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Physician Notes: Ever Feel Like Auditors Are on A Witch Hunt? CMS Responds

Posted on 30. Mar, 2015 by .

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If you get frustrated over auditors’ reviews of your claims, you aren’t alone. A caller to CMS’s Jan. 7 Open Door Forum questioned whether CMS is just performing fishing expeditions, finding practices guilty until proven innocent—and one CMS official explained why.

“Observation management codes, if they’re less than eight hours, they don’t count,” the caller said. Auditors, however, have no idea about whether submitted observation care codes reflect services performed for less than eight hours or not until they receive the practices’ paperwork.

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Final Rule: Beware Potential ‘Ides of March’ Pay Cut

Posted on 30. Mar, 2015 by .

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Only an act of Congress can save the day.

You might have experienced little change in Medicare pay in January, thanks to a stipulation in the Protecting Access to Medicare Act of 2014 (PAMA) that halts sustainable growth rate (SGR) cuts until April 1, 2015.

But the ticking SGR time bomb, along with aggregate RVU changes that bode well or ill for service providers depending on their specialty, could mean that your lab or pathology practice’s financial outlook is not that stable after all.

Read on to see what Medicare pay changes you might expect this year — now and possibly later, too.

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ICD-10: Right, Left, Bilateral Options Expand Carotid Artery Stenosis Choices

Posted on 18. Mar, 2015 by .

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433.10 leads to more choices.

When your cardiologist performs angiography, catheterization, or stent procedures in the carotid artery for conditions such as stenosis, you’ll need more information to accurately report the condition under ICD-10.

You should be ready to implement these changes when ICD-10 goes into effect on Oct. 1, 2015.

ICD-9 offers two codes for carotid artery stenosis:

  • 433.10 — Occlusion and stenosis of carotid artery without cerebral infarction
  • 433.11 — Occlusion and stenosis of carotid artery with cerebral infarction.

But each of these codes grows to four different code choices under ICD-10.

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Reader Question: CCI Edits Direct Whether 96372 Is Allowed With Scope

Posted on 18. Mar, 2015 by .

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Question: When the otolaryngologist performs a scope in the office and also gives a shot (using 96372 for administration and a separate code for the medication), is there any reason to put a modifier on the administration 96372 code? 

Nebraska Subscriber

Answer:

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CPT® 2015: Get to Know 2 New 2015 Advanced Planning Codes

Posted on 18. Mar, 2015 by .

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Pay attention to time documentation for correct use. 

If your urologist does advance care planning for patients, you will likely make use of two new codes that CPT® added for 2015. Read on to learn about the new additions and the lingering questions experts have about how you’ll use these codes.

Add 99497-99498 to Your Coding Arsenal

CPT® 2015 adds two new advance care planning codes: 99497 (Advance care planning including the explanation and discussion of advance directives such as standard forms [with completion of such forms, when performed], by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member[s], and/or surrogate) and add-on code +99498 (... each additional 30 minutes .…).

According to CPT® 2015,

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Physician Notes: CMS: Submit Requested Documentation Within 45 Days, or Face Denials

Posted on 25. Feb, 2015 by .

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Plus: CMS releases 2015 therapy cap amounts

If your payer is performing a pre-payment audit of your claims, the MAC will typically ask you for additional documentation. In the past, some MACs would say you had 30 days to submit the documentation, while other insurers might not have given you a timeframe. CMS has cleared the air on this topic, confirming that you have 45 days to respond to an Additional Documentation Request (ADR), CMS says in MLN Matters article

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ICD-10: Screening Drug Test Orders Use Many Diagnoses

Posted on 25. Feb, 2015 by .

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Get ready for new options later this year

When your lab performs a screening drug test, you can’t expect to get the same diagnosis code every time.

Instead, the reasons clinicians order a drug screen are as varied as the drugs themselves — and your code choices are about to get even more varied when ICD-10 goes into effect on Oct. 1.

Check Out These Crosswalk Options

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Reader Question: Demonstrate Distinct Multiple Procedures to Unbundle CCI Edits

Posted on 25. Feb, 2015 by .

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Question: Our podiatrist visited an established patient at a nursing home but noted an infection and tinea pedis not previously seen. His notes describe an I&D on the left hallux, and he also wrote orders for the tinea pedis. Additionally, he performed nail care 11721 with Q8. How should I code this encounter? Please share some info on the I&D procedure.

Missouri Subscriber

Answer: 

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Practice Management: Avoid Brutal HIPAA Fines with These 3 Steps

Posted on 25. Feb, 2015 by .

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Take HITECH lessons to heart, and protect your bottom line.

They might look like a barrage of random numbers, but two recent reports about HIPAA breaches actually contain nuggets of wisdom that you can use to protect your patients’ private health information.

Make sure you apply the following important lessons from the Health Information Technology for Economic and Clinical Health (HITECH)-mandated reports to keep your general surgery practice out of the penalty zone.

Source:

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ICD-10: Ebola Diagnosis: A Code You Hope You Never Need, But Should Know How to Report

Posted on 12. Feb, 2015 by .

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Contact with and suspected exposure codes are also relevant in Ebola outbreaks

Ebola Virus cases have been everywhere in the news recently and focusing a lot of attention of emergency departments. The medical team has to get the diagnosis right to appropriately treat the patient and prevent widespread exposure to the community. As a coder, you must get the diagnosis code right, as well, for both tracking purposes and accurate payment for services rendered.

Consider this scenario: A 42 year-old health care worker comes to the ED because of a low grade fever. He had recently returned from a medical mission where he was caring for patients who had Ebola Virus Disease (EVD). There are no other symptoms and the patient is medically stable. Based on current Centers for Disease Control and Prevention and your local health department’s guidelines, the patient will be admitted to a special quarantine unit. What…

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