Reader Question: Inadequate History Can’t Support Comprehensive Exam   (December 2011)

Question: Our physician admitted someone as an initial inpatient, but couldn’t get all her information. He performed a comprehensive exam and used medical decision making of high complexity, but was unable to obtain a complete history due to the patient’s current condition. Can we give credit for a comprehensive history even though he couldn’t obtain a comprehensive ROS (review of systems) due to the patient being mentally confused?  South Carolina Subscriber Answer: There is no written [...]

Reader Question: Don’t Count On Pay for Anesthetic Before Injection   (December 2011)

Question: We’ve had increasing problems billing and being paid for the medications we use for trigger point and nerve block injections. We bill J1094 for Dexamethasone 4 mg, S0020 for Marcaine 0.5% and J2010 for Lidocaine 2%. We never get paid for the Marcaine and rarely get paid for the Dexamethasone. Are there other drugs we should be using? Or are we using the correct drugs with the wrong codes? What should I change when [...]

Reader Question: Code 86580 for TB Skin Test   (December 2011)

Question: Can we bill for an administration fee or injection when giving a PPD test? Or is it considered part of the PPD?Iowa SubscriberAnswer: No, you should not bill an administration fee or injection fee for a PPD (tuberculosis) skin test. Explanation: Your staff is not administering a vaccine or a subcutaneous or intramuscular injection, so codes such as 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) do not apply. [...]

Reader Question: Remember Debridement Includes Dressings   (December 2011)

Question: Can our practice be reimbursed for the surgical dressing (supplies) of a partial-thickness burn?Georgia SubscriberAnswer: Medicare and most private payers already factor supplies such as surgical dressings into the value of debridement codes. In these cases, you cannot recoup additional reimbursement using any codes.Some commercial insurers might accept 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, [...]

Reader Question: Verify State Laws, Payer Rules Before Sending Patient to Collections   (December 2011)

Question: I work in a physician’s office handling the collection of past due copays, deductibles, and coinsurance as well as the coding and claims. Can I send extremely delinquent accounts to the credit bureau or a collections agency, even if the patient is paying a few dollars a month, if the practice didn’t agree to a payment plan?Nevada SubscriberAnswer: Yes, you can send information about delinquent accounts to collections agencies and/or credit bureaus – even if [...]

2012 CPT® Updates: Learn CPT® 2012 Updates in Next Two Months   (November 2011)

Updates to vaccine, E/M, Dermatology procedures. CPT® 2012 goes into effect in a matter of weeks, so prepare for new and revised choices related to vaccine administration and prolonged E/M service to ensure your claims stay accurate. Look for Official Inclusion of 90654 CPT® 2012 adds another choice to your flu vaccine coding with the inclusion of 90654 (Influenza virus vaccine, split virus, preservative-free, for intradermal use). The addition expands on the code family 90655-90657 [...]

Rural Health: Revalidation Letters and Diagnostic Imaging Requirements Affect payment   (November 2011)

Understand how CMS changes affect healthcare serviceCMS officials discussed several issues of interest to rural health providers – including revalidation letters and the advanced diagnostic imaging program – during an Open Door Forum call on October 18. Read on for a few highlights that your practice might need to know. Watch for Your Revalidation Letter From CMS As part of the Patient Care and Affordable Care Act (section 6401 a), all new and existing Medicare providers must [...]

Platform 5010: Last Minute Look Through for 5010 Electronic Transactions Implementation   (November 2011)

Buffer time required to handle glitchesAre you ready to say goodbye to forms 4010/4010A1 for electronic transactions? You’ll need to starting Jan. 1, 2012, when your practice should be fully functional with form 5010 to comply with the Health Insurance Portability & Accountability Act of 1996 (HIPAA) electronic transaction standards.Consequence: If you don’t have your 5010 glitches worked out by January, you won’t be able to submit electronic transactions to Medicare.Prepping for ICD-10Version 5010 lays [...]

E/M Update: 99218-99220 Will Have Typical Times in 2012   (November 2011)

Rumor has it the revisions could add options for reporting these observation codes.Have you ever wished that CPT® would put a time guide on its observation codes? Then you’ll be in luck as of Jan. 1, 2012, when the new manual will offer specific typical times that relate to each of the initial observation care codes. Observation Time Guidelines Could Open DoorsWhen CPT® 2011 debuted 99224-99226 (Subsequent observation care, per day, for the evaluation and [...]

ICD-10: Malignant and Benign Hypertension: 404.0x Differs From I13.   (November 2011)

4 ICD-10-CM for hypertensive heart and CKD.You can expect ICD-10-CM to provide you with combination codes for certain chronic conditions just as ICD-9-CM does, but that doesn’t mean the code definitions will be precisely the same.To see a practical example, review the codes below, which you assign when a patient has both hypertensive heart disease (documentation indicates hypertension causes heart disease) and hypertensive chronic kidney disease (hypertension with chronic kidney disease [CKD] even if no [...]