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Part B Insider (Multispecialty) Coding Alert

Part B Payment:
Congress Offers 3-Month Reprieve on Conversion Factor Cuts
Plus: Government moves toward possible SGR repeal. If you weren’t looking forwar... Read more
E/M Coding:
Break These 5 Bad Hospital Coding Habits
Ring in the New Year with an improved understanding of subsequent hospital care coding. ... Read more
2013 Coding Wrap-Up:
Take This Quiz to Determine How Well You've Studied This Year's Coding Regs
You can’t go into 2014 without firm knowledge of the current rules. The calendar... Read more
Part B Compliance Coach:
Focus on 5 Areas for Improvement in Your Provider Documentation
While EMRs improve legibility, they may lead to other issues. When your practice faces... Read more
Physician Notes:
OIG Identifies 'Top Management Challenges'
Plus: HIPAA audits may not be coming soon due to budget issues. Practices that live in... Read more
In other news
You may get a little breathing room on HIPAA audits. The funding for security rule audit... Read more
Reader Question:
Watch For Coding Trends
Question: We recently finished our first internal audit and found a potential issue: One... Read more
Medicare Immunizations:
Don't Expect CMS to Cover Tetanus Shots Unless You've Been Injured
Get familiar with Medicare’s rules from medical necessity to choice of products. ... Read more
CPT® 2014:
Prepare Now for Last-Minute Changes to CPT® 2014
Primary code updates make a big difference for your +93463 claims. If your shiny new C... Read more
Part B Coding Coach:
Perfect How You Report Pelvic Floor Muscle Rehabilitation Services
Break down how each type of provider should code for PFMR. Before turning to surgical ... Read more
Physician Notes:
CMS Postpones Stage Two EHR Meaningful Use Deadline by 1 Year
Plus: Medicare fraud sting snags 20 Michigan suspects for false billings. If your elec... Read more
In other news
Who said good things only come in small packages during the holidays? The Department of ... Read more
Reader Question:
Avoid Confusion Over Lavage and Cell Washing Reporting
Question: Bronchoscopy dictation states, “copious amounts of mucopurulent, brownis... Read more
Reader Question:
Don't Expect Separate Hospital Reimbursement For 96103
Question: My question is in regards to CPT® code 96103 and a hospital site of servic... Read more
Reader Question:
Halfway Point Means Rolling to Next Time Unit
Question: I’m trying to figure out when to “round up” units when the a... Read more
Reader Question:
Arm Isn't Only Access Graft Location
Question: What is a code for a dialysis access graft placement in the leg? The proc... Read more
Part B Payment:
Final 2014 Fee Schedule Confirms 20.1 Percent Conversion Factor Cut
Services hit hardest include ECGs, lesion destruction. If you’re looking for a s... Read more
Compliance:
Get These 3 Compliance Answers Straight From CMS
Want to know how Medicare views compliance issues? Check out these CMS-issued answers. ... Read more
Diagnosis Coding:
Select the Right Diabetes Code With 3 Quick Tips
Heed the etiology/manifestation sequencing guidelines. Your patient’s diabetes i... Read more
Part B Coding Coach:
Help - Don't Hinder - Your Total Hip Replacement Recording By Following This Expert Advice
Never skip the underlying cause, infections, or dislocations. If you’re overlook... Read more
Physician Notes:
CMS Finally Issues Refunds for Beneficiaries Classified as Incarcerated
At long last, CMS is correcting recoupments it made in error for supposedly incarcerated... Read more
Reader Question:
Modifier PT Doesn't Apply to Pathology
Question: We billed 88305 and 88342 with modifier PT for a diagnosis of V76.51 and 211.3... Read more
Endoscopy Coding:
Prepare for CPT® 2014 Esophagoscopy Overhaul
Distinguish ‘rigid’ and ‘flexible’ scopes. You’ll need t... Read more
Ophthalmology:
Clarify Your VF Coding for Glaucoma Suspects
Follow these three tips for solid 92081-92083 claims. Ophthalmologists usually spend a... Read more
Dysphagia Coding:
Follow 4 Steps to Ease Your Dysphagia Dilemmas
Hint: Your best coding starts with a detailed diagnosis. If your practitioner treats a... Read more
Emergency Medicine:
Yes You Can Bill Emergency Services for Patients in Custody
Know your rights when submitting claims to Medicare patients brought in by law enforceme... Read more
Physician Notes:
Prominent Cardiologist Faces Over 6 Years in Prison
Plus: Medicare cracks down on inpatient billing for hospital patients. If your physici... Read more
CPT® 2014:
37217 and More Change Your Vascular Stent Coding Next Year
Look for sweeping changes effective Jan. 1. If your general and vascular surgeons perf... Read more
ICD-10:
Get Specific With Pressure Ulcer Coding in ICD-10
Reporting multiple ulcers? Next year, reduce confusion with separate codes for bilateral... Read more
Part B Coding Coach:
Exam Findings Dictate When 188.x Becomes V10.51
Scour your urologist’s documentation for clues. Deciding when to switch from us... Read more
Physician Notes:
Mark Your Calendars: CMS Sets March 3-March 7 As ICD-10 Testing Week
If you worry about whether your claims will appropriately process on Oct. 1, 2014, fret ... Read more
ICD-10 Advises You to Stick With 188.x, V10.51 Guidelines in 2014
Deciding which code depends on the documentation. As you read in “Determining W... Read more
Reader Question:
Get to Know What Each Exam Measures
Question: Our radiologist obtains MR assisted 3D images in a patient with suspected CSF ... Read more
Reader Question:
Awake' or 'Asleep' Distinguishes 95816 From 95819
Question: The neurologist in our group will only read an EEG when the test is performed ... Read more
Reader Question:
Know the Best Codes for Intranasal Lesions
Question: I need help with coding the following in-office procedure: The patient had a w... Read more
Pulmonary Coding:
Collect for Your Pulmonary Education Services With These 5 Tips
Inhaler demo could pay you $19 — if you know how to navigate the rules. When you... Read more
ICD-10:
J45 Shifts Focus to Severity for Asthma Reporting
Hint: Identify symptoms and medication use for accurate reporting. Asthma is a common ... Read more
Medicare Drug Screens:
G0431, G0434 Define Your Options
Steer clear of the 80100 series for this payer. If you’re reporting drug screeni... Read more
Physician Notes:
CMS Sets Jan. 6 as Ordering/Referring Edit Implementation Date
If your practice put phase two of the Medicare ordering and referring edits on the back ... Read more
Reader Question:
Rereads May Not Warrant Recharges
Question: When one pathologist in our practice asks another pathologist in our practice ... Read more
Reader Question:
Check Records to Nail Down Laryngoscopy Code
Question: Our physician recently performed a laryngoscopy during which he removed a fore... Read more
Reader Question:
Get to Know Modifiers ZA and ZC
Question: Do you have any information on the correct use of modifiers ZA and ZC? I was t... Read more
Reader Question:
Arteriography Offers Several Options
Question: My doctor performed LHC, aortic root arteriography with runoff, and a bilatera... Read more
Reader Question:
Know the Rules for Add-ons
Question: Our physician recently performed the infusion of two anti-neoplastic substance... Read more
Compliance:
RACs Identify 2 Error-Prone E/M Issues
Pay attention to your inpatient, allergy E/M billings. If the majority of your Part B ... Read more
Chiropractic Services:
Could Chiropractors Start Collecting for E/M Services?
CMS appears to be mulling the possibility. Although chiropractors typically open each ... Read more
Diagnosis Coding:
10 Steps to Ensure ICD-9-CM Coding Compliance
Keep one eye on ICD-9 while looking ahead to ICD-10. If your practice is focusing heav... Read more
Part B Coding Coach:
Navigate the New-Versus-Established-Patient Maze With Expert Tips
Different locations, same physician? Use established patient codes. When reporting man... Read more
Physician Notes:
This MAC Is Rejecting Claims Via EDI
Plus: Your email could get you into HIPAA trouble If you’ve recently started usi... Read more
In other news
A slip-up by a hospice employee is leading to some bad press for one hospice — and... Read more
Modifiers:
This MAC Clarifies Use of Modifiers 54, 55 When Co-Managing Patients
Surgery from one practice and postoperative care from another? It is possible to collect... Read more
Surgical Coding:
Straighten Out Your Surgery Claims With These 5 FAQs
We took the most-often asked surgery questions and answered them to share with our reade... Read more
Clip And Save:
Nail Down Modifiers 54 and 55 With This Chart
Follow the flow to find out how to bill surgical and postoperative claims. Now that yo... Read more
Part B Coding Coach:
Watch Out When Billing Discharge, E/M on the Same Day Thanks to New CCI Edits
Don’t miss these closure of vesicouterine fistula edits. The last round of Corre... Read more
Physician Notes:
CMS Wants to Help You Benefit From PQRS
Plus: Add SMRC to the RACs and other audit organizations. If you still haven’t g... Read more
Reader Question:
Strike a Privacy-Identifier Balance
Question:  What guidelines should our group follow to protect the privacy of patien... Read more
Coding Quiz:
Can You Wade Through the Abbreviations to Code This Note?
Know the universal acronyms, then keep an eye out for practice-specific acronyms as well... Read more
E/M Coding:
The Problem in This E/M Note Cost This Practice Over $65
Know what you can’t miss when billing new patient visits. Most medical practices... Read more
Acronym Quiz Answers:
Can You Decipher the Acronyms In Our Quiz? See How You Fared With These Solutions
Hint: When in doubt, check with the practitioners rather than guessing. For most coder... Read more
Part B Coding Coach:
Brush Up on 4 Tips Before Reporting +99140 Emergency
Communicating with your provider is your best first step. Including qualifying circums... Read more
Physician Note:
CMS Improves Upon PECOS Enrollment System
Plus: Texas physician indicted in $1.4 million fraud scheme. Now that the government s... Read more
In other news
Your physician may be a hard worker, but can you say he works more than 24 hours in a da... Read more
Reader Question:
Lip Repair Has Own Code
Question: How should we report a" through and through" laceration repair of th... Read more
Reader Question:
Some Payers Circumvent CCI
Question: Can we bill abdominal (76700) and renal ultrasound (76770) together? Please ad... Read more
Reader Question:
How Can We Screen New Staffers?
Question: We had a staff member who we caught taking some prescription samples for herse... Read more
Appeals:
Appealing Pays, New OIG Report Determines
When you know you’re right, be sure to file a redetermination. If you get a deni... Read more
Privacy:
Learn From These Recent HIPAA Breaches
Tip: 3 focus areas will help you avoid making these mistakes. Laptops, smartphones, th... Read more
E/M Coding:
Keep Your Inpatient E/M Claims Flowing With These 5 Tips
Medicare overspends millions on upcoded inpatient visits. The carriers are scrutinizin... Read more
Part B Coding Coach:
Your MAC May Just Cover Hyperbaric Oxygen Therapy
Be sure to report by session for accurate payment of your HBO services. Are you fully ... Read more
Physician Notes:
Government Shutdown Halts DC Medicaid Payments
Plus: Modifier 77 is your friend for diagnostic ER services. Although the government s... Read more
Reader Question
Question: We treated a patient for leukemia several years ago and now we see her an... Read more
Reader Question:
93458 Requires Coronary Angiography
Question: My doctor performed LHC, aortic root arteriography with runoff, and a bil... Read more
Reader Question:
Documentation Is Everything for Debridement
Question: May I bill debridement if the physician documents no gross contamination?... Read more
Reader Question:
Know When to Report Guidance Separately
Question: Is it acceptable to bill 64450 with guidance code 77002? Answer: Yes, y... Read more
Government Shutdown:
Medicare Keeps Rolling During Government Shutdown
Your MACs will continue processing payments, enrollment, CMS says. Whether you were wo... Read more
The Rumor Mill:
Dispel These 3 Rumors to Ensure Your Claims Run Smoothly
Modifier 59 no longer applicable? Don’t believe everything you read. You might b... Read more
Diagnosis Coding:
No Dx Code on Claim? Find It Yourself With These 3 Tips
Coders may need to delve into the doctors’ notes to find diagnoses. If you&rsquo... Read more
ICD-10:
Debunk These 3 ICD-10 Myths and Mysteries
Aftercare codes won’t be a thing of the past in ICD-10. With the healthcare indu... Read more
Part B Coding Coach:
Add Accuracy To Your Intra-Arterial Chemotherapy Coding
Tip: Keep focus on push, pump, and infusion. When reporting treatment of primary live... Read more
Physician Note:
This MAC Plans to Audit Level 5 Codes
If your physician’s go-to codes are 99205 and 99215, look for a lot more scrutiny ... Read more
Reader Question
Question: I think the transitional care management codes only apply to established patie... Read more
Gastroenterology:
Get Set For Major Changes to Gastroenterology Coding Next Year
Also watch for ERCP changes in 2014. You don’t have to wait for the new CPT®... Read more
Neurology:
Prepare to Add More Chemodenervation Code Choices in 2014
Also: Category II additions expand your data collection arsenal. The new code set, dep... Read more
Otolaryngology:
One Code Change Could Net You Extra Pay in 2014
Hint: The change you’ll love is ‘unilateral.’ What ENT practice hasn... Read more
Part B Coding Coach:
Smart Tips For Pulmonary Ventilation Perfusion Scanning
Look for injection or inhalation to determine perfusion or ventilation scans. When you... Read more
Physician Notes:
Look for Adjustments to Extended Repayment
Plus: Pennsylvania physician breaks bad. Don’t be surprised to see changes if yo... Read more
In other news
A Pennsylvania physician who made his name running a physical therapy and rehab practice... Read more
Reader Question:
Examine Your Choices for Ear Canal Lesion Debridement
Question: The physician used suction and cup forceps to debride an ear canal lesion... Read more
Urology:
Stop Reporting 52332 With 52353 Starting In January, Thanks to CPT® 2014
A new code will change your cystourethroscopy + lithotripsy + stent coding. Because t... Read more
OB-GYN:
Fine Tune How You Report Fetal Evaluations, Fluid Collections, and Ablation of Uterine Fibroids
Overlooking 84112, 99170, 15777’s revised descriptors could delay your reimburseme... Read more
Anesthesia
The American Medical Association has released its first version of CPT® code changes... Read more
Oncology:
Breast Localization Devices And Biopsy Get New Codes In 2014
Keep your focus on the type of image guidance used. Coding for breast procedures gets... Read more
Part B Coding Coach:
Knee: Kick Your Knee Surgery Payment Into Gear With These Expert Tips
Hint: Precertification does not address coverage issues. Knee surgery remains one of t... Read more
What is a breast localization device?
A breast localization device is a wire, needle, clip, or pellet that helps to mark the l... Read more
Physician Notes:
CMS Gives Vaccine Prices A Shot in the Arm
New flu vaccine prices are effective retroactive to August 1. Good news for physicians... Read more
Medicare Errors:
E/M Errors Top Medicare's List of Improperly Billed Codes in 2012
CERT results reveal $29.6 billion in improper Medicare payments--$1.1 billion of which w... Read more
Which Specialties Are Billing Improperly?
The government’s CERT report not only identifies the types of errors that practice... Read more
Shared Visits:
Report Shared Visits Properly to Avoid Being A CERT Statistic
Medicare allows NPP, physician to combine forces on some hospital services If CMS&rsqu... Read more
ICD-10 Prep:
Enjoy Distinct Reporting Options For Hemothorax Next Year
Hint: Use same ICD-10 code if the diagnosis is hemopneumothorax. When your physician d... Read more
Part B Coding Coach:
Avoid Costly 93306 Mistakes to Correctly Code Echocardiography
Work with your clinical team to keep these assumptions from tanking your claim. How do... Read more
Physician Notes:
CMS to Update LCDs With ICD-10 Codes by April 10
Plus: Therapists must now issue ABNs for therapy services that exceed caps. If your pr... Read more
In other news
What’s the difference between a "recommended" advance beneficiary notice... Read more
Reader Question:
Are Global Periods Transferable?
Question: Our physician readmitted a patient who was in a global period for a procedure ... Read more
Reader Question:
Craft Affadavit Before Opting Out of Medicare
Question: We are going to opt out of Medicare for next year because our patient base is ... Read more
Reader Question:
Check Date for Sequestration Questions
Question: Does the two percent sequestration cut apply to claims with dates of service o... Read more
CPT® 2014:
New Edition of CPT® Debuts 'Interprofessional Telephone/Internet' E/M Codes
Plus: You’ll also find changes to cerumen removal, shoulder prosthesis removal cod... Read more
Recovery Audit Contractors:
CMS Has Yet to Follow Through on RAC Recommendations, OIG Says
But your MAC will most likely come down on improper payments soon. If you’ve hea... Read more
Part B Coding Coach:
Attack the Age-Old "Can I Report Extensive Adhesiolysis?" Question
Follow these 4 tips to ensure you collect appropriate payment. If your ob-gyn performs... Read more
Physician Note:
CMS Reminds Practices How to Avoid 1.5% PQRS Pay Cut in 2015
Plus: Even an office manager can face prison time for Medicare fraud. Voluntary incent... Read more
In other news
Do you think that only your physicians are liable if your practice is found guilty of he... Read more
Reader Question:
Include 'Validation' in Drug Screen
Question: Can we separately bill for validation when performing drug screening? Answer... Read more
Reader Question:
Do E/M Codes Have Global Periods?
Question: One of our providers saw a patient in the ER who had a wound on her knee. All ... Read more
Reader Question:
Solesta Coding Remains Unlisted
Question: Our gastroenterologist recently treated a patient with Solesta injection for f... Read more
Reader Question:
Avoid Mammography Codes for Breast Biopsies
Question: Our physician performed a breast biopsy and placed a metallic localization cli... Read more
Reader Question:
Know When Modifiers Apply to Spirometry
Question: I am new to pulmonology coding. I see there are many different codes to report... Read more
Part B Payment:
2 Historically Bad CCI Edits Will Soon Be History, CMS Says
Plus: Recoupments over incarcerated patients flummoxes practices nationwide. If ophtha... Read more
ICD-10:
Conversion to ICD-10 Won't Be A Huge Financial Burden, CMS Reps Say
Plus: ICD-10 claims will allow you to submit the letters as either upper or lowercase, C... Read more
Part B Revenue Booster:
Failure to Differentiate Co-Surgery From Assistant Surgery Could Cost You Thousands
Hint: Separate op notes can help you tell the difference. Our physician performs a pro... Read more
Part B Coding Coach:
Brush Up on Foot Anatomy to Step Toward Coding Success
Tip: Keep modifiers LT, RT, TA-T9 handy to specify work on different areas of feet and t... Read more
Physician Notes:
'Mobile' Physician Service Charged With Fraud
Plus: CMS refers ICD-10 date-span questions to local MACs. Making house calls isn&rsqu... Read more
In other news
The current number one question on CMS’s “Frequently-Asked Questions” ... Read more
Reader Question:
Know How to Email Without Violating HIPAA
Question: I sometimes e-mail patient records to consultants for help on how to bill. How... Read more
Reader Question:
Use Caution When Separating CCI Edits
Question: During a breast biopsy, the surgeon also performed a scar revision involving m... Read more
Medicare Forms:
New CMS-1500 Aims to MakeDiagnosis Coding Easier
Be ready to start using the redesigned paper form as of January 1. It’s not ever... Read more
Critical Care:
99291 vs. 99292: Check for Documentation of Time Before Selecting A Code
Critical care coding can be easy with these quick tips. Whether your providers perfor... Read more
Critical Care:
Let Official CMS and MAC Guidance Direct Your Critical Care Coding
Knowing the critical care coding rules and getting your providers to understand them are... Read more
Part B Coding Coach:
Add Accuracy to Your Intra-Arterial Chemotherapy Coding
Tip: Keep focus on push, pump, and infusion. When reporting treatment of primary live... Read more
Physician Note:
OIG Cites 'Fiscal Challenges' for Delayed 2014 Work Plan Release
Plus: Overbilling kyphoplasty leads to $388,000 settlement for one doctor. It’s ... Read more
In other news
If you’re performing kyphoplasty, make sure you’re reporting the designated ... Read more
Reader Question:
Stop Hunting for Culture Collection Code
Question: One of our providers will often dictate that he “obtained a culture for ... Read more
Part B Mythbuster:
Using Modifier 57? Then Ditch Modifier 25 on That Claim
Medicare carriers don’t require you to append both modifiers. Tips passed around... Read more
Physician Bonus Pay:
Secure Your PQRS Bonus By Differentiating Group Practice Vs. Individuals
How you’ll report depends on the number of providers in your group. Everyone li... Read more
Compliance:
Know the Truth About 5 Common Compliance Beliefs
True or false? Being unaware of accidental overpayments can’t invoke false claims ... Read more
Part B Coding Coach:
Anesthesia Providers Shouldn't Ignore V Codes
Build your diagnosis codes by starting with subterms. Thinking that V code diagnoses m... Read more
Physician Note:
Lesson From Recent $750,000 Case: Repay Overpayments As Soon As Possible
Plus: Senior Medicare Patrol smaller in numbers, but still producing results. If your ... Read more
In other news
Your patients may not be giving you as much scrutiny as in previous years. So implies a ... Read more
Reader Question:
Chondroplasties Are Inclusive to Meniscectomies
Question: What percentage of the meniscus must the surgeon remove before we should bill ... Read more
Reader Question:
Extra Compensation for Obese Patient Case
Question: Recently, our surgeon performed spinal fusion (22630) on an extremely obese pa... Read more
Part B Revenue Booster:
Maximize Your Income With These 7 Tips
A well-oiled billing and collections program will ensure your practice doesn’t los... Read more
Patient Privacy:
Buckle Down for HIPAA's Regs on Patient Access
Get a process in place now for giving patients copies of their records. If a patient a... Read more
Part B Coding Coach:
Hit The Spot on Fiducial Marker Placement Reporting With This Guidance
Hint: Don’t forget to check for any separately reported guidance. When your phys... Read more
Physician Note:
99310: Claims Review Reveals Missing Signatures
Plus: Check out this hospice billing guidance. When Part B MAC CGS Medicare began its ... Read more
In other news
Looking for answers to your hospice billing questions, and a training resource for emplo... Read more
Reader Question:
Get A Handle on Global Period
Question: A patient comes in and has 17 lesions treated. I see that 56501 has a global c... Read more
Reader Question:
Consider Block Scheduling to Balance Late Patient Back-Ups
Question: We’ve had a lot of patients showing up late for their appointments latel... Read more
Reader Question:
'DNR' Doesn't Always Equate to Critical Care
Question: We’ve heard that the patient code status (DNR, DNI, full code) is one of... Read more
Part B Payment:
Proposed 2014 Fee Schedule Suggests Steep Cuts
But in 2015, practitioners could finally see bonuses for non-face-to-face services admin... Read more
Patient Privacy:
HIPAA Audits Begin in Two Months--Are You Ready?
Oct. 1, 2013 is the planned start date for the OCR to start auditing medical practices f... Read more
Part B Coding Coach:
Dermatology Services Impacted Hard by CCI 19.2
Focus on three modifiers for unusual cases. If you’re rusty on when evaluation a... Read more
Physician Notes:
CMS 'Regrets Inconvenience' of Erroneously Requesting Overpayments
Plus: CMS clarifies rules for opting out of Medicare. Your physician treated a patient... Read more
In other news
If you’re one of the physicians who has decided to opt out of the Medicare program... Read more
Reader Question:
Avoid Billing CPAP With E/M
Question: Our pulmonologist recently provided E/M services and also performed ventilatio... Read more
Reader Question:
Don't Hold Your Breath for Medicare Phone Call Pay
Question: Another physician told my doctor that he’s receiving payment from his co... Read more
Reader Question:
Know How to Code Previous Injuries Under ICD-9
Question: One of our patients presented because he’s experiencing neck pain that g... Read more
Reader Question:
Use 'Feigned Illness' Dx Code When Necessary
Question: Our practice recently had a new patient present with a complaint of severe low... Read more
EMR Issues:
See How An EMR Upcoded This Visit by Two Levels
Review this documentation and determine how you’d code it before you read the solu... Read more
Billing:
Brush up on Overpayment Policies Now That CMS Has 5 Years to Request Refunds
Keeping overpayments can get you in hot water with patients, payers, and the law. If y... Read more
Part B Coding Coach:
Make Sure Your Psychiatric Coding Is on Track With 2013 Rules
Hint: The add-on code for interactive complexity is not a time-based code. When your c... Read more
Clip and Save:
Ensure Payers Correctly Apply Every Refund That You Send
Use this sample letter to provide all of the information your payer needs. When you se... Read more
Physician Note:
RAC Auditors Target E/Ms During Global As Problem Area
When CMS sends out a "reminder" about appropriate billing practices, you know ... Read more
Work With EMR Vendor on Templates
When you’re new to electronic medical records (EMRs), it may be tempting to simply... Read more
Recovery Audit Contractors:
5 RAC Findings That Could Be Troubling for Your Practice
New MLN Matters articles focus in on how you can correct these issues. No practice enj... Read more
How to Use Modifiers 76 and 77 to Your Advantage
If you’re one of the practices that the RACs identified as improperly billing dupl... Read more
Clip And Save:
Use This E/M Modifier Cheat Sheet to Bill Correctly Every Time
If you’re often mixing up your E/M modifiers, then clip this article and post it n... Read more
ICD-10:
I49.3 Gives Ventricular Premature Beats Their Own Code in 2014
Term swap: ICD-10 uses ‘depolarization’ instead of ‘beats.’ Ma... Read more
Part B Coding Coach:
Master Spleen Codes With This Splenomegaly Case
This ‘separate procedure’ doesn’t always stand alone. When your surg... Read more
Physician Note:
CPT® Announces New Vaccine Codes for CPT® 2014
Plus: The OIG is watching how many vaccinations you provide. You probably haven’... Read more
In other news
A Maryland practitioner is in the hot seat for providing — and billing Medicare fo... Read more
Reader Question:
Shuffle Diagnosis Order When Necessary
Question: Our physician documented obesity as a contributing factor in a patient’s... Read more
E/M Coding:
Yes You Can Use Two Sets of E/M Guidelines
Follow these tips to know when to pick 1995 vs. 1997. Having two sets of physical exam... Read more
Clip and Save:
Keep This Chart Handy to Help Quickly Calculate Exam Levels
Be sure you choose the guidelines that will be most advantageous to your coding. ... Read more
Enrollment:
Review 3 FAQs to Ensure You Know When a New Provider Should Start Seeing Patients
If a provider starts too soon, you could be giving away free services. Following last... Read more
Part B Coding Coach:
Ace Your G-Tube Placement Coding With These Key Tactics
Hint: Append modifiers when two specialists are carrying out the procedure. When your ... Read more
Physician Note:
This MAC Denied 31 Percent of Hospice Claims
Plus: Don’t attempt to adjust redetermined claims. Make sure your physician&rsqu... Read more
In other news
Keep your claims processing timeline straight to stay away from prohibited actions. That... Read more
Workers Compensation:
Standardize Your WC Processes With 3 Tips
Successful WC reimbursement starts long before the claim gets filed. Even if most of ... Read more
Coding Case Study:
Focus on Fine Needle Aspiration Site to Bring Home FNA Pay
Beware ‘pass’ terminology. With multiple specimens and procedures in a sin... Read more
Part B Coding Coach:
Report Female UI Surgical Procedures Easier With These Tips
If MD does a combined vaginal and abdominal approach to perform a suburethral sling oper... Read more
Physician Note:
Owe Medicare Money? Expect An Enrollment Application Denial
Plus: OIG wants pro-rated hospital pay for hospice discharges. CMS has found a clever ... Read more
In other news
Hospice lengths of stay may get even shorter for patients referred by hospitals if CMS l... Read more
Reader Question:
Report 90714 for All TD Vaccines in U.S.
Question: I know that, as of the first of the year, code 90718 has been deleted. I have ... Read more
Reader Question:
Assess Risk to Arrive at Diagnosis Code Rather Than Payer Type
Question: We have patients from time to time whose benefit plans don’t recognize h... Read more
Medicare Policy Updates:
CMS Knows You're Confused About POS Rules
Agency creates FAQs on the topic—which prompt even more questions. When CMS issu... Read more
Medicare Funding:
Medicare Projected to Go Broke in 2026, Trustees' Report Says
Part A is poised to run out of money — but it’s two years later than pr... Read more
Transitional Care Management:
4 CMS-Approved Tips Keep Your TCM Income Flowing
Hint: These codes apply to both new and established patients. Now that you’ve ha... Read more
Pre-Op Visit Reporting:
Look to E/M Codes and 'V' Codes to Collect for Your Preoperative Clearance Visits
Z01.818 will be your friend under ICD-10 when you perform preop visits. If a surgeon p... Read more
Part B Coding Coach:
Don't Be Blind to 3 Factors When Coding Ocular Foreign Body Removals
Look Closely At The Documentation For These Clues to Determine The Right Code Assignment... Read more
Physician Note:
OIG Recovered $3.8 Billion in the First Half of FY 2013
Plus: Medicaid data mining could happen soon. Medicare may be cutting back on payments... Read more
In other news
You should be paying attention to your claims and other data, because authorities certai... Read more
Reader Question:
Report Finished Procedure Only
Question: After discussing the risks and benefits of both cryotherapy and photocoagulati... Read more
Reader Question:
Know When CCI Bundles Procedures
Question: When we are billing out a transcranial Doppler (TCD), we use codes 93886, 9389... Read more
Part B Mythbuster:
Bust These 2 Critical Care Myths to Maximize Your Income
Here’s what you need to have when reporting critical care to Part B payers. If y... Read more
CPT® 2014:
19102, 37205, and Other Codes Are on the Chopping Block for CPT® 2014
Don’t miss these potential changes to abscess drainage, embolization, and AAA codi... Read more
ICD-10:
Narrow Six 244.x Hypothyroidism Options to Five ICD-10
Your physician will have to think about the hypothyroidism cause. Hypothyroidism is a ... Read more
Part B Coding Coach:
To Report IONM, You Need a Separate Provider -- The Surgeon Can't Do Both
With the right documentation and modifiers, some practices can earn big bucks. If you ... Read more
Physician Note:
58 Percent of PECOS Records Are Inaccurate, OIG Says
Plus: At long last, CMS has a permanent administrator. You diligently transferred your... Read more
In other news
CMS has its first permanent Administrator in seven years. The Senate confirmed former nu... Read more
Reader Question:
Know Your Options Before Reporting 92225
Question: A patient reports flashes and floaters but the optometrist does not find evide... Read more
Reader Question:
Nail Down Radiology Place of Service
Question: One of my coworkers heard that some Medicare rules have changed regarding whet... Read more
CMS Clarifies 3 Hot Issues
From bilateral billing to ICD-10 regs, CMS was busy working on May policy adjustments. ... Read more
Part B Mythbuster:
Collect for Your Cataract Procedures by Avoiding These 3 Common Myths
Tip: You can code vitrectomies separately — sometimes. With several possible sur... Read more
Part B Coding Coach:
Take the Stress Out of Your GI Pressure, Transit Measurement Reporting With This Advice
Hint: Obtain prior pre-authorization to avoid payer denials. You can improve your CPT&... Read more
Physician Note:
CMS Wants Your Feedback on PQRS Measures
Plus: Face-to-face visits aren’t required for all home care patient updates. If ... Read more
In other news
If your physicians have been visiting home care patients more often due to 2013’s ... Read more
Reader Question:
Know When Fluoroscopy is Included
Question: I have looked, but cannot find information regarding whether you can bill 6445... Read more
Reader Question:
Residents' Notes Require Linking Statement
Question: If no linking statement by the attending is present, which part of the residen... Read more
Reader Question:
Differentiate ASC Rules From Office Regs
Question: Our surgeon identified an anal mass of approximately 3 cm upon digital rectal ... Read more
Reader Question:
CMS Will Immediately Deny Outdated Codes
Question: A 65-year-old patient who just enrolled in Medicare came to our office for his... Read more
Sequester Cuts:
Medicare Advantage Taking A 2 Percent Bite? Bite Back
Unless your contracts specifically allow your MAO to pass on its two percent cuts to you... Read more
ICD-10:
Some Worker's Comp Insurers May Opt out of ICD-10, CMS Says
But Medicare and Medicaid plans will not give you an extension past Oct. 1, 2014, the ag... Read more
Part B Coding Coach:
Apply This Expert Advice For Spinal Instrumentation Claims Success
Location and levels lead you to the correct code. When reporting spinal instrumentatio... Read more
Physician Note:
You May Need to Resubmit AWV, IPPE Claims, CMS Says
Rural health clinics may have been shortchanged since January. Have your preventive vi... Read more
Reader Question:
Showing Two Percent Cut on Invoice Is Your Choice
Question: Now that the Medicare remittance is clearly tracking CO-223 for sequestration ... Read more
Reader Question:
Don't Just Pay Lip Service to Vermillion Border Repairs
Question: How would you code through and "through" "laceration" repa... Read more
Reader Question:
Fighting for Rhinoplasty Payment Can Be Rewarding
Question: My doctor says "a fracture is a fracture forever." The patient prese... Read more
MACs Will Soon Be Scrutinizing 'G' Modifiers on Part B Claims
Whether you’re reporting GA, GX, GY or GZ, know that Medicare is watching closely.... Read more
Part B Mythbuster:
Check Out These Top 5 ABN Myths
These surprising CMS rules on ABN use are straight from Medicare policy. You’ve ... Read more
Surgical Assists:
PA Assisting at Surgery? Check These Tips to Bill Properly
Differentiate modifiers AS and 80 for billing success. When PAs serve as first assista... Read more
Part B Coding Coach:
Eliminate Hiatal Hernia Confusion With 2 Quick Cases
Save paraesophageal codes for stomach, other herniation. Don’t be fooled —... Read more
Breakdown Sliding vs. Paraesophageal Hiatal Hernia
What passes through hiatus is key. You can’t pick the proper hernia repair CPT&r... Read more
Physician Note:
Medicare Fraud 'Mastermind' Pleads Guilty to $29 Million Scheme
Plus: Don’t let email trip up your HIPAA efforts. When you think of a criminal m... Read more
In other news
Make sure your staff is thoroughly trained — and reinforced — about HIPAA-co... Read more
Physician Signatures:
Stamp Signatures Are A No-Go, But Attestation Statements Can Be Your Friend
Break down CMS’s requirements before you take a chance on the wrong use of signatu... Read more
Home Visits:
Is There A Doctor in the (Patient's) House? Code for Home Visits Easily With These Tips
Lean on 99341-99350 and POS 12 for these visits, experts say. If your image of a home ... Read more
Clip And Save:
Consider This Sample Signature Attestation Lingo
Novitas Solutions, the Part B MAC for eight states, says that although CMS does not requ... Read more
Appeals:
CMS Just Updated Medically Unlikely Edits--Do You Know How to Appeal Them?
Many MUEs make sense, but for those that don’t, you can fight back. By now, most... Read more
Part B Coding Coach:
Overcome 4 Ovarian Cyst Removal Myths by Highlighting the Approach
Here’s how to potentially add $208 to your bottom line. When an ovarian cyst rem... Read more
Physician Note:
Ready for Ordering/Referring Edits? CMS Is Not
Plus: Auditors accuse CIGNA of overbilling Medicare by $28 million. Part B practices h... Read more
In other news
If you think medical practices are the only entities under the microscope for improper b... Read more
E/M Coding:
Differentiate Office Visits From Admissions With These Quick Tips
Two-day services can be confusing—but there is a way to code visits that result in... Read more
Headaches:
2 Easy Steps Improve Your Migraine Documentation and Coding
Keep the E/M coding guidelines close at hand when seeing migraine patients. If your ph... Read more
Keep Diagnoses at Top of Mind With Migraines
Plus: Know how to report these headaches under ICD-10. When reporting a migraine, the ... Read more
Hearing Services:
Distinguish 92551 From 92552 With 3 Quick Tips
Plus: Get an additional $32 for a threshold exam if justified. You can stop unfamiliar... Read more
Part B Coding Coach:
4 Tips Take the Stress Out of Female Incontinence Procedure Coding
Scour the documentation for pertinent details to direct your coding. Stress incontine... Read more
Physician Note:
Texas Doctor Faces Up to 10 Years in Jail for Changing Dx Codes
Plus: Patient insists on service but refuses to sign ABN? Get a witness. Fraudulent me... Read more
In other news
Does your practice have to be on the hook if a patient refuses to sign an ABN? No, says ... Read more
Denial Management:
Could You Afford to Have 1.85 Percent of Your Claims Denied?
Many practices still skirting PECOS regs, one MAC finds You have only a few weeks to g... Read more
Billing:
Maintain the Physician-Biller Relationship to Keep Claims Flowing
Breaking the communication between billers and practitioners could cause your income to ... Read more
Part B Coding Coach:
Keep This Laryngoscopy Primer on Hand for Distinguishing Three Types
Highlight these key words to know what you should report when. If you’re not cer... Read more
To Bill Same-Day E/M Service, Documentation Must Justify Scope
Check out this handy list of 10 scope indications. When your physician performs an E/M... Read more
Physician Note:
OIG Asks Government for An Additional $82 Million for CMS Oversight
Plus: This hospice fears its protected health information fell into the wrong hands. I... Read more
In other news
A North Carolina hospice is notifying patients of a possible HIPAA breach, and for once ... Read more
Cash Flow:
5 Hidden Income Opportunities Ease the Pain of Sequestration Cuts
Your Medicare pay was slashed by two percent on April 1—these tips will help bring... Read more
Dermatopathology:
4 Tips Maximize Your Mohs Pay
Don’t miss add-ons and separate services. When is a pathologist not just a patho... Read more
Part B Coding Coach:
Make the Most of April Updates to Angiography, Extracorporeal Circulation, and TED
All three changes are retroactive to January 1. Medicare Physician Fee Schedule (MPFS)... Read more
Physician Notes:
Diagnosis Coding Rules Will Change As You Sleep
Plus: Prepare for therapy reviews. As most coders are aware, the ICD-10 diagnosis codi... Read more
In other news
If you furnish outpatient Part B therapy, prepare now for some major headaches billing f... Read more
Practice Management Special Issue:
Spearhead Your Denial Management Efforts With a 'Top 10' Rejections List
Sharing ‘Top 10’ information in physician-staff meetings can help eliminate ... Read more
Divide and Conquer Carriers to Solve Your Denial Woes
3 expert tips help you eliminate the root causes of your rejections Denial management ... Read more
Billing:
Test Your Billing Skills With This Quiz
Think you have a handle on the barrage of billing rules for workers’ comp, motor v... Read more
Billing Quiz:
How Did You Fare on Our Billing Quiz?
Match your responses from the quiz against these answers. Did you take our quiz o... Read more
Physician Note:
Missouri Doctor Faces Sentence for Chronic Upcoding
Plus: Submit your suggestions on SNF therapy payments. A Missouri physician and her hu... Read more
In other news
If you have ideas about how CMS should pay for therapy services in skilled nursing facil... Read more
Contracts:
Weak Contract Negotiations Equal Weak Profits: Sharpen Both With 12 Tips
Hint: Establish a timeline for contract completion - and stick to it Non-Medicare insu... Read more
Reader Question:
Find Out Whether You Can Report 57800 and 57454 Together
Question: Our doctor specifies that the cervical canal has to be dilated (57800) in... Read more
Reader Question:
Know How to Code Toenail Excisions and Cauterizations
Question: A patient presents for a follow-up of an ingrown toenail. The physician finds ... Read more
Medicaid:
Self-Attest Soon for Primary Care Medicaid Pay Boost
Don’t worry if you haven’t seen pay raises yet—they’ll be retroa... Read more
Sequestration Cuts Won't Impact Medicaid
Effective April 1, assuming the government does not act in time to reverse the "seq... Read more
Global Pay:
Know Your Patients' Payers to Capture Legitimate Post-Op Revenue
Don’t automatically skip billing for post-surgical infection care. Wondering whe... Read more
ICD-10:
Know How You'll Report An Infected Surgical Wound Under ICD-10
Hint: Identify the infection and document an infected device, if any.     ... Read more
Part B Coding Coach:
Are You Documenting Your Critical Care Time Accurately?
Check out these resources to see if your policies are in order.     Ever... Read more
Keep These CMS and MAC Critical Care Documentation Guidelines Handy
Ensure you’re following the rules by reviewing these 11 citations and quotes from ... Read more
Physician Note:
CMS Grants 'CLIA-Waived' Status to 9 Lab Tests
Plus: Physician partners can’t sign home health face-to-face documentation. Part... Read more
In other news
Physician documentation practices that work in other areas just won’t cut it for t... Read more
Reader Question:
Non-Par Medicaid? Bill the Patient
Question:We have recently had an influx of patients presenting with a commercial insuran... Read more
Reader Question:
Know How ASC Should Bill Elective Cancellation
Question: I know you shouldn’t report modifier 73 for elective cancellation of a p... Read more
Ordering/Referring:
6 Steps Help You Reduce PECOS Edit Losses
Tip: Check your current referring info to avert financial crisis in May. You’d b... Read more
Appeals:
Appeal Modifier 25 Denials With Confidence Using These 4 Strategies
Hint: Pay attention to global period assignments. Denials are a part of every practice... Read more
Surgery:
Intraoperative Neurophysiology Monitoring: Bill New Codes 95940-95941 Correctly
Beware: This terminology prevents you from billing IONM plus surgery. If your physicia... Read more
Part B Coding Coach:
Add-On Codes Are Adding Trouble to 2013 EP Study and Ablation Claims
You have to dig deep to discover allowed primary codes for mapping and programmed stim. ... Read more
Physician Note:
CMS Allows TCM Code Reporting for Both New and Established Patients
You’ve got questions about the new transitional care management (TCM) codes 99495-... Read more
Denial Management:
CMS Confirms Ordering/Referring Edits Will Start May 1
Ensure that your doctors and those who order/refer are the correct specialty and that yo... Read more
Part B Payment:
CMS Offers Bilateral Pay Boost for 10 Procedures
Plus: G9157 is now payable under the Fee Schedule. Not all fee schedule changes are ba... Read more
Add-on Codes:
Know the 3 Types of Medicare Add-on Codes
CCI pays attention to the add-on tables. Shouldn’t you? CPT® doesn’t d... Read more
Part B Coding Coach:
Avert Payer Denials for New Psych Codes With These Pointers
Researching the new rules is the key. If coping with learning the new codes for psycho... Read more
Physician Note:
Government Trying to Recoup More Medicaid Dollars
Plus: Physician ordered to pay $6.7 million and spend 50 months in federal prison. If ... Read more
In other news
Whether you launder the money or not, ill-received government health care dollars will a... Read more
Reader Question:
Know the Path Codes for Scar Examinations
Question: When our pathologist examines scar tissue, or tissue with a diagnosis related ... Read more
Reader Question:
Get the Facts in Absence of Insurance Card
Question: How should I handle a patient who has new coverage but has not received an ins... Read more
Reader Question:
Diagnostic vs. Screening X-rays
Question: If we routinely perform extra radiological views on patients with a history of... Read more
Part B Pay:
Impact of Sequester Cuts Won't Hit Medicare Until April
Still, however, a two percent cut could damage your income significantly. If you&rsquo... Read more
Privacy:
Would A HIPAA 'Kiosk' Help With Patient Record Requests?
Consider dedicating one office computer to patient record reviews. Allowing your patie... Read more
Practice Management:
Don't Keep Patients Hanging on the Line With These 3 Phone System Pointers
Tip: Make sure a live person answers the phone during business hours. Medical practice... Read more
Part B Coding Coach:
64479-+64484: Heed These Warning Signs to Safely Navigate Injection Pitfalls
Transforaminal epidural injections are a major audit target, so plan ahead for coding su... Read more
Physician Note:
Could May 1 Be Final Deadline for Ordering/Referring Edits?
Plus: Want your say on the new diagnosis changes? Join CMS’s latest seminar. Par... Read more
In other news
ICD-10 isn’t very far away anymore, and CMS wants you to have all the latest news.... Read more
Reader Question:
Check the Regs for 'Co-Therapy'
Question: Our facility is taking extra care to avoid duplication of services between phy... Read more
Reader Question:
Use Lab Encounter Codes Sparingly
Question: One of our patients who need to undergo a CT scan with contrast is required to... Read more
Annual Wellness Visits:
CMS Begins Recouping Overpayments Made for AWVs
When both the facility and the doctor bill for the same service, Medicare ends up double... Read more
Billing:
One Billing Question, 4 Steps to Resolution
Don’t take appeals at face value--research before you write off. It happens to e... Read more
Use This 5-Step Checklist to Simplify Your Secondary Claim Issues
Start with all insurance cards, not just Medicare. If your practice’s internal a... Read more
Part B Coding Coach:
Collect for Hemoccult Testing With These Expert Tips
Hint: Know the reason for the testing before you nail down a code. If you want to keep... Read more
Physician Note:
Physician Who Alters Medical Record Is Charged With Obstruction of Justice
Plus: Some hospice claims will reject thanks to new MAC edits. Ever wondered why follo... Read more
In other news
You’ll soon need to tighten up your tracking of monthly claim submissions for each... Read more
Reader Question:
E/M Format Shouldn't Matter
Question: My physician reported established patient office visit code 99213, but the onl... Read more
Reader Question:
Know How to Report Polyp Snare Without Removal
Question: Our physician performed a colonoscopy and removed a polyp by hot snare. He com... Read more
Reader Question:
Can You Bill E/M Without Vitals?
Question: A daughter brought her mom to our office. The mother was seen by the doctor, b... Read more
Reader Question:
Know the Dx for Post-LASIK Cataracts
Question: A patient who has had LASIK surgery now has cataracts. One of our ophthalmolog... Read more
Reader Question:
Bandages Won't Typically Count As 'Strapping'
Question: A patient reports with a swollen right ring finger that she injured while catc... Read more
Local Mac Spotlight:
This Carrier's Still Developing TCM Rules
Plus: Functional reporting G codes for therapy will be required in July. It’s cl... Read more
Compliance:
Government Rakes in Record-Breaking $4.2 Billion From Fraudulent Billers in 2012
For every dollar spent on health care fraud investigations, the government recovered a w... Read more
ICD-10:
One Old Rule is New Again Under ICD-10
Learn step-by-step instructions to get into the swing of new diagnosis coding. As you&... Read more
Part B Coding Coach:
Don't Forfeit Payment for Heel Spur Treatments
Hint: Check for casts and other devices. If you’re reporting heel spur excision ... Read more
Physician Note:
New Legislation Aims to Reform SGR System
Plus: DOJ nails nurse who submits claims even though facility is closed for snow day. ... Read more
In other news
Providers who intend to submit claims to Medicare should at least confirm that their cli... Read more
Reader Question:
This MAC Won't Allow NP to Bill X-Ray Technical Component
Question: We submitted a claim to Medicare for an x-ray’s global fee under our nur... Read more
Reader Question:
Note Return to OR for Global Procedures
Question: Our physician performed a percutaneous hardware removal during the global peri... Read more
Reader Question:
Don't Look for Clip Placement Pay
Question: We reported +19295 (Image guided placement, metallic localization clip, percut... Read more
Compliance:
OIG Slams Practices for Billing Full Vials of Multi-Use Drugs
Warning: Modifier JW does not apply to multi-use vials. Waste not, want not. That&rsqu... Read more
Patient Care:
Make Sure Test Results See the Light of Day
No news may not be good news to every patient. When your patients give up some of thei... Read more
E/M Quiz:
Find Out How Your E/M Coding Skills Rank
This quick quiz will evaluate whether your E/M codes are on the straight and narrow. T... Read more
Part B Coding Coach:
Master Diagnostic Test Supervision, Easy as 1-2-3
Know where to go to untangle Medicare’s layers of definitions and numerical indica... Read more
Physician Notes:
CMS Launches 'Bundled Payments for Care Improvement' Initiative
Plus: Software vendors must heed HIPAA rules now more than ever. CMS is testing a new ... Read more
In other news...
Your software vendor will face steeper penalties for HIPAA breaches, as recent changes t... Read more
Reader Question:
Know Your Moderate Sedation Options
Question: Our provider administers epidural steroid injections and pain pump trials... Read more
CMS Debuts New Telehealth Code, Offers ICD-10 Insight
Latest Open Door Forum also shed light on transitional care management date of service r... Read more
Modifiers:
This MAC Will Ask for Additional Documentation if You Append Modifier 22
Make sure the physician documents the extra work, and doesn’t just say "see o... Read more
ICD-10:
Prepare Now to Adjust Your Influenza Coding Under ICD-10
Flu season is busy now, but may be even more chaotic if you don’t know how to code... Read more
Part B Coding Coach:
Clear Up Pedicle Flap Confusion with 15740 Changes
Named vessel is key. Changes to CPT® 2013 "other flaps and grafts" instr... Read more
Physician Note:
Congress to Consider Repeal of Medicare Payments Advisory Board
Plus: OIG quickly spending Recovery Act funds. Just what physicians need is another gr... Read more
Question:
Appeal Claims Denied Due to 'Not Recognizing' New Codes
Question: We already have payers that are rejecting the new CPT® codes. They are not... Read more
In other news...
The HHS Office of Inspector General is spending Recovery Act Funds like water, according... Read more
Reader Question:
Local Coverage Decisions Trump NCDs
Question: Our local MAC has a policy stating that only physicians can perform a particul... Read more
Reader Question:
Be Cautious When Sending Emails
Question: I recently heard that the HIPAA privacy rule was changed and it now prohibits ... Read more
Reader Question:
Reporting Units Trumps Use of Modifier 76
Question: We use modifier 76 (Repeat procedure by the same physician other qualified hea... Read more
Reader Question:
Select Actual Service Date for Test Interpretations
Question: The hospital performed an EKG on Jan. 1 and our cardiologist interpreted it on... Read more
Overpayments:
Medicare Now Has 5 Years to Request Money Back From Your Practice
Previous 3-year lookback period was extended with ‘fiscal cliff’ legislation... Read more
RAC Audits:
RACs Rack Up Additional Focus Areas for the New Year
Mohs, cataract surgery, on the radar screen for these auditors. With the new year come... Read more
Compliance:
OIG Asks CMS to Recoup $91 Million From Practices Who Treated Patients 'Unlawfully Present' in U.S.
Another $33 million was erroneously paid for prisoners’ medical care. If you sen... Read more
Part B Mythbuster:
'I Spent An Hour With the Patient' Won't Hold up Unless It's in the Record
Check out this case study and figure out why it doesn’t qualify for time-based cod... Read more
Part B Coding Coach:
Considering LEEP Code? Check Surgeon's Documentation First
Reporting 57460 and 57461 means having one important phrase in your documentation. If ... Read more
Physician Notes:
CMS Urges Contractors to Add ICD-10 Codes to National Coverage Determinations
Plus: CMS podcast reminds practices that phase 2 of ‘ordering/referring’ edi... Read more
In other news...
If a new CMS podcast is any indication, the agency might soon follow through on its long... Read more
Reader Question:
Determine Who Can Perform Record Amendments
Question: If and when the patient’s electronic health medical records needs to be ... Read more
Reader Question:
Know When to Add Critical Care Time
Question: When two physicians of the same specialty and group practice provide critical ... Read more
Inpatient Coding:
Avoid Writing Off Your Death Pronouncement Services
Discharge codes are appropriate, CMS advises. No physician ever wants to lose a patien... Read more
Part B Revenue Booster:
Keep Body Part Descriptions Specific to Avoid Paybacks
Gut vs. stomach vs. GI -- the differences matter. With the OIG continuing to rev... Read more
Front Office Strategies:
3 Steps Help Your Patient Check-Ins Move More Smoothly
Make it your policy to ask for insurance cards at each visit. When a new patient repor... Read more
CCI 19.0:
Latest CCI Edition Targets New CPT Codes
Most specialties under scrutiny with the new edition of CCI. With the new year comes ... Read more
Physician Notes:
CMS Confirms Modifier 62 Is Required With Most TAVR Codes
Plus: Toenail trims lead to 55-month prison sentencing for one podiatrist. New codes f... Read more
In other news
Your podiatrist is absolutely within his rights to perform toenail trims--but he certain... Read more
Part B Coding Coach:
Multiple Fractures Could Prompt Higher Pay
Apply this sequencing advice to ethically maximize reimbursement. Not paying attention... Read more
Reader Question:
Determine What You Can Report With IPPE
Question: I’m trying to understand what we can bill to Medicare during a patient&r... Read more
2013 Payment:
Last Minute Congressional Vote Reverses Across-the-Board Pay Cuts
Medical societies still hopeful for new formula to halt this annual nail-biter. As man... Read more
Part B Revenue Booster:
Get in the Habit of Taking A History That Won't Repeat Itself
These 5 tips will lead the way to taking the perfect history in your documentation. Th... Read more
Use These Tips to Determine the Level of PMFSH
For coding purposes, the history portion of an E/M service requires all three elements&n... Read more
Part B Coding Coach:
CMS Fails to Reimburse 8 New Pathology Codes
To use or not to use the new MAAA codes: that is the question. As with last year&rsquo... Read more
Physician Note:
Practice Size Doesn't Matter When It Comes to HIPAA Settlements
Plus: Medicare focusing on improper payments for illegal immigrant patients. If you think... Read more
In other news...
Medicare payments for illegal immigrants are under the microscope, as the OIG identified... Read more
CPT® 2013:
MAAA Line-up: Get Familiar With 9 New Algorithm Codes
The following new CPT® 2013 codes represent individual MAAA tests: 81500 --... Read more
Reader Question:
Special Codes Will Alert You of New Discounts
Question: I read your article about Medicare’s new policy of applying the Multiple... Read more
Reader Question:
Not All Pain is 'Typical'
Question: What’s the diagnosis code for "atypical" chest pain? Answer:... Read more