Easy Guidelines - Profit $16 from 94664

One thing you should remember while reporting for inhaler demo/ evaluation is the type of service the provider is using; however do not stop with just that. When coding for inhaler services, documentation requirements and qualifying modifiers are just as important.

When you are confused why some payers would deny reimbursement for some inhaler claims, here are some ideas that could guide you to a better understanding of how inhaler service codes work out.

Your ticket to diskus demo pay: 94664

If the nurse or medical assistant taught someone to use an Advair Diskus (Advair Diskus is an “aerosol generator) -- or any other diskus, you should code 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).

Bundle dose in teaching session

The patient may administer medication dose during the teaching session. Both services (treatment + teaching) are bundled into one CPT: 94640; as such you should not report them separately.

Here's why: The administration was carried out as part of the demonstration/evaluation.

Separate education? End it with modifier 59

During an outpatient visit, an asthmatic patient is wheezing and having breathing problems; this requires one or more bronchodilator treatments for intervention: 493.01; 493.02; 493.21, or 493.22. Prior to the visit, the patient did not use his MDI device, nebulizer and the like properly; therefore after the treatment, he was given an education about the use of these devices.

Report it: First, report 94640 (adding modifier 76, Repeat procedure or service by same physician, to separate line items of 94640 for multiple treatments) apart from the proper E/M code minus a modifier, unless the payer needs modifier 25 with the E/M. Then code 94664 with modifier 59 (Distinct procedural service), as the patient required additional instruction for his daily maintenance medication.

This is dissimilar from the medication provided for immediate intervention – 94640.

To put it briefly: If the patient required separate education after receiving an inhalation treatment on the same day, you'd bill both services (treatment plus education) adding modifier 59 to 94664.

Logic: The CCI places a level one edit on 94640 as well as 94664. Therefore, Medicare and payers that follow CCI edits may need modifier 59 on the component code (94664) to indicate that the teaching is a distinct procedure service from the inhalation treatment. It's important that the teaching was not part of the treatment for the patient, which would be one parallel encounter – teaching while treating.

Easy $16 with the aid of medical necessity support

If payers wouldn't pay your 94664 claim, you would need to support it with documentation indicating medical necessity to reimburse about $16 national rate (0.47 RVUs multiplied by 2011 conversion factor of 33.9764). For example, in the plan of treatment portion of the written record you might need to state that the patient needs a teaching session on the use of his MDI, diskus, nebulizer, and the like. What's more, do not forget to note why the session is required.

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The New Z Diagnosis Codes Will Replace Routine Health Check Codes

Take a look at these key factors in your physician's documentation.

It's a known fact that when ICD-9 becomes ICD-10 in 2013, you'll not always have a simple crosswalk relationship between old codes and the new ones. Many a time, you will have more choices that may need tweaking the way you document services and a coder reports it.

Here's a common routine child health check vision scenario that will help you discover what you will report post October 1, 2013.

Present way: When a patient comes in for a scheduled preventive wellness exam, you should attach V20.2 (Routine infant or child health check) to an annual visit code (99381-99385 for new patients, or 99391-99395 for established patients).

ICD-10 difference: This year, you will go for Z00.129 (Encounter for routine child health examination without abnormal findings) to reflect the physician's visit. If the physician did face abnormal findings during the visit, you would instead use Z00.121 (Encounter for routine child health examination with abnormal findings).

Physician documentation: The main difference between Z00.129 and Z00.121 is whether the visit showed an abnormal finding during the examination of the patient. The pediatrician must document this. For example, the physician might examine the patient and note, “patient appears severely speech delayed, which leads to the decision to carry our further testing".

Remember: 'Abnormal findings' does not refer to a blood test, biopsy, or a test that went to pathology. Oftentimes, these key abnormal findings would support a separate E/M visit billed with a modifier 25 (Significant, separately identifiable E&M service by the same physician on the same day of the procedure or other service) during the time of a preventive medicine visit.

Tips for coders: Instead of relying on V20.2 as your catch-all annual visit diagnosis, you will need to examine your physician's documentation. To put it in other words, you will be looking at the examination part of the visit and what the pediatrician notes as his findings.

Article Source :-  http://www.supercoder.com/coding-newsletters/my-pediatric-coding-alert/icd-10-new-z-diagnosis-codes-will-replace-routine-health-check-codes-in-2013-article

Tips to Help You Achieve G0438, G0439 Coding Success

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

Apply G0438 to second year of coverage

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

CMS limits G0438 to one physician

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

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

Add preventive services codes, if performed

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

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

Document the required elements

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

CMS waives the deductible and copay

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

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