Although HIPAA enforcement of 5010 compliance was deferred until March 31, CMS is still expecting you to begin using the standard as soon as possible–and to make that easier, the agency has clarified one formerly confusing issue.Previously, CMS indicated that if you used a code that had “not otherwise classified” in a description, your claim would be rejected. However, a Jan. 13 revision fixes that error, and MLN Matters article SE1138 now notes that using [...]
Reader Question: Get to Know Global Modifiers (January 2012)
Question: Our physician performed a spinal procedure during the global period of a different spinal surgery. Which modifier applies?Answer: The answer may depend on whether the second surgery was a result of a complication from the first surgery or if it was because the first surgery did not provide the desired outcome. If the first surgery did not achieve the desired outcome, even if the second surgery was not planned, it is still staged, to [...]
Reader Question: Turn to CPT® for Lesion Size Coding (January 2012)
Question: In the past I have seen it in writing in the CPT books that if the size of alesion is smaller than 1 cm, we cannot also charge for an intermediate/complex repaircode. I am training new staff and do not see that anywhere in the book. Has this changed over time and I missed it? I don’t want to teach the wrong instruction to my staff.Answer: The Correct Coding Initiative (CCI) holds the answer. [...]
Reader Question: Hold Off on Reporting ICD-10 Codes (January 2012)
Question: I’m writing to find out whether many of your subscribers have started billing with ICD-10 codes, and if so, are claims successfully processing or are you receiving denials? Answer: You should not be billing with ICD-10 yet. MACs will not begin accepting ICD-10 codes until Oct. 1, 2013.To prepare for ICD-10, you can “shadow code” your current claims to determine whether the documentation is sufficient to code for ICD-10 and test your ability to [...]
Reader Question: Private Payers May Prefer to Use Medicare Codes (January 2012)
Question: For private payers, should I report G0364 or 38220 for aspiration and biopsy at the same session?Answer: As is so often the case, you should get your payer’s preference in writing and follow that instruction for that payer. In general terms, when the physician performs a bone marrow aspiration and biopsy at the same site during the same session, you should report 38221 (Bone marrow; biopsy, needle or trocar) for the biopsy. For private payers [...]
Show physicians how to thoroughly document all diagnoses addressed to ensure complete documentation.If your physician sees a large number of patients who have complex cases with multiple diagnoses, selecting an appropriate E/M level might be a challenge. However, once you take the coexisting conditions and the amount of time spent counseling the patient into account, you should be able to see the whole picture–and you may justify selecting a higher E/M level than you thought.The [...]
D.O. Billing: E/M With Osteopathic Manipulation May Be Billable–If You Know the Rules (January 2012)
Avoid appending modifier 25 to all cases–instead, focus on medical necessity in the notes.Because osteopathic physicians (DOs, or osteopaths) are fully licensed physicians who operate under the same licensing and certification rules as medical doctors (MDs), most of their billing matters are handled in the traditional manner. But because DOs also perform osteopathic manipulative treatment, or OMT (98925-98929), many coders have trouble distinguishing between OMT and chiropractic manipulative treatment (CMT, 98940-98943) or manual therapy techniques [...]
Care Plan Oversight: Stop Giving Away Your CPO Services for Free (January 2012)
But ensure that a face-to-face visit took place before you bill. Don’t let carriers undervalue your physician’s care plan oversight (CPO) services: Start getting paid for CPO with a solid understanding of how and when to report 99374-99380 and G0179-G0180.Suppose your physician spends 40 minutes setting up a home-health plan of care for an elderly diabetic patient who falls outside of her home and sprains her right wrist and right ankle with multiple abrasions of [...]
Part B Coding Coach: Take An Advanced Peek At Two New Paracentesis Codes For 2012 (January 2012)
CPT deletes intraperitoneal catheter insertion code.Do you know what CPT changes will affect gastroenterology practices in 2012? Here’s a hint: two peritoneocentesis codes will be missing in your CPT manual. Instead, you need to be ready to report new codes as replacements.Replace Old Peritoneocentesis Codes With Three New OnesThe change will eliminate 49080 (Peritoneocentesis, abdominal paracentesis, or peritoneal lavage [diagnostic or therapeutic]; initial) and 49081 (…subsequent), and will replace them with three new codes:49082 – Abdominal [...]
Plus: Keep PHI out of emails to your MAC.
When your physician admits a patient to the hospital, your coding work isn’t done – you need to know whether the patient was admitted as an inpatient, admitted to observation care, or admitted to the ER (which qualifies as outpatient care). That differentiation cost a Denver hospital over $6 million recently.
Based on a whistleblower lawsuit, the OIG investigated the admission practices of a Denver hospital, which was alleged [...]
