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Posted on 29. Aug, 2012 by dchandhok.
It its recent decision on the Affordable Care Act (ACA), the Supreme Court ruled the requirement that individuals must have health care coverage or face a penalty was an allowable tax (rather than a penalty). But the Court decided the federal government couldn’t require states to expand existing Medicaid programs by planning to disqualify noncompliant states from Medicaid funding.
Here are a few ACA areas to watch for hematology and oncology:
Preventive services: If patients “have a new health insurance plan or insurance policy beginning on or after September 23, 2010,” certain preventive services must be covered when delivered by a network provider. For these services, the patient is not responsible for a copayment, co-insurance, or meeting the deductible. Early detection could mean an increase in oncology and hematology patients.
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Posted on 26. Aug, 2012 by dchandhok.
While 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion)is most commonly reported by dermatology coders, a site-specific biopsy code may help you get your job done better and increase the accuracy of your reporting.
Not only this, a site-specific code will bring in more reimbursement than when you report generic integumentary based biopsy (11100).
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Posted on 22. Aug, 2012 by dchandhok.
It is quite common to package surgery and related radiology services into a single CPT® code, but assuming that percutaneous vertebroplasty falls into that category means leaving dollars on the table. Keep these guidelines in mind for accurate supervision and interpretation coding.
Separate Codes For Surgery and RS&I
Percutaneous vertebroplasty typically involves using anteroposterior (AP) and lateral views to confirm a needle’s path into a vertebral body. The physician then injects a resin mixture into the vertebral body until it is adequately filled.
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Posted on 20. Aug, 2012 by dchandhok.
When your neurosurgeon performs a subdural tap in an infant as a diagnostic, stabilizing, or life-saving procedure, don’t focus on the intent of the tap but instead keep a count of the number of subsequent taps your surgeon performs to recoup all your earned reimbursement. “Subdural drainage in infants may require a series of percutaneous drainage taps to manage reaccumulation of the subdural fluid,” says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.
Use the op note that follows to guide your subdural tap coding:
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Posted on 18. Aug, 2012 by dchandhok.
Although strapping might seem like a simple treatment, there are more details to coding than you might realize—and missing key items means your bottom line gets impacted with every claim. Check out these top rules when coding for injuries that require strapping, so report the correct code each time.
Step 1: Learn Unna Boot, Buddy Tape Definitions
Payers generally define strapping as the application of adhesive tape, one layer overlapping the other, to support and/or restrict movement of ligament structures by exerting pressure upon the extremity or other area of the body. Strapping requires specialized skill and knowledge of the anatomical structures as well as application technique, says Betty Ann Price BSN, RN, President and CEO of PRCS, Inc. in Palmetto Florida.
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Posted on 16. Aug, 2012 by dchandhok.
New Correct Coding Initiative (CCI) edit pairs that affect your surgical practice aren’t the only thing you need to know about in the latest update from CMS.
CCI 18.2 also changes the modifier indicator for 532 existing code pairs. “Unfortunately, 531 went from an indicator of ‘1’ (you can use a modifier) to a ‘0’ (you can’t use a modifier),” states Frank D. Cohen, MPA, MBB, senior analyst with Frank Cohen Group, LLC in his analysis of the changes. And unfortunately for your practice, nearly 250 of those changes to “0″ involve general surgery procedures.
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Posted on 14. Aug, 2012 by dchandhok.
Question: Please explain to me when to use modifier PD. Does this apply to us when a patient comes in for an exam and is admitted to hospital within 3 days even though we are a freestanding facility and not operated by a hospital?
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Posted on 12. Aug, 2012 by dchandhok.
If a new CMS news release is any indication, the agency might soon follow through on its longstanding threat to deny claims that fail the ordering/referring provider edits. Although CMS has had this on the horizon for several years now, the agency has never actually formalized a date when the denials would start.
However, a July 26 news release indicates that CMS “will soon begin denying Part B, DME, and Part A HHA claims that fail the ordering/referring provider edits.” Although CMS has still not set a date, it warns providers that once it does, it will only offer a 60-day notice before the edits are turned on, so you should prepare now.
Posted on 10. Aug, 2012 by dchandhok.
Duodenal switch, Roux-en-Y, limb length … if the language of bariatric surgery has got you stumped, here’s help for you to chose the correct code—and get the deserved reimbursement for your surgeons’ work.
Know the context: Surgeons perform various gastric restrictive procedures for some patients with morbid obesity and co-morbid health conditions. The procedures effectively reduce the stomach size to limit food intake and absorption, leading to weight loss. The most common gastric restrictive surgeries fall into two main categories—bypass procedures, and banding.
When you face an op note for gastric bypass surgery, simply decode the report and zero in on the suitable CPT® code by responding to these four questions.
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Posted on 08. Aug, 2012 by dchandhok.
Having clear documentation of the procedures your surgeon is doing and why one procedure is being listed as a separate procedure in your claim will make all the difference in your claims success. Josie Dunn, CPC, Department of Orthopaedics, University of Maryland Faculty Practices, Maryland shares what Medicare has to say about separate surgical procedures. “The CPT® surgery guidelines further state that the codes listed as “separate procedure “should not be reported in addition to the code for the total procedure or service. In other words, report a separate procedure if it is not performed with a primary procedure that encompasses the “separate” one, or when it adds “appreciably to the time and/or complexity of the procedure.”
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