Undercoding: Answer the $56 Question — Are You Downcoding Your E/M Visits? (July 2011)
You’re not only losing revenue – you’re also coding improperly.
National insurer data from previous years shows that medical practices undercode E/M claims to the tune of over $1 billion annually – that’s money that physicians could have collected based on their documentation, but forfeited because they reported a lower-level code than they should have. But remember that your responsibility as someone who submits claims to medical insurers is to code based on the documentation – anything else is [...]
Check on your address fields now – before mistakes on your claim forms threaten to halt your reimbursement.
You should start double-checking your system’s provider information and claim forms to ensure that your address fields are 5010-form compliant, or you’ll face scores of denied claims once CMS starts requiring the new HIPAA 5010 forms on Jan. 1. Take a look at what you need to know now, before it becomes a major claims issue for your practice.
Beware [...]
ABNs: Tackle Non-Covered, Non-Medicare Services With ABN-Style Waiver (July 2011)
Skipping this step may lead to angry patients and lost reimbursement.
You know that you need to have a Medicare patient sign an advance beneficiary notice (ABN) when your carrier won’t cover a procedure or service your podiatrist is going to perform. But what about non-Medicare patients – should you use an ABN? Follow this expert guidance to ensure you get paid for every service your podiatrist performs while avoiding patient problems by sending bills the patient [...]
An article in Podiatry Coding & Billing Alert Volume 3, Number 6, “You Be the Coder: K-Wire Removal,” incorrectly suggested reporting CPT® codes 26070 (Arthrotomy, with exploration, drainage, or removal of loose or foreign body; carpometacarpal joint) or 26080 (… interphalangeal joint, each) for removal of a buried K-wire in the foot. However, those codes are hand surgery codes, and would not be appropriate for foot procedures.
The appropriate codes to report would be 20670 (Removal [...]
You Be the Coder: Toenail Excisions and Cauterizations (July 2011)
Question: A patient presents for a follow-up of an ingrown toenail. The physician finds that the patient now has two ingrown toenails – one on each foot. The physician removes both from each toe and also did a silver nitrate cauterization. Should I report the following codes: 99212, 11750, 11750-50, 17250?Hampshire Subscriber
Answer: Your claim is partially correct. You should report 99212-25 as well as 11750 (Excision of nail and nail matrix, partial or complete [e.g., ingrown [...]
Reader Question: 28485 Keeps This Reduction Claim From Getting Crushed (July 2011)
Question: I recently performed an open reduction on the first metatarsal head of a patient who has avascular necrosis and smashed her foot against a table, crushing a good portion of the bone. In addition to the open reduction, I needed to use bone paste to reconstruct the metatarsal head and fill in voids, and then applied an external fixation device. How should I code this procedure?
Idaho Subscriber
Answer: Most likely, you will just be able [...]
Reader Question: Steer Clear of ‘Seen and Agreed’ Note or Face Denials (July 2011)
Question: Our physician works with residents each year. It’s very time consuming, but he does review their documentation and indicates whether he agrees with their findings. He doesn’t use a rubber stamp – he actually writes, “Seen and agreed” on the chart before he signs it. A consultant told us during an audit that documenting this way is unacceptable. Can you explain the problem?
California Subscriber
Answer: The consultant is correct. Although you’re correct in knowing that a [...]
Reader Question: Don’t Avoid 25 Because of the Same Diagnosis (July 2011)
Question: I recently heard that you do not need different diagnosis codes to use modifier 25 for reporting an E/M service on the same date as a procedure. But I’ve been told many times in the past by certified coders that when I bill more than one procedure I need to add modifier 25 to the E/M and point the primary diagnosis to the E/M and point a secondary diagnosis to the other procedure. Can [...]
Reader Question: Know When to Bill Secondary Payer (July 2011)
Question: We have many patients with secondary insurance, some of which have deductibles on the secondary. In these cases, should we write off the amount of the deductible because it’s secondary, or do we bill the patient?
Virginia Subscriber
Answer: Most practices do bill the secondary insurance on behalf of patients, but if the patient has a deductible on the secondary insurance, you can and should bill the patient that amount. You can find out about secondary [...]
Hint: Not everything is included under fracture care.
If you want to maximize your reimbursement when you bill a fracture care code (28400- 28675), you have to know what’s bundled into the 90-day global period – and more important, what’s not.
Check out answers to some frequently asked questions to see whether you’re making the most out of casting and strapping procedures.
Question: What is included and excluded in the global period for fracture care codes?
Answer: The Correct Coding [...]
