Here’s the lowdown on how these CMS changes apply to your practice.If you’re a rural healthcare provider, you’ll want to know the latest news CMS officials discussed during an Open Door Forum call on October 18. Read on for a few highlights about revalidation letters that your practice might need to know.Watch for Your Revalidation Letter From CMSAs part of the Patient Care and Affordable Care Act (section 6401(a)), all new and existing Medicare providers [...]
ICD-10: Prepare for ICD-10 Conversion With 2 Simple Tips (December 2011)
Know your anatomy and physiology if you want a quick transition.It’s not too early to start educating yourself about ICD-10 implementation (Oct. 1, 2013), but don’t spend your time trying to memorize code sets. That was the advice Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, shared with attendees at the AAPC’s regional conference in Nashville Sept. 7-9. Buckholtz is vice president of ICD-10 education and training at AAPC and led a general session [...]
CPT® 2012: Establish Whether a Patient Is New With CPT®’s Latest E/M Tweaks (December 2011)
New rules place emphasis on subspecialties. It’s an age-old debate – when an established patient presents to your practice to see a new physician, should you report a new patient office visit code? CPT® 2012 attempts to clarify when that’s possible with a revision to the “New and Established Patient” section of the CPT® manual.The rules: Currently, CPT® indicates that a “new patient” refers to a patient who has not received any professional services, such as [...]
Plus: Avoid PO boxes on 5010, despite what your MAC tells you.Sweating over the fact that your 5010 standard won’t be in place by the Jan. 1 deadline? CMS has an early holiday gift for your practice, with the Nov. 17 announcement that it will not initiate enforcement action regarding 5010 until March 31, 2012.Not a deadline shift: CMS stresses in its statement that the 5010 compliance date remains Jan. 1, 2012. However, the agency [...]
You Be the Coder: Mohs With Frozen Section (December 2011)
Question: The surgeon in our practice usually performs a biopsy of the lesion prior to doing the Mohs, either because he does not have a biopsy report or he’s not sure of the type of the patient’s lesion. How do I bill for this frozen section prior to Mohs?Florida SubscriberAnswer: Mohs micrographic surgery requires a single physician to act as the surgeon and the pathologist. For the frozen section, use 88331 (Pathology consultation during surgery; first [...]
Reader Question: V16.8 Tells Family Melanoma Risk Story (December 2011)
Question: In our practice, we frequently see patients who don’t personally have malignant melanoma but have bad family history that puts them at a high-risk level. What is the ICD-9 code for it?Wisconsin SubscriberAnswer: The family history of melanoma falls under the code V16.8 (Family history of malignant neoplasm; other specified malignant neoplasm), which may not be a covered primary diagnosis.Protect yourself: Don’t opt for V16.8 as primary on the claim form. Instead, use the diagnosis(es) [...]
Reader Question: Diagnosis Is Related to E/M Level, But Doesn’t Dictate Code (December 2011)
Question: Our dermatologist saw an established patient with severe chronic skin allergies. The patient did not present with any symptoms currently, but the doctor documented a detailed history, a detailed exam, and low complexity decision making and circled 99214. Is this possible for a visit where he was just managing a previously-diagnosed condition?Maryland SubscriberAnswer: If the documentation meets the criteria for 99214, you can report it. According to CPT® rules, you need two out of [...]
Reader Question: Modifier 55 Won’t Apply to Suture Removal (December 2011)
Question: An 11-year-old established patient went to the emergency room in another state over the weekend because of a laceration to his arm. The ER staff sutured the cut and told him to follow up with our physician. At the office visit, the provider removed the stitches, cleaned and rebandaged the area, and spoke with the parent about wound care. We reported an E/M code with modifier 55, but insurance only paid $15. What did [...]
Reader Question: Know GC Rules for Resident Surgical Assists (December 2011)
Question: When a resident assists a surgeon in a teaching hospital, do we need to add modifier GC to the procedure code for surgery or is that a modifier for E/M codes only?Florida SubscriberAnswer: Yes, you should append modifier GC (This service has been performed in part by a resident under the direction of a teaching physician) to surgical procedure codes when a resident assists a surgeon in a teaching hospital.Modifier GC is not only [...]
CPT® 2012 Update: New Codes Abound for Skin Substitutes (November 2011)
Plus: Check out time guidelines for initial observation codes. Have you ever wished that CPT® would simplify the skin substitute graft codes? Then you’ll be in luck as of Jan. 1, when the new manual will offer eight new codes to take the place of the 15300-15431 range. These changes and many more can be found in the pages of the new edition of the CPT® manual, with codes that take effect on Jan. 1, [...]
