Case Study: Tackle Challenging Multiple Hernia Repair Procedures With 4 Expert Tips   (July 2010)

You may need to appeal to make your case and get proper payment.
When your general surgeon performs more than one hernia repair during the same session, even in different anatomical areas, figuring out the proper coding can stump even the best coders. Test your know-how with this real-life case study.
Review the Surgical Case
Scenario: A general surgeon performed an initial laparoscopic incisional hernia repair with mesh insertion for a reducible hernia. During the same laparoscopic procedure, [...]

Evaluation and Management: Scope Out Potential Level 4 and 5 E/Ms By Knowing Crucial HPI Facts   (July 2010)

Watch out for CPT/Medicare differences when counting HPI elements.
If you’re not accurately accounting for the history of present illness (HPI) documented by your general surgeon, you could be missing out on opportunities to report level 4 or 5 E/M visits. Ensure you’re not missing higher-pay possibilities by reviewing this guide to capturing HPI elements.
Brush Up on What Qualifies as an HPI Element
HPI is one of the three parts comprising an outpatient E/M history. It describes [...]

Clip and Save: Use These Questions to Capture HPI for Full Reimbursement   (July 2010)

Get your physician to collect the information you need, with this handy list.
In the previous article, you learned how to use history of present illness (HPI) to determine the E/M level reportable for your surgeon’s services. Now, take a look at this checklist to help determine the HPI level a service meets.
When counting elements of HPI, check to see how many of these eight questions your urologist answers in the notes:
1. What is the location [...]

News You Can Use: Welcome a 2.2 Percent Medicare Pay Boost For the Rest of This Year — Finally   (July 2010)

But the news isn’t all good – first, you faced a week of lower payments, and second, there’s still no permanent fix.
For one week in June you faced substantially lower Medicare payments, due to a 21.29 percent cut that hit your Part B claims. Fortunately, the House of Representatives reversed those cuts on the evening of June 24, with a vote that also gives you a 2.2 percent pay increase through November 30.
Check Up on Claim [...]

Reader Questions: Catch Up on Incomplete Claims   (July 2010)

Question: Our surgical practice has a few claims that have missing or incorrect information. I’m not sure what to do with these claims – should I just put them through anyway and keep my fingers crossed?
Indiana Subscriber
Answer: Trying to put through an incomplete or incorrect claim will probably result in an immediate denial, so don’t waste your time doing so. Instead, put these claims on hold or suspend them, then do some homework on these claims [...]

Reader Questions: Straighten Out Your Modifiers For ER Admit   (July 2010)

Question: Our doctor saw a patient in the emergency room and decided to admit him and perform surgery. This patient is not Medicare. Do I code this using 99221-99223, as an outpatient E/M code, or with an emergency room E/M code? Also do I need to add a modifier if our doctor is the admitting physician?
Missouri Subscriber
Answer: You should use 99221-99223 (Initial hospital care …), assuming that your surgeon’s documentation will support the code. Once [...]

Reader Questions: Collect Surgical Deductibles Up Front   (July 2010)

Question: We often have patients who don’t pay their deductible after surgery. Is there a recommended way to collect these payments up front?
South Dakota Subscriber
Answer: Yes, you may collect a deductible upfront. The first step is to confirm the deductible amount with the payer. Insurance verification services now make it possible for practices to determine if a patient has met his deductible, or how much deductible remains unpaid. Others provide just information on what the [...]

Reader Questions: Bill All Scopes If No Parent   (July 2010)

Question: The surgeon performs a biopsy with sigmoidoscopy followed by an endoscopic removal of a foreign body. Which codes should I report for these procedures?
Montana Subscriber
Answer: In this case, neither scope is the base or parent procedure. Therefore, you would report both 45331 (Sigmoidoscopy, flexible; with biopsy, single or multiple) and 45332 (… with removal of foreign body).
Bottom line: If your surgeon performs two scopes in the same family, neither of which is the base [...]

You Be the Coder: Identify Tru-Cut Method to Select Proper Code   (July 2010)

Question: The op note states Tru-Cut liver biopsy. Is this a laparoscopic, percutaneous, or wedge biopsy, and how should I code it?Ohio Subscriber
Answer: A Tru-Cut biopsy is a percutaneous needle biopsy. The correct code in your case is 47000 (Biopsy of liver, needle; percutaneous) or +47001 (… when done for indicated purpose at time of other major procedure [list separately in addition to code for primary procedure]).
Check for stand alone: Choosing the correct code for [...]

Summer Healthcare: Don’t Get Burned by Missing 16000s with E/M Pay   (June 2010)

Pick Dx first to zero in on local treatment codes.
Grills, fireworks, lightning, sunburn … along with summertime fun you’re likely to see an uptick in burn patients in your practice this time of year.
But you won’t see an uptick in revenue if you only report the E/M service and miss up to $165 for dressing and debridement of the burn site.
General surgeons are often the first line of care for burns, according to M. Tray [...]