Supercoder give you ways to boost your Hemoccult Test Coding.

If you want to keep the money coming for in-office examination of fecal occult blood test (FOBT), you should train eyes on the difference between three hemoccult codes and their purpose.

Here's a scenario:

A 60-year old patient presented in the office complaining of diarrhea preceded by intestinal cramping, which lasted two weeks. The patient has no history of cancer in the family. He also did not feel nauseous at all. The physician took a stool sample to test for both parasites and blood. How should you approach this situation?

Assign the right code for each type of collection

Since the year 2007, CPT has assigned two codes that you can use for post digital rectal exam (DREs) and consecutive specimen collection:

82270

82272

Update: With effect from January 1, 2007, CPT has terminated HCPCS code G0107 and replaced by 82270 even for routine Medicare screening FOBT.

Remember: In the above scenario, it is not clear whether the doctor examined the samples herself or sent them to the lab. But as a general rule, parasite exams almost always take place in the lab. Here, the lab would be paid for the test directly.

Do not forget: There are interval limitations for screenings established by Medicare and most commercial carriers.

On the other hand, if a patient presents to the office with symptoms, the gastroenterologist would carry out a diagnostic FOBT, and you should bill it with 82272. One can bill CPT 82272 if 1 to 3 specimens are obtained. The diagnosis code for the test would be related to the patient's presenting symptoms.

Count number of tests

If you are still not sure whether you have got the right code by differentiating screening from diagnostic, you can look further into the test's details. Identify how many tests the gastroenterologist or lab performs. For a three-specimen collection, you would go for 82270. Use a single-specimen collection with 82272.

Red flag: Even though 82270 involves analysis of three specimens, you should always assign 82270 with a “1" in the units field. Some coders incorrectly interpret 82270's descriptor of “one to three simultaneous determinations" to mean they should bill “each of the three determinations with one unit of CPT 82270 (82270 x 3)." The revised description more clearly reminds providers that the code identifies as many as three consecutive determinations.

What if: The patient fails to collect all three samples. You may still bill 82270. If this happens, the laboratory should carry out analysis of the one or two collected specimen, report the results accordingly and record one unit of 82270.

Determine who obtains the sample

Where the sample is collected and who performs it can also include you in to the right FOBT code. CPT Code 82270 will always be billed as a separate service when the developer has been placed on the cards after the three completed cards (or one completed triple card) have been returned to the office. In a nutshell, the doctor should not collect the specimen in the office.

Instead you should use 82272 when the doctor carries out a digital rectal exam in the office and obtains a sample at that time.

How to Code Cosmetic Ptosis Repair

Having issue how to code Cosmetic Ptosis repair. For more on this and all 2011 CPT updates visit a medical coding guide like Supercoder.

There is this Medicare patient of ours who'll be having a leva to resection on his right eye for ptosis. The ophthalmologist wants to do this as a bilateral procedure; however the patient's left eye is a non-seeing eye. As the operation on the right side may be medically necessary, but the left side would likely be considered cosmetic, how should I go about coding this surgery?

Well, you should report each side of the bilateral procedure on a separate line, appending modifiers LT (left side) and RT (Right side), linking each side to the appropriate diagnosis code explaining the necessity for the surgery.

In this situation, one side will be medically necessary, while the other will be cosmetic – the procedure will not benefit the vision on the non-seeing eye.

Here's what you need to do: Before the surgery, have the patient sign an advance beneficiary notice of non-coverage (ABN) prior to surgery, stating that he's aware that Medicare will not cover the procedure carried out on the left eye. Ensure your ABN is in layman's terms and specifies the specific reasons for non-coverage. (you shouldn't use CPT Code, ICD 9 codes on the ABN form).

Source URL :- http://www.supercoder.com/coding-newsletters/my-ophthalmology-coding-alert/reader-questions-report-cosmetic-ptosis-repair-separately-15819-article

You must also specify the estimated cost of the service on the ABN. The original signed ABN indicating the patients decision ( be sure the patient has chosen one of the options) to accept financial responsibility, is maintained by the practice and a fully executed copy must be provided to the patient. Append modifier (Waiver of liability statement on file) to the procedure done on the non-seeing eye to indicate that the patient was informed before and has selected the option to be responsible for the non-covered service and unpaid amount.

For instance: The patient has congenital ptosis (743.61), and his left eye is non-seeing. The ophthalmologist carries out levator resection (67904, Repair of blepharoptosis; [tarso] levator resection or advancement, external approach) bilaterally. Code as follows:

Line 1: 67904-RT linked to 743.61

Line 2: 67904-LT-GA linked to V50.1 (Elective surgery for purposes other than remedying health states; other plastic surgery for unacceptable cosmetic appearance).

If your documentation shows that the procedure was medically necessary on the right side, Medicare will reimburse the full amount for 67904-RT. The cosmetic diagnosis linked to 67904-LT-GA will prompt the carrier to deny the specific service due to the diagnosis and non-coverage of cosmetic services, and the explanation of benefits (EOB) received by the patient will confirm that the patient is responsible for payment.

Wrong Answer Could Weigh Heavily on your Medical Coding Practice

In Medical Coding a mistake can also impact on your practice’s reimbursements.

Your ophthalmologist provides a new patient with a standard office-visit E/M. You use an established patient E/M to report the encounter. And if you thought it’s no big deal, you are wrong.

Not only is the coding wrong, this mistake will also have an impact on your practice’s reimbursements. To add to it, Medicare’s non-payment of consultation codes means that medical coders will have to answer the new versus established question more often than before.

For Medicare and payers that follow their lead, medical coders will now have to choose the correct code, new or established, to bill for what used to be consults and didn’t have a new versus established component concept.

Here’s an expert advice on new and established patients.

If you ignore new patient E/Ms, you could be losing your deserved money

For physician practices, the difference between new and established patient codes is the payment rate. Think about this comparison of average national payouts for new and established level-two E/m codes respectively:

99202 pays about $68 per encounter (1.86 transitioned nonfacility relative value units [RVUs] multiplied by the temporary 2010 Medicare conversion rate of 36.8729)

99212 pays about $40 per encounter (1.08 transitioned nonfacility RVUs multiplied by the temporary 2010 Medicare conversion rate of 36.8729).

That is almost $30 lost if you report 99212 instead of 99202 mistakenly. The main difference between a new and established patient visit, service-wise, can be minimal: Often it includes simple tasks like setting up a new chart and quizzing the patient a little closer to get familiar with him.
First ask 3-year question

If your patient has had a face-to-face service with the ophthalmologist within the last three years, then the patient is considered established. So let us say a patient reports to your ophthalmologist and gets a level-three E/M service on April 20, 2010. The patient’s record points to the fact that she received a previous face-to-face E/M service from another ophthalmologist within the group on Dec. 14, 2008. Since this is an established patient, you should report 99213.

For established patients, Face Time is a must

As a coder, what would you do when the patient has received treatment from your ophthalmologist within the last three years, however the doctor didn’t actually lay eyes on the patient? This is a different coding situation; here’s what you need to do: ‘Interpret the phrase ‘new patient’ to mean a patient who hasn’t received any personal services – to put it separately, an E/M service or other face-to-face service from the physician or physician group practice within the last three years.

This means that you might be able to report a patient as new if your ophthalmologist provided services for the patient less than three years ago, provided it wasn’t a face-to-face service.

Check specialty when deciding status

Coders who work in multispecialty practices will have to pay attention to one more new/established patient status rule.

For more on this, and other evaluation & management coding guidelines, stay tuned to a medical coding guide like Supercoder

New Choice to Boost your Diagnosis Coding

ICD-9 Codes 2011 going to effect in October, and here new ‘attention deficit’ to boost your Diagnosis Coding

The 2011 ICD-9 codes going into effect on October 1 have a few welcome additions for younger patients. Here are some examples of new diagnoses you could find yourself reporting on a regular basis.

Attention deficit options provide a better starting point ICD-9 2011 adds the 799.5x family to the ‘I’ll defined and unknown causes of morbidity and mortality’ section. The just-arrived codes include:

799.51 -- Attention or concentration deficit

799.52 -- Cognitive communication deficit

799.53 -- Visuospatial deficit

799.54 -- Psychomotor deficit

799.55 -- Frontal lobe and executive function deficit

799.59 -- Other signs and symptoms involving cognition.

This new series will be useful for symptoms and signs as a diagnosis before the doctor establishes a definitive diagnosis. Physicians treat children with concerns regarding attention or activity. You do not have sufficinet information after the first visit for an official diagnosis; but then you still need something to report.

V codes address retained fragments

ICD-9 2011 also comes up with a series of specific V codes for diferent types of retained fragments. The series (V90.01- V90.9) address objects ranging from metal, plastic or wood to animal quills or spines, glass, teeth, and other specified foreign bodies, including radioactive fragments.

Remember that you won’t report a code for foreign body removal in conjunction with V90.x. These foreign bodies are retained. You will deal with it in terms of the patient’s history and physical, however not an actual procedure to remove the object.

Want to know more about these attention deficit choices and other 2011 ICD-9 code(http://www.supercoder.com/icd9-codes/) changes? Just stay tuned to a medical coding guide like Supercoder.

Three ways to add an Additional $293 in Minor Procedure Pay

You could be missing out on opportunities to capture higher-paying procedure codes if you are overlooking reporting these splinting and foreign body removal codes.

Procedure 1: Gather $38 for sport injury splinting

Pee-wee football has started up and with it the chance you will see an increased number of patients with jammed fingers. For a non-angulated finger, the pediatrician might fix the sprain, splint the finger and send the patient home.

For the finger splint application, you could report 29130, which contains 1.02 RVUs, using the Resource Based Relative Value Scale. Even though global fracture care codes include the initial cast or application, you may use the casting and splinting codes in addition to an appropriate E/M code with modifier 25 when you don't report a fracture treatment code.

Do not miss: For the history, exam, and medical decision making that led to the decision to splint the finger, you'd report a significant separate E/M service appended with modifier 25. As you are not reporting a global fracture care code, you may also code the x-ray.

Procedure 2: Use tapping procedure code to add on $38

If a toe is broken, the pediatrician might buddy tape it to the adjacent toe and refer the patient to an orthopedist. For the buddy tapping, you could code 29550 (Strapping toes). The Medicare Physician Fee Schedule, which many payers adopt, assigns the code 1.04 RVUs. Report the history, examination and medical decision making preceding the decision to buddy tape the toe with 99201-99215 appended with modifier 25.

For the x-ray, go for 73600.

Procedure 3: Capture $227 on splinter removal

Removing a splinter from a patient's foot can net you around $227. For example, a pediatrician removes a 3 mm wooden splinter from a child's foot. Rather than including the work in an E/M code, you can use 28190, which has 6.15 RVUs.

Tip: Prior to using 28190, check that the documentation includes two details. The code need excising or opening to remove the foreign body. You have to say how and what you removed. Proper documentation could read: “1 mm incision made with X, removed splinter. This entry meets 28190's requirements of incision and removal.

Source URL :- http://www.supercoder.com/coding-newsletters/my-pediatric-coding-alert/revenue-boosting-procedures-29130-29550-28190-3-ways-you-can-add-an-additional-293-in-minor-procedure-pay-article

CPT 2011 Bids Goodbye to 90465-90474, Welcomes Hello Vaccine

For combination vaccines that may involve counseling on as many as five different diseases, getting paid as though you counseled on one never seemed right, however CPT 2011 lets you capture that extra counseling work.

Multiple component vaccines (Pentacel, Kinrix, MMRV) have had an economic disincentive related to the loss of immunization administration codes with these vaccines.

As the present CPT vaccine administration codes (90465-90467) are coded per vaccine, the codes capture payment for only one counseling administration code.

CPT 2011 will delete 90465-90468. The 90471-90474 (Immunization administration ...) codes will remain.

Good news: In the coming year, you will report the immunization administration with counseling codes per component. Here's how:

Step 1: Report 90460 as vaccine adminstration W/ counseling base code

You shouldn't look at administration route when selecting which immunization adminstration with counseling code. For vaccine administration except for H1N1, you'll assign one code for each vaccine's initial component: 90460.

Step 2: Use second vaccine component with +90461

Pediatric coders can heave a sigh of relief as the complexities over deciding which 90465-90468 code to use as the base code will soon end. The CPT codes 2011 for the coming year give you only one vaccine administration with counseling base code (90460). You will report the same add on code for each additional vaccine component: +90461.

If the physician, nonphysician practitioner (NP), physician assistant (PA), or other healthcare qualified professional provides vaccine counseling to a patient less than 19 years old for a second disease/component, you will assign +90461 for the second vaccine component. You will always report +90461 in addition to 90460.

Step 3: Use units to report 3+ Administrations

You will keep using the same add-on code, +90461, for each additional vaccine component. Bill the add-on code, in addition to the number of units that represents the number of components.

For more information on CPT 2011 and the entire CPT code list, sign up for a medical coding guide like Supercoder.com

Do Not Miss Out On Ancillary Procedures with Kyphoplasty, Vertebroplasty

Report radiologic supervision and interpretation, however leave out bone biopsies.

When your orthopedist carries out a vertebroplasty or kyphoplasty procedure, you will need to decide if there are additional services you could be coding and reporting. Get the low down on what you can and cannot report separately.

Modifier 26 brings you radiology pay

You can report the operating surgeon's imaging for needle positioning and injection assessment during a kyphoplasty or vertebroplasty procedure. You will use either 72291 or 72292 in addition to fluoroscopic guidance.

CPT revised these codes for 2006 to use with either vertebroplasty or kyphoplasty. You should be sure to append modifier 26 (PC) to the appropriate radiology service code to show that the surgeon provided only the physician component of the service and didn't supply the equipment, etc.

Caution: If your surgeon doesn't personally carry out the guidance, you can't bill for it. Rather, the healthcare professional who provides the service (often the facility radiologist) will bill for it.

Include bone biopsy with main procedure

When you are reporting 22520-+22522 or 22523-+22525, you won't code separately for a bone biopsy. You shouldn't report 20225 if the biopsy occurs at any of the same spinal levels as the primary procedure.

Here is the reason: The CPT code descriptors stimulate this limitation as do many payer local coverage determinations (LCDs). To add to it, CCI edits(http://www.supercoder.com/coding-tools/cci-edits-checker/) bundle bone biopsy to vertebroplasty and kyphoplasty codes. As there's boney tissue removed during the process anyway, it wouldn't be right to charge for taking some specifically for a biopsy.

Alternative: If your surgeon carries out bone biopsy at a level not addressed by the vertebroplasty or kyphoplasty, but you may report the biopsy separated with modifier 59 (distinct procedural service) to indicate the unrelated nature and separate locations of the two procedures.

Increase your Coding Options for Patients Refusing Dilation

A patient shows up for an exam, however he won’t let the ophthalmologist dilate his pupils that day. Whatever the reason – time, the drive home, etc, you are stuck trying to find the best way to report a dilation at a separate visit.
Most Medicare carriers assume that a dilated fundus exam will be part of any comprehensive eye exam you carry out and bill with 92004 or 92014.

Without dilation, you cannot carry out the fundus exam and without the fundus exam, you don’t have a comprehensive service.

Count two visits as one service

According to CPT, a comprehensive ophthalmological service “often includes" examination with dilation, therefore dilation is not necessarily required to bill 92004 or 92014. But some payers and state specific guidelines may have their own dilation requirements. For instance, according to Trailblazer, the 92004/92014 exams should be done under dilation unless “medically contraindicated. Check with your carrier if you get a denial you think is unfounded.

Do not submit bill until second appointment

The real challenge comes into play when you are expecting the patient to come back for the dilated exam and he never shows up. This’s a difficult situation as you do not want to bill for services not rendered, nor do you want to undercode a visit.

If you bill the insurance company for the initial visit before the time of the second visit, and the patient does not show up, document carefully that the patient refused dilation on the first visit, scheduled a return visit and then refused to keep the appointment. But then it is not recommended to bill for services that have not been rendered or refused by patients under any circumstances.

Better idea: Do not file the claim until the second appointment. You could downcode to a 92002/92012 (intermediate service) if the patient failed to show up and you wouldn’t have to pursue the patient to return. You couldn’t bill the comprehensive codes in this case as the first visit didn’t include a dilated fundus examination.

For more on this and other CPT coding updates, sign up for a medical coding guide like Supercoder!

Do and Don't of Unlisted Procedure Coding

Keep this CPT instruction in mind: "Don't choose a CPT code that merely approximates the service provided." This rule is key for compliant coding, however it leaves you with tough job of submitting a claim without a procedure-specific code. Here are some do's and don'ts to increase your chances of getting the payment your practice earned.

Explain the procedure in Layman's Terms

If CPT does not offer a code specific to the service provided, then you should report the appropriate unlisted-procedure code like 37799 (Unlisted procedure, vascular surgery) for vascular sclerotherapy.

When you file a claim using an unlisted procedure code you should include a cover letter stating why you are using the unlisted code. This separate report should explain in simple straightforward language exactly what the physician did.

According to CPT Assistant (http://www.supercoder.com/coding-references/code-connect)(April 2001), you need to submit reporting documentation identifying the specifics of the procedure such as the procedure report when you file the claim. The supplemental documentation should define the service (nature, extent, need) and the time, effort and equipment required. According to CPT Assistant, you may also include the following factors:

Whether the doctor required help to carry out the service

Whether the procedure was independent of other services

Whether the doctor carried out additional procedures at the same site

Number of times the doctor carried out the service at the encounter

Extenuating circumstances that complicated the service.

You may even want to include diagrams or photographs to facilitate the person reviewing your claim better understand the procedure.

Do not try to use modifiers or multiple units

You shouldn't append modifiers to unlisted-procedure codes or try to report them more than once per encounter.

Suggest an appropriate fee for the service

Unlisted procedure codes don't appear in the Medicare Physician fee Schedule, so they don't have assigned fees or global periods. Your payers will generally determine payment for unlisted procedure claims based on the documentation you provide.

You can suggest a fee by comparing the unlisted procedure to a similar listed procedure with an established reimbursement value.

New Codes for Peritoneal Cavity Chemo and Interstitial Device Placement

If your oncology practice provides chemotherapy into the peritoneal cavity using an indwelling port or catheter, your task will get a lot easier with effect from January 1 next year.

Here's why?

The American Medical Association (AMA) has announced the CPT 2011 codes, and they include a code specific to that service: 96446 (Chemotherapy administration into the peritoneal cavity through indwelling port or catheter).

You will also have new codes describing placement of interstitial devices for radiation therapy guidance, such as the following:

+49327 -- Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (for instance, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if carried out, single or multiple (List separately in addition to code for primary procedure)

+49412 -- Placement of interstitial device(s) for radiation therapy guidance (for instance fiducial markers, dosimeter), open, intra-abdominal, intrapelvic, and/or retroperitoneum, including image guidance, if carried out, single or multiple (List separately in addition to code for primary procedure)

57156 -- Insertion of a vaginal radiation afterloading apparatus for clinical brachytherapy.

Evaluation /Management (E/M) service: Subsequent day observation care will also get new codes (99224-99226), reportable per day. Pay special attention to these codes as they will change the way you code an observation stay longer than forty eight hours.

Source Code:- www.supercoder.com/coding-newsletters/my-oncology-hematology-coding-alert/cpt-2011-update-expect-new-codes-for-peritoneal-cavity-chemo-and-interstitial-device-placement-article

Coding Life Becomes Easier With This Denial Busting Tool

Is the CPT-ICD 9 code linkage pushing you towards denials? Well, ICD Cross-Ref tool lets you know whether you are safe.

To get this Cross-Ref tool and stay away from denials, sign up for Supercoder as the site has come up with this denial busting tool with effect from November 2. This CrossRef allows a coder to look up a surgical CPT procedure code and see which diagnosis codes Medicare and private payers allow.

So the next time you need to take a look at the ICD-9-CM codes that Medicare and private payers accept for a given surgical procedure rightaway, all you need to do is become an Advantage Plus member of the site and look under 'Tools' section. When you do so, you can have access to surgical (series 10000-60000) CPT procedure code to ICD-9-CM CrossRef under Tools.

What's more, come December 1 and you will get common diagnoses associated with radiology (70000 series), pathology (80000 series) and medicine (90000 series) codes.

Not just this, there are more reasons now to become members of Supercoder as it puts more spot on coding with Lay Terms for every CPT code (http://www.supercoder.com/cpt-codes) for major specialties. And to add to it all, SuperCoder Codesets & Tools and Advantage members should look for this feature in addition to visually helpful anatomical illustrations under Code Details.

What's more, onboard Supercoder, you can even have access to ICD-9-CM codes 2011 as well as the CCI Tool, CCI Alert feature, Fee Schedule and lots more!

So get onboard Supercoder today and stay away from denials!

FAQ to Boost Your Pain Management ICD-9 Coding

FAQ to boost your pain management ICD-9 coding

If you do not know how many diagnosis codes you can report, you could find yourself assigning the wrong code. Here's a question followed by the answer that'll help you get quick tips to help your pain management ICD-9 coding:

How many diagnosis codes are 'too many'?

Question: Our pain management specialist treated a patient with diabetes, however he was actually seeing the patient to treat a complication of the diabetic polyneuropathy. During his evaluation, the doctor also noted that the patient has shoulder joint inflammation. Should we use the neuropathy complication only or several ICD-9 codes to represent various conditions of the patient?

Answer: Normally, the primary diagnosis code that you list on your claim should represent the main reason for the encounter, or the condition with the highest risk of morbidity/mortality that the physician tends to during the visit. However, when you deal with a condition like diabetes, the situation changes.

Section 1.A.6 of the ICD-9-CM official

Guidelines for coding and reporting certain conditions have both an underlying etiology and multiple body system manifestations owing to the underlying etiology. For conditions such as this, the ICD-9-CM(http://www.supercoder.com/icd9-codes/) has a coding convention that requires that the underlying condition be sequenced first after the manifestation.

If a patient has more than one manifestation of diabetes, more than one code from category 250 may be used with as many manifestation codes as are needed to describe the patient's diabetic condition fully.

As such, you should first use 250.6x (Diabetes with neurological manifestations). Remember to add a fifth digit to reflect the patient's type of diabetes and status of control. Your secondary code should represent the specific pain manifestation being treated. In this case, you should report 357.2 (Polyneuropathy in diabetes) as the secondary diagnosis. As because your pain practitioner documented joint inflammation, you should also report the right code describing that condition (716.91, Arthropathy, unspecified; shoulder region).

Why so many codes: Even though many payers will link only the first, main diagnosis code that you list to support the provided service's medical necessity, reporting all the diagnoses that follow the HIPAA-mandated guidelines is compliant coding. As of July 2007, Medicare must accept up to eight diagnoses for each electronic claim reported. The additional diagnoses might indicate more complex presenting problems and can provide the help you might need for a higher-level E/M service.

Review Billed Service Levels with These Tips

You cannot get inside your ENT's head to know whether his MDM requires the E/M service code that he reported – however Medicare auditors are training eyes on this area while examining E/M claims, so you need to stay alert.

Auditors are not scrutinizing the exam or history as much as they weigh toward medical decision-making. However you can be your otolaryngologist's front line of defense and ensure his notes withstand scrutiny if you follow these tips:

Tip 1: Take this strategy's help to identify a mismatch

When your staff gets together for an education meet next time, remind your ENTs that medical necessity should be the overarching factor they use to choose the E/M service level. Just because a physician does a comprehensive history and examination does not mean he should report 99215. Medical necessity should drive the components that he carries out. This is of particular importance with the implementation of EHR systems, which automatically code encounters without regard to medical necessity. It's very easy to document high levels of history and exams, particularly for established patients, which'll result in level four services when the medical necessity may dictate only level two or three services.

You can help ensure your doctors are choosing the proper codes by occasionally pulling a sample of their charts. Take a look at the patient's chief complaint and the encounter's outcome or its final diagnosis. If the main ICD-9 code doesn't support a billed upper level of service, you should really read the chart notes.

Tip 2: Look for potential MBM-boosting factors

However, complimenting factors could make 99214 and 461.x a match. The patient may have comorbidities or other chronic conditions. And medications that the patient is already taking or or adverse reactions the patient had to previous medications could up the level of MDM. Comorbidities, frequency of episodes of sinusitis, the plan of care, and the like may complicate the medical decision making also.

To add to it, evaluation of symptoms possibly related to sinusitis like fatigue, headache, fever and cough can boost the MDM. When you work up a sinusitis, if a patient has these other symptoms also, then you ensure he does not have any problems that could be more serious.

Source URL :-  http://www.supercoder.com/coding-newsletters/my-otolaryngology-coding-alert/em-services-5-tips-help-you-review-billed-service-levels-article

Tip 3: Uncover extra complexity in these places

Medication can lead to a higher-level MDM another way. Take a look at the tests and medications the otolaryngologist ordered for clues to the extra complexity the doctor may not be explaining. Here are a couple of tips to make identifying increased complexity easier:

See the history of present illness and review of systems to determine what the ENT is trying to rule out.

Encourage your ENTs to state what diagnoses they hope to rule out or confirm.

Be wary: Do not put such ‘rule out' diagnoses on your claims. Doing so would not be right coding.

Tip 4: Give due credit for clear management options

Intimate your doctors that they should indicate clearly when they are taking an immediate step that they do not believe will solve the patient's problem. For instance, they may try antibiotics before a more aggressive treatment, however that the patient may need a more aggressive approach can boost the level of MDM. Documenting the extra step shows that the physician considered more management options (one element of MDM).

Tip 5: Look at patient's complexity

Sometimes a low level of MDM can support a 99214. You cannot just look at the MDM; you also have to look at the complexity of the patient.

Make Perfect your ICD-9 Coding Skills

OB-Gyn - ensure you have coded high-risk or complicated obstetrical care correctly - and that means perfecting your ICD-9 coding skills.

You can get increased payments when your ob-gyn provides additional visits outside of the normal global ob package; however you'll have to ensure you have coded high-risk or complicated obstetrical care correctly – and that means perfecting your ICD-9 coding (http://www.supercoder.com/icd9-codes/) skills.

Be firm on perfect ICD-9s

To demonstrate the reason for the additional service, you have to link the ICD-9 code on the CMS-1500 claim form (boxes 21 and 24E) to an E/M code. You can add this to the claim that includes the global service or you can submit it as an additional claim.

Here's an example: A 33-year-old patient, gravida 3, para 2 (both normal spontaneous vaginal delivery [NSVD] full term), is tended to 19 times due to developing pre-eclampsia. Post delivery, you review the case and find that the patient required six additional visits (beyond the usual 13) for this care. The documentation for three of these visits supports reporting 99212 while three of the visits have more extensive documentation that supports reporting 99213.

To add to it, post delivery, the patient experiences prolonged pain and irritation owing to a hemorrhoid. The ob-gyn tends to her for a thrombosed hemorrhoid, which he incises in the office two weeks post-delivery. In the end, the ob-gyn rechecks the patient at her six weeks postpartum visit.

Break it down: When coding for this patient, remember the claim form must note both the CPT codes describing the additional services as well as the diagnoses that depict why the patient required the additional services.

Heads up: Observe the fifth digits of these ICD-9-codes. The digit ‘3' that takes place in most of these codes has become a ‘4' in the last ICD-9 code to indicate a postpartum condition rather than an antepartum one. In other words, the patient has been discharged from the hospital after giving birth. Using ‘3' indicates she did not deliver during the hospital stay.

To add to it, after delivery, the patient experiences prolonged pain and irritation owing to a hemorrhoid. The ob-gyn sees her for a thrombosed hemorrhoid, which he incises in the office two weeks post delivery. In the end, the ob-gyn rechecks the patient at her six weeks postpartum visit.