Archive for 'Toolkit'
Use This Sample Appeal Letter As Ammo in Your Fight Against Modifier 25 Denials
Posted on 12. Mar, 2010 by suzanne.leder.
Attach your procedure notes and the OIG’s report to pack extra punch.
Even if you follow all of CMS’s rules in reporting modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), your Medicare payer may sometimes still choose to deny your claim.
If you feel you deserve the pay for the EM service you performed, you should appeal the denial. Alice Kater, CPC, PCS, coder with Urology Associates of South Bend in Indiana, offers the following sample appeal letter (below) as an example of how she has challenged her payer to collect rightful reimbursement. (more…)
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Optometry Coding: Stop 92081-92083 Denials in Their Tracks
Posted on 19. Feb, 2010 by suzanne.leder.
Record visual fields interpretation and report the right way.
Visual fields are a compliance hot spot. Optometrists should use the visual field interpretation and report (I&R) to record what their thinking process was at that moment by recording any changes noticed, how the field compares to other testing like OCT (92135, Scanning computerized ophthalmic diagnostic imaging, posterior segment, [e.g., scanning laser] with interpretation and report, unilateral), their plan for treatment (or not) and when the field needs to be run again. (more…)
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8 Simple Steps Organize Your Op Note Coding
Posted on 12. Feb, 2010 by suzanne.leder.
This aspect of op note coding is the “horse that pulls the cart.”
Stuck on how to tackle this op note or those sitting on your desk? Follow this advice, provided by Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M. and co-presenter of the “Ob-Gyn Op Notes” session at the 2009 Ob-Gyn Coding & Reimbursement Conference in Orlando.
Step 1: Itemize procedures.
Step 2: Assign CPT codes.
Step 3: Eliminate “standard” procedures. (more…)
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Want to Integrate PQRI Measures Into Your Practice? Look Here.
Posted on 28. Jan, 2010 by suzanne.leder.
Participation can put extra bread in your basket.
Back again for 2010 is Medicare’s incentive-driven physician quality reporting initiative (PQRI), aimed at tracking quality metric or patient care services that physicians provide. When the practice treats enough patients in the same category, some PQRI dollars might be only a few codes away.
If you know the basics and focus your efforts, PQRI reporting can be a breeze and a boon to your bottom line.
Anyone confused about PQRI — or with questions about setting up a PQRI program in a specialty setting — should go immediately to the CMS PQRI tool kit.
Where? Check out the tool kit here.
“This kit includes valuable resources to assist eligible professionals in the successful integration of PQRI measurement into their practice. CMS suggests that eligible professionals review and discuss the following materials with their staff,” Medicare says.
The kit lists three PQRI “tools” designed to help practices comply with PQRI:
1. 2009 Implementation Advice for 2009 PQRI and E-Prescribing — A publication that introduces the coding and reporting principles underlying successful PQRI reporting.
2. 2009 PQRI Code Master Single Source — A numerical listing of all codes included in PQRI intended for incorporation into billing software.
3. 2009 Data Collection Worksheets — You should use measure-specific worksheets that walk the user step-by-step through reporting for each measure. “These worksheets may be used by the practice on a concurrent basis to collect PQRI data,” CMS says.
Missed the “2010 PQRI: Preparing for Performance” audioconference? Order a CD.
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Checklist: Collect Surgical Deductibles Up Front to Improve A/R
Posted on 17. Jan, 2010 by Editor.
This 3-step checklist will boost your bottom line.
With fewer patients following through on procedures because of economic and financial struggles, and an increasing number of patients not paying their bills, your practice needs to find ways to improve your A/R and bring in deserved money. Adapting an up-front deductible collection policy is one proven way to do both — and setting up a policy can be as easy as 1-2-3.
1. Confirm the Deductible With the Payer
Insurance verification services now make it possible for practices to find out if a patient has met his deductible yet. Some services can tell you how much of the deductible remains unpaid. Because this information is available online, your practice can get this information last-minute, the day of, the day before, or several days before the patient is scheduled to come in for a service or procedure. (more…)
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ICD-9 Sequencing: Ace Late Effects Diagnosis Coding With This Flow Chart
Posted on 14. Jan, 2010 by Editor.
Combination codes for stroke late effects won’t always cover all the details.
Proper sequencing is essential when coding for late effects, so use this handy chart to sequence your codes correctly every time.
Chart provided by Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates and CoDR — Coding Done Right in Denton, Texas.
For easy ICD-9 code lookup and more ICD-9 coding advice, go to Supercoder.com and sign up for a FREE trial today.
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Keep All the Urodynamics Codes Straight With This Handy Cheat Sheet
Posted on 08. Jan, 2010 by Editor.
Knowing the differences between the tests is your key to proper code choice.
When your urologist says he performed urodynamics tests, you need to dig deeper into his documentation for clues about which code to report. Tack this overview up by your computer to help you quickly choose the right code every time.
• In a simple CMG (51725, Simple cystometrogram [e.g., spinal manometer]), the urologist places a small catheter in the bladder, fills the bladder by gravity, and measures capacity and storage pressures using a spinal manometer.
• A complex CMG (51726, Complex cystometrogram [e.g., calibrated electronic equipment]) involves filling the bladder through a catheter and measuring the pressures with calibrated electronic equipment. If your urologist also performs a urethral pressure profile (UPP), report 51727 (Complex cystometrogram [i.e., calibrated electronic equipment]; with urethral pressure profile studies [i.e., urethral closure pressure profile], any technique). For a complex CMG with voiding pressure study, report 51728 (… with voiding pressure studies [i.e., bladder voiding pressure], any technique). (more…)
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Oncology Billing Toolkit: Factor 8 HCPCS Changes Into Your Superbill
Posted on 07. Jan, 2010 by Editor.
Watch those Taxotere units, or kiss 95 percent of your reimbursement goodbye.
A brand new list of HCPCS codes — including docetaxel and bevacizumab updates — goes into effect Jan. 1 and our 8-step superbill maintenance plan will stop denials in their tracks for 2010.
Not using the proper codes will lead to claim rejection, which means “not receiving the proper reimbursement. And no one wants to start out their new year that way,” points out Lisa Martin, CPC, CIMC, CPC-I, who oversees the charge operations for a large, independent community cancer center in central Illinois and is an active instructor for the AAPC’s Professional Medical Coding Curriculum.
1. Docetaxel Do: Swap J9170 for J9171
The most widely used of the new chemotherapy HCPCS codes may prove to be J9171 (Injection, docetaxel, 1 mg), says Martin. Oncologists may prescribe docetaxel (Taxotere) for breast cancer, non-small cell lung cancer, prostate cancer, gastric cancer, and head and neck cancers. (more…)
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CPT 2010 Code Selection Chart for Paravertebral Facet Joint Injections
Posted on 10. Dec, 2009 by Editor.
CPT 2010 introduces a slew of new codes for paravertebral facet injections, so why not consult our handy flow chart to help you select the correct code?
© Neurology Coding Alert. To read the full article on the new facet joint injection codes for 2010, download your 2 FREE sample issues here.
Was it painful for you to miss the 2010 Pain Management Coding & Reimbursement Conference? Get CDs or MP3s of sessions from Joanne Mehmert, Marvel Hammer & more!
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Zero In On Correct Nasal-Specimen Coding With This Quick Quiz
Posted on 06. Dec, 2009 by Editor.
Missing multiple 88304 specimens could cost your practice $125.
Busting the polyps’ “s” myth and identifying separately billable nasal specimens could add hundreds of dollars to a pathology claim. Make sure you’re not falling into two common coding traps by trying your hand at these two questions; then checking your answers.
Question 1: The lab receives the following tissue individually labeled by the surgeon: right septum polyp, left septum polyp, and left lateral nasal polyp. The pathologist microscopically examines representative portions of tissue from each sample and individually reports each specimen as “nasal polyps.” How should you code the case? (more…)
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Pain Management Coding: TPI Do’s and Don’ts for Pay You Can Keep
Posted on 03. Dec, 2009 by Editor.
Sample ICD-9 codes to support medical necessity for trigger point injections.
Counting the right items, knowing insurer-allowed diagnoses, and documenting affected muscles will get your trigger point injection (TPI) claims paid while protecting you from paybacks.
Further, knowing each insurers’ covered diagnoses for TPIs is vital to healthy coding.
√ Do Count Muscles Injected
Coders should report 20552 (Injection[s]; single or multiple trigger point[s], 1 or 2 muscles) when the internist injects one or two muscles, confirms Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, of MJH Consulting in Denver. (more…)
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Test Yourself: ICD-9 2010 for Ob-Gyn Coders
Posted on 29. Nov, 2009 by sanjay.aikat.
Is your ob-gyn practice using the new codes correctly? 3 quick questions say for sure.
This year, ICD-9 2010 brought new hyperplasia, mammogram, and fertility preservation codes. In some cases, these codes simply expanded on existing options, and it’sup to you to spot when you should report the new versus old alternatives. Dig in to these three scenarios to see if you can choose the proper code for services performed on or after Oct. 1.
Scenario 1: Pick Apart New Puerperal Options Your ob-gyn documents “a puerperal infection,” a bacterial illness following childbirth. How would you report this?
A. 670.0 — Major puerperal infection
B. 670.1x [0,2,4] — Puerperal endometritis
C. 670.2x [0,2,4] — Puerperal sepsis
D. 670.3x [0,2,4] — Puerperal septic thrombophlebitis
E. 670.8x [0,2,4] — Other major puerperal infection
Scenario 2: Don’t Overlook 671 Category Notes You’re reporting a code from the 671 (Venous complications in pregnancy and the puerperium) category, but you need to provide what additional information? Select one of the following options: (more…)
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Coder’s Navigation Tool: 2010 Medicare Physician Fee Schedule
Posted on 08. Nov, 2009 by Editor.
Chart where your practice is going in 2010.
It’s that time of year coders — yes, time to comb through pages and pages and pages of the final 2010 Medicare Physician Fee Schedule. We’ve got a handy place to start.
If you want a quick overview of fee schedule’s financial impact on your physician practice’s specialty, go here and scroll to page 1171. There, you’ll find ‘Table 49,’ which outlines a plus or minus percentage impact on ‘Work RVU Changes’ for 55 specialties and settings.
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Your New Patient Packet Toolkit
Posted on 29. Oct, 2009 by Editor.
How to use technology to speed up new patient check-in.
Not enough hours in the day? Are you always looking for ways to save time? Many medical offices report that sending out new patient packets in advance of the patient’s visit greatly reduces the number of incidents at patient check-in and saves time.
“Normally, it would take patients 15-plus minutes to complete the forms,” says Stephanie Mayer, front desk receptionist for a pediatrician in Queens, NY. “Also, there is the distraction of other patient activity in the waiting room, which could keep patients from concentrating on forms they are supposed to complete.”
Put forms online
If you are not already doing so, talk to your practice administrator about putting new patient packets online.
“Sending or having a patient access our packets from our Web site gives the patient the opportunity to input the information leisurely and accurately, and if needed, the time to research dates, reference medications, and obtain past medical history, says Suzanne E. Keith, practice administrator at Michael W. Goodman, MD, PC, in Chattanooga, TN. “Also, bringing or e-mailing the information in advance allows our office to make a chart and reduces the patients’ wait time.” (more…)
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Radiology Billing Checklist: Rules for Additional Tests without Treating Physician’s Order
Posted on 22. Oct, 2009 by Editor.
Keep these additional test rules at your fingertips if your want to keep auditors out of your hair.
The Office of Inspector General and Recovery Audit Contractors are out to audit non-compliant ultrasound claims, so knowing the rules is more important than ever. And we’ve got a link and a handy checklist to keep you out of trouble.
If you’re wondering when a radiologist can bill for a test without the treating physician’s order, we’ve got the link where CMS answers your question, plus a handy checklist.
CMS explains when a radiologist can bill for a test without the treating physician’s order in the Medicare Benefit Policy Manual, Chapter 15, Section 80.6. (more…)
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Toolkit: Chart Cardiology’s CCI 15.3 Changes At-a-Glance
Posted on 15. Oct, 2009 by Editor.
Hang on to this handy table to avoid cath placement coding temptations.
Correct Coding Initiative (CCI) 15.3 offered long lists of new edits, but we’ve boiled them down to the ones that affect cardiology coders and billers most.
Cardiology Coders: A CCC™ Exam Prep Training Camp is coming to a city near you.
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Keep Medication Units in Check With MAC-Approved Drug Calculator Tool
Posted on 08. Oct, 2009 by Editor.
When Part B MACs publish the top errors that they see in claims submitted by physicians, incorrectly billed drugs are always near the top of the list. If you’re one of the coders that has trouble assigning units to drug claims, one MAC has a solution for you.
Palmetto GBA, a Part B payer, now offers a “Drug Lookup and Calculator Tool,” which was created “to help providers submit the correct number of units on their claims by calculating and converting the dosage administered to the patient.”
Plus: The calculator displays the current maximum allowable units assigned to the drug.
For instance, if you enter J2920 (Injection methylprednisolone sodium succinate) into the system, it will ask you how many milligrams you administered. The system will then tell you how many units to report, with a notation that 83 units are the maximum allowed for this drug.
To access the tool, go here.
© Part B Insider. Get your 2 FREE sample issues here.
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Learn 2 New CMS Appeal Thresholds Before Filing
Posted on 01. Oct, 2009 by Editor.
We’ve got a handy chart to help you keep everything straight, plus quick links to all the rules & forms.
The time has come yet again to update your appeals know-how. CMS announced several changes to the appeals process effective Aug. 3, 2009, in Transmittal 1762.
Focus on Higher Dollar Amounts
CMS has changed the dollar amount in controversy to file certain levels of appeals. For level-three appeals (administrative law judge hearing), requests filed on or after Jan. 1, 2009, must have at least $120 in controversy.
(The old amount was $100.) For level-five appeals (federal court review), requests filed on or after Jan. 1, 2009, must have at least $1,220 in controversy. (The old amount was $1,180.)
Other changes were more directed toward Medicare contractors and included the following: (more…)
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3 Steps Win the Sports Physical Reimbursement Game
Posted on 24. Sep, 2009 by Editor.
These useful strategies assure revenue despite scant insurer coverage.
Right now, a rush of young kids are looking to their family physicians for medical clearance to participate in sports. Commonly referred to as sports physicals, they present unique problems to coders, especially concerning their coverage by insurers. To avoid loss of revenue and to maximize the earning potential of your practice, here are some surefire tips on coding for sports physicals.
1. When Unsure of Coverage, Ask for Cash
To ensure revenue for your practice, you can ask patients, especially those with insurance that you know does not cover it, to pay cash for the sports physicals. “My suggestion is that these are treated as ‘self-pay’ services and offices should collect up front,” says Christy Neff, RMC, physicians billing specialist for Witham Health Services in Lebanon, Ind. (more…)
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Are You Up For ICD-9 2010? Quick Quiz Says For Sure
Posted on 17. Sep, 2009 by Editor.
Surgery Coders: These 5 questions reveal if you need an ICD-9 workout.
October 1 is just around the corner, and that means you’ll soon need to be up and running with the latest ICD- 9 changes. Are you wondering where you should focus your time and energy?
Time-saver: This quiz on the new codes and the basics of diagnosis coding will help you determine whether you’re on the right track, or if you should work on your 2010 diagnosis coding know-how.
Question 1: Once the 2010 ICD-9 changes go into effect on Oct. 1, what diagnosis code should you report when your surgeon documents “chronic venous embolism and thrombosis of superficial veins of left arm”?
A. 453.71
B. 453.8
C. 453.81
D. None of the above.
Question 2: True or false: You can never report a V code as the primary diagnosis.
Question 3: Which of the following is ICD-9 2010 diagnosis code you’ll report for a patient with an unspecified neoplasm?
A. 239.8
B. 239.81
C. 239.89
D. V10.90.
Question 4: True or false: You can never report an E code as the primary diagnosis.
Question 5: Your surgeon sees a patient with a personal history of a malignant neuroendocrine tumor, which affects the surgeon’s medical decision making for treatment. To support the higher-level medical decision making, what ICD-9 2010 diagnosis code will you report?
A. V10.90
B. V10.91
C. V53.50
D. All of the above.
Don’t miss the ASC Coding & Billing Conference this December 6-8 in Orlando.
Click ‘read more’ to check your answers. (more…)
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