11040 and Wound Closure: Watch Out for These Conditions to Explain Separate Reporting

Concentrate on the level of wound repair to maximize your reimbursement.

A lot of clinical scenarios do not need dermatologists to carry out debridement as a distinct service from wound closure. Though, recognizing the times when it is essential can help your practice get the full reimbursement it is worthy of. Follow the expert medical billing and coding advice given below and know what CPT codes apply.

In case you're considering reporting debridement distinctly from a wound closure, ensure that your dermatologist's notes clearly document that the wound was contaminated and needed instrumentation and saline or other substances to cleanse and debride the wound. You would require doing a sharp removal to use the debridement code.

Don't miss: In case you report a debridement code, for instance 11040 (Debridement; skin, partial thickness), along with your wound closure CPT codes, append modifier 59 (Distinct procedural service) to the debridement code. This tells the payer that you recognize that debridement is mostly bundled into wound repair, however that clinical circumstances needed the dermatologist to carry out debridement as a separate service.

1. Watch Out for Wound Repair With the Debridement

CPT® specifies that you might also report debridement CPT codes independently of repair CPT codes once the dermatologist gets rid of large amounts of devitalized or contaminated tissue or once the dermatologist carries out debridement without immediate primary repair of a wound.

The dermatologist might clean debris from the wound excluding repairing the wound as it was not deep enough to need repair or the dermatologist delayed the repair because of an extenuating circumstance.

For instance: The dermatologist may not have sufficient time to repair the wound at that particular time, or the patient may present with a more important skin condition that needs medical attention first. In such an instance, you can bill debridement for full, distinct payment minus a wound repair code.

Even though dermatologists most commonly clean a wound instantly before they repair it, you wouldn't report a debridement code separately. Don't miss: The debridement procedure may also require a repair procedure that will affect your medical billing report.

2. Don't Oversee Intermediate Wound Closure for Your Extensive Debridements

In case the dermatologist carries out a simple repair with nominal amounts of debridement, for example, you must only report a simple repair code (12001-12021). In case that same wound requires extensive cleaning or removal of particulate matter, you may, as an alternative, report an intermediate repair code (12031-12057).

Money opportunity: There is an important difference in payment between simple plus intermediate repair CPT codes . Reporting code 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less) will reimburse you about $93.60, whereas 12031 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.5 cm or less) may pay $235.20.

Accurately Report Pouchoscopy and Overcome Keofeed Reporting Confusion

Know How to Appropriately Report Pouchoscopy With Additional Procedures

Question: Your gastroenterologist recently carried out a pouchoscopy. (The operative report read like this: The patient was turned around and the scope was changed to an Olympus P CF-180 pediatric video colonoscope. There was an anal stricture but I was able to get the scope beyond this. There was inflamed tissue at 40 cm. I bypassed this. There was a stricture at 100 cm and I was unable to bypass it with the scope. I dilated that with a 20 mm balloon. Then I was able to bypass the stricture and the ileum proximal to it appeared normal. The colonoscope was slowly withdrawn and the ileum and pouch were decompressed. The anus was dilated with a 50 French Maloney dilator. The procedure was then terminated. He tolerated it well. There were no immediate complications.)

Should you use a colonoscopy CPT® code to describe the procedure that was carried out?

Answer: Colonoscopy is a diagnostic procedure used to discover problems in the colon or the rectum. A pouchoscopy is carried out on the small intestinal (abdominal or pelvic) pouch. Thus, a colonoscopy CPT® code cannot be used in case pouchoscopy is the procedure your gastorenteroloist is carrying out. If pouchoscopy was the only procedure that your gastroenterologist carried out, then you have to report the procedure using medical billing code 44385 (Endoscopic evaluation of small intestinal [abdominal or pelvic] pouch; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). However, since your gastroenterologist also used dilators to overcome the strictures, if you simply report the procedure with medical billing code 44385, your reporting will only be half-correct.

CPT® does not cover a lot of endoscopy procedures with separate medical billing codes. One such code that is not covered includes pouchoscopy together with dilation to overcome strictures using a balloon, bougie or a guidewire. As, CPT® does not have a distinct code for pouchoscopy with dilation you will have to report the pouchoscopy with 44385 and the dilation with 44799 (Unlisted procedure, intestine).

As you are reporting an unlisted procedure code, you will be required to submit a copy of the operative report together with documentation defining what additional procedures have been carried out by your gastroenterologist. The documentation must also include the time that was taken by your gastroenterologist to carry out the procedure.

Address the Keofeed Reporting Confusion

Question: Your gastroenterologist recently carried out a Keofeed feeding tube placement at our facility. How do you report this?

Answer: The placement procedures for feeding tubes is essentially reported based on the type and method that was used. A Keofeed feeding tube is a kind of nasogastric tube. Nasogastric tubes, as the name specifies, are inserted via the nose into the stomach. The tube insertion is carried out largely for feeding purposes and also for the administration of drugs and other agents for instance activated charcoal. You must report the placement of a nasogastric tube with medical billing  Codes 43752 (Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance [includes fluoroscopy, image documentation and report]).

Follow-Up: Discover Billing Problems in Your Audit? Here's How to Solve Them

Medical Billing

If your physician is trapped in a coding rut, give him the tools to get on track.

Do you have one physician on staff who reports level- four E/M codes for every visit? In case you thought your practice was safe to this type of mistake, your self-audit might expose medical billing problems you didn't know you had.

In case you code the charts of numerous physicians at the similar practice, it may be tough to notice trends in the physician's coding habits.

For example, one physician might code each visit as a 99214 (Office or other outpatient visit for the evaluation and management of an established patient …), however as her charts are mixed in with other physicians' in the practice, you don't notice the pattern as you never code a heap of her charts at the similar time. Besides, as a lot of practices now have their own urologists do their own indiviudal E/M coding, you may have never studied an E/M chart to check on its accuracy.

Medical Billing Tip: Remind Your Physicians How to Select a Level

In case you discover E/M coding difficulties in your chart review, you must remind your physicians how to choose the accurate level. First, highlight to the physicians that the nature of the presenting problem will set the primary level of care that is necessary.

Prior to taking the patient's history of existing illness, earlier medical history, social history, family history, as well as review of systems, the physician must have a pretty good idea what level of service he'll be carrying out based on the presenting illness or injury. Then, the physician must do the exam as well as medical decision-making that meet the level that's necessary for that illness severity, based on the patient's history.

Complexity, MDM is different With Each Patient

In case you find that one of your physicians miscodes his E/M visits, tell him again that even if he constantly sees the same diagnoses (which is unlikely), the complication of the visit and the medical decision-making will differ from one patient to the next.

Medical Billing Example: A 25-year-old female going through an ear infection and no other medical problems might qualify simply as a level-two office visit (99212) as the physician only carried out a problem-focused history and exam, and straightforward medical decision-making.

Though, assume the physician sees a 22-year-old patient with an ear infection, and the patient has hearing loss and balance issues owing to a head injury. The patient has already been on three rounds of antibiotics and it is not improving.

Although this patient also has an ear infection, the coding changes from our previous example above. This patient may be eligible for a level-four or maybe even a level-five visit, depending on the number of treatment options, the tests ordered, the medications ordered, etc.

Remember: In case you carry out medical billing for a surgeon or specialist, the fact that the physician is a specialist does not decide the level of complexity.

IOLs: V2632 Is Just the Beginning – Go to V2787 and V2788 for Multifocal IOLs

Medical Billing

Also: Anticipating extra pay for new-technology intraocular lenses? Read this medical billing and coding article first.

Cataract surgeries are a routine part of a lot of ophthalmologic surgery practices, and intraocular lens (IOL) insertion is a routine part of a lot of cataract surgeries. However a new generation of multifocal IOLs is altering the routine -- both for the surgeon as well as the coder. To get reimbursement, you'll need to keep your HCPCS manual handy. This expert medical billing and coding article will tell you how.

Background: Next to cataract surgery, in which the surgeon gets rid of the patient's natural lens, Medicare will pay for the insertion of a novel standard (monofocal) IOL. In case the surgery takes place in the office, you must assign HCPCS code V2632 (Posterior chamber intraocular lens) to cover the cost of the standard IOL.

For More About  IOLs :- http://www.supercoder.com/coding-newsletters/my-ophthalmology-coding-alert/iols-v2632-is-just-the-start-look-to-v2787-and-v2788-for-multifocal-iols-110579-article

Exception: Code V2632 does not cover the added cost of a multifocal IOL, which not only replaces the natural lens however also corrects refractive errors – for instance an astigmatism-correcting (A-C, also known as "toric") or presbyopia-correcting (P-C) IOL.

P-C IOLs go further than the function of a standard IOL by correcting presbyopia, the incapability to focus on near objects. An A-C IOL fixes astigmatism, an irregular curvature of the cornea.

Medical Billing and Coding Update: Turn to HCPCS Codes for Full Payment

Patients may be given the non-covered lens as well as physicians are recommended to counsel the patient that the cost will be their accountability. Collect the cost up-front or have the patient sign a financial responsibility agreement. Although Medicare will not pay for the additional cost of an A-C or P-C IOL, it is a correct medical billing and coding practice to bill the patient for the dissimilarity, using two HCPCS codes:

A-C IOLs: You must report V2787 (Astigmatism correcting function of intraocular lens). Medicare recognizes these as A-C IOLs:

• AcrySof Toric IOL
• AcrySof IQ Toric IOL
• Silicone 1P Toric IOL.

P-C IOLs: Report V2788 (Presbyopia correcting function of intraocular lens) Medicare recognizes these P-C IOLs:

• AcrySof ReSTOR
• AcrySof IQ ReSTOR
• Crystalens
• ReZoom
• Tecnis Multifocal Acrylic Intraocular Lens
• Tecnis Multifocal 1-Piece Intraocular Lens
• Tecnis Silicone Intraocular Lens.

No More New Technology IOL Reimbursement

Remember, you should not confuse A-C and P-C IOLs with novel technology IOLs (NTIOLs) to make certain that you achieve medical billing and coding accuracy. NTIOLs are a different category of IOLs that reduce corneal spherical aberrations. Medicare identifies them as having definite clinical advantages as well as dominance over existing IOLs with regard to lesser risk of postoperative complication or trauma, enhanced postoperative recovery, lesser induced astigmatism, enhanced postoperative visual acuity, more stable postoperative vision, or other similar clinical advantages.

Modifier 78: Case Study: Reason Decides Correct Modifier for Metatarsal Excision

Read this expert medical billing and coding advice before allocating a code for multi-step procedures.

When a patient comes with a severe infection, you have to deal with numerous treatment steps -- and numerous potential complications for your coding. Test your medical billing and coding know-how by reviewing this scenario and determining the accurate modifiers when three distinct surgeries are required.

Scenario: An established patient who has peripheral neuropathy comes with a severe foot infection. During the evaluation and management, the podiatrist accomplishes a problem-focused exam and history to conclude that immediate incision and drainage is required (28003, Incision and drainage below fascia, with or without tendon sheath involvement, foot; multiple areas). He then concludes to wait for the infection to recede to see if any further procedure is needed.

Four days later, the podiatrist determines that he needs to further excise bone from the second and third metatarsals (28122, Partial excision [craterization, saucerization, sequestrectomy, or diaphysectomy] bone [e.g., osteomyelitis or bossing]; tarsal or metatarsal bone, except talus or calcaneus). The wound is left open for one week to drain the infection before the podiatrist performs a secondary closure (13160, Secondary closure of a surgical wound or dehiscence, extensive or complicated).

Your task: Decide what modifiers will get to the bottom of payment for these procedures.

Medical Billing and Coding Expert Advice: Don’t Forget Your E/M

Prior to deciding on correct modifiers for the excision as well as secondary closure, you want to make certain you’ve covered all your bases coding the initial patient encounter.

In case you just reported 99212 for the E/M accompanied by 28003 for the I&D, you’d be asking for a denial. You should append modifier 57 (Decision for surgery) to the E/M code to let your carrier know that the visit encompassed a separately identifiable service, and not merely a pre-op screening.

Remember to check your global for accurate medical billing and coding: In case the podiatrist carried out an I&D for merely one bursal space (28002), the 10-day global period of that procedure would lead you into appending 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 other hand, the 90-day global of 28003 ascertains it as a major surgery, necessitating modifier 57.

Medical Billing and Coding Tip : The 57 modifier is also applicable to E/M codes done the day before the major procedure. This is correct on condition that that the E&M code is important and distinctly identifiable.

For More Information :- http://www.supercoder.com/coding-newsletters/my-podiatry-coding-alert/modifier-78-case-study-reason-determines-correct-modifier-for-metatarsal-excision-110630-article 

Coding Tips: Master Occipital Nerve Injection Claims With These Strategies

Hint: Follow site of needle insertion to select the accurate code.

While your physician treats a patient for occipital nerve pain, you'll require knowing what your physician does to treat it and where precisely your physician inserts the needle for correct claims. Read on for more medical billing and coding tips on how to ascertain which nerve your physician treats and the services delivered to reach at the right codes.

Build up Your Occipital Anatomy Basics

You will come across three different sets of occipital nerves in the body, thus you'll need to know that which one in particular your physician is treating. You report separate codes for procedures on each nerve.

Coding connection: To get to the accurate code, you must know the origin of the nerves, the structures these nerves supply and their distribution, and also what are the common complaints owing to involvement of these nerves in any pathology.

Identify nerve pathology: One common condition stemming from the involvement of the GON that you will frequently get to report is the occipital neuralgia. You report ICD-9 code 723.8 (Other syndromes affecting cervical region) for occipital neuralgia.

Note: When ICD-10 goes into effect, you'll report M53.82 (Other specified dorsopathies, cervical region) for occipital neuralgia.

Select Right Codes for Specific Nerves

In case of occipital neuralgia, your physician will carry out a block in an office setting excluding any radiologic guidance. You should code this as CPT code 64405 (Injection, anesthetic agent; greater occipital nerve). In case the physician diagnoses LON involvement, your physician may carry out a block for the LON excluding radiological assistance. You then report CPT code 64450 (Injection, anesthetic agent; other peripheral nerve or branch).

There is no specific CPT code for LON block procedure. CPT includes only a limited number of codes for injecting specific peripheral nerves. In case one is not specified, like LON, then CPT code 64450 is applied

You face the real challenge when your physician carries out a block for the TON.

Best code for TON: You may report CPT code 64490 (Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level) for the procedure on the TON.

Medical Billing and Coding Tip: The TON is neither anatomically nor functionally identical with the GON. Look sensibly in the procedure notes what necessitated the physician to carry out the block and where the needle was inserted for the procedure. Your physician may carry out the block on either of the occipital nerves to either diagnose or treat the patient's headache. Your physician will record the medical history and do a clinical examination to limit the choice to block a specific occipital nerve.

ICD-10 Update: Look for Precise Etiology While Determing Acute Bronchitis Dx

Single ICD-9 code transforms to ten codes in ICD-10.

While reporting acute bronchitis, you will need to have a closer look at the documentation to check for the etiology of acute bronchitis as this will carry weight when ICD-10 goes into effect. Here's how the reporting while selecting ICD-9 codes when ICD-10 hits.

ICD-9: There is only one ICD-9 code for acute bronchitis in ICD-9 irrespective of the etiology of the condition. At present, you will report acute bronchitis with ICD-9 code 466.0 (Acute bronchitis)

ICD-10 difference: When ICD-9 changes to ICD-10, you will transform your acute bronchitis coding from ICD-9 code 466.x to J20.x. Remember the expanded ten codes under J20.x that define the etiology of the condition in greater detail, including:

• J20.0 (Acute bronchitis due to Mycoplasma pneumoniae)
• J20.1 (Acute bronchitis due to Hemophilus influenzae)
• J20.2 (Acute bronchitis due to streptococcus)
• J20.3 (Acute bronchitis due to coxsackievirus)
• J20.4 (Acute bronchitis due to parainfluenza virus)
• J20.5 (Acute bronchitis due to respiratory syncytial virus)
• J20.6 (Acute bronchitis due to rhinovirus)
• J20.7 (Acute bronchitis due to echovirus)
• J20.8 (Acute bronchitis due to other specified organisms)
• J20.9 (Acute bronchitis, unspecified)

Medical Billing and Coding Documentation Tip: With ICD-10 Codes , you will need to concentrate more on the cause of the acute bronchitis, so check the encounter notes for these details. If the documentation does not identify the etiology of the acute bronchitis, then you will have to report J20.9. Be sure not to assign a definitive cause unless the physician confirms and documents the causal organism. Just as while selecting ICD-9 codes, do not assign a diagnosis if the physician references a causal organism as "suspected," "probable" or "possible."

For More About ICD-10 :- http://www.supercoder.com/icd-10/

Your pulmonologist will frequently diagnose a case of acute bronchitis by means of the signs and symptoms that the patient is going through. Some of the common signs and symptoms that will you will witness in the documentation will involve fever (R50.9, Fever unspecified), malaise (R53.81, Other malaise), nasal congestion, wheezing (R06.2, Wheezing) and dry or suppurative, persistent cough (R05, Cough).

As most of the instances of acute bronchitis are of viral origin and are self-limiting, the management will merely include treatment of symptoms that the patient is experiencing. In case there is significant amount of sputum formation, then your pulmonologist might be doubtful of a lower respiratory tract infection (such as pneumonia) and order further tests for instance a chest x-ray to rule out or confirm the condition.

Your pulmonologist might order a sputum culture to determine the etiology of the condition. This will often be vital in case your pulmonologist disbelieves a bacterial origin that will require treatment with antibiotics. In case your pulmonologist has ordered a histopathological study, the etiology of the condition stated in the documentation will help define the suitable code that you can report for the case of acute bronchitis to ensure accurate medical billing and coding.

2012 Guideline Addition Explains When Post-Op Pain Management Is Suitable

Remember: Remember modifier 59 helps you

You must have been occupied with new as well as revised procedure or diagnosis codes, however don't forget the coding guidelines that are associated with CPT®, HCPCS, or other sources. Instance: The 2012 Correct Coding Initiative (CCI) coding guidelines include vital information about reporting post-operative pain management that your anesthesia providers will require knowing. Read on this expert medical billing and coding article for details on what CPT codes apply.

Check Timing and Clarify Purpose

Medicare global surgery rules specify that the surgeon performing the procedure is responsible for post-op pain management and should not report the care separate from the surgery. The rules change, however, when the surgeon asks the anesthesiologist or pain management specialist to handle the patient's post-op treatment.

Before asking for an anesthesiologist's help, the actual or postoperative pain should be severe enough to need treatments beyond the experience of the operating physician, as per CCI guidelines. For instance, the surgeon might request that the anesthesiologist place an epidural or nerve block to treat the patient's post-op pain.

Remember: The anesthesiologist might choose to place the epidural before, during, or after the surgery. You can only code the service, however, if the line for the epidural or nerve block is not also used for anesthesia administration during surgery. If it is, you should only report the appropriate anesthesia CPT code for the surgery and not separately code for post-op management.

After you can legitimately report the post-op management, look at following CPT codes as options:

• CPT code 62310 or 62311 ( Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid …)
• CPT code 62318 or 62319 – (Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid …)
• CPT code 64400-64530 – (Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic procedures on the extracranial nerves, peripheral nerves, and autonomic nervous system)

Append modifier 59 (Distinct procedural service) to specify that the anesthesiologist placed the nerve block or epidural for post-op management in place of intraoperative anesthesia. Remind the anesthesiologist to involve a procedure note in the patient's record documenting the block's purpose.

Medical Billing and Coding Tip: Watch Details of Post-Global Help

The surgeon might from time to time demand pain management services after the postoperative anesthesia care period ends. You can certainly code for this situation without thinking much about the fact that the care might be misconstrued as part of the surgical anesthesia. Though, CCI guidelines make clear that you still must append modifier 59 to the correct code for pain management services.

Enhance Your Practice's Bottom Line with These Easy-to-Implement Strategies

Medical Billing

The bonus: You'll help meet your patients' changing payment needs, too.

Each dollar counts in your practice and finding ways to enhance your medical billing and collections -- and then your practice's bottom line -- is vital. Discovering new, innovative ways to meet your patients' medical billing/payment needs and taking up new technologies will guarantee your practice getting every dollar it deserves.

With patients assuming greater percentage accountability for their medical bills, there has never been a more significant time for practices to evaluate the ways they use to process and collect payments.

Start with These 12 Ideas

Take a look at this rundown of medical billing and payment ideas that may help your practice enhance customer service and increase the bottom line. Then, implement the ones that work in your practice and watch your A/R improve.

All practices must consider adopting at least one of these 12 payment and medical billing ideas this year:

1. Convenience Fees: Think of either a 'No Fee to Biller' model by means of pre-set uniform convenience fees which is collected by your processor to retain 100 percent of your billable amounts, or a 'Biller Keeps the Fee' model to generate a new revenue stream and predict the positive impact to your medical billing and collections.

2. Account Verification: Confirm the correctness of the customer's account information and likeliness of positive pay prior to establishing recurring payment plans to evade costly and time consuming setups or frequent returned payments.

3. Virtual Agents: Allow computer-based algorithms handle payment options on succeeding account balances leaving agents as well as customer service reps free for further tasks.

4. ACH: Receive payments via ACH and decrease your processing fees increasing customer satisfaction through providing more competent cash management capabilities compared to traditional paper payments.

5. Cash Payments: Aid your underbanked customers make payments and settle debts by taking electronic cash payments – besides eliminate the risk of managing cash at your locations.

6. E-Billing (EBPP): Decrease your medical billing 's paper and postage costs by introducing e-billing and payment processing so customers can have their bills and pay online while also decreasing your Days Sales Outstanding (DSO) and operational costs.

7. Text payments: Customers appreciate this emerging technology. It offers a convenient option for busy mobile-savvy people; they can get bill reminders and authorize payment by text message.

8. PURLs for Personalized Payments: It is evident that one-time-use personalized URLs inspire electronic payments from paper statements and invoices, thus customers can quickly pay online however disregarding the need to create a profile or you must log into a public online payment portal.

9. Check 21: Substituting electronic images of checks simply means faster access to check payments and greater productivity than physically transporting paper checks in your medical billing procedure . Check 21 empowers non-standard paper checks for instance business checks to be converted to electronic images for processing.

For More Information :-

Medical Billing

Concentrate on the level of wound repair to maximize your reimbursement.

A lot of clinical scenarios do not need dermatologists to carry out debridement as a distinct service from wound closure. Though, recognizing the times when it is essential can help your practice get the full reimbursement it is worthy of. Follow the expert medical billing and coding advice given below and know what CPT codes apply.

In case you're considering reporting debridement distinctly from a wound closure, ensure that your dermatologist's notes clearly document that the wound was contaminated and needed instrumentation and saline or other substances to cleanse and debride the wound. You would require doing a sharp removal to use the debridement code.

Don't miss: In case you report a debridement code, for instance 11040 (Debridement; skin, partial thickness), along with your wound closure CPT codes, append modifier 59 (Distinct procedural service) to the debridement code. This tells the payer that you recognize that debridement is mostly bundled into wound repair, however that clinical circumstances needed the dermatologist to carry out debridement as a separate service.

1. Watch Out for Wound Repair With the Debridement

CPT® specifies that you might also report debridement CPT codes independently of repair CPT codes once the dermatologist gets rid of large amounts of devitalized or contaminated tissue or once the dermatologist carries out debridement without immediate primary repair of a wound.

The dermatologist might clean debris from the wound excluding repairing the wound as it was not deep enough to need repair or the dermatologist delayed the repair because of an extenuating circumstance.

For instance: The dermatologist may not have sufficient time to repair the wound at that particular time, or the patient may present with a more important skin condition that needs medical attention first. In such an instance, you can bill debridement for full, distinct payment minus a wound repair code.

Even though dermatologists most commonly clean a wound instantly before they repair it, you wouldn't report a debridement code separately. Don't miss: The debridement procedure may also require a repair procedure that will affect your medical billing report.

2. Don't Oversee Intermediate Wound Closure for Your Extensive Debridements

In case the dermatologist carries out a simple repair with nominal amounts of debridement, for example, you must only report a simple repair code (12001-12021). In case that same wound requires extensive cleaning or removal of particulate matter, you may, as an alternative, report an intermediate repair code (12031-12057).

Money opportunity: There is an important difference in payment between simple plus intermediate repair CPT codes . Reporting code 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less) will reimburse you about $93.60, whereas 12031 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.5 cm or less) may pay $235.20.

Get Ready For These Key Changes in Observation and Prolonged Services Codes

And look into new guidance on wound, burn and ultrasound services that could have an impact on your revenue.

ED coders turn to E/M section of the 2012 CPT® manual for most of the related changes and additions. But beware: Most of these are slight references to time in related E/M codes for medical billing, frequently concealed in preambles along with parenthetical references that are likely to miss.

Read on for guidance on recognizing the ED changes that could have an impact on your claims, come Jan. 1.

Notice Revised Definitions of New and Established Patients

2012 brings new wording to the New and Established Patient section in the E/M services guidelines in the front of the CPT® book.

Although the new language does not influence the 9928xemergency department E/M codes for medical billing directly, more and more groups are being tasked with increasing their services outside the Emergency Department. As ED groups grow in their search for another revenue streams and the healthcare delivery system evolves towards larger integration, a lot of groups are staffing different urgent care clinics where the dissimilarity between new and established patient status will play a significant role in determining code selection and subsequent reimbursement.

For More Info :- http://www.supercoder.com/coding-newsletters/my-emergency-medicine-coding-alert/cpt-2012-update-prepare-for-these-key-changes-in-observation-and-prolonged-services-codes-108862-article

Note New ED Time Tip Included for 2012

You must search for new "Coding Tips" advice in the CPT E/M section on the significance of time as a factor in making your E/M code selections. "This is not new information but serves as a reminder that the inclusion of time is there to assist physicians in selecting the appropriate codes for medical billing and that the listed times are averages and consequently represent a range of times that may be higher or lower, depending on clinical circumstances.

Key: The ED coding tip repeats that time is not an aspect in choosing ED E/M codes for medical billing.

Use Prolonged Services Codes With Initial Observation

These typical time add-ons to the initial observation codes come into play with novel language relating to the prolonged services codes for medical billing . The preamble to the prolonged services section includes novel language explaining direct patient contact as face-to-face, involving additional non-face-to-face services on the patient's floor or unit of the hospital during the same session. Therefore, the term "face-to face" no longer has a place in the title of the prolonged services code preambles.

More importantly, code +99356 (Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service; first hour [List separately in addition to code for inpatient Evaluation and Management service]) has a parenthetical list of related code ranges that now involve the initial admit to observation codes.

ICD-9 to ICD-10 Conversion: Get Ready or Face Fines

Improve your ICD-10 coding know-how.

Denials aren't the lone thing you have to dread if your practice doesn't implement ICD-10 by the Oct. 1, 2013 deadline. You could be slapped with fines, too, according to CMS.

Here are some FAQs that will surely help you ramp up your ICD-9 to ICD-10 conversion for your practice.

Get ready for Medicare and Other Payers

CMS has no plan of delaying the implementation of ICD-10 further than the Oct. 1, 2013, date. Though, not all entities are ready for the conversion.

Question 1: Just the entities covered by HIPAA need to make the transition form ICD-9 to ICD-10 -- does that imply that workers' compensation insurers will carry on using ICD-9, even after the remaining industry transitions to ICD-10 on Oct. 1, 2013?

Answer: The answer to that is vague, however CMS has heard murmurs that workers' comp. insurers will shift form ICD-9 to ICD-10.

Question 2: How about Medicaid?

Answer: CMS presented rankings for state Medicaid preparation. Remember that state Medicaid programs are at greater peril for not meeting the ICD-10 implementation date, whereas 21 states are at moderate danger. Fifteen states are at little risk, and four states have informed CMS where they stand in the process.

Question 3: What are the penalties fixed for entities that come under HIPAA who wish not to use ICD-10 codes as of Oct. 1, 2013?

Answer: Your claims will be denied -- and you technically could face fines as use of the ICD-10 codes comes under the HIPAA transaction code set regulations.

Denials: From a practical perspective, as of service dates of Oct. 1, 2013, if you don't use ICD-10 codes, most probably your claims will be returned and will be asked to transition from ICD-9 to ICD-10.

Fines: The penalties are the similar penalties that any HIPAA entity would be subject to. Most of you are acquainted with the ongoing HIPAA transaction codeset penalty that calls for a maximum of $25,000 per covered entity per year, but the HITECH legislation of last year in fact increased those transaction and codeset penalties, and they can be as high as $1.5 million per entity every year.

Carry on With Codesets and Coverage

Your ophthalmology practice can't get ready for the ICD-9 to ICD-10 transition all alone. Study the following questions to see how others' preparations can help or hinder you.

Question 4: The Medicare local coverage decisions (LCDs) presently list the payable ICD-9 codes that agree to all Medicare-payable procedures. Will contractors issue updated LCDs to the public before the Oct. 1, 2013 implementation date to demonstrate the payable ICD-10 codes for the procedures?

Answer: The answer to is unclear. The LCDs will be translated as they will need to be translated, however, as it relates to having them accessible to the public prior to the implementation date, that is not yet sure, as everyone is working fast and furious on all of ICD-10 implementation efforts.

The above ICD-9 to ICD-10 information is brought to you by SuperCoder.com. Log on to www.supercoder.com for more expert Medical Billing and coding guidance, news and information. 

Article source :- http://www.supercoder.com/coding-newsletters/my-ophthalmology-coding-alert/icd-10-countdown-get-ready-or-get-fined-thats-the-cms-message-108716-article

Medical Billing Woes? Here're Five Ways to Ease the Pain of Billing Workers' Compensation

Not having relevant patient information before attending to the patient? Well your medical billing process could invite trouble.

Processing workers' compensation claim may give you a harrowing time. Here are some guidelines to stay clear of them all.

Issue: One of the key points of uncertainty is that, while workers' compensation is authorized with federal guidance, it's a state-run program. This is to say that each state comes with its own rules, fee schedule, and process. What's more, add in the fact that federal and railroad employees have their own workers' compensation (WC) programs and you might have a difficult time.

Here are five expert tips to help your practice toward clean WC claims:

Get all relevant claim info before the patient steps in:

Start your work on a WC claim even before the patient arrives at your office. When a patient calls to fix his first appointment for an injury that could have been on the job, say for instance sprained back, the first thing your staff members should ask is whether this injury was work related.

If so, you should gather as much relevant information as possible over the phone.

Train eyes on the state the claim originated from


Oftentimes a patient will sustain an injury in one state, however seek treatment in another. In instances such as these, you should follow the rules for the state in which the injury took place. Train eyes on where the claim was first filed. That state will have jurisdiction over the claim.

Do not depend just on the WC Fee Schedule


You do not require the WC carrier's fee schedule to bill claims. However you may want to since you may actually boost your revenue by following their fee schedule.

Be careful treating and billing other problems

While your physician can technically and legally tend to a patient for a worker's comp visit and other problems not related on the same day, you may find it easier in the long run to keep the visits separate. Remember that you will have to send claims to two different payers if the physician tends to the WC condition and an unrelated problem in the same visit – One claim will go to the WC carrier and the other to the patient's normal insurance.

Focus on special DME Regulations

If you provide DME, you may speed through a few extra hoops to ensure you get paid for those services as well as the office visit and treatment services or procedures.

Some carriers need prior authorization for DME. As such see to it that out have these pre-authorization before dispensing. Having the patient sign an ABN often turns out to be futile.

For more online medical coding billing information, sign up for a good Medical Coding resource like SuperCoder.com.

Medical Billing: Say No to Forms 4010/4010A1 for Electronic Transactions from January 1

In a few months from now, (From January 1, 2012), you will bid goodbye to forms 4010/4010A1 for electronic transactions as you will no longer need fully functional form 5010 to comply with HIPAA electronic transaction standards. You won't be able to submit electronic transactions to Medicare if you do not have your problems worked out by that date.

Gear up now

Version 5010 lays out the technical electronic standards mandated for HIPAA transactions that includes claims, eligibility inquiries, remittance advice and payment data using ICD-10.

The present version (4010/4010A1) doesn't accommodate the ICD-10 code set. That is why CMS will need version 5010 for use by all HIPAA-covered entities as of January 1, 2012.

The agency began accepting 5010 forms from January 1 this year and the agency will require the form as of January 1, 2012. The ICD-10 codes will take effect on October 1, 2013 allowing for 5010 testing and implementation time.

Here are some common 5010 pitfalls you need to stay alert to

Under the new 5010 standards, the place of service address can't be a P.O box, it has to be a street address. The claim will be rejected if it is not a street address. How you fix the problem is up to you. The vendor does not have control of the provider master list.

Upgrade your software now: Now is your chance to research form 5010 problems and see if you need a software upgrade while there is time.

You should correct patient information too: Dig into your claim forms now to see to it that the beneficiary's information is spot on to the letter or you will face lots of denied claims on the just-in HIPAA 5010 forms. This is because CMS will deny claims with a beneficiary's name that does not perfectly match how it is listed on the Medicare ID card. What's more, you need to be sure you include suffixes such as Jr or Sr abbreviations along with the patient's last name. Also, the date of birth you put on the claim form must match with what the Social Security Administration has on file.

The agency will use various new codes on claims once the 5010 form goes into effect. And if you use a clearinghouse, you should discuss with them how they will convey these mistakes to you and how these changes will affect your practice.

On-Call Services: Avoid On-Call Fraud Accusations with These FAQs

Beware: You can't capture ER coverage services with after-hours codes.

If you bill incorrectly when your physician covers for others -- or when another physician covers for your physician -- you could be setting yourself up for charges of fraud.

Don't stress: Remember just a few simple answers to the top three on-call medical billing questions, and you'll be ready to correctly file claims.

1. Which Physician Bills for the Services?

If your physician is on call and handling patient services for another physician, don't fall into the trap of letting the other physician bill for the services. Even though a patient sees a particular physician, that does not mean that physician can bill for any services related to that patient's care. When your physician provides a service, even while on call for another doctor, you should bill the services.

Check the NPI: Each doctor who sees a patient should bill for the appropriate services rendered, under his/ her own NPI (National Provider Identifier) number.

The key: Whoever sees the patient face to face and documents and signs his/her name should be the one billing for those services provided regardless of who the admitting surgeon is.

2. How Do You Report On-Call ER Services?

Often, physicians see patients in the emergency department while on call. Don't turn to the after-hours codes to bill for these services when the hospital pays your physician for on-call status.

Reasoning: If the hospital is already paying the physician to be the on-call physician in the emergency room (ER), you cannot double-bill for his services. You should bill the after-hours codes 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed [e.g., holidays, Saturday or Sunday], in addition to basic service) and 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service) only when your physician sees a patient in your office outside regular office hours andanother third party is not compensating him for his time.

Example: If your office closes at 5 p.m. but your physician sees a patient on an emergency basis at 7 p.m., report 99050 in addition to any other services provided. If your physician saw the patient in the emergency room at 7 p.m., you should not report 99050. Keep in mind: Not all insurers will pay you for the after-hours codes.

Like the article? Click here to read the entire article and to get access to our monthly Part B Insider newsletter.

http://www.supercoder.com/coding-newsletters/part-b-coding-alert

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