Incision and Drainage Mythbuster: Avoid Denial Dilemmas on I&D Abscess   (July 2010)

You’ll get twice the payment when you know where to look.
Incision and drainage (I&D) services are covered for treating abscesses – but recouping the maximum reimbursement is not as easy as you think. One wrong move could cost you as much as $80 reimbursement.
Do not let these 2 myths ruin your I&D abscess coding strategies.
Myth 1: I&D Codes Do Not Differ Significantly From Each Other
Reality: In fact, you’ll discover just the opposite: these codes differ [...]

Coding Quiz: Are You Receiving Denials For Lesion Removals? Help is Here   (July 2010)

The success of your lesion excision coding relies on right timing, accurate reading.
If you want to make sure you’ve got the most accurate CPT and diagnosis code for lesion excision, wait until the lab sends you its report before finalizing your billing. Sometimes, holding off that claim might prove to be the smartest thing you’d have to do.
Try Your Hand at These 3 Scenarios
Scenario 1: Your internist removes a 2-mm suspicious skin lesion from a [...]

Pulmonary Stress Test: How to Differentiate Stress Test Codes and Get Your Claim Paid the First Time Around   (July 2010)

Find out what blood-draw and analysis codes you can report separately.
Pulmonary stress tests (PST, a.k.a. exercise testing) come in handy when your internist wants to evaluate a patient with symptoms of shortness of breath, stridor and/or wheezing that occurs only when exercising. You can pick out one from the two code options that describe a PST, and discern the difference by the amount of equipment a test requires. CPT 94621 (Pulmonary stress testing; complex [including [...]

Coding Quiz Answers: Here’s What You Need Before Coding Lesion Removals   (July 2010)

Learn why preempting 11600 could send $55 down the drain.
Pathology tests aren’t there for nothing. The internist sends the excised lesion to the lab in order to provide her an exact reading of what type the lesion is, and how it is behaving (whether benign or malignant). Only the pathologist can decide on lesion pathology – allow him that privilege.
Caution: In no way you – as coder – should choose the pathology of a lesion based on the [...]

You Be the Coder: Consider Other Factors Besides ICD-9 and CPT In Case of Denial   (July 2010)

Question: A patient undergoes prostate cancer screening in my practice. On the claim, I reported V76.44 for diagnosis, and G0103 for the screening service. Yet, I got denied. Why?Tennessee Subscriber
Answer: Code V76.44 (Special screening for malignant neoplasms, prostate) supports G0103 (Prostate cancer screening; prostate specific antigen test [PSA]). Go back and check your HCPCS code. Remember, the two most common screenings used by physicians to detect prostate cancer are DRE and PSA blood tests. They [...]

On page 40 of May issue (Vol. 13 No. 5):   (July 2010)

On page 40 of May issue (Vol. 13 No. 5): The answer to the Reader Question “PAP/Pelvic Codes Depend on Payer” suggestively referred to V72.31 (Routine gynecological examination, general gynecological examination with or without Papanicolaou cervical smear, pelvic examination [annual] [periodic]) and V76.2 (Special screening for malignant neoplasms, cervix, routine cervical Papanicolaou smear) as procedure codes. In fact, they are the only ICD-9 diagnosis codes that many private payers recognize in order to support the [...]

Reader Questions: Be Wary of Time When Discharging Patients   (July 2010)

Question: Before discharging the patient from the hospital, our internist spends more than 30 minutes examining her, and giving instructions for continuing care and medication to her family. Should I bill 99239?
Nevada Subscriber
Answer: You may report 99239 (Physician discharge management; over 30 minutes) provided documentation indicates the floor time (the time the internist spent preparing and dictating the discharge summary) and what the internist did.
Reminder: The time that the internist spends on discharge planning doesn’t [...]

Reader Questions: Clarify Temp Services Using Modifier Q6   (July 2010)

Question: Our regular internist is taking some time off, and a temporary internist takes her place while she’s gone. What code should I use to indicate that certain services were performed by the substitute internist?
Alabama Subscriber
Answer: The general rule, particularly for Medicare, is to use modifier Q6 (Service furnished by a locum tenens physician) when billing for substitutes. Locum tenens reporting guidelines govern all services provided to Medicare patients by a substitute physician. The modifier [...]

Reader Questions: Get Paid for 94760 Based on Its Physician Fee Schedule Status   (July 2010)

Question: My practice has just started to bill pulmonary function tests (PFTs). In one case, I billed 94060, 94240, 94260, 94360, 94720, and 94760 to Medicare. I got a denial from Medicare for 94760, stating that it was bundled into the main procedure. I checked the CCI edits, which showed no such bundle. Could you explain how this happened?
Illinois Subscriber
Answer: If you looked closely in the Correct Coding Initiative (CCI) edits, you would see that [...]

Preventive Services: Sidestep 5 Traps When Offering Yearly PSA, DRE   (May 2010)

Warning: Code 84153 does not belong on these claims.
Pay attention to prostate screenings’ hidden coding traps to ensure accurate reporting or your patients can get stuck paying for these services.
Prostate cancer is the second deadliest cancer for men. Encourage patients to take advantage of covered prostate screenings so that both you and your patients can benefit from preventive services. Compliantly report these encounters for Medicare beneficiaries and other payers that follow Medicare guidelines by following [...]