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Outpatient Facility Coding Alert

Coding Strategies:
Correctly Code Your Screening Colonoscopies
Take note: The screening might eventually convert to therapeutic or diagnostic. Keepin... Read more
ICD 10 Transition:
CMS Gives a Yearlong Concession Period to Get Used to ICD-10
Ensure the code belongs to the right family and avoid denials. If ICD-10 implementatio... Read more
Skin Updates:
Follow 3 Steps Seize the Right Code for Pilonidal Cyst I&D
Scan through the provider’s detail to spot on the right set of codes! When your ... Read more
Reader Question:
Shave Off the Warts With 17110
Question: A patient was taken to the operating room for wart removal, due to the size of... Read more
Reader Question:
POS 11 Claim Needs Prior Authorization
Question: I just got a recoup payment request from United Healthcare. The physician perf... Read more
Reader Question:
Choose 66982 for Capsular Tension Ring Insertion
Question: How would I bill for capsular tension ring with a complex cataract? Idaho Su... Read more
Reader Question:
20552 Might Be Bundled Into 20610
Question: Is 20552 bundled into 20610? New Jersey Subscriber Answer: According to th... Read more
Reader Question:
Turn to T19 Family for Stent Removal
Question: What ICD-10 code should I report for the urologist’s work removing a ste... Read more
Reader Question:
Bleed Site Helps Determine Epistaxis Code
Question: How do we bill for nose bleed, which generally occurs due to acute hemorrhage ... Read more
You Be the Coder:
Know the Difference Between Adult and Pediatric Hydroceles
Question: How do you differentiate adult versus pediatric hydroceles Ohio Subscriber ... Read more
Neurology News:
Get Confident in Distinguishing Dementia From Alzheimer's
Remember to pay attention to associated conditions. One of the most common challenges ... Read more
Pain Management:
Prevent Denials of Interlaminar Injections by Pinning the Levels
You can drop the bilateral modifier. If your interventional physician performs more th... Read more
Modifier Review:
Know Your Modifier 59 Better for Cleaner Claims
Modifier 59 (Distinct procedural service) is used when two codes are not normally report... Read more
ICD-10 Training:
Delve Deeper Into Open Foot Wounds With More Anatomically Specific Codes
Specify right or left, ankle or foot. The next time you code an open foot wound, get r... Read more
Reader Question:
Tie the Trigger Point Injections With 20552 and 20553
Question: A patient suffered whiplash from crashing his car into a parked vehicle, ... Read more
Reader Question:
Append Modifier to 43239 to Reap More RVUs than 43249
Question: My understanding has been that we do not include a modifier when billing ... Read more
Reader Question:
Don't Include 'Rule Out' Diagnoses
Question: My ED physician saw a patient for anterior wall chest pain. After examina... Read more
You Be the Coder:
Know How to Code for Nasal Valve Suspension
Question: Which CPT® code should I use for nasal valve suspension? Wisconsin ... Read more
Diagnostic Details:
Get a Clear Image of Ultrasound Coding to Claim It Right
You may need to code ultrasound more frequently in your office settings. Physicians ha... Read more
Upper GI Update:
Follow These Tips for Successful Reimbursement of Scope Procedures
Pay attention to the documentation when endoscopy crosses the proximal duodenum. You h... Read more
Take a Look at Why You Should Venture Into Outpatient CDI Collection
It may become a survival tactic sooner than you think. CDI (clinical documentation imp... Read more
ICD-10 Transition:
Breathe Easy, the Transition for Lymphadenopathy in ICD-10 Is a Breeze
Check your note carefully for important details. If you come across notes from the ot... Read more
Reader Question:
Shave Denials with Modifiers for Multiple Sites
Question: The physician shaved three epidermal lesions that the patient chose not t... Read more
Reader Question:
Include Indocyanine-Green Dye in 92240
Question: The physician used indocyanine–green dye for membrane peels and com... Read more
Reader Question:
Your Office Visit Includes MRI Review
Question: A patient brought in an MRI for the doctor to review. What do we bill alo... Read more
Reader Question:
Report Initial TURP with 52601
Question: If a patient who had a laser vaporization of a portion of the prostate by... Read more
Reader Question:
Avoid 15851 and 15852 for Anesthesia-Free Procedures
Question: Our dermatologist recently performed suture removal in the office for an ... Read more
Reader Question:
Know The Reason if You Want To Club Fine Needle Aspiration With Another Biopsy Procedure
Question: The physician performed a fine needle aspiration and then a needle biopsy... Read more
You Be the Coder:
Know How to Report in Case of Separate Organs
Question: The doctor injected Botox in the patient’s bladder wall and then in... Read more
Coding Update:
Use Musculoskeletal Codes for Deep Abscess I&D
Look beyond the skin section for coding abscess. When billing for abscess procedures, ... Read more
ICD-10 Transition:
Digest the Digestive Track Coding With Proper Understanding of the Conditions
ICD -10 reporting doesn’t need any additional suffix. The gastrointestinal syste... Read more
Neurology News:
Don't Miss This 3 Step Heads Up for Headache-Related Nerve Blocks
Harness occipital and trigeminal nerve blocks with 64400 and 64405 If you code for bil... Read more
Reader Question:
Ensure a Signature From the Attending for Hassle Free Claim
Question: A gastroenterologist sent his patient to the hematology unit as an outpatient ... Read more
Reader Question:
Report Follicular Lymphoma With 202.00
Question: What would be the diagnosis code for folic lymphoma? New Mexico Subscriber ... Read more
Reader Question:
Use Modifier 59 When CMS Bundles the Procedure
Question: Our physician performed an EGD with guide wire dilation and also biopsy on a p... Read more
You Be the Coder:
Know How to Bill the "Nurse Visit"
Question: What behavioral health codes can a nurse bill? Can she bill for 99212, 99... Read more
Billing Strategy:
Pay Attention to the Payer-Provider Relationship
Good relations with payers can help you better manage hospital accounts receivables. T... Read more
ICD 10 Update:
You Don't Need to Fret Over Numerous Codes for Strep Throat
Choose one of three options for an appropriate description. You won’t have to se... Read more
RVUs Refresher:
Keep Up On PFS by Building a Comprehensive Understanding of RVUs
Break down the components of your payment. The Centers for Medicare and Medicaid Servi... Read more
Strengthen Your Consolidated Bills With These 4 Tips
Read on to know how to negotiate SNF patient cases. Your physician performs services f... Read more
Reader Questions:
Clear Calcific Band Keratopathy With 371.43
Question: I have a patient with extreme calcific band keratopathy. Is there a more ... Read more
Reader Questions:
Step Away From Traditional "Fee-For-Service" Arrangement
Question: When a surgery being performed in an ASC under general anesthesia, can th... Read more
Reader Questions:
Report 28299 for Bunion Deformity
Question: Can CPT® code 28299 be used for a patient that does not have a bunion... Read more
Reader Questions:
Depend on Number and Nature of the Nails to Choose Between 11719, 11721, 11720
Question: What CPT® code is best for cutting and filing ten toenails? Indiana... Read more
Reader Questions:
Choose 45378 When Colonoscopy is Used as Diagnostic Method
Question: Our physician performed a colonoscopy for a rectal bleed on a Medicare pa... Read more
You Be the Coder:
Know When to Use 31622 and 31623
Question: My doctor wants me to bill 31623 and 31622 for services during the same e... Read more
CMS News:
AAFP Asks CMS for More Codes for Outpatient Settings
A proposal calls for inclusion of new codes in the 2018 Medicare physician fee schedule.... Read more
Coding Update:
Choose From the 4 Colonoscopy Codes for Correct Claims
Pay heed to the physician’s note for method and location. When a physician at yo... Read more
Retinal Reimbursement:
Understand the Procedures Involved for a Fair Claim
Read on to know the common retinal coding pitfalls. Retinal detachments are generally ... Read more
Brush Away Ambiguity With a Succinct ICD-10 Code for Pressure Ulcer
Find stage, location, and side in one code for pressure ulcer. The codes for pressure ... Read more
Reader Questions:
EKG and Cardioversions Are Not Bundled Together
Question: We do a pre- and post-EKG on every elective cardioversion patient. The CC... Read more
Reader Questions:
Report 28005 for Windowing Navicular and Cuboid Bones
Question: How should we code for windowing the navicular and cuboid bones, with imp... Read more
Reader Questions:
Use Modifier 52 for Reduced Service
Question: A patient had a total colectomy and still has a rectal stump. Physician p... Read more
You Be the Coder:
Know How to Code for Physical Therapies
Question: Do you have any information on these types of therapies (97530-97532-9753... Read more
Coding Update:
Combat the Challenges of Coding Symptoms and Definitive Diagnoses for Outpatient Services
Hint: Understand the disease process and its associated symptoms. Knowing how to code ... Read more
Skin Care:
Know What to Look for to Peel off the Ambiguity of Skin Coding
Look into the elements of skin procedures before coding. Although there have been no r... Read more
ICD 10:
Transition of Chronic Laryngitis Will Be a Simple Switchover to a J Code
Remember to report exposure to tobacco or infectious agents separately. If your physic... Read more
Reader Questions:
Align Arthroplasty Coding With 28285
Question: Our physician recently performed “Arthroplasty/arthodesis of the se... Read more
Reader Questions:
Rely on 19499 for Unlisted Breast Procedures
Question: A patient had a mastectomy and had to be brought back to the operating ro... Read more
Reader Questions:
Grasp the Group Therapy with 97150
Question: What code(s) should be used to bill for a Medicare patient’s participati... Read more
You Be the Coder:
Know How to Use 90792
Question: How and when should code 90792 be billed? New Mexico Subscriber Answer: Th... Read more
Clear Your Confusion over Common Coding Instructions for Drug Administration
Read the following three common confusing scenarios to built rightful claims. CMS and ... Read more
Deal With Your Denials in the Right Way
Understand the different level of appeals and prepare your claims! You don’t nee... Read more
ICD-10 Transition:
Assess How Ready You Are With the Available Test Preps
Make use of Medicare’s hand holding end-to-end testing opportunity. Are you awar... Read more
Reader's Question:
Report 42227 for Lengthening of Palate
Question: The provider often gives us unlisted codes which makes it difficult to ge... Read more
Reader's Question:
Code 11420 and 11422 Separately for Excision
Question: Our surgeon diagnosed a patient with a verruca formation on the right mid... Read more
Reader's Question:
Rely on 57415 for Foreign Body Removal
Question: Which code should be used for foreign removal body from the vaginal canal... Read more
Reader's Question:
Go Ahead and Bill EEG With Hospital Visit
Question: Medicare denied our bill for an EEG when our physician read one in additi... Read more
You Be the Coder:
Know the Diagnosis Codes That Support 31575
Question: Which diagnosis codes support 31575?  Ohio Subscriber  Answ... Read more
ENT Refresher:
Know Your Nasal Endoscopy Choices for Correct Coding
Catch the code right with your thorough knowledge! Select the codes based on your in-d... Read more
ICD-10 Update:
Pin the Abdominal Pains in the Outpatient Patients With R10 Codes
What is the trick of painless reporting of abdominal pain?  Hint: It’s simp... Read more
Influenza Information:
Make a Rightful Claim for Second-Strain Flu Testing
The issue is whether to report two line items for two different stains. If your facili... Read more
Reader Questions:
Tackle Your Blood Pressure With V70.8
Question:  What dx code should we use when a patient walks in just for a blood pres... Read more
Reader Questions:
Depend on the Documentation for Vascular Degeneration
Question: What is the right code for vascular degeneration? Iowa Subscriber ... Read more
Reader Questions:
Pin the Palliative Care With V66.7, 290.20, 290.21
Question: A patient has advanced dementia. What diagnosis code can we use for a patient ... Read more
Reader Question:
Hook the Unclassified Meds With J3490
Question: What is the HCPCS code for Bydureon®? It is a diabetic drug with gene... Read more
Reader Question:
Writing Prescriptions Are a Part of an E/M Service
Question: A patient with chronic diabetes was seen for prescription refills. The ph... Read more
You Be the Coder:
Know How to Wrap the Wound
Question: A patient was seen for wound care of a stage-2 for both her right heel and lef... Read more
Procedure Focus:
Here's Your Guide to Selecting Right the Codes for Incision and Drainage
Give Heed to These 3 Questions When Coding I &D. When deciding which codes to use ... Read more
Coding Update:
Tackle Trigeminal Neuralgia Coding With 64400
Tip: Stay away from multiple codes. Trigeminal neuralgia (also called tic douloureux) ... Read more
Medical Refresher:
Understand How the Trigeminal Relates to Other Nerves
Take a look at the anatomy to find coding success. The trigeminal nerve is the fifth o... Read more
Tread Carefully When Billing ' Incident to' Services
Meet the criteria or be ready for the OIG’s scrutiny.  Do you know you migh... Read more
Partial Code Freeze Should Lead to a Smoother Transition
Here’s what the present scenario is. Both the ICD-9 and ICD-10 code sets are cur... Read more
Reader's Question:
A Query to the Facility Can Get the Required Documentation
Question: Our provider admitted a patient for observation, but documentation of ini... Read more
Reader Question:
Code the Correct Corresponding Diagnosis Code to Avoid Denials
Question:  We had a insurance denial for procedure code 20610 with diagnosis c... Read more
Reader Question:
Be Informed When You Can Claim More Than One Unit
Question: Sometimes initial psychiatric diagnostic evaluations are performed in mor... Read more
Reader Question:
Sum the Surface Area of Those Wounds for Multiple Wounds
Question: A patient was seen for stage 2 wound care of ulcers for both right heel and le... Read more
Reader Question:
Grab That Extra Reimbursement for a Breast Biopsy in a Non-Facility Setting
Question: Can we report the technical component of breast biopsy services when we are su... Read more
You Be the Coder:
Know how to Deal with Discharge
Question: A patient was admitted to the hospital with severe dehydration and hypona... Read more
Part D Coverage:
Clear Your Confusion on Self Administered Drug by Focussing on Your Facility's Guidelines
Understand 5 factors related to how the drugs were used. Coding for self-administered ... Read more
Cardiac Clearance:
Keep Pace With Pacemaker Changes With 33233, 33235, and 33206
Can you code when removing an old component? You have a chart documenting where the su... Read more
Pain Management Procedure:
64405 Is Your Right Choice for GON Block
Focus on laterality for appropriate coding The greater occipital nerve block is a comm... Read more
ICD-10 Update:
ICD -9 Directly Crosswalks to ICD-10 With Direct Matches in Non-Infectious Gastroenteritis
Understand the cause to code it right. If your physician diagnoses a patient with gast... Read more
Reader Question:
Know Your Payer to Choose the Vaccine Code
Question: Our facility will be given shingles and the new pneumonia vaccines, Does ... Read more
Reader Question:
Code Your Urine Collection With 99000 In Some Instances
Question: A patient came in for drug screening. Urine was collected. Should I code ... Read more
Reader Question:
Don't Code 65220 When No Foreign Body Is Found
Question: One of the physicians performed a slit lamp exam for a patient. He did no... Read more
You Be the Coder:
Know When to Use Modifier 59 and Modifier 91
Question: According to our billing department, Coventry Insurance requested modifie... Read more
Documentation Tactics:
Here's Your Primer on Necessary Documentation for Each Stage of Care
Remember: If it isn’t in the chart, it can’t be billed. Every coder knows ... Read more
Surgical Focus:
Follow These 4 Steps to Set Wrist Repair Coding on Track
Be well versed in anatomy to differentiate tendon from nerve codes. Hand and wrist sur... Read more
Are You Ready? CMS Sets ICD-10 Deadline -- Finally
Gear up for the shift with training programs and testing . CMS has pushed back the dat... Read more
Go Through These FAQs Before Submitting Your Next Eyelid Procedure Claim
Hint: You must understand which codes are interchangeable. Coding for eyelid procedure... Read more
Reader's Question:
CLIA Does Not Include 83009 and 86677
Question: Do we need to append modifier QW to 83009 and 86677 when they are done in... Read more
Reader Question:
Avoid 99381-99387 Alone for Biometric Coding
Question: An insurer asked us to use wellness codes 99381 to 99397 for biometric sc... Read more
Reader Question:
Clear All Your Doubts on Dilation
Question: Dilation is bundled with 58100. If a provider does some cervical dilation... Read more
You Be the Coder:
Coding for Colon Polyps Resolved With Colonoscopy Methods
Question: How should I report the procedure based on this physician’s notes: ... Read more