can vary greatly depending on the type of foreign body, its anatomic location, and the depth from which the physician must remove it. Here are three case studies to help you find your way. Case 1: No Incision Means No Separate [...] Related articles:
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:
Tip: Make sure the ICD-9 coding & documentation support follow-up visits after the global. Question: Code 19101 has a 10-day global period, which means you cannot bill an E/M for anything related to that procedure within that time frame. If the patient continues to have follow-up visits outside the global period, should we then report the [...] Related articles:
Ever used an unlisted E/M code? Get ready. By now, you’ve heard that CMS is doing away with all inpatient (99251-99255) and outpatient (99241- 99245) consultation codes in 2010 — but are you prepared for the issues this may cause, starting Jan. 1? Ask these three questions of your practice and payers, and you’ll fend off [...] Related articles:
New rules for consult coding straight from the AMA Meeting in Chicago — plus where your practice will gain and lose reimbursement. If you can’t figure out how to match a low level consult to an initial hospital care code, you’re not alone. Code 99251 doesn’t crosswalk to 99221, agreed William J. Mangold, Jr., MD, JD, Noridian [...] Related articles:
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:
Question: My physician removed a catheter in an outpatient hospital exam room. Should I include this removal as part of the E/M? If E/M is appropriate, will the hospital also report an E/M? And, if so, do the physician and hospital E/M codes need to match? Answer: You should include simple Foley catheter removal as part [...] Related articles:
CNS = NP = PA for CPT, but Check State Law Question: Does a certified nurse specialist (CNS) count as a nurse practitioner (NP) for reporting 99213 based on time? Answer: Yes, for CPT purposes, a certified nurse specialist billing under his own provider number counts the same as a nurse practitioner or physician assistant. So if [...] Related articles: