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Primary Care Coding Alert

Nail Down Correct V Codes for IPPE in 4 Quick Steps
Surprise:  Steer clear of V70.0 for more specific diagnoses, expert sayDespite CMS- l... Read more
Determine Who Performs What Before Coding 69210
Take this test to see if your cerumen removal guidelines require updatingThe AMA silences ... Read more
Bulletproof Your Sick/Well Claims Using Clever Checklist
Aetna's new dual-service rule clears payment hurdlesYour imagination isn't running wild--p... Read more
NCCI Update:
Manage New Drug Admin Edits With This Tool
Version 11.3 fills CPT void on 90788's modifier 25 roleNew guidelines confirm that you nee... Read more
Apply Vaccine Coding to Flu Injection
Question: May I use injection code 90782 or G0008 with an influenza shot?Indiana Subscribe... Read more
Count a Non-Healing Lesion as Complicated
Question: Should I use 739.0 as the ICD-9 code for a non-healing lesion of the head?Rhode ... Read more
Override 90782-95115 Edit With 59
Question: A patient receives a bimonthly allergy injection and testosterone shot. Original... Read more
Let Provider Steer Hospice Modifier
Question: When a family physician who is a non-hospice provider performs a medical visit a... Read more
You Be the Coder:
Ponder Depression, Anxiety Coding Options
Question: A family physician treats a patient for depression in the office. Which CPT and ... Read more
Tired of Services Not Qualifying for CPO Reimbursement? Things Are About to Improve
CPT 2006 introduces new 993xx codes, modifier 25 languageIf you-re unsure how to bill mont... Read more
Try This New Strategy for Reporting Telephone Calls
Indirect supervision codes provide coding vehicle for lab review, care plan revision minut... Read more
Rejoice Over New Foolproof Routine Hospital Care Coding
Subsequent care is right-and in 2006 only-choice for inpatient follow-upCPT 2006's elimina... Read more
'Second Opinion' May Be in Non-Consult Territory
CPT's ambiguous language doesn't seal confirmatory consult void When a patien... Read more
7 Stratigies for Superior Screening Reimbursement
Presented by Susan Pincus, CPC, CHC The following supplement to Family Practice Codin... Read more
Clue In to Asthma Fifth Digits
Question: Would you code documentation that states, -acute status asthmaticus- as status a... Read more
Use Different Product Code for Menactra Shot
Question: Should I report the new Menactra vaccine, the same way I code for a Menomune imm... Read more
Don't Assume E/M With ECG Requires 25
Question: When a family physician performs an office visit and an EKG, should I use modifi... Read more
Consider These Proposed IA Values
Question: Which immunization administration (IA) code should I use for FluMist? Because th... Read more
You Be The Coder:
Is SNF OV a No-No?
Question: A family physician treats a patient in the office who has Part A skilled nursing... Read more
New V Codes Will Expand Personal History, Vaccine Contraindication Series
Tell insurers why pneumonia rx w/o dx and shot not given Pneumonia and urinary tract infe... Read more
You Can Bill 99201-99202 With 11720-11721
NCCI deletes 'absurd' new patient OV-nail debridement edit CMS has realized th... Read more
These 10 V Codes Spell Out Why a Patient Was Not Vaccinated
Clip and post your guide to personal history, no immunization changesICD-9's fall introduc... Read more
RHCs Should Break Down ECG, X-Ray Global Codes
Regardless of ZIP code list, use component codes or face denials If your practice falls u... Read more
Diabetes Goes First, ICD-9 Stipulates
Check if payer varies from manifestation second rule You don't need to decipher a visit's... Read more
Reader Questions:
Assign V71.4 When Patient Shows No Problem
Question: My supervisor said that when a case involves workers' compensation or a car acci... Read more
Reader Questions:
Stick With E/M for MMSE
Question: May I report a mini-mental status exam (MMSE) with 96115?Pennsylvania Subscriber... Read more
Reader Questions:
Apply No Age Limit to Feeding-Difficulties Code
Question: Until what age of patient can I report feeding difficulties with 783.3?Kansas Su... Read more
Reader Questions:
Include Nonincision Tick Removal in E/M Service
Question: How should I submit the following claim?: A patient with a tick embedded in hi... Read more
Reader Questions:
Use Time to Code Parent-Only ADD Discussion
Question: When a family physician sees one or more family members to discuss a patient's c... Read more
Reader Questions:
Your Modifier 57 Nonuse Is on Target
Question: I noticed modifier 57 in CPT Appendix A. As a family physician, I have rarely ... Read more
You Be the Coder:
What Codes Does Sunburn Treatment Involve?
Question: A mother brings her 5-year-old son in to our office with blisters on his shoulde... Read more
ICD-9 Introduces 'Too Detailed' Sleep Disturbance Diagnoses
Avoid unspecified insomnia, apnea codes with new 327 series Although this fall's proposed... Read more
Replace Your OHS, Apnea and Hypersomnia Diagnoses
Clip and save your 780.xx to 327.xx crosswalk If you're wondering how the new sleep-rela... Read more
These 2 Components Don't Always Make 99215 Appropriate
Use medically necessary history, exam in E/M code selection If you select 99215 when your... Read more
99215 Claims Often Include 2 Patient Profiles
Consider high-level visit for inpatients-to-be or the seriously ill When a patient is a h... Read more
Reader Questions:
Guidelines' Omission Implies HPI Rule
Question: I have always believed that any staff can take two of the history elements, but ... Read more
Reader Questions:
Include Injection Work in 20610
Question: A family physician performs a joint injection on the shoulder, which I plan on b... Read more
Reader Questions:
AMA Eliminates Modifier Hyphen
Question: I noticed that the September Family Practice Coding Alert didn't include a hyphe... Read more
Reader Questions:
Match Repair Code to Open Wound Dx
Question: When should I report an open wound code rather than a superficial injury? The Se... Read more
Reader Questions:
Consider 3 Solutions to an ED Visit
Question: An emergency department physician requested that a family physician come to the ... Read more
You Be the Coder:
How Should We Code Rehab Ward Services?
Question: After taking care of a hospital patient for three days, a family physician (FP) ... Read more
Watch the Clock to Determine Physical Therapy Units
Experts crack 97032-97124's time requirements To rack up the right number of physical the... Read more
You Can Now Bill Another Massage Unit
Clip and post your minute-to-minute guide on physical therapy increments The "Eight-Minut... Read more
V72.31 Joins Medicare's List of Low-Risk Patient ICD-9 Codes
Reserve V72.31 for Pap during a gynecological exam You'll no longer have to use different... Read more
3 Details Pinpoint Nurse Visit With Vaccine Admin Eligibility
Report unrelated complaint management as 99211 Reporting 99211 plus immunization adminis... Read more
Reader Questions:
I&D Excludes Cyst Excision
Question: A patient had an existing diagnosis of sebaceous cyst, benign, in cheek. An FP o... Read more
Reader Questions:
Day's E/M Includes Team Meeting
Question: Is it appropriate to bill 99361 (Team conference) in addition to 99311-99313 (Su... Read more
Reader Questions:
UHC's Screening Edit Recall Doesn't Spell Payment
Question: A family physician performed a well-woman exam and treated the patient for pink ... Read more
Reader Questions:
'Always' Code Diabetes First
Question: A diabetic patient comes in with a foot ulcer. Should I report the foot ulcer or... Read more
You Be the Coder:
Service Date Solves Circ Modifier Dilemma
Question: A family physician performs an E/M and a circumcision. Should I use modifier -24... Read more
ICD-9 Creates New BMI Series, Dehydration Codes
Update your superbills before Oct. 1, or expect denialsYou can smoothly transition to the ... Read more
Get to Know Just 2 New Kidney Disease ICD-9 Codes
  Speed through upcoming diagnostic changes with our expert's top FP picksLooking ... Read more
Medicare Adds an Extra Factor To Observation Care Coding
Look at date, time when choosing between 99217-99220 and 99234-99236You'll avoid observati... Read more
Let Date, Time Steer Carrier Observation Service Reporting
Our coding tool reveals when you should also charge a discharge To comply with Medicare's ... Read more
Mining the Gold in Care Plan Oversight
Presented by Trish Bukauskas-Vollmer, CMM, CPC, CMSCSThe following supplement to Family Pr... Read more
Consider Using Time for Depression Counseling
Question: A 45-year-old established patient who recently lost his job presents with compla... Read more
All Staff Can Perform History Element
Question: My coworker thinks a family physician must take a patient's history, but I think... Read more
Death Pronouncement Involves Face-to-Face Work
Question: A nursing facility calls a family physician because a patient has died. The phys... Read more
Check Out Follow-Up Exam Alternatives
Question: A patient returns for follow-up of anemia and interstitial fibrosis that the fam... Read more
Update FP's Number, Not Your Incident-to Coding
Question: Will the new National Provider Identifier (NPI) change how we report services in... Read more
Use Modifier 25 to Obtain Admin Pay With E/M
Question: I noticed that the Medicare Fee Schedule lists an "A" status for the injection G... Read more
You Be The Coder:
Additional Inhaler Treatments Require This Key
Question: A child with acute asthma requires three same-visit nebulizer treatments to cont... Read more
Report Combination Nebulizer Medication With 2 New J Codes
Surprise: Premixed means the same thing as compounded HCPCS 2005 adds two new compound in... Read more
Coding Online Services Can Route $25 to Your Bottom Line
Your FP can address simple medical issues on the Internet - and get paid Your patients m... Read more
5 Examples Test Your Biopsy Destruction Clinical Savvy
      This chart shows you when to use higher-paying site-specific les... Read more
Don't Truncate Well Woman Exam Diagnosis
To avoid denials for V72.3x, always add a "1" or a "2" to the code. Assign V72.31 or V72.... Read more
Spearhead Your Denial Management Efforts With A 'Top 10' Rejections List
Sharing Top 10 information in physician-staff meetings can help eliminate the cause of you... Read more
Run These 4 Billing Reports for Success in Fighting Denials
Our experts show you how to make the most of your monthly reportsReviewing your EOBs is a ... Read more
You Be the Expert:
Record Medicare Patient's Exact Card Data - or Face Denials
Question: We've been receiving numerous Medicare claim denials recently, and there doesn't... Read more
Reader Questions:
Pap Smear Shouldn't Trigger Annual Exam Code
Question: Should we always code a well woman exam when the family physician takes a Pap sm... Read more
Reader Questions:
Include Lidocaine Shot in Procedure
Question: Since HCPCS deleted J2000, does a code exist for a lidocaine injection - other t... Read more
Reader Questions:
Check Observation POS, Dates
Question:  A family physician admitted and discharged a patient to observation status... Read more
Reader Questions:
Look Out for Modifier, Lab Code Errors
Question: A patient presents for a family physician to remove four nevi. The FP excises th... Read more
Reader Questions:
Downcode to Documented Component Levels
Question: The chart that we use to select the level of history includes identifiers. For e... Read more
Reader Question:
Get the Scoop on Medicare's Reasons for Denials
Question: Do you have a list of Medicare's "Top 10" reasons for denying practices' claims?... Read more
You Be the Coder:
Use This Many Codes for OV and OMT
Question: A family physician performs an E/M and osteopathic manipulation on the same day.... Read more
Beat OIG Foot Care Scrutiny With These Coding Tips
Clear findings support Q modifier - and fend off auditors You should reserve the foot ca... Read more
Pediatric Coding Corner:
4 Scenarios Extend Your 'Worried Well' Visit ICD-9 Options
Surprise: You'll find the V71 series useful for suspected non-ill cases If you aut... Read more
V Code Nonpayment May Be an Urban Legend
Expect fewer V65.5 rejections in 2005 You dread using a V code with a worried well visit ... Read more
Reader Questions:
Reject Additional Lesion Denials
Question: I reported 17000 and 17003 to Medicare, which paid for 17000 but rejected 17003.... Read more
Reader Questions:
Skip Injection Code With TB Test
Question: What is the correct injection code to file when a nurse injects PPD for a TB ski... Read more
Reader Questions:
Break Up Ob Package for Delivery Takeover
Question: A family physician follows a patient throughout her pregnancy. During delivery, ... Read more
Reader Questions:
Use 90800 Series for Diagnostic Treatment, Therapy
Question: What is the difference between psychiatry codes 90801-90802 and 90804-90829?Sout... Read more
Reader Questions:
95117 Clinches More Than 1 Allergy Shot
Question: A nurse administers three immunotherapy injections to a patient. Should I report... Read more
Reader Questions:
Include Post-Circ Follow-Up in Surgical Package
Question: How should I code when an FP sees a post-circumcision newborn seven days after s... Read more
Reader Questions:
Fluorescein Stain and Angioscopy Aren't the Same
Question: After injuring his eye on the job, a patient presents to a family physician for ... Read more
You Be the Coder:
Discover the Right Way to Count Taking Vitals
Question: A representative does a pacemaker check, and a nurse takes the patient's vitals.... Read more
HPSA and PSA Coders, Beware:
Medicare Requires You to Break 93000 Into These Components
Bill 93005 and 93010 instead of 93000 - or face denials If your practice is located in a ... Read more
CMS Automatically Pays 5-10 Percent Extra on These Services
Making these lists means you don't need modifiers, and you get more money You can elimina... Read more
Pediatric Coding Corner:
Use This Rule When Billing Nurse Visit With Vaccine Admin
Stand-alone E/M notes support 99211-25 When a nurse performs a medically necessary exam a... Read more
Reader Questions:
No IPPE Equivalent Exists for Current Patients
Question: I've been billing an initial preventive physical exam for new Medicare enrollees... Read more
Reader Questions:
Code 16000 Requires Burn Treatment
Question: A family physician diagnoses a patient with a second-degree burn on her right pa... Read more
Reader Questions:
New Td CPT Code Is on the Horizon
Question: My family physician wants to purchase preservative-free tetanus diphtheria (Td) ... Read more
Reader Questions:
Pulse Ox Coverage Depends on Company
Question: When will insurers pay for pulse oximetry? May I report 94760 with other procedu... Read more
Reader Questions:
Patient's Status Determines Hospital, NF Code
Question: My family physician sees an inpatient who is awaiting nursing home placement. Sh... Read more
Reader Questions:
Refile 36415 Denials
Question: Why has Medicare been denying venipunctures that I bill with 36415? I stopped us... Read more
You Be the Coder:
How to Recoup an Extra $25 in Discharge Fees
Question: During morning hospital rounds, a family physician discusses treatment plans wit... Read more
CMS' 2005 Rule Busts This Myth:
Medicare Never Covers Physical Exams
Code initial Medicare well-exams with G0344 A new Medicare benefit means your FP will fi... Read more
Capture IPPE Dollars With These Strategies
Send potential Medicare beneficiaries WTM appointment reminders To make sure that you don... Read more
These Clues Help You Tell 3 Integumentary Procedures Apart
Key: Let method drive your biopsy versus destruction coding You can more easily determine... Read more
Are You Ready to End Your E/M-Guideline Confusion? We Can Help
Use CMS' responses to our questions to report correct E/M levels Like many coders,... Read more
You Be the Expert:
Should You Factor Patient's Status?
Question: During an office visit, my doctor performed an expanded problem-focused history,... Read more
Bonus Question:
Improve Your Prescription Drug Documentation
Find out what CMS has to say about the management options category Calculating a patient'... Read more
Reader Questions:
"Noncontributory" Implies Nonapplicable
Question: I lose audit points when I use the term "noncontributory" for any portion of ROS... Read more
Reader Questions:
Referring to Partner's Work Helps Unify Claim
Question: During an urgent care visit at our after-hours clinic, the on-call family physic... Read more
Reader Questions:
90465 Doesn't Require FP Administration
Question: If a family physician (FP) provides the counseling and steps out of the room dur... Read more
Reader Questions:
Include Pre Flu-Test Work in E/M
Question: When a family physician (FP) performs the QuickVue Influenza test in the office,... Read more
Reader Questions:
Report Related Medicine, Not Equipment
Question: May a family physician's office bill a syringe code with a vaccine administratio... Read more
Reader Questions:
Tackle Synagis-Ig Rejections With 4 Actions
Question: How should you code a Synagis injection? Commercial insurers keep denying the pr... Read more
Reader Questions:
Christmas Comes Early With 1.5% CF Increase
Question: I overheard fellow coders discussing the 2005 physician fee schedule's new rate.... Read more
Reader Question:
Let the Elements Drive Your History Documentation
Question: The chart that physicians use to select the level of history includes identifier... Read more
You Be the Coder:
Practice Your OMT Region-Counting Skills
Question: When a family physician (FP) manipulates the cervical region on both the right a... Read more
Success Story:
Your CPT Code Could Trigger Rejections of ADD-Med Check
Solution: Obtain follow-up payment with 99212-99215, not 90862A simple coding switch can h... Read more
Avoid Lab Code Denials With In-Depth Waived-Status Info
Certificate, modifier, CLIA number help you clinch in-office test payment When your f... Read more
Case Study:
You Can Code Some Services Before the FP Arrives
Warning: Check supervision, payer incident-to requirementsWhen ancillary staff perform off... Read more
Reader Question:
How to Choose Between Hospital Follow-Up Codes
Question: When a family physician performs an inpatient consult, I bill 99251-99255. Sho... Read more
Reader Question:
You Screen for TB, You Don't Vaccinate
Question: We are trying to link the purified protein derivative (PPD) tuberculosis (TB) te... Read more
Reader Question:
Find Out What Supple Means
Question: The September Family Practice Coding Alert, mentioned that you could count the p... Read more
Reader Question:
Some Staff May Use New Vaccine Admin Codes
Question: When a nonphysician practitioner (NPP) who bills independently provides vaccine ... Read more
Reader Question:
250.7x Can Describe Remaining Complications
Question: In the October 2004 Family Practice Coding Alert, you suggest coding diabetes co... Read more
Reader Question:
Use G0107 With 2 V Codes
Question: Which diagnoses does Medicare cover for the screening fecal- occult blood test (... Read more
You Be the Coder
How to Code 3 Pre-Op ServicesQuestion: A family physician performs a preoperative physical... Read more
Complete Your Superbill With Hydration G Codes, Inhalation J Codes
Avoid Medicare B-12 admin injection denials with G0351 If you don't use new codes for inf... Read more
Pediatric Coding Corner:
Reserve 90465-90468 for Same-Day Counseling, Immunization
Good news: You'll now receive Medicare shot administration payment Be careful not to assi... Read more
Test Your Knowledge:
1 Example Reveals Your Vaccine Administration Coding Aptitude
 Find out if staff are up to par on 90465-90474 reporting See if you can apply the m... Read more
Reader Questions:
Reporting Asthma Dx Depends on Condition's Role
Question: A 12-year-old presents with bronchitis with a history of asthma. Should I report... Read more
Reader Questions:
Don't Miss Coding 2 Well-Check-Related Services
Question: During a 4-year-old child's annual preventive medicine service, the family physi... Read more
Reader Questions:
What You Should Bill When Patient Supplies Med
Question: A coworker thinks that when a patient brings a prescription to our office for ... Read more
Reader Questions:
Not All Payers Require Modifier -QW
Question: The January Family Practice Coding Alert article "Avoid Lab Code Denials With In... Read more
Reader Questions:
Opt for 99080 When FP Completes Form
Question: A family physician fills out a form for a new patient. The doctor doesn't obtain... Read more
Reader Questions:
HCPCS Finally Replaces G0001 With 36415
Question: Which code should I use for routine venipuncture of a Medicare patient? My carri... Read more
You Be the Coder:
Easy Way to Locate Sedation-Inclusive Procedures
 Question: A family physician (FP) performs conscious sedation during a diagnostic co... Read more
You Be the Coder In-Depth:
Pre-Op Clearance Yields Consult Opportunity
Warning: Consider 3 items before assuming 9924x is the right choice When you see the phra... Read more