Medical Billing & Coding: Go for a Code Based on PMFSH Element Needs

Physician billing tips to save precious dollars for your practice.

Not billing higher level E/M services because your physician glosses over a patient's past medical, family, and social history (PMFSH)? Well, you could be missing out on up to $69 per E/M if you are not doing so.

In order to ensure you're recognizing every history component the patient mentions, you need to heed these three key things: Determine the level of MPFSH, select a code based on PMFSH Element Requirement and count unchanged PMFSH in current encounter.

After you determine the level of PMFSH your physician documentation contains, you can see which codes that history element supports. Let's zoom in on this aspect:

Watch out: If your physician doesn't document any PMFSH elements, you can see which codes that history element supports. This means the highest codes you will be able to report are a level-two new patient code (99202) or a level-three established patient code (99213). Reporting 99202 will fetch you $71.01, while 99213 will bring in $68.97.

Relevant past medical, family, and social history supports a detailed history level; with detailed history you can report a level-three new patient code (99203) and a level-four established patient code. You will take home $102.95 for 99203 and $102.27 for 99214.

In order to get to level-four and five new patient visits and level-five established patient visits, you need to have an all-encompassing level of history. For that, you must determine complete PMFSH in your physician's documentation. If you can get 99204 or 99205, you will take home $158.33 (4.66 RVUs) and $197.06 (5.8 RVUs), in that order. You can anticipate $137.60 (4.05 RVUs) for 99215 – as much as $69 more than if you are obliged to code 99213 as you did not have adequate PMFSH.

Remember: As established patient office visits need two of three vital components, a higher level service is still possible based on the service's examination and medical decision making (MDM) types. For an established patient, you may decide to leave history off and count only the exam and MDM and then you have the low history. As such, if you have a weak history, you may still get to the higher level evaluation & management.

ICD-10 Updates: A Burn May Be Corrosion Under the Soon-To-Go-Into Effect Code Set

The new diagnosis coding system will allow your surgeon to make a distinction.

When you start using ICD-10 in October 2013, reporting burns by body site/ ‘degree’ plus an additional code for total body surface area (TBSA) won’t change. However, reporting the cause of the burn will.

Changes ICD-10 will bring to burn source

In ICD-9, a burn is a burn; however under ICD-10, a burn may be a corrosion, which is a chemical burn and the new diagnosis coding system will allow your surgeon to make a distinction.

Here’s an Instance:

A patient has a second degree burn of the right thigh from accidentally spilling boiling water. Under the present code system, you would report the condition as 945.26 whereas under ICD-10, you need to list T24.211.

Now let us say you have the exact scenario, except the burn is from an accidental spill of a strong acid. With the present code system, you’d still go for 945.26. However, you’ll use T24.611- (Corrosion of second degree of right thigh) for ICD-10.

ICD-10 helps you zoom in on body site more specifically than the current code set. ICD-10 provides distinct codes for you to report bilateral body sites as right, left or unspecified.

Additional codes

Just like ICD-9, you will need to list a distinct ICD-10 code pointing to the extent of burns (or corrosions) using a unique TBSA code.

Say for instance in ICD-9, you would go for 948.10. But after 2013, you will have two TBSA choices based on the burn/corrosion distinction: T31.10, T32.10.

Corrosion codes in ICD-10: After 2013, not only do you have different corrosion codes in the soon-to-go-into effect ICD-10 code set , you also need to report a unique code to determine the cause of the chemical burn. ICD-10 provides this instruction: Code first: (T51-T65) to identify chemical and intent preceding the corrosion codes.

Medical Billing & Coding: AMA Report Shows 19.3 Percent Claims-Processing Error Rate

Here are some payer updates that will stand your medical coding & billing in good stead.

The findings of the American Medical Association’s (AMA) fourth annual National Health Insurer Report Card (NHIRC) do not paint a rosy picture. As per the association, commercial payers show an average claims processing error rate of 19.3 percent, notes an AMA press release. This is a two percent increase over last year.

Errors galore

According to the release, 20 percent error rate among health insurers talks of a great deal of incompetence that leads to a wastage of $17 billion annually.

Need of the hour

Keeping this huge inefficiency in mind, health insurers must put in more effort into paying claims correctly the first time to save money and bring down needless administrative tasks that take time and resources away from the patient, the release cites.

Payer rankings

As far as claims-processing accuracy is concerned, UnitedHealthcare was the only payer that showed a boost. The firm was ranked first in the list of seven leading commercial payers with an accuracy rate of 90.23 percent while Anthem Blue Cross Blue Shield figured in the bottom with an accuracy rate of 61.05 percent.

Legitimate pay may go unpaid by an insurer

What’s more, the report card also showed that you got no payment at all on around 23 percent of claims you submitted to commercial payers.

There are many reasons a rightful claim may go unpaid by an insurer, the release indicates. It may be denied, edited or deferred to patients. During February and March of this year, the most common reason insurers did not issue a payment was owing to deductible requirements that shift payment responsibility to patients until a dollar limit is surpassed.

Healthcare billing news: For many of the payers included in the report - Aetna, Anthem Blue Cross Blue Shield, Health Care Service Corporation and UnitedHealthcare - there were lower denial rates.

In addition, the report card indicates that Cigna and Humana cut their medical claims response time in half during the last four years.

Resource: More information is available at http://www.ama-assn.org/ama/pub/advocacy/topics/administrative-simplification-initiatives/national-health-insurer-report-card.page.

Fee Schedule: ABN changes? Stay Up to Date

CMS urges you to use the latest version of ABN with effect from November 1.

A couple of months back, the Centers for Medicare & Medicaid (CMS) released its proposed Medicare Physician Fee Schedule (MPFS) for year 2012. This 621-page document zooms in on how the agency configures its relative value unit (RVU) assignments.

Imaging pay will see further cuts if the proposed rule becomes final. Right now, when you carry out multiple radiological procedures on the Multiple Procedure Payment Reduction (MPPR) list during a single session, Medicare brings down the Technical Component (TC) of the lower paid procedures by half.

The agency is proposing that next year, it'll not only slash the TC of subsequent radiological procedures by 50 percent, but will also bring down the PC by half. Total payment would be made for the PC and TC of the highest paid procedure and payment would be brought down by half for the PC and TC for every additional procedure provided to the same patient in the same session.

Note: Payment cuts to radiology procedures could be even more in 2013 and after.

Reaction to radiology cuts:

Professional societies raised their voices at CMS' radiology cuts. The AMA opposed a proposal to use significant cuts to Medicare payments for diagnostic imaging to offset the cost of a trade pack.

What's more, many radiologists noted that multiple interpretations of exams carried out on one patient are not less work-intensive than multiple interpretations of separate patients.

ABN deadline

The time to upgrade to a newer version of the ABN is a couple of months away - mandatory use of the new version starts on November 1, 2011.

Why the upgrade: The present ABN form had an expiration date on it, and as a rule forms are updated every three years based on provider comments.

ICD-9-CM Changes for Neoplasms & Glaucoma

With less than a month to go for ICD-9-CM 2012 codes to go into effect, now is the time to brush up on the latest coding options. This time, the spotlight's on expanded lip neoplasm and glaucoma options in addition to new codes for acute respiratory failure and other complications that result after surgery.

Now you will be able to pinpoint some stages more specifically.

While Neoplasm codes 173.0-173.9 will be axed and replaced by just-in fifth-digit choices - 173.00-173.99, Glaucoma codes expand to the fifth-digit level in order to differentiate the different stages. The just-in codes will be 365.70-365.74.

Since there will be much more spot on diagnosis choices when ICD-10 goes into effect in a couple of years time, these fifth digit expansions to codes will help coders and physicians start thinking in terms of more detailed diagnoses.

ICD 9 procedure codes for Gastric Band 

Source Code :- http://www.supercoder.com/coding-newsletters/my-anesthesia-coding-alert/correction-double-check-new-gastric-band-respiratory-failure-icd-9-codes-109162-article

Since anesthesiologists can find themselves absorbed in cases covering all surgical areas, you need to get acquainted with diagnosis changes for surgical procedures.

Get acquainted with just-in personal, family history choices

There are five new V codes that'll help your physician better indicate conditions a patient might have as part of her personal or family medical history. The just-in choices are:

Personal history of gestational diabetes - V12.21

Personal history of other endocrine, metabolic, and immunity disorders - V12.29

Personal history of pulmonary embolism - V12.55

Personal history of anaphylaxis - V13.81

Personal history of other specified diseases - V13.81

And as far as the revisions are concerned, when you go through the list of codes that have been revised, you'll find many migraine diagnosis listed. Although the descriptors are the same, the punctuation changes a little. Changed descriptors add a comma after the 'so stated' phrase in the fifth-digit '1' subclassification descriptor for each type of migraine mentioned.

Fee Schedule: There's a Distinct Difference Between XXX & 000 Global Periods

The classification XXX means that the service is completely free of global surgical bundling issues while the 000 indicator applies to the date of the procedure only.

The Centers for Medicare and Medicaid (CMS) has changed the global periods for both 51736 and 51741 from 000 to XXX in this year's January release of the Medicare Physician Fee Schedule. The agency drastically brought down the payment you get for both simple and complex uroflowmetry for this year. However in doing that they put the code in the category of 'global concept doesn't apply'.

Remember: The change to XXX applies to the global codes - 51736 and 51741 – as well as their Professional Component (PC) and Technical Component (TC). This means that whether you bill 51736/51741, 51736/51741-26 or 51736/51741-TC, there is no global period related with these flow rate size.

XXX versus 000

Even though both XXX and 000 global periods appear free of global bundling issues, you should know that there's a distinct difference between these two.

The classification XXX means that the service is completely free of global surgical bundling issues, and you can separately report services that your urologist carries out on the same day as the surgical procedure.

The value of this global period has always meant that the global concept does not apply to the procedure. Its value has always meant that the global concept does not apply to the procedure.

While the 000 indicator applies to the date of the procedure only. As such, Medicare will bundle all services that the physician carries out on that surgery date into codes with this indicator. On the other hand, 000 is for endoscopic procedures or minor procedures. If you have a code with a zero day global period make sure you include related pre operative and post operative care on the day of the procedure only.

Here's how other global periods function: Key surgical procedures covers a 90-day global period while lesser surgical procedures may include a global period of 10 days.

What you need to remember: The YYY global period to unlisted procedures only to unlisted-procedure codes and points to the fact that the payer is free to determine a global period for the procedure. The ZZZ designation denotes an add-on procedure for which the global period is covered in the primary procedure.

Here's what you should do: You should verify your payers' policies before you code your next claim. For more global-period information, go to the Medicare Fee schedule database available at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html?redirect=/PhysicianFeeSched/

ICD-9 2012 Brings more Specific Choices for Your Ob-Gyn Coding

As the nation celebrates 'Labor Day' in a few days from now, SuperCoder brings you a never-before coding offer - a gift card worth $25 to take your coding to a denial-free and maximum-profit zone.

If you're an ob-gyn coder, this year you'll run into more specific ICD-9 codes; this means you need to get on top of these changes that go into effect on October 1. And the Labor Day offer from SuperCoder couldn't have come at a more opportune time as it provides you with the code look-up tools and specialty advice you need for denial-proof coding.

New ICD-9 codes reflect early spontaneous labor with a planned cesarean delivery

You will choose from among these codes - 649.81 and 649.82 – when a patient was thinking about having the cesarean but went into labor early and had to have the cesarean early. This time round, there is also a new diagnosis to demonstrate a chemical or 'false' pregnancy post October; take a look at 631.0. What's more, if a patient has a blighted ovum or mole, you will go for 631.8.

996.39 will make an exit

From October 1 this year, you'll bid code 996.39 goodbye if the patient has an erosion or exposure of mesh material used during pelvic reconstruction surgery. In place of this, you'll have two more specific choices: 629.31, 629.32.

You need to treat new Hemorrhagic Disorder Codes as Secondary Dx

If a patient who's pregnant has antiphospholipid antibodies, you will have two new codes to use as secondary diagnoses. Note that your primary diagnosis would be from the coagulation defects category (649.3x). And if the patient simply had the antibody as a finding, here the secondary code would be the present code 795.79. If the condition happens to be with a hypercoaguable state, the secondary code would be the current code 289.81. But again if the patient has the antibody and has a present hemorrhagic disorder, you can use a new code - 286.53 – to report it.

To add to it all, ICD 9 also adds an 'Other' code to the 286.5x category - 286.59.

More V code choices

When your ob-gyn documents a patient's personal history, you'll have more V code choices: V12.21, V12.29, V23.42 and V23.87.

And the codes these V codes will be replacing are 631 and V12.2.