You Be the Coder: Diabetes Patient, Post-Amputation   (November 2011)

Question: A patient visited our clinic for a checkup for some ulcers on her right ankle. She had the toes on her right foot amputated six months ago due to gangrene. She has type II diabetes, peripheral vascular disease (PVD), and malignant hypertension. How should I code her condition?Delaware SubscriberAnswer:  For your patient, code:443.81 (Peripheral angiopathy in diseases classified elsewhere)250.70 (Diabetes with peripheral circulatory disorders; type II or unspecified type, not stated as uncontrolled)V49.73 (Lower [...]

Reader Question: 27698 Is Best for ‘Brostrom’ Procedures   (November 2011)

Question: My podiatrist gave me an op note for a “Brostrom procedure,” and I have no idea what this is except that the podiatrist operated on the ankle of a soccer player who had repeated sprains. The note mentions a posterior tibial tendon reconstruction and a lateral tendon reconstruction. Is this part of the Brostrom? If so, what is this procedure and what codes should I report? Iowa SubscriberAnswer: The tendon reconstruction you speak of is part [...]

Reader Question: Base E/M on Time for Counseling/Coordination Only   (November 2011)

Question: If the physician documents: “Time spent in the evaluation of the patient with mostly medical decision making time (two thirds) is 75 min” can I choose the E/M code based on time alone?Nevada SubscriberAnswer: No, you cannot code based on time with just the documentation you have mentioned. Here’s why: You should only code an E/M service based on time alone if at least 50 percent of the visit was spent on counseling or coordination [...]

Reader Question: Collect Surgical Deductibles Up Front   (November 2011)

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 SubscriberAnswer: 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 [...]

CCI Update: 28190-28193 Includes Wound Exploration   (October 2011)

Your documentation must support the clinical reasons for breaking Correct Coding Initiative bundles. If your podiatrist is in the habit of coding wound explorations separately from foreign body removals, he’d better break that habit quickly – or risk running afoul of the Correct Coding Initiative (CCI). CCI version 17.3, which takes effect Oct. 1, offers 1,380 new edit pairs and 835 terminated bundles, according to an analysis by Frank Cohen, MPA, MBB, principal and senior analyst [...]

Modifier Mythbuster: Clean Up Your Modifier 24 Claims By Learning the Truth About 5 Common Myths   (October 2011)

Focus on the podiatrist’s documentation, not the appointment book.If you want to ensure you get paid for services your podiatrist performs after a major procedure while you’re still billing in the global period of the procedure, you need to know the ins and outs of modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period). Even seasoned billers struggle with this modifier at times. Overcome modifier 24 claim challenges by [...]

Reimbursement Roundup: Uncover Must-Know Appeals Changes Established By New Federal Law   (October 2011)

Now’s the time to find out how ERISA and PPACA impact your practice – or you’ll face major reimbursement losses.New Federal claims appeals regulations went into full implementation on July 1, so if you haven’t gotten to know the new law and honed your Employee Retirement Income Security Act (ERISA) knowledge, you could be costing your practice thousands. Read on for advice on how to master these rules.Background: The Patient Protection and Affordable Care Act (PPACA), [...]

You Be the Coder: Go In-Depth With Rigid Mallet Toe Treatment   (October 2011)

Question: A patient came into the office with a “rigid mallet toe.” How will my podiatrist most likely treat this condition and which CPT® codes should I look at?Pennsylvania SubscriberAnswer: Your podiatrist may treat a rigid mallet toe with many correction techniques.One popular one is a DuVries arthroplasty done at the distal interphalangeal joint (DIPJ), often accompanied by a flexor digitorum longus tenotomy done through the same incision. You should code this with 28285 (Correction, [...]

Revenue Booster: Keep Money Flowing With These 6 Income Opportunities   (October 2011)

Take the time to ensure that you aren’t bleeding revenue in these areas.Just because Medicare’s regulations are complex and challenging doesn’t mean you can’t collect all of the revenue that your Medicare Administrative Contractor (MAC) owes you. Heed these six quick tips to make sure you aren’t losing cash. 1. Update Your ICD-9 codes.It’s that time of year when you should be finalizing your new superbills. Oct. 1 has arrived, and that means the new [...]

Reader Question: List As Many PQRS Codes As Needed   (October 2011)

Question: Can we report more than one PQRS code measure on the same claim?Virginia SubscriberAnswer: Yes. You aren’t limited to reporting just one Physician Quality Reporting System (PQRS) code per visit. “EPs [eligible professionals] may submit multiple codes for more than one measure on a single claim,” CMS says in its PQRS Implementation Guide. “Multiple CPT® Category II and/or G-codes for multiple measures that are applicable to a patient visit can be reported on the same [...]