Archive for 'Hot Coding Topics'
Posted on 01. Nov, 2009 by .
Question: A patient came in for a GDX and visual field (VF) tests. During the same visit, the ophthalmologist put in temporary plugs. Can we get paid for all services on the same day? I know the office visit needs a modifier. Do I need to put one on the GDX & VF, too?
Answer: Provided the ophthalmologist made the decision to perform the tests during this visit, you may bill for the office visit and the testing. You should be able to get paid for all services using four modifiers — one on the office visit as you indicated, one on each plug code, and one on the GDX. You do not need a modifier on the VF (92081-92083, Visual field examination, unilateral or bilateral, with interpretation and report …).
Warning: If the patient was scheduled to come in for the GDX and VF testing as the result of a previous office visit, you should bill only the GDX and VF testing.
Unless there is a need for the physician to perform another office visit evaluation (worsening symptoms, new symptoms), do not report the office visit. Inserting a plug (68761, Closure of the lacrimal punctum; by plug, each) is a minor procedure that includes related evaluation and management work. You should only report an E/M when documentation supports the service as significant and separately identifiable from the plug insertion. In these cases, you need modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the office visit (99201-99215, Office or Other Outpatient Services).
Make sure to use separate diagnoses for the problem and for the primary reason or diagnosis for the visit. (Please click ‘read more’ for a money-saving tip and how you should code for an insurer that doesn’t recognize E modifiers.) (more…)
Posted on 29. Oct, 2009 by .
The 2010 version of CPT attempts to organize the facet joint injection codes by deleting 64470-64476 and debuting 64490- 64495 in their place, as follows:
• 64490 — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level
• 64491 — … second level
• 64492 — … third and any additional level(s)
• 64493 — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level
• 64494 — … second level (more…)
Posted on 29. Oct, 2009 by .
Question: My physician removed a catheter in an outpatient hospital exam room. Should I include this removal as part of the E/M? If E/M is appropriate, will the hospital also report an E/M? And, if so, do the physician and hospital E/M codes need to match?
Answer: You should include simple Foley catheter removal as part of an E/M service. These follow-up visits will often be low-level visits (such as 99212, Office or other outpatient visit …). Inpatient E/M codes would also be appropriate when your physician performs these services in the hospital (for example, 99231, Subsequent hospital care, per day, for the evaluation and management of a patient …).
The hospital sometimes may have the option of whether or not to report an outpatient E/M code for an outpatient ambulatory payment classifications (APC) reimbursement. For example, if the patient has another procedure during the same encounter as the catheter removal, then the hospital would not report its E/M service separately from the other procedure.
In most cases, the physician’s outpatient E/M level will determine the hospital APC and any other outpatient procedure reported on the same day. The 2009 Outpatient Prospective Payment System (OPPS) final rule states that “while awaiting the development of a national set of facility-specific codes and guidelines, we have advised hospitals that each hospital’s internal guidelines that determine the levels of clinic and emergency department visits to be reported should follow the intent of the CPT code descriptors, in that the guidelines should be designed to reasonably relate the intensity of hospital resources to the different levels of effort represented by the codes.”
Translation: The hospital E/M code choice should reflect the hospital’s resource use, not the physician’s. You may see a difference in new versus established code choices, as well. For hospitals, “beginning in CY 2009, the meanings of new and established patients pertain to whether or not the patient has been registered as an inpatient or outpatient of the hospital within the past 3 years,” the rule states.
Posted on 27. Oct, 2009 by .
If you’ve ever wondered whether Medicare actually pays attention to CPT’s Category III codes, the AMA offers an answer with the release of the new codes included in CPT 2010.
First and foremost, CPT will delete the Category III cardiac computed tomography (CT) imaging codes 0144T-0151T and replace them with new, permanent Category I codes, as follows:
• 75571 — CT, heart, without contrast material, with quantitative evaluation of coronary calcium
• 75572 — CT, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed) (more…)
Posted on 27. Oct, 2009 by .
Question: Does a certified nurse specialist (CNS) count as a nurse practitioner (NP) for reporting 99213 based on time?
Answer: Yes, for CPT purposes, a certified nurse specialist billing under his own provider number counts the same as a nurse practitioner or physician assistant. So if the office visit meets the requirements for time-based billing — counseling and/or coordination of care comprises more than 50 percent of the face-to-face CNS-patient encounter and documentation indicates the encounter’s total face-to-face time, the counseling minutes, and a discussion summary — the CNS can choose the office level using time, such as 15 face-to-face minutes for 99213 (Office or other outpatient visit for the evaluation and management of an established patient …) as the sole criteria.
Be careful: Check your state law. State scope of practice laws may restrict services and procedures that nonphysician practitioners may provide.
Posted on 25. Oct, 2009 by atif.adnan.
Correctly billing your nonphysician practitioners (NPPs) incident-to services means the difference between 85 and 100 percent reimbursement. But if you bill incident-to haphazardly, you’re just waving a red flag at auditors.
And those auditors are jonesin’ to find incident to billing problems. Just check out this recent report from the HHS Office of Inspector General to learn the kinds of mistakes they’re looking for.
But have no fear. If you use the following list of questions to evaluate your incident-to claims for all the must-have components, and be sure the documentation includes the same, you’ll have nothing to worry about if auditors come knocking.
1. Do the Services Involve Direct Supervision?
Direct means that the supervising physician must be in the immediate office suite while incident-to services are being provided. But if you’re too conservative with the word direct, you could be giving up the extra reimbursement that comes with billing incident to. Direct doesnt mean that the physician has to be supervising the work elbow-to-elbow with the NPP. (more…)
Posted on 25. Oct, 2009 by sanjay.aikat.
Question: During a practice meeting last week, the subject of Clinical Laboratory Improvement Amendments (CLIA) waivers came up. We are currently not CLIA-waived, and we will discuss it again at next month’s meeting. I was wondering if you could offer any input? Should we apply for a CLIA waiver?
Answer: Whether or not the waiver is worth it is up to your individual practice. However, a practice is not allowed to perform many basic laboratory services without CLIA-waived status. So if your practice does not get the waiver, you could be missing out on possible pay for some simple screens.
Example: Here are a few of the tests that have CLIA-waived status to help you decide:
• 81002 — Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy
• 82270 — Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided three cards or single triple card for consecutive collection) (more…)
Posted on 25. Oct, 2009 by .
The OIG is watching your ultrasound orders and code combinations — and it doesn’t like what it sees. Take note of these problem spots to keep your claims in the clear.
An OIG audit of ultrasound services billed in 2007 found that nearly one in five ultrasound claims “had characteristics that raise concerns about whether the claims are appropriate,” according to a July 2009 audit report titled “Medicare Part B Billing for Ultrasound.”
The most common error: Roughly 17 percent of 2007 Part B ultrasound claims lacked prior service claims by the ordering physician, the OIG indicated.
What this means: Several physicians ordered ultrasounds for patients that they hadn’t treated within the last year. “The OIG would wonder why the doctor would order an ultrasound for a patient who [the ordering physician] hasn’t examined,” notes Allison Larro, Esq., an Atlanta-based attorney. (more…)
Posted on 22. Oct, 2009 by .
Question: My anesthesiologist performed a sciatic nerve block for a patient with postoperative pain on the same day he provided general anesthesia for that patient’s knee surgery. How should I code this?
Answer: Use modifier 59 (Distinct procedural service) when you need to show that your physician performed two distinct services on the same day. When your physician places a sciatic nerve block for postoperative pain management (for example, 64445, Injection, anesthetic agent; sciatic nerve, single), and on the same day provided general anesthesia for knee surgery (01400, Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified), your final codes are 64445-59 for the block, along with 01400 for the anesthesia.
Posted on 22. Oct, 2009 by .
You could be losing money to a computer glitch and not know it, experts say.
If you don’t nip a computer glitch in the bud, you may be plagued with improper denials and other claim holdups. Here are seven things you can do to seek out and solve glitch-related problems:
1. Eyeball Your EOBs
Watch your explanation of benefits (EOB) forms, and keep your eyes open for denials and downcodes that don’t look correct.
2. Check Your A/R
Always review your accounts receivable (A/R) to ensure that you’ve received the payments you’re due. If a computer glitch kept your MAC from paying you, don’t hesitate to point it out to the payer. (more…)