E/M: HPI Know-How Helps You Catch Level 4 and 5 E/M Opportunities   (December 2011)

Beware of CPT® and Medicare differences when counting HPI elements.Not accurately accounting for the history of present illness (HPI) documented by your podiatrist could result in missing appropriate opportunities to report level 4 or 5 E/M visits. Ensure you’re not missing higher paying possibilities by reviewing this guide to capturing HPI elements.Brush Up on What Qualifies as an HPI ElementHPI is one of the three parts comprising an outpatient E/M history. It describes the patient’s [...]

You Be the Coder: T3 Skinplasty   (December 2011)

Question: What is the proper code for a skinplasty on an overlapping fourth toe on the left foot (T3)?Florida SubscriberAnswer:  Do not use code 28286 (Correction, cock-up fifth toe, with plastic skin closure [e.g., Ruiz-Mora type procedure]). That particular skinplasty is only for procedures that involve the fifth toe, which this case does not. So you should not bill 28286-T3.If there were any other procedures performed besides the skinplasty, you should code and bill for those. [...]

Reader Question: Diagnosis Is Related to E/M Level, But Doesn’t Dictate Code   (December 2011)

Question:  Our podiatrist saw an established patient with chronic diabetes. 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 three elements [...]

Reader Question:Modifier 55 Won’t Apply to Suture Removal   (December 2011)

Question:  An established patient went to the emergency room in another state over the weekend because of a laceration to his foot. 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 we [...]

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 [...]

Reader Question: Verify Copay Early to Save Time, Money   (December 2011)

Question: A patient came to our office with the same insurance card she’s had for years. We charged her the standard copay of record. Then I found out her employer changed he terms of the insurance, so the copay she paid was short by $20. What went wrong?Vermont SubscriberAnswer: You might easily assume that when a patient has the same insurance company, the copay is the same as it has always been. But unless you [...]

Hallus Valgus: 28298 for Austin-Aiken Procedure? Not So Fast   (November 2011)

Wait until you’ve seen the whole op note before assigning osteotomy code. Getting a lot of denials for your hallux valgus corrections, and you swear you’re pinpointing the right procedure in your coding book? You could be dealing with double osteotomies–which means there’s another hidden procedure in the op report that you’re missing. If this is the case, your first step is to become familiar with synonyms for common bunionectomy procedures so you can easily [...]

Part B Pay: CMS Slashes 2012 Conversion Factor by Over 27 Percent Vs. Current Rates   (November 2011)

Plus: Pay for podiatry may increase a little, while other specialties will drop even more.Get ready for another year of nail-biting to find out whether your Medicare payments will be dramatically reduced. The calendar year 2012 Physician Fee Schedule conversion factor is $24.6712, notes the 2012 Medicare Physician Fee Schedule Final Rule, printed in the Federal Register that will be published on Nov. 28. This amounts to a dismal 27.4 percent cut compared to the [...]

Modifier Mythbuster: Learn the Truth Behind 3 More Common Modifier 24 Myths   (November 2011)

Hint: Know your payer’s policies on billing complication treatment.To ensure payment for E/M services your physician performs within the global period of a surgical procedure, you must know the ins and outs of modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period). Last month, we busted the first two myths: Modifier 24 applies to any service done in the post-op period and scheduled office visits rule out modifier 24. [...]

Collections Q&A: Create a Solid Financial Policy That Tells Your Patients Exactly What You Expect   (November 2011)

Get answers to your top financial policy questions from a billing expert.Having a financial policy is essential for any practice’s financial success. A detailed and documented policy helps both your employees and your patients know how your practice handles the financial side of healthcare. Follow this advice from billing and reimbursement expert, Cyndee Weston, CPC, CMC, CMRS, executive director of the American Medical Billing Association in Davis, Okla., to ensure your practice employs financial policies [...]