Proposed Rule 2012: 29.5 Percent Cut in Physician Payment Rates Likely

With physician pay cut looming large, right now you need to have a lasting (Sustainable Growth Rate) SGR fix to do away with this problem for good.

If the 2012 Medicare payment rates proposed in the Centers for Medicare & Medicaid fee schedule becomes final, physician practices could be taking yet another hit. Physician practices can expect a 29.5 percent payment cut for covered services, According to CMS' July 1 release.

According to the release, total projects under the Medicare Physician Fee Schedule (MPFS) in CY 2012 will be to the tune of $80 billion.

A brief background: The release further informs that the proposed rule threatens to bring down payment rates based on the SGR formula. But then the cuts have been avoided every time except in the year 2002. In fact, last year, it took three different legislations to prevent the cuts, informs the release.

Consequences: Said Dr. Donald M. Berwick, CMS Administrator in the release, "This payment cut would have serious consequences and we cannot and will not allow it to happen."

In the proposed rule, the agency is significantly expanding the potentially misvalued code initiative, the release notes.

Strong efforts are required to assess Medicare's fee schedule to see to it that it's paying right and ensuring that Medicare beneficiaries remain to have access to vital services like primary care services, the release cites.

Among other changes, the agency is also proposing to expand its multiple procedure payment reduction to the professional interpretation of advance imaging services.

ICD-9 2012 Update: 173.0-173.9 Get Specific Next Year with New Fifth Digits

Expanded diagnosis code sets will allow coders to classify whether skin cancer is basal, squamous, or unspecified.

On October 1, dermatology coders will be able to more accurately report the location of carcinomas and other neoplasms of the skin.

The Centers for Medicare & Medicaid Service (CMS) has released its proposed changes to ICD-9 2012, and they include an expansion of the 173.x (Other malignant neoplasm of skin) series. Each code in that series will get a list of fifth digits that will specify whether the malignant neoplasm is basal cell, squamous cell, or unspecified.

Example: Now, dermatology coders would report 173.0 (Other malignant neoplasm of skin of lip) for any non-melanoma malignant neoplasm of the lip. But when ICD-9 2012 becomes effective on October 1, 2011, coders can choose from:

173.00 -- Unspecified malignant neoplasm of skin of lip

173.01 -- Basal cell carcinoma of skin of lip

173.02 -- Squamous cell carcinoma of skin of lip

173.09 -- Other specified malignant neoplasm of skin of lip. Additionally, in October, 173.0 will become an invalid diagnosis code.
The changes in the other skin cancer categories follow this pattern, with the fifth digit of "0" referring to an unspecified malignant neoplasm, "1" denoting a basal cell cancer, "2" referring to a squamous cell carcinoma," and "9" describing another specified malignant neoplasm.

The new, revised, and invalid codes have been approved by the by the ICD-9-CM Coordination and Maintenance Committee and were published in the Federal Register on May 5, 2011. After the new codes take effect on Oct. 1, CMS will only add new ICD-9 codes on an emergency basis as it prepares to switch over the diagnosis coding system to ICD-10.

Get Staff Up to Speed on Changes

With only a few months before implementation, the time to act is now, says Pamela Biffle, CPC, CPC-P, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas.

"Coders will have to maker sure their systems are updated with the new codes," she notes. "Training will have to be done for all the staff."

Good idea: "This is a great example of when to have a lunch and learn session for all providers and other clinical staff that may be assigning diagnosis codes," Biffle suggests. Source URL :-

New ICD-10 Coding Conventions You Should Be Aware Of

Here are a few things you need to keep in mind as you make the transition from ICD-9 to ICD-10.

Excludes may include two different things
When you switch to ICD-10, one key change you'll see is 'excludes' will be of two types. Initially, this might seem like more burden to your coding work; however, this will only ease your work by getting rid of one of ICD-9's mistakes.

'X' or "X?" in your code listing? Well, this is here to help you
When you get hold of your ICD-10 manual, you will notice certain codes that include an 'X' or an "X?" in them – however don't assume that it's a printing error as it is there to assist you.

Whether left side or right side was treated while dealing with some anatomic areas
Worried about your ICD-10 manual ( Source "http://www.supercoder.com/icd-10/") being thicker than the ICD-9 book? Don't be. Because much of the book's additions are owing to the fact that many codes will require you to denote whether the left side or right side was treated while dealing with certain anatomic areas – it could be eyes, ears, hands, hands, feet, ovaries, and the like.

Right now, when you report acute atopic conjunctivitis, you use 372.05. In some rare examples, when insurers want to figure out which eye was affected, you add the RT or LT modifiers. When you make the transition, you will not only signify the specific type of conjunctivitis by reporting the most spot on diagnosis code, but will also have to specify which eye was affected. As such, depending on the eye infected, an acute atopic conjunctivitis diagnosis could track to one of these codes: H10.10, H10.11, H10.12 and H10.13.

A/R process: Tips to get your Practice its Deserved Reimbursements

Here are some medical billing tips to refine your accounts receivable (A/R) process swiftly and easily to bring in the money more efficiently. For the uninitiated, AR is the money that is owed to the practice.

Don't be a code it, bill it and forget it company - keep a tab on each claim you send out

Don't follow the footsteps of other companies who don't take any step to bring in the money. Ensure that someone in your practice monitors closely all the claims you submit. Enquire whether the insurance company received the claim or try to find out whether the patient paid her copay portion of the bill. Also, make it a point to follow up early; doing so can save you time. If it gets delayed, find out why.

Follow up if you get unpaid and denied claim

Every practice meets with unpaid and denied claim. The best way to ensure your practice is among dollars is to follow up on denials and appeal as the situation demands. Review your explanations of benefits (EOB), focusing on your denials. You can pick up a lot of information from your EOBs such as how quickly insurers are paying you, whether your fee schedule is enough, whether coders are doing their job properly, why insurance companies are denying your claims and if you are being paid as per your contracted rates.

You should update your A/R process

You need to produce a variety of reports to help you evaluate your A/R process. You can invest in a good management system and learn all of its capabilities. You should pay special attention to the reporting abilities of the system you use to ensure you get the data you need to manage your practice's A/R. It could be the practice's gross collection rate, net collection rate and average days in A/R for claims. After this, you can use this information to assess the efficiency of your practice's A/R management.

Source Code :- http://www.supercoder.com

ICD-9 codes 2012: A new Saddle Embolus Code Likely

Here's a refresher on some of the ICD-9 codes that you might have to use starting October 1.

ICD-9 2012 goes into effect on October 1 this year. As such, you need to be all geared up for the changes. Here are some proposed changes you need to be aware of.

Saddle embolus code: This time you may get to use a new saddle embolus code 415.13. For the uninitiated, a saddle embolus is where you have a very large blood clot that dislodges and then goes through the blood stream and lands in a big division of an artery.

NCHS proposes that the diagnosis gets its own code

This code came to the fore after National Center for Health Statistics (NCHS) realized that there is no ICD-9 index entry pointing to a proper pulmonary saddle embolus choice. Presently, ICD-9 does link the term 'saddle embolus' to the aorta. If you look under 2011 code 444.0, you will see 'saddle embolus' in the inclusion list. However this year's ICD-9 code changes will take that connection a step further. You can anticipate 444.0 to expand to provide more spot on coding: 444.01 (Saddle embolus of abdominal aorta) and 444.09 (Other arterial embolism and thrombosis of abdominal aorta).

Source URl :- http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/icd-9-2012-74731-promises-new-option-for-pulmonary-artery-disorders-107260-article

Apart from this, ICD-9 2012 intends to add V12.55 to provide a unique code for this part of the patient's history. What's more, you can even expect ICD-9 2012 to expand 747.3 to a range of five-digit codes: 747.31, 747.32 and 747.39. 747.31, the first proposed code refers to coarctation and atresia, both of which currently fall under 747.3.

Apart from these, as a radiology coder, you also need to watch out for expansion of cystostomy complication coding options. The proposal expands 596.8 into a new range of five digit codes.

Also anticipate: To add to it all, 997.5 and 996.39 might also undergo changes.

ICD-10 Preparation: Not Planning to Transition to ICD-10 as of Oct. 1, 2013? You Might Be Liable to Face Millions in Fines, CMS Reps Say

Plus: CMS officials are considering how to handle dates of service that span the pre- and post-ICD-10 implementation dates.

If you think the ICD-10 codes won't apply to your Medicare claims as of Oct. 1, 2013, CMS has news for you—not only will your claims be denied if you continue to submit ICD-9 codes to Medicare after that date, but you could face fines. CMS representatives shed light on this and several other issues during the agency's May 18 "ICD-10 National Provider Teleconference," and we've broken down the five FAQs that best apply to Part B practices.

Question 1: How will CMS handle claims that span from before Oct. 1, 2013 through dates after Oct. 1, 2013? Should the practitioner use ICD-9 or ICD-10 codes for these claims?

Answer: CMS is mulling how to handle this situation, but hasn't yet arrived at a firm decision. "We are getting very close to finalizing our decision for all claim types, including professional claims, supplier claims, and the various types of institutional claims," said CMS's Sarah Shirey-Losso during the call. "Some claims will continue to use the discharge date, some will use the ‘from' date, and some may be required to be split," she said.

Stay tuned: CMS is currently working on a final decision, which the agency will issue in a "Change Request" document this summer.

Date of service issue: If, however, you submit a claim for a single date of service, you'll submit ICD-9 codes for dates of service through Sept. 30, 2013, and ICD-10 codes for dates of service Oct. 1, 2013 and thereafter. For instance: If you send in a claim on Oct. 15, 2013, but the date of service is Sept. 1, 2013, you'll still use ICD-9 codes.

Question 2: Will workers' compensation insurers still use ICD-9, even after the rest of the industry transitions to ICD-10 after Oct. 1, 2013?

Answer: The answer to that is unclear, but CMS has heard murmurs that workers' comp. insurers will switch over to ICD-10.

"We've heard anecdotally that even though they're not required to transition to ICD-10, that many of them are planning to, just because it's more practical to do so and they see that it's the way the rest of the industry is going," said CMS's Denise Buenning, MsM, during the call.

Article Source :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/icd-10-preparation-not-planning-to-transition-to-icd-10-as-of-oct-1-2013-you-might-be-liable-to-face-millions-in-fines-cms-reps-say-106761-article

Closures: 12001 or 13100? Consider More Than Layers to Code Correct Closure Level

Follow our tips to dig deeper and find the differences between 'simple,' 'intermediate,' and 'complex.'

All closures aren't created equal; one of the nuances of coding these procedures is knowing how to distinguish one type from another. Read on for our experts' advice on how to assess the three closure levels and assign the best codes.

Remember 'Simple' Doesn't Mean 'Easy'

A simple repair involves primarily the dermis and epidermis. It might involve subcutaneous tissues, but not deep layers.

Draw the line: How do you know when a closure might involve subcutaneous layers but is still considered a simple repair? Your provider's documentation is the key. The difference is whether the wound is closed in layers or just a single layer, experts note. The provider might decide to include the subcutaneous layer in the closure but does so by bringing the needle through the dermis into the subcutaneous and back. That results in a single-layer closure rather than closing the subcutaneous layer first and then the dermis/epidermis second in separate closure techniques.

But "simple" doesn't mean the repair is something anyone could do. Simple repairs involve one-layer closure, which helps set them apart from a standard E/M procedure. Simple repair also includes "local anesthesia, and chemical or electrocauterization of wounds not closed," says Dilsia Santiago, CCS, CCS-P, a coder in Reading, Pa.

For example, if your dermatologist uses adhesive strips to close a laceration, consider it an E/M service that you'll report with the best-fitting choice from CPT codes 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient) or 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient). Most Steri-strip applications are done by nursing staff; but even if the physician applies them, they're included in the E/M service .

If, however, your dermatologist uses sutures, staples, or tissue adhesives to close the laceration, consider it a separate procedure. Choose your code from 12001-12007 (Simple repair of superficial wounds of scalp, neck, axillae, eternal genitalia, trunk and/or extremities [including hands and feet]) or 12011-12018 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes), based on the lesion's location and size.

Measuring tip: For excision of soft tissue tumors, measure the longest dimension of an oblong mass, according to John P. Heiner, MD, professor at University of Wisconsin Hospital and Clinics in Madison.

Medicare exception: Guidelines change when your physician performs a single-layer laceration repair on a Medicare patient. You'll report G0168 (Wound closure utilizing tissue adhesive[s] only) instead of reporting standard CPT codes. If your physician uses sutures instead of tissue adhesive for Medicare patients, turn back to the standard suture/repair codes.

Source URL :- http://www.supercoder.com/coding-newsletters/my-dermatology-coding-alert/closures-12001-or-13100-consider-more-than-layers-to-code-correct-closure-level-article


Jerry Salley, CPC, has over six years' experience writing about coding, focusing especially on ophthalmology coding with The Coding Institute's Ophthalmology Coding Alert . He has also written about optometry, gastroenterology, dermatology, audiology, and urology coding, as well as Joint Commission accreditation, healthcare human resources, and behavioral healthcare reimbursement issues. A graduate of Furman University, Jerry is a certified professional coder through the American Academy of Professional Coders.

Diagnosis Coding: Follow These 4 Steps to Master 940-949 Burn Diagnoses

Proper ICD-9 coding for burn patients can require several codes.

Dermatology coders who cannot choose the proper diagnosis codes for each burn treatment patient could end up costing their practices time and money.

How? Let's say your dermatologist provides local burn treatment for a patient (16000, Initial treatment, first degree burn, when no more than local treatment is required). If the claim contains an inaccurate burn diagnosis code, or no diagnosis code at all, the insurer could deny claims for burn treatment based on lack of medical necessity. Snuff out potential denials by following these four quick steps to picking the perfect burn diagnosis codes for each burn treatment encounter.

Step 1: Check Notes for Location of Burn

When choosing a burn diagnosis code, you first need to check the anatomic location of the burn, confirms Kevin Arnold, CPC, director of compliance for LYNX Medical Systems, based Washington. If you have notes indicating the anatomy of the burn, you'll first choose a burn diagnosis code from the 940.x (Burn confined to eye and adnexa …) to 947.x (Burn of internal organs …) code set.

The first three digits of the 940.x-947.x codes “refer to the general anatomic location of the burn. The fourth digit refers to the degree of the burn, with the fifth digit being the most specific anatomic location of the group," says Arnold. Not all of the codes in this diagnosis set have fifth-digit requirements, but you must code to the fifth digit if the code specifies it.

Example: The dermatologist treats a patient with first degree burns on his left foot. On the claim, you would report 945.12 (Burn of lower limb[s]; erythema [first degree]; foot) to represent the patient's condition.

If you have no evidence of burn location in the notes, choose a code from the 949.x code set instead, explains Jeffrey Linzer Sr., MD, FAAP, FACEP, Associate Medical Director for Compliance, Emergency Pediatric Group, Children's Healthcare of Atlanta at Egleston.

For example, operative notes indicate that a patient suffered second-degree burns, but there is no indication as to the anatomical location of the burn. For this claim, you would choose 949.2 (Burn, unspecified; blisters, epidermal loss [second degree]) as a diagnosis code.

Step 2: Ensure You've Coded for All Burns

You'll also need to make sure that you are coding for each burn the patient suffered. How many codes you include to represent the patient's injuries depends on encounter specifics.

Article Source :- http://www.supercoder.com/coding-newsletters/my-emergency-medicine-coding-alert/diagnosis-coding-follow-these-4-steps-to-master-940-949-burn-diagnoses-article

Medical Office Billing and Collections Alert

Reimbursement Roundup: Modifier PT Helps Your Practice Capture Screening-Turned-Diagnostic Colonoscopy Pay

New modifier became effective Jan. 1 -- here's how you'll report it.

The question of how to code a screening colonoscopy that becomes diagnostic during the course of the procedure -- and whether the patient's deductible applies -- has long puzzled some practices, but a new Medicare modifier solves that problem. Learn how modifier PT (CRC screening test converted to diagnostic test or other procedure) can solve your colonoscopy reimbursement woes.

Get to Know Modifier PT Basics

Effective Jan. 1, Medicare carriers accept new modifier PT to explain when your physician starts a screening colonoscopy that then becomes a diagnostic procedure.

"This tells the MAC contractor that the service started as a screening procedure (e.g. G0105 [Colorectal cancer screening; colonoscopy on individual at high risk], G0121 [Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk]) but an abnormality was found and the procedure became diagnostic or therapeutic," says Joel V. Brill, MD, AGAF, CHCQM, American Gastroenterological Association, AMA/Specialty Society Relative Value Update Committee (RUC) Advisory Committee Member.

When appended to your procedure code, "the modifier will indicate to Medicare to waive the deductible for a diagnostic procedure," says Christine Ross, CPC, with Digestive Healthcare Center in Hillsborough, N.J.

Why the change? Practices needed a way to tell MACs that their procedures started out as screening services but changed to diagnostic but didn't want patients subjected to deductibles for these services. "The Affordable Care Act waives the Part B deductible for colorectal cancer screening tests that become diagnostic," CMS noted in MLN Matters article MM7012, which announced the new modifier PT (http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7012.pdf).

Avoid Reporting G Code With Modifier PT

Once the physician indicates that the screening procedure has turned diagnostic, you'll bill only the diagnostic colonoscopy code, and not the screening code (G0104-G0106, G0120-G0121). Not only is this correct coding, but it's also the only way you can use modifier PT.

The MLN Matters article notes that modifier PT should only be appended to a CPT code in the surgical range of 10000 to 69999. Therefore, you should not append modifier PT to a G code, says Brill, who represents the American Gastroenterological Association on the CPT Editorial Panel.

Tips to Help Your Discontinued Procedure Claims

While going about your anesthesia coding duties, you might encounter various challenges. When your anesthesiologist sees some risk that could threaten the patient's health if the procedure continues, you might turn to modifier 53 (discontinued procedure). Here are some tips to guide you the right way.

Electronic filing challenges

Now in the age of HIPPA and electronic standards, you must first bill electronically. Previously, you may have been told to submit paper claims reporting modifier 53 so you can add a written explanation with the claim. Once you bill electronically with modifier 53, the payer might need more information. If your physician is documenting the right way, the anesthesia note should contain all the information the carrier requires.

Remember: In case you had a failed procedure, the record should state why and what failed. If your physician discontinued the procedure owing to the patient's condition, the record should tell what factors prevented the procedure from going ahead.

You should know when the case was canceled

When you know exactly when the case was cancelled in terms of the anesthesiologist's work will help guide your code choices.

You need to include the right diagnosis

Mention the reason for cancellation by reporting the proper diagnosis code or codes. For instance, a patient experiences syncope while still in the pre-op area before her procedure.

In case a patient experiences syncope while still in the pre-op area before her procedure, you could include diagnosis codes V64.1 and 780.2 on the claim. You may also report the diagnosis for the scheduled procedure depending on when the physician canceled the case.

Time Management Tips to Ace Your CPC Exam

While taking your CPC exam, it's very important that you know the tactics of time management. If you don't allot your time the proper way, your hard work will come to naught.

Read on for some time management tips to seal your chances at the CPC exam and take your medical coding career to new heights.

The CPC exam is divided into three sections – and it's a known fact that to pass the exam, you need to go through each section.

What you shouldn't do: Sometimes you could be really slow at the start and ace the first section. You could pass the second section too, but then fail in the last section due to lack of time. What you should do: The exam is more about pass and fail and not about getting an A. Therefore, you need to divide your time and pass each section. When you open your exam, you'll find an answer grid with three columns comprising 50 questions each. Give yourself an hour for each column – a couple of hours for the one with the surgery questions. This means this'll take up four hours of the 5.5 hour exam. 1) After four hours, scan your answer grid – which column has the most unanswered questions. At the outset, take some time on that column and then spread the rest of your time on your unanswered questions. This technique will boost your chances of having good number of rightly-answered questions in each section. 2) Remember that answering simple and easy medical terminology question carries as much weight as a time consuming surgical question. 3) Make it a point not to miss out on any question. Use the last 20 minutes of your exam time to take a guess at any unanswered question. There's at least 25 percent possibility of getting it right even without looking at the question. For further details on this and for other medical coding updates, sign up for a one-stop medical coding guide like Supercoder.com.

5010 Version: Don't List Your Practice's Place of Service as A P.O Box

If you do so, your claims will be denied straightaway.

As we approach the transition deadline for ICD-10 code set and version 5010, there are many out there who are still figuring out how to take the plunge. CMS, as we all are aware, will want you to be using form 5010 from January 1 next year. You need to start double-checking your system's provider information and claim forms to see to it that address fields are 5010-form ready.

One important thing you need to keep in mind while making the transition is staying away from confusions created by your P.O box.

Don't let your 5010 claims list your practice's place of service as a P.O box. If you do so, your claim will be instantaneously denied.

What's more, don't rely on your vendor to do all of your work for you. You will be unlucky in this department as the vendor will not be able to make changes like this for you as they are in your system and not the vendor's data files. Even if the vendor is truly on top of this, there are things the providers/billers have to do in their systems that vendors cannot do for them.

The vendor does not have a say on what they call the provider master list; the practice or billing company has to see to it that address is a street address. Remember that the 'pay to' address can remain to be a P.O box or lockbox. However the hitch is that some of the low-end systems do not have a place for two addresses. They have just one address field which serves as both the office address and pay to address. And in case they have been using a P.O box earlier, they cannot do it any longer.

And those practices that maintain lockboxes with P.O box addresses, however who do not have the ability to fill in two different fields will either have to give up their lockboxes so the claim won't be denied; or use the lockbox address and face claim denials. They will alternatively have to get a software update or upgrade so they can have two fields for the separate addresses.   For More Information :- http://www.supercoder.com

ICD-10 Prep: Get to Know How Eye Infection, Strep Diagnoses Will Change in 2013

Hint: Your diagnosis coding will depend on which eye was infected once ICD-10 hits.

When ICD-9 becomes ICD-10 in 2013, you'll have to be prepared for changes across the board when it comes to diagnosis coding. Often, you'll have more options that may require tweaking the way you document services and a coder reports it. Check out the following examples of how ICD-10 will change your coding options when the calendar turns to Oct. 1, 2013.

Nail Down These Upcoming Eye Infection Coding Changes

Conjunctivitis is an eye infection that can affect patients of all ages, and your practice is probably familiar with the signs and symptoms of this condition. But, like all other conditions, conjunctivitis will fall under new codes under ICD-10.

You currently have several coding options for conjunctivitis, depending on the type of condition that the physician treats. The following is a sampling of ICD-9 codes that most practices use:

372.00 (Acute conjunctivitis, unspecified)

372.01 (Serous conjunctivitis, except viral)

372.05 (Acute atopic conjunctivitis)

372.10 (Chronic conjunctivitis, unspecified)

372.11 (Simple chronic conjunctivitis)

372.30 (Conjunctivitis, unspecified)

ICD-10 Changes: Under ICD-10, you'll have to not only denote the specific type of conjunctivitis by using the accurate diagnosis code, but you'll also have to indicate which eye was affected. The following is a sampling of ICD-10 codes that will affect pediatricians under the new coding system.

H10.10 (Acute atopic conjunctivitis, unspecified eye)

H10.11 (Acute atopic conjunctivitis, right eye)

H10.12 (Acute atopic conjunctivitis, left eye)

H10.13 (Acute atopic conjunctivitis, bilateral)

H10.2x (Serous conjunctivitis, except viral)

H10.3x (Unspecified acute conjunctivitis)

H10.40x (Unspecified chronic conjunctivitis)

H10.9 (Unspecified conjunctivitis)

The "x" designations above show where you'll input an additional digit to denote the affected eye. As shown in the H10.10-H10.13 range above, you will have options for the left eye, right eye, bilateral, or unspecified in most categories under ICD-10.

Article Source :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/icd-10-prep-get-to-know-how-eye-infection-strep-diagnoses-will-change-in-2013-article

Proposed 2012 Fee Schedule: Imaging Interpretations to Witness Further Cuts

Radiologists and oncologists will witness a four percent cut to their total Medicare reimbursement in 2012; radiation therapy centers could face five percent cuts.

This proposed rule addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services.

On July 1, the Centers for Medicare and Medicaid went ahead with its proposed Medicare Physician Fee Schedule for 2012. And news is the bad run for imaging practices continues.

Background: Over the past five years, diagnostic imaging has witnessed significant cuts. So if the proposed rule becomes final, the radiologists and all practitioners who interpret diagnostic imaging tests will face cuts. “This payment cut would have serious consequences and we cannot and will not allow it to happen. That's why the President's budget and his fiscal framework call for averting these cuts and why we are determined to pass and implement a permanent and sustainable fix," said Donald M. Berwick, MD, the CMS administrator in the agency's release.

Imaging pay cuts

If the proposed rule is finalized, imaging pay will be badly hit. Presently, you get 100 percent of the global fee for your primary study when you carry out multiple radiological procedures that are within the same family. But then for the second and subsequent studies, you collect 100 percent of the professional component (PC) and 50 percent of the technical component (TC).

In 2012, the agency is likely to slash both the TC and PC of subsequent radiological procedures by 50 percent.

Further cuts: In fact, the proposed rule indicates that payment cuts could be even deeper in 2013.

Specialties likely to gain if the proposed rule 2012 becomes final

Specialties like anesthesiology, ophthalmology, neurology, and physical medicine are likely to witness a 2 percent raise in Medicare pay for 2012 if all of the proposals are finalized.

ICD-9 2012: Embolism Coding Changes in the Offing

This time, ICD-9 code set will bring new embolus codes.

Reflecting Centers for Medicare & Medicaid Services' (CMS) continued effort to strive for greater specificity in diagnosis coding in view of the transition to ICD-10, the agency has posted its proposed changes to diagnosis coding that are scheduled to go into effect on October 1 this year.

As in previous years, ICD-9 2012 has brought with it innumerable additions, changes and deletions. This time there will be around 166 new codes along with 88 deletions and 168 revisions. Neoplasm, digestive system, sense organs, etc. have witnessed the most number of code changes in this edition of ICD-9 code changes.

What's in store for cardiology coders?

As a cardiology coder, if you thought you would sit just back and relax, think again as this time it brings a slew of changes as far as your specialty is concerned. In this direction, be prepared for some new embolus codes.

You should gear yourself up for these new embolus codes:

415.13, Saddle embolus of pulmonary artery

444.01, Saddle embolus of abdominal aorta

444.09, Other arterial embolism and thrombosis of abdominal aorta

V12.55, Personal history of pulmonary embolism.

747.3 (Anomalies of pulmonary artery) may be replaced with codes requiring a fifth digit

One code that has been affected by the ICD-9 2012 changes is 747.3 (Anomalies of pulmonary artery). It is likely to be replaced with codes requiring a fifth digit specify coarctation and atresia, arteriovenous malformation, or other anomalies.

Prepare for it now: Since the code changes will go into effect without grace period, you need to prepare for it now.

Accounts Receivable: Improving Your A/R Process With These 4 Tips Means Improving Your Collections

If you aren't following up on denials, you're leaving money on the table.

The economic downturn coupled with looming healthcare changes means that your practice -- and all others -- are under more pressure than ever to collect every penny you deserve. You can refine your accounts receivable (A/R) process quickly and easily to bring in the money without a lot of extra effort.

A/R defined: "Accounts receivable (A/R) is the money that is owed to the practice," explains Elin Baklid-Kunz, MBA, CPC, CCS, a director of physician services in Daytona, Fla., during The Coding Institute's audioconference "Top A/R Tactics: Fight Back Against Lower Payments and Increased Government Scrutiny." Follow these four best practices to set your practice on an improved A/R track and avoid thousands in lost reimbursement.

1. Monitor Each Claim You Send Out

The first step in perfecting your A/R process is to make sure someone in your practice is paying attention to what happens to every claim you submit. Ask questions such as: "did the insurance company even receive the claim?" and "Did the patient pay her copay portion of the bill?"

"There are companies out there I call ‘code it, bill it, and forget it companies,'" says medical coding , billing, and practice management consultant Steven M. Verno, CMBS, CMSCS, CEMCS, CPM-MCS, in The Coding Institute's audioconference "Reveal and Recover Hidden Money You Didn't Know You Missed." "They code the claim, they bill the claim, and then they forget about it. They leave it out there and don't do anything to bring the money in. They don't follow up on the claim."

Source Code :- http://www.supercoder.com/coding-newsletters/my-practice-management-alert/accounts-receivable-improving-your-ar-process-with-these-4-tips-means-improving-your-collections-article

Following up on your submitted claims early in the game can save you time. First ensure that once your practice submits a claim that it is accepted. If the claim is rejected, the first order of business is to research why. Catching it in the initial submission phases saves you time in the long run and ultimately gets your money in the door faster.

Set a reminder: Try placing an event reminder on your Outlook or Web calendar every week that reminds you to check all accounts receivable for the past 30 days. Print a report, and go online or call to check claim statuses.

Phototherapy: 96900 or 96910? The Answer Could Mean $70 for Each Vitiligo Treatment

Avoid misrepresenting phototherapy services by following this expert advice.

Is your dermatologist treating vitiligo or dychromia patients with phototherapy? If so, you need to dig into your physician's documentation to determine what type of light, wavelength, and materials he used. Check out these two frequently asked questions and combat both E/M and multiequipment correct coding initiative (CCI) situations with this expert advice.

Evaluate These Phototherapy + E/M Tips

If you're charging for an office visit on the same day as phototherapy, your reimbursement may depend on whether your physician's documentation warrants a different diagnosis code. Payers may reimburse at times if the doctor sees the patient for a different problem, thus with a different diagnosis code, experts say.

Example: If your physician performs 99212 (Office or other outpatient visit for the evaluation and management of an established patient ... Physicians typically spend 10 minutes face-to-face with the patient and/or family) with phototherapy, you will bill it with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the E/M service. You can only consider reporting modifier 25 when coding an E/M service, Janet Palazzo, CPC, a coder in Cherry Hill, N.J., says. Remember your E/M documentation has to show medical necessity for the additional work.

Note: If you reported the nurse visit code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician ...), your payer would likely consider it bundled into the light treatment.

Ask 2 Questions to Choose Best Light Therapy Code

For patients with vitiligo (709.01), your dermatologist may use narrow band UVB phototherapy.

The dermatologist administers phototherapy two to three times per week for several months until the patient achieves repigmentation of the skin. For this procedure, you need to pinpoint what types the physician used (UVA, UVB) and the varying wavelengths.

To choose the appropriate code, ask yourself these two questions:

Part B Coding Coach: 10120 or Beyond: Site, Depth, Complexity Drive Code Choice

Follow 3 pointers to snag maximum pay.

From just under the skin to deep within the bowels, your general surgeon might perform a foreign body removal (FBR) that calls on a wide range of coding know-how. Zero in on the right code every time by implementing these four principles:

1. Use 10120-10121 for Any Site Under Skin

If your surgeon makes an opening to remove any foreign body, such as a glass shard or a metal filing, but doesn't indicate an anatomic site or depth in the op report, you'll probably choose 10120 (Incision and removal of foreign body, subcutaneous tissues; simple). You can't choose a more specific code if the surgical report doesn't provide any more documentation.

Caveat: Because the code requires incision, look for a sharp object when considering 10120. If the documentation doesn't include this detail, use an E/M service code (such as 99201-99215, Office or Other Outpatient Services) instead of the skin FBR code.

Look for complications: If the surgeon uses the term "simple" in the op note or fails to note any extenuating circumstances, you're good to go with 10120. But the surgeon might perform a complicated FBR, meaning that the foreign body was harder than usual to remove. In these situations, the note should indicate, for example, extended exploration around the wound site, presence of a complicating infection, or sometimes the need to use visualization and localization techniques, such as x-ray. In those cases, you should choose 10121 (… complicated) for a subcutaneous FBR with no mention of anatomic site.

Article Source :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/part-b-coding-coach-10120-or-beyond-site-depth-complexity-drive-code-choice-106763-article


2. Search Musculoskeletal Codes for Specific Site

CPT codes contain higher-paying FBR codes than 10120- 10121, but the surgeon needs to document the following two details before you can use the codes:

Location: You'll find myriad FBR codes scattered throughout CPT's "Musculoskeletal System" section (20000-29999), but you can't use any of them if the surgeon doesn't document the removal's anatomic site.

Depth: In addition to anatomic site, the musculoskeletal codes distinguish FBR based on the depth of the foreign body. When coding or auditing, look in the notes for the term "fascia," suggests Pamela Biffle, CPC, CPC-P, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Watauga, Texas. CPT provides two FBR codes for many anatomic sites: one for subcutaneous (above the fascia) removal, and one for "deep" (below the fascia) removal.

CMS releases proposed changes to ICD-9 2012

Ensure your systems are updated with the just-in codes.

Recently, the Centers for Medicare and Medicaid Services (CMS) released its proposed changes to ICD-9-CM diagnosis codes 2012, which are effective for dates of service on or post October 1 this year. This time, as in previous years, there are hundreds of additions, changes and deletions. These codes are compulsory for all health insurance claims filed from October 1 this year till September 30, 2012.

These changes have been approved by the ICD-9-CM Coordination and Maintenance Committee and were published in the Federal Register on May 5, 2011.

Key: Post the October 1 deadline goes into effect, the agency will only add new ICD-9 codes on an emergency basis as it gears up to switch over the diagnosis coding system to ICD-10.

Good news for dermatology coders: If you're a dermatology coder, there's good news for you as you will be more spot on with the reporting of the location of carcinomas and other neoplasms of the skin.

Obsolete: When ICD 9 2011 codes go into effect, 173.0 will become an invalid diagnosis code.

This time, there is an expansion of the 173.x (Other malignant neoplasm of skin) series. In this series, each code will get a list of fifth digits that'll specify whether the malignant neoplasm is basal cell, squamous cell or unspecified.

Dermatology coders will now report 173.0 for any non-malanoma malignant neoplasm of the lip. When these codes go into effect, coders can take a pick from 173.00, 173.01, 173.02, and 173.09.

What you should do now?

With just a few months before implementation, now is the time to act. Get your systems updated today!

Be prepared for: Will there be any expanded skin neoplasm codes when coders update their diagnosis codes in 2013 with ICD-10? Well, it's not sure.

For the latest on ICD 9 2012 changes and for other medical coding updates, sign up for a good coding resource like Supercoder.

Place of Service Address has to be a Street Address in the New Form 5010

From January 1, 2012, your practice needs to be ready with Version 5010 for electronic claim submission. But although the deadline is fast approaching, there has been lukewarm response in this direction. Even the national 5010 form testing day that CMS organized on June 15 was attended by very few.

Irrespective of the tepid response, you need to be form 5010 ready.

Key: Do not anticipate any delay in the compliance deadline.

You need to start getting in touch with your vendors by pulling all your contracts and assessing how each system and vendor will have a say on its implementation in your practice. While doing so, various people in your practice – physician, biller and coder – should be involved.

Here’s what you and your practices should be doing now:

Work with your software vendors as soon as possible to see to it that no issues will exist with claims submissions using ICD-10.

Check if they are ready for the transition.

Take a look at your forms to ensure they are 5010-form compliant. Now since the place of service address cannot be a PO box as per new 5010 standards, your practice has to ensure that your address is a street address. If you don’t, your claims will be rejected.

Take a look at anything written in the contract that says government mandates are covered. If there’s anything written, find out the cost to your practice – if upgrades are an essential part of your contract, your practice might have saved itself a bundle.

Set up timelines to get your practice’s system ready

Now go crack your CPC exam with these tips

Sure-fire tips to seal your chances of passing the CPC exam.

So you have been taking the CPC exam for a long time, and each time without success? Here are some medical coding tips to help you sail past your CPC exam and how:

1) See to it that you have sound coding background before you take an exam prep class.

Remember that CPC training camps do not teach you everything from scratch. The camp will not be of much use to you if you don't have some coding background prior to taking this class.

2) Bring your own tools to the exam hall

You should come stocked with your own tools for remembering things. However see to it that it makes sense to you; or else even the best tools won't be of any help to you. As you study, mark up your manual. For example, while using the Physician Fee Schedule, mark all the codes in your CPT manual that can take modifier 26.

3) Tips while taking the exam room time management.

First you should make an effort to finish the shortest questions first. All the questions on the exam carry equal number of points – be it one-liners or longer coding scenarios that take you quite a while. As such, go for the shortest answers first so that you can get the most points if you finish the shortest questions first.

4) Answer the short questions first

While taking your test, go for the short answers in your test booklet first and answer them if you can. As soon as you're through it, move to the two-line questions, and so on and so forth. After this, go to the longer op note and coding scenario questions later on, starting with specialties you're most familiar with.

Now that you know how to crack your CPC exam, go take a shot at it today!

Seal Your CPC Exam with These Tips

Taking your CPC exam? Reading this article will certainly help you in your exam taking efforts.

There has been an information boom in recent years, so much so that it makes it difficult for you to sift through so much information, adding to your confusion. This article will throw some light on how you should prepare for your CPC exam given the huge information boom.

a) A good option is to head to a certification training camp

Even if you are a good specialty medical coder, you will not be able to pass the CPC exam just by cramming on the coding information which is not so familiar. This is where the training certification camps come to your rescue. Such camps offer a qualified instructor who can cover each area of the CPC exam: Be it ICD-9 Codes, CPT and HCPCS codes ( Source "http://www.supercoder.com/hcpcs-codes/") and everything in between.

b) Tell your doctors you will stick around for a year if they foot your CPC camp bill

CPC camps come for a price. Normally physicians might not be willing to pay the training money for fear of the employee leaving the practice in search of greener pastures after getting the certification. A one-year commitment will certainly make your employers more secure about spending money on your training.

What you should do: Tell your employer that if they shell out money for your training and you pass it, you will stick around for at least a year.

Benefit: It shows that you can know the investment the employer could be making in you and that you want to pay that investment back. The fact of the matter is that lots of medical coders do stick with their employer even after they have their CPC certification in hand; they grow their careers as the practices they work for grow.