CCI Edits - Codes You Shouldn't Pair

Sometimes you might not be able to find your two-code pair in the CCI edits. How would you know which code would be considered as column 1 code and which would be considered as column 2 code in order to put your modifier on the proper code?

If the codes are not listed, the codes are not bundled under the CCI (Correct Coding Initiative ) edit pairs. For that reason, most likely you would need a CCI modifier such as 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), 57 (Decision for surgery), or 59 (Distinct procedural service), to override the edit when required.

A private payer could have a black box edit, though. You need to check with a rep for a recommendation. To add to it, the CCI manual and CPT guidelines may offer broad instructions on types of services that normally should not be reported together. You should also be sure you check both non-mutually exclusive and mutually exclusive CCI edits.

But remember that just because a code does not have a bundle in CCI does not mean a modifier is out of the picture. Even if you do not need a CCI modifier to override an edit, you might need a payment modifier for a code.

You can get Medicare's other allowed modifiers for any CPT code that is in the Medicare Physician Fee Schedule (MPFS). Columns Y-AC point to whether certain modifiers such as modifier 50 apply.

Article source :-  http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/reader-questions-look-beyond-cci-for-codes-you-shouldnt-pair-article

Stay Away From A 'Finders Keepers' Overpayment Mentality

Recently, we found out that a patient overpaid us on her copay. We gathered $50, which was the last copay we had on record. It turns out that the patient's plan changed, but she is still under the same payer. However, her copay is now only $25 for an office visit. In this situation, can we just credit her account or do we need to issue a refund?

Well, you certainly need to issue a refund to the patient; however how you do that depends on the patient. As soon as you discover that a patient has overpaid you, your practice should notify the patient.

You cannot hold onto the money indefinitely.

You can credit the patient's account; however only if the patient agrees to that. If the patient will be returning to your office you can suggest that you apply the overpayment as a credit toward the patient's co-payment for the next visit. If the patient does not want to apply it toward a future visit, however, you must return the overpayment.

You should provide two options:

A credit on the patient's account that you will apply to future services

A refund of the overpayment.

Tip: You may find it easier to just send the overpayment amount back to the patient with a letter explaining the situation, rather than notifying the patient and discussing options. Go for whichever process works best for your practice.

Bottom line: You can't and shouldn't keep an overpayment – from a patient or a payer. That practice may land your provider in big trouble. The agreement to return to any overpayments is fundamental to a provider's eligibility to participate in the Medicare program.

Section 1866(a)(1)(C) of the Social Security Act (42 U.S.C. § 1395cc) needs participating providers to provide information about payments made to them and to refund any monies incorrectly paid. The 2010 Patient Protection and Affordable Care Act creates new obligations under the False Claims Act (FCA) whereby a Medicare provider who fails to timely report and refund an overpayment may be subject to substantial damages and penalties.

For further details, sign up for a medical coding guide like Supercoder.

Fracture Care: Manipulation versus Non-Manipulation

See to it that you take advantage of manipulation opportunity when your orthopedist performs fracture care or you could be losing out on your payments without the right manipulation knowledge.

For instance the orthopedist carries out closed treatment on a fractured fibula; if she uses manipulation, the service is worth about $119 more than a non-manipulation encounter. But then you should consider various factors before you decide a manipulation warrants the treatment. Equip yourself with these three tips to get you started.

Know what you are dealing with

If you have no idea what manipulation is, you cannot support your claim. Manipulation involves reduction or attempted reduction of the fracture or dislocation. Orthopedists would normally perform a 'closed' manipulation, which takes place when the physician is repositioning or relocating a displaced closed fracture back to the correct anatomical position without opening it surgically. Nevertheless, there is such a thing as 'open' manipulation.

Payout: From the previous example of closed treatment on a fractured fibula, you'd think about two CPT codes to report the treatment: 27780 and 27781. CPT 27780 pays about $272.49, while 27781, with 10.61 RVUs, pays about $391.22.

Key words give away manipulation procedure

If you depend on physician's notes to give evidence of manipulation, you have a chance of being misled.

Here's why: The word 'manipulation' doesn't make its way into physician encounter notes very often.

Normally, what you should look for is the term 'closed reduction', which is used for non-operative treatment of fractures that are treated without surgery. Other terms that might help identify a manipulation procedure include 'reduce', 'align' and 'reset'.

Spot manipulation evidence in these examples

You will be able to distinguish a manipulative treatment from a non-manipulative one only when you learn to read your physician's notes between the lines.

An instance of manipulative care.

Example 1: A 20-year-old patient injured himself when an opponent in a football game tackled him. The doctor documents a level-three E/M, which includes a foot X-ray the physician diagnoses a distal interphalangeal joint dislocation (DIPJ) of the toe. The physician notes that he reduced and reset toe.

An instance of non-manipulative care.

Example 2: A 16-year-old new male patient reports to the orthopedist with an injured left toe, which happened during a tackle football game. The doctor documents a level-two E/M with an X-ray and pain meds. After reviewing the X-ray the doctor diagnoses a proximal phalanx fracture on the foot, which he wraps in a splint. The encounter notes read 'non-displaced fracture splinted in good position. Treatment with NSAIDS for pain."

For more medical coding guide visit site Supercoder.com

Tips to perform a successful self-audit

Try to engage the whole staff: See to it that every member of your practice know what you are doing and why. Also, remind them that you are not trying to get anyone in a tight spot. Instead, you want to find out whether they are helping to bring in the right amount of payments and minimizing denials.

Choose the charts: Most auditing specialists recommend that you review 10 to 15 records per physician during your audit.

Examine documentation: Go through the documentation and find out which ICD-9 codes(http://www.supercoder.com/icd9-codes/) and CPT codes you think apply to the chart. Then see which codes were actually assigned to the services.

Focus on difficult services: While examining physicians'records, review not only the procedures but also the E/M services. Some records such as consults or time-based E/M records are trickier to code.

Time-based pitfall: You must have a credible reason to justify providing the majority of the service on counseling/ coordination of care to justify basing your E/M level on time. Bronchitis taking a lot of time to explain to a 20-year-old is not a supportable reason.

The official recommendation is that the documentation should have the start and end time of the counseling/coordination of care. For time to count in the outpatient setting, it must be face-to-face with the patient and/or family.

It is better to have this written from the physician, rather than just from an EMR time stamp. Without seeing how a system's time stamp works, it is difficult to say if the ‘start' time indicates the time the exam started or the time that the patient came into the room. Auditors will look at having time in documentation when reviewing your records.

Score sheet: Some insurers or physician associations offer audit tool score sheet templates that can aid you while auditing documentation.

The audit tool helps the auditor document the findings so that by the end of the record review, the documented information can be totalled to finalize the E/M key elements and come up with the proper level of E/M.

Tip: See to it that the tool is compliant with the documentation guidelines. A record of the review should be kept as proof of the internal audit.

After the audit, show your practitioners, coders and billers what the outcome was so you can positively address any problem areas.

CCI 17.0 Takes Aim at Just-In Vaccine Administration Codes

The latest CCI edits (17.0) that went into effect on January 1 this year include 19,822 new active pairs and 9.778 code pair deletions. Many of the new code pair additions involve CPT codes that debuted on January 1, with CCI now halting payment if you report certain procedures together.

For example, you will find vaccine administration codes 90471 and 90473 bundled into new vaccine administration code 90460 and no modifier can separate these edits. This edit prevents mixing and matching the new immunization administration codes with the old, established immunization administration codes when delivering multiple vaccines at the same visit.

What's more, CCI bundles the new new subsequent observation care codes 99224-99226 into inpatient neonatal and pediatric critical care codes 99468-99476.

Good news on the modifier front

Not all news coming out of the latest CCI edits is bad. With effect from January 1, you will be able to use a modifier (such as 59, Distinct procedural service) to separate the edit bundling wound care management codes 97597-97602 into the just-revised debridement codes 11042-11044. Earlier, if your pediatrician performed both procedures on the same DOS, you could not collect for both no matter what; however now you'll be able to if your documentation demonstrates the separate and distinct nature of the services and you use the proper modifier.

Swapped pairs: To add to it, CCI did an about-face on several edits this round. Previously, if you reported 94660 or 94662 with an outpatient E/M code (99201-99215), CCI would reimburse you for the pressure ventilation and deny the E/M service. But then CCI version 17.0 now makes the E/M service the primary code, and the pressure ventilation code will be denied if you report the services together. These edits cannot be separated by any modifier.

Capture Every Allowable Non-Par Dollar with These Strategies

As insurance companies threaten to pay physicians less for services, your practice may gather that it just isn't worth participating with some payers. However, if you continue to see patients with insurance you no longer participate with, you may have to amend your collection practices to get the money you deserve.

The reason: When you are a non-participating provider with a payer, the patient directly receives the check from the insurance company. However some patients don't and then use those funds to pay the bill your practice sends. Here are some strategies to ensure you are not letting money go out of the window.

Collect before the patient steps out of your office

If you are aware that a patient has an insurance that your practice does not participate with, then you know the payer will send the check right to the patient. As such, you should collect your fee straight from the patient at the time of service.

First step: See to it that your patients know they are responsible for paying non-covered services. They should be advised that you're not participating with their insurance when they call to make the first appointment.

Outline your expectations in the financial policy you give all patients and post a sign in the waiting area stating that payments are due at the time of service. All practices should have a financial policy they give their patients on the first visit.

One more good practice is to remind patients when they make their appointments that they will owe any non-covered fees for the visit as well as the payment methods your practice gets.

Do not rule out sending the patient to collections

If you decide not to collect at the time of service, you can send the patient's delinquent account to a collection agency, to small claims court or even to the Internal Revenue Service (IRS). Don't be apprehensive of using a collection agency whenever a patient who owes you money refuses to pay.

Accept assignment with payers, even if you are non-par

If you are not able to implement an upfront collections process for some reason, you are not out of luck when it comes to easily collecting your services. You can still submit claims to the payer and accept assignment if the patient agreed to allow you to accept assignment, even though you don't participate with that payer.

For more strategies to ensure you are not letting money go out of the window, sign up for a medical coding guide like Supercoder.com

Tips to Help You Achieve G0438, G0439 Coding Success

Here are five tips to stop denials and keep your annual visit claims picture perfect this year.

Apply G0438 to second year of coverage

Be wary of applying these codes to new Medicare patients coming in to your doctor's practice this year. This is because Medicare will only reimburse the initial visit (G0438) during the second year the patient is eligible for Medicare Part B. Simply put, during the first year of the patient's coverage, Medicare will only cover the Initial Preventive Physical Exam (IPPE), also known as the Welcome to Medicare exam.

CMS limits G0438 to one physician

If your FP sees the patient for the initial visit (G0438) and the patient sees a different physician during the next annual wellness visit, that second physician will only get reimbursement for the subsequent visit (G0439), despite never having seen the patient before.

Reason: CMS has indicated that when a patient returns to the same or new physician in a third year, they might only pay for the subsequent visit. As such, it's vital that you convey this information to any new physician the patient goes to.

Add preventive services codes, if performed

You can bill the new annual visit codes in addition to any other preventive service such as G0102 and/or Q0091 in the covered year.

Remember: You won't need to append any modifier for this combination as the G codes are not problem-oriented E/M services to which that modifier applies. If you do report the annual codes with a problem-oriented E/M service (with modifier 25 appended to the problem-oriented code), CMS indicates that this situation should be rare, owing to the nature of the wellness visit requirements which are very time intensive. They also expect that given these requirements, you'll not bill the patient for a non-covered preventive service in addition.

Document the required elements

Prior to billing the new annual visit codes, the physician or physician team must document certain elements.

CMS waives the deductible and copay

Under provisions listed in the ACA, all plans covered by the rules contained in the Act must offer coverage of a comprehensive range of preventive services that are recommended by experts and the US Preventive Services Task Force (USPSTF) with a grade of A (strongly recommends) or grade B (recommends). This means these codes fall under coverage that doesn't impose any costsharing requirements.

For more tips to keep your annual visit claims picture perfect, sign up for a one-stop medical coding guide like Supercoder.com

In CCI 17.0, Anesthesia Overrides Bronchoscopy

The latest CCI edits (CCI 17.0) that went into effect on January 1 this year clarifies that typical anesthesia includes services described by new catheter and tube placement codes. Read on for more on this:

Just-in codes appear in Non-mutually exclusive pairs
Non-mutually exclusive edits apply to services that a doctor may carry out during the same care session but that are not billable together. The reason is one of the codes (the component code) is included in the services represented by the second (comprehensive) code of the pairing. You can bill individual components if the doctor doesn't carry out the entire comprehensive procedure. However if the doctor carries out the entire (comprehensive) procedure, you should bill the comprehensive code in place of the individual parts or components.

The latest CCI includes non-mutually exclusive edits for virtually every anesthesia code when carried out with various new CPT codes. Coding for the anesthesia procedure overrides the following codes when the doctor provides both services during the same session:

0251T -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), initial lobe

0253T -- Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach, into the suprachoroidal space

31634 -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, with assessment of air leak, with administration of occlusive substance [example, fibrin glue], if performed

43753 -- Gastric intubation and aspiration(s) therapeutic, necessitating physician's skill (example., for gastrointestinal hemorrhage), including lavage if performed

43754 -- Gastric intubation and aspiration, diagnostic; single specimen (example., acid analysis).

The same edits apply to anesthesia during three catheter and coronary angiography procedures:

93451 -- Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when carried out

93456 -- Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization

93457 -- Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization.

Exceptions: Each edit pair carries a modifier indicator of "1,"which means you can sometimes bypass the edit by filing the right modifier. See to it that you have enough supporting documentation to justify payment for both codes before filing with a modifier, say for instance 59 (Distinct procedural service).

Forget subsequent care with anesthesia

This time CPT introduces three new codes for subsequent observation care (99224-99226, Subsequent observation care, per day, for the evaluation and management of a patient …). The latest CCI edits clarify that standard anesthesia care includes services represented by 99224-99226. These edits carry a modifier indicator of "0", meaning you cannot report the services with a modifier to try and be paid for both codes. If you submit both codes on the same claim, you will get an automatic denial.

Article Source :-  http://isupercoder.blogspot.in/2011/01/in-cci-170-anesthesia-overrides.html

Going to Report E/M & OB Service Together?

CCI 17.0 brings 698,042 new edits. But that does not mean you need to push the panic button as most of the edits affecting your ob-gyn claims won't be tough to apply to your daily coding practice.

For example, if you are already comfortable with bundles that exist for 57155, then you are ready for the new bundles added to the new code 57156. They're the same.

Break the rest of the edits into two categories: fluoroscopy edits and E/M edits.

Consider four fluro codes as included in Gyn procedure

Your claims could face problems if you attempt to bill a fluroscopic code in addition to just about everything in the gynecology section in the CPT manual.

CCI 17.0 particularly highlights the following four fluoroscopic codes: 76000, 76001, 77001, 77002. Essentially, CCI 17.0 bundles 76000, 76001, and 77001 into some codes and only 77001 and 77002 into others.

Break down these Evaluation/Management edits

With a broad brush stroke, the latest CCI edits bundles E/M services into all delivery and delivery plus postpartum care codes. These edits carry a modifier indicator of "1", which means you can separate these bundles with a modifier so long as you can show these encounters are separately identifiable. Remember, these delivery and delivery plus postpartum care codes already include admission, subsequent hospital care, discharge, and postpartum care under CPT guidelines.

But then what's new is that you should now include observation care, which hasn't been a part of routine ob care in the past. What's more, you should include the nursing facility care, rest home care, and home care visits – which make no sense for ob patients anyway.

Antepartum care only codes 59425 Antepartum care only; 4-6 visits) and 59426 (7 or more visits) didn't escape CCI 17.0's notice. These codes now include 99201-99215 (Office or other outpatient visit ...). What's more, you can separate these edits with a modifier; but again be sure to include documentation to show payers how these services are separately identifiable. These bundles apply to the same date of service; as such, it's unlikely that you'd bill antepartum care and a separate E/M code on the same DOS unoless the E/M service was not related to pregnancy.

In the end, observation care (99217-99220, Initial observation care, per day, for the E/M of a patient …) is now part of G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) and Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory)…

Base TPI Codes on Muscles: 20552 & 20553

Question: My understanding is that the paraspinal muscle is a group of individual muscles that combine and run along the spine. Our provider administered bilateral trigger point injections in the cervical paraspinal area. From a coding perspective, should I think about these two injections into two separate muscles?

Solution: Coding for trigger point injections is based on the total number of individual muscles. Injections of trigger points into one or two muscles would be billed with 20552(Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]) whereas trigger point injections into three or more muscles would be reported with 20553 (Injection[s]; single or multiple trigger point[s], 3 or more muscle[s]). Compliant documentation for trigger point injections would include the specific muscles injected rather than use of a broad term such as paraspinal.

Anatomy: The deep muscles (sometimes referred to collectively as paraspinal muscles) form a thick mass on each side of the spine, extending from the base of the skull to the sacrum. This muscle mass consists of many separate, overlapping muscles of different lengths, attached to the spinous or transverse processes of different vertebrae. The semispinalis capitis, the splenius capitis and the multifidus muscles are some of the deep paraspinal muscles of the neck region.

Bilateral muscles that have separate origin and insertion sites normally are considered to be separate muscles. For instance, separate trigger point injections into both the right and left splenius capitis muscles could be considered to be two muscles for coding purposes.

Source URL :- http://www.supercoder.com/coding-newsletters/my-anesthesia-coding-alert/reader-questions-20552-20553-base-tpi-code-on-muscles-article

C34 - Requires Location for Malignant Neoplasm Of Main Bronchus

Both ICD-9 2011 and ICD-10 2011 have coding options for a malignant neoplasm of the main brochus. Both indicate that the codes are proper for malignant neoplasms of the carina or hilus of lung.

Difference: ICD-9 2011 includes simply 162.2 (Malignant neoplasm of main bronchus). On the other hand, ICD-10 2011 offers options specific to location:

Unspecified: C34.00 -- Malignant neoplasm of unspecified main bronchus

Right: C34.01 -- Malignant neoplasm of right main bronchus

Left: C34.02 -- Malignant neoplasm of left main bronchus.

ICD-10 2011 also lists an instruction to 'use additional code to identify':

Exposure to environmental tobacco smoke (Z77.22)

Exposure to tobacco smoke in the perinatal period (P96.81)

History of tobacco use (Z87.891)

Occupational exposure to environmental tobacco smoke (Z57.31)

Tobacco dependence (F17.-)

Tobacco use (Z72.0).

Likewise, ICD-10 2011 also lists an instruction to "Use additional code to identify":

Exposure to environmental tobacco smoke (Z77.22)

Exposure to tobacco smoke in the perinatal period (P96.81)

History of tobacco use (Z87.891)

Occupational exposure to environmental tobacco smoke (Z57.31)

Tobacco dependence (F17.-)

Tobacco use (Z72.0).

So when ICD-10 goes into effect on October 1, 2013, you should apply the codes and official guidelines in effect at that time (or more specifically always use the codes and guidelines effective for the relevant date of service ).

Article Source :- http://www.supercoder.com/coding-newsletters/my-icd-10-coding-alert/reader-question-c34-requires-location-for-malignant-neoplasm-of-main-bronchus-108832-article

CPT 2011: Tips to Make Your 74176-74178 Use Clearer

If you have been scratching your head about the wording of new code 74178, then you are not alone. To help you in this direction, the AMA has released more details that should guide you to the proper code.

Anatomic combination is key to 74176-74178

The creation of 74176-74178 is one of the big coding changes this year. The codes are:

74176 -- Computed tomography, abdomen and pelvis; without contrast material

74177 -- with contrast material(s)

74178 -- without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions.

According to a presentation at the AMA's 2011 CPT and RBRVS Symposium in Chicago, patients often have imaging of the abdomen and pelvis carried out at the same setting, and the intent of the just-in CPT codes 2011 is to reflect this reality. Emphasis was given on the importance of using the new codes and not unbundling the abdominal and pelvic services when they are carried out at the same session. One should select just one code for the entire session.

Summary: If you are reporting an abdominal CT alone or a pelvic CT alone, your coding will remain the same this year. You will continue to choose either a pelvic code from 72192-72194 or an abdominal code from 74150-74170.

However if the abdominal and pelvic CTs are carried out at the same session, you should go for the single code from 74176-74178 that represents the services provided. You shouldn't additionally report a code from 72192-72194 (pelvis) or from 74150-74170 (abdomen).

Do not miss 74178 reporting opportunities

The guidelines are particularly helpful in deciphering how to use 74178, which would perhaps be more clearly worded as "without contrast material in one or both body regions, followed by contrast material(s) and further sections in the other body region or both body regions."

According to a chart provided by CPT, 74178 is apt when the patient has:

An abdominal CT without contrast followed by a pelvic CT with contrast

An abdominal CT without contrast and a pelvic CT without contrast followed by a pelvic CT with contrast

A pelvic CT without contrast followed by an abdominal CT with contrast

A pelvic CT without contrast and an abdominal CT without contrast followed by an abdominal CT with contrast

Pelvic and abdominal CTs without contrast followed by pelvic and abdominal CTs with contrast.

For More Information :- http://www.supercoder.com/coding-newsletters/my-radiology-coding-alert/cpt-2011-74176-74178-use-becomes-clearer-with-these-tips-article

Stay Away From a 'Finders Keepers' Overpayment Mentality

Scenario: We found out that a patient overpaid us on her co-pay. We gathered $50, which was the last co-pay we had on record. It turns out that the patient's plan changed but is still under the same payer. However, her co-pay is now only $25 for an office visit. In this case, can we just credit her account or do we need to issue a refund?

Answer: You do need to issue a refund to the patient; however how you do that is up to the patient. As soon as you find out that a patient has overpaid you, your practice should notify the patient.

You cannot hold onto the money for an indefinite period of time.

You can credit the patient's account, however only if the patient agrees to that. If the patient will be returning your office you can suggest that you apply the overpayment as a credit toward the patient's co-payment for the next visit. But again if the patient does not want to apply it toward a future visit, you must return the overpayment.

You should offer two options:

A credit on the patient's account that you'll apply to future services

A refund of the overpayment

You may find it easier to just send the overpayment amount back to the patient with a letter explaining the situation, rather than notifying the patient and discussing options. Go for whichever process works best for your practice.

Bottomline: You cannot and shouldn't keep an overpayment – from a patient or a payer. That practice may land your provider into big trouble. The pact to return any overpayments is fundamental to a provider's eligibility to participate in the Medicare program. Section 1866(a)(1)(C) of the Social Security Act (42 U.S.C. § 1395cc) calls for participating providers to furnish information about payments made to them and to refund any payments paid incorrectly. The 2010 Patient Protection and Affordable Care Act creates new obligations under the False Claims Act (FCA) whereby a Medicare provider who fails to report timely amd refund an overpayment may be subject to substantial damamges and penalties.

Article Source :- http://www.supercoder.com/coding-newsletters/my-optometry-coding-alert/reader-questions-avoid-a-finders-keepers-overpayment-mentality-103512-article

Anesthesia Overrides Bronchoscopy in CCI Edits 17.0

The latest Correct Coding Initiative edits (CCI 17.0), which went into effect on January 1, 2011 clarifies that typical anesthesia includes services described by new catheter and tube placement codes. Just-in codes appear in non-mutually exclusive pairs Non-mutually exclusive edits apply to services that a doctor might carry out during the same care session but that are not billable together. This is because one of the codes (the component code) is included in the services represented by the second (comprehensive) code of the pairing. You can bill individual components if the doctor doesn't carry out the entire comprehensive procedure. However, if the doctor carries out the entire (comprehensive) procedure, you should bill the comprehensive code in place of the individual parts or components.

The latest CCI edits include non-mutually exclusive edits for almost every anesthesia code when carried out with several just-in CPT codes. Coding for the anesthesia procedure overrides the following codes when the doctor provides both services during the same session.

0251T -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when carried out; with removal of bronchial valve(s), initial lobe

0253T -- Insertion of anterior segment aqueous drainage device, minus extraocular reservoir; internal approach, into the suprachoroidal space

31634 -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when carried out; with balloon occlusion, with assessment of air leak, with administration of occlusive substance [example fibrin glue], if carried out

43753 -- Gastric intubation and aspiration(s) therapeutic, necessitating physician's skill (example for gastrointestinal hemorrhage), including lavage if performed

43754 -- Gastric intubation and aspiration, diagnostic; single specimen (example acid analysis).
The same edits apply to anesthesia during three catheter and coronary angiography procedures:

93451 -- Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed

93456 -- Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization

93457 -- Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization.
There are exceptions: Each edit pair carries a modifier indicator of “1", which means you can sometimes bypass the edit by filing your claim with a proper modifier. Ensure you have enough supporting documentation to justify payment for both codes prior to filing with a modifier such as 59 (Distinct procedural service).
Forget subsequent care with anesthesia
CPT 2012 codes brings in three just-in codes for subsequent observation care (99224-99226, Subsequent observation care, per day, for the E/M of a patient …). CCI 17.0 clarifies that standard anesthesia care includes services represented by 99224-99226. These edits carry a modifier indicator of “0", which means you cannot go for the services with a modifier to try and be paid for both codes. If you submit both codes on the same claim, you'll get an automatic denial. Source URL :- http://www.supercoder.com/coding-newsletters/my-anesthesia-coding-alert/cci-170-anesthesia-overrides-bronchoscopy-in-newest-edits-article

Know How to Differentiate Between the Two Codes for Pulmonary Stress Test

Finding it difficult to differentiate between the two codes for pulmonary stress test? The key is to look for clues in their descriptions.

A doctor orders pulmonary stress testing on patients who complain of shortness of breath. The test allows the doctor to determine if the underlying cause is heart disease or lung disease. If you would have to code this test, there are two codes to choose from:

94620 -- Pulmonary stress testing; simple [example., six-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry]

94621 -- Pulmonary stress testing; complex (including measurements of CO2 production, O2 uptake, and electrocardiographic recordings).

'Simple' and 'complex:

When you are coding 94620 and 94621, you would find that the words 'simple' and 'complex' differentiate one from the other. But then these words are not enough to look for hints. If you understood what the descriptors imply in detail, you could differentiate 94620 from 94621 more easily. For example, if documentation supports it, most six-minute walk tests can be coded as 94620 - a test performed for pulmonary assessment.

CPT Assistant indicates documentation should include heart rate, blood pressure, oxygen saturation, and liter flow of supplemental oxygen. Each of these should be recorded at rest, during exercise, and during recovery. CPT code 94620 also includes physician analysis of data, interpretation of the test, and a written report.

94621 constitutes a series of metabolic test

94621 involves measuring the integration of cardiac and pulmonology function, and the status of physical fitness. This includes measuring CO2 production, O2 uptake, and electrocardiographic recordings of the patient's response to the stress.

 Article Source "http://www.supercoder.com/coding-newsletters/my-pulmonology-coding-alert/pulmonary-stress-test-94620-94621-take-the-stress-out-of-walk-test-coding-article"

Optometry Coding: Has a Broken Payment Pact Come to a Conclusion?

If you have a patient who continues to break the terms of your payment agreements, you need to know how you can dismiss that patient and keep your practice's legal bases covered. While your practice can end the physician-patient relationship at any time for a number of reasons, non-payment is a valid reason to do so. When you do come at the point of sending a letter, see to it to include the following elements to dismiss a patient in a fair and straight forward manner.

Offer to continue care for a period of 30 days

When your practice decides to put an end to physician patient relationship, you should not put the patient in a situation that could compromise her health.

Important: Failure to offer care could provide the patient the opportunity to accuse you of abandonment. If the patient is discharged, then it's his or her responsibility to find another doctor, however it may take time to find another provider. Standard practice is to give the patient a 30-day time window in which to find a new provider.

Provide the patient with a referral

However, the 30-day period does not mean you should continue to give your services for free. If the patient does not have the copay or means to pay that day, you do not have to see that patient in the 30 days.

Remember: If the patient doesn't have any immediate health risks and you are still operating within the 30-day window, you might provide a referral to another provider.

Leave out reasons for dismissal

Remember that any written correspondence the patient gets from your office could potentially be used against you down the road. As such, above all, don't include any reasons for why you are dismissing the patient. I'd not give them a reason to call.

Send the letter certified

For a key document like a dismissal letter, many experts suggest sending it through certified mail with a return receipt. You'll then have a record of who signed for the letter. You should keep the receipt with the patient's chart. If the patient does call the office to question the dismissal letter, then whoever takes the call will be able to explain the reason for dismissal to the patient.

Make your statement upfront

In sports, it is said that the best defense is a good offence. You can put this motto to use by having your financial policy well documented and easily available. You can avoid sending letters of termination if you have a good written financial policy upfront. The aim of a good financial policy is to communicate to the patient 'this is what we expect of you in this office.'

For more on this, sign up for a medical coding guide like Supercoder.com

Tips To Get Adequate Reimbursement for These Services

Even small practices are expected to have a Humphrey visual field analyzer. But then, many optometrists are not aware of the secrets for securing ample reimbursement for these services - and they even go far as to put themselves at risk for costly audits owing to lack of documentation.

Stop shortcharging yourself with intermediate codes

CPT lists three different vidual field examinations - the higher the code, the higher the reimbursement: 92081, 92082 , 92083.

Snag: A common error optometrists make is billing 92082 when they could legitimately bill 92083.

The key to selecting the proper VF code is the code descriptors themselves. For instance, if you plot only two isopters on the Goldmann perimeter, CPT would call that “intermediate," based on its description of 92082. But then if you plotted three isopters, that would be an 'extended' examination that would qualify for 92083.

Rule of the thumb: An intermediate test is one of the screening tests that you'd go for if you suspect neurological damage. However optometrists use the threshold exam (92083) when they suspect something that causes a slow, progressive dimming of peripheral vision, such as glaucoma.

Glaucoma causes a loss of vision like a light bulb slowly becoming dimmer and dimmer, while trauma often leads to sudden, complete loss of central or peripheral vision. In screening fields, you're testing whether the retina is 'on or off', while in threshold testing you are testing 'how dim a light you can perceive.'

Document now to save yourself the trouble later

When you send in a CMS-1500 form, Medicare only sees the front part of the form. What Medicare does not see is what's on the other side of that form, which is your documentation. They take it that your documentation is correct until they do an audit.

If Medicare does an audit and finds that your documentation is not in order, you could land yourself having to pay them back for all the claims they find problems with. That is why it's vital to carefully document the medical necessity of the visual field exam in the patient's medical record.

For further detailed information, sign up for a medical coding guide like Supercoder.

Modifier 62 is Your Route to Clean CO-Surgeon Claims

You should watch your surgeon's op note for second surgeon signs. For instance, did another surgeon help with approach or closure? If yes, you will have to take some adsitional steps to get your deserved reimbursements:

Look to modifier 62 for co-surgeons

When two surgeons work together to carry out distinct portions if a procedure CPT identifies with a single reportable code, you will need to access modifier 62 (Two surgeons.

Suppose a neurosurgeon carries out an anterior approach arthrodesis, and requests a general surgeon to expose the surgical area and close the patient following the procedure. The neurosurgeon carries out the arthrodesis, along with related bone graft and instrumentation procedures.

When a general surgeon does the exposure for a spine case, go for modifier 62. Both surgeons are carrying out distinct portions of the procedure.

The neurosurgeon and general surgeon should report the same CPT and diagnosis codes. You should even send copies of both physicians' operative notes with your claim.

Cooperation matters in medical coding

When reporting co-surgeries, you should work closely with the other operating surgeon's staff to see to it that each practice gets its fair share of the reimbursement. Both doctors need to dictate their portion of the procedure in order to fulfil the requirements of the co surgeon modifier.

Medicare and most payers reimburse procedures coded with modifier 62 at 125 percent of the regular fee schedule amount. The payer divides this between the two surgeons reporting the procedure; as such each surgeon gets 62.5 percent of the standard fee. However, do not change your fee in anticipation of the adjustment. Charge your normal fee for your physician's services and allow the insurer to make the adjustment.

For modifier advice, check fee schedule

To confirm that the procedure you wish to report qualifies for modifier 62, check the Medicare physician fee schedule (MPFS) database. In order to be eligible for payment, ensure that the procedure codes have a Medicare co-surgery indicator of either “1" or “2." If not, your doctors cannot code and bill as co-surgeons for that procedure.

For detailed information on this, sign up for a medical coding guide like Supercoder.

43200, 43202: Two Possible CPT Options for TNE

If you're wondering how to code a transnasal esophagoscopy (TNE), read on and find out how:

Select one of two CPT codes, depending on whether the TNE involved a biopsy.For a TNE in which the otolaryngologist does not carry out a biopsy, report 43200.When the TNE involves a biopsy, report 43202.

You can expect more pay for 43200 or 43202 when the otolaryngologist performs the TNE in the office instead of in a facility. The National Physician Fee Schedule assigns 5.59 transitional nonfacility total relative value units (RVUs) in the office than in the facility --7.31 NF RVUs versus 2.99 RVUs.

Probable ICD-9 codes you can use with a TNE include:

Dysphagia, 787.2

Reflux esophagitis, 530.11

Hiatal hernia, 553.3

Aspiration, 933.1

Barrett's esophagitis, 530.2x

Esophageal stricture, 530.3

Zenker's diverticulum, 530.6.

Urge your otolaryngologist to document the procedure's medical necessity, as well as the following items, which will help in the wake of a denial. The physician should comment on the type of anesthesia used (nalely local), the approach used (namely transnasal), and why the TNE was performed. For instance, the patient had laryngopharyngeal reflux with fear of Barrett's esophagitis, esophageal ulceration, or possibly even esophageal malignancy. After this, the doctor must comment on all findings, including those in the larynx,the esophagus, possibly the stomach, and the GE junction. He should also note whether a hiatal hernia is present. And if he carries out a biopsy, he should point to whether it was a brush biopsy or a regular biopsy.

Article Source :- http://www.supercoder.com/coding-newsletters/my-otolaryngology-coding-alert/reader-questions-43200-43202-weigh-2-possible-cpt-options-for-tne-article

Lesion Removal: Tips to Ensure Correct Diagnosis and Maximize Pay

Waiting for the pathologist to measure an excised lesion could cost you dear. However not waiting for the pathology report could burden the patient with a misdiagnosis. Here are some tips to ensure correct diagnosis and maximize pay.

Measure first

You should choose the proper lesion excision size code based on the surgeon's report. If the surgeon does not measure the lesion before he cuts it out, he is cutting his reimbursement in half.

Once the specimen is in the jar, the specimen shrinks down to half its original size. If the surgeon does not put the original size in the note, the coder has to code based on the smaller excision size listed in the pathology report. And this will cost the practice a lot of money.

CPT's excision sizes, including margins, are based on the surgeon's measurements. You should train providers to measure an excision and document it with a statements such as “I'm going to excise this X cm length by X width lesion. I took 4 cm margins." You should also explain to your surgeon the financial impact of including these details.

Hold diagnosis for Path Report

Always make it a point to select the malignant or benign excision code on the basis of the results of the pathology report, even if the surgeon does not have that information during the time of the surgery. The pathology report offers the definitive diagnosis that serves as the basis for the CPT excision code selection.

A surgeon might visually identify a lesion as benign or malignant, however, you still want to code the excision based on the pathology report. In the event a benign-appearing lesion really ends up being malignant, the physician has to protect himself for malpractice reasons. On the other hand, you don't want to mislabel the patient. The diagnosis could cause the patient's insurer to drop coverage.

Check Anatomic Location

After getting the pathology report, review the documentation for excision size and location. Then it is all about location from the anatomical site to ensure the practice is getting all revenue.

Each anatomical group contains lesion excision sizes ranging from small to large lesions.  Source URL :- http://www.supercoder.com/coding-newsletters/my-general-surgery-coding-alert/lesion-removal-11443-or-11441-measure-correctly-and-add-54-to-this-excision-claim-103792-article

ICD-9 2011: You'll Code Influenza, BMI and Jaw Pain

As an otolaryngology coder, are you up and running with the last ICD-9 changes that went into effect on October 1? Are you thinking where you should focus your time and energy? The following tips on the new codes that affect otolaryngology will help you figure out whether you are on the right track or if you should work on your 2011 diagnosis coding know-how.

New flu codes make appearance

ENT practices that treat the flu are in luck – the codes in the 488.0x and 488.1x subcategories provide greater specificity now.

Previously, these sub-categories did not provide the level of detail that category 487 (Influenza) does; as such the ICD-9 Coordination and Maintenance Committee expanded the codes at 488.0 and 488.1. This means six new influenza with pneumonia codes for the 2011 ICD-9 update.

Some patients may go straight to their ENT at the first sign of sinus trouble and might think they have allergeies or sinus issues when in reality they may be dealing with the flu. As such, these flu diagnoses could be applicable to otolaryngology practices.

New BMI Codes are if effect

Effective October last year, you can no longer report V85.4 (Body Mass Index 40 and over, adult). In its place, you should be using one of the following V codes:

V85.41 -- BMI 40.0-44.9, adult

V85.42 -- BMI 45.0-49.9, adult

V85.43 -- BMI 50.0-59.9, adult

V85.44 -- BMI 60.0-69.9, adult

V85.45 -- BMI 70 and over, adult.

Otolaryngologists may use the new BMI codes for various reasons. First, you might list the patient's BMI as a secondary or tertiary code when treating a patient with snoring issues. In addition, the BMI V codes might be used as secondary diagnoses to justify the use of modifier 22 on a complicated surgery.

Remember: When a V code is your only option, you can report it as the primary diagnosis. Although when you use a BMI diagnosis as a primary ICD-9 code, it may be tough to get reimbursement from some insurance companies.

Look for jaw pain codes

You will find the new code code 784.92 (Jaw pain) in effect throughout 2011.

Source URL :- http://www.supercoder.com/coding-newsletters/my-otolaryngology-coding-alert/icd-9-2011-youll-code-influenza-bmi-jaw-pain-article

99202-99205: Taking PFSH Level to a New Plane

Someone newly-initiated to E/M coding has a question about past, family, and social history (PFSH). They have new patients sign and date a history form, and the surgeon reviews the form. So is it ok if the surgeon's office note includes past and social history but not family history for a new patient?

Well, your scenario about a new patient visit with documentation of two of three areas (past medical and social) qualifies as relevant PFSH.

How it functions: There are three levels of PFSH, which are none, pertinent, and complete. With no PFSH, you can reach only a detailed history level, which is associated with 99203 (Office or other outpatient visit for the E&M of a new patient). You may see this level for some surgical patients; however most likely not for complex cases such as patients thinking about bariatric surgery.

What's relevant: For PFSH portion of detailed level of history, you need a pertinent PFSH, which is 'a review of the history area (s) directly related to the problems identified in the HPI.

According to the guidelines, a pertinent PFSH calls for documentation of atleast one specific item from any of the three PFSH areas. CPT needs a minimum of a detailed history for 99203.

Complete PFSH: To go beyond that reach a thorough level of history (required for 99204-99205), documentation must include a complete PFSH. Whether you must have documentation of two areas or three areas for a complete PFSH depends on the type of service. As per the guidelines, for a new patient visit, you need one specific item from each of the three areas. In comparison, you'd need items from only two of the three areas for an established patient office visit.

Remember: If you figure out that a surgeon is consistently leaving out any of the elements in the PFSH, the compliance team may want to consider planning a session with your doctors to go over documentation requirements for E/M services.

For more on this and other evaluation & management guidelines, turn to a medical coding guide like http://www.supercoder.com/

99441- 99443: The Harsh Reality about Telephone Calling Codes

In a certain situation, another physician told my surgeon that he is receiving payment for his contractor for telephone calling codes. My surgeon would like to begin using these codes as well. So does Medicare pay for telephone calls?

Medicare takes telephone call codes 99441- 99443 (Telephone E/M service provided by a physician to an established patient, parent, or guardian not originating from a related Evaluation/Management service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; …) to be non-covered services.

Here's how: You can find a code's status in column D of the 2010 Medicare Physician Fee Schedule.

Silver lining: Technically, your physician is getting paid for telephone calls made in relation to performed office visits. “The physician work resulting from telephone calls is considered an integral part of the pre-work and post-work of other physician services, and the fee schedule amount for the latter services already includes payment for the telephone calls.

The relative value units (RVU) for office visits include time for work that's spent prior to and after the visit on items like pulling the chart, reviewing lab results, and calling the patient. As the fee schedule includes RVU for 99441- 99443, some private and other public payers may pay for the codes, however remember that the guidelines are very specific for reporting these codes. The patient must be established to the practice, must have initiated the call to the physician and the information discussed cannot be directly related to a visit seven or less days prior to the phone call. What's more, the call cannot take place when the patient makes an appointment to see the doctor regarding the health issue within a day.

For further updates on telephone calling coding and Medicare Physician Fee Schedule updates, sign up for a medical coding guide like Supercoder.

CMS Announcements and Pecos Edits

According to CMS, it may not deny Provider Enrollment, Chain and Ownership System (PECOS) claims starting this month. But then there are two contradictiory statements doing the rounds. Find out which one to believe.

You may or may not meet claim denials this month owing to PECOs edits, depending on which CMS announcement you read.

Background: Presently, if you submit claims for services or items ordered/referred and the ordering or referring physician's information is not in the MAC's claims system or in PECOS, your practice will get an informational message letting you know that the practitioner's information is not there in the system. Earlier, it was believed that CMS would start denying these claims on January 3: however now that's up in the air.

Last November, CMS distributed an email that the agency referred to as an 'Important Update on PECOS and Ordering/Referring', in which CMS noted, "While there are some rumors that the edits will be turned on this month, we want to emphasize that the agency has not announced any date as to when ordering /referring edits will be turned on.

In writing: Even though the agency now clearly denies ever announcing that claim rejections would begin on January 3, MLN Matters article MM6417, which CMS distributed on Feb. 26, 2010, stated "Effective January 3, 2011, if the ordering/ referring provider is not in PECOS, the carrier or Part B MAC will search its claims system for the ordering/referring provider. If the ordering/referring provider is not in PECOS and is not in the claims system, the claim will be rejected."

So which CMS statement to believe? At this juncture, the agency seems to be indicating that you may not face ordering/referring denials this month, despite the earlier MLN Matters article to the contrary. Your best choice is to ensure that you and your ordering/referring providers are in PECOS as soon as possible, just in case the MAC edits become a reality.

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

Fracture Care: Take Advantage of 'Manipulation' Opportunity

When your podiatrist carries out fracture care, see to it that you take advantage of manipulation opportunity or you could be missing out on your payments without the proper manipulation knowledge.

Say for instance the podiatrist carries out closed treatment on a fractured fibula: if she uses manipulation, the service will fetch you about $119 more than a non manipulation encounter. But then you should think about several factors before you decide a manipulation warrants the treatment. Equip yourself with these three tips and get started:

Know what you are dealing with

You cannot support your claim if you have no idea about what manipulation is. It involves reduction or attempted reduction of the fracture or dislocation.

Podiatrists would normally carry out a 'closed' manipulation, which occurs when the physician is repositioning or relocating a displaced closed fracture back to the correct anatomical position without surgically opening it. Nonetheless, there is such a thing as "open" manipulation.

Important words give away manipulation procedure

If you depend on physician's notes to give evidence of manipulation, you have a chance of being misled.

Here's why: The word 'manipulation' does not make its way into physician encounter notes regularly.

Typically, what you should look for is the term 'closed reduction', which is used for non-operative treatment of fractures that are treated without surgery. Other terms that might help identify a manipulation procedure include 'reduce', 'align' and 'reset'.

Spot manipulation evidence

Only when you learn to read your physician's notes between the lines will you be able to tell a manipulative treatment from a non-manipulative one.

Source URL :- http://www.supercoder.com/coding-newsletters/my-podiatry-coding-alert/fracture-care-manipulative-fracture-care-attracts-hundred-dollar-profit-difference-article

Pediatric Coding: Are You Allowed Calming Shot Fee?

Situation: A patient of ours was going to have an MRI at the hospital. His mother stopped by at our office and asked if her son could get a shot of 'something' to help calm his nerves. The nurse administered an injection of Diazepam and the patient did not see the doctor. Can we bill the injection in addition to an Evaluation/Management service? What diagnosis would apply here?

Answer: If the nurse provided an E/M of the patient in addition to administering the Diazepam injection, then start by coding an appropriate E/M service. In this situation, the most likely E/M code is 99211 since the patient didn't see the physician.

Use modifier 25 (Significant, separately identifiable E/M service by the same doctor on the same day of the procedure or other service) to the E/M code to denote that it was significant and separately identifiable from the injection service.

Then, report the injection code (such as 96372, Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]: subcutaneous or intramuscular). Lastly, use J3360 (Injection, diazepam, up to 5 mg) for the medication.

Your best diagnosis choice is either a non-specific anxiety code such as 300.00 (Anxiety state, unspecified) or 300.09 (Anxiety state: other), or the general symptom code for nervousness, 799.21 (Signs and symptoms involving emotional state: nervousness).

Document: As the doctor did not see the patient, verify that he was in the building at the time and wrote an order for the injection. This will help support a billable service according to incident-to rules, where applicable.

The nurse should complete an E/M note to support billing 99211. This should include a history and assessment, including important signs. That apart, you should in conjunction with the physician document the decision to proceed with the requested injection. The doctor should countersign this note.

CPT 2011 Brings Changes to Flu Vaccines and Counseling Codes, Deletes 90658

This year, your vaccine coding will be action-filled thanks to changes in codes and administration reporting. Two more updates every FP should now involve new Q codes for some Medicare flu vaccines and expanded ages for adolescent vaccine counseling.

Nix 90658 for Medicare Patients this year

CMS has come up with new HCPCS codes (Source "http://www.supercoder.com/hcpcs-codes") and payment allowances to replace 90658. Effective January 1, Medicare will no longer pay for; as such, choose from the new codes instead, based on the specific product: Q2035, Q2036, Q2037, Q2038 and Q2039.

Timing: Codes Q2035-Q2039 went into effect on Oct. 1, last year. When filing claims for dates of service from October 1 to December 31, last year, you had two code choices: To bill Medicare right away with 90658 or hold the claim until January 1, 2011 and file with the proper Q code. For vaccines administered now, post January 2011, you should only report the applicable Q code.

Use 90460, +90461 through age 18

Thanks to CPT, you will be able to use medicine series vaccine administration with counseling codes on older patients and when a nurse provides the counseling.

As counseling for adolescents can involve as much time as counseling on vaccines for younger children, the American Academy of Pediatrics recommended that the age limitation on the vaccine administration with counseling codes be raised. New codes extend vaccine administration with counseling to patients through 18 years of age.

Take advantage of RN/LPN Counseling and still get the payments

Busy practices will be thrilled at being able to use their registered nurses (RN) or licensed practicing nurses (LPN) to capture the higher relative value units (RVU) some private payers associate with the vaccine administration with counseling codes. The just-in vaccine administration with counseling code descriptor expands who can provide the vaccine counseling described in the deleted immunization administration with vaccine counseling codes (90465-90468). Earlier, CPT 2010 vaccine administration with counseling codes 90465-90468 limited the counselor role to a physician and, subject to state scope of practice laws, nurse practitioner or physician assistant.

The just-in vaccine administration with counseling code extend the counseling opportunity to any 'qualified health care professional' practicing within his/her state described scope of practice. An RN, LPN or medical technician could provide the counseling and the practice could still use the vaccine administration with counseling code.

Documentation & Chief Complaint: Are You Missing Something

If you're getting dinged on audits because you do not have a chief complaint listed at the top of your physician's documentation, do not give up until you have a look at the entire note.

Even though you'll benefit from a chief complaint documented clearly at the start of the note, Medicare does not require that you list it at the top. The chief complaint should be illustrated clearly.

Listing it amongst the assessment might not give you the brightest picture. There might be other issues that came out in the visit (or other conditions the clinician is concerned about as they relate to the chief complaint or the possible treatment options), however they might not be the exact complaint.

The 1995 and 1997 CMS Evaluation/Management documentation guidelines point to the fact that the chief complaint, review of systems(ROS), and the past family social history may be listed as separate elements of history, or for that matter they may be included in the narrative of the history of present illness (HPI). As such, the chief complaint cannot just be anywhere on the record. It must be listed separately or in the HPI.

Key: The guidelines do not come out and say 'it must be at the top of the note,'; however the guidelines are very clear that the chief complaint shouldn't be implied but stated clearly.

What can be done: In order to avoid having to dig into the assessment section of the physician's note, urge your gastroenterologist to write "c/c" at the top of the visit notes. Post this, the gastroenterologist should write a word or two telling why the patient needs to be seen by a physician. The gastroenterologist could simply write "follow up for ulcer," "follow-up for gastritis complicated by MAC," or "follow-up for chronic pancreatitis and nausea."

Urge your gastroenterologist not to write vague statements like 'feeling better', 'feels well', 'much better', 'comfortable', or 'resting quietly' as the chief complaint. Who can record it: Medicare carriers differ regarding which staff members can document the chief complaint. For example, WPS Medicare, the Part B payer in four states points out that "the 1995 and 1997 Documentation Guidelines do not address who can record the chief complaint [CC]. WPS Medicare will allow the chief complaint to be recorded by ancillary staff.

Remember: Most other payers need the physician (or billing provider) to document the CC.

Source URL :- http://www.supercoder.com/coding-newsletters/my-gastroenterology-coding-alert/documentation-hail-to-the-chief-complaint-heres-what-you-might-be-missing-article

Debridement Code or an Active Code? CPT Comes to Your Rescue

As you enter 2011, as a dermatology coder, you have a lot of CPT changes to adapt to. So for instance you may be confused about when to select a debridement code and when to go for an active wound code. CPT 2011 comes to your rescue with revised debridement code guidelines that show you how to select between the two code groups.
Depth is the only documentation item you need to figure out the correct code. Active wound care has a 0 day global period and is for active wound care of the skin, dermis or epidermis. For deeper wound care, make use of debridement codes in the proper location.

For instance: Codes 11040 and 11041 have made an exit. The parenthetical note under the codes' deletion says, "For debridement of skin, that is., epidermis and/or dermis only, see 97597, 97598."

The codes are then revised to reflect the change. For example, 11042 removes "Skin, and" and adds after subcutaneous tissue "includes epidermis and dermis, if carried out."

Code 97597's revision involves "mainly rewording to elucidate how active wound care is separate from integumentary wound care.

This time CPT includes guidelines that indicate two requirements for active wound care management. These guidelines train eyes on:

Intent: "Active wound care procedures are carried out to remove devitalized and/or necrotic tissue and promote healing."

For more on this and for all CPT code updates affecting your dermatology practice, sign up for a medical coding guide like Supercoder.

Hint: For deeper wound care, reserve debridement codes
We provide you simple, instant connection to official code descriptors & guidelines and other tools for 2010 CPT code, HCPCS lookup that help coders and billers to excel in the work they do every day.

Article Source :- http://isupercoder.blogspot.in/2011/01/debridement-code-or-active-code-cpt.html

President Obama signed into law to Put a Halt on Medicare Pay Cut for a Year

Even though the government appeared poised to take a big share out of your next Medicare payments, you can heave a sigh of relief for one more year. For this year, you won't need to worry about losing pay. This is because the 23 percent Medicare pay cuts that practices have feared since last January were once again kicked to the curb by Congress.

You will not face the same nail-biting payment woes this year as you did last year, owing to a Senate Finance Committee bill that'll freeze Medicare pay at present levels for one more year.

The House of Representatives gave a nod to the Medicare and Medicaid Extenders Act of 2010 on December 9 and the Senate voted on it the day before moving it to the President's desk for signature. The bill will rid the 25 percent cut that medical practices were going to face from January 1.

Physicians cheered the news that they will not have to wait for the new Congress and Senate members to take their seats prior to determining whether a payment fix would take place.

Many physicians made clear that last year's roller coaster ride, caused by five delays of this year's cut, forced them to make difficult practice changes like limiting the number of Medicare patients they could tend to.

History: Senate Finance Committee chair Max Baucus (DMont.) and ranking member Charles Grassley (R-Iowa) had vowed to take up a full-year fix to the Medicare payment formula they could enact prior to the 25 percent cuts kick in on January 1, according to a November 29 statement on the Senate Finance Committee's Website.

The bill was passed as a bipartisan effort, and the Senate Finance Committee noted that it'll cost $14.9 billion over 10 years to implement the physician pay fix. It'll be funded by making minor adjustments to the Affordable Care Act, the health care legislation that President Obama signed into law in March last year.

For more on this and the latest on the Medicare pay cuts, sign up for a medical coding guide like Supercoder.

Spot on Coding Does not Require An Overly-Detailed Coding Policy

Spot on coding does not require an overly-detailed coding policy. ICD-9 Coding policy can certainly help keep your claims.

An ICD-9 coding policy can certainly help keep your claims flowing smoothly, but then you cannot just set it up and sit back. Read on and know how to establish a policy that'll remain current and help you duck the the auditors when they come calling.

The first element of a well-designed coding policy is to point out that you adhere to the ICD-9-CM Official Guidelines for Coding and Reporting. If you do not stay tuned to these standard rules you may land in trouble.

Secondly, establish your coding process, including who does the coding and how you make corrections.

Third, describe how your coding staff will stay tuned and maintain their coding competencies. Keeping pace with the changes can be especially important, whether to the official guidelines, payer requirements or the ensuing transition to ICD-10.

Document your auditing process, including the percentage of charts you will audit for accuracy and how often you will conduct those audits. Internal auditing can help ensure your dermatology coding is accurate before your mistakes are found in a costly audit from a ZPIC, RAC, or one of the other auditing entities.

Gauge your dermatology coders' accuracy. Paired with auditing, establishing an accuracy rate for your medical coders can help set the bar for your commitment to accurate coding. If you need your coders to maintain a 95 percent accuracy rate with their coding, include this information in your policy.

Keep policies up to date. Do not let your coding policy sit on the shelf and grow dusty. Try to check your policy periodically to ensure it's current.

For more on this and other diagnosis coding tips, sign up for a medical coding guide like

http://www.supercoder.com/

Collections: Strategies to Capture Every Non-Par Dollars

As insurance companies threaten to pay you less and less for services, your practice may decide that it is not worth participating with some payers. However if you continue to treat patients with insurance you no longer par with, you may have to revise your collection practices to get your deserved money.

The reason: When you are a non-participating provider with a payer, the patient directly receives the check from the insurance company. However some patients don't, then use those funds to pay the bill your practice sends. Take a look at these strategies to see to it that you are not letting hundreds or even thousands of dollars go out of the window.

Collect before the patient leaves your office

If you know beforehand that a patient has an insurance that your practice does not participate with, then you know the payer will send the check right to the patient. As such, you should collect your fee straight from the patient at the time of service.

Getting patient insurance (information) prior to the appointment is important. For a non-par plan we would find out if the patient had out of network benefits and collect any balance due.

Step 1: See to it that your patients know they are responsible for paying for non-covered services. Patients should be advised that you are not participating with their insurance when they call to make first appointment. You should outline your policy in the financial policy you give all patients and you should put up a sign in the waiting area stating that payments are due at the time of service. All practices should have a financial policy they give their patients' first visit.

One more practice is to remind patients when they make their appointments that they'll owe any non-covered fees for the visit as well as the payment methods your practice accepts.

Do not rule out sending the patient to collections

If you choose not to collect at the time of service, you can send the patient's account to a collection agency, to small claims court or even to the Internal Revenue Service (IRS). Do not be afraid to use a collection agency whenever a patient owes you money but refuses to pay you.

Good practice: Write a letter or a form that states the patient will get payment from the payer and as such the patient will be responsaible for paying the bill.

The letter should state that the insurance company will be sending the patient the payment; as such, making him responsible for the services provided. The patient will then need to pay services in full at the time of the visit or arrange to make payments.

Also, you can create a form letter you send to non-par patients reminding them that they owe you the payments. Right now we have a letter we send after we get an EOB from the insurance saying they paid the patient.

Pointer: Send the patient a statement first and try to collect prior to taking further measures.

Even if you are Non-Par, accept assignment with payers

If you are unable to implement an upfront collections process for some reason, you are not necessarily out of luck when it comes to collecting your services easily. You can submit the claims to the payer accepting assignment if the patient agreed to allow you to accept assignment, even though you don't participate with that payer.

Practices should accept assignment on all claims whether you are par or non-par.

Article Source :- http://www.supercoder.com/coding-newsletters/my-practice-management-alert/collections-corner-capture-every-non-par-dollar-you-deserve-with-3-strategies-article