Overcome 3 Myths and Claim Reimbursement Opportunities using Modifier 22

Posted on 20. May, 2011 by .

Don’t fall for these common body habitus, time, and fee traps.

If you overuse Modifièr 22 (Increased procedural services), you may face increased scrutiny from your payers or even the Office of Inspector General (OIG). But if you avoid the modifièr entirely, you’re likely missing out on reimbursement your cardiologist deserves.

How it works: When a procedure requires significant additional time or effort that falls outside the normal effort of services described by a particular CPT® codè — and no other CPT® codè better describes the work involved in the procedure — you should look to modifièr 22. Modifièr 22 represents those extenuating circumstances that do not merit the use of an additional or alternative CPT® codè but do land outside the norm and may support added reimbursement for a given procedure.  Take a look at these three myths — and the realities — to ensure you don’t fall victim to these modifièr 22 trouble spots.

Myth 1: Morbid Obesity Means Automatic 22

Sometimes, (more…)

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Follow 3 Tips to Improve Your A/R Process and Boost Your Collections

Posted on 10. May, 2011 by .

Avoid the ‘code it, bill it, and forget it’ mentality — don’t be afraid to follow up on your claims.

The economic downturn coupled with looming healthcare changes means that your practice — and all others — are under more pressure than ever to collect every penny you deserve.  You can refine your accounts receivable (A/R) process quickly and easily to bring in the money without a lot of extra effort.

A/R defined: “Accounts receivable (A/R) is the money that is owed to the practice,” explains Elin Baklid-Kunz, MBA, CPC, CCS, a director of physician services in Daytona, Fla., during The Coding Institute’s audioconference “Top A/R Tactics: Fight Back Against Lower Payments and Increased Government Scrutiny.”

Follow these three best practices to set your practice on an improved A/R track and avoid thousands in lost reimbursement. (more…)

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CCI Edit: 93454-93461 Note These Column Changes For Correct Cardiology Coding

Posted on 18. Apr, 2011 by dchandhok.

Correct Coding Initiative version 17.1 brings 11,831 new edit pairs, effective April 1 for physicians. That’s the word from a March 17 announcement by Frank Cohen, principal and senior analyst for the Frank Cohen Group. Here’s a look at the major pointers you need to keep in mind to comply with the new cardiology-related edits, including cardiac catheterization, radiological supervision and interpretation, cardiac rehabilitation, and more.

1. Prevent Denials by Remembering 93454-93461 Are Diagnostic

New edits will prevent you from reporting heart catheter/angiography codes 93454- 93461 (column 2) with the following cardiovascular therapeutic services and procedures (column 1):

• 92975 — Thrombolysis coronary; by intracoronary infusion, including selective coronary angiography
• 92980 — Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel
• 92982 — Percutaneous transluminal coronary balloon angioplasty; single vessel
• 92995 — Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; single vessel.

The 929xx codes in column 1 describe coronary therapies. The 934xx codes in column 2 are (more…)

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Worried about Delayed Pay? Verify Your State’s Prompt Pay Laws

Posted on 16. Apr, 2011 by dchandhok.

How many times has it happened with you that you submit a clean claim but still don’t get paid even three months later? Do you have any recourse? Yes, thanks to the prompt pay laws that each payer must follow when paying your medical claims.

Verify Which Laws Apply to Your Practice

Each state requires private insurers to pay all clean claims within a certain time frame. If the insurer does not pay the claim in a timely manner, then the payer is subject to paying interest on the charges owed to the practice (or directly to the beneficiary). Most time frames range from 15 to 45 working days, with 30 days about the average.

“If you are a little adventurous, you could search for your state law on the Internet,” says Joseph Lamm, office manager with Stark County Surgeons, Inc. in Massillon, Ohio. Lamm warns, however, that “reading through state laws and their multiple exceptions, references (more…)

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Two New CPT Codes Lend Specificity to Interstitial Device Coding

Posted on 02. Apr, 2011 by dchandhok.

Until now, you could not code for the additional service — and hence not get the pay — when your general surgeon placed interstitial devices for radiation therapy guidance during a distinct open or laparoscopic abdominal procedure. But two new CPT 2011 codes for the procedure help you capture all the pay you deserve.

Open, Lap, or Percutaneous Approach Distinguish Placement

Last year, you had one code to use when your surgeon placed an abdominal interstitial device for radiation therapy guidance — 49411 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], percutaneous, intra-abdominal, intra-pelvic [except prostate], and/or retroperitoneum, single or multiple).

“If your surgeon performed the device placement during an open or laparoscopic procedure (more…)

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CMS: Prove Your Exemption From the E-Prescribing Penalty With New G Codes

Posted on 27. Mar, 2011 by dchandhok.

Even if you don’t have prescribing privileges, you can rest assured now as CMS will not cut your pay as a penalty for failing to comply with the new e-prescribing incentive program.

As you are probably aware, starting in 2012, you may be subject to a one percent payment adjustment on your Part B pay if you don’t successfully participate in e-prescribing this year. In 2013, that payment adjustment will go up to 1.5 percent, and in 2014 it will rise to two percent, CMS’s Daniel Green, MD noted on a Feb. 15 CMS-sponsored call.

“To earn an incentive in 2011, an eligible professional must e-prescribe 25 times during the year, ten of which must be in the first six months,” Green said. “If they are a successful e-prescriber during the calendar year, they not only would avoid the 2012 payment adjustment, they would get a (more…)

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ICD-10: Prep Yourself for New Hyperlipidemia Codes

Posted on 25. Mar, 2011 by dchandhok.

When ICD-10 goes into effect in 2013, high cholesterol will still be a challenge for your patients. Here’s a look at how coding for this, and similar diagnoses, compares between ICD-9 and ICD-10.

ICD-9-CM Codes:

• 272.0, Pure hypercholesterolemia
• 272.1, Pure hyperglyceridemia
• 272.2, Mixed hyperlipidemia
• 272.4, Other and unspecified hyperlipidemia (more…)

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ICD-10: A J Code To Replace 471.0 In 2013

Posted on 16. Mar, 2011 by dchandhok.

Nasal cavity polyp also goes by the term “choanal” and “nasopharyngeal.”

If the otolaryngologist performed a removal of a middle turbinate endoscopically, you would report it with CPT 31240 — subsequently linking this procedure to a diagnosis code. One possibility is 471.0 (Polyp of nasal cavity).

When ICD-9 becomes ICD-10 in 2013, you will have to shift to coding type of polyp using (more…)

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93224-93226: Snag Extra Cash With These Tips

Posted on 13. Mar, 2011 by dchandhok.

The catch is you have to make the request for your rightful dollars.

Here’s a piece of good news for you. As per the Medicare’s April update, three Holter monitor codes will get a slight boost in pay.

The change has an implementation date of April 4, 2011, and an effective date of Jan. 1, 2011. That means contractors have to be ready to comply with the change by April 4, but the change in practice expense relative value units (PE RVUs) is retroactive to Jan. 1 dates of service.

Medicare isn’t requiring contractors to search their files to adjust claims they have already paid (which is good news for any physician who reports a code seeing a fee decrease). But contractors do have to (more…)

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Be In The Know With Chemodenervation and Botulinum Toxin Changes

Posted on 12. Mar, 2011 by dchandhok.

Effective April 1, your practice’s bottom line is going to be hit, especially if your provider uses chemodenervation to treat patients. Reason: Medicare Physician Fee Schedule is all set to introduce a bunch of changes. So here’s the big news.

Bilateral Indicator Shifts to ‘2’

Neurologists and pain management specialists sometimes use chemodenervation to help relieve symptoms of spasmodic torticollis (333.83), cerebral palsy (such as 343.x), or other conditions. The codes you rely on for these procedures include:

• 64613 — Chemodenervation of muscle(s); neck muscle(s) (e.g., for spasmodic torticollis, spasmodic dysphonia)
• 64614 — … extremity(s) and/or trunk muscle(s) (e.g., for dystonia, cerebral palsy, multiple sclerosis).

Previous versions of the physician fee schedule listed a bilateral status indicator of “1” for 64613 and 64614. That meant you could (more…)

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