Audit / Cardiology / Oig / Provider News

OIG Auditors to Cardiologist: You’re Billing Medicare Properly

Report reveals what he and his billing staff did right. Does your practice have the right stuff? Turns out the old saying is true: If you haven’t done anything wrong, an OIG audit is nothing to worry about. A New York cardiologist who collected over $1.3 million over a three-year period for 5,061 claims caught the OIG’s [...] Related articles:

  1. Double Ultrasound Codes Spell Double Trouble With AuditorsAuthorities scrutinize medical necessity for 76830 & 76856. The OIG...
  2. Medicare Fraud Fighter Reveals 9 Billing Patterns That Draw HEATA Department of Justice senior trial attorney behind the widely...
  3. HHS Plans to Crack Down on Fraud, Improper BillingMedicare loses $60 billion a year in improper payments. A...

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October 20, 2009
Coding Challenge

How Do You Code Sigmoidoscopy with Anoscopy, Biopsy?

Question: Notes indicate that the gastroenterologist performs a rigid sigmoidoscopy; during the encounter, he also performs an anoscopy without anesthesia and three biopsies of the mucous membrane. How should I report this episode? Can I report the exam separately with 46600? Answer: You can report a single code for these three services. On the claim, report 45305 (Proctosigmodoscopy, rigid; with biopsy, single or [...] Related articles:

  1. CPT 45380 Challenge: Endoscopy with BiopsyQuestion: My gastroenterologist performs mapping biopsies on patients who have...
  2. Looking for Tonsil Biopsy Code?Question: My physician did a punch excisional biopsy of the...
  3. Is this Biopsy Mistake Costing Your Urology Practice $400 Per Claim? Tip: Look beyond the term ‘fulguration’ when you choose...

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October 13, 2009
Coding Challenge / E/M

E/M Coding Education: Does ‘No SOB’ Fall Under HPI or ROS?

Question: For a chart with a chief complaint of resolving pneumonia, a note indicates, “No coughing, SOB.” Should I give the pediatrician credit for this ‘no coughing & no shortness of breath’ statement under history of present illness (HPI) or as a review of systems (ROS)? Answer: This is a gray area of E/M coding that [...] Related articles:

  1. E/M Coding Focus: Geriatric Patients & DementiaDetermine HPI or ROS during assessment for geriatric patients. Your...
  2. Mid-Level E/M Coding BreakdownOur chart shows you how to choose among 99212, 99213 &...
  3. Test Your E/M Coding & Billing Savvy Are you an E/M Emeritus? Take this quiz to...

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October 12, 2009