Archive for 'Hot Coding Topics'
99000 Lab Specimen Handling: More Than Just a Messenger Fee
Posted on 09. Mar, 2009 by .
The AMA changed its mind — and you should change your policy.
If you reserve 99000 for incurring charges, you need a primer on the code’s musts to collect this fee from private payers.
“I am under the impression that the code can only be used if you collect the specimen then send it to an outside lab,” says Jamie Kurrasch, CPC, with Primary Care Partners, PC in Junction City, Colo. She’s looking for a code her lab can use for the specimen collection for the flu and RSV test that the practice runs at its in-house lab.
Check out these 99000 guidelines. (more…)
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Coder’s Anatomy: Tongue Base Suspension
Posted on 06. Mar, 2009 by .
If you have trouble visualizing what happens in the operating room during surgical procedures to fix sleep apnea, here’s the scoop on 41512 from Dr. Charles Koopmann, an otolaryngologist and reimbursement expert at the University of Michigan Medical Center.
Tongue Base Suspension is performed under general anesthesia. (You’ll understand why as you read more; it sounds like it hurts.) It used to be reported with an unlisted code, but now it has its own. Don’t confuse this procedure with 41500 or 41510, the good doctor warns.
“The procedure involves placing sutures through the tongue to pull it anteriorly, especially the tongue base,” Dr. Koopmann told attendees at the recent Coding Institute conference in Las Vegas. The “suture is fixed to screw on the inner table of the mandible, intraoral or submental approach.”
Results the surgeon is aiming for: Enlarge the retrolingual airway to prevent obstruction during sleep.
AN AUDIO MUST-LISTEN: Modifiers for Otolaryngology, with Barbara Cobuzzi.
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Anesthesia & Pain Management Denials: Sweep Them Away Now
Posted on 06. Mar, 2009 by .
‘Good Housekeeping’ tips that reduce denials.
Tip 1: Beware Messy Bundled Anesthesia Services
Most anesthesia services are bundled with other services. According to Cindy Lane, CPC, CHCC, with Advanced Coding Solutions LLC in White House, Tenn., you need to stay up to date with the most recent Correct Coding Initiative (CCI) edits. Currently, anesthesia includes services such as:
• Transporting, positioning, prepping, draping of the patient for satisfactory anesthesia induction/surgical procedures
Training Event: Secrets for getting paid for endoscopic anesthesia.
• Placement of external devices necessary for cardiac monitoring, oximetry, capnography, temperature, EEG, CNS evoked response, Doppler flow (more…)
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Modifier 25 vs. Modifier 57: Here’s an Easy Way to Choose
Posted on 05. Mar, 2009 by .
If choosing between modifier 25 and modifier 57 is a head scratcher, check out this easy way to remember the difference from John Verhovshek at the AAPC.
“Modifier 25 applies to E/M services separately provided with minor procedures–those having 0-day, 10-day, or no global period,” he writes in the March issue of Coding Edge. Modifier 57 is for E/M services that prompt a major surgical procedure with a 90-day global period.
Check out our 2009 Modifier Coding Survival Guide.
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Audit-Proof Your ‘Incident To,’ 99211 ‘Nurse Visits’
Posted on 05. Mar, 2009 by .
Safeguard almost $20 per claim
With incident-to services on insurers’ radar, you’ve got to ensure documentation supports your 99211 claims to avoid facing huge paybacks.
Code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of the physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) pays approximately $18.75 (0.52 relative value units on the 2009 Medicare Physician Fee Schedule) per encounter.
AUDIO: Exact documentation requirements for 99211 visits, with Kim Garner-Huey.
To see if your 99211 charges will stand up on review, take this quiz. (more…)
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Cataract Removal Eye-Opener: 66984
Posted on 04. Mar, 2009 by .
CPT 66984 is the number-one procedure performed in ASCs, according to an article in the March issue of AAPC’s Coding Edge.
Watch Out: Many physicians and coders think there is a national policy with a visual acuity requirement, but there isn’t. Coverage varies by carrier, and good documentation should indicate what impact the cataract has had on the patient’s daily living activities, authors Sue Vicchrilli & Kim Ross advise.
The 3 most common mistakes coders make with cataract co-management.
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Smoking Cessation Codes: 99406, 99407 Truths Revealed
Posted on 04. Mar, 2009 by .
Now that 99406 and 99407 are no longer new codes, some payers are creating ‘payment cessation’ policies. Bust these myths regarding coding for stop-smoking counseling to make sure your practice’s expected reimbursement does not go up in smoke.
Myth 1: You Need a Plan and Referral to Support 99406, 99407
“Last year, I was told as long as the doctor noted he advised on the risks, advised the patient to quit, gave an Rx, it would support 99406,” recalls Kathleen Goodwin, coding coordinator at LaPorte Regional Physicians Network in Indiana. “How much documentation is needed to support 99406, which is for 3-10 minutes of smoking cessation counseling, and 99407, which is for more than 10 minutes of counseling?” she asks. (more…)
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Nerve Conduction Study Coding Tip
Posted on 03. Mar, 2009 by .
Did you know that new medical devices are opening doors for more specialties to perform nerve conduction studies?
The bad news: Coding and billing for these studies hasn’t gotten any easier, and there’s some bad coding advice floating around from some medical device companies that’s leading some coders astray.
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Cardiac Anesthesia Workshop: Coding for TEE
Posted on 03. Mar, 2009 by .
Discover if your transesophageal echocardiography (TEE) anesthesia is payable or included in the procedure using this get-the-right code action plan.
Distinguish Between Diagnostic and Monitoring
The most common problem associated with billing and obtaining reimbursement for TEE is determining whether the procedure is for diagnostic (93312-93317) or monitoring (93318) purposes, says Kelly Dennis, MBA, ACS-AN, CPC, CPC-I, with Perfect Office Solutions of Leesburg, Fla. It is often difficult to tell whether the TEE was diagnostic or not unless your physician identifies the study’s purpose.
In order to bill for a diagnostic TEE, a written report is needed. In many cases clinicians will write a report ONLY for diagnostic or therapeutic reasons. If you were just using the TEE for monitoring there would be little reason to report that in writing. (more…)
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Protect Sleep Study Pay With These Documentation Essentials
Posted on 02. Mar, 2009 by .
How to keep your polysomnography claims off Medicare’s hit list.
You shouldn’t lose sleep over whether you’re in the clear when it comes to proper polysomnography billing practices. To avoid haggling for payment, look here for the inside scoop on when sleep studies are justified, what carriers need to see, and how to keep costs in check.
Have you Stark-proofed your sleep lab? Wayne Miller tells you how to know for sure.
Find Out What’s Sparking Audits
The Office of the Inspector General (OIG) is taking a hard look at sleep studies this year because there has been such an increase in volume, says Jill M. Young, CPC-ED, CPC-IM, president of Young Medical Consulting LLC in East Lansing, Mich. The agency wants to make sure that doctors aren’t using the studies in response to non-covered complaints, such as insomnia, she says. (more…)
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