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Internal Medicine Coding Alert

CCI Edits Update:
Update Yourself on Latest Edits to Keep Your Coding on Track
Tip: Suture repairs and pain injections require special attention. The latest Correct ... Read more
Latest Flu Vaccine Payments: Check With Local MAC
Tip: Pay attention to codes with locally-controlled pricing.CMS released its annual update... Read more
Impacted Cerumen Coding: Physicians to Note 'Right' or 'Left' for ICD-10
The H61.2- family will have all your code choices. You know that certain requirements ... Read more
Reader Question:
No FBR Found? Append Modifier 52 to 10120 or 28190
Question: A patient came to our office after stepping on a nail. He was afraid some mate... Read more
Reader Question:
Only Use E/M With G0438 for Separate Diagnostic Condition
Question: One of our providers completed her first annual wellness visit for a patient. Mo... Read more
Reader Question:
Medical Assistant Can Choose Codes
Question: One of our physicians allows his medical assistant to choose his E/M codes. The ... Read more
Reader Question:
Modifier 25: Use Carefully with E/M Codes Only
Question: I don't think our office is using modifier 25 correctly. Does this get us... Read more
Reader Question:
82270 or 82274: Don't Bill These Until Patient Returns Hemoccult Test
Question: I've always been told that if you give a patient a take-home hemocult test, that... Read more
You Be the Coder:
Coding Diabetes With Neuropathy
Question: The physician indicated the patient has diabetes complicated by peripheral neuro... Read more
CPT® 2013:
Flu and Hepatitis B Vaccine Changes to Affect Coding in 2013
Here's your heads-up on some new options that won't be in the CPT® book yet.2013 wil... Read more
E/M Upcoming Changes:
Track New E/M Descriptor Updates That Will Affect Your NPPs
Plus: 2013 brings time assignments to some codes.Get ready for E/M coding changes when Jan... Read more
Changes In Connective Tissue Diagnoses
Familiarize yourself with few codes that will have broader application. Your diagnosis cho... Read more
Reader Question:
Choosing Between 715 and 716 for Knee Arthritis
Question: Our physician wrote "knee pain" and "arthritis left knee" as a diagnosis. Would ... Read more
Reader Question:
No Code If No Incision for Cyst Drainage
Question: The PA found a cyst on a patient's labia during her pelvic screening (the patien... Read more
Reader Question:
Code 95117: Two-Injection Visit
Question: A patient comes to our office once each week for allergy injections. The nurse... Read more
Reader Question:
NPP/Nurses Can Also Gather Patient History
Question: Is the physician the only person who can take a patient history, or can a nurse ... Read more
Reader Question:
Add E/M Care When Patient Visits Multiple Times in a Day
Question: Two internal medicine physicians from our group saw the same patient in the offi... Read more
Reader Question:
Locum Tenens: Append Modifier Q6 for NP Services
Question: One of our physicians will be away for eight weeks. She has made locum tenens ar... Read more
Reader Question:
401-405 or 272.x Can Help Justify Coding 36415
Question: Some of our Medicare patients want to drop by and have blood drawn so that when ... Read more
Reader Question:
Don't Bill 82270 or 82274 Until Patient Returns Hemoccult Test
Question: I've always been told that if you give a patient a take-home hemoccult test, tha... Read more
You Be the Coder:
E Code: Peanut Butter Allergic Reaction
Question: What do you recommend as the most specific E code for anaphylaxis reaction to pe... Read more
CPT® 2013 Update:
Get Ready For New Codes For Vaccines in 2013
Sneak peek at proposed 2013 code changes.The CPT® Editorial Panel's February meeting... Read more
Payment Decision:
Proposed 2013 Fee Schedule Would Boost Medicare Payment by Seven Percent
New payments for hospital transitions could further bolster your bottom line.CMS published... Read more
Preventive Care Coding:
3 Areas for CVD Behavior Therapy Claims Improvement
CMS outlines necessary items. Medicare added five preventive services to its coverage ... Read more
Topic: Coding Tenderness or Rebound Tenderness of the Abdomen
Be more specific on Type of pain, quadrant affected in the new code system. If a patie... Read more
Reader Question:
Carrier LCD Determines Whether to Expect Payment for J7325
Question: One of our Medicare patients receives knee injections for her arthritis. She's i... Read more
Reader Question:
Dressing Change: Check for Extra Service
Question: Our family physician performed a dressing change for a patient who had an absces... Read more
Reader Question:
J1070 and J1080: Dosage Amount Dividing The Codes
Question: What is the correct way to bill J1080? Florida SubscriberAnswer: Code J1080 (Inj... Read more
Reader Question:
Newborn Discharge Services: Report 99238 or 99239
Question: What code covers a newborn hospital discharge?Arizona SubscriberAnswer: CPT... Read more
Reader Question:
Billing 28470 and 29405 Together: Check CCI Updates
Question: Is it appropriate to bill 28470 with 29405? I don't quite understand what 28470 ... Read more
Reader Question:
Phone Call Billing: Points To Justify 99441-99443
Question: A patient called during the weekend and left a message for our physician asking ... Read more
Reader Question:
Prescriptions Are Included in E/M Service
Question: My physician heard that there's a code we can report and be paid for just when h... Read more
You Be the Coder:
All Supplies Will Not Be Covered By Insurers
Question: Can our physician's office bill a syringe code with a vaccine administration cod... Read more
CCI 18.2:
New CCI Coding Edits Affect Vaccine Administration Codes
Be careful since some codes become non-reportable. You now have more details to consider ... Read more
Future Acute Bronchitis Coding: Etiology is Important
Single ICD-9 code transforms to ten codes in ICD-10. You'll face big changes in reporting... Read more
Healthcare Update:
Affordable Care Act: Supreme Court Upholds Legality
Experts speculate how ACA could affect family physician groups. June 28, 2012, marked ... Read more
Reader Question:
Fracture Care Can Apply
Question: Our physician saw a patient for a non-displaced tarsal bone fracture, which di... Read more
Reader Question:
Confirm Atrophy Before Assigning 728.2 as Dx Code
Question: A three-month old was diagnosed with decreased strength and motion in her left ... Read more
Reader Question:
Beware of Billing Office Visit With Vaccine
Question: Our physician tried to bill an office visit (99213) along with codes for a vacc... Read more
Reader Question:
ABN for Benign Lesion Excision
Question: Our state Medicaid doesn't cover benign lesion excisions, but we don't know it'... Read more
Reader Question:
Mole Removal: Location, Size To Be Calculated
Question: I can't seem to fit \"removal of mole\" with any of the existing CPT®&nbs... Read more
Reader Question:
Diagnosis and E/M Codes Should Go Hand In Hand
Question: A PCP performed evaluation and management for a patient and referred him to our... Read more
Reader Question:
Insurances Won't Pay for These Supplies
Question: Can our physician's office bill a syringe code with a vaccine administration co... Read more
You Be the Coder:
Best Codes for Asthma Education
Question: What's the best code to submit when one of our providers offers asthma educatio... Read more
Step-by-Step Guide to Coding for Strapping
Materials used filters down code choices. Strapping might seem like a simple treatment... Read more
Sunburn Care:
Physician Documentation Crucial for Choice Between E/M or 16000
Burn treatment, level of care and Severity of condition narrows your coding options.Just b... Read more
E/M Coding:
Stumped by '95 or '97 Guidelines? Counting Bullets/Points Differently Can Help
Physical exam element can point you to the better set.Choosing whether to follow the 1995 ... Read more
Acute Laryngitis Coding With J04.0 in ICD-10
Look for different conditions the code will represent in ICD-10 regimen.Diagnosis coding i... Read more
Reader Question:
Modifier 33: Scrutinize the Preventive Care
Question: Some of our payers deny claims with modifier 33 because they state the modifier ... Read more
Reader Question:
Check Specifics Before Reimbursing Tertiary Insurer
Question: One of our patients has Medicare as her primary insurance and Gerber Life as sec... Read more
Reader Question:
Go Through Contracts for Specialized Lab Test Billing
Question: Our physician has been running some very specific tests (saliva, stool, heavy to... Read more
Reader Question:
TB Test: Follow-Up Charge Could Depend on Result
Question: Do we include modifier 25 when a TB test is administered during an office visit?... Read more
Reader Question:
94664 for Asthma Education
Question: What's the best code to submit when one of our providers offers asthma education... Read more
Reader Question:
Code by Confirmed Diagnosis, Not Signs & Symptoms, When Possible
Question: I've been told that if the treating physician orders a test based on a sign or s... Read more
You Be the Coder:
EKG Services: Different Codes To Report
Question: We own the EKG/ECG machine in our office. We know that 93000 is the global code ... Read more
Diagnosis Coding:
Do not Ignore E codes, Use to Document Circumstances in Detail
Beware: Never use E codes as primary code. Accidents happen, and your physicians probably ... Read more
E/M Coding:
Remain Vigilant When Coding 4th and 5th Digit E/M Codes
OIG is watching on usage of these high-level codes.A recent OIG report found that family p... Read more
Personal History of Colon Cancer: From V codes to Z-series Code
Code descriptor may not change when ICD-10 kicks off.A personal history of colon cancer ca... Read more
News Flash:
Recent CMS Proposal Might Boost Primary Care Medicaid Pay
Tip: Get Your Physicians Enrolled In PECOS Before It's Too Late.As most practices remember... Read more
Reader Question:
Incorrect Documentation in Physician Note, Patient Record
Question: The physician saw several patients on the same day with sore throat symptoms. Hi... Read more
Reader Question:
Long Term Estrogen Use: V07.4 Applicable
Question: Does ICD-9 include a code for prolonged use of estrogen? Texas Subscriber Answer... Read more
Reader Question:
Choice for Education Code - Documentation Drives 98960 or 99211
Question: A patient with testosterone deficiency comes to our office for injections. After... Read more
Reader Question:
Ensure That Diagnosis Matches Patient's Condition
Question: When I bill Medicare for deep debridement (11042) using the diagnosis the physic... Read more
Reader Question:
HPI is Instrumental in E/M Pay
Question: A new patient visited our office for evaluation for an epidermoid (sebaceous) cy... Read more
Reader Question:
17110 for Wart Removal Without Cryosurgery
Question: A patient presented with a plantar wart. The physician documented, "Dermatology ... Read more
Reader Question:
Base Contraception Diagnosis on Specific Information
Question: One of our practitioners discussed sexual activity and contraception with an ado... Read more
Reader Question:
EKG Services: Separate Codes -- Not 26/TC
Question: We own the EKG/ECG machine in our office. We know that 93000 is the global code ... Read more
Reader Question:
Rule To Billing Medicare
Question: We are participating with Medicare. We bill and submit claims to Trailblaze... Read more
You Be the Coder:
The Difference Between 36415 and Incident-To
Question: We have a repeated discussion in our office about whether we can bill 36415 (Col... Read more
IPPE Billing:
Straight Answers From CMS to Clear IPPE Billing Confusion
Remain up-to-date with IPPE visits criteria requirements The initial preventive physical e... Read more
Cover All Your Bases Before Coding IPPE
Here's your checklist of what providers must document. "The various components of the IPPE... Read more
G8553: Techniques for Solid Claims Success
Check filing dates and charge guidelines to smooth processing every time. HCPCS doesn't in... Read more
Regular Internal Audits for Catching Billing Slip-Ups
Starting with a baseline audit will set your practice up for success.Would your practice p... Read more
Coding Urosepsis Under ICD-10
You won't find "urosepsis" terminology after October 2014.If your physician notes the term... Read more
Reader Question:
Differentiate Pain Killing Agents in Plantar Injections
Question: Our physician administers a lot of steroid injections and injections of anesthet... Read more
Reader Question:
Prolonged E/M Coding: Descriptor Change In 2012
Question: How can we report prolonged face-to-face E/M services provided by our physician ... Read more
Reader Question:
Too Small for Intermediate Closure
Question: I'm aware of a "rule" regarding lesion excision and closure charges that I am qu... Read more
Reader Question:
Drug Coding for J3301: Generic vs. Brand Name
Question: My doctor is using Kenalog 40 (NDC 0003029328) from Bristol Myers Squibb. He say... Read more
Reader Question:
Tobacco-Use Cessation Counseling Criteria
Question: Aren't we allowed to bill for counseling for smoking cessation? If so, wha... Read more
You Be the Coder:
Coding for Total Body Skin Check
Question: A patient with a history of skin cancer presented for a total body skin check. T... Read more
Ear Complication:
Check Documentation Carefully for Cerumen Impaction or Ear Irrigation Code
69210 or E/M inclusion depends on service and provider. A patient visits your office,... Read more
Diabetes Management:
Diabetes Coding: Many Codes -- Simple Approach
Eye on diabetic complications related to current episode of care.Long-gone are the days of... Read more
Rural Health:
CMS Updated Definition of "Privileged Provider" for Ordering Hospital Services
CMS released updated guidelines in 2011 regarding physician orders for hospital rehabilita... Read more
Epistaxis: Change to R04.0 Under ICD-10
Remember LT/RT modifiers according to payer policy.Under ICD-9 rules, you have just one co... Read more
Billing Errors:
Top 5 Errors Usually Made by Payer -- Know How You Can Avoid Making the Same Mistakes
Did you catch a miscoded service today before sending out a claim? You just missed making ... Read more
Reader question:
Code 11740 for Drainage of Toe Nail Hematoma
Question: A patient visited our office because of a hematoma under her toe nail. The phy... Read more
Reader question:
Inexact ICD-9 Code? Refer to Nearest Diagnosis Equivalent
Question: My internist saw a patient for "ciliary dyskinesia." This condition occurs in th... Read more
Reader question:
Hepatitis A Vaccine: Verify Patient Age, Dosing Schedule
Question: One of our payers has denied the second shot of a hepatitis A vaccine as a dupli... Read more
Reader question:
V72.83 as Primary Diagnosis for Surgical Clearance
Question: What's the best CPT® code for a pre-operative clearance visit?Minnesota Su... Read more
Reader question:
Methylcobalamin Takes You to HCPCS Code J3490
Question: One of our physicians wants to order Methylcobalamin for a patient who cannot ha... Read more
Reader question:
Failure to Thrive 779.34 or 783.41 Depends on Age
Question: What diagnosis should we submit for a newborn who is not gaining enough weight?F... Read more
Reader question:
Insurers May Require Bundling Same-Day E/M Services
Question: Can we bill two office visits on the same day? We reported 99214 twice for the s... Read more
You Be the Coder:
E/M: Total Body Skin Check
Question: A patient with a history of skin cancer presents for a total body skin check. Th... Read more
Incident-to Billing:
Incident-to Claim: Avert OIG Audit with These Tips
Heads up: 4 must-know tips for coding help. The HHS Office of Inspector General (OIG) plan... Read more
Coding Tips:
Diagnosis and Management Option Should Tally For Crohn's Claims
Concentrate on the full picture for maximum ethical reimbursement. If your physician t... Read more
CMS Corner:
Updates on Incentive Payment Program and ICD-10
Plus: Rural health providers, check your listing for accuracy. If you have a physician or ... Read more
Varicose Vein Diagnoses: Adding Multiple Codes
Your coding options explode with ICD-10. Recent statistics show that up to 25 percent of w... Read more
Reader question:
Options for Best Answer to Split Admit/Discharge Scenario
Question: When you have a patient admitted by one physician, but a different physician dis... Read more
Reader question:
Two Units of 87804 Is OK -- But Add Correct Modifier
Question: A patient with only Medicaid coverage came to our office for a flu test. We bill... Read more
Reader question:
IPPE: Only Report G0403 for EKG
Question: Can we only bill a screening EKG with an IPPE (initial preventive physical exam)... Read more
Reader question:
Overly Damaged Hair Could Mean 704.2
Question: A teenager came to our practice with a note saying she could not return to schoo... Read more
Reader question:
Vitamin B-12 Charge Depends on Payer and Site of Service
Question: Our clinics frequently provide B-12 shots as stand-alone charges with no E/M cha... Read more
Reader question:
Double Check Copay Early to Save Future Hassles
Question: A patient came to our office with the same insurance card she's had for years. W... Read more
Reader question:
No Modifier 55 for Suture Removal
Question: An established patient went to the emergency room in another state over the week... Read more
Reader question:
Improper ICD-9 Code? Refer to Closest Diagnosis Equivalent
Question: My internist saw a patient for "ciliary dyskinesia." This condition occurs in th... Read more
You Be the Coder:
Reason for DES Reporting Points Diagnosis
Question: We have a new patient in our office whose mother took DES while pregnant. What i... Read more
CCI Update:
2012 Guideline Modifications Change Reporting of Screenings
Tip: Confirm before reporting G0396, G0397 with E/M services. You're probably accustomed t... Read more
Diagnosis Coding:
Coding Gout Condition: Check all codes in ICD-9 and ICD-10
Heads up: ICD-10 will include many more options in 2013. A diagnosis of gout might seem si... Read more
Protect Yourself From Audits with These Documentation Tips
Records corrections need to be done wisely.A long list of government entities pour over yo... Read more
Part B Payment:
US Congress Decides to Boost Conversion Factor Through February 29
At nearly the last minute, lawmakers ensure that you won't lose 27 percent.Although the go... Read more
Chronic Sinusitis Coding Options
Watch for new code family J32.x with a fourth digit to specify location. Under the cur... Read more
Reader Question:
Paper Claims Is Going To Be Different for ICD-10 Prep
Question: If we file paper claims to Medicare, will the claims form change once we begin u... Read more
Reader Question:
692.x May Be Code of Choice for Unknown Skin Rashes
Question: We recently treated a patient for a skin rash that seemed to be an allergic reac... Read more
Reader Question:
Prepare Well for Payer Fee Negotiations
Question: We're getting ready to begin contract renewal negotiations with one of our payer... Read more
Reader Question:
Payment for Diabetes Education
Question: Our physician and physician assistant are educating some patients on diabetes, e... Read more
Reader Question:
Notes of 'No Fever' Go In ROS Section
Question: I have found information and heard at seminars conflicting information regarding... Read more
Reader Question:
30300 Appropriate for Nasal FBR Coding
Question: I'm a bit confused. When reporting a foreign body removal of the nose, would I u... Read more
You Be the Coder:
Chemical Peel Coding
Question: Our physician used glycolic acid to remove actinic keratoses from around a patie... Read more
CCI Edits:
Latest CCI Edits 18.0: Understand New Bundled Codes
Plus: 94150 'separate procedure' doesn't always mean separate coding. New... Read more
Worker's Compensation:
Select the Most Advantageous Fee Schedule for Worker's Comp (WC) Claims
Make you filing hassle-free by checking schedules.Worker's compensation (WC) cases raise o... Read more
E/M Coding:
Stop Downcoding E/M Visits, and Add Minimum of $56 to Your Bottom Line
Trap: You might not only be losing revenue -- you're also drawing chance of audit.National... Read more
5010 Readiness:
Medicare Extending 5010 Implementation Deadline till March 31, 2012
Plus: Avoid PO boxes on 5010, despite what your MAC tells you.Sweating over the fact that ... Read more
Watch for Product, Dependence Clues for Coding of Nicotine Dependence Scenarios
Choices expand from 305.1 to F17.2-- beginning Oct. 1, 2013.When the internal medicine spe... Read more
Reader Question:
Debridement Includes Dressings
Question: Can our practice be reimbursed for the surgical dressing (supplies) of a partial... Read more
Reader Question:
Choose 23650 Over 23655 for Local Anesthesia Administration
Question: One of our physicians administered a shot of meperidine HCL while treating a sho... Read more
Reader Question:
Inadequate Height Increase Could Lead to Dx Code 783.43
Question: The physician documented that the patient has inadequate growth (in terms of his... Read more
Reader Question:
No Documented HPI Leads to No Coding for New Patient
Question: A new patient visits the physician with a chief complaint. I don't have a review... Read more
Reader Question:
Consult Codes Could Still Be Utilized
Question: An established patient who was about to undergo a tonsillectomy presented to our... Read more
You Be the Coder:
Differentiating a Self-Limited or Minor Problem in E/M Visit
Question: An established patient saw the physician with a new complaint. Through the E/M, ... Read more
CPT® 2012:
AMA Clarifies About New Patients and 'Qualified Healthcare Professional'
Note the changes affect your use of 99201-99205, 99460-99461, and more. Coding guidelines ... Read more
2012 MPFS:
Flu Vaccine Reimbursement Increases in 2012
Pay for 3 of your most common vaccine codes will rise. Your internal medicine physician sh... Read more
Workers' Compensation:
Make Your Workers' Compensation Billing Smooth with These Tips
Gather information before seeing the patient to avoid trouble during billing process.Just ... Read more
Stress Echo Update:
93351-26 Is Correct for Stress Test With Echo in Facility, CPT® Updated
Choose codes depending on which elements your physician performed.Review the 2012 Echocard... Read more
Sinusitis With Multiple ICD-10 Codes
Code J32.x with a fourth digit to specify location.When following the ICD-9-CM code set, y... Read more
Reader Question:
J3490 Covers Used EpiPen® Kit in Office Set Up
Question: We used the EpiPen® kit in the office on a patient who experienced an alle... Read more
Reader Question:
Do Not Add Lacerations at Different Site and Level
Question: A patient with a 1.5-cm laceration on his eyebrow presented to our practice. Our... Read more
Reader Question:
Select E Code for Initial Fall Visit Only
Question: An established patient came to the office complaining of back pain related to a ... Read more
Reader Question:
Inadequate History Can't Support Comprehensive Exam
Question: Our physician admitted someone as an initial inpatient, but couldn't get all her... Read more
Reader Question:
Don't Count On Pay for Anesthetic Before Injection
Question: We've had increasing problems billing and being paid for the medications we use ... Read more
Reader Question:
Code 86580 for TB Skin Test
Question: Can we bill for an administration fee or injection when giving a PPD test? Or is... Read more
Reader Question:
Remember Debridement Includes Dressings
Question: Can our practice be reimbursed for the surgical dressing (supplies) of a partial... Read more
Reader Question:
Verify State Laws, Payer Rules Before Sending Patient to Collections
Question: I work in a physician's office handling the collection of past due copays, deduc... Read more
You Be the Coder:
Can Counseling Be Coded Separately With Consult Codes?
Question: Our physician provides pre-op consultations for requesting surgeons. He complete... Read more