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Primary Care Coding Alert

CPT® Coding Strategies:
Sanitize Your Flu Vaccine Coding With These 4 Tips
Hint: Don’t forget to report administration with separate codes. As your code ch... Read more
Back to Basics:
Follow The 3-Year Rule To Determine Patient Status
Hint: The place of service(POS) won’t influence your choice. The first step to c... Read more
ICD-10 Update:
Concentrate on Severity While Reporting Asthma With J45
Hint: Identify symptoms and medication use for accurate reporting. When your FP diagno... Read more
Reader Question:
Facing Denials For Same Session 99407 and E/M? Check This
Question: I am billing 99407 with 99213 and getting denials. I have used the modifier 25... Read more
Reader Question:
Report Appropriate DSMT Codes Based on Time and Provider
Question: A patient seen for diabetes (250.02) in the doctor’s office and the phys... Read more
You Be the Coder:
Count Number of Muscle Groups For Accurate TPI Reporting
Question: Our FP recently performed trigger point injections to relieve muscle spasms. H... Read more
CPT® 2014 Update:
Incorporate New E/M and Ultrasound Wound Care Therapy Codes in 2014
Good news: Common TCM guidelines will rid confusion while reporting transitional care. ... Read more
2014 Physician Fee Schedule:
Brace Yourself for Fee Deductions If Proposed MPFS Gets Accepted
Sunny side: Chronic care non-face-to-face services might bring in bonuses in 2015. Whi... Read more
ICD-10 Update:
Don't Get Sidelined By These 3 ICD -- 10 Myths
Don’t assume that ICD-10 will allow you to use the same code twice. With the hea... Read more
Reader Question:
Include Supply Codes With Depo Provera Administration
Question: Our FP saw a patient for her third Depo Provera shot. What is the appropr... Read more
Reader Question:
Append EF Modifier For EPSDT Examination Codes
Question: We are receiving denials from Medicaid stating 92551 (hearing exams) whic... Read more
Reader Question:
Append Modifier for Destruction, Excision Procedures
Question: One of our physicians destroyed a premalignant lesion on a patient’... Read more
You Be the Coder:
Factor in Counseling to Select Vaccine Codes
Question: Rotavirus vaccine is only given to children less than the age of eight at 2,4,... Read more
CPT® 2014 Update:
Get A Grip On Coding Changes Affecting Family Practice In 2014
Good news: You will now have a new code set for inter-professional discussions. If you... Read more
Mythbuster:
Bust The Bubble On 3 EHR Myths That Could Cost Your Practice Precious Dollars
Warning: Blindly relying on your electronic system could mean payer audits. If you are... Read more
ICD-10 Update:
Enjoy Better Specificity For Pressure Ulcer Coding in ICD-10
Separate codes for bilateral locations reduce confusion while reporting multiple ulcers.... Read more
Reader Question:
Focus on Muscles - Not Left/Right - for TPIs
Question: Our physician administered bilateral trigger point injections in three locatio... Read more
Reader Question:
Check Bundling Between Epidurals and E/M Depending on DOS
Question: I have done continuous epidural for my patient and injected different concentr... Read more
Reader Question:
Report Appropriate E/M for Suture Removal by Another Physician
Question: We recently had a patient coming into our practice to meet our family physicia... Read more
You Be the Coder:
Joint Codes Are Best Bet for Sinus Tarsi Injection
Question: Question: I recently received a denial for a cortisone injection to the sinus ... Read more
CCI 19.2 Update:
Bundles Revise Your E/M With Office Procedures Reporting
In addition: Watch for these bundles affecting negative wound pressure therapy. Apply ... Read more
Money Matters:
Enhance Your PQRS Reporting Bonus Ethically By Selecting Right Options
Hint: Base your decisions by analyzing the number of providers in your group. If you&r... Read more
ICD-10 Update:
Get Set For Broader Reporting Options For Anorectal Abscess
Hint:  Use separate code when you clinician diagnoses anal and rectal abscesses. ... Read more
Check These Anorectal Abscess Types
Based on location of the abscess in the anal and rectal regions, anorectal abscesses can... Read more
Reader Question:
Include 94010 for Spirometry During Office Visit
Question: What is the proper way to bill an E/M visit when performing spirometry during ... Read more
Reader Question:
File Appropriate E/M Code for Pre-Op Clearance
Question: What CPT® code do we file for preoperative clearance by one of our family ... Read more
Reader Question:
Consider Block Scheduling to Balance Late Patient Back-Ups
Question: We’ve had a lot of patients showing up late for their appointments recen... Read more
Reader Question:
Get Good Documentation for Unexpected Shot for Nerves
Question: One of our patients was on his way to have an MRI at the hospital. His daughte... Read more
You Be the Coder:
Billing 2 MD Visits on Same Day Is OK if Specialties Differ
Question: Can a patient be seen by two different providers in a billing group on the sam... Read more
CPT® Coding Strategies:
Cue Into Accurate Newborn Exam Reporting With This Guidance
Hint: Use new patient or established codes depending on previous review of the infant. ... Read more
Key Elements:
Forgetting to Document PFSH Details Might Cost You More Than $70 Per Encounter
Hint: Omitting history captured in previous visits will mean loss of revenue. When you... Read more
ICD-10 Update:
Segregate Your Diabetes Mellitus Codes Based on Type
Hint: Use fourth and fifth digit expansion to specify complications. When your FP diag... Read more
Reader Question:
Let Medical Necessity Drive Your E/M Code Choice
Question: Our physician documents office visits very thoroughly. Because he documents in... Read more
Reader Question:
E/M With G0438, G0439 Is Possible, But Tricky
Question: Can we bill an E/M code with a 25 modifier along with annual check-up codes G0... Read more
Reader Question:
Here's When to Report 300.4 Instead of 311 or 300.00
Question: What is the appropriate way to code a claim when the physician calls out anxie... Read more
You Be the Coder:
Correctly Report Pre-Op Clearance for Surgery
Question: What CPT® code should we submit for pre-op clearance by one of our family ... Read more
TCM Codes:
Remember 4 Things When Reporting Transitional Care to Medicare
New rules apply when you follow CMS guidelines instead of CPT® Now that you’... Read more
Well Visits:
Understand Payer Differences Before Coding Pap Smears With Yearly Physicals
Heads up: Medicare follows its own guidelines, not CPT® rules. If your physicians ... Read more
E/M Coding:
Take Steps to MDM Determination Success - Every Time
This system will help you correctly calculate each piece of the MDM puzzle. Are you in... Read more
ICD-10:
Neck Pain Makes Easy Shift from 723.1 to M54.2
Good news: You won’t need to learn a new descriptor for ICD-10. Family physicia... Read more
Reader Question:
Special In-House Code Might Be Best for CDL Physicals
Question:  One of our physicians wants to bill an E/M code for a commercial driver&... Read more
Reader Question:
Verify Anatomic Locations Before Submitting Multiple Lines of 20600
Question: Our physician treated a patient who has osteoarthritis in her hands by injecti... Read more
Reader Question:
Switching Diagnoses on Claim Can Be OK
Question:  Our physician documented gingivitis as a contributing factor in a patien... Read more
Reader Question:
Verify MD/NP Collaboration Agreement Before Locum Tenens Time Starts
Question:  One of the physicians in our practice will be traveling for two months a... Read more
Reader Question:
Include Retained FB Code With Toe Blister, When Applicable
Question: I’m coding a case of treatment for an ischemic blister of the right grea... Read more
You Be the Coder:
Understanding Whether to Report 11042 With 10120
Question: Is it acceptable to code 11042 and 10120 together? If so, do I need to include... Read more
CCI 19.1:
Newest Coding Edits Reverse Bundling for Some Injection Administrations
Start reporting vaccine administration with office consultation. The latest update fro... Read more
Office Visits:
Don't Miss These 3 Chances to Bill Services With Preventive Care
Tip: Check whether the payer also requires modifier 25. Preventive wellness visits are... Read more
Billing:
Follow These 3 Steps to Cleaner Incident-To Claims
Don’t forget to check your state’s laws for NPP scope of services. Having... Read more
ICD-10:
Get Extra Details to Avoid 'Unspecified' Viral Infection Diagnosis
Code 079.99 makes an easy switch, but payers might not reimburse. When your physician ... Read more
Reader Question:
Bill 92504 Alone, Not With 69210
Question: The physician cleared cerumen impaction from the patient’s left ear and ... Read more
Reader Question:
Replace Deleted Code G0366 With G0402 or G0403
Question: A 65-year-old patient who just enrolled in Medicare came to our office for his... Read more
Reader Question:
Q2038, G0008 Is Acceptable Fluzone Pairing for Medicare Patients
Question: Medicare denies our claims for flu vaccines with claim status codes of 25... Read more
Reader Question:
Submit 692.6 for Poison Ivy Diagnosis
Question: I’m having trouble finding a diagnosis code for 96372 when the physician... Read more
Reader Question:
Code 90714 Applies to All TD Vaccines in U.S.
Question: I know that, as of the first of the year, code 90718 has been deleted. I have ... Read more
You Be the Coder:
Diagnosing Initial Vs. Follow-Up Fracture Visit
Question: Our physician treated a patient for a fracture of the second metatarsal. A fol... Read more
Preventive Services:
Yes, You Can Bill a Separate Problem During a Well Check Visit
Watch for significant service that could boost pay. When a patient comes to your offic... Read more
ICD-10:
4 J Code Options Help You Nail Strep Throat Diagnoses
Wait for lab results before assigning the final code. ICD-9 coding: When using the ICD... Read more
Billing:
Follow This 3-Step Advice Before Waiving Copays
Tip: Get your own verification of financial hardship. Every physician wants to collect... Read more
Reader Question:
Penalties Could Be Coming for Illegible Documentation
Question: My physician’s handwriting really is difficult to read sometimes, a... Read more
Reader Question:
Watch Details When Deciding Between Levels 4 and 5 E/M
Question: We have enough details for an encounter to reach these levels: &mi... Read more
Reader Question:
No Incision Means No 10120 for Removal
Question: My physician documented that a tick was embedded in the patient’s abdome... Read more
Reader Question:
Look at 917.2 for Toe Blister
Question: What is the correct diagnosis for an ischemic blister of the right great toe? ... Read more
Reader Question:
Start With V13.3 for Atypical Nevus Diagnosis
Question: I can’t seem to find a clear diagnosis code for personal history of atyp... Read more
You Be the Coder:
Billing Same-Day Physician/NP Services
Question: Our nurse practitioner (NP) is working with our family physician in the same c... Read more
Follow These 3 Tips to Strengthen Your Bone Density Coding
Check your LCDs to see if coverage is once every 2 years. The restrictions Medicare se... Read more
Documentation:
Need to Amend a Patient Encounter? Better Check These Directions First
Heads up: Single-line corrections are fine. If you discover your family practitioner f... Read more
ICD-10:
Watch for Where BMI Codes Get More Specific Under ICD-10
Good news: Most ICD-9 codes have straight crosswalk for ICD-10. Obesity in adults and ... Read more
Reader Question:
Use V65.40 or V65.49 for Visit to Discuss Lab Tests
Question: A patient would like to schedule an appointment with her physician to review l... Read more
Reader Question:
17110 Includes Simple Repair Work
Question:  Our physician performed an excision of two warts (one from the elbow and... Read more
Reader Question:
Begin With 95004-95071 for Allergy Testing
Question:  Our physician’s documentation regarding an allergy test is as foll... Read more
Reader Question:
Preventive Codes Could Apply to 'Health Coach' Services
Question: I am looking for CPT® or HCPCS codes for health coach services that would ... Read more
Reader Question:
Submit 29405 and Q4038 for Second Cast Placement
Question: A patient was put in a cast after surgery, then came to our clinic the very ne... Read more
Reader Question:
Yes, You Can Report COPD and Chronic Bronchitis, but Not With Separate Codes
Question: Is it appropriate to code 491.0 with 496 when the patient has chronic bronchit... Read more
Reader Question:
No CC or Prescribed Service Could Mean Preventive Counseling
Question: A patient met with our physician to discuss his need for a scooter. He denied ... Read more
You Be the Coder:
No Patient History? Here's How to Decide E/M Level
Question: Our physician saw patient in the office, but couldn’t get all necessary ... Read more
CCI 19.0:
Implement These Edits For Multiple Vaccines
Tip: Pay special attention to 300+ E/M pairs with influenza vaccines. Family practice ... Read more
CPT® 2013:
Brush Up on Counting Criteria Before Reporting New TCM Codes
Tip: Watch individual days, not just calendar months.  CPT® 2013 introduced t... Read more
ICD-10:
Watch Your Fifth Digits for Otalgia Coding in 2014
ICD-10 will introduce 4 new options. Otalgia is one of the most common complaints in a... Read more
Reader Question:
Signature Variations Are Acceptable, if They're on Your Signature Log
Question: We’re having trouble making sure our providers meet signature requi... Read more
Reader Question:
Report 255.0 for Hypercortisolemia
Question: One of our providers ordered labs with hypercortisolemia as the supportin... Read more
Reader Question:
E/M Without Vitals Is Billable - With Good Documentation
Question: A daughter brought her mom to our office. The mother was seen by the doct... Read more
Reader Question:
+99354 Can Apply to Office Visit After Hospital Stay
Question: What is the best way to code for an extended office visit following an ac... Read more
You Be the Coder:
Choosing Between Routine Screening and Diagnostic Test Result
Question: A patient came in for a bone density scan, which was positive for osteope... Read more
CPT® 2013:
Watch the Clock to Get Full Advantage from New Care Coordination Codes
 Heads up: Here’s your chance to report services across multiple specialties ... Read more
Compliance:
Does Your Electronic Prescription System Pass Muster?
  Get started now to avoid further pay hits in 2014. deputy director of the ... Read more
News Flash:
Add Modifiers 24 and 27 to Your Choices for Bypassing CCI Edits
Plus: You can also override bundles with modifiers LM and RI Coders learned years ago ... Read more
ICD-10:
K Codes Require You to Extract More Acute Appendicitis Details
Hint: Start your search based on the presence or absence of peritoneal involvement. A... Read more
Reader Question:
Consider Each Additional Service When Billing With G0402
Question: I’m trying to understand what we can bill to Medicare during a patient&r... Read more
Reader Question:
Check Payer Guidelines for Submitting Modifiers With L4360
Question: One of my third-party payers is denying L4360 because they are asking for &quo... Read more
Reader Question:
Multiple Diagnoses Are Fine – if They Aren't Symptoms
Question: Can I code tonsillitis, pharyngitis, and upper respiratory infection together?... Read more
You Be the Coder:
Choosing a Modifier for Non-Surgical Service in Global Period
Question: A patient came to our office for a minor skin surgery procedure. He was back f... Read more
2013 AMA Symposium Update:
Get the Scoop on Transition Codes, PCIP Pay Requirements for FPs
Caution: Missing primary care designation could wreck your Medicare pay. . Family pract... Read more
E/M Coding:
Implement These 5 Simple Tips to Boost Your E/M Bottom Line.
Heads up: Dig past 'follow-up' for acceptable chief complaint. E/M coding might be part... Read more
ICD-10:
Ratchet Up Your Mono Coding to Include Infection, Complication Details
Heads up: Coding under ICD-10 will depend on the level of detail providers note. When ... Read more
Reader Question:
Note That Modifier 50 Doesn't Apply to 69205
Question: The physician administered anesthesia before removing a bead from each of a ch... Read more
Reader Question:
Check These Code Families for 'Case Management' Possibilities
Question: Services such as phone calls to patients, filling out forms, and coordinating ... Read more
Reader Question:
Always Pair Vaccine Product With Administration Code
Question: I'm new to family medicine coding and have a lot to learn. Can I bill 90658 al... Read more
Reader Question:
Steer Clear of Submitting 99211 With 96372
Question: One of our patients purchases her medicine through her prescription program an... Read more
Reader Question:
Codes Specify Partial ECG Service, Not Modifiers
Question: Our office owns an EKG/ECG device. How should we bill for tests performed in o... Read more
Reader Question:
Headache Doesn't Always Point to 346.x
Question: A co-worker says we can submit "headache" and "migraine" on the same claim, bu... Read more
You Be the Coder:
Follow-Up Coding for 10060
Question: A patient saw our physician because of an abscess, and returned for a follow-u... Read more