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 (more…)

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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 (more…)

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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 (more…)

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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 (more…)

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Watch for Denials If You Take Shortcuts on Form 5010

Posted on 12. Aug, 2010 by jennifer.godreau.

Say goodbye to form 4010A1 for ICD codes as well, starting in 2012.

Dig into your claim forms now to ensure that the beneficiary’s information is accurate to the letter, or you’ll face scores of denied claims on the new HIPAA 5010 forms.

Why it matters: CMS will deny claims on which the beneficiary’s name doesn’t (more…)

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Heads Up Coders: 2013 ICD-10 Implementation Date Is Firm

Posted on 18. Jun, 2010 by Editor.

Plus: CMS has proposed freezing the ICD-9 codeset after next year.

If you were hoping that the Oct. 1, 2013 ICD-10 implementation date wasn’t set in stone, you are out of luck. That’s the word from CMS during a June 15 CMS Open Door Forum entitled “ICD-10 Implementation in a 5010 Environment.”

“There will be no delays on this implementation period, and no grace period,” said Pat Brooks, RHIA, with CMS’s Hospital and Ambulatory Policy Group, during the call. “A number of you have contacted us about rumors you’ve heard about postponement of that date or changes to that date, but I can assure you that that is a firm implementation date,” she stressed.

Brooks indicated that the rumor about a potential delay in the implementation date continues to persist throughout the physician community, and recommended that practice managers alert their physicians to the fact that that the rumor is untrue.

The Oct. 1, 2013 date will be in effect for both inpatient and outpatient services. Keep in mind that the ICD-10 implementation will have (more…)

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Radiology Coding: Bone Scan Rate Benefitting From Healthcare Reform

Posted on 16. Jun, 2010 by Editor.

Don’t let 2006 DXA code references lead you to use wrong codes.

Which codes should you use to reap the benefit of CMS’s new calculations for bone scan payment? During an April 13 CMS Open Door Forum, that’s what one caller wanted to know.

Good news: He was delighted that, thanks to the new healthcare reform legislation, CMS will be raising payment for  bone density tests, but noted that the legislation listed old bone density test codes 76075 and 76077. The caller asked whether MACs will be requesting those old codes going forward, or whether practices should continue reporting current codes 77080-77082 (Dual-energy X-ray absorptiometry [DXA] …).

Advice: You should use (more…)

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Wound Coding: 3 Tips Help You Recover Your Full Debridement Pay

Posted on 14. Jun, 2010 by Editor.

Maximize 11040-11044 pay with modifier 51.

In most cases, your practice won’t report debridement separate from wound repair codes. But when exceptions arise, follow these three tips to choose the appropriate wound repair code.

If you’re considering reporting debridement separate from a wound closure, make sure your physician’s notes clearly document that the wound was contaminated and required saline or other substances or instrumentation to cleanse and debride the wound.

Don’t miss: If you report a debridement code with your wound closure codes, append (more…)

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Urology Coding: Capture Kegel Exercise Pay With E/M

Posted on 08. Jun, 2010 by Editor.

Don’t assume 90911 is the correct code choice.

Question: Is there a procedure code for billing for Kegel exercise teaching? Can we use code 90911 or possibly 97110?

Answer: There are no specific CPT or HCPCS codes for the performance of or teaching of Kegel exercises. To bill for teaching a patient how to properly perform these exercises, a nurse or medical technician must document a brief history and physical examination as well as the indications for and the expected goals of the Kegel exercises. Under these circumstances, you can then report 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician …) for this encounter.

About the service: Kegel exercises are voluntary contraction and relaxation of the perineal musculature including the urinary sphincter (pelvic diaphragm). These exercises are usually performed outside of the office without medical staff supervision, and are a non-invasive and non-surgical treatment for female and occasionally male stress urinary incontinence.

Pitfall: You should only use (more…)

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Ob-gyn Coding: Clue In To These CCI Edits Before You Choose 0193T

Posted on 07. Jun, 2010 by Editor.

Overlooking these new Interstim and hemorrhoid destruction bundles could mean denial headaches.

Don’t let CCI version 16.1’s lack of ob-gyn mutually exclusive edits lull you into a false sense of security. Here’s what you need to know to prevent a denial from landing on your desk.

Payers like Noridian Part B will cover the female stress urinary incontinence treatment code 0193T, but before you submit a 0193T claim, you’ll have to check with the Correct Coding Iniative (CCI) version 16.1’s edits. For instance, as of April 1, the work represented by 0193T will include that of cystourethroscopy codes 52000-52001 and 52281.

1. Look For 0193T in Both the Column 1, Column 2 Position

In 2009, CPT added 0193T (Transurethral, radiofrequency micro-remodeling of the female bladder neck and proximal urethra for stress urinary incontinence) to your possible stress urinary incontinence (SUI) treatment coding options. This code includes the Renessa transurethral collagen radiofrequency denaturation procedure. Ob-gyns typically perform this nonsurgical, minimally invasive alternative (more…)

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