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Part B Insider (Multispecialty) Coding Alert

Medicare Errors:
Providers Underbilled More Than $1 Billion to Medicare in 2010
CERT results reveal $34.3 billion in improper Medicare payments--$1.1 billion of which was... Read more
Part B Revenue Booster:
Collect for New Medicare Preventive Services With These 'G' Code Additions
Services became payable within the last two months, so you can begin billing MACs for them... Read more
HIPAA Audits Are Heating Up--Is Your Practice Prepared?
Contact experienced outside counsel immediately, our experts advise.Establishing HIPAA pro... Read more
Pull Together Your HIPAA Audit Plan With These Pointers
It's never too late to start getting into compliance.Assemble a team: "Covered entities sh... Read more
Physician Note:
CMS Releases Updated, Aggressive 5010 Timeline
Plus: Congress has yet to pass 2012 payment fix.CMS offered an early holiday gift to medic... Read more
In other news
As 2011 comes to a close, it's clear that Congress plans to take the looming Medicare pay ... Read more
Reader Question:
Forget About Collecting for 'S' Codes From Medicare
Question: We've had increasing problems billing and being paid for the medications we use ... Read more
Reader Question:
Get to Know Pecking Order for CPT® Codes
Question: I know that as a general rule the highest RVU has a higher billed amount and tha... Read more
Reader Question:
1 Exam Bullet May Require 3 Vitals
Question: Can you please explain how taking the vital signs contributes to determining the... Read more
Part B Revenue Booster:
Keep These 6 Essential Coding Tips in Mind for 2012
Ring in the New Year without a hitch by implementing these simple strategies.As your pract... Read more
Keep These Additional 3 Non-Coding Tips in Mind As 2012 Approaches
While January 1 is typically a great time to catch up on your new code options, a new year... Read more
Make Audit-Proof Record Corrections With These 5 Tips
Documentation clarifications can be a big help -- if you use them wisely.With the ple... Read more
Documentation Red Flags:
Know When A Clarification Hurts Instead of Helps
If you correct or add to every medical record that gets reviewed, you may come to regret i... Read more
Part B Coding Coach:
94640: Take This Quick Short-Interval Inhalation Therapy Quiz to Aid Your Coding
94640: Take This Quick Short-Interval Inhalation Therapy Quiz to Aid Your CodingDoes your ... Read more
Physician Note:
CMS to Change NPI Listings in PECOS
Plus: A clinician's signature can cost them money--and jail time.You may have to tweak you... Read more
In other news
Practitioners should never sign documents without reading them first--that's the lesson le... Read more
Reader Question:
Don't Heed Hearsay When Coding Teaching Physician Services
Question: We are getting a lot of feedback that our emergency physician faculty members, w... Read more
CMS Identifies Most Egregious Errors in New Compliance Report
Compilation of RAC findings, ZPIC audits, and MAC errors shows you which Part B mistakes y... Read more
CMS Is Converting Coverage Decisions to Include ICD-10 Codes
Plus: Medicaid contractors are working to meet ICD-10 deadline.As we reported in the last ... Read more
Tis The Season For Giving " If You Stay Within the OIG's Guidelines
Keep government guidance in mind when deciding on your holiday gift list.Under the face-to... Read more
Just Say No to Giving Most Gifts to Patients
It may be better to give than to receive, but keep costs low.You'd love to spread some hol... Read more
Part B Coding Coach:
57283: Avoid This Code With Other Procedures Involving Enterocele Repair, CPT® Warns
Practices that perform urology procedures should pay close attention to these CPT® 2... Read more
New HCPCS Code Will Bring You $32,000 x 3 -- If You Bill It Properly
Include proper primary and secondary diagnosis codes to ensure payment. If your urologist ... Read more
Physician Note:
CMS to Cover Obesity Screening and Counseling
Plus: You're still looking at a 27 percent potential Medicare pay cut on Jan. 1.This holid... Read more
In other news
When it comes to looming Medicare pay cuts, the government sure likes taking things down t... Read more
Reader Question:
Scrutinize Documentation for G0389 Crosswalk
Question: We use G0389 for AAA screening of Medicare patients. What is the corresponding... Read more
Reader Question:
Modifier 50 Doesn't Always Apply
Question: When our physicians administer Botox for chronic migraines, we bill the HCPCS J ... Read more
Reader Question:
Check With Individual Payers' Incident-to Guidelines
Question: Can we bill under the physician even if she's not in the office when the speech ... Read more
CPT® 2012:
Establish Whether A Patient is New With CPT®'s Latest E/M Tweaks
Plus: Get to know new thoracoscopy codes.It's an age-old debate--when an established patie... Read more
Medicare's 'Three-Day Payment Window'--Do You Know What It Means?
One of the least publicized changes in the 2012 Medicare Physician Fee Schedule could be o... Read more
CPT® 2012:
Get Some Closure on Skin Repair Guidelines
Plus: We'll tell you when debridement is considered 'separate.'If your eyes bulged when yo... Read more
Looking Ahead:
What You Can Expect in 2013
Rumors of ICD-10's death have been greatly exaggerated.It isn't even 2012 yet, but the CPT... Read more
5010 Readiness:
Medicare Won't Penalize You for 5010 Non-Compliance Until March 31, 2012
Plus: Avoid PO boxes on 5010, despite what your MAC tells you.Sweating over the fact that ... Read more
Part B Coding Coach:
CPT® 2012: New Radiology Code Simplifies Coding for Abdominal and Pelvic CTA
Plus: 36251-36254 Create a New Coding World for Renal Angiography CPT® 2012 update... Read more
Physician Note:
Make These Key Changes to CPT® 2012
Plus: Chiropractors may face delayed reimbursement when billing 98941.The ink is just bare... Read more
In other news
Part B practices that report chiropractic manipulative treatment code 98941 shouldn't be t... Read more
Reader Question:
Patient Wants Physical But Refuses AWV? Document Everything
Question: Several of our patients have presented to our office for a complete preventive p... Read more
Preventive Care:
CMS to Cover Annual Cardiovascular Disease Prevention Visit
Coverage will apply to primary care practitioners, Decision Memo indicates.Amidst growing ... Read more
Preventive Care:
CMS Further Expands Preventive Care to Cover Depression and Alcohol Misuse Screenings
If alcohol misuse is found, CMS will cover four additional counseling visits.The news that... Read more
CMS Extends Timeline for Revalidation Effort by Two Years
Plus: You can now check the database to determine whether you've been sent a revalidation ... Read more
CPT 2012:
CPT Defines 'Other Qualified Healthcare Professional'
Unfortunately, RNs don't make the cut under CPT's new definition.Wondering just who is eli... Read more
Part B Coding Coach:
4 Tips Help OB-Gyn Practices Prepare for CPT 2012 Adjustments
Plus: Check out new pathology codes that reflect the tests your ob-gyn can order. If you w... Read more
Physician Note:
CMS Offers ICD-10 Templates, Planning Assistance
Plus: MACs will no longer send three letters seeking overpayments.The transition for medic... Read more
In other news
If you typically wait until you receive Medicare's third warning that you need to refund a... Read more
Reader Question:
Consider Sacral MRI Code
Question: We have orders for MRI of the sacrum and pelvis, and the exam includes a complet... Read more
Reader Question:
LCDs Reign Supreme
Question: What diagnosis code should be used for vein mapping prior to hemodialysis?New Yo... Read more
Reader Question:
Straighten Out Bilateral Coding Rules
Question: When our physicians administer Botox for chronic migraines, we bill the HCPCS J ... Read more
Part B Pay:
CMS Slashes 2012 Conversion Factor by Over 27 Percent Vs. Current Rates
Plus: Pay for Radiation oncology, pulmonology, and cardiology will drop even more.Get read... Read more
Annual Wellness Visits:
2012 Fee Schedule Boosts AWV Pay, Adds 'Health Risk Assessment' Tool Criteria
Look for five percent more in your annual wellness visit RVUs effective Jan. 1.Although yo... Read more
Check Out CMS's Definition of 'HRA'
In the absence of a CMS-issued health risk assessment (HRA) form for practices to complete... Read more
CMS Reminds Practices of 60-Day Revalidation Timeline
But, the agency stresses, wait for a request letter before you revalidate.If you're still ... Read more
Part B Coding Coach:
CPT® 2012 Vastly Impacts Pathology Code Section
3 groups clarify parallel services.Prepare for a CPT® special-stain overhaul startin... Read more
Chart Your New Course for Special Stain Coding 2012
Clarify groups and units.Use the following table to look ahead to CPT® 2012 special ... Read more
Physician Note:
90654: Quell Confusion About New Flu Shot Code
Plus: If hospice patient recovers, he may not be eligible for hospice.When it comes to Par... Read more
In other news
Medicare may not pay for discharge planning when a hospice patient is no longer terminally... Read more
Reader Question:
ABN Not Required for These Psychiatric Visits
Question: We know that "PR-122" is a "Psychiatric reduction in payment" code for Medicare ... Read more
CPT® 2012:
Vaccine Code Set Gets A Booster Shot in 2012
Plus: CPT offers slight overhaul to electromyography codes.CPT has left its electromyograp... Read more
Part B MACs Now Using 'Predictive Modeling' of Claims to Catch Fraud
Fortunately, software alone won't be responsible for nabbing claim issues.Don't ever accus... Read more
CPT® 2012:
Replacing A Pacemaker? Follow CPT®'s New 'Lead'
Plus: Expansion of lung biopsy section could please pulmonology codersHave you been stymie... Read more
CPT® 2012:
New Radiology Codes Bring Light to Additional Imaging Options
Plus: CPT overhauls lung scan codes.Radiology coders are sure to cheer when they receive t... Read more
Part B Coding Coach:
These 5 Tips Can Lead You to Myomectomy Coding Bliss
Find out how the weight of myomas can trump the number of them. Deciding which myomectomy ... Read more
Physician Note:
CMS Adds 16 Lab Tests to CLIA-Waived Status
Keep a careful eye on your vaccination reimbursement this month.Part B practices will bene... Read more
In other news
Pay attention to your claims for flu vaccinations, or you may be losing Medicare reimburse... Read more
Reader Question:
Not All Modifier 59 Denials Warrant Appeals
Question: I have an insurance company that is not paying for a code, stating it is bundled... Read more
CPT® 2012:
New Codes Abound for Skin Substitutes, Rhizotomy, Orthopedics
Plus: Check out time guidelines for initial observation codes. Have you ever wished that C... Read more
Part B Payment:
CMS to Alert Some Practices Facing E-Prescribing Penalty Ahead of Time
Plus: Just over a week left to get your exemption applications in to CMS. Worrying about w... Read more
Know the Potential Hardship Exemptions
If your practice is set to face an e-prescribing penalty but fits into one of the followin... Read more
Physician Note:
Report: Some Medicare Fraudsters Are Swiftly Reinstated to the Program
Plus: Don't forget to prep new ABN before Jan. 1. Although you may have heard much buzz a... Read more
In other news
Beginning Jan. 1, you must use the new 2011 version of the Advance Beneficiary Notice, or... Read more
Reader Question:
Know Your Tinnitus Diagnoses
Question: Our physician documented "ringing in head" for a new patient. Which diagnosis c... Read more
Reader Question:
Know CMS Vs. CPT® Differences When Counting Time
Question: If the physician documents: "Time spent in the evaluation of the patient with m... Read more
Reader Question:
Document Modifier 22 Justification
Question: Our surgeon excised a very large lipoma located primarily in the upper back, bu... Read more
Reader Question:
State Laws Are Paramount When Dealing With Collections
Question: I work in a physician's office handling the collection of past due copays, dedu... Read more
Reader Question:
67912 Includes Supply Charge
Question: How would I code for insertion of gold eyelid weights to correct lagophthalmos?... Read more
Part B Pay:
MedPAC Recommends Big Cuts to Specialists' Pay
Plus: Under advisory body's latest suggestions, primary care docs would face ten year pay ... Read more
Part B Revenue Booster:
4 Steps Keep Your Practice's Reimbursement Flowing
Front desk processes lacking? You could be kissing dollars goodbye.Collecting your due fro... Read more
Tighten Up Your Independent Therapy, Large Part B Payments in 2012
Get to know these two issues that will impact therapists next year under the OIG's 'Work P... Read more
Prepare for ICD-10 Conversion With 2 Simple Tips
Know your anatomy and physiology if you want a quick transition.It's not too early to star... Read more
Physician Note:
2 States Expand Patient Privacy Breach Notification Requirements
Plus: DOJ crackdowns nail providers nationwide.If you live in certain states, you may need... Read more
In other news
The feds continue to rack up fraud convictions of providers across the country.An RN forme... Read more
Reader Question:
Know When to Add Laceration Repair Lengths
Question: A patient with a 1.5-cm laceration on his eyebrow presented to our practice. O... Read more
Reader Question:
Not All I&D Codes Are Alike
Question: Can anyone tell me the correct CPT® code for an I & D of a knee absces... Read more
Reader Question:
Medicare May Not Pay for 'Standby' Service
Question: Our surgeons sometimes "standby" for other surgeons in some high-risk procedures... Read more
Reader Question:
Sequence Hospital E/M Services Properly
Question: I have trouble figuring out how to charge for a patient that was in observation,... Read more
Reader Question:
Keep A Handle on KX With This MRI
Question: Do the new rules on coverage for MRI with pacemaker affect coding?Answer: Yes. M... Read more
RACs Corrected Over $92 Million in Improper Payments Last Year Payments Last Year
The good news? Almost $17 million of that went back to doctors who had been underpaid.You ... Read more
OIG to Focus on Incident-to Claims, E/M Services, And More in 2012
New OIG Work Plan offers insight into where the agency will be focusing its reviews next y... Read more
E/M Coding Quiz:
Arm Yourself With Accurate E/M Knowledge
Determine whether your E/M coding skills are top-notch with this quick quiz.It's time agai... Read more
Part B Coding Coach:
Strabismus Claim Success Depends on Detailed Anatomy Understanding
How many muscles? Horizontal or vertical? The answers will keep your coding from getting... Read more
Physician Note:
Tricare HIPAA Breach Could Affect 4.9 Million Patients
Plus: One MAC may have overpaid you for your PQRS participation.Recent spotlights on HIPAA... Read more
In other news
Has PQRS paid off more than you expected? You might have accidentally been double-paid.Par... Read more
Reader Question:
Get Modifier QW Details on CMS's Web Site
Question: We are a CLIA waived lab. How can we find out if a specific test kit is som... Read more
Part B Mythbuster:
99221-99223: Are These Merely 'Admit' Codes, or Can Non-Admitting Docs Report Them?
Get to the bottom of this growing myth and you'll be on the road to easier claim reimburse... Read more
Immunization Coding Primer:
Torn Between V06.6 And V04.81 for Vaccine Diagnoses? We've Got You Covered
Iron out your immunization coding regs to keep collecting your due.It's that time of year ... Read more
Part B Revenue Booster:
Keep Money Flowing With These 6 Income Opportunities
Take the time to ensure that you aren't bleeding revenue in these areas.Just because Medic... Read more
Part B Coding Coach:
4 Tips Help Streamline Your Pulmonary Rehab Reimbursement
G0424 requires monitored exercise, and an hour's therapy of up to two sessions per day per... Read more
Physician Note:
Kentucky Physician Pays Over $300,000 to Settle Double-Billing Allegations
Plus: It's up to you to find out if your employees are excluded from Medicare.A Kentucky d... Read more
In other news
Check and double check your employees for exclusion from federal health care programs. Tha... Read more
Reader Question:
List As Many PQRS Codes As Needed
Question: Can we report more than one PQRS code measure on the same claim?Answer: Yes. You... Read more
Part B Updates:
Vendor Won't Be Ready for 5010? Get Claims in Before 2011 Ends, CMS Advises
Plus: E-prescribing hardship exemptions are due in November, CMS reminds.Practices from al... Read more
E/M Coding:
Only 'Treating Physician' Can Report Subsequent Observation Care, CMS Clarifies
All other doctors who evaluate the patient must report outpatient E/M codes.In effect for ... Read more
ICD-9 Coding Quiz:
Test Your Knowledge of the New ICD-9 Codes
Know whether you're ready for changes to diagnosis codes that kick in Oct. 1.With so much ... Read more
Recovery Audit Contractors:
RAC Audits Will Impact Medicaid Claims Jan. 1, CMS Says
Recent delays have given you more time to prepare.You've benefited from several delays in ... Read more
Part B Coding Coach:
Diagnostic Test Came Back Normal? Look to Signs, Symptoms
Heed 3 quick rules to code these testing results.You think you may have mastered most ICD-... Read more
Physician Note:
Vaccines Receive Booster Shots for 2012
Plus: This MAC may accidentally double-request overpayments.Good news for physicians who a... Read more
In other news
Don't get stressed if you get a second overpayment letter from MAC National Government Ser... Read more
Reader Question:
Take Note of Who Can Supervise Allergy Shots
Question: Can a nurse give an allergy shot to a Medicare patient if the doctor is out of t... Read more
Part B Forms:
Small Practices Could Be Exempt From Using HIPAA 5010 Form, CMS Says
You must request and receive approval for an ASCA waiver before you're in the clear.If you... Read more
Mac Spotlight:
Enrolled in PECOS Last Year? You'll Still Have to Revalidate, This MAC Says
Practices groaned at the notion that they'll have to track down physicians for more signat... Read more
Correct Coding Initiative:
New Edition of CCI Won't Allow Laparoscopic Appendectomies With Most Other Abdominal Surgeries
Plus: CMS also aims to stop you from billing AWVs with IPPEs.Your surgeon was "in the area... Read more
Part B Coding Quiz:
Suffering From The E/M Billing Blues? Find A Solution Fast
Determine whether you need to hone your E/M coding skills with this quiz.Evaluation and ma... Read more
Physician Note:
Stanford Hospital HIPAA Breach Exposes 20,000 ER Patients' PHI for Almost A Year
Plus: Privacy enforcement could heat up even more thanks to new OCR director.Despite the f... Read more
In other news
The HIPAA fines and settlements you've seen may be just the tip of the iceberg. HHS Secret... Read more
Reader Question:
Know How to Code Wheezing
Question: Sometimes our physician suggests diagnosis 519.11 for wheezing, but sometimes he... Read more
Reader Question:
Every Tendon Counts When Coding Arm Injury
Question: The surgeon did a wound exploration with irrigation and debridement, repair of e... Read more
Reader Question:
Established Patients Remain Established, Despite New Problems
Question: Our office saw a patient six months ago for a certain condition, and sent the ... Read more
Reader question:
Check Fee Schedule for Global Days
Question: Our surgeon was called to consult for an inpatient with ascites. The surgeon per... Read more
Could Your Billing Service Be Putting You at A Compliance Risk?
This billing service overcharged Medicare by millions for physicians' charges.You've hired... Read more
Hcpcs Coding:
MAC Denying Your Supplies Claims? Try Modifiers NU, KX
Crutches, refractive lenses, and other supplies will require you to get sharp on modifiers... Read more
RACs Can't Catch You Off-Guard If You Use These Simple Strategies
It's time to improve your billing, documentation.The RAC program is fully on-board with Me... Read more
Part B Mythbuster:
Same-Day E/M Visit? Modifier 25 May Not Always Be Your Best Bet
Keep E/M documentation apart to demonstrate the service's 'separate' statusWhen you report... Read more
Part B Coding Coach:
Repeat Pap Smear Payment Can Be Yours If You Follow These Simple Steps
The wrong diagnosis code could cost you $41 per patient.If your patient's Pap smear result... Read more
Physician Note:
Theft Tops List of HIPAA Breaches, HHS Report Notes
Plus: Federal healthcare prosecutions could rise by 85 percent this year.Just because HIPA... Read more
In other news
It's not just your imagination--healthcare fraud busts are way up this year. Data obtained... Read more
Reader Question:
Let Physicians Know That Vague Diagnoses Won't Fly
Question: My physician documented "multilobar pneumonia." Which ICD-9 code should I report... Read more
Reader Question:
MACs May Differ on Modifier Policies
Question: If we perform a duplex scan of both upper extremities and of both lower extremit... Read more
E-Prescribing Penalty:
CMS Finalizes Four New Ways to Avoid 2012 E-Prescribing Payment Penalty
Get your exemption application to CMS no later than Nov. 1 if you want to be considered.Ho... Read more
Part B Payment:
CMS Offers Great News With Fee Schedule Changes
Boost co-surgery, multiple surgery, and bilateral surgery pay for these select procedures.... Read more
Patient Privacy:
Avoid These HIPAA Land Mines Involving Your Practioners' Cell Phones
Contacting on-call physicians via text or mobile phone? Make sure those communications are... Read more
Physician Note:
Revalidation Requests Don't Trump Standard CMS Processes
Plus: Physician pleads guilty in Medicare fraud schemeSubmit your usual CMS enrollment cha... Read more
In other news
A Florida physician is the latest practitioner to plead guilty as part of the government's... Read more
Reader Question:
Be Aware of When Global Applies
Question: If a code has global period designation in the fee schedule which implies that i... Read more
Reader Question:
Don't Jump to Coding Conclusions
Question: A patient presents to the emergency department after he cut the tip of his finge... Read more
Reader Question:
Assign 3 'Vitals' to Just 1 Exam Bullet
Question: I read your previous article on "double dipping" with great interest (the Inside... Read more
Reader Question:
Labs Should Get Reason for Urinalysis
Question: A physician client routinely sends our lab orders for "screening" urinalysis for... Read more
Part B Payment:
CMS Unveils Bundled Payments Initiative
Under the new program, physician's pay for a hospital procedure would be bundled with hosp... Read more
99211 Coding Quiz:
Can You Identify Which of These Quick-Visit Services Qualify for 99211?
Hint: You can't automatically tack 99211 on to every service just because the nurse ... Read more
Know These 99211 Facts Before You Submit Your Claim
Even if you aced our 99211 quiz on page 234, it's a good idea to brush up on some basic fa... Read more
Part B Coding Coach:
Tighten up Your Adhesiolysis Coding Knowledge With These 5 Tips
Key: Your ob-gyn's documentation must emphasize the unusual difficulty.If you've ever code... Read more
Set Aside 10 CPT® Codes to Report Adhesiolysis
Although ob-gyns generally deal with lysis of adhesions in only four sites, CPT® pro... Read more
Physician Note:
CMS Clarifies Whether You'll Report ICD-9 Codes When Dates of Service Span ICD-10 Implementation Date
Plus: Medicare explains overpayment recovery process.As most practices know, MACs will no ... Read more
In other news
If you've ever wondered about the logic behind Medicare's overpayment recovery system, CMS... Read more
Reader Question:
Documentation Should Support Diagnoses
Question: Our physician circled an initial diagnosis of COPD (chronic obstructive pulmonar... Read more
E/M Coding:
Get to the Bottom of the 'Double Dipping' Debate
One MAC goes on record about using the same element twice.The physician has left you copio... Read more
ICD-10 Readiness:
Start Small When Prepping for ICD-10 Conversion, CMS Says
Acquaint yourself with the top 30 diagnoses that your practice sees and you'll get a... Read more
E/M Documentation:
Documenting 'All Others Negative' Could Cost Your Physician $87 Per Visit
Ensure that your MAC accepts this commonly-documented phrase before you see your documenta... Read more
Physician Note:
Chiropractors Aren't Eligible to Order/Refer Services to Medicare Beneficiaries, CMS Says
Plus: CMS makes it easier for you to determine the source of Medicare payments.As if Medic... Read more
In other news
It's always nice to get money from Medicare, but when you don't know why your MAC is sendi... Read more
Reader Question:
Consider Modifier 22 for Extra Work
Question: Our surgeons often encounter complicated recurrent ventral hernia repairs that i... Read more
Reader Question:
Know How 'Vitals' Contribute to Exam
Question: Can you please explain how taking the vital signs contributes to determining the... Read more
Reader Question:
Look for Coding Clues in Global Period Indicator
Question: Our cardiologist was called in to consult for an inpatient presenting with angin... Read more
Reader Question:
Modifier 76 Denotes Repeat Procedure
Question: After our physician performed manipulation he performed an x-ray, but he was not... Read more
Part B Payment:
Government's Debt Deal Could Hurt Your Medicare Pay
Medicare cuts are on the back burner for now, but will be on the docket if future cuts are... Read more
Diagnosis Coding Quiz:
Are Your Dx Coding Skills Up to Snuff? Take This Quick Quiz to Find Out
Hint: Coders shouldn't be interpreting test results to get quick diagnosis codes.As your p... Read more
Part B Mythbuster:
Don't Forget to Check Secondary Coverage When Reporting Preventive Exams
Tip: Obtain Medicare denial so the claim can cross over.Myth: You can't bill for a prevent... Read more
On-call Services:
Avoid On-Call Fraud Accusations With These FAQs
Beware: You can't capture ER coverage services with after-hours codes.If you bill incorrec... Read more
Part B Coding Coach:
4 Common Interventional Pain Management Procedures You Can't Afford To Miss
Get the lowdown on when to code separately for fluoroscopy.If your physician performs inte... Read more
Physician Notes:
Look for RAC Demand Letters Directly From Your MAC
Plus: Physician + Ministers + Supplier = Medicare Fraud?You've been waiting for years to h... Read more
In other news
A Louisiana church health fair may have offered more than medical flyers--it also was accu... Read more
Reader Question:
Don't Expect Payment For 'Healthy' Appendectomy
Question: I heard that Medicare will not pay separately for the removal of a healthy appen... Read more
Reader Question:
Blink And You'll Have Missed Specialty Code 95
Question: Can you clarify under which circumstances we'll need to use specialty code 95 fo... Read more
Preventive Care:
Don't Look to CMS for AWV Diagnosis Coding Advice
Plus: Know what you can legitimately report with annual wellness visit.You can forget abou... Read more
Bilateral Procedures:
One Size Doesn't Fit All for Bilateral Services
Regs don't just differ between MACs--they also vary within the same MAC. When you ... Read more
Part B Revenue Booster:
Say Goodbye to X-Ray Denials With These Simple Tips
Palmetto providers: Add this 'history of' code to the list of covered conditions.If you pr... Read more
Physician Note:
CMS Identifies the 4 Biggest Errors Among Therapy Claims
Plus: CMS finds 'significant' portion of chiropractic claims paid inappropriately.When it ... Read more
In other news
CMS has revealed the results of the OIG's recent audits of chiropractic claims, and the ou... Read more
Reader Question:
Know the Ropes When Coding Paps
Question: Which CPT® code should we submit for a Pap smear?Texas SubscriberAnswer: Y... Read more
Reader Question:
Don't Always Add Together Lesion Sizes
Question: Following a melanoma excision, our surgeon performed a layered closure. I've hea... Read more
Reader Question:
Know When Product Cost is Included in Surgery
Question: We have a patient that needs a special ureteral stent, and we had to order it ou... Read more
Reader Question:
Second Opinions on X-Rays May Not Be Payable
Question: We are a radiology facility that our radiologists own, so we bill globally. We h... Read more
Reader Question:
92025 Should Do the Trick for Corneal Topography
Question: What are the rules are for coding corneal topography? I can't find a CPT® ... Read more
Facility Pays $865,500 Fine After Staffers Peeked at Patient Health Records
You don't need celebrity patients to learn from this HIPAA mistake.If you knew Brad Pitt w... Read more
Your Employees' Facebook Posts Could Come Back To Haunt You
on't risk patients' privacy just to blow off steam.The last thing your practice needs is t... Read more
Part B Mythbuster:
Buying Equipment? Ensure Medicare Reimbursement First
Don't let manufacturers snow you into investing in new gadgets.A neighboring medical pract... Read more
Diagnosis Coding:
Know Your OB-Gyn Diagnoses With This Handy Chart
Plus: Get to know the ICD-10 codes for these conditions.Doctors who treat gynecological co... Read more
Code Charts Properly Every Time by Nailing Down Acronyms
Would you be able to count E/M bullets properly if the physician wrote 'WBC WNL'?Sometimes... Read more
Physician Notes:
MRIs Are Now Billable for Patients with Pacemakers, CMS Says
Plus: MACs offer new opportunities to perform 5010 testing.Not all coverage news coming ou... Read more
In other news
If you missed the first 5010 form testing day in June, never fear--CMS has not only announ... Read more
Reader Question:
92025: Corneal Topography Shouldn't Require Unlisted
Question: What are the rules are for coding corneal topography? I can't find a CPT® ... Read more
Reader Question:
Avoid Outdated Diagnoses
Question: Our practice recently saw a patient who had been having intractable seizures. Th... Read more
Reader Question:
'MIP' and 'MEP' Require Unlisted Diagnoses
Question: How should I bill MIPs (maximum inspiratory pressures) or MEPs (maximum expirato... Read more
Reader Question:
Only Hawaii Requires Coding Certification
Question: I attended a conference recently and a speaker said that CMS is or will be requi... Read more
Reader Question:
Consider Shaving, Photo Documentation Integral Parts of EGD
Question: My gastroenterologist wants me to bill photo documentation along with an EGD. Ca... Read more
Part B Payment:
Proposed 2012 Fee Schedule Targets Further Cuts to Imaging Interpretations
Plus: Next year's conversion factor is set at a dismal $23.9635.As if imaging practices di... Read more
Lab Signatures:
Good News: CMS Retracts Lab Signature Requirement
Physician signatures on every lab requisition were perceived as cumbersome, unnecessary.Cl... Read more
Traveling With Patient Files? You Can Still Stay HIPAA Compliant If You Use These Tips
Becoming PHI travel-savvy is especially important if you work in several locations or in p... Read more
Prepare For These 3 New ICD-10 Coding Conventions
Hint: Two kinds of 'excludes' notes exist in ICD-10 aftercare codes.While many coding conv... Read more
Part B Coding Coach:
74176-74178: Compare 2011 Coding to How You Tackled These Notes in 2010
Test yourself to be sure you've mastered this year's coding changes. Codes for... Read more
Physician Notes:
Physician Nailed for Role in $200 Million Medicare Fraud Scheme
Plus: Medicare now covers Provenge® for prostate cancer patients. Medicare wants p... Read more
In other news
You'll no longer have to wait for case-by-case determinations on whether your MAC will cov... Read more
Hipaa Compliance:
Physician Faces up to 5 Years in Prison for Sharing Medical Information With Patient's Employer
Here's how you can avoid facing a similar fate.HIPAA enforcement is still going full-throt... Read more
Part B Forms:
You Must Use New ABN by Nov. 1, CMS Says
New form doesn't include major changes, but you are required to switch over to it.It may s... Read more
ABN Forms:
Check out These Quick Examples of Appropriate ABN Use
Following are examples of when and how to properly use ABNs.Because of personal concerns, ... Read more
5010 Readiness:
Vendors Won't Be Able to Fix This Potential 5010 Snafu, Experts Say
Check on your address fields now--before mistakes on your claim forms threaten to halt you... Read more
Part B Coding Coach:
Choose the Correct Physical Exam Level Every Time With These 4 FAQs
Tip: Use Caution When Keeping E/M Templates at Hand.Whether you're a veteran coder or you'... Read more
Quickly Determine Which Exam Level Your Physician Has Documented With This Handy Chart
With two sets of guidelines -- 1995 and 1997 -- for assigning a physical examina... Read more
Append Modifier 50 to A Single Code
In Volume 12, number 5 of the Insider, our reader question "Look to 11750 for Ingrown Toen... Read more
Physician Notes:
CMS Updates Teaching Physician Documentation Regs
Plus: Health care reform provisions won't undergo scrutiny.Medicare's teaching physician r... Read more
In other news
Don't expect a sudden reprieve to come from above from your new regulatory burdens related... Read more
Reader Question:
Are 2 Separate E/M Visits at 2 Locations Both Billable?
Question: We saw a patient in the office and then sent her to the hospital for observation... Read more
Correct Coding Initiative:
New Edition of CCI Won't Allow AWV With ECG, E/M, Or Behavior Assessment
Plus: CMS also aims to stop you from billing FNA with excisions, resections, and biopsies.... Read more
Puzzled By CCI Specs? We've Got Answers to Your Top 3 CCI Questions
Tip: Keep edits in mind for other payers besides Part B MACs.With the new round of Correct... Read more
Preventive Service Coding:
CMS Sheds Light on Several Preventive Service Coding and Billing Mysteries
The agency won't provide a standard AWV diagnosis code.It has never been simple to navigat... Read more
Part B Coding Coach:
Avoid Giving Care Away for Free During Global With These Quick Tips
Keep modifiers, separate services in mind when offering postoperative care.If you aren't c... Read more
Physician Notes:
Florida Fraudsters Steal Identity of Legitimate Therapist to Bilk Medicare Out of Thousands
Plus: Deadline For PECOS Edits Still Up In The AirPractitioners may be keeping an eye on t... Read more
In other news
You can put PECOS edits a little further down on your crowded priority list. CMS "has not ... Read more
Reader Question:
99215 Won't Always Apply When Documentation Says 'Extended Visit'
Question: Can I use 99215 for an extended office visit?Answer: You would report 99215 (Off... Read more
Reader Question:
Don't Expect More Payment for All Multiple Injections
Question: Our physician administered two injections into the left knee in two separate loc... Read more
Avoid These 5 Major Modifier Errors to Keep Your Cash Flowing
Reporting modifier 78 for a staged procedure? Expect denials.When it comes to appending CP... Read more
Medicare Errors:
No Physician Order for These Services, No Part B Payment
One MAC shows exactly which errors it found during a recent review.If your physician is si... Read more
Part B Revenue Booster:
Don't Get Stuck Paying A 15-Percent Penalty If You Know You've Met Incident to Regs
Follow these tips to ensure you're reporting incident to properly.As most Part B practices... Read more
Can You Bill All Services as Incident-to Under One Physician's ID Number?
Incident-to rules apply to the relationship between a physician and a mid-level provider.I... Read more
We Want Your AWV Feedback!
Have you developed an amazing annual wellness visit checklist? Did you create a quick and ... Read more
Physician Notes:
Button Up Those E/M Claims, CMS Tells Providers
Plus: Wrong NPI type might trigger payer edits.Assigning E/M levels willy-nilly? You might... Read more
In other news
Don't be too quick to blame PECOS for all the informational messages you receive about cla... Read more
Reader Question:
Managing Chronic Problems May Elevate E/M Level
Question: Our physician often sees patients who come in with a long list of problems that ... Read more
Reader Question:
Avoid Modifier 57 When Surgery Was Planned in Advance
Question: Our physician planned to perform a radical hysterectomy (58210) on one of our ... Read more
Reader Question:
Conversion to Open Procedure Warrants Open Code Only
Question: My doctor did a laparoscopic cholecystectomy with intraoperative cholangiogram. ... Read more
Reader Question:
'Seen And Agree' Notation Might Get Your Service Denied
Question: Our physician works with residents every year and it is very time-consuming for ... Read more
EHR Penalties:
CMS Proposes 4 Additional Exemptions to Help You Avoid EHR Penalty
The agency is accepting comments on the proposal through July 25.Hoping to avoid a one per... Read more
Diagnosis Coding:
CMS Proposes New Glaucoma, Skin Cancer, Dementia Codes
Many new codes abound in final update to proposed ICD-9-CM code set.If you've felt that yo... Read more
Patient Privacy:
Peeking at Patient's PHI? Soon, They May Know You Did It
HHS proposes giving patients access to a list of providers who accessed their records.If y... Read more
Part B Payment:
CMS Offers Great News With Fee Schedule Changes
Boost co-surgery, multiple surgery, and bilateral surgery pay for these select procedures.... Read more
Part B Coding Coach:
Q0091 Won't Do the Trick When Reporting Post- Hysterectomy Pap
Remember: The rules change when malignancy is involved.Warning: The rules for coding stand... Read more
Physician Notes:
OIG Recovers $3.4 Billion in First 6 Months of Fiscal Year 2011
Plus: Sleep Clinic Pays $650,000 to Settle False Claims Allegations.Citing a "period of in... Read more
In other news
If you ever wondered whether whistleblowers really collected for their revelations, a new ... Read more
Reader Question:
94010 and 94070 May Require Modifier When Billed Together
Question: My physician wants me to bill separately for a spirogram and methacholine test p... Read more
Reader Question:
99024 vs. E/M for Pump Follow-Up--Check Catheter Placement
Question: Our pain management physician began a patient on an intrathecal pump trial. He s... Read more
Part B Mythbuster:
Get to Know These 2 E/M Myths That Could Be Affecting Your Practice
Hint: Just because your doctor visits the ICU doesn't mean he can report critical care. ... Read more
Breaking News:
CMS Proposes Adding Additional Exemptions to Help You Avoid EHR Penalty
As Part B Insider was going to press, CMS released a new proposal that would allow exempti... Read more
5010 Prep Quiz:
Are You And Your Vendor Ready to Use the 5010 Form? Take This Quiz to Be Sure
The June 15 test date is fast approaching.As we reported in last week's Insider, CMS will ... Read more
Modifier 57 Still Applies to Some Part B Claims, Despite Consult Pay Elimination
Don't ignore modifier 57 just because CMS stopped reimbursing for consults.Medicare may ha... Read more
Physician Notes:
CMS Paid First EHR Incentive Bonuses Last Week
Plus: CMS Officials Want ACOs to Tackle Dual Eligible ProblemsPart B practices that have b... Read more
In other news
Medicare officials would like to see Accountable Care Organizations help alleviate your pr... Read more
Reader Question:
Modifier AI: Use 2 Letters, No Numbers
Question: The inside cover of my CPT® manual shows modifier A1 (letter A, number 1) ... Read more
Reader Question:
91110: Nail Down Which Date of Service You Should Report
Question: When coding for a video capsule endoscopy (91110 or 91111), should we bill for t... Read more
Reader Question:
Know the Dx Codes for Self-Inflicted Poisoning
Question: A patient comes to the office after taking 15 Paxil, nine Ativan, and ingesting ... Read more
Reader Question:
MILD Procedure Requires Unlisted Code
Question: What is the best CPT® code for minimally invasive lumbar decompression (MI... Read more
Reader Question:
CPT® Does Not Include Every Lab Panel
Question: A physician ordered a urine "kidney stone risk panel" for a patient with serial ... Read more
Medicare Funding:
Medicare Risks Going Broke in 2024, Trustees' Report Says.
CMS says it is making changes to ensure the program stays funded longer than projected.The... Read more
ICD-10 Preparation:
Not Planning to Transition to ICD-10 as of Oct. 1, 2013? You Might Be Liable to Face Millions in Fines, CMS Reps Say
Plus: CMS officials are considering how to handle dates of service that span the pre- an... Read more
Is Your Doctor 'Absent-Minded?' That Excuse Won't Fly With OIG
Plus: Auditors have been known to tap into hospitals' wireless hotspots from the parking l... Read more
Part B Coding Coach:
10120 or Beyond: Site, Depth, Complexity Drive Code Choice
Follow 3 pointers to snag maximum pay.From just under the skin to deep within the bowels, ... Read more
ICD-10 Will Alter Your Foreign Body Removal Claims
Fortunately, most codes will have a one-to-one crosswalk when 2013 rolls around.When your ... Read more
Physician Notes:
Get Ready for 5010 Compliance by Trying Out Your Claims on June 15 Test Day
Plus: Physical therapist pleads guilty to submitting false claims--to the tune of nearly $... Read more
In other news
A New York-based physical therapist faces up to 50 years in prison after pleading guilty t... Read more
Reader Question:
Specialists' Non-Physician Practitioners Can Collect Primary Care Incentive Bonuses
Question: Our cardiology practice employs a non-physician practitioner (NPP) who performs ... Read more
E/M Coding:
Answer the $56 Question--Are You Downcoding Your E/M Visits?
You're not only losing revenue--you're also coding improperly.CMS data from previous years... Read more
Diagnosis Coding:
Adjust Your Codes Easily When Diagnosis Changes During A Patient's Hospital Stay
Educate your physician to keep you in the loop on patients' development.Just because a pat... Read more
Are You Considering 'Firing' A Patient? Proceed Carefully to Avoid Getting Burned
These tips will help you avoid legal pitfalls in discharging deadbeat beneficiaries.Delinq... Read more
Part B Coding Coach:
G0431, G0434--Consider Drug Classes Before Selecting the Right Code
Steer clear of 80100, 80104 on Medicare claims.If your pain management specialist conducts... Read more
Physician Notes:
Congress Hears AMA Plea to Consider Physician Payment Reform
Plus: Use CMS resources to ensure you're ready for new 5010 standards.Congress may have pa... Read more
In other news
The Jan. 1 compliance date for the new HIPAA 5010 standards is fast approaching. Take adva... Read more
ICD-10 Preparation:
G89 Family Will Bring Chronic, Acute Pain Options
Hint: One-to-one cross from ICD-9 eases transition.When ICD-10 goes into effect in October... Read more
Reader Question:
93970 Global May Lead You to Require Modifier
Question: Can you bill a bilateral scan (93970) along with an office visit and get paid fo... Read more
Part B Payment:
Five Mistakes Each Week Could Create $25,000 Revenue Drain
Are you staying on top of claims submissions and appealing when you know you billed proper... Read more
OIG Finds 69 Percent Error Rate in New Outpatient Audit
Avoid these common mistakes so you won't have to refund your MAC.If you're billing an inco... Read more
EHR Incentive Pay:
Follow This Advice to Avoid Forfeiting Your EHR Incentive Pay
Hint: CMS provides a simple calculator to tell you whether you're ready for attestation.CM... Read more
Prepare Now for New Motor Vehicle Accident Diagnosis Code
You'll replace 'E' code with 'V' code under ICD-10.CMS has repeatedly confirmed that it wi... Read more
Physician Notes:
RACs Hauled in $162 Million in Overpayments in First Quarter of 2011
Plus: CMS paid out over $380 million in PQRS and ePrescribing incentives in 2009.You may n... Read more
In other news
Medical practices raked in millions in 2009, thanks to incentives from the Physician Quali... Read more
Reader Questions:
No RVUs May Mean No Pay for You
Question: Can you explain to me why some codes (such as 99172) do not have an associated r... Read more
Reader Questions:
1005F Won't Bring You Any Income
Question: One of our physicians monitors our asthma patients with an asthma control test. ... Read more
Reader Questions:
Look to Modifier 59 When Reporting These Codes Together
Question: Can we bill 76856 together with 93975 using modifier 59?Answer: Yes, you may rep... Read more
Reader Questions:
Modifier 52 May Not Always Suit You
Question: My ob-gyn saw a patient with ovarian cancer. He performed a total abdominal hyst... Read more
Reader Questions:
Consider 27750, 27752 for Splint Replacement
Question: Is code 27752 appropriate for replacement of a splint after debridement of blist... Read more
Reader Questions:
Avoid Appeals 'Form Letters' If You're Hoping for Success
Question: After checking to be sure we haven't made a coding or billing entry error, our p... Read more
Reader Questions:
Modifier 79 Denotes Unplanned Procedure During Global
Question: Eight days after an initial wart freezing, the patient returns, and the physicia... Read more
Medicare Claims Errors:
Part B Practices Still Making Modifier, Timely Filing Mistakes, One MAC Says
Plus: Don't avoid checking LCDs to find out your MAC's rules. Appending modifi... Read more
OIG: Physician Orders Missing for 9 Percent of Emergency Dept. X-Ray Interpretations
Plus: Insufficient documentation found on 19 percent of CTs and MRIs, and 14 percent of x-... Read more
Summertime Coding Quiz:
Prepare Now for These Summertime Coding Rules--Take Our Quick Quiz to Test Your Skills
Hint: Have the appropriate 'Q' modifier ready for substitute physicians who fill in when y... Read more
Summer Coding Quiz Answers:
Are You A Summer Coding Whiz, Or Will You Be Facing Summertime Coding Blues? Check Out the Answers Below
Tally your score with the following three solutions.Determine whether you're ready for sum... Read more
Part B Coding Coach:
Stop Forfeiting Level Four and Five E/Ms With 3 PMFSH Tips
Make your physician's job easier by letting the patient or nurse document the history.If y... Read more
Aspects of PFSH
Per CPT®, past medical, family and/or social history is divided into three subsectio... Read more
Physician Notes:
CMS Adds Three Lab Tests to CLIA-Waived Status
Plus: Proving Services Unrelated To Terminal Dx May Get HarderPart B practices will benefi... Read more
Patient Privacy:
Determine Whether You're at Risk of Making This HIPAA Mistake
If your staff carries paper PHI offsite, implement these proactive strategies.HIPAA enforc... Read more
Eye Coding Primer:
Know These 3 Quick FAQs to Envision Eye Procedure Payment
Hint: Foreign body removal may be best reported with an E/M code, depending on the circu... Read more
Handle Your Eye Diagnoses With Care By Pinpointing Anatomic Site
Differentiate your conjunctiva from your macula and you'll be on your way to coding bliss.... Read more
Part B Coding Coach:
Boost Collections With These 4 Quick Tips
If you aren't following up on denials, you're leaving money on the table.The economic down... Read more
Physician Notes:
CMS Holding Colorectal Cancer Screening and Hepatitis B Vaccine Claims
Plus: CMS announces new specialty code for advanced diagnostic imaging accreditation.If so... Read more
In other news
CMS has added another specialty designation to your list, so when you submit claims you ca... Read more
Reader Question:
'V' Code Can Help You Support Lab Test Claims
Question: Our laboratory received an order for a PSA test for a patient one year after s... Read more
Part B Payments:
Reprocessed Claims From Last Year Are Headed Your Way Soon, CMS Reps Say
Plus: CMS cagey when asked whether RNs can perform annual wellness visits.The check is in ... Read more
CMS Offers Quick Annual Wellness Checklist
Your practice might already be on the right track when it comes to documenting and billing... Read more
Accountable Care Organizations:
CMS Outlines How Joining An ACO Will Benefit Practices, Beneficiaries
Under the "shared savings program," ACO participants will collect a portion of the amount ... Read more
Laboratory Signatures:
CMS Appears Poised to Delay Labs' Physician Signature Requirements Further
Although the agency doesn't specifically rescind the rule, it does indicate that more info... Read more
HCPCS Codes:
CMS Introduces Several New 'Carrier-Priced' HCPCS Codes
You'll be able to report these codes effective July 1.It's not even mid-2011 yet, but you'... Read more
Part B Coding Coach EGD Coding:
Know the 3 Factors That Make Up The Core of These Gastroenterology Procedures
Differentiate "sample collection" from actual biopsy.When your physician ventures into a p... Read more
Physician Notes:
ICD-9-CM Committee Considers New Diagnoses for Partial Rotator Cuff Tear, Malnutrition, and More
Plus: Physician Gets Jail Time for Home Care FraudOctober 1 might sound far away, but the ... Read more
In other news
The physician involved in a Miami-area home care fraud ring has been sentenced to two year... Read more
Reader Questions:
Turn to Modifiers 76 or 77 for Repeat Procedure
Note: Modifier 59 won't apply to situations when the physician performs the exact same pro... Read more
Reader Questions:
Does One-Hour E/M Warrant Add-on Prolonged Service Code?
Question: Our physician provided a one hour E/M service, most of which was spent on counse... Read more
Reader Questions:
Follow Drug Dosing Rules to Pick Correct 'J' Code
Question: Depo-Medrol comes in three different strengths, but the code doesn't state how m... Read more
Revenue Boosting Quiz:
Avoid Leaving Thousands of Your Dollars in Your MAC's Hands
Determine whether you're collecting every dollar you're owed.Could your medical practice a... Read more
Prepare Now for New Sinusitis, Bronchitis Diagnosis Codes
Get ready for bronchitis Dx set to expand from one code to ten.CMS has repeatedly confirme... Read more
Revenue Boosting Quiz Answers:
Are You Collecting Every Dollar You Deserve? Check Your Quiz Answers Here
Hint: Modifiers are key to collecting for screening-turned-diagnostic colonoscopy.Answer 1... Read more
Face-to-face Rule:
New CMS Clarification May Help With Your Documentation When Certifying A Patient's Home Health Eligibility
Physician staff can prepare the face-to-face documentation, CMS says in new Q&A.With t... Read more
Part B Coding Coach:
Converting Laparoscopic Cancer Surgery to Open? Read These Tips Before You Code
This Ob-gyn case study will show you how to properly convert your coding.If your ob-gyn co... Read more
Physician Notes:
CMS Glitch Could Mean You'll Face Consolidated Billing Denials
Plus: Get a handle on how to read remittance advice statements from your MAC.Keeping track... Read more
In other news
Have trouble deciphering the Remittance Advice (RA) that your MAC sends to you? One carrie... Read more
Reader Question:
Comforting Dying Patient Is Not Critical Care
Question: A patient becomes unresponsive in the emergency department (ED) and the physicia... Read more
Annual Wellness Visits:
You Aren't Legally Required to Offer AWVs, One MAC Says
Plus: RNs can perform AWVs even for new patients, as long as they meet state licensing req... Read more
Correct Coding Initiative:
CCI Now Bars You From Reporting Alcohol and Tobacco Screening Codes With E/M Services
But the good news is that you'll soon be able to report operating microscope code 69990 wi... Read more
Part B Mythbuster:
Don't Confuse Facility's Documentation Rules With Surgeon's Report
Concentrate on your physician's thorough note rather than comparing with the facility, exp... Read more
Medicare Error Rates:
Reporting 'Low-Level' 99211? You Still Need Complete Documentation, One MAC Reminds
Just because 99211 is known as a 'nurse visit' doesn't mean you can report it without the ... Read more
Know These 5 Common Pitfalls When Using PQRS
Once again, provider documentation could be the linchpin in your success.Whether you're ne... Read more
Physician Notes:
CMS Resolves Vast Majority of Hotline Complaints, OIG Report Says
Plus: CMS still hasn't set final date on ordering/referring provider edits.As most Part B ... Read more
In other news
Your Medicare contractor may not be instituting ordering/referring PECOS edits this July, ... Read more
Reader Questions:
Disease Counseling May Qualify You for Post-Op Pay
Question: We had a breast biopsy patient with a breast cancer diagnosis who had an office ... Read more
Reader Questions:
Driver's Physicals Probably Won't Qualify As E/M Visits
Question: What is the best way to code and bill for driver's physicals? I'm thinking the p... Read more
Reader Questions:
Know How to Report Nursing Home Visits
Question: How do I bill if our physician went to the nursing home to see Medicare patients... Read more
Reader Questions:
Modifier 52 Applies to Terminated Procedures
Question: My cardiologist attempted a PTCA but determined after several attempts that it w... Read more
Reader Questions:
Secondary Dx May Be Required With 702.11, 702.19
Question: Our physician excised a 0.4 cm lesion and documented, "She has a bleeding black ... Read more
Reader Questions:
Code Friction Burns Using Standard 'Burn' Dx Rules
Question: Our physician saw a patient who suffered multiple friction burns from a treadmil... Read more
Electronic Health Records:
'Audit-Proof' EHRs Don't Exist, Experts Say
The responsibility is on your practice--and not the software or software vendor--to ensure... Read more
AWV News:
Part B MACs Currently Holding Annual Wellness Visit Claims Billed on Certain Types of Bills
Submit AWV claims on type of bill (TOB) 12X or 13X and you won't collect until April 4.If ... Read more
OIG Revisits Recommendation to Adjust Eye Global Surgery Fees
OIG discovered inconsistent billing for global eye surgery and believes adjustments could ... Read more
ICD-10 Preparation:
Get to Know How Lyme Disease, Ear Pain Diagnoses Will Change in 2013
Hint: Your diagnosis coding will depend on which ear was affected once ICD-10 hits.CMS has... Read more
Have You Overlooked These 7 Coding Opportunities?
When your practice is feeling pinched, it's important to ensure that you aren't forgetting... Read more
Part B Coding Coach:
Do Your Services Warrant Modifier 22? Find the Truth Behind These 3 Myths Before You Answer
If you assume you can always append modifier 22 in certain situations, you're headed towar... Read more
Physician Notes:
Follow '180-Day Rule' to Keep Your Medicare IACS Account Active
Plus: One carrier denies 75 percent of long-stay hospice claims.The transition from paper ... Read more
In other news
Hospices that aren't documenting their long-stay hospice patients' terminal diagnoses care... Read more
Annual Wellness Visits:
G0438-G0439: MACs Share Additional Information About AWVs
Hint: You can perform AWVs on new patients.Part B practices looking for answers about the ... Read more
RAC 'Bounty Hunters' Turning Their Sights on Medicaid Claims
Fortunately, recent delays give you more time to plan for these audits.If you thought you ... Read more
Do Your Providers Meet Signature Requirements on Their Charts?
Answers to 2 common questions help ensure you're on track.Including provider signatures is... Read more
Clip and Save:
Use This Handy Chart to Remember What Equals a Signature
Steer clear of stamps.Learning the ins and outs of what constitutes a compliant handwritte... Read more
Patient Privacy:
Keep HIPAA Concerns at Bay With Simple Risk Analysis
Beware 'willful neglect' penalties up to $50,000 per violation now in effect.If you think ... Read more
Part B Coding Coach:
Follow These 4 Quick Guidelines to Collect for Inhaler Education Claims
Learn what steps to take when provider charges for a Diskus demo.One thing you should keep... Read more
Physician Notes:
OIG Offers Free, Pre-Written Presentation for Teaching New Physicians About Compliance
Plus: Respond to CERT requests ASAP, MACs say.When your practice hires a new physician, th... Read more
In other news
You'll be bringing yourself to CMS's attention if you fail to respond to Comprehensive Err... Read more
'Willful Neglect' Violations May Eventually Expand to Stolen Laptops or Other Devices Containing Unencrypted PHI
It could happen, says HIPAA expert.Willful neglect violations can lead to some humongous f... Read more
Check Out This MAC's Quick Tips on Prepping for Medicare Audits
Accurate documentation will be the most important tool you have in fighting off accusation... Read more
Part B Revenue Booster:
These 5 Tips Will Make Your ASC Coding A Snap
As CMS issues its quarterly ASC payment rates, the time to brush up is here.True or false:... Read more
NCCI Update:
97597-97598: Correct This Selective Debridement CCI Glitch in Your Notes
Hang on to your claims for these wound care management codes until MACs straighten out the... Read more
ICD-10 Prep:
Get to Know How Eye Infection, Strep Diagnoses Will Change in 2013
Hint: Your diagnosis coding will depend on which eye was infected once ICD-10 hits.When IC... Read more
Part B Coding Coach:
92082 or 92083? Choose Wisely With This Expert Strategy
With over $70 on the line, don't risk submitting the wrong code or inadequate documentatio... Read more
Physician Notes:
Medicare Strike Force Nails 111 People for Over $225 Million in False Billing
Plus: HIPAA violations trigger millions in penalties for two large entities.The Medicare F... Read more
In other news
If HIPAA privacy regulations have slipped to the back of your mind in recent years, it's t... Read more
Reader Question:
58565 for Medicare Patient? Don't Expect Payment
Question: One of our ob-gyns did an Essure procedure on a Medicare patient for recurrent s... Read more
Part B Payment:
One Medicare Contractor OK's RNs and LPNs to Furnish Annual Wellness Visit
Plus: 'Hundreds of millions of claims' to be reprocessed in coming weeks, CMS says.CMS sta... Read more
Part B Coding Quiz Answers:
G0206 or 77055? Test Your Mammogram Coding Skills
Plus: Review CMS's 2010 updates to signature requirements.How sure are you that your mammo... Read more
3 Tips Will Get You Closer to ICD-10 Compliance
Hint: You won't always find a simple crosswalk between ICD-9 and ICD-10.When ICD-9 becomes... Read more
Know When You Can Write Off a Patient Balance --And When You Should Avoid It
You'll end up on the audit radar if you try to skirt the issue.Being a compassionate, cari... Read more
Physician Notes:
CMS Confirms Codes for 16 CLIA-Waived Lab Tests
Plus: President Obama proposes freezing physician pay rates for another two years.Part B p... Read more
In Other News
Part B practices breathed a sigh of relief in December when Congress froze Medicare paymen... Read more
Reader Questions:
Differentiate Between Graft Types
Question: What's the difference between a spinal allograft and an autograft?Answer: If the... Read more
Reader Questions:
Consider 45990 for Rectal Exam With Anesthesia
Question: I can't seem to find a proper CPT code for this: The surgeon used a bivalve, suc... Read more
Reader Questions:
Planning Determines Difference Between Modifiers 58, 78
Question: In December, a patient had extracorporeal shock wave lithotripsy, which carrie... Read more
Want to Show Your Exemption From the E-Prescribing Penalty? Use New G Codes, CMS Says
Three new codes show your MAC why you collect your full pay next year.Never fear -- i... Read more
Part B Payment:
It's Only February -- And CMS Is Already Changing Its Fee Schedule
The bad news appears to outweigh the good news, unfortunately.When it comes to changing th... Read more
Part B Coding Quiz:
G0206 or 77055? Test Your Mammogram Coding Skills
Plus: Review CMS's 2010 updates to signature requirements.How sure are you that your mammo... Read more
Know When Modifier 62 Applies to Your Claims
Make sure documentation shows each physician's role in the surgery.Not every CPT code is e... Read more
Part B Coding Coach:
847.0 for Whiplash: Persistent Symptoms May Warrant Billing Diagnostic Tests
Watch for scans, TPIs, and more as treatment options intensify.Coding for whiplash diagnos... Read more
Physician Notes:
HHS Nails 20 People for $200 Million in Fraudulent Healthcare Billing
Plus: Providers Throng OIG Compliance SessionsDespite massive scrutiny on healthcare billi... Read more
In other news
The OIG is offering free half-day compliance training sessions in six cities -- Houst... Read more
Reader Question:
Know When to Report Hospital Admission Codes
Question: Our physician saw a patient in the office, then admitted her to the hospital lat... Read more
87804: Avoid Denials for Second-Strain Flu Testing
When determining whether a patient has both A and B strains, look to your MAC regarding wh... Read more
Part B Modifiers:
Modifier GZ Denials Will Arrive Faster, Thanks to New CMS Transmittal
No more 'complex medical review' for these non-covered services.Most of the time, when Med... Read more
Compliance FAQs:
Are You Appropriately Protecting Your Practice From Potential Compliance Allegations?
The answers to these 5 questions can ensure that you stay on the straight and narrow.Most ... Read more
Part B Coding Coach:
76881 Will Net You $85 More Than 76882 for Extremity Ultrasounds
Beware of overcoding tendon or muscle scan.A remarkable rise in the number of extremity ul... Read more
Physician Notes:
Third-Party EHR Registration Will Be Functional By May, CMS Says
Plus: New 'Super MedPAC' could be around the corner.If you've been frustrated by the fact ... Read more
In other news
The only thing standing between you and deep Medicare cuts may be your congressional repre... Read more
Reader Question:
Determine Tissue Infection Diagnosis
Question: Our physician treated a soft-tissue infection on a patient's finger. Which diagn... Read more
Payer Spotlight:
Medicare Enrollment Turnaround Times Are Delayed, One MAC Explains
But your effective date for billing Medicare won't depend on when the MAC finally processe... Read more
Tighten Up Your Compliance Program With Answers to These 3 FAQs
Quick tips help you identify your practice's risk areas.Our article in last week's Part B ... Read more
Part B Mythbuster:
These 7 Deadly Myths Could Damage Your Practice
Test yourself against these coding and compliance pitfallsDoes your staff subscribe to any... Read more
Annual Wellness Visits:
Cahaba GBA Reprocessing AWV Claims That Were Denied in Error
No need to resubmit claims, the MAC says.Last week, we gave you the breakdown of how vario... Read more
Physician Notes:
Government Issues First-Ever "OIG's Most Wanted" List
Plus: Your clinic, hospice, x-ray business, or rural health clinic may soon be offering Me... Read more
In other news
In addition to offering patients HIPAA forms, financial agreements, and insurance forms, y... Read more
Reader Questions:
Consider Documentation for Walking Oximetry Payment
Question: Medicare never pays us for walking oximetry. For instance, if we have a visit an... Read more
Reader Questions:
Check Payer Guidelines for Colonoscopy Pay
Question: My gastroenterologist performed a colonoscopy on a patient who is less than 50 y... Read more
Reader Questions:
Avoid Reporting 99281-99285 for Phone Call
Question: One of our patients presented to the ER. The ER physician called our oncologist ... Read more
Reader Questions:
You Can't Choose Not to Bill for Post-Surgical Care
Question: Our practice sees several patients who are on limited incomes. Our physician wou... Read more
Reader Questions:
Look to 11750 for Ingrown Toenail Removal
Question: A patient presents for a follow-up of an ingrown toenail. The physician finds th... Read more
Annual Wellness Visits:
G0438-G0439: Find Out What the MACs Are Saying About the New AWV Codes
Tip: Don't get discouraged if your claims were denied--many carriers are reprocessing.Less... Read more
PQRI and E-Prescribing Feature Several Changes This Year
Plus: You may still be subject to E-prescribing penalty -- even if you don't prescrib... Read more
5 Tips Help You Keep Compliance Problems At Bay
How often do you review your compliance plan?In the health care field, it seems like not e... Read more
Part B Coding Coach:
Clearly Outline Practice Expectations With No Show Letters and Fees
Check your payer rules before charging your patients.Every practice has the occasional pat... Read more
Physician Notes:
Missing Physician Signature Could Lead to Unpaid Claims
Plus: Face-to-face hospice requirement causing much grief among providers.The old saying, ... Read more
In other news
The face to face hospice encounter requirement is causing hospices massive confusion as th... Read more
Reader Question:
You Will Need a Diagnosis Code for a Feigned Illness
Hint: Select the diagnosis code based on the physician's documentation, even if you end up... Read more
Medicare Modifiers:
Modifier PT: Use This When Colorectal Screening Becomes Diagnostic
New modifier became effective Jan. 1--here's how you'll report it.The question of how to c... Read more
Lab Coding:
Labs Can Stop Sweating Physician Signatures for Now
CMS delays need for signed requisitions until after first quarter, 2011.If you've been wor... Read more
Part B Coding Coach:
99214: Tally Review of Systems Accurately And You May Qualify for Higher-Level Codes
Without documentation of each system, prepare to assign a lower code.Medical practices tha... Read more
Clip And Save:
Use This Simple Tool to Ensure You Cover Every System Possible
Confirming that your doctor's documentation captures every system he reviewed guarantees y... Read more
Physician Notes:
CMS Offers Good News And Bad News Regarding Home Oxygen Payment for Cluster Headaches
Plus: Cross These Items Off Your Hospice To-Do ListIf you've been battling your carriers a... Read more
Reader Question:
Keep An Eye on New Modifiers
Question:Thank you for the informative articles on the CPT changes for 2011. We have alrea... Read more
PECOS Ordering/Referring Edits Won't Start Until July, CMS Says
Six month reprieve gives you extra time to ensure that you're in the system.CMS has offere... Read more
Part B Payment:
CMS Tweaks 2011 Conversion Factor
Despite adjusted rate of 33.9764, changed RVUs should ensure that your payments will stay ... Read more
OIG's Semiannual Report Reveals Place-of-Service Coding Errors, Other Issues
Plus: Investigators found one high-utilization county for Medicare therapy dollars.If you'... Read more
Documentation Challenge Answers:
How Did You Code This 'Consult' Note?
Medicare no longer recognizes consult codes, so you had to put on your thinking cap to cod... Read more
Part B Coding Coach:
Modifier 23 Could Apply--If Your Physician Performed Anesthesia That's 'Unusual'
Knowing enough details about procedure, location can give you the green light.The time of ... Read more
Physician Notes:
Make These Quick Corrections to CPT 2011
Plus: You can now register for the EHR incentive program.The ink is just barely dry on CPT... Read more
In other news
CMS has opened registration for the electronic health record (EHR) incentive program, so n... Read more
Reader Questions:
Don't Simply Hold on to Overpayment
Question: We've discovered that a patient overpaid us on her copay. We collected $50, whic... Read more
Reader Questions:
20552, 20553 Cover Paraspinal Muscle TPI
Question: My understanding is that the paraspinal muscle is a group of individual muscles ... Read more
Most Practices 'Surprised' By How All-Encompassing ICD-10 Transition Has Been
Best bet: Establish your initial plan for conversion immediately so you can project your ... Read more
ICD-10 Crosswalks:
Never Fear--New Diagnosis Crosswalks Are Here
You'll benefit from the new code set, which includes 2011 diagnoses. In its attemp... Read more
CPT 2011:
91117, 91013 Give You A Much-Needed Digestive System Coding Boost
Plus: CPT 2011 has revised esophageal pH monitoring codes. Gastroenterology coders have l... Read more
Clip And Save:
Handle Your Gastro Diagnoses With Care by Pinpointing Anatomic Site
Here's how to differentiate your ascending colon from your rectosigmoid junction. Doctors... Read more
Reader Questions:
Cancer Surgery Could Impact Patient Diagnosis
Question: When can we bill a visit after a surgery for cancer? Our understanding is that ... Read more
Reader Questions:
Patient's Self-Diagnosis May Not Stick
Question: A 48-year-old female, fearing she has H1N1, reports to the emergency department... Read more
Reader Questions:
Make Sure Diagnoses Are in the Right Order
Question: Many of our ophthalmology patients claim general reasons for their visit, such ... Read more
Reader Questions:
Consider Modifier Options When Dealing With CCI
Question: Sometimes I cannot find my two-code pair in the CCI edits. How do I know which ... Read more