http://www.supercoder.com/forum/ Supercoder Forum Forum: Family Practice Coding - Recent Posts en Wed, 08 Sep 2010 22:33:19 +0000 http://www.supercoder.com/forum/topic/g0431qw#post-1605 Thu, 02 Sep 2010 19:16:30 +0000 Alicia Morris 1605@http://www.supercoder.com/forum/ <p>I BILL GO431 QW WITH 5 UNITS, KEY IT BY LINE- EXAMPLE GO431 QW 1<br /> G0431 QW 1<br /> G0431 QW 1<br /> G0431 QW 1<br /> G0431 QW 1<br /> Medicare MLN states G0431 QW will be paid the same as 80101 QW- Have no ideal why it needs to be by line to pay. </p> http://www.supercoder.com/forum/topic/trigger-point-examples#post-1599 Thu, 02 Sep 2010 13:31:44 +0000 Jennifer Godreau 1599@http://www.supercoder.com/forum/ <p>Yes, you are correct in the CPT codes you are using.</p> <p>Jen Godreau, CPC, CPEDC </p> http://www.supercoder.com/forum/topic/trigger-point-examples#post-1598 Thu, 02 Sep 2010 13:30:44 +0000 Jennifer Godreau 1598@http://www.supercoder.com/forum/ <p>I would like to make sure we are correctly billing TPIs.<br /> Example one: The Family Physician does 4 trigger pt injections in the Rt trapezius muscle this would be code 20552 for<br /> For one muscle group?<br /> Example two: The Family Physician does 4 trigger pt injections in the Rt trapezius muscle and 4 trigger pt injections<br /> In the Lt trapezius muscle this would be code 20552 for two muscle groups?<br /> Example three: The Family Physician does 4 trigger pt injections in the Rt trapezius muscle and 4 trigger pt injections<br /> In the Lt trapezius muscle and 1 trigger pt injection in the Lt thigh muscle this would be 20553 for three<br /> Muscle groups?<br /> All are billed with 1 in the unit field correct? </p> http://www.supercoder.com/forum/topic/g0431qw#post-1545 Sat, 28 Aug 2010 13:15:46 +0000 Rose Laurenxo 1545@http://www.supercoder.com/forum/ <p>Yes It is 4 unit cause I this time I am getting denials from medicare for more than four units. I would like to know if anyone knows to to bill more unit correctly with a modifer </p> http://www.supercoder.com/forum/topic/90801-is-there-a-time-requirement#post-1509 Wed, 25 Aug 2010 21:36:28 +0000 alex wills 1509@http://www.supercoder.com/forum/ <p>Length of session (these are not timed codes, however, the standard length of time is generally considered to be between 45 minutes and one hour). Also, Medicare will not cover more than three 90801 or 90802 (or a combination of both) per year, per beneficiary, same or different provider. </p> http://www.supercoder.com/forum/topic/90801-is-there-a-time-requirement#post-1481 Tue, 24 Aug 2010 08:41:43 +0000 john legler 1481@http://www.supercoder.com/forum/ <p><code>90801</code> Is there a time requirement invoved in this examination or does it fall within the descretion of the practioner's individual<br /> ability to complete the patients examination? </p> http://www.supercoder.com/forum/topic/modifier-for-unfound-cci-pair#post-1441 Wed, 18 Aug 2010 09:47:45 +0000 Jennifer Godreau 1441@http://www.supercoder.com/forum/ <p>If the codes are not listed, the codes are not bundled per CCI. You would not need a modifier to override the edit when appropriate.</p> <p>A private payer could have a black box edit. You would need to check with a rep for a recommendation (Good luck!).</p> <p>You can also find Medicare’s other allowed modifier’s in the Physician Fee Schedule. Columns Y-AC indicate if modifier 51, 50 etc. apply.</p> <p>This info is also in Supercoder's fee schedule information (<a href="http://www.supercoder.com/coders-toolkit/fee-schedule/)" rel="nofollow">http://www.supercoder.com/coders-toolkit/fee-schedule/)</a>. In October, we’ll have this in an easier to read view.</p> <p>Jen Godreau, CPC, CPEDC<br /> Content Director, Supercoder.com </p> http://www.supercoder.com/forum/topic/modifier-for-unfound-cci-pair#post-1440 Wed, 18 Aug 2010 09:46:32 +0000 Jennifer Godreau 1440@http://www.supercoder.com/forum/ <p>If I cannot find my two code pairs in the CCI edits, how do I know which code would be considered a column 1 code and which would be considered a column 2 code so that I could put my modifier on the correct code?<br /> Judy </p> http://www.supercoder.com/forum/topic/lesion-removal-biopsy-bundle#post-1389 Wed, 11 Aug 2010 03:55:22 +0000 Jennifer Godreau 1389@http://www.supercoder.com/forum/ <p>Since the excision and destruction treat separate lesions, you may report both procedures. CCI bundles 11400 into 17000 but allows a modifier to override the edit when circumstances are appropriate. To indicate that the excision is on a separate site from the destruction, append modifier 59 to 11400 (the component code). Your coding should include:<br /> 17000<br /> 11400-59.</p> <p>Jen Godreau, CPC, CPEDC<br /> Content Director, Supercoder.com </p> http://www.supercoder.com/forum/topic/lesion-removal-biopsy-bundle#post-1388 Wed, 11 Aug 2010 03:52:28 +0000 Jennifer Godreau 1388@http://www.supercoder.com/forum/ <p>A physician destroyed a premalignant lesion on a patient's arm and excised a benign lesion on the patient's other arm. Can I report both the destruction and the excision per CCI? </p> http://www.supercoder.com/forum/topic/g0431qw#post-1303 Wed, 04 Aug 2010 04:24:20 +0000 alex wills 1303@http://www.supercoder.com/forum/ <p>Present CMS has assigned no frequency limits for G0430 and G0431. Since these are new codes, they have not yet been assigned Correct Coding Initiative frequency limits (MUEs). It is expected that, in the near future, G0430 will be assigned an MUE value of 1 since CMS would not expect the code to be reported more than one time for each date of service. G0431 will probably be assigned a higher, but unpublished, frequency limit. It is CMS policy to keep frequency limits they believe may be abused confidential. 80101 had MUE of 16 so it can be expected that the same would apply to its replacement code.] </p> http://www.supercoder.com/forum/topic/g0431qw#post-1302 Tue, 03 Aug 2010 14:35:00 +0000 marilyn cadiz 1302@http://www.supercoder.com/forum/ <p>Effective July 1, 2010, what is the allowed units to bill Medicare for code 'G0431'? I heard it's 4. Does anyone know? </p> http://www.supercoder.com/forum/topic/rotovirus-vaccine-admininstration-codes#post-1275 Wed, 28 Jul 2010 08:46:01 +0000 Jennifer Godreau 1275@http://www.supercoder.com/forum/ <p>While codes 90467 and 90468 apply only to children younger than 8 years of age, that is not the sole requirement for using the 90464-90468 code range. The physician, NP, or PA must have provided vaccine counseling and documented the counseling in the chart.</p> <p>If the FP provides -- and documents -- vaccine counseling, you would be correct in using 90467 or 90468 for the administration to a baby. However, without physician or nonphysician practitioner (NP or PA) vaccine counseling, Rotovirus administration would fall under either 90473 or 90474. </p> http://www.supercoder.com/forum/topic/rotovirus-vaccine-admininstration-codes#post-1274 Wed, 28 Jul 2010 08:43:03 +0000 Jennifer Godreau 1274@http://www.supercoder.com/forum/ <p>Rotovirus vaccine is only given to children less than the age of eight at 2 ,4,6 months and is given orally. I believe we should only ever use admininstration codes '90467' and '90468' oral administration for persons less than 8 years of age. Alternatively, could 90473 or 90474 apply?</p> <p>Holland </p> http://www.supercoder.com/forum/topic/anyone-got-a-definitive-reprocessing-protocol#post-1162 Thu, 01 Jul 2010 18:14:22 +0000 Melanie Cramer 1162@http://www.supercoder.com/forum/ <p>"Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed."</p> <p>Basically what Medicare does (something similar happened when I worked for Medicare) - they will do what they call a "Global Reprocess" - in this situation, they will query all claims by DOS' in the month of June with the greater/equal to the new 2.2% update rates, Medicare is automatically reprocessing those claims. In reality - it will probably be a two to three week basis, give or take. If you dont see anything within the first 30 days, you will need to call in. </p> <p>For the section that reads "Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment." - basically, this is viewed as a clerical error on the claims, and therefore Medicare cannot do an automatic reprocess without expressed verbal permission from the facility/provider to have them reprocessed. A representative from Telephone Reopening should be able to tell you over the phone whether or not you can handle this with them directly.</p> <p>A Global Reprocessing action is definitely not an across-the-board definition of the same action... Why the overage is getting a global reprocess and not the lower? In my humbled opinion, I sit back and ask - "Whats the difference"?</p> <p>Medicare is about as crooked as my husband's sense of humor... and THATS hard to beat! </p> http://www.supercoder.com/forum/topic/modifier-for-99407-smoking-consultation#post-1151 Wed, 30 Jun 2010 14:13:59 +0000 T Coop 1151@http://www.supercoder.com/forum/ <p>We use diagnosis codes 305.1 and V15.82 with the procedure codes 99406 and 99407. I use a different diagnosis for the office visit.<br /> Example:<br /> 99213-25 DX: 440.22, 443.9<br /> 99406 DX: 305.1, V15.82<br /> We do get payment from Medicare and Commercial carriers but we do not from Medicaid. Make sure the counseling is fully documented and the time documented in case they do ask for your office note.<br /> Hope this helps. Have a good day. </p> http://www.supercoder.com/forum/topic/modifier-for-99407-smoking-consultation#post-1149 Wed, 30 Jun 2010 12:08:53 +0000 alex wills 1149@http://www.supercoder.com/forum/ <p>Contractors shall only pay for 8 Smoking and Tobacco-Use Cessation Counseling sessions in a 12-month period. The beneficiary may receive another 8 sessions during a second or subsequent year after 11 full months have passed since, the first Medicare covered cessation session was performed. Claims for smoking and tobacco use cessation counseling services shall be submitted with an appropriate diagnosis code. Diagnosis codes should reflect: the condition the patient has that is adversely affected by tobacco use or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use.<br /> Your TOS should be 1 (Medical care) not 9. I think this is the main cause for denial otherwise there should not be any issues with this claims. But, even if this is not accepted and paid then you need to call your insurance or consider this service as being part of E/M only. </p> http://www.supercoder.com/forum/topic/modifier-for-99407-smoking-consultation#post-1148 Wed, 30 Jun 2010 11:32:58 +0000 cathi berns 1148@http://www.supercoder.com/forum/ <p>I am billing '99407' with '99213' and getting denials. I have used the modifier '25' with '99213', but it seems to be asking for a modifier for the '99407'. Can anyone help me with this modifier?</p> <p>Also I am using TOS '9' for consultation, would this be correct or should I be using TOS of '1'? </p> http://www.supercoder.com/forum/topic/anyone-got-a-definitive-reprocessing-protocol#post-1131 Mon, 28 Jun 2010 10:52:40 +0000 Jennifer Godreau 1131@http://www.supercoder.com/forum/ <p>My favorite lines iin the conversion factor change transmittals are:<br /> Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed. Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment.<br /> Submitted charges on claims cannot be altered without a request from the physician/provider.<br /> How’s that automatic? </p> http://www.supercoder.com/forum/topic/mpfs-up-2-after-down-22#post-1130 Mon, 28 Jun 2010 09:16:33 +0000 Jennifer Godreau 1130@http://www.supercoder.com/forum/ <p>After a week of 1994 rates, CMS increases conversion factor.<br /> MACs distributed substantially lower Medicare payments last week, due to a 21 percent cut that hit your Part B claims -- but the House of Representatives reversed those cuts on the evening of June 24, with a vote that will also give you a 2.2 percent pay increase through November 30.<br /> On June 18, 17 days' worth of claim holds expired, and with Congress slow to come to a legislative agreement, your practices paid the price after MACs began processing claims based on a conversion factor 21 percent lower than what you'd been collecting. "CMS today directed contractors to lift the hold and begin processing June 1 and later MPFS claims under the law’s negative update requirement," CMS said in a June 18 statement. "Held claims will be released and processed on a flow basis, first-in/first-out."<br /> It's unclear how many claims were processed using the lower conversion factor, but after the House voted through the 2.2 increase bill on June 24, CMS was expected to automatically reprocess claims that were paid based on the 21 percent cut. However, practices still worry about having to check up on those claims to ensure that they were reprocessed correctly. In addition, you'll have to keep an eye on any secondary insurers' payments to ensure that adjustments are accurate across the board.<br /> Medical Societies Express Frustration<br /> After physicians were left collecting the lower rates last week, practices and physician advocacy organizations across the country expressed anger.<br /> "Physicians are forced to make difficult practice changes to keep their practice doors open," said AMA President Cecil B. Wilson in a June 17 statement. "Continued short-term actions are creating severe instability that harms seniors as physicians make decisions to protect their practices from Medicare’s volatility. Continuing down this path just slaps a Band-Aid on a problem that needs urgent surgery," Wilson said.<br /> Not only were physicians stymied by Congressional inaction, but they were stunned by the way the new payments were rolling back the clocks by several years. "The 21 percent pay cut that went into effect June 1 has pushed their Medicare compensation to levels they haven’t seen since 1994," said Lori Heim, MD, president of the American Academy of Family Physicians in a June 23 statement.<br /> President Obama urged lawmakers to permanently reform the Medicare payment formula so practices could avoid these issues in the future. "Kicking these cuts down the road just isn't an adequate solution to the problem," the President said in a June 24 statement. "The current system of recurring cuts and temporary fixes was passed into law more than 10 years ago. It's untenable." </p> http://www.supercoder.com/forum/topic/medicare-starts-processing-claims-at-28-conversion-factor#post-1071 Fri, 18 Jun 2010 18:08:26 +0000 Jennifer Godreau 1071@http://www.supercoder.com/forum/ <p>Expect $14 less for 99213, starting June 18.</p> <p>Bemoaning Medicare shortfalls? The situation just got worse.<br /> The Senate failed to pass the American Jobs and Closing Tax Loopholes Act (H.R. 4213) late Thursday night. The clock ran out on the claims hold that expired June 17 that was delaying payment processing at the cut rate.</p> <p>Result: Medicare contractors may start processing claims starting today, June 18, at the -21.3 percent cut. That puts the new conversion factor rate at 28.3868, down from 36.0846.</p> <p>You’ll get almost $14 less per 99213. For 99213, Medicare was paying an unadjusted rate of $65.67, which under the new CF will be reduced to $51.66.</p> <p>The future may be rosier. As in past years, Congress is expected to intervene and repeal the Medicare Physician Fee Schedule cut retroactively to June 1st. In this case, CMS contractors will automatically reprocess all claims with dates of service on June 1, 2010 or later (and thus subject to the fee cut) to capture that additional payment. </p> http://www.supercoder.com/forum/topic/jen-godreau%e2%80%99s-top-4-aapc-takeaways-4#post-1041 Wed, 16 Jun 2010 19:57:14 +0000 Jennifer Godreau 1041@http://www.supercoder.com/forum/ <p>Thousands of American Academy of Professional Coders members gathered in Jacksonville, Fla. for 3 jam-packed days of coding advice, camaraderie, and learning. Coders’ biggest struggle was narrowing down which sessions to attend. For those of you who wonder what you missed and for coders who couldn’t make this year’s national conference, here’s a sneak peak at the documentation improving tips and scenario solutions experts offered. </p> <p>These are my top 4:<br /> 1. Eliminate stress with a wacky dance. Seriously, psychologist Dr. Farris Jordan demonstrated how responding to computer melt downs with a pseudo Church Lady strut can turn that frown to belly rolls.</p> <p>2. Timesaving method boosts discharge management pay by $31. “I was never seeing a note with discharge management time,” reported nurse practitioner Kerin Draak, MS, RN, WHNP-BC, CPC, CEMC, COBGC, in “Hospital Coding … Making the Rounds”. Boost 99238 to 99239 every legit time with a checkbox for “More than 30 minutes”.</p> <p>3. You can break 64450 denials with modifier 59. Rejections for nerve blocks were stumping a coder whose mystery was solved with expert advice from Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACSPM, CHCO, owner of MJH Consulting in Denver in Anesthesia and Pain Management Coding Alert part of Supercoder.com’s coding suite of products.</p> <p>4. As one coder told me, "Supercoder's a no-brainer! I get the guidance of 3 coding books and the expert solutions found in The Coding Institute's newsletters all in one easy-to-search place!" Go to <a href="http://www.supercoder.com/sales" rel="nofollow">http://www.supercoder.com/sales</a> and enter promo code aapc97 by June 30th to get the power of Supercoder.com's code search and payment tools plus the specialty-specific Coding Alert of your choice for just $97 for a full-year!</p> <p>This was just a bit of what I learned in the 3 jam-packed conference days. It was great to meet so many of you at the conference - and for those who missed it, make plans to be there next year!</p> <p>Cheers,<br /> Jen Godreau, BA, CPC, CPEDC<br /> Content Director, Supercoder.com<br /> Expert help for coders… at any level, in any specialty! </p> http://www.supercoder.com/forum/topic/id-vs-excision#post-953 Mon, 07 Jun 2010 07:36:40 +0000 Ash 953@http://www.supercoder.com/forum/ <p>I would go with a benign lesion excision code (11400-11446), because here the cyst was not drained but completely excised. You need to know the site and dimension of the cyst to get the specific benign lesion excision code. In case dimension is not mentioned, you have to consider the code for the smallest lesion (i.e. 0.5 cm or less) for the anatomical region. </p> http://www.supercoder.com/forum/topic/id-vs-excision#post-952 Sat, 05 Jun 2010 19:57:30 +0000 alex wills 952@http://www.supercoder.com/forum/ <p>To know the diffrence between and to get a clear picture of these two codes see Supercoder lay description. </p> http://www.supercoder.com/forum/topic/id-vs-excision#post-951 Fri, 04 Jun 2010 15:33:41 +0000 apoorba ganguly 951@http://www.supercoder.com/forum/ <p>I do not see any mention of tissue / flap transfer from adjacent site of the cyst. In this scenario where we have limited Px description, I would go with 10060. </p> http://www.supercoder.com/forum/topic/id-vs-excision#post-950 Fri, 04 Jun 2010 15:24:16 +0000 Mary Jane Zismer 950@http://www.supercoder.com/forum/ <p>'14000' vs. '10060' </p> http://www.supercoder.com/forum/topic/id-vs-excision#post-949 Fri, 04 Jun 2010 15:23:37 +0000 Mary Jane Zismer 949@http://www.supercoder.com/forum/ <p>We have some differences of opinion on how to code this. I am interested in knowing how you would code the following:<br /> The cyst was excised after performing a central incision directly on the cyst. All the material was expressed, then cyst capsule was removed completely and excised completely. Packing was performed. </p> http://www.supercoder.com/forum/topic/55-modifier#post-754 Mon, 26 Apr 2010 14:42:38 +0000 GINA DELPUERTO 754@http://www.supercoder.com/forum/ <p>please disregard question </p> http://www.supercoder.com/forum/topic/55-modifier#post-753 Mon, 26 Apr 2010 14:27:12 +0000 GINA DELPUERTO 753@http://www.supercoder.com/forum/ <br /> http://www.supercoder.com/forum/topic/boarding-home-physical#post-747 Fri, 23 Apr 2010 10:50:06 +0000 Pam Thompson 747@http://www.supercoder.com/forum/ <p>Thank you very much </p>