Reader Question: 99360 Is One to Skip for Medicare Billing (October 2011)
Question: Our podiatrists sometimes “standby” for other surgeons in some high-risk procedures or cases. They want to code for their time, and we want to use 99360. How should they document their time to be able to charge 99360?Georgia SubscriberAnswer: CMS and many other payers don’t pay for 99360 (Physician standby service, requiring prolonged physician attendance, each 30 minutes [e.g., operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG]), so the [...]
Save your practice $100 with knowledge of anatomic specifics. Mistaking bimalleolar and trimalleolar fracture codes? If so, you could be costing your practice almost $100 – the difference in reimbursement between the open repair codes for these ankle fractures. Podiatrists must be specific when documenting fracture repair because CPT®’s index breaks down the ankle fracture codes into five types: lateral, medial, bimalleolar, trimalleolar, or posterior malleolus. Important: The term “open”‘ implies the site of the fracture [...]
ICD-10 Readiness: Start Small When Prepping for ICD-10 Conversion, CMS Says (September 2011)
Acquaint yourself with the top 30 diagnoses that your practice sees and you’ll get a head start toward compliance.If you’ve taken a look at the ICD-10 book, you know that it would be virtually impossible to memorize all of the codes that it contains. But preparing for ICD-10 won’t require you to even try to know the codes by heart, CMS reps indicated during the August 3 CMS call, “ICD-10 Implementation Strategies for Physicians.”Take heart: [...]
Version 5010: Make Sure Your Electronic Transactions Don’t Bomb on Jan. 1 (September 2011)
Compliance, payment, and ICD-10 hang in the balance.Say goodbye to forms 4010/4010A1 for electronic transactions starting Jan. 1, 2012. That’s the date you’ll need fully functional form 5010 to comply with the Health Insurance Portability & Accountability Act of 1996 (HIPAA) electronic transaction standards.If you don’t have your 5010 glitches worked out by that date, you won’t be able to submit electronic transactions to Medicare.Get Ready for ICD-10Version 5010 lays out the technical electronic standards [...]
Beware the 1995 vs. 1997 guidelines pitfall by choosing just one at a time.When selecting an E/M code for an office visit there are multiple factors – and when you throw in two sets of physical examination guidelines, your head can spin. Let our experts take the confusion out of the 1995 versus 1997 guideline debate with these top four exam questions.1. How Do I Determine the Physical Examination Level?There are two sets of guidelines you [...]
You Be the Coder: Biopsy of Nail Unit (September 2011)
Question: How should I code for the biopsy of nail bed and a 0.4- cm lesion on the left foot (great toe and second digit, respectively), for possible melanoma? Which ICD-9 code should I use?Maine SubscriberAnswer: Wait until the pathology report comes back before you do anything, because the codes you need depend on whether the lesion is malignant. If the biopsy comes back as malignant, report 172.7 (Malignant melanoma of the skin; lower limb, [...]
Reader Question: 99214: Give Credit For Time Spent With Patient (September 2011)
Question: Our physician spends a lot of time discussing treatment options, imaging results, and other issues with patients. How should she document this to support coding E/M based on time?Arizona SubscriberAnswer: When counseling and/or coordination of care take up more than 50 percent of the encounter, and you choose to code based on time, CPT®’s E/M guidelines tell you “the extent of counseling and/or coordination of care must be documented in the medical record.” Medicare’s 1995 [...]
Reader Question: Can Provider Change Tax ID? (September 2011)
Question: One of our physicians wants to stop billing under the group’s tax ID and start billing under his own tax ID. I’m concerned that doing so will confuse the insurance companies and slow down his income, even though he has personally called some to notify them of the change and the effective date. Some payers are now asking for new W9 forms. Is there an easy way to do it?North Dakota SubscriberAnswer: If your physician [...]
Reader Question: Condition Doesn’t Change Patient Status (September 2011)
Question: Our office saw a patient six months ago for a certain condition, and sent the patient back to his primary care provider for further treatment. The same patient was recently referred back to us for a different condition. Should we bill that patient as new, since he’s coming back for a different reason?New Mexico SubscriberAnswer: This patient should be considered “established” for many reasons. If your physician sees a patient any time within a [...]
Surgical Repair: 13131: Layers Plus Complexity Could Be Key to Earning $260 (August 2011)
Dig deeper to find the key to ’simple,’ ‘intermediate,’ and ‘complex’ closures.
Getting the wrong repair code could cost your practice plenty – for instance, you’d lose $260 for a 2.5 cm complex foot wound closure wrongly billed as a simple foot repair. And considering that some procedures include simple closure but allow you to separately bill for complex closure, you stand to lose even more if you don’t distinguish repair complexity.
Read on for our experts’ advice [...]
