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Pulmonology Coding Alert

HCPCS Coding:
Foolproof Your J7613 Coding With These Tips
CMS lists J7613 as last year's most-billed code. When most pulmonology practices think of... Read more
Part B Coding:
Get the Scoop: Part B MAC Rep Outlines the Top Errors, Questions It Sees
Got questions about denials? You're not alone. Your pulmonology practice likely has Medic... Read more
Check These Special Circumstances When Coding Chest X-rays
Curious about how to code a chest X-ray when a line is placed? Find out here. If you've s... Read more
Reader Question:
Give Patients Their Medical Records
Question: We had a patient ask for her medical records and we misplaced the request and fo... Read more
Reader Question:
Use Double the Codes When You See 2 Patients
Question: Can we bill based on time if we see two patients during the same visit? I spent ... Read more
Reader Question:
Look to “J” Series for This COPD Solution
Question: A patient who we diagnosed with COPD last year presented to our office last week... Read more
You Be the Coder:
Remember: Medicare Advantage Isn’t Supplemental Policy
Question: We have a patient with a Medicare Advantage secondary/supplemental policy. We ar... Read more
CPT® 2020:
Latest Edition of CPT® Offers Updates to Chest Wall Excision, E-Visit Codes
You'll also see a revision to airway resistance by oscillometry code 94728. Some years, t... Read more
Smoking Cessation:
3 FAQs Lead You to Smoking Cessation Coding Bliss
Know when 99406 is the right choice — and when it's not. Many pulmonology patients are ... Read more
Increase Cash Flow With 5 Quick Tips
The key is mastering your accounts receivable, experts say. If your pulmonology practice ... Read more
Reader Question:
Consider Second ICD-10 Code for CPAP Intolerance
Question: We recently saw a patient who was unable to see any improvement with the CPAP ma... Read more
Reader Question:
XX Out the Belief that These Global Periods Are the Same
Question: What›s the difference between an “XXX” global period and a “000” globa... Read more
Reader Question:
Nail Down This Place of Service
Question: A patient presented to our office with shortness of breath. Our physician subseq... Read more
Reader Question:
Evaluate PA-C’s Drug Check Choices
Question: Our pulmonologist put one of our established patients on a new drug regime. The ... Read more
Reader Question:
Is A Newsletter A No-No?
Question: We would like to send a quarterly email newsletter to our patients, which includ... Read more
You Be the Coder:
Are CCI Edits Flexible?
Question: After reading your article last month about which Correct Coding Initiative (CCI... Read more
CCI Edits:
Know When Bronchoscopies Can — And Can’t — Be Billed With Thoracotomies
You can't always break out modifier 59 with these code pairs. Most pulmonology coders wou... Read more
PFT Coding:
3 FAQs Help You Report Pulmonary Testing Codes
Have you learned the ropes of 94617-94618? Your practice probably performs pulmonary func... Read more
E/M Coding:
E/M Visits Over the Phone? Know How to Use 99441-99443
Stick to these rules when performing virtual visits. If your pulmonologist is spending ti... Read more
Reader Question:
Manage Multiple Diagnoses
Question: We need to submit a claim with more than 12 diagnoses. Is there a way to do that... Read more
Reader Question:
Electronic Faxes Become ePHI
Question: Our office recently switched to receiving faxes electronically. What is the best... Read more
Reader Question:
Nail Down PAP Dx
Question: We recently saw a patient who presented with shortness of breath and a cough. Th... Read more
Reader Question:
Differentiate Observation From Inpatient Visit
Question: Our pulmonologist admitted a patient to the hospital at 11:30 a.m. A different p... Read more
Reader Question:
Know Which Documentation to Maintain for Vent Management
Question: What documentation is necessary when reporting vent management? New Mexico Subs... Read more
You Be the Coder:
Are Modifiers Required for PFTs?
Question: We've always reported 94640 with 94664, using modifier 59 on the nebulizer demon... Read more
Diagnosis Coding:
Stay in the Know: New Pulmonary Embolism Codes to Debut Oct. 1
You'll find hundreds of changes in the 2020 diagnosis code set. When it comes to treating... Read more
Hospital E/M Services:
Are Your Pulmonologist’s 99233 Claims Above the Average?
Examine the outcomes from this comparative billing report for the scoop. Pulmonologists a... Read more
Follow These 99233 Best Practices
If the results of the recent Comparative Billing Report revealing pulmonologists' subseque... Read more
Could Incident-To Become A Thing of the Past?
If MedPAC has its way, this billing mechanism could go away. If your practice utilizes ... Read more
Reader Question:
Know When CCI Bundles Can Be Separated
Question: I read your article last month about the new CCI edits and I have a question. Yo... Read more
You Be the Coder:
Watch Antigen Unit Overkill
Question: For our physician's allergen immunotherapy services, we reported CPT® code 9516... Read more
CCI 25.2:
Beware Coding Adjustments Due to New Bronchoscopy with Lesion Ablation Bundles
Skip C9751 with a wide range of testing procedures, E/M encounters.  In the latest r... Read more
Supply Reimbursement:
Have You Got Your WOPD and Your 5EO Ready?
Your nebulizer claims won't “pass go” with Medicare unless you can submit these two th... Read more
CPAP Compliance:
Look to Pilot Project for CPAP Documentation Streamlining
CMS wants to make your life easier with a new EHR component. CMS is really on a roll this... Read more
Biopsy Results Determine Your Pulmonary Nodule Dx Coding
Scan the note for bronchus or lung location to assign 5th digits for malignant neopla... Read more
Reader Question:
Confirm Medical Reasonableness
Question: Can you help me understand what criteria are used by Medicare in their claims re... Read more
Reader Question:
Check for Bilateral Lesion Destruction
Question: Our physician performed laryngoscopy which included lesion destruction. What cod... Read more
Reader Question:
Discern 2 Types of Pulmonary Hypertension
Question: I was very interested in the article “5-Group System Helps You Classify Pulmon... Read more
You Be the Coder:
Review 99226 Subsequent Care Rules
Question: Our pulmonologist was called in to the hospital by the admitting doctor as a spe... Read more
Coding Focus:
Alleviate Your Patients’ Flight Stress With HAST Evaluations
Flight simulation in a pulmonology practice? Absolutely. You could safely say that most o... Read more
Resource Simplifies Your Asthma Outcomes Reporting
Check out this outcome measures report from AHRQ. You know yourself that you've got your ... Read more
5-Group System Helps You Classify Pulmonary Hypertension
Turn to I27.22 for left heart disease. Selecting the right code to describe a patient's p... Read more
Reader Question:
Choose Between 96401 or 96372 for Monoclonal Antibody
Question: How do you know whether to use CPT® code 96401 or 96372 for administration of a... Read more
Reader Question:
Watch for Cloned Notes
Question: In auditing our physicians' documentation in our EMR system, I'm seeing a patter... Read more
You Be the Coder:
Sort Out Bronchoscopy with Left Lobe Procedures
Question: Our physician performed the following procedures during a fiberoptic bronchoscop... Read more
Proposed Codes May Change Your Cough Coding in October
Acute and chronic cough might be coded differently if the proposals are finalized. Cough ... Read more
Supervision Rules:
Nail Down Supervision Rules for These Services
Can you differentiate general supervision from direct? Supervision can be a tricky issue,... Read more
Patient Privacy:
Bust These HIPAA Disclosure Myths
HIPAA Privacy Rule does not trump state law-required reporting. You know you have to keep... Read more
Dispel These Bonus Myths to Ensure HIPAA Compliance
In addition to the disclosure myths above, check out these common HIPAA myths that many pr... Read more
Reader Question:
Know the Unlisted Code Rules
Question: We reported 94799 for a service that had no CPT® code assigned to it but we are... Read more
Reader Question:
Consider Options for Differential V/Q Study
Question: Our physician performed a differential ventilation/perfusion scan (or V/Q study)... Read more
Reader Question:
Find out How Scripting Can Help Your Front Desk Staff
Question: We had a consultant come to the office who told our front desk staff to create s... Read more
Reader Question:
Check the Trach Tube Coding Solution
Question: Our physician assistant recently changed a trach tube in our office. How should ... Read more
You Be the Coder:
Does Medicare Have Pulmonary Rehab Frequency Rules?
Question: Thanks for your article last month on how the recovery audit contractors are scr... Read more
RACs Launch Scrutiny of Pulmonary Rehab Claims
Are your services being reported correctly? Although most pulmonology coders would agree ... Read more
Sleep Studies:
Get the Lowdown on Ordering CPAP Devices
Plus: Nail down the most common diagnoses. Giving a patient a continuous positive airway ... Read more
Respiratory Testing:
Are You Ready to Get Past These Commonly-Held PFT Myths?
Keep modifiers in mind when reporting multiple tests. With all their confusing terminolog... Read more
Reader Question:
Remove “O” From Your MBI Alphabet
Question: We've encountered some slight confusion when accepting the new MBI numbers on pa... Read more
Reader Question:
ICD-10 Guidelines Can Aid Your Specificity Explanation
Question: One of our pulmonologists wants to see in writing where she has to document anyw... Read more
You Be the Coder:
Which Diagnosis Applies in Observation Care?
Question: Our understanding is that the first-listed diagnosis must be used in lieu of the... Read more
Medicare Pay:
4 Tips for Smooth Consolidated Billing Practices
Seeing SNF patients can lead to payment hurdles if you don't know the rules. Almost every... Read more
Check This Sample Consolidated Billing Contract
Consolidated billing -- in which you bill the SNF directly for some services, and the SNF ... Read more
CCI Edits:
Latest CMS Update Specifies When Modifier 59 Applies to NCCI Edits
Changes aren't earth-shattering, but do help provide clarity on this frequently-used modif... Read more
E/M Coding:
Can You Master This ROS Coding Quiz?
Don't take this essential E/M element for granted. You may not think too carefully about ... Read more
Reader Question:
Should You Trust E/M Time Determination From EHR?
Question: One of our pulmonologists started billing based on time for more visits tha... Read more
Reader Question:
Find out How to Pinpoint Pertinent, Complete PFSH
Question: We are having trouble choosing between pertinent and complete levels of past, fa... Read more
You Be the Coder:
Bronchitis Coding Gets Very Specific
Question: A chronic smoker with tracheobronchitis who is on albuterol came to our office a... Read more
Use This Quick Advice to See Your Audit Odds
Plus: We've got resources to help you make pulmonology-specific calculations. The rate of... Read more
These Are the Big Five Focus Areas
Pulmonology coders should get to know five main areas involved in provider audits: E/M ... Read more
Perform Self-Audits Efficiently With These Tips
Your audit plan is the most important part of your compliance program, because without it,... Read more
Confirm Which Services Are Inherently Bilateral Before Submitting
Sometimes the code refers to a service performed on one lung only. Lung care coding often... Read more
Check These Examples of Unilateral, Bilateral Lung Services
Before you report the bilateral modifiers on your claim, make sure you know whether your c... Read more
Reader Question:
Know When Modifier 22 Applies
Question: Our pulmonologist saw a patient with unusually thick and large mucus plugs, so h... Read more
Reader Question:
Find Out Who Can Record ROS
Question: Who can record the review of systems, and how should we document it? SuperCode... Read more
Reader Question:
Dig Deeper on New Patient Determination
Question: We were recently audited and an established patient visit was marked as incorrec... Read more
You Be the Coder:
Keep An Eye on the Clock for Observation Care
Question: I read your reader question last month about same-day admission and discharge fo... Read more
Coding Errors:
CMS: Pulmonologists Logged $128 Million in Improper Part B Payments
Plus: Chest physicians among worst offenders when it came to subsequent hospital visit err... Read more
Get to Know CMS’ Evaluation Criteria
CMS identified a total of $31.6 billion in total improper payments among providers during ... Read more
Seeing Extrinsic Allergic Alveolitis Patients? Avoid These Common Mistakes
Hint: Some tests will be bundled. If you see patients with extrinsic allergic alveolitis ... Read more
E/M Coding:
Can You Differentiate MDM From Medical Necessity?
Your E/M payment could depend on the difference. When it comes to coding E/M claims, unde... Read more
Reader Question:
Go Beyond Follow-up for Chief Complaint
Question:  Our pulmonologist lists the chief complaint for all follow-up visits using... Read more
Reader Question:
New Year, New Collection Process
Question: We ended the final quarter of 2018 furiously trying to submit charges to patient... Read more
You Be the Coder:
Confirm Status for Same Day Admit, Discharge
Question: One of our physicians admitted a patient to the hospital at 11:30 a.m., and late... Read more
Coding 101:
Monitoring Cystic Fibrosis? Check This Primer
Hint: Mind the NCCI edits. If you're monitoring patients with cystic fibrosis, chances ar... Read more
2019 Payment:
CMS Won't Institute Big E/M Changes This Year
But don't wait two years to review what could be coming your way. Pulmonology practices h... Read more
Looking Ahead:
Here's What to Expect in 2021
Although CMS won't be instituting big changes to E/M coding and documentation when the cal... Read more
Differentiate Alkalosis, Acidosis to Find Correct Dx Code
Don't mix up these two conditions. Maintaining an optimal level of carbon dioxide in the ... Read more
Reader Question:
Will 94762 Qualify for Overnight Desat Payment?
Question:  How should I code for an overnight desaturation oximetry for a Medicare pa... Read more
Reader Question:
Does Extended HPI Guarantee High-Level E/M?
Question: Thank you for your article last month about coding history of present illness (H... Read more
Reader Question:
Know the Rules When Communication Problems Exist
Question: A new patient who is unable to communicate clearly and to explain her medical pr... Read more
You Be the Coder:
Does CPT® Include A PFT Code?
Question: We performed pulmonary function tests (PFTs) on an outpatient basis at the hospi... Read more