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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
Reimbursement:
Latest Flu Vaccine Payments: Check With Local MAC
Tip: Pay attention to codes with locally-controlled pricing.CMS released its annual update... Read more
ICD-10:
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
ICD-10:
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
ICD-10:
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
ICD-10:
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
Treatments:
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
ICD-10:
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
ICD-10:
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
Checklist:
Cover All Your Bases Before Coding IPPE
Here's your checklist of what providers must document. "The various components of the IPPE... Read more
E-Prescribing:
G8553: Techniques for Solid Claims Success
Check filing dates and charge guidelines to smooth processing every time. HCPCS doesn't in... Read more
Billing:
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
ICD-10:
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
ICD-10:
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
ICD-10:
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
Documentation:
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
ICD-10:
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
ICD-10:
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
ICD-10:
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