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Part B Insider (Multispecialty) Coding Alert

Get These 7 Compliance Plan Tips Straight From the OIG's Medical Director
The Affordable Care Act requires a firm compliance plan, so use these tips as a guidelin... Read more
Follow This Compliance Director's Advice
As you use Dr. Taitsman’s advice to create a compliance plan, keep the following q... Read more
Follow 5 Steps to Ensure You're Handling Specialist Payment Arrangements Correctly
Here’s your guide to splitting service fees with other physicians.  Special... Read more
Part B Coding Coach:
5 Expert Answers Help Clarify Your Top Eye Coding Questions
Read these frequently asked questions before coding your next eyelid procedure claim. ... Read more
Physician Notes:
This MAC Outlines How to Handle Revalidation Requests
If you enrolled in Medicare before March 25, 2011, the Affordable Care Act requires you ... Read more
Reader Question:
Document An Incomplete ROS
Question: When we have an established patient that comes into our office that needs to b... Read more
E/M Coding:
Can you Spot the Problem With This E/M Code Assignment?
A thorough read is all it takes to identify the most glaring issue. Sometimes, we&rsqu... Read more
Part B Documentation:
Unclear Organ Site Documentation Could Force Your Claim to Be Downcoded
Physicians should strive to be more precise in E/M documentation. The OIG and Part B M... Read more
CPT® 2015:
Open Up Carotid Artery Stent Coding Options
Don’t separately code angioplasty. When your cardiologist places an intravascula... Read more
Right, Left, Bilateral Options Expand Carotid Artery Stenosis Choices
433.10 leads to more choices. When your cardiologist performs angiography, catheteriza... Read more
Part B Coding Coach:
Recording Time in Documentation is Key to Pulmonary Rehab Pay
These ‘G’ codes may be mysterious, but we’ll help you answer your top ... Read more
Physician Notes:
'No Show' Physician Faces 5 Years in Prison Over $13 Million Scheme
A Brooklyn, NY healthcare clinic was raking in cash over the past several years, despite... Read more
Reader Question:
Pinpoint How to Code Varices Treatment
Question: What methods can gastroenterologists use to treat esophageal and gastric ... Read more
Reader Question:
Friction Burns Are Still Coded As Burns
Question: A patient presented with multiple friction burns from a treadmill. He had... Read more
Reader Question:
Look to the Future for Cystitis ICD-10 Codes
Question: Our physician reported interstitial cystitis in a patient who had hematur... Read more
2015 Coding Quiz:
Will You Be Able to Code These Services Next Year?
Take this 2015 coding quiz to ensure that you’re ready for the calendar to turn. ... Read more
Q Modifiers Could Be Key to Podiatry Reimbursement
These modifiers tell the payer that you aren’t performing routine foot care. If ... Read more
Part B Coding Coach:
Follow These 4 Tactics to Gain Additional Dollars for Concha Bullosa Work
Yes, you can get paid for 31240 with other procedures.  If you’re getting d... Read more
Physician Notes:
CMS: Submit Requested Documentation Within 45 Days, or Face Denials
Plus: CMS releases 2015 therapy cap amounts. If your payer is performing a pre-payment... Read more
In other news
Coders and therapists may not like hearing about therapy caps, but they know it’s ... Read more
Reader Question:
You May Be Behind on Your Ablation Codes
Question: We used to bill radiofrequency ablation codes 64633, 64634, 64635, and 64... Read more
Reader Question:
This Quick Tip Helps Distinguish Mastectomy Codes
Question: I’ve heard that the distinguishing difference between 19303 and 193... Read more
Reader Question:
Ask Payer Preference for Modifier 91 vs. 59
Question: Our lab performed a basic metabolic panel with total calcium, and the phy... Read more
Reader Question:
Incorporate G Code Into Home Sleep Study Claim
Question: I am coding for a physician who is interpreting sleep studies. The physic... Read more
Reader Question:
Know the Rules for Multiple Critical Care Doctors
Question: Recently, our facility admitted an established heart patient with acute r... Read more
Part B Payment:
CMS Outlines the 6 Conditions of Chronic Care Management Payment
Plus: Here’s why the conversion factor looks slightly different in January than no... Read more
Patient Access:
Dispel 3 Common Myths to Properly Provide Interpreter Services
Passing the cost on to the patient is considered taboo. Your practice likely serves ma... Read more
Don't Miss These Vertebral Fracture Diagnosis Coding Changes Next October
Tip: Confirm underlying disease and site before you pick up the right code. Vertebral ... Read more
Part B Coding Coach:
Dodge Double-Billing Interp Claim Mishaps With This Advice
You may not always be able to report the CPT® code, but discover this big benefit. ... Read more
Physician Notes:
CMS Reminds Practices of 'GW, GV' Modifier Requirements
Plus: Physicians allegedly took kickbacks as incentives to use cardiac products. Recen... Read more
In other news
If a medical supplier offers you a financial incentive to use its products, turn around ... Read more
Reader Question:
Accurately Calculate Time Spent
Question: If a doctor bills a 99204 based on time (45 minute visit with more than 50 per... Read more
Part B Payment:
Final Fee Schedule Confirms Phasing out of Global Periods
Plus: You will see an extra $40.39 for every month of chronic care management. When CM... Read more
OIG Sets Sights on Hospital Admissions, Place of Service Coding
The latest Work Plan focuses on several new areas. This year, you’ll want to mak... Read more
Part B Coding Coach:
Expert Answers to Top Five Questions Ease Your Integumentary Biopsy Reporting
You may lose up to $75 per procedure for any erroneous reporting. Whenever your provid... Read more
Physician Notes:
CMS Clears up the Most Common ICD-10 Myths
Plus: MACs to increase minimum dollar amounts for appeals in 2015 You’ve heard t... Read more
In other news
The minimum dollar amount required for your appeal to go before the ALJ or federal court... Read more
Reader Question:
Know How to Report Single Blepharospasm Injection
Question: How would I report a Botox injection to control blepharospasm in only one... Read more
Reader Question:
Choose Thin-Prep Pap Codes by Screening Technique
Question: I’m trying to select the proper code for the thin-prep Pap tests th... Read more
Part B Records:
Auditors 'Vexed' by Providers' Lack of Documentation
Want your audit to be over quickly? Hand over the records. If you’ve ever wonder... Read more
Patient Interaction:
Answer These Top 5 Part B Questions From Patients
Make sure your patients are well-informed on their Medicare benefits. Although much of... Read more
Part B Coverage:
Could New Legislation Open Doors to Telehealth Payments?
Congress’ actions could be key to reimbursement for this service. The Medicare T... Read more
Part B Coding Coach:
Tests That Your Ob-Gyn May Order Highlight the New CPT® Changes for Next Year
Infertility clinics, rejoice: This category III code becomes a category I code. You wo... Read more
Physician Notes:
This MAC Highlights the Most Common Prolonged Service Errors
Remember to bill each add-on code with its companion code. Reporting prolonged service... Read more
Reader Question:
Avoid 90662 for Patients Under 65
Question: We reported 90662 for a patient’s Fluzone shot and it was denied. T... Read more
Update Your HIPAA Policies to Reflect New Same-Sex Marriage Rules
OCR augments the definitions of spouse, marriage, and family member. The U.S. Supreme ... Read more
Pulmonology Coding:
Let CMS's Vent Management Rules Guide Your Code Selections
Documentation determines choice between E/M and ventilation management coding. You may... Read more
Part B Coding Coach:
Latest CCI Edition Makes Scores of Changes to Ob-Gyn Codes
You may not be able to use a modifier to bypass the majority of them. The Correct Codi... Read more
Physician Notes:
HIPAA audits reveal that smallest entities had most trouble staying compliant
If you’re wondering how covered entities fared during the first round of audits by... Read more
Listen for Medicare Approvals When You Report Audiology Codes
Remember physician order to ensure you’ll collect for these services. If your pr... Read more
E/M Coding:
You Must Meet Both the "Critical" Illness and the Time Thresholds to Accurately Report Critical Care
Review these strategies to avoid auditors’ scrutiny.  Critical care coding ... Read more
Part B Coding Coach:
Expect Contrast Bundles Thanks to New CCI Release
Include venous access, radiology in many procedures. You’re facing the last annu... Read more
Physician Notes:
CMS Keeps Part B Deductibles at Same Level
Plus: Look beyond HIPAA when data breaches occur. You won’t have a new number to... Read more
In other news
HIPAA isn’t your only compliance worry when it comes to patients’ health inf... Read more
Reader Question:
Know How to Prep for 2015 Advanced Planning Codes
Question: I saw that CPT® 2015 includes advance care planning codes. Can you ex... Read more
Reader Question:
Remember to Report Primary Reason for Procedure First
Question: Our GI just performed a colonoscopy on a Medicare patient for control of bleed... Read more
Part B Documentation:
New MAC Tip Reminds Practices What the Nurse Can--and Cannot--Document
Hint: Documenting HPI is the job of the doctor or NPP. Your nurse might be quite adept... Read more
Differentiate Skin Substitute Graft From Dressing with Modifiers JC, JD
Talk to your payers to see if Q codes need a modifier to prevent denials. Because Medi... Read more
Advance Beneficiary Notices:
Get the Four ABCs of ABNs
Learn how to use the ‘courtesy’ modifier.  You may often face this hu... Read more
Part B Coding Coach:
Cardiology Codes for S-ICDs Will Feature Big Changes in 2015
Don’t miss how system insertion/replacement coding changes in the new year. You&... Read more
Physician Notes:
Don't Forget Former Staff for HIPAA Compliance
You still have to worry about employees’ laptops and portable devices when it come... Read more
Reader Question:
Can I Share PHI With Another Doctor?
Question: Our physician wants to talk to a specialist about a patient’s condi... Read more
These 3 ICD-10 Answers May Surprise You
Hint: Forget everything you know about ICD-9’s ‘excludes’ codes after ... Read more
Follow These Modifier 26 Dos and Don'ts to Keep Claims Flowing
Master your professional component claims with these quick tips Modifiers 26 and TC go... Read more
3 Lessons You Can Learn From These Medicaid Audits
Follow this advice to make sure you aren’t in the hot seat. The word “audi... Read more
Part B Coding Coach:
Steer Clear of the Multiple-Endoscopy Limitations With These Pointers
Don’t get confused between multiple-procedure and multiple-scope rules. If you&r... Read more
Physician Notes:
Wondering Why Your PQRS Payment Is Low? Look at Sequestration
CMS has finally released the 2013 Physician Quality Reporting System (PQRS) ince... Read more
In Other News:
Is Your Facility Reporting Abuse & Neglect Allegations?
Iowa Nurse Heads to Federal Prison An Iowa-based nurse will be heading to federal pris... Read more
Reader Questions:
Nail Down Chiropractic Codes
Question: A patient presents with a subluxation of the lumbar and sacral spine with... Read more
Reader Question:
Say Yes to EMG, NCS on Same Day
Question: Can we report nerve conduction studies with electromyography? Are modifie... Read more
Reader Question:
Injection With Psychotherapy Depends on CCI
Question: If our psychiatrist (or our nurse) is providing the patient an injection ... Read more
Part B Revenue Booster:
Stop Repeatedly Making This $35 Mistake
Document your discharge services properly or you’ll be forced to downcode. How m... Read more
Injection Coding:
Study These 5 Injection FAQs to Perfect Your Accuracy
From pain management injections to TB testing, we’ve got your answers. Although ... Read more
Watch Out For Sophisticated Malware Breaching Your Systems From Overseas
Pay attention: Massive breach teaches you four crucial lessons. The latest HIPAA breac... Read more
Part B Coding Coach:
Give Your Multiple Infusion Reporting A Much-Needed Makeover
Submit one initial service code and primary purpose, not medication sequence, matters mo... Read more
Incentive Programs:
CMS Reps: Deadlines Fast Approaching to Avoid Pay Cuts
Act now to avoid penalties if you haven’t already started participating Your pra... Read more
Look for Updated Hospice Attending Physician Rules
Tip: Make sure your election form includes language indicating patient choice. If you ... Read more
CMS Forms:
Group Enrollment? CMS-855-B Is Your New Best Friend
Knowing which form applies to your clinic or group is the first step of the process. I... Read more
Part B Coding Coach:
CPT® 2015 Includes Several Important Orthopedic Surgery Changes
Don’t miss the new terminology for cervical disc replacement. Orthopedic surgeon... Read more
Physician Notes:
Applications Open for ICD-10 End-to-End Testing
The fact that ICD-10 won’t take effect until next year is no matter for local MACs... Read more
Part B Coverage:
Medicare Launches New Code for Hepatitis C Screening
CMS now provides coverage for these tests in certain populations. After several months... Read more
Part B Mythbuster:
Abolish These Modifier 27 Myths
Hint: Although this modifier applies to outpatient services, it won’t work in the ... Read more
Hospice Coding:
Strike Nearly 40 Dx Codes off Your List for Hospice Claims
Debility, Adult Failure to Thrive, Dementia codes and more will get your claim kicked ba... Read more
Part B Coding Coach:
Jumpstart Your General Surgery Coding for Next Year
Expect systematic digestive tract changes effective Jan. 1. Forewarned is forearmed, s... Read more
Physician Notes:
CMS Explains Difference Between NPI and PTAN
Plus: AHA asks HHS to halt OIG audit practice of extrapolation. You know just where to... Read more
In other news
Nobody likes to get audited by the OIG, but the American Hospital Association (AHA) has ... Read more
Reader Question:
Show Necessity for Multiple Polyp Removal Codes
Question: Recently, our gastroenterologist removed three polyps during a colonoscop... Read more
Reader Question:
Avoid Malignancy Codes When Not Accurate
Question: Our physician is treating a patient for lung cancer. The patient has no b... Read more
CPT® 2015:
Look for Revised, Updated Chronic Care Management Codes in January
Plus: You’ll find new flu shot coding options. Although 2015 might sound rather ... Read more
Part B Errors:
Documentation for Obesity Counseling Sorely Lacking, CMS Says
Don’t forget the ‘Five A’ strategy in your documentation. When CMS e... Read more
Avoid These 3 Common Mistakes in Your Preventive Care Coding
Report your well-patient services properly to collect accurate reimbursement. Obesi... Read more
Part B Coding Coach:
Engage These 3 Challenges for a Clean Endometrial Cancer Surgery Claim
You need to know whether your ob-gyn did a limited or complete lymphadenectomy. If you... Read more
Physician Notes:
Unnecessary Services Lead to Criminal Charges for Cardiologist
Plus: Check out new interventional cardiology specialty code. An Ohio cardiologist is ... Read more
In other news
Interventional cardiologists who struggled over which specialty code to report on Medica... Read more
Reader Question:
76140 Payment Remains Tricky
Question:  We are receiving repeated denials for code 76140. How can we earn for th... Read more
Medicare Errors:
E/M Errors Plague Medicare Claims Accuracy
CERT results reveal $38.2 billion in improper Medicare payments--$1.4 billion of which w... Read more
Frequently Asked Questions:
5 Ways to Perfect Your Cold and Flu Claims
Hint: E/M codes and vaccines may not always go hand-in-hand. The cold weather is loomi... Read more
Note These Additional CERT Areas of Concern
Although E/M claims ranked very high among Part B errors on the government’s most ... Read more
ICD-10 to Bring Colon Polyp Codes Into Modern Era
Distinguishing between non-neoplastic and neoplastic polyps will save your claims. Nex... Read more
Part B Coding Coach:
Check FEVAR, Stent and Embolization Codes to Reflect the Latest Changes
Expanded 37241-37244 guidelines aim to help you capture catheterization pay. The time ... Read more
Physician Notes:
CMS Reveals ICD-10 Testing Dates
As promised, CMS has finally revealed the dates of its latest ICD-10 testing opportuniti... Read more
CMS Debuts 4 New Modifiers to Substitute for -59
Medicare will still accept modifier 59, but use the new modifiers instead when applicabl... Read more
Patient Privacy:
Include Photography Rules in HIPAA Policy
Plus: Laptop theft places hospital in treacherous waters. Recent class-action lawsuits... Read more
Coding Quiz:
Can You Spot Which 99211 Rules Are Accurate?
Hint: You can’t automatically tack 99211 on to every service just because the nurs... Read more
Know These 99211 Facts Before You Submit Your Claim
Even if you aced our 99211 quiz, it’s a good idea to brush up on some basic facts ... Read more
Part B Coding Coach:
Check out How to Code These 4 Common EEG Scenarios
Here’s how to differentiate ‘drowsy’ or ‘asleep’ choice. ... Read more
Physician Notes:
CMS Launches New ICD-10 Training Webcast Series
Plus: OIG outlines self-disclosure protocol. Your coders are well-versed in the nuance... Read more
In other news
Contrary to popular belief, contractors are required to self-disclose possible violation... Read more
Reader Question:
Differentiate 77002 From 77003
Question: What is the difference between the codes 77002 and 77003? Is it based on ... Read more
CMS Updates ICD-10 Instructions
New advice more accurately mirrors the current ICD-9 regulations. Although ICD-10 won&... Read more
Surgical Coding:
Your 5 Biggest Global Period Questions Answered
Unlisted global? Ask the payer. With the recent news that CMS may be preparing to prac... Read more
Patient Privacy:
Portable Device Theft Gets Spotlight in HITECH Reports
HHS collected millions in HIPAA penalties in recent years. HIPAA breaches caused by ... Read more
Part B Coding Coach:
Use this Case Study to Shore up Your Physiotherapy Severity Modifier Coding
Don’t forget to report the non-payable G codes, too. While G8990-G8992 are only ... Read more
Take 3 Steps to Avoid Punishing HIPAA Penalties
Look for compliance clues in two new government reports. Recent HIPAA reports manda... Read more
Physician Notes:
CMS Issues New 'K' Codes
Plus: This MAC clarifies modifier 22 submissions. If you simply can’t wait until... Read more
In other news
If you consider yourself modifier 22’s biggest fan, chances are high that your MAC... Read more
E/M Coding:
Get These 5 E/M Answers--Straight From the Source
Know who needs to sign incident to records—and who doesn’t. When it comes ... Read more
CMS Solidifies 2015 Date, Clarifies Testing
The agency also offers an alternative claim submission method. Although the latest ICD... Read more
Part B Mythbuster:
Lack of Symptoms May Not Sink Your E/M Claims
No pain? You may still gain. Myth: You can’t bill an evaluation and management c... Read more
Part B Coding Coach:
Excisions, Perineoplasties, Anoscopies, and E/M Top Ob-Gyns' CCI Target List
Pay attention to the modifier indicator for each edit — or face a denial. You ma... Read more
Physician Notes:
Reporting Inpatient Services Instead of Outpatient Cost This Hospital $98 Million
Plus: HIPAA penalties might leave you broke, despite insurance coverage.  When yo... Read more
In other news
If your company undergoes a HIPAA investigation, will your directors and officers insura... Read more
Reader Question:
Even Local Relocation Could Impact Insurers
Question: Our practice is going to be moving a few towns over, which means we will ... Read more
Reader Question:
3 Steps Help Tackle TEE Denial
Question: I get a denial when I report 93312, +93320, and +93325 together. Can you ... Read more
Medicare Funding:
Medicare Projected to Go Broke in 2030, Trustees' Report Says
Part A is poised to run out of money — but it’s four years later than previo... Read more
E/M Coding:
Miscoding ROS Level Could Cost You $91
Differentiate extended and complete systems review to judge if 99204 wins out over 99203... Read more
Find Positive Answers for 'All Others Negative'
Here’s how to handle ROS black holes - and avoid scrutiny There’s no quest... Read more
Anesthesia Medical Direction:
Work With Your Carrier to Define 'Short Duration' and Meet Criteria
Know whether extra services help or hurt your claim Your anesthesiologist is medically... Read more
Part B Coding Coach:
Refer to These Rotator Cuff Upgrade Strategies to Guarantee Your Claim's Success
Is your payer’s advice lacking? Here’s how to create internal guidelines for... Read more
Physician Notes:
HIPAA Penalties Heat up
Plus: Excluded Employee Costs Hospice Six Figures HHS continues to keep HIPAA enforcem... Read more
Part B Payment:
CMS Proposes Eliminating Mammogram G Codes
Plus: You could see moderate sedation changes in January. The potential updates to Med... Read more
Part B Mythbuster:
Yes, You Can Collect Coinsurance on the Service Date
For Part B, you may need to collect after the service—but before the patient walks... Read more
Part B Coding Coach:
CCI Takes Aim at Urology Codes
Good news: Most new edit pairs will allow a modifier. Round three of the 2014 Correct ... Read more
Physician Notes:
CMS Finally Releases Stats on ICD-10 Testing
Plus: Diagnosis freeze may thaw. Although many practices were eager to hear news about... Read more
In other news
Medicare has extended its ICD-9 code freeze through Oct. 1, 2015, but that doesn’t... Read more
Reader Question:
Get to Know Charge Capture
Question: What is charge capture and how do we incorporate it into our practice? Answe... Read more
Reader Question:
Negative Notation Could Be Positive
Question: Our physician writes “all others negative” for the ROS on eve... Read more
Part B Payment:
Proposed Fee Schedule Suggests Major Global Period Changes
Plus: You could see $42 for every month of chronic care management. Although the propo... Read more
Doctors' Face-to-Face Requirement Could Do An About-Face
By 2015, your face-to-face requirement might be a thing of the past. The Physician Fee... Read more
Citing Misuse, CMS Changes MUE Rules for Several Bilateral Procedures
Unless modifier 50 works on your code, you’re out of luck. If you’re one o... Read more
What Are MUEs?
Although CCI may be very familiar to you, any practice filing a claim with Medicare shou... Read more
Part B Coding Coach:
Spot These Easy-to-Miss Bundling Changes, Implemented July 1
Stent placement and fluoroscopy updates could affect your claims. The medically unlike... Read more
Physician Notes:
CMS Reveals Auditors' Findings Regarding AWVs
Plus: Need guidance on signature requirements? CMS has your document. Although annual ... Read more
In other news
Whether you’re certifying terminal illness for hospice, ordering a diagnostic test... Read more
Reader Question:
Know How RVUs Impact You
Question: In your last issue, you referred to a code’s “RVUs.” I ... Read more
OIG: We're Looking at You, Laboratories
Latest ‘Special Fraud Alert’ hones in on labs’ connections to physicia... Read more
Coding Quiz:
Can You Code These Pain Management Scenarios?
Hint: Equate Marcaine with lidocaine rules when it comes to injections. Coding for pai... Read more
Enhanced Documentation Is Key to ICD-10 Success
Every staff member should work toward this shared goal. As you work toward mastering I... Read more
Part B Coding Coach:
Collect Concurrent Care Pay in 4 Easy Steps
Documenting separate diagnoses help all specialists involved.  It’s not unc... Read more
Physician Notes:
AHA Sues HHS over Appeals Delays
Plus: Medical records sitting in the driveway? That’ll cost you $800,000. If you... Read more
In other news
When a Midwestern physician retired in 2008, the last thing she expected to find on her ... Read more
Reader Question:
Comparison X-Rays May Not Be Payable
Question: We recently saw a patient who injured his leg in a car accident. The surg... Read more
Reader Question:
Identify the Correct Form
Question: I used to bill for a facility and am new to the role of practice manager ... Read more
Senior Medicare Patrol Recovered $9.1 Million by Watching for Fraud and Abuse
Seniors volunteer for this program, which aims to help CMS detect issues that might cons... Read more
This Payer Now Rejects Most Modifier 25 Claims
Navigate the modifier maze with quick advice. You’ve followed the modifier 25 gu... Read more
Electronic Health Records:
CMS Proposal Could End EHR Meaningful Use Woes
If this rule is finalized, you could get more time to comply. As quickly as you’... Read more
Mental Health Coding:
3 FAQs Help You Code Psych Services Properly
Differentiate between E/M and evaluation codes with this advice. If your practice stru... Read more
Part B Coding Coach:
Selecting the Wrong Hemorrhoid Code Could Cost You $255
One note allows mixed codes for internal procedures. If you crack open your CPT® b... Read more
Physician Notes:
Check This Progress on Billing 69210 With E/M Codes
Plus: Burwell confirmed as new HHS secretary. If you’ve been frustrated by halte... Read more
In other news
As expected, the popular Director of the White House Office of Management and Budget has... Read more
Reader Question:
Bronchoscopy Coding Can Be Tricky
Question: Our pulmonologist performed a bronchoscopy with left upper and lower lobe... Read more
E/M Coding:
This Payer Clarifies 'New Problem' From MDM Perspective
You can get extra points under ‘management options’ for new problems…... Read more
Part B Mythbuster:
Op Note Scrutiny Focuses on More Than Just the Title
Plus: Bust this myth about same-day E/M services. Myth: You should work twice as hard ... Read more
Hernia Coding:
These 3 FAQs Lead You on the Right Hernia Coding Track
Hint: Double the mesh may not equal double the reimbursement. If your practice perform... Read more
Patient Privacy:
Your Associate's Mistakes Shouldn't Cost You Money
Look out: Private lawsuits can be just as costly as federal HIPAA fines. You might thi... Read more
Part B Coding Coach:
Anesthesiologists Could Collect Extra Units for Field Avoidance
Even if Medicare won’t pay, other payers often do.  Seeing a note of &ldquo... Read more
Physician Notes:
Doctor Gets Nearly 2 Years in Jail for Kickbacks
Plus: Excluded employee costs this rehab center six figures. Exchanging wads of cash i... Read more
In other news
Beware: Even if you don’t self-disclose your employment of a staffer excluded from... Read more
Reader Question:
Know the Ear, Nose and Throat Bundles
Question: Can we bill CPT code 31600 with codes 38724, 41120, and 42890, or are the... Read more
Modifier 59 Won't Apply to All 'Separate Site' Examples, New CMS Advice Says
Treating ‘contiguous structures’ is an exception to this well-known rule. ... Read more
E/M Coding:
Incorrect E/M Coding Is A $6.7 Billion Per Year Problem, OIG Says
These 5 tips ensure that you select the right E/M code. What’s $30 in miscoded c... Read more
Part B Mythbuster:
Stabilization Doesn't Always Equal Fracture Care
Plus: Don’t forget to bill supply codes to Medicare. A patient reports to your p... Read more
Part B Coding Coach:
Don't Miss Picking Up $258 More For Closed Hip Dislocation Treatments Requiring Anesthesia
Here’s how to steer clear of traumatic hip dislocation’s hidden traps. To ... Read more
Physician Notes:
One Doctor Indicted in $33 Million Medicare Fraud Charges
Highlighting your documentation can be good—but not if done literally. Imagine h... Read more
In other news
Don’t make things worse instead of better when it comes to medical review. Probl... Read more
Reader Question:
Watch for Flu Shot Bundles
Question: We have been receiving denials for flu vaccine codes when submitted with ... Read more
Part B Revenue Booster:
Late Effects Codes Could Be the Key to Reimbursement
5 strategies keep complications out and reimbursement in. With ICD-10 delayed yet anot... Read more
Put Your Late Effects Knowledge to the Test
3 coding scenarios challenge what you’ve learned  Choosing late effects cod... Read more
ECG Coding:
5 Tips Ensure You're Collecting for ECG Services.
E/M code lets you capture review credit. Attaching an incorrect modifier to an electro... Read more
Part B Coding Coach:
Unlock Stone + Dilation Procedure Payment With This Case Study Analysis
Tip: Pay attention to dilation approach.  One word can make all the difference in... Read more
Physician Notes:
One Physician Causes Biggest HIPAA Settlement in History
Plus: OIG recovers over $3.1 billion in first half of 2014. If you search your loved o... Read more
In other news
Even as Medicare slashes payments for some services, the government still has additional... Read more
Reader Question:
Know the Teaching Physician Rules
Question: A physician in our group recently started supervising a resident’s ... Read more
Nursing Facility Visits:
This Payer Is Scrutinizing Nursing Facility Visits Carefully
Codes 99309-99310 are under the microscope for NGS Medicare practices. If you think CM... Read more
OIG Considers Expanding Civil Monetary Penalties
You could be subject to penalties for five additional reasons if the proposal is finaliz... Read more
Keep Track of Where Your Doctors Are When Your Ancillary Staff Performs Service
Otherwise, you could be violating supervision requirements.  Like many practices,... Read more
Part B Coding Coach:
Ace Tumor Ablation Coding With This Expert Advice
Hint: Watch for CCI bundling for multiple procedures involving other tumor removal metho... Read more
Physician Notes:
'Two Midnight' Rule Needs Revision, OIG Says
Plus: Billing extra codes for urine testing cost this lab over $4.6 million. It hasn&r... Read more
In other news
Coding urine drug testing seems pretty straightforward—but for one laboratory, rep... Read more
Reader Question:
Historical Review May Not Be Billable
Question: A patient had her past medical records, containing more than 10 years of hist... Read more
Reader Question:
Determine When Flu Vaccine, E/M Are Both Payable
Question: I have been reporting the flu vaccine with E/M visits and other in-office... Read more
Reader Question:
Know What 'Split Night' Entails
Question: I’ve been hearing the term “split-night service” lately... Read more
CMS Answers ICD-10 Questions--By Not Answering
Representatives stay mum about the details of the delay. The recent delay of ICD-10 un... Read more
Part B Mythbuster:
Don't Avoid 99221 Series Just Because You Didn't Perform Admission
The admit rules changed with the introduction of modifier AI. If your coding education... Read more
Part B Revenue Booster:
Incomplete Service Doesn't Mean Nonexistent Payment
Know the rules for modifiers 52 and 53 to collect your payments despite not completing p... Read more
5 Easy Billing Tips for Modifiers 52 and 53
File preparation and clear documentation are the keys to getting these claims paid Whe... Read more
Part B Coding Coach:
Wondering What's Ahead for Cardiology in CPT® 2015? Start the Search Here
Check out what the CPT® Editorial Summary of Panel Actions reveals. With summer fa... Read more
Physician Notes:
PECOS System Just Got Easier to Navigate
If your attempts at adding practitioners to the PECOS system have become incredibly frus... Read more
HIPAA Case Study:
Could You Be Left Paying the Bill for a BA's Mistakes?
Safeguard your practice with a thorough look at your BA’s privacy practices. You... Read more
Spruce Up Your BAAs:
Do your 'pre-existing' BAAs need an update?
Now’s the time to give your BAAs a spring cleaning. The Health Information Technol... Read more
Save Your Claims From These 5 Modifier 24 Pitfalls
Remember that 24 only applies to E/M services. When your physician treats a patient wh... Read more
Part B Coding Coach:
Overcome Periurethral Cyst Procedure Coding Confusion with 4 Tips
Pay attention to cyst location to help guide your coding. For urology practices, periu... Read more
Physician Notes:
2 Payers Face Settlements, CAPs for Laptop Breaches
Plus: Watch out for aggressive OCR audits this fall.   Stolen unencrypted laptops... Read more
In other news
Keep your eyes peeled this autumn for a notification and data request from the HHS Offic... Read more
Advance Beneficiary Notices:
Know These 4 Categories of Noncovered Services
Sometimes it can be hard to determine what’s considered ‘noncovered.’ ... Read more
Follow This Chart to Ease ABN Concerns
Use this table to pick the right modifier -- every time. With four choices and changin... Read more
Face-to-face Visits:
OIG: One-Third of F2F Claims Don't Pass Muster
Avoid these common F2F pitfalls identified by the watchdog agency. Physicians’ f... Read more
These 6 Items Must Appear in Your F2F Documentation
Don’t let missing title, date torpedo your claim. Physicians and home care provi... Read more
Part B Coding Coach:
Conquer the Ins and Outs of Esophageal Dilations With This Expert Advice
Optimize payments by looking specifically for the use of fluoroscopy. If your clini... Read more
Physician Notes:
New ICD-10 Implementation Date Oct. 1, 2015, IPPS Says
Plus: This hospital faces a steep fine for giving cardiology group preferential treatmen... Read more
In other news
Although most physicians know that they can’t collect cash for hospital referrals,... Read more
Reader Question:
Know What Sinus Surgeries Include
Question: Is partial excision of the middle turbinate considered a separate procedu... Read more
Patient Privacy:
Just One Laptop Theft Causes $1.7 Million HIPAA Settlement
Reminder: If you know your systems are at risk, fix them immediately. It’s just ... Read more
Part B Mythbuster:
Can You Report Critical Care Time Outside the ICU?
The answer to this commonly-held belief may surprise you. Your physician performs CPR ... Read more
Observation Coding:
Medicare Observation Services Increased by 100 Percent, Report Reveals
Expect carrier scrutiny in light of this leap and ensure you’re coding accurately.... Read more
Part B Coding Coach:
Get Set For Fresh Edits Bundling Allergy Immunotherapy and E/M Codes
You will also face potential problems when reporting allergy testing codes with E/M serv... Read more
Physician Notes:
Hold Off on End-to-End ICD-10 Testing Prep
Plus: Recovery auditors have until June 1 to conduct automated reviews. If you’v... Read more
In other news
Don’t be lulled into complacency by the break in Addition Documentation Requests (... Read more
Reader Question:
Breathe Easy When Billing for Pulmonary Rehab
Question: Is it appropriate for me to bill for pulmonary rehab using G0424 for non-... Read more
Make the Most of the ICD-10 Extension With These Quick Tips
New implementation date has not been announced, but be ready. Whether you’re che... Read more
3 Additional Features to Learn About the 'Pay Fix' Bill
New legislation is more than just an ICD-10 extension. Although the ICD-10 delay has g... Read more
5 Questions Lead You to Orthopedic Coding Success
This quick quiz will show you where your orthopedic coding and billing skills fall. Wa... Read more
Avoid 99339 for Phone Call
Question: Our doctor spent a long time on the phone with a patient’s son discussin... Read more
Know How to Report Repeat Lab Test
Question: A physician ordered an electrolyte panel for a 72 year-old female patient expe... Read more
Know How to Report Zometa Injections
Question: I heard that the coding for Zometa injections changed in 2014. What shoul... Read more
Congress Considers One-Year Delay to ICD-10
Plus: Bill would push back 24 percent cut. Congress attempted to kill two birds with o... Read more
Part B Payment:
Look for RVU, Diagnostic Supervision Changes in April
Carriers also add new G-code for documentation of medical indication of induction RVU ... Read more
Anesthesia Coding:
Remember 3 Foundational Points Before Adding +99100 to Your Claim
Hint: Even though Medicare won’t pay, don’t write off all other payers. ... Read more
Part B Mythbuster:
Make Your Global Period X-Ray Claims Picture Perfect
Find out when to apply modifier 76. Myth: X-rays that you shoot or interpret during th... Read more
Part B Coding Coach:
Hone Your Pap Coding Skills With This Screening-Turned-Diagnostic Case
See if you can code the case. With 15 CPT® codes and 10 HPCS Level II codes for Pa... Read more
Physician Notes:
New CMS-1500 Requires Letters, Not Numbers, for Dx Pointer
Plus: HIPAA gets its random audit program into gear. Although CMS’s latest itera... Read more
Respond to These 6 Practitioner Complaints About ICD-10
Think we should just ‘wait for ICD-11?’ Here’s why you can’t. ... Read more
Sleep Studies:
Rest Easier Knowing Where to Draw the Line Between Sleep Studies and Polysomnography
Hint: Focus on 3 factors to reach the best coding option.  Being faced with in... Read more
Part B Coding Coach:
Check Out These Six Ob-Gyn 2014 OIG Work Plan Hot Spots
Tip: Your practice’s expenses for ultrasound procedures should be in line with you... Read more
Terminology Check:
Here's How Sleep Studies and Polysomnography Relate to Each Other
Hint: Eliminating one points you to the other. Sleep studies are tests that watch what... Read more
Physician Notes:
Psychotherapy With E/M? Break Down Time Spent on Each
When CPT® revised the psychotherapy and psychiatry codes last year, many mental heal... Read more
Talk to Workers' Comp Insurers Now to Head Off ICD-10 Issues
Although not required to transition to the new coding system, they might anyway. Train... Read more
E/M Coding:
This MAC Reveals The Top Prolonged Service Errors
Follow these tips so you can avoid making these mistakes. Part B practices need to kee... Read more
Denial Management:
Respond Appropriately to These 5 Common EOB Denials
Know the denial codes and then set a course for appeal when applicable. All explanatio... Read more
Part B Coding Coach:
Can You Spot the Trouble Areas in These EP Study/Ablation Scenarios?
Plus, you’ll get a hint of how the ICD-10 transition will affect coding for these ... Read more
Physician Notes:
County Settles With HHS Over HIPAA Violations
Plus: CMS resolves hospice NPI issue. Even government entities are finding that keepin... Read more
Reader Question:
Drill Down to the Correct Bundling Rules
Question:  I used the Correct Coding Initiative (CCI) edits checker tool and entere... Read more
Medicare Errors:
Practices Underbilled $1.3 Billion in 2013, CMS Report Shows
CERT results reveal that initial hospital care, chiropractic visits topped list of Part ... Read more
Which Specialties Are Billing Improperly?
The government’s CERT report not only identifies the types of errors that practice... Read more
Hospital Care:
Report Hospital Visits Properly to Avoid Being A CERT Statistic
These 7 quick steps will help you ensure that you bill inpatient visits properly. If C... Read more
Check Your Billing Expertise With 3 FAQs
Hint: Get on top of your denial management procedures now or pay the price later. Most... Read more
Part B Coding Coach:
Secure Nail Care Pay With This Expert Advice
Don’t forget to use modifiers and appropriate diagnosis codes to prevent denial. ... Read more
Physician Notes:
Unable to Get Patient History? Follow These Tips
Plus: CMS set to deny ‘related’ claims. Nearly every physician has been th... Read more
Recovery Audit Contractors:
This RAC Targets 'Excessive' Hospital Visits
Plus: Angioplasty will be targeted for review effective immediately. Your doctor sees ... Read more
These 5 Questions Solidify Your Compliance Savvy
From staffing to coding and beyond, determine whether your compliance plan is accurate. ... Read more
Part B Coding Coach:
CPT® 2014 Includes Clarifications for General Surgeons
Wondering exactly who can perform surgery? CPT® spells it out. If you’ve eve... Read more
Physician Notes:
Government Reaches All-Time Highest Recovery of $4.3 Billion in 2013
Plus: Be ready for ICD-10 testing this week. If you collected $8.10 every time you spe... Read more
In other news
Ready or not, ICD-10 testing is here. Your MAC will allow you to submit test claims usin... Read more
CMS to Offer 'End-to-End' ICD-10 Testing This Summer
The agency intends to select participants by April. You are already aware of the ICD-1... Read more
ICD-9 Coding:
Keep Five Digits in Mind When Coding Diabetic Manifestations
Don’t default to 250.00 — follow these three crucial tips to find the right ... Read more
Part B Coding Coach:
Alleviate Your Chemo Injection and Infusion Coding Stress With This Expert Advice
Route of administration guides you to right code. The Current Procedural Terminology (... Read more
Physician Note:
NPs Without Masters' Degrees Face Issues With PECOS
Plus: False Billings Lead to Mail Fraud Charge for Texas Physician If your nurse pract... Read more
In other news
You’re aware of the fact that the government could charge you with Medicare fraud ... Read more
Reader Question:
Debridement May Be Bundled
Question: Our orthopedic surgeon did a debridement of the labrum along with a rotator cu... Read more
Part B Coding:
Check These Answers to 5 Burning Medicare Questions
From coding to billing and beyond, get the answers you’re seeking straight from th... Read more
Correct Coding Initiative:
Check Out the Latest CCI Edits That Could Halt Your Claims
New bundles may be bad news—but read on for deletions as well. Every new year br... Read more
Part B Coding Coach:
3 Scenarios Show You Which Anesthesia Modifier to Use
Latest OIG Work Plan urges you to focus on these modifiers. With last week’s ne... Read more
Meet All 7 Criteria Before Claiming Medical Direction
Plus: Know when exceptions might apply. Before appending modifiers QY (Medical direct... Read more
Physician Notes:
Know Your Therapy Modifiers for Claims Success
Therapists who have been submitting claims to Medicare with the therapy modifiers for th... Read more
Reader Question:
Keep '3 Year Rule' In Mind
Question: A patient came in to see our general surgeon in December and had a unilateral ... Read more
Reader Question:
You Don't Get A Pass on History Portion of E/M
Question: I need help with the E/M for a patient with dementia. The patient took a fall ... Read more
OIG Sets Sights on E/M Services, Place of Service Coding
The latest Work Plan focuses on several new areas. This year, you’ll want to mak... Read more
Consider These Additional OIG Hotspots This Year
Although E/M services and place of service codes are used almost every day in Part B pra... Read more
Part B Payment:
Bilateral Cerumen Removals Could Prompt Denials
Medicare decides not to pay for two cerumen removals in the same visit. When  CPT... Read more
Part B Coding Coach:
Break Down Bone Scan Coding By Type, Diagnosis, and Time Frame
Four types of bone density scans mean numerous  CPT® options. If you’re... Read more
Physician Note:
CMS: Time Is on Your Side for Psych Billing
Revisions to CPT’s psychiatry and psychotherapy codes last year led to helpful new... Read more
In other news
March 3 is less than a month away, so Part B MACs are prepping now for ICD-10 testing we... Read more
Reader Question:
Keep Face-to-Face Visit in Mind
Question: My physician sends patients to the hospital to receive IV antibiotic therapy w... Read more
Reader Question:
Collect Insurance Cards Frequently
Question: A patient came to our office. The physician performed an exam and administered... Read more
Reader Question:
Know When Modifier QW Applies
Question: We always like reading your updates about CLIA-waived tests, but we have a que... Read more
Reader Question:
Two Patients Deserve Two Records
Question: Can we bill based on time if we see two patients during the same visit? For in... Read more
This Part B Payer Answers 10 Pressing ICD-10 Questions
Should you buy your book now or wait? These answers may guide you. As ICD-10 approach... Read more
Use These Straight-From-the-Source Examples of Modifier 25 Rules
These scenarios show you when to use modifier 25—and when to avoid it. We’... Read more
Part B Coding Coach:
Don't Miss Medicare's Final Decision on PILD Reimbursement
Plus: Learn about new treatment options for uncontrolled seizures. A Jan. 14, 2014, de... Read more
Physician Note:
Medicare Strike Force Prosecutes Record Number of Healthcare Fraudsters
If it feels like news about healthcare prosecutions is winding down, don’t be fool... Read more
Reader Question:
Know Your No Show Policy
Question: During the snow storm last week, we had several patients call in and say they ... Read more
Reader Question:
Are Modifiers Required for Standing X-Rays?
Question: Are there specific CPT® codes for weight bearing X-rays? Our physician obt... Read more
Reader Question:
Know the 'Change' Code for G-Tube Procedure
Question: A patient presented with a partially dislocated gastrostomy tube with pain at ... Read more
Reader Question:
Therapists Should Avoid Modifier 25
Question: Do you know if Medicare requires modifiers to be in a specific order? For exam... Read more
E/m Coding:
Can You Spot the Problem in This Inpatient E/M Note?
Review this documentation and determine how you’d code it before you read the solu... Read more
Determine Your Modifier Skill Level With This Quiz
Once you have your modifiers straight, you’ll be coding with ease. It’s be... Read more
Part B Coding Coach:
Don't Let Improper Time Documentation Ruin Your Claims
Replace Outpatient E/M codes with a single G code for Medicare PHP claims. According t... Read more
Physician Notes:
Noridian's Modifier 59 Notice Shocks Coders
Plus: ‘New’ CMS-1500 is effective now. A little-noticed but highly confusi... Read more
Reader Question:
Know Who Can Perform Spirometry, Oximetry
Question: Is there a valid code (accepted and paid) for the interpretation of spiro... Read more
Reader Question:
No Specific Dx for Easy Bruising
Question: What is the ICD-9 code for “easy bruising”? Answer: Ea... Read more
CPT® 2014:
Check Is Not in the Mail for New Telephone/Internet Consult Codes
Sadly, the Final Rule does not include any RVUs for 99446-99449. Each year when the ne... Read more
PECOS System:
PECOS Rejections Are Live--Follow These 8 Steps to Reduce Yours
After a long wait, PECOS edits went into effect on Jan. 6. There’s no doubt that... Read more
Coding Angiodysplasia of the Colon Is Tricky--And Will Get More Complex in October
Confirm the presence of hemorrhage to get to the right code. If your physician sees pa... Read more
Part B Coding Coach:
37241-37244: Update Your Vascular Embolization/Occlusion Coding
Drop 37204 and 37210 from your repertoire. Four new codes and an entire new introducto... Read more
Physician Notes:
Windows XP Won't Be HIPAA Compliant Starting April 8
Plus: Get to know the 2014 therapy cap. You may have heard that Microsoft announced th... Read more
In other news
Coders and therapists don’t actually look forward to hearing updates about therapy... Read more
Reader Question:
Not All Hardware Removals Are Payable
Question: My physician’s note states, “Previous incisions incised.....b... Read more
Reader Question:
Documentation Should Reveal Coding Options for FAST Test
Question: I have a chart that indicates that the ED physician treated a patient with con... Read more
Look Out for These New RAC Audit Issues
Tip: Keep the 8-hour observation threshold at top of mind. If you’ve been sweati... Read more
Check These 3 RAC FAQs
Although CMS’s Recovery Audit Contractor (RAC) program has been around for several... Read more
Prep Now for New Pneumonia Diagnosis Code
Starting this October, you’ll be required to report J18.9 for pneumonia. Althoug... Read more
Part B Coding Coach:
4 Top Tips for Following New Chemodenervation Guidelines for 2014
Hint: Count muscles correctly and you’ll be on the right track. If your physicia... Read more
Physician Notes:
This HIPAA Breach Lasted 4 Years
lus: CMS Grants ‘CLIA-Waived’ Status to 9 Lab Tests You know that it&rsquo... Read more
In other news
Part B practices will benefit from six new lab tests now classified as “CLIA-waive... Read more
Reader Question:
2 Surgeons May Equal 1 Code
Question: Two neurosurgeons in our practice treated a post-trauma patient twice on the s... Read more
Reader Question:
Know the Hospital Rules Before Billing Testing
Question: Our ENT completed allergy testing for a patient in the outpatient clinic, whic... Read more
Reader Question:
Let Modifier 52 Be Your Friend When Necessary
Question: My doctor did an incomplete colonoscopy and I’m not sure how to code it.... Read more
Part B Payment:
3 FAQs About 2014 Medicare Payments Help You Collect
From the new conversion factor to the sequestration debacle, we’ve got the answers... Read more
Pecos Edits:
Beware 'N544' Errors Now That PECOS Edits Are Active
Unless CMS retroactively reverses the decision, those edits were turned on Jan. 6. You... Read more
Cardiology Supply Codes:
Check HCPCS 2014 to Confirm G0275 and J0152 Changes
Update adenosine unit requirements to avoid shortchanging your practice. CMS recently ... Read more
Part B Coding Coach:
Put Your ECT Reporting on Track With This Guidance
Hint: Don’t report the pre-treatment evaluation with an E/M code as a norm. When... Read more
Physician Notes:
OIG Recovered $5.8 Billion in the Second Half of FY 2013
Between conversion factor issues and sequestration, Medicare is cutting back on payments... Read more
Reader Question:
Don't Fret Over Capturing Spirometry With Inhalation Therapy
Question: If our pulmonologist performs spirometry to assess a patient and then decides ... Read more