Archive for 'Provider News'
Posted on 07. Jul, 2011 by rpandit.
Check whether your group might fall into one of four new categories.
The push toward e-prescribing is in full swing, with physicians possibly being subjected to a one percent payment hit on CMS claims in 2012 if you don’t successfully participate in e-prescribing this year (and larger hits in 2013 and 2014). If your physicians haven’t yet met e-prescribing criteria, take hope: CMS has proposed four additional ways that eligible professionals (EPs) can potentially avoid the adjustment in 2012. (more…)
Posted on 27. Jun, 2011 by rpandit.
Hint: Just because your doctor visits the ICU doesn’t mean he can report critical care.
Most medical practices report outpatient E/M codes (99201-99215) every day, but some Part B providers are still falling victim to several of the most common E/M myths. Button up your coding processes by dispelling these three commonly-held misunderstandings.
Myth 1: When reporting 99211 “incident to” a physician, you should bill it under the name of the physician on record for that patient. (more…)
Posted on 24. Jun, 2011 by rpandit.
Keep your CCI edits in mind for PFT bundles.
When a patient presents with common respiratory conditions, your pulmonologist should perform an extensive history and examination, and may order several diagnostic tests before he can settle with a definite diagnosis to report in the claim. Along with the primary diagnosis (if achieved), you should report the patient’s signs and symptoms or else risk an audit.
Consider this scenario: The pulmonologist sees a patient for fever, shortness of breath, chest pain, weight loss, and fatigue. After undergoing a detailed history and examination, the patient becomes suspect for hypersensitivity pneumonitis, otherwise known as extrinsic allergic alveolitis (495.x). The physician orders a diagnostic bronchoscopy with fluoroscopic guidance, as well as a spirometry to verify the patient’s condition. To justify each service performed by the same provider or group, you might be accumulating payer inquiries or denials. This 2-step technique should carry you through potentially puzzling spirometry-E/M coding situations.
1. Don’t Leave Out Signs and Symptoms On Your Claim (more…)
Posted on 24. Jun, 2011 by rpandit.
Take a hint from a CPT®’s global period when choosing between modifiers 25 or 57
Contrary to popular thinking, modifier 57 does not apply exclusively for consultation codes only. Medicare may have stopped paying for consult codes, but this doesn’t mean you have to stop using modifier 57. Here are two tips on how you can use this modifier to suit your practice’s needs.
Background: Starting January 1, 2010, the Centers for Medicare and Medicaid Services (CMS) eliminated consult codes from the Medicare fee schedule.
Non-Consult Inpatient Codes Keep Modifier 57 Alive (more…)
Posted on 24. Jun, 2011 by rpandit.
Boost co-surgery, multiple surgery, and bilateral surgery pay for these select procedures
You’ll no longer have to eat the cost of your services if your physician acts as co-surgeon on spine revisions. Thanks to several Fee Schedule changes that CMS recently enacted. CMS had good news in MLN Matters article MM7430, which had an effective date of Jan. 1, 2011 and an implementation date of July 5, 2011.
Look for Potential Co-Surgery Payment for These Codes: (more…)
Posted on 22. Jun, 2011 by rpandit.
Beware of CPT® and Medicare differences when counting HPI elements.
Not accurately accounting for the history of presentillness (HPI) documented by your oncologist could result in missing appropriate opportunities to report level 4 or 5 E/M visits. Ensure you’re not missing higher paying possibilities by reviewing this guide to capturing HPI elements.
Brush Up on What Qualifies as an HPI Element
HPI is one of the three parts comprising an outpatient E/M history. It describes the patient’s present illness or problem, from the first sign/symptom to the current status, and typically drives a provider’s decisions about the physical examination and treatment. (more…)
Posted on 17. Jun, 2011 by atif.adnan.
Tactics help you recoup deserved pay for 24357-24359.
Tennis elbow claims faults can wreak havoc on your reimbursement for these services. But you can clean up your method if you can spot in the note how the surgeon reached the elbow tendon and whether the tendon was released or repaired. By doing so, you stand to gain your full earned pay for codes 24357, 24358, and 24359, which is $437.27, $514.74, and $647.59, respectively.
Review Structures Treated
When you are confident in your elbow anatomy knowledge, you’ll have a better chance of understanding where the operative note is directing you. The codes are simple and can easily be applied if you are reading correctly. “Coding these procedures became much easier when CPT condensed the codes from the previous five down to the current three,” confirms Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, New Jersey and orthopedic coding division director, The Coding Network, LLC, Beverly Hills, CA. The bones, –humerus above and the radius and ulna below– articulate in a manner to allow 180 degrees of movement that helps you use the upper limb for various functions.
The numerous muscles that originate and insert around the joint allow movement; particularly important is the bundle of extensors including the muscle extensor carpi radialis brevis (ECRB) that originates at the lateral epicondyle which is the lateral prominence of the humerus at the elbow joint. Repeated back movements of the wrist joint, as seen when playing tennis, can cause small micro tears in the tendon of origin and result in inflammation known as lateral epicondylitis or ‘tennis elbow.’ The term is highly deceptive, though; the condition affects non-athletes as well, and is not solely confined to tennis players. As the pathology progresses, the damaged tendon(s) may rupture and secondary fibrosis and calcification may ensue.
Follow 4 Simple Tips for Modifier 62 to Get your Game Plan in place for both Codes and Documentation
Posted on 08. Jun, 2011 by .
When two surgeons work together to perform one procedure, each physician’s individual documentation requirements can get jumbled up. Make sure your physician isn’t passing the documentation buck and that he or she knows to follow these four tips when you submit claims with modifier 62.
Tip 1: Each physician should identify the other as a co-surgeon. Also make sure that the other physician is billing with modifier 62. A lot of confusion can arise when physicians from different practices are reporting the same procedure.
You may find yourself in a situation where one physician may report the other physician’s work as that of an assistant surgeon, in which case the claims would not correspond. This means a denial will hit your desk. One surgeon cannot simply indicate the other as the co-surgeon. Both physicians must submit claims for the same procedure, both with modifier 62. To accomplish this all you only need to call with a simple courtesy to the other physician’s billing or coding department.
Tip 2: Each physician should document her own operative notes. When surgeons are acting as “co-surgeons,” it is implied that they are each performing a distinct part of the procedure, which means they can’t “share” the same documentation. Each physician should provide a note detailing what portion of the procedure he or she performed, how much work was involved, and how long the procedure took. Including a brief explanation of the need for co-surgeons will help to avoid denials and reimbursement delays.
Tip 3: Each physician must link the same diagnosis code to the common procedure code. Though this requirement may seem obvious, if two physicians serve as co-surgeons to perform one procedure, the diagnosis code(s) they link to the CPT® code should be the same. Before submitting a claim with modifier 62, someone in the practice must confirm that both claims have the same ICD-9 code(s).
Tip 4: Each physician must submit his own claim with his own documentation. Because claims for co-surgeons of the same specialty can come under scrutiny, each physician must diligently detail both the work he or she performed and the work the other physician performed.
Many physicians submit a letter to the carrier detailing the reason for two surgeons. Because modifier 62 requires so much claims coordination, get game plans together outlining what each surgeon is going to do to complete the procedure and how they are both going to document and code for it. This is one surefire way to improve your chances of getting the reimbursement you deserve on the first try.
Posted on 08. Jun, 2011 by .
Do you ever meet with parents before their baby is even born? In these cases, you might be hesitant to charge for the visits because the patient isn’t present yet—but can you collect anything for the physician’s time? Check out the following 4 options, along with our expert advice before billing to insurance.
1. Consider an Office Visit
Some practices think of meet-and-greets, in which they tell the parents about the way they run their practice, more as an office visit, such as 99201. However, this would need to be billed based on time to the mother’s insurance company and would likely be questioned by the insurance company. For practices that do charge for these services, there’s a diagnosis code you can use: V65.11. ICD-9 guidelines allow you to list the code as a first or additional diagnosis.
2. Ensure You Meet Criteria Before Using 99401-99404
As an alternative to use a problem-oriented office visit code, the American Academy of Pediatrics (AAP) suggests the pediatrician may deem an appropriate counseling or risk factor reduction code. You may report these codes for prenatal counseling “if a family comes to the pediatrician/neonatologist either self-referred or sent by another provider to discuss a risk-reduction intervention (i.e., seeking advice to avoid a future problem or complication),” according to the AAP’s Coding for Pediatrics 2009.
You would report the service under the mother’s insurance, according to the AAP. Make sure you don’t use 99401-99404 if the mother or her fetus has any existing symptoms, an identified problem, or a specific illness. As per CPT®’s Counseling Risk Factor Reduction and Behavior Change Intervention guidelines, “these codes are used to report services for the purpose of promoting health and preventing illness or injury.”
Codes 99401-99404 aren’t necessarily shoo-ins for typical meet and greets. The AAP gives the following examples of prenatal counseling encounters that qualify for 99401-99404.
Scenarios include a mother with:
- A history of hypertension or diabetes
- A family history of a genetic disease
- A history of a premature neonate.
Most insurers do not pay 99401-99404. If, however, you have an insurer that covers the codes and you’ve met the above requirements, choose the appropriate code based on the prenatal counseling session’s time.
The medical record must include “documentation of the total counseling time and a summary of the issues discussed.” Check out the academy’s appropriate documentation example for 99401: “I spent 15 minutes with both parents reviewing the risks of recurrent preterm delivery and the mortality and morbidity risks if delivery occurs at less than 36 weeks.”
3. Limit Consults When Mother Has a Problem
You’ll have an easier time giving the green light to coding for a prenatal visit in which another physician asks you to meet with the expectant mother. For insurers that still accept consultation codes (99241-99245, Office consultation for a new or established patient …), you can report the appropriate code from this range with a report back to the ob-gyn if the ob refers the patient to you and asks you to meet with the patient. This consultation would again be billed under the mother’s insurance if the baby is still in uterus.
“If an ob refers the patient to me I could technically bill a consult code but it would have to be totally time-driven because a pediatrician isn’t going to examine an expectant mother,” says Richard Lander, MD, FAAP, medical director with Essex-Morris Pediatric Group in New Jersey.
In these cases, the mother may be angry about you charging her a copy for the visit. Explain that co-payments are an issue between the insurance holder and the insurer. Your office must follow these contractual agreements.
4. Think of Get-Acquainted Visits as Good PR
Some pediatricians simply consider doing meet-and-greets as good public relations (PR) and consider them a practice builder. “We don’t charge patients or the insurance for these visits,” Lander says. “The visits can get time consuming if you let them—several years ago, I was seeing maybe four or five prenatal visits a week.”
Therefore, Lander uses a strategy that ensures that the visit won’t span longer than 20 minutes. “I introduce myself, tell them about our basic philosophies, ask them a few questions (for instance, whether there are any genetic diseases in the family, if they’ll be breastfeeding, if they plan to circumcise), talk to them about how our practice does not rush to give meds, and explain our other policies, and that way, most parents don’t have many questions since I already gave a detailed explanation.” For those parents who do pull out a list of questions, Lander tells them he needs to get back with his patients, so he’s happy to answer the parents’ top two questions.
If you decide not to bill for the service to the parent or the insurer, you might want to create an internal reporting code, which is used to gather data that you can use to evaluate meet-and-greets’ value. You can later analyze the information to determine how many patients actually joined your practice following the meet-and-greet.
Posted on 08. Jun, 2011 by .
EMR signature pitfalls could be a daily challenge with which you often deal. Check your answers against our experts’ advice to verify your group’s signature compliance.
Question 1: Some of our physicians use handwritten signatures on their charts and others prefer electronic signatures. Is either kind acceptable?
Answer 1: According to CMS documents, Medicare requires a legible identifier for services provided or ordered. The identifier — or signature — can be electronic or handwritten, as long as the provider meets certain criteria. Legible first and last names, a legible first initial with last name, or even an illegible signature over a printed or typed name are acceptable. You’re also covered if the provider’s signature is illegible but is on a page with other information identifying the signer (letterhead, addressograph, etc.). Also be sure to include the provider’s credentials. The credentials themselves can be with the signature or they can be identified elsewhere on the note.
Pre-printed forms might include the physician’s name and credentials at the top, side, or end. All qualify as acceptable documentation as long as the coder or auditor can identify the provider’s credentials. You can also use (more…)