Archive by Author
Surgical Modifiers: Protect Yourself From Instant ‘PC’ Claim Denials
Posted on 19. Mar, 2010 by suzanne.leder.
Don’t let ‘wrong surgery’ modifier mistakes stall your reimbursement.
You use modifier TC for the technical component of a test. So logically, you should use modifier PC for the professional component, right? Wrong. But many coders are making that mistake…
Continue Reading
Senate Votes to Delay Medicare Pay Freeze Until October — But It’s Not Final Yet
Posted on 19. Mar, 2010 by suzanne.leder.
Find out what steps Congress must take to delay the much feared 21.2 percent pay cut.If a new bill — already approved by the Senate — moves forward, you could have another six months before the 21.2 percent…
Continue Reading
CMS Speaks: Weigh Your 2-Payer Consult Coding Options
Posted on 18. Mar, 2010 by suzanne.leder.
In MSP cases, non-consult code for both payers may be best.
If you have payers who didn’t play follow-the-leader with Medicare in cutting out consult codes, you have a dilemma on your hands. You have to decide what to do…
Continue Reading
Modifiers, not Math, Make Multi-Excision Claims Go
Posted on 15. Mar, 2010 by suzanne.leder.
Measuring total removal lengths is a no-no … here’s why.
Your ED physician removes a pair of benign lesions from the patient’s left thigh; you add the repair lengths and code based on those numbers. You’ve coded correctly … right?…
Continue Reading
Surgery Challenge: Ensure a Clean Claim by Interpreting Detailed Central Line Note
Posted on 15. Mar, 2010 by suzanne.leder.
Find out which you can report separately: a tunneled or a non-tunneled line.
Question: What code should we bill when we remove a central venous pressure (CVP) line and insert a Hickman catheter at a different site?
New York Subscriber…
Continue Reading
Learn the Ins and Outs of Add-on Codes to Ensure Payable Claims
Posted on 12. Mar, 2010 by suzanne.leder.
Knowing how to use add-on codes can net you up to $258 in additional reimbursement.
CPT is full of “add-on” codes, additions to minor and major surgical procedures as well as to E/M services. Fortunately for urology there are not…
Continue Reading
Use This Sample Appeal Letter As Ammo in Your Fight Against Modifier 25 Denials
Posted on 12. Mar, 2010 by suzanne.leder.
Attach your procedure notes and the OIG’s report to pack extra punch.
Even if you follow all of CMS’s rules in reporting modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the…
Continue Reading
Surgery Coding: Look at Service Date Before Appending Modifier 59
Posted on 12. Mar, 2010 by suzanne.leder.
Make sure your documentation supports the additional substantial complexity of the hernia repair and mesh.
Question: A patient presented for a colectomy for colon cancer. The physician also discovered that the patient had a ventral incarcerated hernia that required a…
Continue Reading
Ob-gyn Coding Challenge: Deliver Postpartum V Codes With Care
Posted on 10. Mar, 2010 by suzanne.leder.
Bonus: Get exposure to ICD-10 coding equivalents.
Question: A mentally-challenged patient who delivered at home was admitted to the hospital for postpartum care. The patient delivered the placenta at home, and once admitted, she had no complications, but the ob-gyn…
Continue Reading
Breathe New Life Into Your Asthma Coding Claims
Posted on 10. Mar, 2010 by suzanne.leder.
Focus on form and drug to pinpoint the correct asthma supply code.
Are you clear on how to report asthma procedures and inhalers? Follow this advice, and you’ll breathe easy when it comes to asthma related claims.
Propellant-Driven Inhaler Falls…
Continue Reading
Want to Bill the Patient? Make Sure You Use Two ABN Modifiers
Posted on 10. Mar, 2010 by suzanne.leder.
A revised GA and new GX hope to clarify some of Medicare’s non-coverage policies.
At least one aspect of dealing with Advance Beneficiary Notice of Non-Coverage (ABN) forms is about to get a little simpler, thanks to two modifiers.
CMS…
Continue Reading
Ensure Multi-Vaccine Payment With This Coding Advice
Posted on 09. Mar, 2010 by suzanne.leder.
You may need to append modifier 25, depending on payer policies.
Question: Our physician billed 90634, 90710, and 90606 for vaccines given to a 5-year-old patient. The insurance company denied payment and said they required a modifier. What should we…
Continue Reading
Achieve Modifier 25 Success in Just 3 Easy Steps
Posted on 08. Mar, 2010 by suzanne.leder.
Understand ‘significant’ and ‘separate’ to earn a gold star.
Knowing when to report modifiers and choosing the best one for each situation can be an easy trip-up for coders. If you find yourself especially befuddled…
Continue Reading
EM Coding: Should I Select 99211 for Most Med Checks?
Posted on 06. Mar, 2010 by suzanne.leder.
Insurers might want to see a clear explanation as to why the E/M was necessary.
Question: An established patient with a plan of care in place for her gastroesophageal reflux disease (GERD) reports to the gastroenterologist; two weeks ago, the…
Continue Reading
E/M Coding: Use Current Diagnosis to Support E/M Visit
Posted on 05. Mar, 2010 by suzanne.leder.
Don’t forget to include the code for the arthrocentesis.
Question: A new patient sees the orthopedist because of shoulder problems. The physician schedules an MRI and the patient returns the following week to discuss the findings. The physician had already…
Continue Reading
Think You Understand the New Consult Rules? Find Out Fast
Posted on 04. Mar, 2010 by suzanne.leder.
Check your 2010 consultation coding savvy.
Find out if you’re set to properly code your physician’s consultation services this year by tackling three problems and their solutions.
Check With Your MAC for Guidance
When…
Continue Reading
Ob-gyn Coding Challenge: EM End-Result Tells You What ICD Code To Go For
Posted on 03. Mar, 2010 by suzanne.leder.
Check out these ICD-10 ob-gyn diagnosis coding equivalents.
Question: A patient presented for an initial OB visit. Another clinic confirmed her pregnancy, but she has never received prenatal care. The patient got her usual initial OB service (i.e. lab orders),…
Continue Reading
Stay in the Game With the Correct Ligament Repair, Reconstruction Codes
Posted on 02. Mar, 2010 by suzanne.leder.
Remember ligament repair abbreviations to simplify elbow ligament surgeries.
Baseball players are gearing up for the season, which means your orthopedist could see a sudden increase in elbow ligament injuries. If conservative therapies fail to help torn medial (841.1) or…
Continue Reading
Give Your Radiosurgery or Gamma Knife Surgery Coding a Check-Up
Posted on 28. Feb, 2010 by suzanne.leder.
Improve your reimbursement chances by applying modifier 58 in this situation.
When your surgeon targets the brain or spine with stereotactic radiosurgery (also called gamma knife surgery) to treat multiple lesions over multiple sessions, you need to know two crucial…
Continue Reading
Ob-gyn Challenge: Take the Pressure Out of a 3D US Coding
Posted on 28. Feb, 2010 by suzanne.leder.
No severe problems? You may have trouble with reimbursement.
Question: The ob-gyn performed and OB ultrasound (US) on a patient. Can I bill 76376 in addition to the ultrasound if the ob-gyn used 3D?
Montana Subscriber
Answer: Yes. You can…
Loading ...