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2013 OIG Work Plan: HHS Targets Three Areas
For The Record

From a coding perspective, mechanical ventilation, cancelled surgeries, and Medicare’s transfer policy take top billing in the OIG work plan for 2013.

Last October, the Office of Inspector General (OIG) released its work plan for fiscal year (FY) 2013, an event that sometimes can trigger anxiety among health care organizations. Published annually, the work plan outlines the OIG’s enforcement priorities, enabling health care facilities to better identify compliance risks and more accurately gauge their chances of meeting the requirements.

According to the OIG, the work plan is part of “a dynamic process, and adjustments are made throughout the year to meet priorities and to anticipate and respond to emerging issues with the resources available. We assess relative risks in the programs for which we have oversight authority to identify the areas most in need of attention and, accordingly, to set priorities for the sequence and proportion of resources to be allocated.”

In creating the work plan, the OIG evaluates several factors, including mandatory requirements by law, regulation, or directive; congressional, Health and Human Services (HHS), or Office of Management and Budget requests and concerns; management and performance challenges facing HHS; collaborative work performed with partner organizations; and management’s responsiveness to results from previous reviews. Among OIG’s areas of focus for 2013 are coding related to payments for mechanical ventilation and cancelled surgeries as well as Medicare’s transfer policy.

Read More: http://www.fortherecordmag.com/archives/0613p22.shtml

 

Cardiology: 93010 Is Sometimes the Right Choice on Cardiac ?ť?ŠCath ?ť?ŠDay

The Coding Institute

ECGs are bundled into cardiac catheterizations. But if you overlook opportunities to report ECGs on cardiac catheterization days, you could be shortchanging your practice. ?ť?ŠMedicare offers rules for reporting ECGs on the same date as cardiac catheterizations. The gist is that routine ECGs performed during cardiac caths are not billable in addition to the cardiac cath. But you may bill separately for diagnostic ECGs performed before or after the cardiac cath service. Here’s a closer look.

During cath: Medicare’s Correct Coding Initiative (CCI) manual, Chapter 11, Section I.4, indicates that because ECG monitoring is routinely used during cardiac catheterization, ECG codes aren’t reportable in addition to cardiac cath codes.

(The manual is available from the Downloads section at www.cms.gov/Medicare/ Coding/NationalCorrectCodInitEd/index.html.)

Note the Diagnostic Exception

Although ECGs that are an integral part of the cardiac cath aren’t separately payable, the patient may have diagnostic ECGs before or after the cath session. Those diagnostic ECGs are separately payable by Medicare when you append modifier 59 (Distinct procedural service) to the ECG code.

The CCI manual, Chapter 11, Section I.16, supports this by stating, “Cardiac catheterization procedures or a percutaneous coronary artery interventional procedure may require ECG tracings to assess chest pain during the procedure. These ECG tracings are not separately reportable. Diagnostic ECGs performed prior to or after the procedure may be separately reportable with modifier 59.”

Note: Don’t confuse standardized patient care with diagnostic ECGs. Some physicians will routinely order an ECG before and after a cardiac catheterization and/or interventional procedure. This is considered standardized patient care.

Helpful: If you’re having trouble determining whether the service performed meets the definition of diagnostic, consider the requirements listed in the National Coverage Determination (NCD) for Electrocardiographic Services (Section 20.15). The NCD manual is available by clicking the link for Publication 100-03 at www.cms.gov/ Regulations-and-Guidance/Guidance/Manuals/Internet- Only-Manuals-IOMs.html.

Use the Appropriate Code for Diagnostic ECG

Once you’ve determined that a patient had a reportable ECG on the same date as a cardiac cath, you need to choose the correct code. For interpretation and report of a typical 12-lead diagnostic ECG performed in a facility, the appropriate code is 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only). Recall that to override the cardiac cath/ECG edit, you must append a modifier to the ECG code.

Tip: The code definition refers to “at least 12 leads.”?ō For proper coding, you should know that a “lead”?ō and an “electrode”?ō are not the same thing. For instance, providers may refer to 10 electrodes placed on a patient for a 12-lead ECG. To simplify, think of a lead as an electrical view or snapshot of the heart from a particular perspective, creating what the provider sees on the graphic representation. A combination of electrodes can provide a single lead.

The use of “at least”?ō in the 93010 code definition is also important because it means the code is appropriate for 12 or more leads. ?ť?ŠConsequently, 93010 is correct when documentation shows 10 electrodes for a 12-lead ECG or 14 electrodes for a 15- lead ECG because in both cases there are 12 or more leads.

Bottom line: On cardiac cath days, experts advise only coding ECGs ordered/documented as diagnostic and performed before or after the cardiac cath. Baseline screenings or monitoring ECGs are not considered diagnostic.

 

Gastroenterology: How to Have Stress-Free GI Pressure, Transit Measurement Reporting

The Coding Institute

You can improve your CPT?ę 2013 code 91112 claims success if you focus on whether or not the procedure was complete and concentrate on who owns the equipment for the procedure. These codes replaced the former Category III codes 0242T.

Check Payer Rules for 91112

When your gastroenterologist performs a wireless capsule test for GI pressure and transit measurement, you will report the procedure and the interpretation of results using 91112 (Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report).

Note: Many payers still consider the procedure of using a wireless capsule to measure GI pressure and transit as investigational and might not provide coverage for the procedure. Many payers also mention that this procedure needs pre-authorization, so check with payers’ coverage policies to avoid the risk of denials.

Append Suitable Modifiers for Discontinued Procedures

Your gastroenterologist may attempt a capsule study for pressure and transit measurement but may need to discontinue the procedure. One such scenario is when the patient has difficulty swallowing the capsule. In such a situation, you will have to append modifier 53 (Discontinued procedure) to 91112 to indicate the incomplete work. Another situation that warrants you to report this modifier is when the capsule gets retained in the stomach.

If your gastroenterologist repeats the procedure by placing the capsule endoscopically in the duodenum for the repeat procedure, then you need to report the procedure using 91112 and the modifier 52 (Reduced services) to the code to indicate that your gastroenterologist used the wireless capsule to measure pressure and transit in the areas beyond the stomach.

Reminder: Don’t forget to report the endoscopy that your gastroenterologist performed to place the capsule. You will have to report it with 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

Separate Components When Appropriate

When reporting 91112 for GI transit and pressure measurements, you will have to check who owns the equipment that is being used. If your gastroenterologist owns the recording device and provides the capsule for the procedure, you will just have to report the entire procedure and the interpretations along with the report using 91112.

However, if your gastroenterologist is only providing interpretations and prepares the report for the GI transit and pressure measurements, and the hospital owns the equipment, you will have to report components of 91112 separately. In such a scenario, you will have to report the services of your gastroenterologist using 91112 with the modifier 26 (Professional component) and the hospital will report its part using 91112 with the modifier TC (Technical component).

 

Internal Medicine: Injection Administration Coding Edits–New?ŠBundling Policies

The Coding Institute

The latest update from the Correct Coding Initiative (CCI) brings some limited–but good–news for internal medicine physicians: approximately 30 edits involving immunization administration and evaluation and management (E/M) services now have a modifier indicator of 9, meaning that the previous bundles have been deleted and are no longer valid. The changes took place April 1, 2013, when CCI 19.1 became effective, and the deletion date is January 1, 2013, indicating the change is retroactive to the first of the year.

The explanation for the changes falls under “CPT?ę manual or CMS manual coding instructions.”?ō

Six immunization administration codes are part of the reversed edits:

– ?ť?Š90460 –?ŠImmunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered

– ?ť?Š+90461–?Š?Š…each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure)

– ?ť?Š90471 –?ŠImmunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)

– ?ť?Š+90472?Š1–?Š?Š…each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

– ?ť?Š90473 –?Š?ŠImmunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)

– ?ť?Š+90474 –?Š?Š…each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure).

You can now report these administration codes in conjunction with any level of inpatient consultation without the necessity of appending a modifier to the inpatient consultation code to get both services paid, according to specialists. The affected codes are:

“Unfortunately, the other edits bundling office, outpatient, and preventive E/M services with vaccine administration codes in the absence of a valid modifier remain in place,”?ō a coding specialist notes. “That means you’ll need to continue appending a modifier, such as 25, to an affected E/M code provided at the same encounter as a vaccine administration to get paid for both services under the CCI edits.”

Exception: The one exception is 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services.). Code 99211 is bundled with a vaccine administration code, regardless of whether you include a modifier.

Recoup: The deletion date for these edits is January 1, 2013, which suggests that the change is retroactive to that date. If you had any services denied on the basis of these particular edits for dates of service between January 1 and April 1, 2013, you may want to consider appealing the denials on the basis of CCI release 19.1.

 

Neurology: 4 Tips for Conquering Carpal Tunnel Coding Challenges

The Coding Institute

A lack of definitive results from diagnostic tests can complicate carpal tunnel coding. Take care not to jump to a definitive diagnosis code. But this does not mean you will compromise on payment. Follow these tips to ensure you earn what you should for carpal tunnel cases.

1. Don’t Jump to a Diagnosis Too Soon

When your neurologist treats carpal tunnel syndrome (CTS), you usually report diagnosis code 354.0 (Carpal tunnel syndrome).

Note: Your neurologist may document “suspected”?ō CTS in the clinical record. If so, don’t report the definitive diagnosis code 354.0 just yet. While your neurologist is waiting for test results, you should report the patient’s symptoms in support of any services your physician provides.

Reason: ICD-9 official guidelines instruct you to use signs and symptoms codes in the office setting when your neurologist documents an uncertain diagnosis. According to ICD-9, “Do not code diagnoses documented as ‘probable,’?ō ‘suspected,’ ‘questionable,’ ‘rule out,’?ō or ‘working diagnosis,’?ō or other similar terms indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit.”

You may find the ICD-9 guidelines on the CDC website: http://www.cdc.gov/nchs/ icd/icd9cm_addenda_guidelines.htm#guidelines

2. Check for Diagnostic Testing

To establish a diagnosis of CTS, your neurologist may perform nerve conduction studies (NCS) and/or electromyography (EMG). Each one has its own diagnostic significance.

You report 95860 or 95861 only when no NCS is performed. If both NCS & EMG are performed, then you need to look at either add-on code +95885 (Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited [List separately in addition to code for primary procedure]) or +95886 (Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels [List separately in addition to code for primary procedure]).

Watch for the complete limb EMG. Additionally, the 95860 (Needle electromyography; 1 extremity with or without related paraspinal areas) — 95864 (Needle electromyography; 4 extremities with or without related paraspinal areas) codes, as well as the 95886 code is ONLY billed when a complete limb EMG study has been performed — testing performed on five or more muscles studied, innervated by three or more nerves or four or more spinal levels’ otherwise the code would be 95870 (Needle electromyography; limited study of muscles in 1 extremity or non- limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters) if no NCS are performed.

Count nerves for NCS: You select from codes 95907 (Nerve conduction studies; 1-2 studies) — 95913 (Nerve conduction studies; 13 or more studies) depending upon the total number of separate nerves that are tested.

3. Submit Single Code Once Diagnosis Is Established

When your neurologist has established the diagnosis of CTS, focus on code 354.0. In this case, you do not report the codes for the signs or symptoms, such as numbness, tingling or finger pain. According to ICD-9, “Signs and symptoms that are integral to a disease process should not be assigned as additional codes.”

Reason: Your neurologist may be doing nerve conduction studies and/or electromyography to confirm the diagnosis of CTS. In this case, do not report the signs and symptoms as secondary diagnoses as these are integral to the primary definitive diagnosis.

4. Code for the Treatment Provided

Your neurologist may begin with noninvasive, conservative treatments in the early stages of CTS and include injections in later stages of the disease.

Initial treatment may include pain-relieving medications and a wrist brace or splint.

When pain-killers, splints, and physical therapy have failed or cannot be used for one or more reasons, your neurologist may administer injections into the carpal tunnel to perform a nerve block and relieve the symptoms. If so, submit 20526 (Injection, therapeutic [e.g., local anesthetic, corticosteroid]; carpal tunnel). Depending upon what option your payer prefers, you report either modifier 50 (Bilateral procedure) or modifiers LT (Left side) and RT (Right side) when your neurologist injects both carpal tunnels.

If the symptoms still persist, your neurologist may refer the patient for surgical treatment to relieve the pressure on the median nerve.

Note: Ensure all treatment steps are documented in the treatment plan, or payers may reject your claim based on lack of medical necessity.

 

Obstetrics: Troubleshoot Your Pregnant Patient Transfer Claims by Counting Visits

The Coding Institute

Prepare for coding your OB-GYN’s services up to the date of the patient’s move depending on how many antepartum visits the physician provides — here are tips for one to three and four to six visits:

1-3 Visits Mean Office E/M Codes

If your OB-GYN sees a pregnant patient for only one to three antepartum visits, how should you report it?

Answer: You need to report the appropriate E/M codes for payment. You won’t have a set E/M code for the patient’s first visit. Your patient could be new to the practice, or the first visit may meet the criteria for a level-five established visit. Therefore you should look to the entire code series (99201-99205 for new patients, 99211-99215 for established patients) as possible options.

Second and third visits: Now your coding options are more limited.

When Medicare and ACOG were developing the relative value units for antepartum care, the follow-up visit was estimated to be a 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...), so this code is your best bet for each of these visits in the absence of documented problems.

Note: In some rare circumstances, such as when the patient has absolutely no problems during the visit, however, the documentation might support reporting only 99212 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 10 minutes face-to-face with the patient and/or family) for each visit.

If the patient’s pregnancy is without complication, your diagnosis would be either V22.0 (Supervision of normal first pregnancy) or V22.1 (Supervision of other normal pregnancy).

Watch out: Because you do not have a specific antepartum code for one to three visits and have to report E/M codes, payers sometimes will deny these claims and tell you to “include in the global.”?ō You are forced to appeal these decisions. Explain to the payer that you cannot report a global code because you are no longer the patient’s OB care provider.

4-6 Visits Mean Antepartum Code

Your ob-gyn sees a pregnant patient for four to six antepartum visits. How should you report this?

Answer: Four to six visits means you?ů‘ťľ‘šůll be flipping through your book to the maternity care and delivery section — particularly the antepartum codes. You should report 59425 (Antepartum care only; 4-6 visits), which represents the total services rendered by your ob-gyn. This means that you’ll report only one unit of this code.

 

Opthalmology: Focus Your Cataract Coding With This Tip

The Coding Institute

With several possible surgical treatments for cataract procedures, which you probably code more often than any other surgery, there’s a lot of room for error — with over $800 at stake for complex cataract procedures in 2013.

Use this tricky scenario as a guide:

Document Necessity for Planned Vitrectomy

Scenario: During the course of a cataract removal, the vitreous collapses and the ophthalmologist finds it necessary to perform a vitrectomy.

Question: Can you code separately for the vitrectomy?

Answer: The answer depends on whether the vitreous collapse was an iatrogenic (inadvertently introduced) complication. Ophthalmologists often have to perform a vitrectomy during cataract surgery due to vitreous collapse in the course of removing a dense, senile cataract. In these cases, Medicare considers the vitrectomy a component of the cataract surgery, and thus not separately payable.

The National Correct Coding Initiative bundles vitrectomy codes 67005 (Removal of vitreous, anterior approach [open sky technique or limbal incision]; partial removal) and 67010 (…subtotal removal with mechanical vitrectomy) into cataract surgery ?Šcodes 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification], complex …) and 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]).

Rationale: When procedures are performed together that are basically the same, or performed on the same site but are qualified by an increased level of complexity, the less extensive procedure is included in the more extensive procedure. The column 1 code generally represents the comprehensive service, and the column 2 code is the component that is part of the more extensive column 1 procedure.

Exception: If a prolapsed vitreous exists and is known in advance — and documented in the patient medical record — it is not considered a complication of the cataract surgery. Therefore, the physician who plans to perform a vitrectomy during the same operative session of cataract surgery could code separately for the vitrectomy using modifier 59 (Distinct procedural service): 67005-59 or 67010-59.

Key: Use 379.26 (Vitreous prolapse) for the vitrectomy and the appropriate cataract diagnosis (366.x, Cataract) for the cataract removal.

Be prepared to provide documentation in case you receive denials when using the cataract and vitrectomy codes together, despite using modifier 59. Payers are aware of the potential for abuse of 59 and may want you to go through the review process to prove you’ve met the definition of “distinct procedural service.”?ō

Provide the chart notes to show that you knew about the vitreous collapse in advance and that you made plans to repair it prior to the surgical session of another service. Also, you should provide the operative report with clear documentation showing that there was another condition, besides the cataract surgery, that made the vitrectomy medically necessary.

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Specialists, take note of these valuable tips for improving your coding, for cardiologists, neurologists, OB/GYNs, ophthalmologists and others.

 

Cardiology

Coding for Acute Coronary Syndrome

Acute coronary syndrome (ACS) is classified to ICD-9-CM code 411.1, which is the same code assigned for unstable angina. It is vital to review the entire medical record to make sure the information presented supports the final code assignment. Therefore, if the record contains evidence that the patient may have experienced an AMI but only ACS is documented, then it may be appropriate to query the physician for clarification of the final diagnosis. Final code assignment always is based on physician documentation…?ŠRead More

 

Gastroenterology
The Coding Corner: Coding for an Incomplete Colonoscopy

Medicare rules for coding colonoscopy differ from American Medical Association (AMA) rules, particularly with regard to “incomplete”?ō colonoscopies. For a Medicare patient undergoing a screening colonoscopy, if the surgeon is able to advance the scope past the splenic flexure, consider the colonoscopy “complete”?ō and report the appropriate code…?ŠRead More

 

Neurology
Modifier Indicators: Keys to Success for 64615 Edit Pairs

The Coding Institute

The latest Correct Coding Initiative (CCI) edits–version19.1, effective April 1, 2013–introduced a number of edits for new chemodenervation code 64615 (Chemodenervation of muscle[s]; muscle[s] innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral [e.g., for chronic?Šmigraine]). Read on for the rundown of how the changes could affect your pain management coding.

Check Whether a Bypass Is Possible
Some of the edits involving 64615 can be “bypassed”?ō by appending a modifier in order to report both procedure codes. You can’t slip past the edit for other pairs, however, so pay attention to the assigned modifier indicators.

Bypass option: Approximately 20 other edits involving 64615 are classified with modifier indicator “1”which means you can sometimes append a modifier to break the edit and report both services. The most appropriate modifier will depend on the situation, but coders often turn to modifier 59 (Distinct procedural service).

Some of the edits in these pairs that you might be able to unbundle and report with 64615 include:

– 92585 -?ŠAuditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive
– 95822 -?ŠElectroencephalogram (EEG); recording in coma or sleep only
– 95907-95913 -?ŠNerve conduction studies
– 95925 -?ŠShort-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs
– 95928 -?ŠCentral motor evoked potential study (transcranial motor stimulation); upper limbs
– 95938 … –?Šin upper and lower limbs.

 

OB/GYN
How to Avoid Making Modifier 22 Mistakes

The Coding Institute

Appending modifier 22 (Increased procedural services) may be something you think you’ve got down pat, but that doesn’t mean your coding will always be error-proof.

The following three modifier 22 tips will clarify how much longer a procedure should take to append modifier 22, if you can use an unlisted procedure code instead, and whether you have regular CPT?ę code alternatives.

1. Some experts suggest that you shouldn’t use modifier 22 unless the procedure takes at least twice as long as usual. Several memorandums from Medicare carriers indicate that time is an important factor when deciding to use this modifier. The additional time and work must be significant. Rule: A procedure should take at least 25 percent more time and effort than usual.

2. Using an unlisted-procedure code instead of modifier 22 is a big mistake. Some coders go this route because they think the payer will manually review such claims and the carrier’s computer cannot automatically deny them. But you could be setting your practice up for missed reimbursement, because quite a few insurers will deny the service on first submission–which will lead to appeals. Conversely, all claims that go in with a modifier 22 will be reviewed.

3. Instead of attaching modifier 22 when a procedure is above and beyond its normal scope, you should consider reporting a CPT?ę code that more specifically explains why the procedure was prolonged or unusual. In other words, before you use modifier 22, you should always look to see if there’s another CPT?ę code that more accurately reflect the work the OB/GYN did.

 

Ophthalmology
Include Lens Fitting In These Cornea Codes

The Coding Institute

If your ophthalmologist is using a relatively new code for the fitting of a therapeutic contact lens, you will need to know the new CCI rules.

According to the new set of CCI edits, CPT?ę code 92071 (Fitting of contact lens for treatment of ocular surface disease), introduced in 2012, is now bundled into:

– 65220-65222 -?ŠRemoval of foreign body, external eye …
– 65275-65286 -?ŠRepair of laceration …
– 65400 -?ŠExcision of lesion, cornea (keratectomy, lamellar, partial), except?Špterygium
– 65410 -?ŠBiopsy of cornea
– 65420 -?ŠExcision or transposition of pterygium; without graft
– 65426 -?ŠExcision or transposition of pterygium; with graft
– 65430-65600 -?ŠRemoval or destruction procedures on the cornea
– 65710-65757 -?ŠKeratoplasty procedures on the cornea
– 65760-65782 -?ŠOther procedures on the cornea.

These edits all carry a modifier indicator of “1”,?ō meaning that you can use a modifier to break the bundle under the appropriate clinical circumstances, and report the two bundled codes separately.

For more information on the Correct Coding Initiative, visit http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html?redirect=/nationalcorrectcodinited/.

 

Orthopedic
3 Steps to Sharpen Your Skills for Strapping Codes

The Coding Institute

A simple treatment like strapping could really tie you in knots–if you’re not clear on some coding fundamentals. Take these three steps to strapping coding success.

1: Understand Unna Boot, Buddy Tape Definitions

Before you go ahead and assign a code for strapping, you’ll need to understand how your payer defines strapping. Strapping may be done to support and/or restrict movement of ligament structures by exerting pressure upon the extremity or other area of the body.

Unna boot?Šapplication is one method of strapping. An Unna boot is a type of paste bandage.

The Unna boot bandage restricts the volume of the distal lower extremity, controls edema, and promotes venous blood return. You report Unna boot application with (29580, Strapping; Unna boot).

A common mistake is to overlook the removal of an Unna boot. Check if the removal was done by same or another provider. Removal of an Unna boot applied by another provider outside the practice may be reported using CPT?ę code 29700 (Removal or bivalving; gauntlet, boot or body cast).

Remember: Confirm with your payer specific reporting guidelines for Unna boot removal.

Another example of strapping is buddy tape or “buddy splint.” Buddy straps are prefabricated straps made of canvas or foam and Velcro and are reported with codes 29280 (Strapping; hand or finger) or 29550 (Strapping; toes).

Step 2: Look to Body Area for Code Selection
CPT?ę arranges strapping codes by body area. Begin with code family 29000-29799 (Application of casts and strapping), then narrow your code choices by anatomic area (body, upper extremity, or lower extremity). Each anatomic section has options for splints, casts, and strapping. In particular, the strapping codes are in ranges 29200-29280 (body and upper extremity) and 29520- 29590 (lower extremity).

Step 3: Keep Up With Payers’ Supplies Guidelines

Payers support strapping when the physician has stabilized a joint with non-rigid materials allowing the patient to retain some range of motion, such as tape, web rolls and possibly an elastic (e.g., ACE) bandage. But the sole use of elastic bandages as strapping may be controversial among certain payers. Check with your payer to see if specific codes are applicable.

 

Radiology
Avoid Separate Imaging with Thoracentesis

Thoracentesis is a puncture made between the ribs into the pleural cavity to aspirate or remove accumulated fluid (pleural effusion) from the chest cavity. A needle attached to a syringe is introduced through the skin and chest wall until it penetrates the pleura.

For 2013, CPT?ę deleted 32421 and 32422, previously used to describe thoracentesis, and replaced them with two new codes…?ŠRead More

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The Coding Institute
Here are some excellent tips from a leading resource for coding training and information.

CMS Clarifies 99495 and 99496 Use: Answers to Place and Date of Service Questions

CMS offered some new insights into how Medicare payers expect you to use 2013‘«÷s new transitional care management (TCM) codes during the agency‘«÷s March 12 Open Door Forum, noting several important points about the TCM codes to keep in mind when completing your claims.

The new TCM codes are:

99495, Transitional care management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within two business days of discharge, medical decision-making of at least moderate complexity during the service period, and face-to-face visit within 14 calendar days of discharge

99496, Transitional care management services?Š with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within two business days of discharge, medical decision-making of high complexity during the service period, and face-to- face visit within seven calendar days of discharge.

The codes are intended to apply when a physician oversees a patient whose health issues necessitate moderate to high complexity medical decision making (MDM) during the shift from a healthcare facility setting back to the patient‘«÷s community (home) setting.

‘«£A face-to-face visit is required within a specific time frame after the patient‘«÷s discharge, depending on which code you‘«÷re reporting,‘«ō said David A. Ellington, MD, an AMA CPT?ę Editorial Panel member who presented E/M changes at the CPT?ę and RBRVS 2013 Annual Symposium (www.ama-assn.org/resources/doc/cpt/04-e-and-m-ellington.pdf). ‘«£The initial interactive contact ‘«Ų face-to-face, phone call, or email ‘«Ų should be within two business days of discharge. If you make two attempts to contact the patient or caregiver within that time but are unsuccessful, CPT?ę states that you can still report transitional services if the other criteria are met.‘«ō

Additional Pointers
During the March 12 CMS forum, CMS‘«÷ Ryan Howe emphasized the following areas:

– When determining which place of service (POS) code to use on your TCM claim, you should use the location that ‘«£required the face-to-face visit.‘«ō

– The 30-day TCM period begins on the date of discharge and continues for the next 29 days. Your date of service should be the thirtieth day of care‘«Ų not the first, Howe said during the CMS call.

– CMS will reject any claims with dates of service prior to Jan. 30, 2013, because the codes became effective on Jan. 1 and only cover 30-day periods.

– You can report TCM codes for both new and established patients, Howe said, which is a departure from CPT?ę rules. ‘«£CPT?ę guidance suggests that the codes are only for established patients, but for Medicare purposes, they can be reported for new patients as well,‘«ō he said.

– If 30 days pass between discharge and the initial communication with the TCM practitioner, you cannot report TCM codes, Howe said during the call.

– Medicare will pay only the first TCM claim received per beneficiary in one 30-day period beginning on the date of discharge, so if more than one practitioner reports the code for the same patient, only the doctor whose claim is received first will get paid.

– If the patient dies before the thirtieth day of TCM, you cannot report the TCM codes because they cover a full 30 days. Instead, you‘«÷d report the appropriate E/M code.

For more on the TCM codes, read the FAQs at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/FAQ-TCMS.pdf.

 

Reduce ‘«£Ordering/Referring‘«ō Edit Losses with These Quick Steps

Key: Double check physician NPI is individual and not group practice NPI.

If you have been postponing updating your ordering/referring physician info, take action or you may have begun seeing losses starting in May.

Phase 2 of the ‘«£ordering/referring‘«ō edits hit May 1 and CMS indicated they would issue costly denials as opposed to less burdensome returned claims when practices have invalid ordering/referring physician information. The system will deny claims when the doctor isn‘«÷t in the Provider Enrollment, Chain, and Ownership System (PECOS) file or when the name doesn‘«÷t match.

Smart practices will take these six steps to minimize cash flow delays and financial losses due to ‘«£ordering/referring‘«ō edit denials:

1. Check and recheck. CMS posts a ‘«£Medicare Ordering and Referring File‘«ō on its website with the full list of ‘«£the National Provider Identifier (NPI) and legal name (last name, first name) of all physicians and non-physician practitioners who are of a type/specialty that is legally eligible to order and refer in the Medicare program and who have current enrollment records in Medicare (i.e., they have enrollment records in PECOS),‘«ō CMS explains on the site. The website is at http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/MedicareOrderingandReferring.html. CMS updates the report weekly, it says in newly?Šrevised MLN Matters article SE1305.

Now is the time to step up PECOS file checking. Pay attention to which physicians are sending referrals and ordering services and verify that those physicians are eligible to do so and are currently enrolled in PECOS.

2. Spur enrollment. If you find your docs don‘«÷t have a record in PECOS, you‘«÷ll need to get them to enroll in it or you won‘«÷t be able to get paid.

Resource: Links to educational Medicare articles about enrolling in PECOS are in the ‘«£Additional Information‘«ō section at the end of the MLN Matters article at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1305.pdf.

3. Match the PECOS file exactly. If your claim calls a physician ‘«£Jack‘«ō and he‘«÷s listed as ‘«£John‘«ō in the PECOS file, it will get shot down. Also, don‘«÷t use credentials such as ‘«£Dr.‘«ō in the name field, CMS advises.

Key: On paper claims, be sure to list first name first and last name last in item 17.

Don‘«÷t let software differences trigger unnecessary edits. Make sure that the physician information that is on file in the providers‘«÷ software systems and is being coded on the claim for enrolled physicians matches the PECOS information, including both the NPI and physician name.

4. Use the right NPI. ‘«£Ensure that the name and the NPI you enter for the Ordering/Referring Provider belong to an individual physician or non-physician practitioner and not to an organization, such as a group practice that employs the physician or non-physician practitioner who generated the order or referral,‘«ō CMS instructs.

5. Know the rules for exceptions. Use the teaching physician‘«÷s information for interns and residents, CMS directs. The exception is for docs in states that license their residents. State-licensed residents may enroll in PECOS on their own to order and/or refer and may be listed on claims.

 

Separate Problem Can Be Billed During a Well Check Visit

When a patient comes to your office for a preventive wellness visit, if the patient mentions a health problem or other concern during the preventive visit, the encounter might qualify for two codes.

Checkpoint: If the problem ranks as ‘«£significant,‘«ō you can report your work to address it in addition to the preventive care. This may take the form of a problem- oriented E/M code (e.g. 99201-99215), a procedural service, or both.

Key: Although poorly covered in the past, many payers now recognize and pay for these separate, significantly identifiable services addressed during preventive medicine visits. Of course, those additional services, if covered, may also result in a patient financial obligation (e.g. deductible, copay, or coinsurance) that would not accrue with a simple preventive visit. ?ŠManaging patient expectations in this situation is important.

3 Tips: If you‘«÷re still unsure whether you‘«÷re justified in billing a problem- based E/M code along with the preventive visit, keep a few criteria in mind:

1. If the problem is significant enough that it would require or justify the patient to come back for another visit if the internal medicine physician doesn‘«÷t address it, that could be a clue that you‘«÷re dealing with a problem-based E/M situation.

2. Check whether the problem has its own ICD-9 diagnosis code. If so, that means addressing the issue could be a stand-alone (and separately reportable) service.

3. Look for additional evaluation and treatment options, such as X-ray or lab tests, or written prescriptions. These can be other signs that the physician is addressing a significant problem.

 

Penalties Could Be Coming Your Way for Illegible Documentation

If your physician‘«÷s handwriting is really difficult to read, you should be worried–because payers are getting stricter about illegible documentation and he may face penalties, advises The Coding Institute.

Physicians could actually have problems with payers in the future if the payers cannot read their notes. Billers should stress the importance of legible notes to their providers and may even want to suggest that they print, use dictation, or invest in an electronic medical record (EMR) system to ensure legibility.

Many coders shake their heads when they hear that some physicians maintain incomplete notes, and that auditors ask those physicians for money back since their documentation didn‘«÷t support the codes they billed. But have you ever thought that writing illegibly could make you qualify for CMS‘«÷s interpretation of incomplete notes?

‘«£When determining the medical necessity of an item or service billed, Medicare‘«÷s review contractors must rely on the medical documentation submitted by the provider in support of a given claim,‘«ō CMS says in MLN Matters article SE1237. ‘«£Therefore, legibility of clinical notes and other supporting documentation is critical to avoid Medicare FFS [fee-for-service] claim payment denials.‘«ō

To read the MLN Matters article, visit http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1237.pdf.

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Review these articles from a variety of sources to insure your coding is up to date on E/M, LCD, and other techniques.

Wolves at the Door: E/M Coding Now

Barbara Aubry, a regulatory analyst for 3M Health Information Systems, reports that in the last few weeks, she has read some startling news:

1. The University of Illinois Hospital and Health Sciences System and Mount Sinai Hospital in Chicago owe CMS $145 million in disproportionate share Medicaid overpayments “because they had overcharged poor patients,” according to a FierceHealthFinance news report Feb. 27. What’s even more startling is the alleged overcharges took place 13 years ago.

2. Another stunning article reported Feb. 14 by HealthLeaders Media discussed the case of a respected surgeon who was found guilty of fraudulent coding on claims submitted between August 2002 and October 2003. The doctor was “acquitted of two counts of Medicare fraud but convicted of two counts of making false statements in connection with surgical (CPT) codes submitted” on old claims. He is now serving a 10-month prison sentence.

The Association of American Physicians and Surgeons (AAPS) warns, according to the article, “physicians will now need to practice ‘defensive documentation,’ taking more time away from patient care in order to double and triple check operative notes.” Barbara prefers to call it clinical documentation improvement (CDI), but agrees with the AAPS: Documentation is more important than ever. Read More

 

Modifier Minute: Modifier 32

Modifier 32?ŠMandated services?Šapplies when a third party, such as an insurer or government agency, specifically requests/requires a service on a patient‘«÷s behalf. For instance‘«™ Read More

 

Follow New CMS Guidelines ?Što Keep Record Amendments Updated

No practice ‘«Ű or physician ‘«Ű is immune to documentation that needs to be updated; maybe the physician left out an important piece of information, such as the amount of time spent counseling the patient, or the patient‘«÷s diagnosis. When records need to be amended, advises The Coding Institute, be sure your practice follows the latest CMS rules, which were revised on Dec. 7, 2012, in Transmittal 442.

When adding, correcting, or entering information after the date of service, you should identify it as an amendment, and the physician should sign and date it. Never delete the original entry‘«Ųinstead, ensure that all original content is identifiable. You can do this on a paper record by using a single strike line through the original content. For electronic records, you must ‘«£provide a reliable means to clearly identify the original content, the modified content, and the date of authorship of each modification of the record,‘«ō CMS says in the transmittal.

If an auditor ever reviews your files, CMS directs them to consider your amended entries‘«Ųbut only if you follow the rules. Auditors ‘«£shall not consider undated or unsigned entries handwritten in the margin of the document,‘«ō for instance, the Transmittal advises.

CMS advises MACs and auditors that see potential fraud in the documentation to refer those cases to the ZPIC auditors. To read the complete transmittal, visit www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R442PI.pdf.

 

CMS corrects edit 84, deletes modifiers

Justcoding.com reports in an April 30 article that CMS corrected edit 84, added five APCs to the I/OCE, deleted two APCs, and changed the description of another as part of the April updates to the I/OCE. In addition, CMS deleted all of the genetic testing modifiers, retroactive to January 1‘«™ Read More

 

Denials Management: With MUE Claim Denials, Appeal, and Appeal Again
If you receive a claim denial due to MUEs, you can appeal, according to a recent article by The Coding Institute.

You should follow three steps during the appeals process:

Step 1: Determine the reason for the denial. First, figure out if you made a coding or billing error. If you find a coding error

‘«Ų?Š?Š?Š such as the wrong number of units entered in the units box

‘«Ų?Š submit a corrected claim. If you don‘«÷t find a coding or billing error, move on to the next step.

Step 2: Decide if you have a legitimate reason to appeal. If you believe there is medical necessity for the services over and above the allowable under the MUE, you should appeal to the contractor. ‘«£If there is no medical necessity, take a look

again at coding,‘«ō Harrington says. ‘«£Make sure service is coded properly, and appropriate modifiers have been assigned.‘«ō

Step 3: Appeal the claim. File an initial appeal with your carrier and follow the standard five-level Medicare appeals process. ‘«£If appealing the claim due to a clinical reason, you may wish to employ clinical expertise when putting together your appeal letter,‘«ō Harrington suggests.

 

Healthcare News: CMS Adds Codes to Conditionally Bilateral List

Also from Justcoding.com: CMS added seven CPT codes to the conditionally bilateral list as part of the April update to the Integrated Outpatient Code Editor. When a provider performs a conditionally bilateral service bilaterally, coders must append modifier -50 (bilateral procedure) to the code. Read More

 

Local Coverage Determinations Provide the Missing Link to Complement Coding Guidelines

The missing link to correct coding, according to an article in Justcoding.com, is coder knowledge and practical application of Local Coverage Determinations (LCDs). LCDs are integral to complete documentation governing accurate ICD-9 diagnoses coding. LCDs in essence complement official coding guidelines and Coding Clinic advice. Few coding staff actually know and apply?Šofficial LCDs in their region to complement official coding guidelines and policies. Read More

 

Observation Services: Many Shades of Gray

This recent article in For the Record states that unique challenges give hospitals and physicians little room for error when it comes to correctly documenting these encounters. According to Betsy Nicoletti, MS, CPC, coauthor of Codapedia.com, one complicating factor is that while a hospital ultimately determines the category of a patient‘«÷s admission status, the rules are clear that a patient‘«÷s observation stay begins and ends with a physician‘«÷s order‘«™ Read More

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Coding for Pediatric Chronic Lung Disease
Update your knowledge of chronic lung disease and how to code it in this article from For the Record. Read More
 

Cardiology Coding: +92973 Coding Is Limited to Mechanical Thrombectomy

The Coding Institute reports in The Cardiac Coding Alert that the aspiration thrombectomy question has finally received an answer with the 2013 addition of the term ‘«£mechanical‘«ō to thrombectomy code +92973:

2012: +92973, Percutaneous transluminal coronary thrombectomy

2013: +92973, Percutaneous transluminal coronary thrombectomy mechanical.

There has been a lot of confusion in the past about whether coders could use +92973 for more than mechanical thrombectomy, specifically whether the code applied tor aspiration thrombectomy, according to Julie Graham, BA, CPC, cardiology coder and compliance specialist for Concentra.

By specifying ‘«£mechanical,‘«ō the code definition change resolves that confusion, says Graham. Be sure to check the guidelines, too, she adds. The 2013 guidelines state, ‘«£Non-mechanical, aspiration thrombectomy is not reported with 92973, and is included in the PCI code for acute myocardial infarction (92941), when performed.‘«ō

The language change aligns with an article in CPT?ę Assistant (March 2002) from the year when the code was created. CPT?ę Assistant stated that +92973 was added to describe a catheter-based angiojet ‘«£procedure using a unique method of fragmenting and removing clots from the coronary artery‘«ō lumen. A vignette in the article describes?Š a reportable thrombectomy that includes advancing the thrombectomy catheter distal to the lesion, activating the catheter using a foot pedal, and then manually withdrawing the catheter to remove the thrombus (repeating as needed).

 

Gastroenterology Coding: Don‘«÷t Automatically Use 44705 For Fecal Bacteriotherapy
In the Gastroenterology Coding Alert, The Coding Institute advises that if your gastroenterologist performs fecal bacteriotherapy as a treatment for Clostridium difficile infections, you shouldn‘«÷t forget to look at payer policies before you report the assessment and preparation of the fecal microbiota sample with the newly introduced CPT?ęcode 44705. For fecal bacteriotherapy services reporting, turn to two codes: one for the preparation and assessment of the fecal microbiota sample and the other for the instillation in the patient‘«÷s gut.

Use code 44705 (Preparation of fecal microbiota for instillation, including assessment of donor specimen) to cover your gastroenterologist‘«÷s work developing the microbiota sample that will be instilled in the patient‘«÷s digestive tract and for assessing the sample. To indicate the medical necessity for performing fecal bacteriotherapy, you will have to support documentation using the ICD-9 code 008.45 (Intestinal infection due to clostridium difficile).

In addition to reporting 44705, you‘«÷ll report an additional code, depending on the method your gastroenterologist uses to introduce the fecal sample in the patient‘«÷s digestive tract.
 

Coding for Ovarian Cancer
Get a good review of ovarian cancer in this article, which reviews key issues including coding functional activity. Read More
 

Internal Medicine and OB/GYN Coding: Bone Density or DEXA Scan Coding: Tips to Help You Out

The restrictions Medicare sets for bone density tests can keep even the most conscientious coders guessing about whether they‘«÷ve met the medical necessity and frequency guidelines. The Coding Institute‘«÷s experts offer real-world advice that will keep you on track and strengthen your chances of success in a recent article:

Tip 1: Gather the Supporting Documentation

Documentation for the bone scan must include an order from a physician or qualified non-physician practitioner who is treating the beneficiary and an interpretation of the test results (Medicare Benefit Policy Manual, Chapter 15, Section 80.5.4). Signing the machine printout doesn‘«÷t count as an interpretation.

The physician also needs to document a complete diagnosis. Medicare doesn‘«÷t offer a national list of covered ICD-9 codes, but it does state that an individual qualifies for coverage when she meets one of five conditions (Medicare Benefit Policy Manual, Chapter 15, Section 80.5.6).

Check your payer‘«÷s local coverage determination (LCD) for the specific ICD-9 codes it says support medical necessity. For example, Aetna lists several diagnoses that may prove medical necessity, such as 627.2 (Symptomatic menopausal or female climacteric states) and 733.90 (Disorder of bone and cartilage, unspecified).

Tip 2: Go With Documented Diagnosis
Only report the documented diagnosis ‘«Ų never choose a diagnosis simply because you know you‘«÷ll get paid for it.

Tip 3: Get the Frequencies Straight
Medicare will pay for bone mass measurements on qualified individuals every two years, but does offer exceptions. (Medicare Benefit Policy Manual, Chapter 15, Section 80.5.5).
 

Coding for Cognitive Disorders
For the Record offers a good overview of coding for cognitive disorders, from attention-deficit disorder to traumatic head injury. Read More

 
Neurology Coding: Earn Payment for Psychotherapy Services with Add-On Codes
While managing a chronic debilitating illness like multiple sclerosis, your physician may engage with the patient and/or family to help improve quality of life for the patient. When psychotherapy is part of the treatment that your neurologist provides, a recent article from The Coding Institute advises that you don‘«÷t ignore that component when it‘«÷s time to code. Here‘«÷s their expert advice on how to submit the right codes for situations when your neurologist may provide psychotherapy ‘«Ű and get the pay you deserve.

Determine Duration of Psychotherapy
Your first step to success is to determine the psychotherapy treatment‘«÷s duration. Choose between three codes, depending on how long the session lasted: ?Š90832 ‘«Ű 30 minutes; 90834 ‘«Ű 45 minutes; 90837 ‘«Ű 60 minutes. Be careful, the article notes, as each code now has a specific amount of time.

Look for E/M Services
Check the clinical note to verify whether the psychotherapy was done in conjunction with an evaluation and management (E/M) service. If so, you need to again confirm the duration of the psychotherapy before assigning a code: +90833 ‘«Ű 30 minutes; +90836 ‘«Ű 45 minutes; +90838 ‘«Ű 60 minutes. ?Š(Each should be listed separately in addition to the code for primary procedure.)

Note that all options are add-on codes. Report the appropriate one with the applicable E/M code, such as 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient ‘«™) or 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient ‘«™).

Confirm the Family Involvement
Your neurologist might schedule a psychotherapy session to discuss how family interactions can benefit the patient and how the care provided can affect the patient‘«÷s course of illness. The patient may or may not be present for the session, which guides your coding.

Depending upon whether the patient was present, you‘«÷ll report 90846 (Family psychotherapy [without the patient present]) or 90847 (Family psychotherapy [conjoint psychotherapy] [with patient present]). ‘«£It is important it remember that the family psychotherapy codes are not based on the amount of time but rather whether the patient was present or not,‘«ō says Hammer. ‘«£The family psychotherapy codes should be reported only once for the patient, not for each of the family members in attendance.‘«ō

 
Ophthalmology Coding: Show Blepharoplasty Procedures Aren‘«÷t Always Cosmetic
Many ophthalmologists are not claiming legitimate reimbursement for medically necessary blepharoplasty, advises a recent article from The Coding Institute. Most insurers, the article says, including Medicare carriers, are predisposed to denying payment, and to assuming the procedure is cosmetic. However, they offer expert advice for successful claims such as:

Blepharoplasty Procedures Are Not Always Cosmetic

Whether or not a blepharoplasty procedure is cosmetic depends on the procedure and the patient‘«÷s main complaint. Procedures to remove excess skin and fat from the eyelids are frequently done due to medical necessity ‘«Ų but to support medical necessity and convince Medicare, you need to submit the correct codes and airtight documentation.

For blepharoplasty procedures, look to CPT?ę codes 15820-15823 (Blepharoplasty‘«™). Insurers cover blepharoplasty procedures 15822 (Blepharoplasty, upper eyelid) or 15823 (‘«™ with excessive skin weighting down lid) when the patient suffers from decreased vision or other specific medical problems.

But remember that CPT?ę codes 15820 (Blepharoplasty, lower eyelid) and 15821 (‘«™ with extensive herniated fat pad) are almost never covered. Insurers believe that excessive skin or fat in the lower eyelids do not usually obscure vision.

Keep Everything Documented
Keep this documentation in your blepharoplasty patient‘«÷s file:
– history and physical which documents the patient‘«÷s complaint extensively to support problems with performing activities of daily living (e.g., driving, reading, chronic eye irritation, etc.)
– operative report
– visual fields (taped and untaped)
– photographs (taped and untaped).

The visual field (VF) tests (92081-92083, Visual field examination, unilateral?Š or bilateral, with interpretation and report …) show the extent of the patient‘«÷s decreased vision. Most carriers want two sets of visual fields ‘«Ų one with the upper eyelid at rest and one with the eyelid taped up to demonstrate an expected improvement. Be sure to document both sets of results with the physician‘«÷s interpretation and report. Many LCDs state that the visual fields ‘«£must demonstrate a minimum 12 degrees or 30 percent loss of upper field of vision.‘«ō

 
Orthopedic Coding: Refine Your Post-Op Infection Coding with These 3 Examples
You could be sabotaging your claims for post-op infections if you aren’t well-versed on individual payers’ global policies and unsure of what modifiers to append, according to a recent article from The Coding Institute. Here are three common scenarios the article offers to facilitate better reporting of postsurgical infection billing:

Coding example 1: Several days following an open repair of distal fibular fracture, 27792 (Open treatment of distal fibular fracture [lateral malleolus], includes internal fixation, when performed), the patient develops a stitch abscess with drainage at the site of the incision. The patient schedules an unplanned visit to the office of the orthopedic surgeon. The surgeon prescribes antibiotics and a follow-up.

For a private payer that follows the AMA CPT?ę guidelines for post-operative complications, you would report an E/M service (such as 99213, Office or other outpatient visit for the evaluation and management of an established patient …) appended with modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period), if the payer requires you to do so. The modifier is usually needed because any service in the global is automatically denied within payer software systems.

Tip: Use the abscess as the diagnosis, not the reason for the open repair. You report this with code 998.59 (Other postoperative infection). The abscess diagnosis shows the ‘«£unrelated‘«ō reason for the E/M service. The modifier indicates that the payer does not include the service in the initial surgery‘«÷s global fee. Had the patient been covered by Medicare, however, the office visit counts as a part of the global package, and you cannot file an additional claim.

Coding example 2: A week following surgery, the surgeon readmits the patient to the hospital for IV antibiotics but does not take the patient back to the operating room. Once again, in this case, you may not report a separate service to Medicare, even though the orthopedist readmitted the patient. CMS guidelines specify that when the physician readmits the patient within the original surgery‘«÷s global period for complications of the original surgery, you cannot charge evaluation and management services for the readmission or for other E&M services if another physician admits the patient.

But for payers not following CMS guidelines, and follow the AMA CPT?ę guidelines, you may be able to report an appropriate admission code (for example, 99221, Initial hospital care, per day, for the evaluation and management of a patient …) with modifier 24 appended.

Coding example 3: The patient from example 1, who developed a stitch abscess, goes on to require an incision and drainage in the OR, for example, 10180 (Incision and drainage, complex, postoperative wound infection).

In this case, you should report 10180-78 for both Medicare and private payers. Don‘«÷t forget the diagnosis to consider is 998.59, to any CPT?ę codes you report.

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Last week we looked at how to write an effective appeals letter, but obviously there‘«÷s much more to the process. To review how to effectively manage your appeals process, we‘«÷ll turn to two experts in the field: Elizabeth W. Woodcock, MBA, FACMPE, CPC, and Nancy Clark, CPC, CPC-I.

Practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, offered ‘«£A Dozen Steps to Successfully Appeal Denied Claims‘«ō in this article, including these tips:

Recognize denials. The key is to identify it as separate and distinct from a contractual adjustment, which is ‘«Ű and should be ‘«Ű a write off.

– Don‘«÷t procrastinate. There is often a timeframe in which you can resubmit a claim after it‘«÷s been denied.

– Make a compelling case. Among the tips Woodcock provides here are: Develop a professional letter that begins by referencing the claim number, date of service and patient; then, briefly describe the particulars of the service in question; use the insurer‘«÷s own language if possible; look to see if Medicare or Medicaid pays for the service; if they do, you can argue that even the government has determined that payment is appropriate; Copy and attach sections that support your case from coding manuals, including past issues of the American Medical Association (AMA) CPT Coding Assistant.

– Confirm receipt. Don‘«÷t just send the appeal and hope for the best, Woodcock advises. Review your submission online, or call the insurance company to confirm that they received your appeal, noting the name of the operator, extension number, date and time. Follow up in 30 days.

– Set boundaries and don‘«÷t go overboard. Establish protocols for dollar thresholds that you‘«÷ll appeal only once, twice, etc. Avoid fighting for a claim that should have never been submitted in the first place, such as an undocumented service.

– Carbon copy stakeholders. Your appeal to reverse a denial is a matter between you and the insurance company, but sometimes pulling in other key stakeholders helps. Your first, and most important, advocate is the patient.

– Maintain a hassle folder for each insurance company and develop supportive language in your contract. It pays to maintain a record of reimbursements and denials in order to effectively review your contract for its strategic contribution to the practice‘«÷s bottom line. Proactively negotiate the inclusion of language that supports your efforts to appeal claims.

– Compile appeals. Appealing claims one-by-one may get the results you need, but it is laborious. If you‘«÷ve seen the same service denied for the same reason multiple times, compile your appeals and present them together for reconsideration.

Read the full article at http://www.kareo.com/gettingpaid/2010/08/a-dozen-steps-to-successfully-appeal-denied-claims/

In a separate article, The Real Deal About Appeals, Part 1, expert Nancy Clark, CPC, CPC-I, offers additional useful advice, including:

– Clarify the reason for the denial. For example, is the service not covered because it is deemed medically unnecessary? Is this procedure specifically excluded from the patient‘«÷s benefits contract? Did the insurance carrier not recognize a modifier or modifiers on the claim?

– When the cause of denial has been clearly identified, ask what documentation you need to appeal the claim. For example, they may request operative notes and pathology reports.

– Confirm the insurance carrier‘«÷s formal appeal process. This may require using a form provided by the company or it may require a written appeal on the practice‘«÷s letterhead. Some commercial carriers and Medicare Administrative Contractors (MACs) have a standardized form available on their websites, while some carriers may prefer the use of a form from the state‘«÷s department of banking and insurance.

– Obtain the specific address to which the claim should be mailed. Include the name of the department or person to whose attention it should be addressed. If possible, get a fax number. This may yield faster results.

– Document the phone call, the representative‘«÷s name, and the date of the conversation. Keep this information in the appeal file.

Read the full article at http://news.aapc.com/index.php/2012/04/the-real-deal-about-appeals-part-1/

Be sure to prepare for battle when you‘«÷re appealing claims by having a plan, doing your homework, and writing an effective appeals letter.

When you need assistance with your appeals, contact Medical-Billing.com at 800-966-9270. Medical-Billing.com allocates over 50% of its billing costs to the successful collection of the last 20-30% of charges that typically do not get paid on first submission. We can help you get paid for the tough claims your staff doesn‘«÷t have time to pursue.

Related Articles

Medical Billing Update: Appeals That Work, Part I
Medical Billing Appeals: Make Sure They‘«÷re Working for You

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We‘«÷ve gathered an assortment of coding and billing tips from expert sources in a variety of specialties to help insure you‘«÷re receiving the maximum reimbursement available.

All Specialties

2013 New and Revised CPT Codes: Here Are the Changes Most Likely to Affect the Most Practices

Texas Medical Association

Here are some of the changes noted by the Texas Medical Association:

– Getting paid for time-based codes now requires passing the midpoint of the time specified in the code. For example, for a code that requires one hour, 31 minutes must be met to bill the time-based code, and it must be documented.

– Multiple new laboratory and pathology (81400-81408 and 81500-81599) codes have been added and coding descriptions for Tier II procedures revised.?ŠCheck the patient‘«÷s benefits and carrier medical policies for coverage, as some of the new codes are for screening a patient for the potential of developing specific conditions.

– Nerve conduction codes (95905-95913):?ŠSeveral codes have been deleted and new codes added.

These are only portion of the changes for 2013.?ŠBe sure to review the CPT 2013 guidelines for the above sections carefully and the sections with codes you use most often.?Š In addition, check with carriers for coverage requirements of the new codes and the patient‘«÷s benefits.

 

ASC

Avoid Surgery Center Claim Denials: 5 Expert Tips

Becker‘«÷s ASC Review

Here are five tips from ambulatory surgery center experts on optimizing billing operations and reducing claim denials from commercial payors, including:

1. Look out for bundled codes
2. Make sure no information is missing
3. Do not misuse modifiers.
4. Check for problem with the payor’s system
5. Work with coding professionals.

Read More

 

Gastroenterology

Check CCI Bundling for Motility Studies and Capsule ?ŠEndoscopy; Catch Pairing with Anesthesia and Injection Services

The Coding Institute

When your gastroenterologist performs a gastrointestinal transit and pressure measurement (91112, Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report) using a wireless capsule, you cannot report any other motility studies or a capsule endoscopy procedure that is performed concurrently. The latest round of Correct Coding Initiative edits (19.0) include a host of codes that you cannot report when you are reporting 91112:

– 91020 ‘«Ų Gastric motility [manometric] studies
– 91022 ‘«Ų Duodenal motility [manometric] study
– 91111 ‘«Ų Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus with interpretation and report
– 91117 ‘«Ų Colon motility [manometric] study, minimum 6 hours continuous recording [including provocation tests, e.g., meal, intracolonic balloon distension, pharmacologic agents, if performed], with interpretation and report

Avoid Reporting Therapeutic or Diagnostic Injections with 91112
The Coding Institute also advises that when your gastroenterologist performs gastrointestinal transit and pressure measurement, you cannot report any injection procedures that are performed in the same session, according to CCI edits 19.0, and provides a list of the codes you cannot report along with 91112 when these procedures are performed in the same session.

 

Cardiology

37211-37214 Focus on Initial, Subsequent, and Final Day for Non-Coronary Thrombolysis Coding

The Coding Institute

Thrombolysis coders trained to find 75898 reporting opportunities will need to develop new habits for 2013. As part of the non-coronary thrombolysis code update, related services all fall under 37211-37214. Here are the details:
2013: Base Code Choice on Vessel and Day
CPT?ę 2013 deletes 37201 and 37209, and replaces them with new options that include S&I. Because the new infusion codes include S&I, 75900 has been deleted for 2013. Codes 75896 and 75898 have not been deleted, but they have been revised to specify they apply to transcatheter therapy infusion ‘«£other than for thrombolysis,‘«ō says Julie Graham, BA, CPC, cardiology coder and compliance specialist for Concentra in Texas.

You‘«÷ll also notice that the new codes apply to an entire day of treatment. Use a ‘«£midnight to midnight time period,‘«ō stated Sean P. Roddy, MD, FACS, of the Society for Vascular Surgery and member of the AMA CPT?ę Advisory Committee, in the ‘«£Vascular Surgery and Interventional Radiology‘«ō presentation at the AMA‘«÷s CPT?ę and RBRVS 2013 Annual Symposium.

 

OB/GYN

2013?ŠBrought New CCI Bundles, Many Targeting New CPT?ę Codes

The Coding Institute

Among their advice on the 2013 coding changes, The Coding Institute advises that OB/GYN coders pay attention to the modifier indicator to determine which ones you can override and which you can‘«÷t.

CCI 19.0, which took effect on January 1, 2013, added 37,587 new bundles and deletes 16, 716. Not surprisingly, many of the new CCI edits target new 2013 CPT?ę codes, and OB/GYN wasn‘«÷t spared any changes. Among those you should watch for:

Add These Column 2 Codes to 52287

You will find new Botox bladder injection CPT?ę code 52287 (Cystourethroscopy with injection[s] for chemodenervation of the bladder) has a variety of new codes that you should consider included in this service. These column 2 codes include:

– Anesthesia 00910 and 00916
– Category III codes 0213T, 0216T, 0228T, and 0230T
– Wound closure codes 12001-12057, 13100-13153
– Intravenous codes 36000, 36405-36406, 36410, 36420-36430, 36440, 36600, 36640
– Transcatheter therapy code 37202
– Gastic tube placement code 43752
– Catheterization codes 51701-51703
– Cystoscopic codes 52000, 52001, 52310, 52315
– Urethrotomy and meatotomy codes 53000-53025
– Urethral dilation codes 53600-53665,
– Pelvic exam under anesthesia code 57410.
– Injection codes 62310-62311, 62318-62319, 64400-64530
– Microsurgical technique code 69990
– Fluoroscopic codes 76000-76001, 77001-77002
– Echocardiography codes 93000-93010, 93040-93042, 93318
– Ventilation and oxygen codes 94002, 94200-94250, 94680-94770
– EEG codes 95812-95955
– Intravenous codes 96360-96365
– Therapeutic injection codes 96372-96376
– Moderate sedation codes 99148-99150
– Lidocaine HCL injection code J2001
– Catheterization for collection of specimen code P9612

Some of these noted edit pairs have a modifier indicator of ‘«£0,‘«ō which means you cannot separate these edits with a modifier. Others, like the wound closure codes, intravenous and venous codes, and 52001 (Cystourethroscopy and evacuation of multiple obstructing clots), have a modifier indicator of ‘«£1.‘«ō That means that you can use a modifier to override the bundling under specific clinical circumstances.

 

IM

Immunization Coding Affected By Latest CCI Changes; Pay Special Attention to Influenza Vaccines

The Coding Institute

New restrictions to vaccine coding are the biggest area of interest to internal medicine physicians in the latest Correct Coding Initiative (CCI) edits. Here is the lowdown on CCI 19.0 and what you can ‘«Ű and can‘«÷t ‘«Ű report together during the same encounter:
Watch Whether Vaccine Is Reported or Ignored

Physicians often administer multiple vaccinations during the same encounter, but that doesn‘«÷t mean CCI edits allow you to bill for each immunization.

More than 30 mutually exclusive edits under CCI 19.0 involve pairs of immunization codes ‘«Ű particularly those for influenza and hepatitis.

A closer look shows that many of the edits involve two influenza codes and do not permit a modifier to override the edit. This is because it would not be clinically appropriate to administer two different influenza vaccines to the same patient on the same date. If you inadvertently report two influenza vaccines for the same patient on the same date, which one will be paid will depend on the pair that you report. For example, new code 90672 (Influenza virus vaccine, quadrivalent, live, for intranasal use) will be paid instead of other influenza vaccine codes 90653 ‘«Ű 90668 if reported with any of them. Note also that several of the codes are pending FDA approval:

– 90653 ‘«Ű Influenza vaccine, inactivated, subunit, adjuvanted, for intramuscular use
– 90661 ‘«Ű Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use
– 90666 ‘«Ű Influenza virus vaccine, pandemic formulation, split virus, preservative free, for intramuscular use
– 90667 ‘«Ű Influenza virus vaccine, pandemic formulation, split virus, adjuvanted, for intramuscular use
– 90668 ‘«Ű Influenza virus vaccine, pandemic formulation, split virus, for intramuscular use.

Careful: Some of the same influenza vaccine codes that are a Column 2 code in one edit may be a Column 1 code in other situations. Codes 90654-90668, for example, will always be paid instead of 90653 if listed for the same patient on the same date of service.

Hepatitis look: Edits also clarify that some hepatitis vaccines should not be administered (and reported) on the same day as other hepatitis vaccines. For instance, based on the CCI edits, physicians should not administer hepatitis B vaccine 90739 (Hepatitis B vaccine, adult dosage [2 dose schedule], for intramuscular use) during the same encounter as the following hepatitis vaccines:

– 90636 ‘«Ű Hepatitis A and hepatitis B vaccine (HepA- HepB), adult dosage, for intramuscular use
– 90723 ‘«Ű Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and poliovirus vaccine, inactivated (DtaP-HepB-IPV), for intramuscular use
– 90740 ‘«Ű Hepatitis B vaccine, dialysis or immuno- suppressed patient dosage (3 dose schedule), for intramuscular use
– 90743 ‘«Ű Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
– 90744 ‘«Ű Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
– 90746 ‘«Ű Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
– 90747 ‘«Ű Hepatitis B vaccine, dialysis or immuno- suppressed patient dosage (4 dose schedule), for intramuscular use
– 90748 ‘«Ű Hepatitis B and Hemophilus influenza b vaccine (HepB-Hib), for intramuscular use.

‘«£Like the influenza vaccine edits above, these edits make sense clinically. In each case, the Column 1 code already includes the Hepatitis B vaccine, and there is no clinical indication for administering two Hepatitis B vaccines to the same patient on the same date,‘«ō states Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians in Leawood, Ks.

 

Orthopedics

Guidance for Heel Spur Treatment Claims Success

The Coding Institute

If you‘«÷re reporting heel spur excision as a lone procedure, you could be leaving money on the table. Your surgeon may be doing more than just an excision and not capturing those services means lost pay. Let the advice that follows guide you to accurate and complete claims. You report code 28119 (Ostectomy, calcaneus for spur, with or without plantar fascial release) if your surgeon excises a calcaneal spur. You report this code regardless of whether your surgeon makes release incisions on the stressed or irritated plantar fascia. You may read in the operative note to confirm any fasciotomy done by your surgeon.

If your surgeon removes a part of the calcaneus, you report code 28118 (Ostectomy, calcaneus).

Look for Casts and Devices
Check the procedure notes for details on any casts applied. Your surgeon may apply a walking cast at the time of the heel spur surgery. Keep in mind that the first cast applied at the time of surgery is a part of the global package; you may report subsequent casts, if any. For instance, for a short leg cast, you would report 29425 (Application of short leg cast [below knee to toes] walking or ambulatory type

Note: A change of cast in the global period requires you to confirm if there was a cause for the change. For example, your surgeon may decide to change the cast due to a pressure ulcer. In this case, you report 29425 for the cast and append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to the cast application code. In addition, you also report the diagnosis code 707.06 (Pressure ulcer, ankle), 707.07 (Pressure ulcer, heel), or 707.09 (Pressure ulcer, other site) depending upon where the pressure ulcer is located. If your surgeon documentation does not support the location of the ulcer, you may report code 707.00 (Pressure ulcer, unspecified site).

Cast applied later? You may read that your surgeon did apply a cast but only after the surgical excision of the heel spur was completed. For example, your surgeon may choose to defer the cast application due to excessive swelling, although this is fairly rare.

In this case, you‘«÷d append modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) to report the application of a cast in the physician‘«÷s office during the postoperative period. You may bill separately for a cast put on in the office.

 

Ophthalmology

92225-92226 Coding: Get to Know These Guidelines for Extended Ophthalmoscopy

The Coding Institute

Many ophthalmology coders aren‘«÷t clear on when it‘«÷s appropriate to report 92225 (Ophthalmoscopy, extended, with retinal drawing [e.g., for retinal detachment, melanoma], with interpretation and report; initial) or 92226 (…subsequent). The procedure pays about $27 each time, so mistakes can add up. Read on to see if one of the following EO myths could be taking money out of your practice‘«÷s pockets.

EO Is Not Always Included in Eye Exam

Routine ophthalmoscopy is included in a comprehensive eye exam (92004 and 92014), but according to the National Correct Coding Initiative, extended ophthalmoscopy isn‘«÷t. CPT codes 92225 and 92226 are not bundled into 92004 or 92014, as of the latest set of NCCI coding edits.

You might still see denials, however. Some carriers have a longtime edit in place not to pay for extended ophthalmoscopy when billed with 92014. If this is the case in your area, you will either need to bill the services and end up in the review and appeal process proving medical necessity.

Bilateral EO Requires Documentation
Despite what some coders may assume, carriers will not automatically pay twice the fee schedule amount for one eye if you report EO bilaterally.

Reality: Carriers will not pay double for bilateral EO unless you can justify medical necessity for performing EO on both eyes. If you‘«÷ve diagnosed a problem in one eye, don‘«÷t assume the other eye has the same diagnosis ‘«Ų although chances are it will. You must report ICD-9 codes showing medical necessity in each eye you performed EO on. The diagnoses don‘«÷t have to be different for each eye, but they do have to demonstrate medical necessity for the EO.

 

Neurology

Faced with ADHD Claim Denials? Focus on These Strategies for Improved Results

When you report a follow-up visit for ADD (Attention Deficit Disorder) or ADHD (Attention Deficit Hyperactivity Disorder), do you submit an office visit code or a pharmacological management code? ‘«£Office visit‘«ō is the correct answer ‘«Ų and your ticket to avoiding denials and earning your deserved payment. Here‘«÷s why:

Remember E/M Is an Essential Component

When the neurologist spends time discussing complaints with the patient and/or family and does a physical examination before prescribing medication for ADHD, report an E/M code such as 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components ‘«™ Typically, 10 minutes are spent face-to-face with the patient and/or family) or 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components ‘«™ Typically, 40 minutes are spent face-to-face with the patient and/or family).

Tip: Carefully check the follow-up components. A neurologist will often do a medical examination prior to renewing a prescription. The patient may or may not be on psychotherapy in this case.

We hope you find the tips from these leading sources helpful. For additional help improving your medical billing and coding results, contact Medical-Billing.com at 800-966-9270.

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By Steve Elliott, COO, Medical-Billing.com

On November 1, 2012, the Centers for Medicare and Medicaid Services (CMS) released the final rule for the 2013 Medicare Physician Quality Reporting System (PQRS). To date, the PQRS has been a voluntary program, offering incentives to physicians who report on a designated set of quality measures. While the PQRS will remain voluntary, starting with the 2013 reporting year, it will include both incentives for 2013 (+0.5%) and penalties for non-participation in 2015 (-1.5%).?Š For complete information on PQRS reporting options for receiving the 2013 incentive payment (and avoiding the 2015 payment adjustment) click on the following link: ?Šhttp://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2013MLNSE13__AvoidingPQRSPaymentAdjustment_020113.pdf

2015 penalties may also be avoided by electing to participate in the ‘«£administrative claims-based reporting mechanism‘«ō by October 15, 2013.?Š However, details on how to choose this option have not yet been published by CMS.

Our recommendation is for our clients to pursue reporting options for receiving incentive payment.?Š To this end we offer the following summary for your decision making, which includes:

1. Selection of Individual Professional or Group Practice reporting

2. Selection of Reporting Mechanism

3. Selection of Measure Type(s)

Individual or Group Reporting

Most of our clients will likely report at the Individual Professional level.?Š Group Practices are limited to reporting for Individual Measures only and must report via Registry (see Measure Type and Reporting Mechanism discussion below).?Š Unless Groups have already initiated PQRS reporting using an EHR for 2013, it is likely too late in the year to begin.

Reporting Mechanism

There are three ways to report PQRS data: Claims, Registry or Direct via Qualified EHR Product (or Qualified EHR Data Submission Vendor).?Š We can assist with claims-based reporting as part of our billing services.?Š However, to report using Registry or Direct via EHR will necessitate working directly with your EHR vendor.

Measure Type(s) (for Claims-Based Reporting)

There are two options for reporting PQRS ‘«£Measures‘«ō ‘«Ű Individual and Group.?Š There are 259 Individual PQRS Measures and 22 Measures Groups for traditional reporting options.?Š If the Individual option is selected, a minimum of 3 Measures must be reported and for at least 50% of the eligible professional‘«÷s Medicare Part B patients.?Š If a Measures Group option is selected, only 1 Group is required and for at least 20 Medicare Part B patients.

Based on our conversations to date with clients, it seems there is much greater interest in selecting the Measures Group reporting option (mainly because of the finite number of patients that can be easily measured).?Š Following is a link to 2013 PQRS Measures Codes, with related links and downloads at the bottom of the web page:?Š http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/MeasuresCodes.html

For more information on how Medical-Billing.com can assist in helping you avoid PQRS penalties, please contact us today at 800-966-9270.

Steve Elliot, COO – With over 32 years’ healthcare experience in various?Šfinancial, corporate and administrative positions, Steve founded his?Š?Š first?Šmedical billing company in 1992. ?ŠHis expertise is in the?Šimplementation of?Špractice management systems, development of?Šmiddle ?Š?Š management infrastructure,?Šand revamping the company‘«÷s billing model.?Š?ŠSteve also manages client?Šdevelopment, financial and administrative?Š?Š activities of the company.?Š He has a?ŠBBA from Georgia College and did?Šhis graduate studies at the University of South?ŠCarolina.

Posted on September 28, 2012 by · Leave a Comment
Filed under: Neurology  

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You are all aware of the EP studies and related headaches, right? The fact is, practitioners performing Neurology coding and billing routines often fall in to pits. This is because they lack proper knowledge regarding the same. You can minimize the coding mistakes by knowing the accurate units of a particular EP code. You must also know the exact time to report the studies. In this article about neurology coding, we will discuss some important codes to help you increase the reimbursements.

Neurology coding and billing: understanding the codes

As you all know, EP studies are carried out to measure the electrical activity of the brain. This is done by stimulating certain specifies nerve fibers. After recording the information, the practitioner makes use of the same to diagnose nerve disorders.?Š This technique is also used to diagnose other conditions such as multiple sclerosis. On the other hand, you can also locate damaged nerves with this technique. During a surgical procedure, you can use this reading to evaluate a patient‘«÷s condition. You can use six important codes to report the EP studies. You can classify this as somatosensory, visual and auditory.

You can use the code 92585 to report the auditory evoked potentials concerning the evoked response during the neurology coding routines. This is in the case of audiometry and is also used for testing of the central nervous system. You can report the limited procedures using the 92586 code. With the help of the nephrology code 95925, you can report short latency somatosensory potential study. This is with respect to the stimulation of peripheral nerves. You can use the code 95926 to report the lower limbs during the neurology coding routines. On the other hand, you can use the code 95927 to report the heads or trunk. The code 95930 can be used to report the VEO testing during the neurology coding routines.

You must note that the studies mentioned above include recording of the physician‘«÷s actual work. At the same time, you need to also provide physician interpretation and report for the same. If the practitioner only provided the interpretation, it is really important to append the modifier 26 along with the report. This will highlight the professional component.

Hope the above article titled ‘«ˇNeurology coding tips: increasing the reimbursement potential‘«÷ was informative and educative. Goods day folks, thanks for the visit!

 

Posted on September 28, 2012 by · Leave a Comment
Filed under: Nephrology  

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Physicians specialized in the treatment of kidney diseases often find themselves in a really bad situation when it comes to the billing and coding aspects. According to the real time basis, this process takes a lot of time and patient hour. Taking the record of the patient itself is really time consuming. A Nephrologist should be ready to devote more time towards realistic research in order to understand the Nephrology billing and coding system. There is yet another challenge in this regard. For instance, it is important to understand the

It is also a challenging for capturing the utility of the nephrology billing software and makes the most important use of it. If a doctor is able to do it with a short period of time, he will be able to get access the data anytime he wants.

Nephrology billing and coding software: understanding the software

Such software are basically used for handling the records of the patient who suffer from different types of kidney problems.?Š There are different types of problems regarding the kidneys such as infections and renal failure. With the help of the Nephrology billing software, you can get additional information of the patient. On the other hand, you can record any amount of data and change it according to the condition of the patient. For instance, you can record the critical condition of the patient.?Š You must note that most of the healthcare units make use of different types of software for performing the Nephrology billing and coding routines. The fact is, this trend creates a level of confusion among the practitioners. You must note that the basic pattern remains the same no matter how sophisticated the application is. Utilizing good Nephrology software will help you spend more time with the patients. As such, you can improve the quality of the treatment.?Š However, a thorough training is required to make yourself an expert in the same. The good news is, you can perform the patient demographics, charge entry and medical coding with the help of single software.?Š Not to mention, you can also make note of the contacts who need follow ups. You can even record the time and date, medicines used and medical condition of the patient. You can also view the emergency medical report.

Hope the article titled ‘«ˇNephrology billing software: taking the patients records‘«÷ was interesting.

 

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