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Part B Insider (Multispecialty) Coding Alert

Part B Payment:
CMS Isn't Holding Claims in Anticipation of Cuts, Agency Says
Reps remain hopeful that Congress will act before conversion factor drops to $25.008 on ... Read more
Storing PHI Offsite? Refer to This Checklist to Stay Compliant
Use these 7 steps as a guide to ensure you don’t suffer PHI leaks. If your Part ... Read more
Do You Need to Use Eyelid Modifiers?
The answer may depend on your carrier. Thanks to the abundance of bilateral coding rul... Read more
Part B Coding Coach:
Ask 2 Questions Before Coding Sinus Debridement -- or Pay the Price
You can report 31237 as a post-op procedure If denials and quickly advised "don&r... Read more
Physician Note:
CMS Helps Ensure Your Mobile Devices Are HIPAA-Compliant
Plus: Physician convicted of over $17 million in fraudulent claims. Many Part B practi... Read more
In other news
Falsified plans of care got a Houston-area physician in trouble with the Department of J... Read more
Reader Question:
Use Standard Codes for White Light Colonoscopy
Question: What is the appropriate CPT® code for a colonoscopy when documentation sta... Read more
Reader Question:
Even 10-Day Globals Should Be Taken Seriously
Question: A patient saw our physician because of an abscess, and returned for a follow-u... Read more
Reader Question:
Add Sizes or Lesions?
Question: When our surgeon excises multiple lesions, I’ve heard that we should we ... Read more
Part B Revenue Booster:
These 5 Errors Could Be Causing You to Bleed Money
Avoid making these mistakes and you’ll keep the reimbursement flowing. Certain t... Read more
Prepare for ZPIC Audits Using These Quick Tips
Why you should focus on specific problems. With the wide variety of compliance issues ... Read more
How To Win A ZPIC Appeal
What evidence is most compelling to auditors. Wading through the appeals process for Z... Read more
Part B Coding Coach:
Check These 10 Surgical Changes for 2013 to Start the New Year on the Right Coding Track
Catheter changes lead the charge. You’ll be using CPT® 2013 codes before you... Read more
Physician Note:
Use 'Single Line Strike to Amend Medical Record, CMS Says
Plus: Without Congressional intervention, you’re still looking at Medicare cuts on... Read more
In other news…
The New Year is approaching, but along with good cheer, Part B practices were hoping to ... Read more
Reader Question:
'Overdocumenters' May Not Qualify for 99215
Question: Our physician is an amazing documenter -- for established patients (which... Read more
Reader Question:
Until ICD-10, Go With 'Unspecified' Appendix Code
Question: Our physician performed a procedure to remove the patient’s appendix. Th... Read more
Reader Question:
Any Physician Can Report ED Codes
Question: An emergency department (ED) physician asked our doctor to see a patient. The ... Read more
Reader Question:
Hit 'Record' to Bill Ultrasound
Question: Will you confirm whether printed US images must be present in the medical... Read more
Reader Question:
Choose Between 92133 and 92134 for Inconclusive HRT
Question: How should I code for a nonconclusive HRT? One of our patients had one done, b... Read more
OIG Revisits Recommendation to Adjust Global Surgery Fees Based on E/M Services
OIG discovered inconsistent billing for global surgery and believes adjustments could sav... Read more
Locum Tenens Billing Doesn't Apply to New Docs Who Aren't Yet Credentialed
Uncredentialed physicians don't fall into any 'locum tenens loophole.' Myth: Tired of wai... Read more
Clip And Save:
13 Tips for Recouping Payment for Substitute Physicians
Hint: Don't mix up modifiers Q5 and Q6. Although you can't bill locum tenens for new phys... Read more
2013 AMA Symposium Update:
Get the Scoop on CPT's All-New Transition Codes
Caution: Missing primary care designation could wreck your Medicare pay. Primary care ph... Read more
Part B Coding Coach:
HCPCS Q2048 or J9002 in 2013? Doxil Coding Changes Again in the New Year
Plus: See what's different for Erwinaze, Adcetris, mitomycin, and more. Other specialties... Read more
Physician Note:
Physicians Still Rank High on List of Fraudsters
Plus: New CMS provider call could shed light on billing therapy services. The percentage ... Read more
In other news
Want to get up-to-speed on therapy functional reporting? CMS is holding a National Provid... Read more
Reader Question:
Drain Removal Could Warrant Modifier
Question: Surgeon A performed a posterolateral fusion, laminectomy, and pedicle screw ins... Read more
Reader Question:
Some Symptoms Inherent in Diagnoses
Question: Can I report the diagnosis codes for tonsillitis, pharyngitis and upper respira... Read more
Reader Question:
State Laws Dictate Who the Doc Can Supervise
Question: Can a physician bill as a supervising provider when the staff member (in our ca... Read more
CMS: Modifiers 24 And 57 Will Soon Allow You to Bypass CCI Edits
Plus: You can also override bundles with modifiers LM and RI We've all heard the old co... Read more
CPT® 2013:
4 New Codes Upgrade Your Coding for Revision Arthroplasty of Shoulder And Elbow
Tip: Determine if one or both components of joint are revised. 2013 brings you a new ar... Read more
Physician Note:
CMS Stresses 'Importance of Legible Medical Records'
Plus: OIG recovered $6.9 billion in FY 2012. You may shake your head when you hear that... Read more
In other news…
Medicare may be cutting back on payments for some of your services, but the OIG has foun... Read more
Reader Question:
Know the Rules for Assistant Surgeons
Question: I'd appreciate some help with how to bill for the following scenario for a pat... Read more
Reader Question:
Two Same-Day Visits, Different Diagnoses
Question: Can you advise regarding a successful way to get Medicare to pay for two emerg... Read more
Reader Question:
Know What 92226 Entails
Question: I just got a denial on 92226. I think I might be using this code incorrectly. ... Read more
CPT® 2013:
5 New EP Study and Ablation Codes Help Electrophysiology Practices
When the physician combines multiple services in one session, you've got a coding 'combo p... Read more
CPT® 2013:
Gastro Practices Benefit From Four New Optical Endomicroscopy Codes
Check new codes for fecal bacteriotherapy and capsule endoscopy too. Starting Jan.1, y... Read more
CCI 18.3:
Latest CCI Edition Forces You to Halt Closure Coding with (Almost) Anything
Report repair alone or with lesion excision only. In case you've ever wondered if ... Read more
Part B Coding Coach:
3 Steps Steer Your Tonsil/Adenoid Removal Claims Toward Success
Secret: You can use 42820, 42821 as universal T&A codes.Warning: You must know a patie... Read more
Physician Note:
With Election Over, All Eyes Turn to Medicare Cuts
Plus: Prepare now for supply concerns from diabetic patients.With the election over, provi... Read more
In other news…
Your diabetic patients may have more difficulty obtaining their test strips following an O... Read more
2013 Payment:
Finalized 2013 Fee Schedule Includes 26.5 Percent Cut
Plus: Transition care management pay is formalized with assignment of codes 99495-99496.CM... Read more
Your ICD-10 Transition Plan Should Encompass 6 Phases, Expert Says
A working budget should include every aspect of planning, including productivity training.... Read more
Consider Working With Staff on "Scripted" Responses to Common Patient Privacy Questions
Front office staffers shouldn't have to create privacy responses on the fly.If all the wor... Read more
Part B Coding Coach:
CCI 18.3 Strikes Suture Repairs, Facet Joint Injections, and More
Know when you can append a modifier to separate these new edit pairs.The latest Correct Co... Read more
Physician Note:
Take Note of Errors in CPT 2013, AMA Instructs
Get out your favorite red pen to delete, add instructions to your new book.If you're scrat... Read more
In other news…
The government is proving that it's no longer keeping its hands off of physicians when bus... Read more
Reader Question:
Know Whether Medical Assistant Can Select Codes
Question: One of our physicians allows his medical assistant to choose his E/M codes. The ... Read more
Reader Question:
'Grandfather Provision' Expiration Causes Headaches for Labs
Question: Since the TC Grandfather Provision ended July 1, 2012, we're receiving approxima... Read more
ICD-9 Coding:
It's Likely That Your MAC Won't Accept 'Likely' Diagnoses
Specific phrases in your physician's notes will lead you to the optimal dx.In most situati... Read more
Inpatient Coding:
Avoid These Hospital Discharge Pitfalls
Making any one of these five mistakes could cost you thousands.Even coders who have a firm... Read more
Quality Reporting Burdens May Ruin Small Hospices
Hospice providers give CMS an earful on quality reporting proposals.Hospices are hoping to... Read more
Part B Coding Coach:
77080: 3 Tips Make Bone Density Coding a Snap
Check your LCDs to see if coverage is once every 2 years.If you find tracking Medicare's D... Read more
Physician Note:
Therapy Cap Approvals Must Use Latest Form, MACs Remind
Plus: CMS puts physician's enrollment responsibility in writing.If you're submitting pre-a... Read more
In other news…
You may have heard that physicians are responsible for the details on their enrollment app... Read more
Hospices Wary of 'Comfortable Dying' Details
Some patients should be excluded from this new quality reporting measure, providers tell C... Read more
Reader Question:
Shoulder Revisions Comprise Multiple Steps
Question: How would you code a right reverse total shoulder arthroplasty revision to hemia... Read more
Reader Question:
Know When Aspiration Becomes Drainage
Question: A patient presented to the ED with a peritonsillar abscess (PTA) and underwent a... Read more
OIG Always Looking at 'Emerging Fraud Trends,' Reps Reveal
Plus: The organization has over 600 people charged with fraud investigation, officials say... Read more
Diagnosis Coding:
2 Important Exceptions Will Keep Your 'Late Effects' Coding Compliant
The order in which you place your codes is essential to MACs.When coding for late effects,... Read more
Know How to React If You See Potential Fraud on Your Providers' Claims
Contact physician before panicking.With compliance in the spotlight, many coders are on hi... Read more
Part B Mythbuster:
Locum Tenens Won't Solve Billing Problems for New Physicians Who Aren't Yet Credentialed
Medicare won't accept locum tenens an appropriate billing scenario for an uncredentialed p... Read more
Part B Coding Coach:
Look to New Cat. I Codes for Bronchial Thermoplasty and Airway Sizing
Simplified reporting of thoracentesis all set to help pulmonology coders.If you were in th... Read more
Physician Note:
Missing Documentation Leads to $7 Million Fraud Settlement
Plus: OIG exclusion list is no joke.A New York-based mental health center is at the center... Read more
In other news…
You should have lots of good reasons for taking the time to check your staff against the O... Read more
Reader Question:
Add Lesions Based on Code Regulations
Question: My physician saw a patient with one hyperkeratotic lesion on the left foot and f... Read more
Part B Mythbuster:
Don't Buy Into These 3 Common EHR Fallacies
Protect your Part B pay by avoiding these mistakes involving electronic health records.Mos... Read more
DOJ Arrests 91 People for Medicare Fraud Worth $492 Million
Know what this type of arrest could do to your income.No practitioner is safe from governm... Read more
Hipaa Privacy:
Avoid Using These Non-HIPAA Compliant Statements With Patients
We polled patients to find out which HIPAA slip-ups Part B practices might be making--the ... Read more
Part B Coding Coach:
You Deserve Repeat Pap Smear Payment -- Make Certain Your Practice Gets It
The wrong diagnosis code could cost you $42 per patient.If your patient's Pap smear result... Read more
Physician Note:
Expect More Consolidated Billing Woes From This MAC
Plus: HIPAA breach costs one practice $1.5 million.Consolidated billing is difficult as it... Read more
In other news…
Remember, criminals don't have to actually use your patients' private health information f... Read more
Reader Question:
Know What's Coming for the 2013 Version of ICD-9
Question: Are there any ICD-9-CM updates planned for 2013?Answer: No ICD-9-CM diagnos... Read more
Reader Question:
Two Burns Can Mean Three Codes
Question: We are providing physical therapy for gait training for a patient who also has a... Read more
'Revalidation is Here to Stay,' CMS Reps Say
Plus: The agency acquiesces and begins accepting faxed, emailed supporting documents.If CM... Read more
Patient Privacy:
Even CMS Accidentally Breaches Patient Privacy Sometimes, CMS Says
OIG investigates CMS's ability to keep PHI private.Maintaining the privacy of your patient... Read more
Avoid Spending Thousands to Clean up HIPAA Compliance Issues
Follow these 8 tips to comply with security rule.How would your practice handle the notifi... Read more
Eliminate E/M Coding Confusion With 5 FAQs
Make sure your practice doesn't become an E/M coding error statistic.You've met all of the... Read more
Part B Coding Coach:
12 Cardiology Changes You Need to Know Before 2013
Procedure during AMI? Soon you'll have a code for that.Before you know it, you'll have dou... Read more
Physician Notes
Plus: CMS to turn on PECOS edits 'soon,' agency saysThe OIG wants New Mexico to recover $1... Read more
In other news…
You're in a race against the clock to make sure that you and your referral sources are enr... Read more
Reader Question:
Avoid +69990 for Routine Follow-ups
Question: A surgeon in our group practice wants to report 92504 every time he looks into t... Read more
RAC Audits:
One RAC's Decision to Audit E/M Claims Draws Fire
Connolly becomes the first RAC to focus on E/M inaccuracies.Recovery audit contractors (RA... Read more
OIG to Focus on E/M, Incident-to, and Global Modifiers in 2013
Plus: You'll also see extra scrutiny on anesthesia and ophthalmology claims, among others.... Read more
Electrical Stimulation:
Know the Specifics When Coding H-Wave Studies
Keep Stark laws in mind when the physician dispenses the device. The differences betwe... Read more
Part B Mythbuster:
No 'Standard' Code Applies to Specialty E/M Services
Select the appropriate code based on the documentation--not the specialty or diagnosis.Whe... Read more
Physician Note:
Vaccines Receive Booster Shots for 2013
Plus: Consider these lab tests officially 'CLIA-waived.'Good news for physicians who admin... Read more
Reader Question:
99232 Isn't Appropriate for Every Hospital Follow-up
Question: The anesthesiologist placed an indwelling thoracic epidural catheter at T6-T7 fo... Read more
Reader Question:
Medicare Won't Reimburse Extra for Modifier 33
Question: Some of our payers deny claims with modifier 33 because they state the modifier ... Read more
Reader Question:
Dosage Size Doesn't Dictate 'Prescription Strength' MDM
Question: I have a provider who has stated that if he recommends that a patient take OTC m... Read more
Reader Question:
Use Different Rules for Same-Day Visits
Question: We had a patient with a hiatal hernia who saw one surgeon in our practice, and t... Read more
Reader Question:
Unlisted Codes May Require Extra Notes
Question: Our gastroenterologist recently performed a laparoscopic procedure on a patient ... Read more
Reader Question:
Know When 1 Code Covers 8 Views
Question: I've got a report for eight TMJ views with the mouth in a variety of positions (... Read more
CPT® 2013:
Start Learning These Allergy Changes Now
New CPT® manual will update ENT codes.If you treat otolaryngology or allergy patient... Read more
Venous Cath Coding:
Answer These 5 Questions to Select Catheter Insertion Code
Hint: Know how many access points the physician addressed before selecting a code. CPT® ... Read more
E/M Coding:
Answer These 3 Quick Test Questions to Evaluate Your E/M Knowledge
Test your skills with these questions to see where you should focus your E/M education.Eva... Read more
Part B Coding Coach:
Does Your Shoulder Incision And Drainage Coding Make the Grade?
Hint: Get to the right code by confirming what your surgeon drained.Your surgeon may perfo... Read more
Quick Quiz Answers:
Evaluate Your Own E/M Coding Skills With 3 Test Answers
See where you should focus your E/M education.Answer 1: Yes. Based on E/M guidelines, if a... Read more
Physician Note:
HHS Sternly Warns Hospital Organizations of EHR Upcoding Risks
Plus: Therapy caps leading some patients to cancel appointments.Most coders have known for... Read more
In other news…
Part B isn't the only area where therapy caps are becoming a problem.CMS "began issuing it... Read more
Coding CVAs? Don't Follow Brand Names
Making assumptions can point you to the wrong code. Physicians typically tunnel some brand... Read more
CPT® 2013:
Urology Coding Changes Will Take Your Claims to A New Level
You'll have to wait until later in the year to hear about payment, however.Since urologist... Read more
CPT® 2013:
CCI Past Is Seen in 64561's Future
Avoid separately reporting 76000 or 77002.Not all of the coding changes for next year invo... Read more
CPT® 2013:
Ob-Gyn Coders: Consider Several Revisions to Your CPT® Manual
The few new codes will be overshadowed by verbiage changes.Although the 2013 CPT® ma... Read more
CPT® 2013:
Pleural Aspiration and Drainage Will Be Easier to Code in 2013
32555 and 32557 promise a simpler coding path as well, experts say.Radiologists who perfor... Read more
CPT® 2013:
From X-rays to Thrombolysis, CPT® Holds Many Changes for Radiology Practices Next Year
Check out this overview to help you prepare for 2013 changes. Coding radiology services ca... Read more
CPT® 2013:
Don't Miss the Updated Chemodenervation Codes -- Including One for Migraine Treatment
Plus: Many E/M and some pain pump codes cover more providers now. You won't find your neur... Read more
Physician Note:
False Claims Conviction Also Leads to HIPAA Charges
Plus: CMS eases face-to-face burden for both physicians and home care.If a new Department ... Read more
Reader Question:
Avoid Assumptions With Headache Dx
Question: A co-worker says we can submit "headache" and "migraine" on the same claim, but ... Read more
Overcome Primary vs. Secondary Payer Woes with Answers to Your FAQs
Start with the basics and then move on to learning the intricacies.When a patient is cover... Read more
Guest Column:
The Facts You Need to Know About Primary vs. Secondary Coverages
Written by Steven M. Verno, CMBS, CMSCS, CEMCS, CPM-MCS Health care is not as simple a... Read more
Physician Note:
CMS Reconfirms MACs Will Manually Approve Therapy Services Over $3,700 Threshold
Plus: Hospices must keep promises, one MAC says.CMS has finally revealed details about the... Read more
In other news:
In other news:
Medicare contractors are putting hospices on notice that they are watching for shady deali... Read more
Reader Question:
Collect First From Secondary, Then Patient
Question: We have many patients with secondary insurance, some of which have deductibles o... Read more
CPT 2013:
CPT Moves TAVR Into Category I Territory
New code series differs from previous Category III codes, so check documentation carefully... Read more
CPT 2013:
Expect Additions to Molecular Pathology Codes As of Jan. 1
But payment remains a mystery. After last year's vast additions to the molecular p... Read more
Prepare for Bronchitis Dx to Hinge on Cause Under ICD-10
Used to a single ICD-9 code? Ten codes will exist in ICD-10.You'll face big changes in rep... Read more
Physician Note:
Selling Your Practice? Check in on New Owner Afterward
Plus: Physician faces jail time for exaggerating complexity of two surgeries. If you sell ... Read more
In other news…
If you think exaggerating the complexity of even one surgery is okay, you could be in for ... Read more
Reader Question:
'H' Wave And 'F' Wave Aren't Interchangeable
Question: How do we code when our physician prescribes an H-wave device for electrical sti... Read more
Reader Question:
CPT Does Not Include PEG Tube Removal Code
Question: Our gastroenterologist performed EGD on a patient on one day and colonoscopy alo... Read more
Reader Question:
Don't Code 'Suspected' Abuse
Question: A patient presented at our office with a bruise. The physician examined the pati... Read more
Reader Question:
Allergy Injection Reignites 'New Vs. Established' Patient Debate
Question: I have a patient who was seen over three years ago. But, from 2009 through 201... Read more
CPT® 2013:
New Edition of CPT® Includes Care Coordination Codes
New CPT® manual will feature 186 new codes and 119 deletions, AMA reveals.Although t... Read more
CMS Confirms Oct. 1, 2014 As New ICD-10 Implementation Date
One year delay is expected to allow practices more time to prepare.It's been nearly eight ... Read more
Recovery Audit Contractors:
RAC Sets Sights on Auditing Nerve Conduction Study Code 95904
If you bill more than 3 units at a time, expect an auditor to call.Are nerve conduction st... Read more
ICD-10 Training Tip:
Clarify Substance 'Abuse' Vs. 'Dependence' to Select the Right ICD-10 Code
You may have to drill down to manifestations to find the code that suits your patient.Get ... Read more
Part B Coding Coach:
Maximize Reimbursement for Microsurgery
Identify primary procedure and bundles -- and watch the units you report.Reporting yo... Read more
Physician Note:
Hospitals May Be Asking for Your Doctors' NPIs Soon
Plus: Whistleblower case heads to court.New CPT® codes won't be the only change you'... Read more
In other news…
Add one more whistleblower action to the list of lawsuits the feds have joined. U.S. Distr... Read more
Diagnosis Coding:
CMS Establishes Additional Safeguards to Prevent You From Reporting 'E' Codes As Primary Diagnoses
Whether you bill electronically or on paper, you'll get an instant denial if your primary ... Read more
EHR Compliance:
Joint Commission Changes Course, Allowing Physician Assistants to Direct EHR 'Scribes'
PAs are once again listed as 'independent practitioners' thanks to new verbiage.The use of... Read more
Determine How 2013 Fee Schedule Proposal Will Impact Your Rehab Claims
Learn the six new G codes that describe patient function.Last winter the Middle Class Tax ... Read more
Physician Note:
CMS Issues New 'Centralized Flu' NPP Specialty Code
Plus: Court case shines the focus on how hospice patients can appeal denials.If you were b... Read more
In other news…
Hospices may have to cover more drugs and services they don't approve, thanks to a court c... Read more
Reader Question:
Know Which Doctor Spends the Most Time With Patient
Question: A recent surgical case involved two of our anesthesiologists: one for two hours ... Read more
Reader Question:
You Can Now Use Modifier PD
Question: Please explain to me when to use modifier PD. Does this apply to us when a patie... Read more
Reader Question:
Don't Base E/M Code Solely on Tube Removal Procedure
Question: Our gastroenterologist performed EGD on a patient on one day and colonoscopy alo... Read more
Reader Question:
Assistant Surgeons Are Typically Present for Majority of Surgery
Question: When we have an assistant surgeon from our practice scheduled to assist the prim... Read more
Reader Question:
Payers May Disagree About Colon Biopsy Diagnosis Code
Question: When our pathologist examines a colon biopsy from a screening colonoscopy (turne... Read more
Reader Question:
Appropriate Back Ultrasound Code May Surprise You
Question: Which ultrasound code applies for examining a mass on the back?Answer: The answe... Read more
CPT® 2013:
AMA Offers Sneak Peek at Upcoming Vaccine Coding Changes
If your payer is denying 90718, you should appeal through the end of the year. Your CPT b... Read more
Part B Errors:
Assigning the Wrong E/M Code to Your Claims? You're Not Alone, CMS Says
Joint replacements, pacemakers also log high error rates. Would your practice be comfo... Read more
Preventive Services:
Document Time Spent on Preventive Services, Despite No CMS Directive to Do So
Plus: Don't forget modifier 25 when reporting preventive services with E/M. CMS introduce... Read more
E/M Coding:
Calculate Medical Decision-Making With These Quick Tips
Hint: The \"if this, then that\" notes are key when determining level of risk. Selecting ... Read more
Part B Coding Coach:
Nail Down Strapping Reimbursement With 3 Quick Tips
In many cases, you can bill an E/M code along with strapping. Strapping might seem lik... Read more
Physician Note:
CMS Vastly Improves PECOS System
Plus: Avoid these diagnoses on your hospice claims to quell denials. As most Part B pract... Read more
In other news…
Don't submit a hospice claim with one of these diagnoses, unless your documentation thoro... Read more
3 Outdated Billing Habits You Must Overcome Now
You may already be struggling with denials for these issues--update your processes now to ... Read more
Part B Revenue Booster:
Avoid These Common Errors to Increase Pay in 2013's Hardest-Hit Specialties
Prepare now to avoid losing money on your oncology, ophthalmology, cardiology services. ... Read more
Make Sure Your Business Partners Don't Sabotage Your HIPAA Compliance
This stolen laptop led to headaches for one health entity.How far do you want to go in pol... Read more
Physician Note:
CMS to Start Denying Claims That Don't Meet Ordering/Referring Edits 'Soon'
Plus: Private payer partnership bolsters government's compliance efforts.If a new CMS news... Read more
In other news…
You'll have more eyes looking over your claims for fraud, thanks to a new partnership betw... Read more
Reader Question:
Base Lymph Removal Code on Modification
Question: My surgeon performs a selective neck dissection of levels 1-3. How should I bill... Read more
Reader Question:
Medicare Has No Love for Modifier 33
Question: Some of our payers deny claims with modifier 33 because they state the modifier ... Read more
Reader Question:
Medicare Pays for Face-to-Face Time, Not Standby Time
Question: A surgeon has requested that our anesthesiologist be on stand-by for a procedure... Read more
Reader Question:
Mass Size Dictates Gout Removal Code
Question: Our physician recently excised a soft tissue mass from the foot of a patient suf... Read more
Reader Question:
Avoid Modifier 50 With 72220
Question: Is 72200 unilateral or bilateral?Answer: You should think of 72200 (Radiologic e... Read more
Several Medicare Screenings Now Bundle Into E/M Visits
But CCI 18.2 does allow a modifier when medically necessary, separate procedures are perfo... Read more
Part B Mythbuster:
Procedures Are Bundled? In Some Cases You Can Still Bill Them Together
Interpret CCI properly to know when you can report both.When your physician performs two m... Read more
Lesion Coding:
Look Past the Urban Myth About Adding up Lesion Sizes
Pay attention to your non-Medicare carriers' policies on multiple lesionsMyth: When your d... Read more
Clip And Save:
Measure Your Modifier 59 Applicability With This Quick Chart
Follow the flow to confirm which modifier applies.Your physician performs two separate pro... Read more
Part B Coding Coach:
Medicare Requires G0275 With Cath Codes in Limited Circumstances
Coding peripheral vascular services in addition to cardiac catheterizations is one of th... Read more
Physician Note:
CMS Grants 'CLIA-Waived' Status to 11 Additional Lab Tests
Plus: Don't count on ICD-11 transition.Part B practices will benefit from 11 additional te... Read more
In other news…
Despite endorsement of a direct move to ICD-11 from the American Medical Association and o... Read more
Part B Revenue Booster:
Achieve Global Dominance With This Global Period Primer
Confuse 'XXX' with '0' global days and you could be flushing money away.Ignoring global pe... Read more
Create Your Compliance Plan in Advance of ACA Requirement
Both Medicare and Medicaid will eventually make compliance programs a requirement.Do you k... Read more
Pencil These Important Compliance Steps Into Your Calendar
There's no better job security for a billing staff than being able to prove you're current... Read more
Know What Identification Theft Can Mean for Your Part B Practice
Just one infraction can shut down a small practice and put you out of business.If you don'... Read more
Part B Coding Coach:
Capture Each Step of 2-Phase Case to Boost Breast Surgery Pay
Distinguish lesion excision, lumpectomy. When a patient advances through multiple diagnost... Read more
Physician Note:
CMS Offers NPI Advice
Plus: CMS clarifies pulmonary rehab coverage.National provider identifiers (NPIs) have bee... Read more
In other news…
CMS has allowed payment for physician-supervised pulmonary rehab programs since 2010, but ... Read more
Part B Payment:
Proposed 2013 Fee Schedule Targets Cardiologists, Ophthalmologists
Plus: CMS projects 27 percent cut to overall pay, based on sustainable growth rate.CMS is ... Read more
AMA Aims to Replace Payment Formula Completely
With turmoil over the conversion factor and the sustainable growth rate taking place every... Read more
3 Facts Show You What the Government's Healthcare Ruling Means for Your Part B Practice
Give patients this info when they balk at filling new prescriptions due to 'donut hole' co... Read more
Physicians' Face to Face Documentation Continues To Challenge Home Health Agencies
Proposal would allow NPPs to perform inpatient face-to-face visits.A small change to face-... Read more
Part B Coding Coach:
Collect Accurate Bone Mass Measurement Reimbursement With 5 Quick Tips
Plus: Know how Medicare changed your payment calculations for these services. Bone mass me... Read more
Physician Note:
CMS Clarifies Which Staff Members Can Perform AWV, WTM Exam
Plus: Senior Medicare Patrol program boosts its ranks.Ever since CMS began to pay for annu... Read more
In other news…
The Senior Medicare Patrol Project is stepping up its activity. In 2011, the 54 Senior Med... Read more
Denial Management:
Avoid Claim Rejections by Checking Practitioner Specialty Code
Plus: Medicare's one-year payment window causing massive headaches.If you report a new pat... Read more
Consider These 3 Self-Audit FAQs As You Review Your Practice's Claims
Time can drive E/M level--if it's documented.Most Part B practices routinely perform self-... Read more
Part B Coding Coach:
Perfect Your Injection and Infusion Claims With These Quick Tips
Consult payers for proper codes when new drugs hit the market. Injection and infusion codi... Read more
Physician Note:
Stolen PHI-Filled Jump Drive Leads to $1.7 Million Settlement
Plus: CMS offers NPI search tip.If your employee's car gets robbed, you typically don't ex... Read more
In other news…
You can now resume your regularly scheduled NPI checks. CMS has now resolved "the latency ... Read more
Reader Question:
Insurers Won't Pay for These Supplies
Question: Can our family practice office bill a syringe code with a vaccine administration... Read more
Performing Non-Payable Services for Private Insurers? Consider This ABN-Style Waiver
Avoid reimbursement leaks by having patients sign this contract.Most Part B practices know... Read more
Follow 3 Steps to Achieve Copay Waiver Compliance
Make sure you document financial hardship when applicable.Most practices have heard the ma... Read more
Clip and Save:
This Patient Responsibility Form Can Make Your Life Easier
For non-Medicare patients, use this form as a springboard to creating your own custom docu... Read more
Physician Note:
AMA 'Evaluating ICD-11' As ICD-9 Alternative
Plus: Keep Weekend in Mind for 5010 Transition. The American Medical Association (AMA)... Read more
In other news
You may have a few less days to make the switch to the 5010 claims format than you thought... Read more
Reader Question:
Know When You Can Write Off Employee Copays
Question: My physicians are looking at giving employees a courtesy for their co-pays but w... Read more
Reader Question:
Select Critical Care Codes Based on Service, Not Location
Question: After a patient with chest pain "coded" in the ER and was admitted to the ICU, o... Read more
Reader Question:
Don't Bill No-Show Fee on Behalf of Others
Question: Can a physician who refers a patient to another physician (specialist) charge hi... Read more
Reader Question:
State Laws Dictate Collections Rules
Question: I work in a physician's office handling the collection of past due copays, deduc... Read more
Reader Question:
Secondary Insurance Deductibles: Don't Do Automatic Writeoffs
Question:We have many patients with secondary insurance, some of which have deductibles on... Read more
Coding Errors:
Initial Hospital Care, New Patient Office Visits Suffer Highest Error Rates, CMS Says
Plus: Ob-gyns, thoracic surgeons, chiropractors make the most mistakes on claims. If y... Read more
CMS Eliminates 12-Month Claim 'Lookback' Period
Your MAC could request files older than 1 year, thanks to new transmittal.When a Part B MA... Read more
OIG Saves Medicare $1.2 Billion Over 6 Months
With 1,264 exclusions and 388 criminal actions, the OIG cracked down.Medicare may be cutti... Read more
Part B Coding Coach:
Nail Down Your Cardiac Cath Coding With This Updated Advice
Read this op report and figure out how you would code it. Coding medical charts is alw... Read more
Physician Note:
Avoid These Common 5010 Rejection Reasons
Plus: NJ doctor confesses to accepting cash for imaging referrals.You have just a few week... Read more
In other news
Accepting cash in exchange for referring patients to an imaging facility won't just net yo... Read more
Reader Question:
Don't Blithely Report Cancer Diagnoses
Question: My physician removed a patient's second lesion. The path reported severe dysplas... Read more
Reader Question:
Don't Forget to Bill for Allergen Prep
Question: Our physician recently saw an established allergic asthma patient whose symptoms... Read more
Time Is of the Essence With Prolonged Service Codes
This Part B MAC shares the biggest errors it sees--so you can avoid making them.Part B pra... Read more
You Might Report POS 22 More Often Starting in October
Focus on face-to-face service when choosing your code.CMS has announced a new place of ser... Read more
E/M Coding:
Translate the Alphabet Soup of E/M Coding With These 5 FAQs
From HPI to PMFSH, we've got the scoop on E/M coding.Last week, we told you that Part B MA... Read more
Part B Coding Coach:
96000-96004 Survival Guide: 3 Simple Rules for Claims Success
Hint: Don't bill the gait analysis code if the physician only performed one component of t... Read more
Physician Note:
OIG Audit Finds Only 15 Percent of E/Ms With Eye Injections Were Properly Billed
Plus: HIPAA slip costs director his job.Tacking an E/M code onto your eye injections as a ... Read more
In other news
If you're not paying too much attention to information security at your organization, prep... Read more
Medical Community Split on Advantages to ICD-10 Delay
But AMA wants further delay to 2015.Whether you submitted comments to CMS about the new pr... Read more
Diagnosis Coding:
Your Top 5 Diagnosis Coding Questions Answered
Hint: Documentation will reveal appropriate 'Welcome to Medicare' Dx code.Although your pr... Read more
Part B Coding Coach:
5 Tips for Large Tumor Excision Exemplify Skin Replacement Rules
Know when to capture pay for preparation, placement, and more.With new codes and an update... Read more
Physician Note:
Claims Sent to Wrong MAC Will Now Be 'Returned As Unprocessable'
Plus: Differentiate your PTAN from your NPI.If your practice routinely sees patients from ... Read more
In other news
Medicare maintains so many acronyms that it can be a full-time job to keep track of them. ... Read more
Reader Question:
Avoid Modifiers to Report EMG with Nerve Conduction
Question: We have received a denial for codes 95860 (Needle electromyography; 1 extremity ... Read more
Part B Mythbuster:
Mid-Level Providers Can Help With the Tough Cases
Using your non-physician practitioners only for the simple visits could cost you.Myth: Mid... Read more
Refresh Your Modifier 57 Knowledge to Keep Reimbursement Flowing
Hint: Avoid using 57 for minor procedures.In these tough economic times, every dollar coun... Read more
Use This Map to Navigate Your ICD-10-CM Manual
We've got the tips you need to make sense out of the new diagnosis coding system.Good news... Read more
Part B Coding Coach:
Consider Urinalysis Method Before Selecting From 81000-81003 Series
Be sure you have the right code, whether you test for 1 element or all 10.Urinalysis may s... Read more
Physician Note:
EMR Signature Must Translate to Printed Copy, One Medicare Contractor Says
Plus: CMS Approves "Check Box" for Physician's Home Health DocumentationElectronic medical... Read more
In other news
Medicare has finally loosened up on some unnecessarily strict documentation requirements f... Read more
Reader Question:
Avoid 79101 on 78452 Claim
Question: Why am I getting denials for radiopharmaceutical injection (79101) with MPI (CPT... Read more
Reader Question:
Know Nerve Injected Before Billing
Question: Our physician administers a lot of steroid injections and injections of anesthet... Read more
Reader Question:
Labs Must Have Specific Orders on File
Question: A cardiologist ordered "CVD markers" for a patient presenting with chest pain. W... Read more
OIG to Send CMS Names of 1,700 Docs Who Overbilled High-Level E/M Codes
Frequency of reporting 99214 and 99215 increased 17 percent over 9-year period. If you ... Read more
Global Surgery Package Pay for Cardiovascular, Musculoskeletal Surgeons Could Be Slashed
Latest OIG reports indicate that these specialists aren't performing all included E/Ms. ... Read more
Part B Revenue Booster:
Your Top 3 Hospital E/M Billing Questions Answered
Can you navigate the intricacies of inpatient E/M services? Check these expert solutions. ... Read more
CMS Assigns New Specialty Codes to Sports Medicine, Sleep Medicine
Codes went into effect on April 2, so you can use them now. Rumors of new specialty cod... Read more
Part B Coding Coach:
3 Steps Help You Translate Your Hysterectomy Claims into Common Sense
Find out why knowing the weight of the uterus is so important. Don't just correct your ... Read more
Physician Note:
New CMS Proposal Would Boost Primary Care Medicaid Pay
Plus: Make Sure Your Docs Are Enrolled In PECOS Before It's Too Late As most practices ... Read more
In other news
In May 2010, CMS published an interim final rule based on the Affordable Care Act, requiri... Read more
Reader Question:
Notchplasty Warrants Unlisted
Question: Our surgeon does the following procedures: Lateral & medial meniscectomy, al... Read more
Reader Question:
Straighten Out Functions of Specific Sinusectomy Codes
Question: When should I report sinusectomy codes? When a surgeon suctions purulent mucoid ... Read more
2013 CPT® Coding:
CPT® 2013 May Include Vaccine Code Overhaul
AMA offers preliminary peek at proposed 2013 codes.This year isn't even halfway over, but ... Read more
107 Providers Charged in Biggest Medicare Fraud Takedown in History
Improper billings of $452 million were identified prior to arrests.More than 150 medical p... Read more
Know When Your Financial Arrangements Could Cause Compliance Nightmares
Writing off coinsurance could get you into sticky situations.Following the government's an... Read more
Stick to G0010 for Hepatitis B Vaccine, CMS Reminds Practices
Inaccuracy in Medicare manual may have led you astray. If you've been taking your... Read more
Part B Coding Coach:
35476 Accuracy Hinges on AV Shunt Segment Definitions
Pinpoint arterial code opportunities by understanding the exception to the venous rule.Ign... Read more
Physician Note:
CMS Debuts New 'Date of Death' Code
Plus: CMS accepting comments on ICD-10 delay through May 17.When a patient passes away whi... Read more
In other news
Practices that have an opinion--either positive or negative--on the proposed new ICD-10 co... Read more
Reader Question:
Know These 3 Reasons You Should Wait for Dx
Question: Is there a hard-and-fast billing rule that requires us to wait for the patholo... Read more
Reader Question:
Payer Contract Trumps ABN
Question: We dispensed a splint to a patient, but the amount our insurer allows for it is ... Read more
CMS Is Now Accepting Hardship Exemption Applications to Avoid 2013 E-Prescribing Penalty
Submit your application by June 30 to find out whether you qualify.Hoping to avoid a 1.5 p... Read more
E/M Billing:
Hospital Nailed for Billing E/Ms That Should Have Been Included in Procedures
Consider these tips to avoid the same fate.If you see a patient in the hospital prior to h... Read more
Medicare Funding:
Medicare Projected to Go Broke in 2024, Trustees' Report Says
Part A is poised to run out of money -- and although safe for now, Part B could be at... Read more
Your Top 3 Secondary Payer Questions Answered
Start with the basics and then move on to learning the intricacies.Last week, we told you ... Read more
Part B Coding Coach:
Consider This Add-on Advice When Your Doctor Uses Photodynamic Therapy
Forget even one step of this process and you could sacrifice reimbursement.When your physi... Read more
Physician Note:
Providers Are Appending Modifier KX Willy-Nilly, OIG Says
Plus: One health insurer learned a HIPAA lesson worth $1.5 million.Trying to ensure that y... Read more
In other news
Blue Cross Blue Shield of Tennessee agreed to pay the Department of Health and Human Servi... Read more
CMS Won't Double-Zing Practices on Imaging Cuts
Groups won't be subject to the reduction, CMS clarifies.CMS no longer plans to apply the M... Read more
Reader Question:
Consider Modifier 26 With 76942
Question: For code 76942, which modifiers are allowed, and how do I report units?Answer: I... Read more
Reader Question:
Ensure That Physician Performs Initial Nursing Facility Visit
Question: I am receiving denial C0-170 (Payment is denied when preformed/billed by this ty... Read more
Follow These 7 Steps to Secure Your Outpatient Therapy Payments
Hint: Once you're past the cap amount, ABNs are strongly recommended (although not require... Read more
Part B Mythbuster:
Think You Know the 2012 Rules for Shoulder Surgeries? Check These Tips First
The new '+' symbol preceding 29826 makes a bigger difference than you think.Myth: If you p... Read more
Part B Coding Coach:
81000-81003 Confusion? You're in Luck With This Urinalysis Primer
Tip: The definition of 'automated' could drastically impact your coding.Urinalysis may see... Read more
Physician Note:
NJ Doctor Sentenced for Billing 900 Endoscopies on One Patient
Plus: Don't revert to 4010 form if you can avoid it.Wondering whether insurers are actuall... Read more
In other news
CMS may have delayed 5010 enforcement until July 1, but you'd be wise to adopt the new HIP... Read more
Reader Question:
Count the Minutes for Moderate Sedation
Question: If the physician documents 36 minutes of moderate sedation, may we report 99144 ... Read more
Diagnosis Coding:
CMS Proposes One-Year Delay for ICD-10
Don't count on the delay quite yet, coding expert warns.Part B practices have been wonderi... Read more
CMS Clarifies Rules for Submitting Medicare Secondary Payer Claims
Hint: Copy all beneficiary insurance cards, not just the Medicare one.When Part B practice... Read more
Don't Click That Link! Medical Practices Particularly Vulnerable to Online Security Threats, Experts Say
Get to know this and other privacy risks so your practice remains compliant.As a healthcar... Read more
Non-Covered Services:
3 Answers Help Ease Your ABN Coding Questions
Hint: Modifiers may be required in many ABN situations.You use advance beneficiary notices... Read more
Part B Coding Coach:
Summer's Coming: Know How to Bill for Sunburn Treatment
Watch out: Not all burn care is created equal -- you may need to code some as E/M.You... Read more
Physician Note:
CMS Releases New Agriflu Code, Along With 6 Additional HCPCS Codes Effective July 1
Plus: Expect major delays when reporting code 33249 with C1882 Although we have to wai... Read more
In other news
Practices that frequently report 33249 (Insertion or replacement of permanent pacing cardi... Read more
Reader Question:
Avoid Assumptions When History Is Undocumented
Question: Our physician admitted someone as an initial inpatient, but couldn't get all her... Read more
Reader Question:
Know Your X-Ray Terminology to Decode This Report
Question: How should I code the following report? X-rays: I interpreted Rosenberg, lateral... Read more
Preventive Services:
Don't Bill Annual Wellness Visit As 'Incident To,' CMS Says
The agency provides answers some of your most pressing AWV questions. Whether you cons... Read more
Avoid Five Common Compliance Landmines
Follow these strategies to ensure you stay on the right side of the law.Every medical prac... Read more
Know Which Notes Can Be Counted When Scribes Do the Documenting
Take heed of these rules when considering what the scribe can document. If your practice h... Read more
Part B Coding Coach:
Bust 4 Myths to Breathe Easy When Submitting Tracheotomy Claims
Beware separate-procedure status of planned tracheostomy. If you're making assumptions abo... Read more
Physician Note:
CMS Is 'Looking at All Options' Regarding ICD-10 Delay Process
Plus: CMS offers Medicare billing certification.If you're hoping that CMS can offer insigh... Read more
In other news…
Are you a Medicare billing pro? CMS now offers certification so you can prove that.On Marc... Read more
Reader Question:
Cold Air Challenge Coding Doesn't Have to Be A Challenge
Question: Our pulmonologist performed a cold air challenge along with multiple spirometric... Read more
Reader Question:
Contact Your State for Billing Time Frame
Question: Is there a time limit on when you can bill a patient for their balance due after... Read more
Reader Question:
Know When 'Incident To' Rules Apply
Question: I have a case where one physician (physician A) in my practice covered an establ... Read more
Reader Question:
Generic vs. Brand Name Won't Change Your J3301 Billing
Question: My doctor is using Kenalog 40 (NDC 0003029328) from Bristol Myers Squibb. He s... Read more
Create a Solid Financial Policy That Tells Your Patients Exactly What You Expect
Get answers to your top financial policy questions from a billing expert.Having a financia... Read more
Clip And Save:
Identify Financial Problems in Your Practice With Special Acronyms
Assigning payment and denial codes will help you track your claims success.If you don't kn... Read more
Successfully Collect for Services When Your Practice Does Not Participate
Follow these 4 quick tips for optimal reimbursement.As payer contracts get more and more c... Read more
Keep Your Practice Out of Hot Water By Knowing When You Can -- and Can't -- Write Off a Patient Balance
Don't try to skirt around the system or you'll end up on the audit radar.Being a compassio... Read more
Physician Note:
CMS Extends 5010 Compliance Period
Plus, if you made a claim in the AMA suit against UHC, start looking for your check.Practi... Read more
In other news
If you filed a claim during the legal battle between the American Medical Association (AMA... Read more
CMS to Institute Payment Edits for E/M Services During Global
When RACs find massive errors, MACs listen.Starting this July, modifiers will be more impo... Read more
Physicians Urged to Find Workaround After MACs Deny Hypertension PQRS Measure 235
After April, Medicare will count this measure toward PQRS once more.If collecting a PQRS b... Read more
Check Out These Four Essentials Before Filing an Incident-to Claim
Heads up: Skip these items and you'll be in the OIG's hot seat. Your physician diagnoses a... Read more
Part B Coding Coach:
11640-11646 Demystified: Can You Conquer These Excision Coding Scenarios?
Referrals, unexpected findings, and multiple excisions -- check out these case studie... Read more
Physician Note:
Sleep Medicine to Get Its Own Specialty Code in April, CMS Says
Plus: PECOS surrogate program to go live this spring.Billing Medicare for subspecialists c... Read more
In other news
Looking forward to the day when you can sign into PECOS on your physician's behalf using y... Read more
Reader Question:
Pathology Findings Lead Dx
Question: Our pathologist examined a biopsy from a screening colonoscopy that the physicia... Read more
Reader Question:
Keep Tobacco-Use Cessation Counseling Criteria in Mind
Question: How do we bill for counseling for smoking cessation? If so, what codes are being... Read more
Reader Question:
707.21 May Describe Complete Pressure Ulcer Dx
Question: An established elderly patient reported to our physician for inspection of sores... Read more
At Long Last, CMS Agrees to Allow E-Signatures on PECOS Applications
Plus: Avoid adding discharge date to 5010 claims for outpatient services. Ever since C... Read more
Part B Revenue Booster:
5 Strategies Lead You to 99211 Success
Hint: Don't use level 1 visit for all vaccinations and allergy shots. Many physici... Read more
Master These 3 Modifier 25 Issues to Get Claims Paid
Hint: Modifier 25 may apply to E/M performed with xxx global-day procedures.Want to collec... Read more
Modifier 25:
Conditions for Use
When appending modifier 25, the E/M service must meet these requirements:The E/M is signif... Read more
Your Staffers Will Be Less Likely to Whistle If You Follow These Tips
A robust reporting mechanism is your best defense against a whistleblower suit.If your com... Read more
Follow OIG Compliance Plan Guidance Step By Step
Missing an element could set you up for a costly lawsuit, or worse.Don't get caught in thi... Read more
Part B Coding Coach:
Avoid These Hot Spots When Coding Burn Care
Hint: Anesthesia coders follow the same tactic as surgical coders. Coding for burns that a... Read more
Physician Note:
CMS Rolls Out New Medicare Advantage Auditing Plan
Plus: Dallas Physician Arrested As Part of $375 Million Scheme.CMS has been auditing Medic... Read more
In other news
Most medical practices are lucky to see $375 million in the course of several decades--but... Read more
Reader Question:
Not All Drug Wastage Is Billable
Question: How should I bill for wasted drug? Our physician often splits a single vial betw... Read more
RACs Are Now Checking Your Modifier 25, Injection Claims
Plus: Contractors are also auditing place of service, bilateral services, and consolidated... Read more
Claims Errors:
This MAC Denied Over 1,200 Claims for Services Administered to Deceased Patients
Avoid these top ten Medicare errors to avoid revenue drains.What's the top tool in your ar... Read more
Part B Coding Coach:
6 Quick Tips Help You Differentiate Repeat Procedure Modifiers
Use modifiers 59, 76 and 77, and 91 without jeopardizing your pay.When you consider report... Read more
Clip And Save:
Study These 'Repeat Procedure' Modifiers--And When You Should Use Them
Keeping your repeat modifiers straight can be confusing--look to this simple chart to help... Read more
Physician Note:
HHS Settles With Dialysis Center Over Failure to Offer Sign Language Interpreter
Plus: Practitioners collected $3.1 billion in EHR incentives, HHS says.If you can't commun... Read more
In other news
CMS has put its money where its mouth is when it comes to electronic health records (EHRs)... Read more
ICD-10 Date Will Be Postponed, HHS Confirms
Delay could offer practices additional time to prepare for new diagnosis coding system.Jus... Read more
Part B Payment:
Congress Reaches Tentative Deal to Avert 27 Percent Medicare Cut
However, 10 month delay will only push payment formula problems to 2013.If you were biting... Read more
You May Soon Have Only 60 Days to Return Medicare Overpayments--Or You'll Face Penalties
New CMS proposal would impact all self-identified overpayments that your contractor sends ... Read more
Part B Coding Coach:
Gynecology: Answer 3 Questions to Bolster Your Biopsy Coding Efficiency
The number of biopsy units doesn't always go by the number of samples.Are you sure you're ... Read more
Physician Note:
OIG Offered Practices Second Chance to Submit Required Records, But Most Didn't Take It
Plus: If you aren't ready for 5010 yet, it's time to kick your efforts into high gear.You ... Read more
In other news
The April 1 enforcement deadline for using 5010 claim standards is fast approaching. "To e... Read more
Reader Question:
Modifier 59 Isn't the Only Answer to Bundling Issues
Question: What advice can you offer for finding a particular code-pair when I am checking ... Read more
Reader Question:
Medicare Typically Won't Reimburse You for Self-Administered Drugs
Question: I do the coding and billing for a urologist who is under the impression that whe... Read more
Reader Question:
Technical Clinical Lab Services Fall Under Separate Fee Schedule
Question: Our laboratory billed the global charge for 84165, but then the pathologist, who... Read more
Reader Question:
Differentiate Removal From Ablation
Question: As part of a colonoscopy, the surgeon noted internal hemorrhoids, which he ablat... Read more
OIG Urges Physicians to Use 'Heightened Security' When Reassigning Medicare Payments
You could be liable for false claims submitted by those entities. Reassigning your Med... Read more
Part B Payment:
Congress in Apparent Deadlock Over Medicare Cuts, With 27 Percent Cut Looming
Effective March 1, you'll watch Medicare payments drop unless legislators come to an agree... Read more
This MAC Shares the Dirt on 4 Common Audit Types
Chinese restaurant menu didn't cut it as documentation for one hospital.Does it sometimes ... Read more
Part B Coding Coach:
Coding Tips: Splinting or Strapping? These Tips Help You Decide
Hint: Look to materials to narrow down your selection.When a patient reports to your physi... Read more
Physician Note:
CMS Grants 'CLIA-Waived' Status to 13 Additional Lab Tests
Plus: One MAC recently corrected vaccination underpayments.Part B practices will benefit f... Read more
In other news
Waiting on adjustments for underpaid vaccinations from September? You should see those pay... Read more
Know What Constitutes 'Exceptional' Documentation
Keep the 'Five W's' in mind for records that stand out.Most of us are familiar with the ba... Read more
Reader Question:
Modifier 78 Signals 'Unplanned' Return
Question: Our surgeon performed a colonoscopy with polyp removal 45385, and discharged the... Read more
Annual Wellness Visits:
5 Strategies Help You Deal With Patients Who Refuse to Complete HRA Form
If necessary, show patients the regulations in writing. You pored over creating a simp... Read more
CMS Coverage:
Medicare Announces New Code for Sexually-Transmitted Disease Counseling
Know what constitutes 'high risk' patients in CMS's view.You may have heard that Medicare ... Read more
Part B Coding Coach:
Simplify Your Pulmonary Function Test Coding With This Diffusing Capacity Change
CPT® simplifies reporting by combining two codes into one. Have you ever struggled w... Read more
Understanding Diffusing Capacity Tests
Carbon monoxide diffusing capacity and membrane diffusion capacity form a part of complete... Read more
Physician Note:
Four Doctors Nailed for Alleged Kickback Scheme
Plus: Follow these pointers when billing for TENS. Are you referring a vast number of ... Read more
In other news
Trying to figure out how to bill TENS unit instruction for your outpatient Part B patients... Read more
Reader Question:
69210: Know the Definition of 'Impacted'
Question: When we report 69210 (Removal impacted cerumen [separate procedure], 1 or both e... Read more
Reader Question:
Modifier 52 Can Be Your Ally
Question: If we perform a unilateral imaging service and the only available code specifies... Read more
Reader Question:
31238: Know the Ropes for Nosebleed Control
Question: A patient came into our office with a nosebleed. My physician provided epistaxis... Read more
Part B Update:
Despite CPT® Revision, Medicare Won't Update 'New Patient' E/M Rules for 2012
Plus: Claims reprocessing has completed, so make sure your claims have been corrected.As m... Read more
3 Steps Can Correct Your Cash Flow Woes
These simple strategies can improve your bottom line.If your accounts receivables (A/R) se... Read more
Clip And Save:
Personalize This Template to Get Your No-Show Policy in Writing
Incorporate the no-show policy as part of your new patient financial packet.When missed ap... Read more
Part B Coding Coach:
ENT Coding: Expand Your Diagnostic Scope Coding Options to Ensure Maximum Pay
Tip: Make this 'rigid' versus 'flexible' scope distinction. Are you relying on 31575 for a... Read more
Physician Note:
Medicare Offers Handy Tool to Ease Preventive Service Billing Burden
Plus: Part B therapy cap will be held off a bit longer, thanks to Congressional vote.Betwe... Read more
In other news
The 27 percent Medicare rate cut for physicians isn't the only thing that got put off unti... Read more
Reader Question:
Know What Constitutes 'High Risk'
Question: We have a 39-year-old patient who is asking for a routine screening of the colon... Read more
Part B Revenue Booster:
'Follow-Up' Is Not A Sufficient Chief Complaint
Improve Your E/M Payment Odds With These 5 Quick TipsMost practices report E/M codes every... Read more
Hernia Coding:
Mesh Coding Doesn't Have to Be Difficult--If You Follow These 4 Steps
Modifier 22 is the choice for difficult removal during hernia repairMesh placement may be ... Read more
Clip And Save:
Use This Chart to Select the Right Hernia Codes Every Time
Match the site to the documentation to choose the correct options.When it comes to hernia ... Read more
Physician Note:
Check Out What Your RACs Are Reviewing These Days
Plus: CMS clarifies 5010 advice.When the Recovery Audit Contractor (RAC) system first bega... Read more
In other news
Although HIPAA enforcement of 5010 compliance was deferred until March 31, CMS is still ex... Read more
Reader Question:
Get to Know Global Modifiers
Question: Our physician performed a spinal procedure during the global period of a differe... Read more
Reader Question:
Turn to CPT for Lesion Size Coding
Question: In the past I have seen it in writing in the CPT books that if the size of alesi... Read more
Reader Question:
Hold Off on Reporting ICD-10 Codes
Question: I'm writing to find out whether many of your subscribers have started billing wi... Read more
Reader Question:
Private Payers May Prefer to Use Medicare Codes
Question: For private payers, should I report G0364 or 38220 for aspiration and biopsy at ... Read more
Part B Revenue Booster:
Document Counseling and Coexisting Conditions to Justify E/M Level
Show physicians how to thoroughly document all diagnoses addressed to ensure complete docu... Read more
D.O. Billing:
E/M With Osteopathic Manipulation May Be Billable--If You Know the Rules
Avoid appending modifier 25 to all cases--instead, focus on medical necessity in the not... Read more
Care Plan Oversight:
Stop Giving Away Your CPO Services for Free
But ensure that a face-to-face visit took place before you bill. Don't let carriers underv... Read more
Part B Coding Coach:
Take An Advanced Peek At Two New Paracentesis Codes For 2012
CPT deletes intraperitoneal catheter insertion code.Do you know what CPT changes will affe... Read more
Physician Note:
Difference Between 'Observation,' 'Inpatient,' and 'Outpatient' Became $6 Million Question for Denver Hospital
Plus: Keep PHI out of emails to your MAC.When your physician admits a patient to the hospi... Read more
In other news
Don't risk HIPAA violations when you're trying to get help with your Medicare claims. You ... Read more
Reader Question:
'None' May Not Be Good Enough Answer When Recording Family History
Question: Our physician often records the word "none" under the "family history" section o... Read more
Part B Payment:
Congress Votes to Boost Conversion Factor Through February 29.
At nearly the last minute, lawmakers ensure that you won't lose 27 percent.Although the go... Read more
Correct Coding Initiative:
Reporting Compression Application With Fracture Care? Not Anymore, Thanks to CCI 18.0
New edition of bundling edits targets 2012 CPT® codes.You may just be digging in to ... Read more
Correct Coding Guidelines:
CCI Policy Manual Reveals When Postop Pain Treatment Can Be Billed Separately From Surgery
Plus: Find out the details behind one confusing MUE edit.Stumped by why a medically unlike... Read more
Find Out What the Stark 'Physician Self-Referral Law' Actually Covers
Need an exception? They only apply in specific scenarios.If anything in the healthcare ind... Read more
Part B Coding Coach:
Fine Tune Your Fibroid Claims By Studying These Removal Methods
Check out this minimally invasive, nonsurgical option. To accurately report uterine fibroi... Read more
Confused by Fibroids Vs. Polyps? Here's How to Make the Distinction
You may have to wait for the pathology report.Fibroids and polyps are similar because they... Read more
Physician Note:
CMS Outlines New ICD-10 Codes for 2012
Plus: Some RAC programs have been put on the back burner for now.You may not be familiar w... Read more
In other news
Sometimes common sense does seem to prevail at the policy-making level.CMS has agreed to d... Read more
Reader Question:
Keep CMS Rules in Mind When Coding Based on Time
Question: If the physician documents: "Time spent in the evaluation of the patient with mo... Read more