Archive for 'Provider News'
Posted on 01. Sep, 2011 by rpandit.
You’re not only losing revenue — you’re also coding improperly.
If your coders are sometimes tempted to report CPT code 99203 instead of CPT code 99204 (or 99213 instead of 99214) to “be on the safe side,” you might not be so safe after all.
National insurer data from previous years shows that medical practices undercode E/M claims to the tune of over $1 billion annually. That’s money that physicians could have collected based on their documentation, but forfeited because they reported a lower-level code than they should have. Your responsibility is to code based on your physician’s documentation – but don’t fall into the trap of downcoding just to be “on the safe side.”
Could You Be Triggering an Audit? (more…)
Posted on 29. Aug, 2011 by rpandit.
Making the transition to ICD-10 isn’t the only industry initiative your office should be learning about these days. January 1, 2012 marks the deadline for compliance with the new HIPAA Version 5010. Industry experts say the change will be time consuming, costly, and complicated — which is why you need to take steps now toward successful migrations.
Get to Know Version 5010
The start of your transition to ICD-10 (which will be effective in October 2013) actually begins with a piece of health insurance reform legislation known as Version 5010. 5010 lays out the technical electronic transaction standards mandated for Health Insurance Portability & Accountability Act of 1996 (HIPAA) transactions, and includes, among other things, requirements for transmission of claims and payment data using ICD-10. (more…)
Posted on 26. Aug, 2011 by rpandit.
Procedure, modifier and documents determine your payment
It’s common in neurosurgery to encounter procedures where another surgeon was required to complete the surgery, so knowing how and when to report the services of another surgeon can help you avoid compromising payment for these claims.
“It is good to read the office note prior to surgery and the operative report in which the surgeon states that another surgeon will be helping with the approach or a specific part of a procedure. He is also listed as the co-surgeon on the operative report,” explains Teresa Thomas, BBA, RHIT, CPC, Practice Manager II, St. John’s Clinic – Neurosurgery, Springfield, Missouri. To ensure full and timely payments focus on meticulous maintenance of records and proper use of modifiers.
Make Sure the Procedure Qualifies (more…)
Posted on 23. Aug, 2011 by rpandit.
Your surgeon may end up offering free care in the global period if you miss reporting a service
Not capturing services that follow an initial surgical procedure such as return to the OR for an unanticipated bleed after evacuation of a hematoma could be costing you. Heed the advice below on identifying all services rendered by your surgeon and for the reporting of any post-surgical complications or investigations performed.
Know the Global Period Parameters
You affirm the global period by identifying the day of the surgery but you don’t want to omit any preliminary services provided beforehand. (more…)
Posted on 19. Aug, 2011 by rpandit.
X-rays are a common diagnostic tool in any orthopedic practice. For accurate X-ray coding you need to focus on the number of views instead of number of films and append the correct modifiers for bilateral views, distinct services, and repeat procedures.
Remember these tips before you finalize your claims:
- Count the Views, Identify Location
To document an X-ray, you should carefully read through the note to make sure which area was X-rayed and how many views were obtained. Also, read to know what was done to the patient after the X-ray. (more…)
Posted on 11. Aug, 2011 by rpandit.
Staying with basic 99211 might be safest option.
If you’re shaky on how to report Gilenya (fingolimod) as a first-line treatment for relapsing forms of multiple sclerosis (MS, ICD-9 Code 340), you’re not alone. Gilenya questions have circulated ever since the FDA approved the drug in September 2010. Check our answers to three of the most common questions coders have so you’ll be ready when your neurologist offers the initial treatment dose to patients. (more…)
Posted on 05. Aug, 2011 by rpandit.
The agency won’t provide a standard AWV diagnosis code.
It has never been simple to navigate the rules and regulations of CMS’s preventive service payment structure, but the agency has attempted to simplify the process with a new publication that outlines the ins and outs of collecting for these visits.
Although you’ll now have access to all of the preventive service specs in one place, it won’t be a quick read. The new document, entitled, “The Guide to Medicare Preventive Services,” is 298 pages long. To read the complete book, visit www.cms.gov/MLNProducts/downloads/MPS_guide_web-061305.pdf. But in the meantime, we’ve distilled the guidebook down to share the most essential issues that you’ll need to code these services. (more…)
Posted on 04. Aug, 2011 by rpandit.
Incident to, critical care must meet certain criteria.
As a family medicine coder, you’re accustomed to reporting office/outpatient E/M codes (99201-99215) on an everyday basis. Some Part B providers are falling prey to several common E/M myths; so read on to be sure you know the facts.
Myth 1: Report Supervising Physician for “Incident to” (more…)
Posted on 26. Jul, 2011 by rpandit.
Check for documentation of each system — or prepare to assign a lower code.
Your surgery practice might see lots of level-four and –five office visits, but if you incorrectly tally the history, exam, and medical decision-making (MDM), you will miss out on the pay you deserve for higher level codes.
The third element for the historical portion of an E/M service, after the chief complaint (CC) and the history of the present illness (HPI) is the review of systems (ROS). This portion of the E/M service trips up many coders because the provider may not document pertinent negative responses, or may inappropriately use the statement “all systems negative.” (more…)
Posted on 20. Jul, 2011 by rpandit.
Checklist Extra: The physician’s credentials have a role to play, too.
Your CPT® coding may be spick and span, but if you fail to fulfill your physician signature requirements, your claims could end up in hot waters because not following these rules can trigger audits and other compliance headaches. Getting your provider to sign your patient’s charts is a basic documentation prerequisite that calls for your relentless compliance. (more…)