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Outpatient Facility Coding Alert

Billing 101:
Get Versed in Successfully Handling 3 Compliance Issues for ASCs
Follow these 3 steps to navigate all your claims. Many aspects of coding and billing ... Read more
Procedure Focus:
Manage De Quervain's Syndrome By Zeroing in on Injection and Incision Sites
First step: Confirm the extent of tenosynovitis and injection site. You can take the t... Read more
ICD 10:
Ensure You're Prepared to Get Staff Prepped for ICD-10
Be prepared to clock in for an approximate 16 hours of coding training. With ICD-10 im... Read more
Clip and Save:
Remember 9 Checkpoints for All Your ASC Claims
Billing for ASC services can be quite different from billing for inpatient facilities or... Read more
Reader Question:
Report 99455 or 99456 for Work Related Exams
Question: How do you code for a work related exam? Arkansas Subscriber Answer:&... Read more
Reader Question:
Use 45378 for Routine Colonoscopy, Not 45380
Question: During a patient’s routine screening colonoscopy, there were approx... Read more
Reader Question:
Don't Always Count on Time for Modifier 22
Question: One of my doctors performed a procedure to excise a lesion on an obese pa... Read more
Reader Question:
Hook in Extracapsular Cataract Removal With 66982
Question: Our ophthalmologist wants me to submit a claim for 66982, along with stre... Read more
Reader Question:
Find Out Whether 31295 Is Coupled With Another Procedure
Question: One of our third-party insurers has sent two denials for claims with code 3... Read more
You Be the Coder:
Understand How to Count Exam Element Obtained Through a Scope
Question: When reviewing my physician’s notes, how should I count exam elemen... Read more
Coding Update:
Heads Up: Some Outpatient Codes Are Ready to Bundle Up as 'Mini DRGs'
Your reporting could change drastically in 2015, thanks to comprehensive APCs including ... Read more
Modifier Refresher:
Use Modifier 59 to Indicate That the Two Procedures Are Separate and Distinct
Remember to support your claim with medical records. Modifier 59 (Distinct procedural ... Read more
Maintain 7 Criteria to Keep Your Diagnosis Coding On Track
Follow our experts’ advice to turn down the risk of down coding.  You may b... Read more
Reader Question:
Find Out if You Need a Modifier for Malignant Neoplasm Procedures
Question: I submitted a claim for 14040 and 17311 with diagnosis 173.3. Should I ha... Read more
Reader Question:
Use 36000 as Catheter Placement Code
Question:  Our surgeon noted that, for a 62-year-old patient, he inserted a central... Read more
Reader Question:
Know the Joint the Physician Treated
Question: How should I code tendon injections to both of the patient’s thumbs... Read more
Reader Question:
Check With the Payer When Reporting Urine Drug Screening
Question: If a urine sample was collected on site for onward to the lab for drug sc... Read more
Reader Question:
Familiarize Yourself With the 4 DME Modifiers
Question: What other modifier do I use with RT or LT when I bill for DME equipment?... Read more
Reader Question:
Don't Code 10021 and 10022 Together
Question: The physician performed a fine needle aspiration and then a needle biopsy... Read more
You Be the Coder:
Know How to Report Chalazion
Question: How should I report treatments for chalazions? Pennsylvania Subscriber ... Read more
Gastro Focus:
Here's Your Key to Dealing with Multiple-Endoscopy Procedures
Prepare yourself with these pointers for multiple-procedure and multiple-scope rules. ... Read more
Sinus Procedures:
Don't Mess Up Maxillary Cyst Removal Coding
Watch when you’d be better off choosing 31256 over 31267. Sometimes a code&rsquo... Read more
ICD-10 Update:
Avoid 3 Myths to Help Your Facility Make a Smooth Transition
Bear in mind the new timeline and be educated. With the healthcare industry on edge an... Read more
CPT® 17110 bundles 11305,11900 for Plantar's Wart Removal
Question: Our dermatologist recently performed removal of a plantar wart approximat... Read more
Reader Question:
Don't Code Service to Fix Problem Caused By the Physician
Question: My doctor attempted to do a banding of esophageal varices. He could not p... Read more
Reader Question:
Pair Correct Diagnosis Code While Reporting E/M
Question: A 48-year-old female, fearing she has H1N1, reports to the ED complaining... Read more
Reader Question:
Look at the Location, Depth and Procedure Complexity for Sialolithotomy
Question: Please provide me with the correct CPT® codes for when the physician ... Read more
Reader Question:
Arthrocentesis, Aspiration and Injection Can Sometimes Bundle Into One Code
Question: If our physician is performing an arthrocentesis procedure and injects a ... Read more
You Be the Coder:
Know How to Couple Anemia and Colonoscopy
Question: Can I use the diagnosis of iron deficiency anemia for a colonoscopy? The ... Read more
Cataract Procedures:
Keep YAG Capsulotomies Separate From Cataract Globals With 66821
Don’t miss that extra $160 for after-cataract services. Post-op complications af... Read more
ICD-10 Update:
Focus on Obstruction for Successful Acute Laryngitis Coding
Don’t miss the change to separate code families under ICD-10.  Part of the ... Read more
CMS Coding Guidelines:
Don't Panic When Coding 38220-59 if You Meet These Medicare-Approved Conditions
Remember your ‘G’ code as another option in some cases. If your physician ... Read more
Focus on 4 Steps to Get a Leg Up on Varicose Vein Treatments
Remember some payers might not pay for the care.  Spider vein and varicose vein t... Read more
Reader Question:
31615 Covers Both Surgical and Diagnostic Bronchoscopy
Question: A vent dependent patient underwent bronchoscopy through an established tr... Read more
Reader Question:
Easier Coding for I&D of Complex and Multiple Cysts
Question: Mrs. Brown presents to the center with cysts all over her body. The derma... Read more
Reader Question:
Don't Forget to Link 832.00 With 24640 for Nursemaid Elbow
Question: Our physician treated a 2-year-old child for nursemaid elbow. What proced... Read more
You Be the Coder:
Rightfully Flex Your Flexor Digitorum Codes
Question: A patient lacerated both the flexor digitorum superficialis and the flexo... Read more
Coding Strategies:
Advice Helps You Better Manage Your Dupuytren Claims
Crux is to identify and report the treatment option. When your providers treat a patie... Read more
Modifier News:
Simplify Your Life When You Code Multiple Encounters on the Same Day: Here's How
Knowing which codes qualify for -27 is your first step toward success. When your physi... Read more
Get Ready to Code for Knee Injuries
Here’s What You Must Know to Embrace ICD-10 System of Coding Increased emphasis ... Read more
Reader Question:
Stick to 307.9 for Unspecified Headache
Question: When we reported diagnosis code 307.81 for tension headache, the payer de... Read more
Reader Question:
Rely on Unlisted Codes 41599, 40799 to Release the Tied Tongue
Question: Should I use the code 40806 or 41010 for an incision of labial ankyloglos... Read more
Reader Question:
Look Back on the Documentation of Initial Visit for Follow-up Claims
Question: A patient saw our physician because of an abscess, and returned for a fol... Read more
Reader Question:
Be Informed on the Codes for Laser Conization and Ablation
Question: Our physician documented the following report: “I brought in the co... Read more
Reader Question:
Is IOL Bundled With Keratoplasty?
Question: The surgeon performs intraocular lens (IOL) placement with cataract surge... Read more
Reader Question:
Check With Your Payer to Include the Service of Surgical Assistant
Question: The physician does Austin bunionectomy and treats a hallux valgus by surg... Read more
You Be the Coder:
How to Time Your Polypectomy Coding
Question: Do we need to wait for the final pathology report before coding a polypec... Read more
Modifier Review:
Brace Yourself with Modifier 59 for Distinct Procedural Services
Refer to Medicare’s Correct Coding Initiative (CCI) before using Modifier 59 Mod... Read more
ICD-10 Transition:
Don't Fall for the Myth That ICD-10 Won't Affect Outpatient Services
Be equipped with the plan of action to embrace the new system  The notion that ou... Read more
Reader Question:
Count the Number of Muscles and Not Injections
Question: The physician administered trigger point injections to fingers 2-5 on bot... Read more
Reader Question:
Biopsy Is Bundled With Excision Code 31541
Question: During an operative session, the surgeon performed two procedures: D... Read more
Reader Question:
Code 14040 Suffices for Lesion Removal and Tissue Transfer
Question: The dermatologist performed an adjacent tissue transfer. Should I also co... Read more
Reader Question:
Keep the Global Period in Mind When Using 66821 For the Same Eye
Question: The ophthalmologist performed a YAG laser capsulotomy. The patient on a r... Read more
Reader Question:
Remember Many Payers Consider Renessa Experimental
Question: Mrs. Smith had Renessa as a treatment option for stress urinary incontine... Read more
Reader Question:
Check Documentation for Any Additional Post Operative Services
Question: The pain management specialist inserted a catheter for a continuous femor... Read more
You Be the Coder:
Learn the Strategy for Coding Skin Lesion
Question: Mr. Johns was referred by the family physician to one of our physicians f... Read more
Modifier Focus:
Watch the Clock to Know Whether Modifier -73 or -74 Applies
Plus: Here’s what your bottom-line difference will be.  Most procedures in ... Read more
Burn Coding:
Don't Get Burned When Reporting Burn Cases
Tip: Focus on degree and percentage affected. An insight to types of burns and a summa... Read more
Procedure Focus:
Answer 3 Questions to Get a Clear Snapshot for 20526
Evidence of previous treatments are a part of successful CTS injection claims. When co... Read more
Check Out How Your CTS Diagnosis Coding Will Change in 2015
Select distinct diagnosis code for ICD-10   Several diagnoses can apply when a su... Read more
Reader Question:
Choose Between 20550 and 20605 When Coding for Sinus Tarsi
Question: How do we report a cortisone injection to the sinus tarsi?  Montan... Read more
Reader Question:
Know the "Why" to Report 10022
Question: The physician performed a fine needle aspiration and then a needle biopsy... Read more
You Be the Coder:
Know the Anatomy to Report 20605
Question: A patient in our clinic was administered injection on the lateral epicond... Read more
Modifier Check:
Ensure You're Coding Precisely With Modifiers 50 and 52
Tip: Fee schedules and payers help guide when you should report. As the name implies, ... Read more
Modifier 101:
Refresh Your Memory on Modifier Intent
Don’t miss when you shouldn’t report RT, LT, or 50. A modifier gives cl... Read more
Allergy Alert:
Tackle Your Allergy Test Coding With 95004
Starting point: Note the number of allergens tested. The green grass, blossoming trees... Read more
For Asthma, Shift Your Focus From Etiology To Severity
Key point: Identify the severity to correctly code for asthma in ICD-10  Spring c... Read more
Reader question:
Follow Your Physician Note to Code Cerumen Removal
Question: How to we bill an impacted cerumen removal with general check-up at our o... Read more
Reader Question:
Code Your Colonoscopy With 45383 and 45381
Question: The doctor used an Olympus scope guide in the transverse colon. The repor... Read more
You Be the Coder:
Coding for Nose Bleed
Question: A patient comes to a clinic after sustaining injuries during a soccer gam... Read more
ICD-10 Delay:
Use Extra Time For Thorough Prep for ICD-10, Experts Advise
Tip: Keep focusing on clinical documentation.  If you weren’t quite sure wh... Read more
Procedure Spotlight:
Remember 5 Things to Correctly Code for Knee Arthroscopies
Taking note of compartments is one step to success. Spring and summer are time for get... Read more
Arthroscopy Explained:
Take a Quick Look at Arthroscopy
Read this refresher to remember what you’re coding. Arthroscopy is a procedure t... Read more
Get an "E" Prefix for Your Charge Capture
Electronic charge capture process can increase your return on investment. Accurate cha... Read more
Get Specific With Site, Laterality, and Severity for Accurate Ulcer Coding
You will need to list the underlying cause before you code for ulcer. Diagnosis 707.9 ... Read more
Reader Question:
Don't Bother About Image Guidance Code 77003 With 64483
Question: I need a clarification on professional fees POS 24. Procedure 64483 was per... Read more
Reader Question:
Use Code 10140 to Manage Incision and Drainage
Question: The physician recorded a patient’s diagnosis as ‘knee wound w... Read more
Reader Question:
Know When to Use UB04 vs. CMS-1500 Form
Question: Under which circumstance can a freestanding ASC use both the UB-04 and CM... Read more
Reader Question:
Check for Transfer of Care Before Appending Modifier 55
Question: If another otolaryngologist, not the physician who performed the surgery,... Read more
You Be the Coder:
Understand How to Submit 31625 and 31645 Together
Question: What would be the correct way to bill 31624 and 31645? Should we use modi... Read more
Patient Status:
3 Steps Show You When Facility's Overnight Patient Qualifies for Outpatient Coding
Not every outpatient passes through the freestanding or ASC facility. A patient stayin... Read more
Ankylosing Spondylitis Coding Options Explode Under ICD-10
Providers will need to document spinal area for success. Patients diagnosed with ankyl... Read more
APC Payment Update:
Don't Miss These Changes to EAM Codes for 2014
Hint: More services will qualify than ever before.  Every outpatient coder needs ... Read more
Plan Ahead to Ensure Your Facility Stays Compliant After Computer Security Changes
Windows XP shift could jeopardize your HIPAA compliance. When someone mentions HIPAA s... Read more
Reader Question:
Report Colonoscopy with 45384 - 45385, Plus Modifiers if Needed
Question: A colonoscopy was done in August 2013 on a patient with snare removal of ... Read more
Reader Question:
Stick to 64616 for Chemodenervation of Neck
Question: The diagnosis was documented as left sided torticolitis with sever spasms... Read more
Reader Question:
Start with 17110 for Wart Removal Without Cryo
Question:  The dermatologist documented, “Dermatology treatment rendered in t... Read more
Reader Question:
Base Arthroscopy Code on Extent of Debridement
Question:  How do we report the arthroscopic excision of a detached anterior labral... Read more
Reader Question:
Watch Whether 60260 Is Allowed at Your Facility
Question:  A patient had a right hemithyroidectomy 2 years ago, but our surgeon cla... Read more
Reader Question:
Yes, You Can Have Success Reporting 64642 and 64615 Together
Question:  I have a patient who suffers from migraines and receives treatment with ... Read more
Reader Question:
Look to 69799 for Sedation During Ear Tube Insertion
Question:  Our physician removed a patient’s ear tubes in an ASC setting unde... Read more
You Be the Coder:
Understanding What 28730 Can Encompass
Question: The podiatrist completed first metatarsal-cuneiform arthrodesis (lapidus ... Read more
Watch 6 Letters to Know Whether to Expect OPPS Payment Approval or Refusal
Tip: Keep tabs on the Status Indicators along with alternate HCPCS codes. When you wan... Read more
Get Paid for Scar Procedures By Proving They're Medically Necessary
Tip: Documentation should show that excisions are a part of aftercare. If you’re... Read more
Here's How to Handle Extra Evaluations When Reporting Functional Limitation
Hint: Now you can report separate evaluations on progress report day. As the new funct... Read more
Dyskinesia Diagnoses Get More Precise With the New Coding System
You’ll still have an ‘unspecified’ option when lacking details. Abno... Read more
Reader Question:
Look at 29828 for Tenodesis and 29825 for Lysis and Debridement
Question: The surgeon documented arthroscopic biceps tenodesis along with arthroscopic e... Read more
Reader Question:
Start With G0105 for High Risk Medicare Screening Colonoscopies
Question: Should we use G0105 or 45380 when we bill a screening colonoscopy for a high r... Read more
Reader Question:
Circumstances Help Dictate Whether You Can Submit 72275 With 64479
Question: I am a coder working with a pain clinic. Could I charge for 72275 along with t... Read more
Reader Question:
HIPAA Supersedes Lesser State Retention Laws
Question: How long do we need to keep medical records? Iowa Subscriber Answer: The a... Read more
Reader Question:
Choose 43760 for Gastrostomy Tube Change
Question: A patient presented with a partially dislocated gastrostomy tube with pain at ... Read more
You Be the Coder:
Consider Your Choices for Neck Biopsy
Question: The pathology report revealed a benign lymph node on the left posterior side o... Read more
News and Notes:
Start 2014 by Adding 4 New Procedures to Your 'Approved' List
Plus: AMA extends Medicare status deadline. The CMS Final Rule for 2014 added four ne... Read more
AMA Symposium:
Keep Counting Muscles to Correctly Report Chemodenervation in 2014
New guidelines also specify which services you can submit as bilateral. Attendees at t... Read more
Learn Why 'Repair' vs. 'Reconstruction' Can Make or Break Your Collateral Ligament Claims
Tip: Knowing the surgeon’s preferred terminology can point you in the right direct... Read more
Terminology Resource:
Here's Your Easy-to-Understand Collateral Ligament Aid
Boost your coding proficiency with this at-a-glance tool When you coding elbow collate... Read more
Check Whether Your Facility Is On the OIG Hit List
Ambulatory and outpatient services were in top POS mistakes. Recovery audit contractor... Read more
Reader Question:
Choose Between 38500 and 38510 for an Open Biopsy
Question: What would be the CPT® code for excision of a left posterior neck mass? Th... Read more
Reader Question:
Coding for Inguinal Hernia Could Be a Breeze
Question: What would be the correct code for the following: left indirect/inguinal herni... Read more
Reader Question:
Code 31240 Suffices for Both Antrostomy and Resection of Concha Bullosa
Question: The surgeon did a right middle meatus antrostomy and resection of concha bullo... Read more
Reader Question:
Code for Transforaminal Over Interlaminar ESI During Same Encounter
Question: Our pain management physician wants to bill for an aborted interlaminar epidur... Read more
Reader Question:
Single 54162 Covers Penile Lysis + Repair
Question: Are lysis of penile adhesions and repair of penile skin bridge the same proced... Read more
Reader Question:
Adjacent Tissue Transfer Includes Lesion Removal
Question: If the dermatologist performs an adjacent tissue transfer, can I also code for... Read more
You Be the Coder:
Best Options for Rotator Cuff Incision
Question: The surgeon performed rotator cuff surgery on a patient because of infection. ... Read more