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Primary Care Coding Alert

CCI Edits 18.3:
Pay Special Attention to Suture Repairs, Pain Injections to Keep Coding on Track
Latest coding edits touch on some of your most common procedures. The latest Correct Codi... Read more
Get Your System Up to Speed With Latest Flu Vaccine Payments
Tip: Pay attention to codes with locally-controlled pricing. CMS released its annual upda... Read more
Train Docs to Note 'Right' or 'Left' for Future Impacted Cerumen Coding
The H61.2- family will have all your code choices. You know that certain requirements ... Read more
Reader Question:
No FBR? Append Modifier 52 to 10120 or 28190.
Question: A patient came to our office after stepping on a nail. He was afraid some mate... Read more
Reader Question:
Only Use E/M With G0438 for Separate Problem
Question: One of our providers completed her first annual wellness visit for a patient. M... Read more
Reader Question:
Yes, Medical Assistant Can Choose Codes
Question: One of our physicians allows his medical assistant to choose his E/M codes. The... Read more
Reader Question:
Verify All Services, E/M Care for Modifier 25
Question: I don't think our office is using modifier 25 correctly. Does this get use... Read more
Reader Question:
Don't Bill 82270 or 82274 Until Patient Returns Hemocult Test
Question: I've always been told that if you give a patient a take-home hemocult test, tha... Read more
You Be the Coder:
Coding for Diabetes With Neuropathy
Question: The physician indicated the patient has diabetes complicated by peripheral neur... Read more
CPT® 2013:
Watch for Flu and Hepatitis B Vaccine Changes to Affect Your Coding in 2013
Plus: Here's your heads-up on some new options that won't be in the CPT® book yet.20... Read more
CPT® 2013:
Don't Miss These E/M Descriptor Updates That Will Affect Your NPPs
Heads up: 2013 also brings time assignments to some codes.Get ready for E/M coding changes... Read more
Check How Your Most Common Connective Tissue Diagnoses Could Change
Familiarize yourself now with a few codes that will have broader application. Your diagnos... Read more
Reader Question:
Choosing Between 715 and 716 for Knee Arthritis
Question: Our physician wrote "knee pain" and "arthritis left knee" as a diagnosis. Would ... Read more
Reader Question:
No Incision for Cyst Drainage Means No Code
Question: The PA found a cyst on a patient's labia during her pelvic screening (the patien... Read more
Reader Question:
Code 95117 for Two-Injection Visit
Question: A patient comes to our office once each week for allergy injections. The nurse a... Read more
Reader Question:
MD Isn't the Only One Who Can Gather Patient History
Question: Is the physician the only person who can take a patient history, or can a nurse ... Read more
Reader Question:
Add E/M Care When Patient Visits Multiple Times in a Day
Question: Two family physicians from our group saw the same patient in the office at diffe... Read more
Reader Question:
Append Modifier Q6 for NP Services Under Locum Tenens
Question: One of our physicians will be away for eight weeks. She has made locum tenens ... Read more
Reader Question:
401-405 or 272.x Can Help Justify 36415
Question: Some of our Medicare patients want to drop by and have blood drawn so that when ... Read more
You Be the Coder:
Coding Peanut Butter Allergic Reaction
Question: What do you recommend as the most specific E code for anaphylaxis reaction to pe... Read more
CPT® Coding:
2013 Might Bring More User Friendly Coding for Vaccines and E/M
Here's your sneak peek at proposed 2013 code changes.If you've ever wished for a list of a... Read more
2013 Fee Schedule:
Look Forward to a Possible Seven Percent FP Medicare Pay Boost
Heads up: New payments for hospital transitions could further pad your bottom line.CMS pub... Read more
Preventive Care:
Focus on 3 Areas for CVD Behavior Therapy Claims Success
Hint: CMS call outlines exactly what to do. Medicare added five preventive services t... Read more
Verify Whether You're Coding Tenderness or Rebound Tenderness of the Abdomen
Type of pain, quadrant affected will still be crucial in the new code system.If a patient ... Read more
Reader Question:
Carrier LCD Guides Whether to Expect Pay for J7325
Question: One of our Medicare patients receives knee injections for her arthritis. She's i... Read more
Reader Question:
Check for Extra Service Before Reporting Dressing Change
Question: Our family physician performed a dressing change for a patient who had an absces... Read more
Reader Question:
Watch Dosage Amount to Select Between J1070 and J1080
Question: What is the correct way to bill J1080? Florida SubscriberAnswer: Code J1080 (Inj... Read more
Reader Question:
Report 99238 or 99239 for Most Newborn Discharge Services
Question: What code covers a newborn hospital discharge?Arizona SubscriberAnswer: CPT... Read more
Reader Question:
Yes, You Can Sometimes Bill 28470 and 29405 Together
Question: Is it appropriate to bill 28470 with 29405? I don't quite understand what 28470 ... Read more
Reader Question:
Phone Call Billing? Here's What Justifies 99441-99443
Question: A patient called during the weekend and left a message for our physician asking ... Read more
Reader Question:
Include Prescriptions in E/M Service
Question: My physician heard that there's a code we can report and be paid for just when h... Read more
You Be the Coder:
Take Note of Supplies Insurers Won't Cover
Question: Can our physician's office bill a syringe code with a vaccine administration cod... Read more
CCI 18.2:
Check These New Vaccine Administration Edits
Be careful: Some codes switch from acceptable to non-reportable.You now have more details ... Read more
Start Thinking About 'Cause' for Future Acute Bronchitis Coding
Heads up: Single ICD-9 code transforms to ten codes in ICD-10. You'll face big cha... Read more
News You Can Use:
Supreme Court Upholds ACA Legality: Here's What You Might Expect
Experts weigh in on how ACA could affect family physician groups.The nation has been buzzi... Read more
Reader Question:
Fracture Care Can Apply, Even Without Manipulation or Follow-Up
Question: Our physician saw a patient for a non-displaced tarsal bone fracture, which did ... Read more
Reader Question:
Confirm Atrophy Before Assigning 728.2
Question: A three-month old was diagnosed with decreased strength and motion in her left a... Read more
Reader Question:
Beware of Billing Office Visit With Vaccine
Question: Our physician tried to bill an office visit (99213) along with codes for a vac... Read more
Reader Question:
Pull Out ABN for Benign Lesion Excisions
Question: Our state Medicaid doesn't cover benign lesion excisions, but we don't know it's... Read more
Reader Question:
Take Into Account Mole Removal's Location, Size
Question: I can't seem to fit \"removal of mole\" with any of the existing CPT® ... Read more
You Be the Coder:
Best Choices for Asthma Education
Question: What's the best code to submit when one of our providers offers asthma education... Read more
3-Step Guide Shores Up Your Coding for Strapping
Hint: Knowing materials helps narrow your selection. Strapping might seem like a simple tr... Read more
Sunburn Care:
Resolve Your E/M or 16000 Quandaries With Physician Documentation
Burn treatment and level of care streamlines your coding options.Just because a patient di... Read more
E/M Coding:
Stymied by '95 or '97 Guidelines? How You Count Steers You Down the Right Path
Physical exam element can point you to the better set.Choosing whether to follow the 1995 ... Read more
Acute Laryngitis Remains Easy Coding With J04.0 in ICD-10
Look how many conditions the code will represent when ICD-10 goes into effect.Diagnosis co... Read more
Reader Question:
Scrutinize the Preventive Care to Determine if Modifier 33 Applies
Question: Some of our payers deny claims with modifier 33 because they state the modifier ... Read more
Reader Question:
Dig into Specifics Before Reimbursing Tertiary Insurer
Question: One of our patients has Medicare as her primary insurance and Gerber Life as sec... Read more
Reader Question:
TB Test Follow-Up Charge Could Depend on Result
Question: Do we include modifier 25 when a TB test is administered during an office visit?... Read more
Reader Question:
Check Your Contracts for Specialized Lab Test Billing
Question: Our physician has been running some very specific tests (saliva, stool, heavy to... Read more
Reader Question:
Stick to the Details to Separate 36415 from 36416
Question: Can we bill separately for 36416, or is the collection included in the E/M code?... Read more
You Be the Coder:
Differentiating EKG Services
Question: We own the EKG/ECG machine in our office. We know that 93000 is the global code ... Read more
Diagnosis Coding:
Ratchet Up Your E Code Know How to Clinch Medical Necessity, Fully Document Accidents and Injuries
Tip: Never list E codes as primary diagnoses. Accidents happen, and your physicians probab... Read more
E/M Coding:
Steer Clear of OIG Scrutiny With Pointers for Legitimate High-Level Codes
OIG report on 99214 and 99215 increase means you need to be extra careful. Reporting h... Read more
News Flash:
Get Your Physicians Enrolled In PECOS Before It's Too Late
Recent CMS proposal might boost primary care Medicaid pay.As most practices remember, the ... Read more
Look to Z85.038 For Personal History of Colon Cancer
Don't expect code descriptor changes when new system kicks off.A personal history of colon... Read more
Reader Question:
Document Incorrect Test in Physician Note, Patient Record
Question: The physician saw several patients on the same day with sore throat symptoms. Hi... Read more
Reader Question:
V07.4 Applies to Long Term Estrogen Use
Question: Does ICD-9 include a code for prolonged use of estrogen? Texas Subscriber Answer... Read more
Reader Question:
Documentation Drives 98960 or 99211 Choice for Education
Question: A patient with testosterone deficiency comes to our office for injections. After... Read more
Reader Question:
Ensure That Diagnosis Matches Patient's Condition
Question: When I bill Medicare for deep debridement (11042) using the diagnosis the physic... Read more
Reader Question:
Miss HPI and You'll Miss E/M Pay
Question: A new patient visited our office for evaluation for an epidermoid (sebaceous) cy... Read more
Reader Question:
Select 17110 for Wart Removal Without Cryo
Question: A patient presented with a plantar wart. The physician documented, "Dermatology ... Read more
Reader Question:
Base Contraception Diagnosis on Specifics
Question: One of our practitioners discussed sexual activity and contraception with an ado... Read more
You Be the Coder:
The Difference Between 36415 and Incident-To
Question: We have a repeated discussion in our office about whether we can bill 36415 (Col... Read more
Initial Visits:
Clear IPPE Billing Confusion With Straight Answers From CMS
Start with G0402 and confirm details from there. The initial preventive physical ex... Read more
Tool Helps Cover All Your Bases Before Coding IPPE
Here's your checklist of what providers must document. "The various components of the ... Read more
Here's Your 3-Step Prescription for G8553 Claims Success
Check filing dates and charge guidelines to smooth processing every time. HCPCS doesn'... Read more
Catch Potential Billing Slip-Ups With Internal Audits, Before an Outside Auditor Does
Starting with a baseline audit will set your practice up for success. Would your practi... Read more
Clarify Urosepsis Diagnosis Before Coding Under ICD-10
You won't find "urosepsis" terminology after October 2014. If your physician notes the ... Read more
Reader Question:
Distinguish Pain Killing Agents in Plantar Injections
Question: Our physician administers a lot of steroid injections and injections of anesthet... Read more
Reader Question:
Prolonged E/M is no Longer Restrictive to Physician Services
Question: How can we report prolonged face-to-face E/M services provided by our physician ... Read more
Reader Question:
Generic vs. Brand Name Won't Change Your J3301 Billing
Question: My doctor is using Kenalog 40 (NDC 0003029328) from Bristol Myers Squibb. He say... Read more
You Be the Coder:
Coding a Total Body Skin Check
Question: A patient with a history of skin cancer presented for a total body skin check. T... Read more
Test Yourself:
Check 3 Areas Before Choosing Your Ear Irrigation Code
69210 or E/M inclusion depends on service and provider. A patient visits your office,... Read more
Diabetes Management:
Follow These Simple Steps to Successful Diabetes Coding
Tip: Focus on diabetic complications related to current episode of care.Choosing the corre... Read more
Rural Health:
Follow the Updated Definition of "Privileged" Provider for Ordering Hospital Services
CMS clarifies Transmittal 72 regarding rehab, respiratory care referrals. If you work in a... Read more
Change to R04.0 for Epistaxis Under ICD-10
Plus: Remember right/left modifiers according to payer policy.Under ICD-9 rules, you have ... Read more
Reader Question:
Inexact ICD-9 Code? Refer to Closest Diagnosis Equivalent
Question: My family physician saw a patient for "ciliary dyskinesia." This condition occur... Read more
Reader Question:
Verify 2 Factors Before Choosing Hepatitis A Vaccine Code
Question: One of our payers has denied the second shot of a hepatitis A vaccine as a dupli... Read more
Reader Question:
Include V72.83 as Primary Diagnosis for Surgical Clearance
Question: What's the best CPT® code for a pre-operative clearance visit?Minneso... Read more
Reader Question:
Report 11740 for Draining Toe Nail Hematoma
Question: A patient visited our office because of a hematoma under her toe nail. The phy... Read more
Reader Question:
Methylcobalamin Takes You to J3490
Question: One of our physicians wants to order Methylcobalamin for a patient who cannot ha... Read more
Reader Question:
Failure to Thrive 779.34 or 783.41 Depends on Exact Age
Question: What diagnosis should we submit for a newborn who is not gaining enough weight?F... Read more
Reader Question:
Insurers May Require Bundling Same-Day E/M Services
Question: Can we bill two office visits on the same day? We reported 99214 twice for the s... Read more
You Be the Coder:
Coding Advice for F1-F9
Question: I've seen conflicting advice on whether to use finger and toe modifiers with rad... Read more
Family Practice Coding Alert:
Meet These 4 Must-Watch Criteria Before Filing an Incident-to Claim
Heads up: Skip these items and you'll be in the OIG's hot seat. Your family physician diag... Read more
Test Yourself:
Can You Confirm the Criteria for 'Additional Work Up' and 'Moderate' Decision Making?
Read our scenario and decide which way you'd code. Just because you code for your physicia... Read more
News and Notes:
Don't Miss the Latest Updates on Incentive Payment Program and ICD-10 Help
Plus: Rural health providers, check your listing for accuracy. If you have a physician or ... Read more
Prepare Now for Greatly Expanded Varicose Vein Diagnoses
Your coding options explode with ICD-10. When your family physician diagnoses varicose vei... Read more
Reader Question:
Evaluate Options for Best Answer to Split Admit/Discharge Scenario
Question: When you have a patient admitted by one physician, but a different physician dis... Read more
Reader Question:
Two Units of 87804 Is OK -- With the Correct Modifier
Question: A patient with only Medicaid coverage came to our office for a flu test. We bill... Read more
Reader Question:
Only Report G0403 for EKG as Part of IPPE
Question: Can we only bill a screening EKG with an IPPE (initial preventive physical exam)... Read more
Reader Question:
Overly Damaged Hair Could Mean 704.2
Question: A teenager came to our practice with a note saying she could not return to schoo... Read more
Reader Question:
B-12 Charge Hinges on Payer and Site of Service
Question: Our clinics frequently provide B-12 shots as stand-alone charges with no E/M cha... Read more
Reader Question:
Double Check Copay Early to Save Time, Money
Question: A patient came to our office with the same insurance card she's had for years. W... Read more
Reader Question:
Forget Modifier 55 for Suture Removal
Question: An established patient went to the emergency room in another state over the week... Read more
You Be the Coder:
Reason for DES Reporting Determines Diagnosis
Question: We have a new patient in our office whose mother took DES while pregnant. What i... Read more
CCI Update:
2012 Guideline Changes Could Alter How You Report Some Meds or Screenings
Tip: Double check before reporting G0396, G0397 with E/M services. You're probably accusto... Read more
Diagnosis Coding:
Tophi and Other Details Lead You to Correct Gout Choices
Heads up: ICD-10 will include many more options in 2013. A diagnosis of gout might seem si... Read more
Correcting Records? Follow These 5 Guidelines For Audit-Proof Corrections
Clarifying documentation can be a big help -- if used wisely.A long list of governmen... Read more
Watch for New Code Family J32.x for Chronic Sinusitis
Descriptors will add a fourth digit to specify location.Under the current ICD-9-CM code se... Read more
Reader question:
Prepare Wisely for Payer Fee Negotiations
Question: We're getting ready to begin contract renewal negotiations with one of our payer... Read more
Reader question:
Evaluate Your Diabetes Education Options
Question: Our physician and physician assistant are educating some patients on diabetes, e... Read more
Reader question:
Notes of 'No Fever' Go In ROS
Question: I have found information and heard at seminars conflicting information regarding... Read more
Reader question:
30300 Works for Nasal FBR Coding
Question: I'm a bit confused. When reporting a foreign body removal of the nose, would I u... Read more
Reader question:
Yes, Consult Codes Might Still Be Viable
Question: An established patient who was about to undergo a tonsillectomy presented to our... Read more
Reader question:
Check State Laws, Payer Rules Before Sending Patient to Collections
Question: I work in a physician's office handling the collection of past due copays, deduc... Read more
You Be the Coder:
Know the Ropes for Sick Evaluation During Well Visit
Question: When parents present with infants for regular health checkups at two, four, an... Read more
CCI 18.0:
Latest Edits Clarify TPI, Tendon Injections Override 100+ Other Procedures
Plus: 94150 'separate procedure' doesn't always mean separate coding. New... Read more
Worker's Compensation:
Choose the Most Advantageous Fee Schedule for Worker's Comp Claims
Checking schedules and avoiding multi-problem visits streamline your filing. Worker's comp... Read more
E/M Coding:
Stop Downcoding E/M Visits, and Add $56 to Your Bottom Line With These Tips
Trap: You might not only be losing revenue -- you're also coding improperly.National ... Read more
CPT® 2012:
Don't Miss Terminology Change in 96110, 96111
Developmental 'testing' changes to 'screening.' Focusing on new codes will help keep your ... Read more
Watch for Product, Addiction Clues for Nicotine Dependence Coding
Choices expand from 305.1 to F17.2-- beginning Oct. 1, 2013.When the family physician sees... Read more
Reader Question:
Remember Debridement Includes Dressings
Question: Can our practice be reimbursed for the surgical dressing (supplies) of a parti... Read more
Reader Question:
Inadequate Height Increase Could Lead to 783.43
Question: The physician documented that the patient has inadequate growth (in terms of his... Read more
Reader Question:
Choose 23650 Over 23655 for Local Anesthesia
Question: One of our physicians administered a shot of meperidine HCL while treating a sho... Read more
Reader Question:
No HPI Equals No Coding for New Patient
Question: A new patient visits the physician with a chief complaint. I don't have a review... Read more
Reader Question:
Remember V16.8 for Family Melanoma Risk
Question: Our physicians sometimes see patients who don't personally have malignant melano... Read more
You Be the Coder:
Differentiating a Self-Limited or Minor Problem
Question: An established patient saw the physician with a new complaint. Through the E/M, ... Read more
CPT® 2012:
Don't Miss These Clarifications About New Patients and 'Qualified Healthcare Professional'
See how changes affect your use of 99201-99205, 99460-99461, and more. Coding guidelines c... Read more
2012 Physician Fee Schedule:
Good News: Expect More Flu Vaccine Reimbursement in 2012
Pay for 3 of your most common vaccine codes will rise. Your family physician should be smi... Read more
Workers' Compensation:
2 Tips Point You Toward Pain Free Workers' Compensation Billing
Get pertinent information before seeing the patient to avoid trouble when you start the bi... Read more
Ensure Compliance With Sinusitis' One-to-One Relationship For ICD-10
Code J32.x with a fourth digit to specify location.When following the ICD-9-CM code set, y... Read more
Reader Question:
J3490 Covers Used EpiPen® Kit in Office
Question: We used the EpiPen® kit in the office on a patient who experienced an alle... Read more
Reader Question:
Only Add Lacerations at Same Site and Level
Question: A patient with a 1.5-cm laceration on his eyebrow presented to our practice. Our... Read more
Reader Question:
Select E Code for Initial Fall Visit
Question: An established patient came to the office complaining of back pain related to a ... Read more
Reader Question:
Lack of History Can't Support Comprehensive Exam
Question: Our physician admitted someone as an initial inpatient, but couldn't get all her... Read more
Reader Question:
Don't Count On Pay for Anesthetic Before Injection
Question: We've had increasing problems billing and being paid for the medications we use ... Read more
Reader Question:
Stick With 86580 for TB Skin Test
Question: Can we bill for an administration fee or injection when giving a PPD test? Or is... Read more
Reader Question:
Extent of FBR Work Separates 10120 From 10121
Question: A patient had a head injury but could not have an MRI because of decorative st... Read more
You Be the Coder:
Can Counseling Bump Up Consult Codes?
Question: Our physician provides pre-op consultations for requesting surgeons. He complete... Read more