Archive by Author
Place-of-Service Codes Caused $13 Million in Overpayments
Posted on 31. Aug, 2010 by jennifer.godreau.
Double check POS 11 shouldn’t be 22 — or 24.
Entering your place-of-service (POS) number on your claim form may seem routine, but a recent OIG audit found that practices are not giving POS numbers the care they deserve.
Based on a review of 100 non-facility Part B claims from 2007, the OIG found that only 10 of the sampled claims had the correct POS code assigned to it, resulting in overpayments of over $4,700. Based on the sample, the OIG estimated that Medicare nationally overpaid physicians $13.8 million in POS coding errors, according to the report.
Physicians collect higher payments for services rendered in the physician’s office, a patient’s home, an ASC, a nursing facility, or another non-hospital facility versus those services performed in a facility setting (such as a hospital). The OIG review of 100 sample claims found that 90 of the services were coded as having been performed in a non-facility location, even though
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CPT 99406, 99407 Coverage Extended to All Smokers
Posted on 31. Aug, 2010 by jennifer.godreau.
CMS announcement is triumph for physicians who haven’t collected in the past.
If you’ve been writing off tobacco cessation counseling as non-payable, it’s time to change your tune.
In the past, CMS only covered 99406-99407 (Smoking and tobacco use cessation counseling visit…) for a beneficiary with a tobacco-related disease or with signs or symptoms of one. But on Aug. 25, CMS announced that “under new coverage,
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Pre-Cataract Surgery Coding Myths You Should Bust
Posted on 26. Aug, 2010 by jennifer.godreau.
Improperly coding IOL Masters or A-scans can cost your practice $30 per patient.
Calculating intraocular lens power for patients facing cataract surgery has gotten more precise as A-scan and IOL Master technology has advanced. But to make sure your practice is getting fairly reimbursed each time, you need to understand the bilateral rules for 76519 and 92136.
Could one of these myths be damaging your claims?
Include Bilateral and Unilateral Components in Global Code
Myth: If the ophthalmologist calculates IOL power in both eyes, you should report 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation) or 92136 (Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation) twice (e.g., 76519-RT and 76519-LT, or 76519-50).
Reality: You should not report 76519 or 92136 with modifier 50 even if the ophthalmologist calculated the IOL power of both eyes, warns Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, Director, Best Practices-Network Operations at Mount Sinai Hospital in New York City. To understand why,
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ICD-9 2011: Avoid H1N1, Fecal Incontinence Denials With 5th Digit Savvy
Posted on 26. Aug, 2010 by jennifer.godreau.
488.1x Cheat sheet makes fast work of snagging correct code.
Don’t let rumors of few ICD-9 changes in prep for ICD-10 blindside you to top diagnosis changes for 2011. Without the scoop on expansion to the 488, 784, and 787 categories, denials for invalid codes will derail your claims delaying your payments.
In ICD-9 2011, “Codes continue to become more and more specific necessitating a provider to document clearly and thoroughly to allow for selection of the most specific and accurate code,” says Jennifer Swindle, RHIT, CCS-P, CEMC, CFPC, CCP-P, PCS, Director Coding & Compliance Division, PivotHealth, LLC.
Good news: Updating your ICD-9 coding by the Oct. 1, 2010, effective date doesn’t have to be a chore. Start using your new choices in no time flat following these guidelines.
Look at Manifestation When Assigning “Swine Flu” Dx
This fall, when a patient has H1N1 (“swine flu”) pay attention to two details. The medical record will have to
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92541 + 92544 Will Soon Be OK
Posted on 25. Aug, 2010 by jennifer.godreau.
AMA corrects vestibular test codes to allow partial reporting.
The Correct Coding Initiative (CCI) came down hard on practitioners who perform vestibular testing earlier this year, but a new correction, effective Oct. 1, should ease the restrictions and help the otolaryngology, neurology, and audiology practices that report these services.
The problem: CCI edits currently restrict practices from reporting 92541, 92542, 92544, and 92545 individually if three or less of the tests are performed, notes Debbie Abel, Au.D., director of reimbursement and practice compliance with the American Academy of Audiology.
The solution: Starting October 1, 2010, “if two or three of these codes are reported for the same date of service by the same provider for the same beneficiary,
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Medical Record Retention: How Long Should You Keep Patient Charts?
Posted on 25. Aug, 2010 by jennifer.godreau.
CMS says keep patient medical records for 6 years.
Medical practices often hear conflicting advice regarding how long they must hang on to a patient’s medical records, but CMS intends to clear up any misinformation with new MLN Matters article SE1022, issued this month.
Although many physicians follow state laws when determining whether they can discontinue retaining a patient’s records, it’s important to keep in mind that you must hang into the patient’s records for at least six years, according to HIPAA laws. If your state requires
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ICD-9 2011 Coding: Prepare for New Fluid Overload and Seizure Codes
Posted on 25. Aug, 2010 by jennifer.godreau.
Code 276.6 denials will plague you unless you’ve got the code’s expansion details.
Come October 1, you must be ready to report the new and changed 2011 ICD-9 codes. Now that CMS has finalized the update, you can get a jump start on the changes.
Add Detail to Fluid Overload
Starting in October, you’ll need to code with a higher degree of specificity when it comes to reporting fluid overload.
2010’s 276.6 (Fluid overload) category will expand to include
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Cyst Expression: I&D or Excision?
Posted on 12. Aug, 2010 by jennifer.godreau.
Question: Documentation reads, “The cyst was excised after performing a central incision directly on the cyst. All the material was expressed, then cyst capsule was removed completely and excised completely. Packing was performed.” Should I code the procedure as an I&D or an excision?
Answer: You should look at the pathology report and any further excision description to reach the correct code set. “Excision is defined as full thickness [through the dermis] removal of a lesion …,” according to CPT’s Excision-Benign Lesions guidelines. The documentation you provided
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ICD-9 2011 Diagnosis Coding: New Ectasia Codes Come Oct. 1
Posted on 12. Aug, 2010 by jennifer.godreau.
Check out V13.65 for corrected congenital heart malformations.
Each October you’re faced with new ICD-9 codes to add to your diagnosis arsenal. 2011 is no exception, with new ectasia, congenital malformation, and body mass index (BMI) codes you’ll need to learn. Take a look at the proposed changes that will affect your cardiology practice, so that you’re ready when fall rolls around.
End Your Ectasia Hunt at 447.7x
The proposed changes to ICD-9 2011 add four codes specific to aortic ectasia, which could be
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Medicare Repeat Pap Smears: Find Out If 99000 Is OK
Posted on 12. Aug, 2010 by jennifer.godreau.
Hint: Abnormal versus insufficient cells mean different diagnosis codes.
When a patient returns to your office for a repeat Pap smear, you’ve got to weigh your options of E/M and specimen handling codes, as well as diagnosis codes. Take this challenge to see how you fare and prevent payment from slipping through your fingers.
Question 1: When a patient comes in for a second Pap smear, what CPT code(s) should you apply and why?
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