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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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How do you choose the right medical billing service for your practice? Too often, the decision is made too quickly, based on things such as a colleague‘«÷s recommendation or what you disliked about your previous billing service. This can result in a skewed view of the new billing service‘«÷s benefits.

That‘«÷s why we recommend a more analytical approach. As we have mentioned in previous posts, when considering an external medical billing service there are several criteria you should take into account:

  • Performance
  • Customer Service
  • Compliance
  • Reporting/Transparency
  • Technology
  • Capability/Scalability
  • Pricing

In this post, let‘«÷s look at Pricing. For previous sections, see our blog posts on Performance, Customer Service, Compliance, Reporting/Transparency, Technology, and Capability/Scability.


A key concern for many practices when considering whether to outsource their medical billing is price. While you definitely want to investigate price, the key factor to consider, as with most things, is the return on investment. You may be concerned that one medical billing service is charging 8 percent of collections when another is charging 6 percent. However, if the first service is able to increase your bottom line by 15 percent and the second service only maintains the status quo, you are ahead by 7 percent (or 13 percent if you consider the 6 percent fee for maintaining the status quo to be a loss). Also, remember that a 10% improvement in quality means 10 times more to your bottom line than a 1% reduction in price.

That said, here are some considerations for the most common pricing models:

Pricing ?Š?Š Model

How?ŠIt Works



Percentage You‘«÷ll be charged a?Špercentage of collections, or a percentage of gross claims submitted or total?Šcollections. The success of the billing?Šcompany is tied to the success of your practice. Due to a lower return on?Šinvestment, your small claims may not be pursued as aggressively as larger?Šclaims.
Fee With this model, you‘«÷ll be charged?Ša fixed dollar amount per claim submitted. Potentially more cost effective. Provides less incentive for?Šyour billing service to follow-up on denied claims.
Hybrid In this model, you‘«÷ll be charged ?Š on a percentage basis for certain carriers or balances and a flat fee for ?Š others. Potentially more cost?Šeffective, if negotiated correctly. Provides less incentive for?Šyour service to follow-up on certain claims that provide a lower return.


Consider the advantages and disadvantages of the different models for your specialty and practice, based on the types of claims you usually encounter. Also consider how well your current model works for your practice, and adjust accordingly.

A particular medical billing service may have been right for your practice once, but you may have outgrown their capabilities even if their pricing seems good. If so, you need to look for a medical billing service that offers the capabilities, technology and pricing your practice needs now.

Get our new free white paper, When and How to Select the Right Medical Billing Service, now. It includes handy checklists you can use to evaluate the medical billing services you are considering, and to thoroughly vet their references.


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Choosing the right medical billing service for your practice is vital: The decision affects not only your financial health, but also your mental health and even your care for your patients. If you‘«÷re worried about the financial health of your practice, it becomes difficult to be satisfied with your practice and may even distract you from your primary consideration: your patients,

As we mentioned last week, when considering an external medical service there are several criteria you should take into account:

  • Performance
  • Customer Service
  • Compliance
  • Reporting/Transparency
  • Technology
  • Capability/Scalability
  • Pricing

This week, let‘«÷s look at Customer Service. You can read last week‘«÷s post on Performance as well. In future posts, we‘«÷ll discuss each of these areas and key points you need to evaluate for each.

Customer Service

Customer service is very important in revenue cycle management, both with patients who may be calling about bills, and with physicians who must know how the practice is performing, whether only for their own peace of mind or to report to a managing committee. What level of customer service will the medical billing service guarantee? Do they guarantee a response to questions within a specific time frame?

Does the service provide an Account Manager? If so, what level are they and what authority do they have? How many clients will they be handling?

Inevitably, even with the best medical billing service, problems will occur. What is the service‘«÷s process for reporting and escalating problems? If there is no established process for handling problems, this is not a good sign; it doesn‘«÷t mean that there are no problems but just that the service doesn‘«÷t have a good process for dealing with them.

What options are you offered for claim submission? Is it online only, scanning, faxing, FTP, courier? If you have multiple options, this allows for continued processing even when the network is down, the scanner is broken, etc. Flexibility works to your benefit.

Pay attention to the service‘«÷s responsiveness while you are interviewing them. If they are not as responsive as you would like during the ‘«£dating‘«ō phase, they are not likely to become more responsive after you‘«÷re ‘«£married‘«ō to their service.

Strategic partners?

Also, does the medical billing service present itself as a vendor or as a strategic partner to the practice? The third-party vendor who is committed to working with the practice to ensure the success of the entire revenue-cycle process will look at this affiliation not as another cog in the cash-flow wheel, but as a win-win strategic partnership for all parties.

Look for billing services that have the capabilities to do more in-depth revenue analysis and not just billing. Also, a service with management that is connected in the industry can help keep you informed about current trends, issues, etc., and possibly even help with strategic alliances or referral relationships.

Contract monitoring

When considering your medical billing service, it‘«÷s also important to find a partner who will help you insure that you are paid your contracted amount by consistently monitoring actual payments versus your contract. If you think this isn‘«÷t important, think again; the AMA‘«÷s 2012 National Health Insurer Report Card shows that while there has been significant improvement over 2011, the lowest ranked insurer still paid correctly just 87% of the time.

That means that you could lose 13% of revenue you have earned every time you process a claim with that insurer. And if your medical billing service is not monitoring your payments versus your contract, you would never know. Ask your medical billing service candidates if they provide this type of monitoring‘«Ųit could mean a significant percentage added to your bottom line.

As you evaluate these items, be sure to think about whether this is the group you want to entrust with your practice‘«÷s lifeblood. If the firm you‘«÷re talking to doesn‘«÷t seem to offer the customer service capabilities you want, the scalability you‘«÷ll need for growth, and the ability to help you improve your practice‘«÷s performance, then keep looking.

And when you‘«÷re ready to talk to a national firm with local offices coast to coast that is trusted by hundreds of doctors, contact at 800-966-9270, or email

Our nationwide network of experienced, highly qualified billing experts and dedicated account managers insures that you will receive the best management of your practice revenue possible.

Related Posts
What Criteria Should You Use for Evaluating a Medical Billing Service?
Medical Billing Appeals: Make Sure They‘«÷re Working for You
Medical Billing Service or Internal Billing? Consider the True Costs

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When you decide to consider an external medical billing service, there are several criteria you should consider:

  • Performance
  • Customer Service
  • Compliance
  • Reporting/Transparency
  • Technology
  • Capability/Scalability
  • Pricing

Today, let‘«÷s look at Performance. In future posts, we‘«÷ll discuss each of these areas and key points you need to evaluate for each.


One of the first areas to consider, of course, is performance. If a medical billing company can‘«÷t keep your denials, DRO, net collection rate and other key performance indicators (KPI) within industry standards (or better), then other issues such as customer service are moot.

Key Performance Indicators

To get a feel for how well the medical billing service candidate performs within common KPIs, ask:

  1. What is your clients‘«÷ average Days in Receivables Outstanding (DRO)?
  2. What is your clients‘«÷ average A/R over 120 days percentage?
  3. What is your clients‘«÷ net collection rate?
  4. Has your clients‘«÷ cash flow improved or declined over the last 90 days? If it has declined, why?

Also ask:

What resources does the group dedicate to the last 20-30% of claims that are harder to collect and often never paid?

What is the service‘«÷s process for continuous improvement? Do they evaluate their performance every month and assess where improvement is needed? You want to find a group that is striving to be better and will help to make your practice better.

Try Our Practice Revenue Assessment Tool to Gauge Your Practice‘«÷s Financial Health

You can analyze how your practice is currently performing compared to industry standards with this quick assessment tool.

Other key components of performance are Timeliness and References, so that you know the service can actually deliver what they are promising.


Ask if adequate checks and balances are provided between the practices and the medical billing service to assure that all charges or superbills are being entered in a timely fashion. A typical benchmark for this would be a guaranteed entry rate of 48 hours or better. Does the service have a good audit system to confirm charge entry against a service/procedure log to avoid missed charges?


Can the medical billing service provide you with references in your specialty? If you talk to the key contact, be sure to ask the performance questions above to validate the information you are receiving from the service. Ask if they are offered any compensation for acting as a reference, and if so, what is it? A small gift is normal, but anything extravagant raises questions about the validity and enthusiasm of the reference.

As you‘«÷re considering medical billing services, be sure to consider Our nationwide network of experienced, highly qualified billing experts insures that you will receive the best management of your practice revenue possible.

And, we dedicate over 50% of our billing costs to the successful collection of the last 20-30% of charges that typically do not get paid on first submission. These are the claims your staff probably doesn‘«÷t have either the time or expertise to collect on‘«Ųbut we do, and we do it every day.

Don‘«÷t let that money slip through your fingers‘«Ųlet the experts handle it. Call today at 800-966-9270, or email

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Medical Billing Services: What Do You Get for Your Percentage?
When It Comes to Medical Billing, Don‘«÷t Settle for Less Than You Deserve
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Why should you use a medical billing service for your practice? The answer depends on several factors, including:

  1. Your specialty
  2. Your practice‘«÷s financial performance
  3. The difficulty of finding and hiring qualified internal staff in your area
  4. Internal abilities to handle upcoming challenges such as CMS audits and ICD-10 coding
  5. The true costs of billing internally vs. using a medical billing service

Because practices are being squeezed more and more by reduced reimbursements, rising costs and new regulations, a highly efficient revenue cycle is more important than ever to medical practices. And that is leading more and more practices to consider a professional outside group to manage their revenue cycle.

Essentially, there are two options for handling medical billing:

  1. Inhouse medical billing staff
  2. Medical billing service

Many practices handle the medical billing process completely inhouse; others handle some parts inhouse and hand it off to a medical billing service at various points in the process.

Still others ask a medical billing service to take full control of their revenue cycle management process.

Many people feel the medical billing service option is one that makes more sense now than the inhouse option, for several reasons including the level of training now required, audits, increasing denials, the cost of staffing internally, and more complex coding.

Entrusting your practice revenue to someone who‘«÷s not fully qualified is even less wise in today‘«÷s environment, when you‘«÷re dealing with:

‘«ů An increasing threat of CMS audits
‘«ů Increased denial rates requiring more and better appeals
‘«ů Heavier patient responsibility that leads to increased patient collection efforts
‘«ů And of course, looming over it all: ICD-10

What are your alternatives?

There are a couple of solutions to the problems requiring increased expertise:

1. Train and certify your biller‘«Ųif you can afford the time and money, and you think the person has the ability
2. Hire a trained, certified biller for your practice‘«Ųif you can find the right person and can afford them
3. Let the experts handle it‘«Ųhire a trusted, nationwide medical billing service

Consider the True Cost of Billing Internally

Many practices assume that inhouse medical billing is the less expensive option. However, it‘«÷s important to look closely at what the true costs are. In addition to the opportunity costs above in terms of potential lost revenue from denied claims, failed appeals, etc., the cost of maintaining an internal staff is often much higher than most providers believe.

With internal medical billing, salary is typically only about 70-75% of your employee costs ‘«Ű when you figure in payroll taxes, FICA and insurance, the costs add up quickly. Costs to include in your calculations are:

  • Medical Billing Specialist‘«÷s Employee salary
  • Medical Billing Specialist‘«÷s Employee benefits
  • Worker‘«÷s compensation
  • FICA
  • Healthcare insurance
  • Vacation, sick leave, etc.
  • Performance bonus
  • Computer hardware purchase & maintenance
  • Software purchase & renewal

Plus, consider the added paperwork cost of administering the employees. And when your medical billing specialists are sick or on vacation, you‘«÷re still paying them‘«Űfor not working. When you outsource your billing and take advantage of our professional medical billing specialists, the overhead and paperwork is ours, not yours.

And don‘«÷t forget, when your billing is handled internally, if you lose a core member of your team you can lose years of training and knowledge. With a reasonably-sized medical billing service, you are guaranteed complete redundancy so that there is continuity of business processes ‘«Ű which is a significant burden off your shoulders.

Finally, don‘«÷t forget the importance of insuring that none of your medical billing staff has been excluded by CMS. If you are employing excluded staff, you could lose your right to bill Medicare‘«Ųand that could be disastrous. A medical billing service protects you from this risk, insuring that all of their staff is legally able to handle Medicare claims. Again, they must do this because it means their business if they don‘«÷t.

Taking all of these factors into account, you can see why it may be time to reassess the benefits of using a medical billing service.

To find out how a highly qualified, nationwide medical billing service can help improve your bottom line, contact at 1-800-966-9270 or email us:

Posted on October 16, 2012 by · Leave a Comment
Filed under: Medical Billing, Physician billing, Podiatry Billing  

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According to a recent article in Outpatient Surgery, the most difficult podiatric procedure to code is Haglund’s deformity resection, also known as a ‘«£pump bump.‘«ō

The author of the article, Lolita Jones, RHIA, CCS, says that ‘«£When auditing ASC podiatry cases, I usually find that the Haglund’s deformity resection has been miscoded, and during coding training sessions with ASC coders, I find that many are unclear about the clinical aspects of both the deformity and the surgical procedure.‘«ō

Jones explains that in the May 2011 CPT Assistant newsletter, the American Medical Association provided the following coding guidelines: Haglund’s deformity and retrocalcaneal bursa removal with osteotome is coded as 28118:

28118 Ostectomy, calcaneus;
If additional work other than for exposure is also performed on the Achilles tendon, such as debridement of necrotic tissue, then also assign code 28200:

28200 Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon
If there is a spur on the bottom of the foot and a plantar fascial release is also performed, assign code 28119 (with or without 28118):

28119 Ostectomy, calcaneus; for spur, with or without plantar fascial release.

But more important than your knowledge of this coding challenge is the question: Does your medical billing team know how to code it‘«Ųand your other podiatric procedures‘«Ų for maximum reimbursement and to avoid audits?

Many coders will tell you that they find podiatry surgery to be one of the most challenging specialties to code.

And if your medical billing team isn‘«÷t up to speed on how to appropriately code these procedures, you could be facing lost revenue or, worse‘«Ųa painful CMS or RAC audit.

Why run the risk of these time-consuming, expensive audits or worse, of losing your practice?

As challenging as podiatric coding can be, it amazes me how many podiatric practices are entrusting their practice revenue‘«Ųthe lifeblood of their practices‘«Ųto people who are essentially amateurs.

We know how it happens: You hired a nice woman who handled medical billing for a colleague, and she did the work out of her home. You were just getting started, or your practice was smaller, and it was before things got so complicated.

But now, things have changed‘«Ųand revenue cycle management needs to change with the times.

Entrusting your practice revenue to an amateur is even less wise in today‘«÷s environment, when you‘«÷re dealing with an increasing threat of CMS audits, increased denial rates requiring more and better appeals, and of course, looming over it all: ICD-10.

We‘«÷d like to help you insure you are bringing the maximum amount to your bottom line. is currently serving 100 plus DPM practices, so you know that we understand your specific needs. Our billers and account managers have dealt with nearly every podiatric coding challenge possible.

Plus, we collect that last 20-30% that most can‘«÷t. 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. These are the claims your staff probably doesn‘«÷t have either the time or expertise to collect on‘«Ųbut we do, and we do it every day.

And, we offer unlimited reporting‘«Ųno more being kept in the dark about your practice revenues. You will know where your revenue stands.

Want to know more? Call now at?Š1-800-966-9270 to discuss how we can help you improve your bottom line.

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Choosing a medical billing service is one of the most important things you can do for the financial health of your practice. After all, these are the people who will make sure that you get paid, and get paid in a timely fashion.

So how do many people choose a medical billing service?

Without putting enough thought into it.

Here are 4 key points to consider when choosing the right medical billing service for your specialty:

1. Referrals are good, but are not everything. Just because your colleague is happy with a medical billing service doesn‘«÷t mean it‘«÷s the right medical billing service for you. Do they have the same expectations in terms of reporting and cash flow as you do? Get a referral, by all means, but probe to find out what your colleague is getting from their medical billing service and if it will meet your needs. We all know someone who does business with ‘«£someone they like‘«ō or ‘«£someone they trust‘«ō (even when they shouldn‘«÷t).

2. Specialty knowledge is good, but also not everything. Many physicians will only use a medical billing service that specializes in their particular specialty. That is, the billing service must understand podiatric billing because they‘«÷re already handling three podiatry practices. Of course, the key follow up questions include:

  • How well are they handling those podiatric practices? Is cash flow where it should be? How is the Days Revenue Outstanding (DRO )? Do they handle patient collections well?
  • Do they have capacity to handle additional practices? Just because they specialize in a particular specialty doesn‘«÷t mean they‘«÷re able to effectively take on additional practices. Many ‘«£kitchen table‘«ō billers understand a particular specialty extremely well‘«Ųbut since their ‘«£billing company‘«ō is comprised of one person, their capacity is extremely limited.

3. Reporting is key. Many, many providers complain that they don‘«÷t get accurate, timely, insightful reports on their practice revenue. One physician described his relationship with his billing service like this:

‘«£Basically, I am dealing with a system where I am completely in the dark.?Š I have to pull teeth to see copies of the transmission reports, accounts receivable, etc.?Š Essentially, I send stuff and never know when it is uploaded.?Š I become acutely aware when my bills have not been sent in because cash flow drops and then I have to call to find out (or hear the latest excuse). Pretty much it seems to me that if I submit bills to a company on a regular basis, then I should be receiving checks from the insurance carriers on a regular basis.‘«ō

You don‘«÷t want this to be you‘«Ųand with current billing software, there is no reason why it should be. Ask the billing service to show you the types of reports you can expect, and how often you will receive them. And then hold them to it.

4. Local is good, but National with Local service is better. Even though technology makes it possible to work anywhere in the world, many providers still insist on having their billing service in their neighborhood, and limit their choices as a result. Why is this a mistake? Because you want to choose the best medical billing service for your practice, not just the closest best service. Particularly if your practice is located in a small town, you are limiting your options way too much.

Instead, consider a national medical billing service with local offices. This type of ?Šbusiness can bring resources to bear on your collections that a small billing service, and certainly not a ‘«£kitchen table‘«ō biller, could ever have. is just such an option; we‘«÷re a national company, but we have offices in New York (both Manhattan and Long Island), Maine, Georgia, & California. That means that workload can be shifted between offices, expertise can be shared across offices both in terms of specialty and billing strategies, and in case of a natural disaster, your billing doesn‘«÷t have to miss a beat.

Choose the best medical billing service for your practice; call today at 1-800-966-9270 or email us: to find out why we‘«÷re the best fit for hundreds of practices across the nation.

Posted on July 26, 2012 by · Leave a Comment
Filed under: Physician billing  

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Thyroid lobes removal and malignant lymphatic chain removal are some of the important procedures in the medical industry. Unfortunately, many of the combination procedures cannot be coded using the CPT guide. You must note that the thyroidectomies are not bundled with the neck dissections according to my friends at the National Correct Coding Initiative. To resolve this situation during the physician billing routines, you must apply the multiple-procedure rules. Given below are some of the important codes in this regard. Let‘«÷s check them out, shall we? You can use the code 60240 to report the total thyroidectomy during the physician billing procedures. Even if the patient doesn‘«÷t have a malignancy, you can use the same code. As such, malignant neoplasm is a common element in most total thyroidectomy-neck dissection scenarios. You can use the code 38724 to report the modified radical neck dissection. In this case, you can use the code to report the cervical lymphadenectomy. You must use the modifier 51 to report the multiple procedures carried out during the same session while carrying out the physician billing routines. This must be done to the code with lesser value. Here, you can use the code 38724 60240-51, since 60240 has less relative value units.

Physician billing: modifier 59

You must appeal the bundle if the payer bundles the radical neck dissection which is modified. Here, it would be appropriate to use the modifier 59. This modifier establishes distinct procedural service in the claim. As such, it should be appended to the lower valued procedure. In this case, the code is 60240. On top of that, you can use the modifier 59 to report the various sites during the physician billing routines. You can report the correct code if the surgery is involved in both sides. Let‘«÷s take a medical scenario to understand the things better. Assume that the limited neck dissection and thyroidectomy is performed by the physician. On the other side, he perfumed a radical neck dissection. You can use the code 60252 for the first procedure and code 38724 for the second during the physician billing functions. Here, you need to apply the modifier 59 to the code with lesser relative value.

Hope the above article titled ‘«ˇPhysician billing and coding process regarding the modifier 59 usage‘«÷ was plain and interesting. Thanks for visiting. Good day folks!

Posted on July 26, 2012 by · Leave a Comment
Filed under: Physician billing  

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One of the common procedures performed by the surgeons is Unna boot. In the previous articles we have seen a lot of methods to accurately describe the same. In this article, we will discuss some more physician billing tips for better revenue management. The most important thing regarding billing is the debridements and this should be billed separately. For instance, patients with venous stasis ulcers strictly require this procedure. As such, you can use the code 454.0 to report the same. During this stage, you need to adopt certain separate debridement code as a part of the procedure. For example, to report the skin partial thickness, you need to apply the 11040 Debridement code. On the other hand, you can use the code 11041 to report the skin full thickness during the physician billing process.

Physician billing shortcuts: sorting out the correct codes

The most important code in this regard is 11042 used to report the subcutaneous and skin tissue. You can also use the code 11043 to report the subcutaneous muscle and tissue. The code 11044 basically reports the muscle and bone during the physician billing routines. But experts recommend you use the code 97601 to report the NPP’s services. This code basically reports the devitalized tissue removal. This also includes the selective debridement excluding the anesthesia. Wound assessment instructions are a major resource for the same. The code 97602 reports the non-selective debridement. Another important method is regarding the reporting of the bilateral treatment. As such, you need to use the modifier 50 along with the code 29580, if both the legs are involved in the procedures. In some cases, carriers prefer to use the -LT and ‘«ŰRT modifier along with the physician billing codes.

Based on the Medicare bilateral surgery guidelines, it is compulsory to reimburse the bilateral Unna boot application at the fee schedule‘«÷s 150 percent. This will change when the procedure is performed at a hospital facility. Physician billing experts point out that the code 29580 has RVU of 1.23 while performed in an office setting. As such, CIGNA states that only a reduced reimbursement is allowed if the procedure is performed in a hospital.

Hope the above article titled ‘«ˇPhysician billing shortcuts to obtain accurate reimbursement for surgical procedures‘«÷ was simple and educative. Please leave a comment at the bottom section. Good day folks!

Posted on July 25, 2012 by · Leave a Comment
Filed under: Physician billing  

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We have discussed the various codes that report the lysis of adhesions in the past. To make things simpler, this article would like to introduce certain physical medical billing and coding tips. The above mentioned tips will simplify the whole process and make the reimbursement faster. Practitioners need to exercise the same in order to generate more revenue. Let‘«÷s get down to the points.

Physician medical billing tips: simplifying medical billing

The most important thing is to assess the ob-gyn’s documentation for information. This becomes more vital when you try to code adhesiolysis and primary procedures. When the physicians perform the lysis procedures, the soft filmy adhesions removal is not reimbursed by the carriers. On the other hand, if you provide the necessary documentation along with a description of the significant work carried out, things will be on the right track. Let‘«÷s take a simple example of a physician medical billing scenario to understand the situation. While performing the abdominal surgery, the practitioner documents information about lysing the pelvic and intestinal adhesions. Here, you can use the code 58740 and 44005 to report the same during the physician medical billing routines.

The next tip is nothing but establishing facts where the surgeon lysed the adhesions. This will help the practitioners determine the accurate codes. You can report the code 44200 or 44005 to describe the adhesiolysis of the bowel during the physician medical billing routines. On top of that, the above codes depend on the mode of approach used by the physician. At the same time, you can report the code 58740 or 58660to report the lysed pelvic adhesions during the physician medical billing routines. This, however, depends on the exact location of the adhesion. Let‘«÷s take an example. The surgeon documents dense adhesions during a laparotomy. This also involves an omentum and bowel. The main procedure requires about two hours of adhesiolysis. You can report the code 44005 based on the information given above along with the 58150. The latter basically reports the total abdominal hysterectomy during the physician medical billing routines. The code 58150 is bundled in to the 44005 by the National Correct Coding Initiative (NCCI) along with a modifier “0”.

Hope the above article titled ‘«ˇPhysician medical billing and coding tips to resolve the confusion regarding adhesiolysis‘«÷ was interesting to read. Good day folks!


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