Billing How-To: Should A Provider Change Tax IDs?

Posted on 16. Jun, 2010 by Editor.

Despite disadvantages, a new tax ID is a must when physicians leave your group.

Question: One of our optometrists wants to stop billing under the group’s tax ID and start billing under his own tax ID. I’m concerned that doing so will confuse the insurance companies and slow down his income, even though he has personally called some to notify them of the change and the effective date. Some payers are now asking for new W9 forms. Is there an easy way to do it?

Answer: Your optometrist can change his tax ID at any time, but you must submit a new W9 to your payers, in addition to (more…)

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Collect HPV Pay with Proper Screening vs. Reflex Diagnoses

Posted on 10. Jun, 2010 by Editor.

Align ‘medical necessity’ with ICD-9 instruction.

Ordering a human papillomavirus (HPV) screen with a Pap test isn’t the same as ordering a reflex HPV screen following an abnormal Pap. Although ICD-9 instruction and coverage rules might appear to be at loggerheads, our experts can show you the way out.

Question: Should the physician order a screening and/or reflex HPV Pap test (such as 87621, Infectious agent detection by nucleic acid [DNA or RNA]; papillomavirus, human, amplified probe technique) with V73.81 (Special screening examination for human papillomavirus [HPV])?

What you stand to gain: “Many ‘V’ codes are paid as part of a screening benefit for patients who have those specific benefits,” says Tina Burkhalter, billing manager with SouthEastern Pathology in Rome, Ga. On the other hand,

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Avoid CVA Diagnosis Coding Pitfalls with 438.13, 438.14

Posted on 17. May, 2010 by Editor.

You’ll turn to a V code when your neurologist reports ‘no effects,’ however.

When your neurologist sees a patient who had a stroke, either recently or in the distant past, he may record a number of different conditions — which makes your job more difficult. If you remember a few guidelines, you’ll select the proper ICD-9 codes for every cerebrovascular accident (CVA) case your neurologist treats.

Get Specific With 2 CVA Diagnosis Codes

When your neurologist sees a patient who has had a stroke, or CVA, he may document multiple deficiencies, both new and lingering. When the patient presents with speech and language deficits you have two diagnosis codes to choose from.

To help both differentiate the etiology of speech and language deficits, and to add specificity to those deficits, ICD-9 2010 includes two cerebrovascular disease lateeffects codes: 438.13 (Late effects of cerebrovascular disease, speech and language deficits, dysarthria) and 438.14 (…, fluency disorder [stuttering]). (more…)

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Watch Key Conditions to Scratch Eye Allergy Coding Itch

Posted on 02. May, 2010 by Editor.

Get the specifics on eye irritation to find the most accurate diagnosis code.

The spring allergy snap will be here soon. Be prepared to treat and code eye irritations to recoup all your deserved reimbursement with this advice from the field.

Get Specific With 3 Key Conditions

For your claims to be processed successfully, you must report the most specific diagnosis code available for your patient’s eye irritation. Most patients you see with eye irritations will have one of three major conditions: (more…)

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Navigate Your Way to Proper Internal/External Hemorrhoid Coding

Posted on 30. Apr, 2010 by Editor.

Don’t miss CPT 2010 ‘either/or’ instruction for hemorrhoid location.

You can’t choose a hemorrhoidectomy code if you don’t know the distinction between internal and external hemorrhoids. Let our experts guide you through the anatomy and coding maze to help you choose the proper code.

Location Should Guide You

“External hemorrhoids occur outside the ‘anal verge,’ which is at the distal end of the anal canal,” explains Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPCP, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program.

Conversely, “internal hemorrhoids are proximal to the anal verge and can be much more difficult to diagnose and treat,” she continues.

Vital to identifying different hemorrhoid types is … (more…)

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Boost Injection Pay — Just Ask, Listen for Missed Items

Posted on 28. Apr, 2010 by Editor.

Uncircled vaccines, administrations could cost your practice 10%.

Think increasing payments in 2010 is a fairy tale? Your magic wand is right at your front desk.

“Check-out coding can have a significant financial impact,” reported Norman “Chip” Harbaugh, MD, in “Vaccine Reimbursement — Quite a Quandary” at The Coding Institute’s December 2010 Pediatric Coding and Reimbursement Conference in Orlando. Not having the check-out person make sure the pediatrician circles all performed services and procedures can cost a practice with median collections of $556,000 between 2.2 percent to 10.2 percent or $12,340 to $57,000.

To shore up those payment holes, train your front desk staff to spot two signs of overlooked coding opportunities. (more…)

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EM CODING: Don’t Bill High-Level E&M Codes Until You Read This

Posted on 26. Apr, 2010 by Editor.

Sicker patients may not always mean higher MDM.

If your physician bills a lot of high-level office visits, he may be at risk of an audit — which may not be cause for concern — if his documentation justifies his code choices.

“Some physicians believe their patients are sicker than others’, so they feel they’re justified using more 99215s, when in fact that may not be the case,” says Crystal S. Reeves,CPC, CPC-H, consultant with Coker Group in Alpharetta, Ga. “The CPT manual outlines the requirements of the E/M codes, there are clinical examples in the back of CPT, and CMS publishes a Table of Risk that can help guide you, so use all of those resources to determine whether you’re billing properly,” she advises.

Training is Key: If you advise your physician that he is overbilling the high-level codes and he says, “But all of our patients are really sick,” show the doctor CMS’s Table of Risk, “which can be an eye opener for physicians,” Reeves says. (more…)

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2 Tips Lead to Modifier 22 Success Every Time

Posted on 15. Apr, 2010 by Editor.

Watch frequency and provide documentation to rationalize extra pay.

Applying modifier 22 (Increased procedural services) can help increase reimbursement if your neurosurgeon documents a greater-than-usual effort during a surgical service. To ensure your claims’ success, surgeons and coders must also exert a special effort outside of the operating room — especially in terms of documentation.

1. Apply 22 Sparingly

Payers won’t accept a modifier 22 claim unless you can provide convincing evidence that the service or procedure was truly “out of the ordinary” and significantly more difficult or time-consuming than usual.

Here’s why: (more…)

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Face Off Against Common Sports Physical Coding Challenges

Posted on 15. Apr, 2010 by Editor.

Hint: Gathering upfront pay and watching E/Ms make a difference.

Children need physicals to participate in their favorite sports year round, but the demand can grow with warm weather approaching. Ideally, the need for sports physicals should provide the opportunity to offer complete age-appropriate medical exams following the American Academy of Pediatrician’s Bright Futures Guidelines. If your practice runs into reimbursement obstacles for full-scale physicals, however, follow our experts’ advice to code correctly and still stay in the game.

Tackle Coverage Issues (more…)

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Don’t Let Money Go Down the Drain Due to Modifier 52, 53 Confusion

Posted on 07. Apr, 2010 by Editor.

Anesthesia, patient well-being can clue you in to the best modifier choice.

When your urologist ends a procedure early, you know you need to append a modifier to the procedure code, but the challenge is deciding between modifier 52 or 53. Learn the very specific criteria for reporting each modifier to ensure successful coding every time.

Turn to 52 for ‘Physician Discretion’

You should use modifier 52 when your urologist, while performing a service or procedure, chooses to partially reduce or eliminate a portion of the code’s requirements. (more…)

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