Archive for 'Toolkit'

ICD-10 Bridge

Posted on 27. Oct, 2011 by .


Once target=”_blank”>ICD-10 is implemented, the diagnosis codes in the above story will be different. Check out this crosswalk for diagnoses related to blurred vision, eye pain, dry eye, and foreign bodies:


368.8 (Visual disturbances; other specified visual disturbances)
H53.8 (Other visual disturbances)
370.33 (Certain types of keratoconjunctivitis; keratoconjunctivitis sicca, not specified as Sjögren’s) H16.221 (Keratoconjunctivitis sicca, not specified as Sjögren’s; right eye)H16.222 (… left eye)H16.223 (… bilateral)

H16.229 (… unspecified eye) (more…)

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Buying Equipment? Ensure Medicare Reimbursement First

Posted on 13. Oct, 2011 by .


Don’t let manufacturers snow you into investing in new gadgets.

A neighboring medical practice raves about the latest equipment that treats intractable conditions and says its sales rep assured them that it’s reimbursable — should you buy it? The reality is that you could be stuck with denials if you make a purchase without doing your homework first.

Warning: Manufacturers’ sales reps may make vague promises about Medicare reimbursement. For example, they’ll promise that Medicare will cover a new technology in most parts of the country. But you walk on dangerous ground if you go solely by the manufacturer’s general guidelines.

Find out whether your own Medicare carrier covers a new technology before you make a purchase, experts say. Check on your private payers, Medicaid, and state workers’ compensation insurer as well — with new technologies, your carrier may wait until the evidence is overwhelming before jumping on the bandwagon. (more…)

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Get to Know Your New Skin Cancer Dx Codes

Posted on 19. Sep, 2011 by .


In October, you’ll see a few changes in the 173 (Other malignant neoplasm of skin) series in your 2012 ICD9 Manual. Keep an eye out for these four-digit codes that will become obsolete, and these five-digit codes that will replace them:

Invalid Codes in 2012 New Codes in 2012
173.0 — Other malignant neoplasm of skin of lip 173.00 — Unspecified malignant neoplasm of skin of lip173.01 — Basal cell carcinoma of skin of lip173.02 — Squamous cell carcinoma of skin of lip173.09 — Other specified malignant neoplasm of skin of lip
173.1 — Other malignant neoplasm of skin of eyelid, including canthus 173.10 — Unspecified malignant neoplasm of eyelid, including canthus173.11 — Basal cell carcinoma of eyelid, including canthus173.12 — Squamous cell carcinoma of eyelid, including canthus173.19 — Other specified malignant neoplasm of eyelid, including canthus (more…)

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394.x-398.x and 424.x: Clarify the Role of ‘Rheumatic’

Posted on 13. Jul, 2011 by .


Use this cheat sheet to aid your non-congenital valve disorder coding


Code Descriptor Role of ‘Rheumatic’ 
394.0  Mitral stenosis  Use if specified as rheumatic or unspecified. If specified as non-rheumatic, use 424.0. 
394.1 Rheumatic mitral insufficiency Specific to rheumatic cases. For others, use 424.0.
394.2 Mitral stenosis with insufficiency Use if specified as rheumatic or unspecified. If specified as non-rheumatic, use 424.0.
394.9 Other and unspecified mitral valve disease Use if specified as rheumatic or unspecified. If specified as non-rheumatic, use 424.0.
424.0 Mitral valve disorders Use if specified as non-rheumatic. Also use for mitral insufficiency of unspecified cause.
395.0 Rheumatic aortic stenosis  Specific to rheumatic cases. For others, use 424.1.
395.1 Rheumatic aortic insufficiency Specific to rheumatic cases. For others, use 424.1.
395.2 Rheumatic aortic stenosis with insufficiency Specific to rheumatic cases. For others, use 424.1. (more…)

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37220 to+37223: Narrow Down On Correct Code With This Handy Tool

Posted on 16. Dec, 2010 by .


Make the transition to new iliac revascularization codes a little simpler by using this chart. Be sure to read “37220 to +37223 Revamp Your Iliac Intervention Coding Options” on the cover to get more information on these new codes.

Use the appropriate modifiers to report bilateral services. And if the physician also performs iliac atherectomy, also report 0238T (Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; iliac artery, each vessel).

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JCAAI 99211+95115: Appealing E/M With Allergy Injection Denials

Posted on 23. Nov, 2010 by .


March 21, 2007

Dear JCAAI Member:

We recently surveyed JCAAI members regarding reimbursement for an E&M service on the same day as a skin test or on the same day as an injection (95115 – 95117). Well over 80% are paid for an E&M service on the same day as a skin test. Far fewer are paid for an E&M service on the same day as an injection. In particular, the majority of allergists reported that they were not paid for an injection on the same day they billed a minimal office visit (99211).

Under Medicare policy, neither the injections codes nor the skin testing codes have global periods. Codes that have global periods (typically procedure codes) usually cannot be billed with an office visit because the E & M service is considered bundled into the procedure. Codes that do not have global periods do not include any bundling of E & M services; thus, coding policy generally permits them to be billed on the same day as an E & M without the use of modifier-25. However, as our survey results indicate, not all payers are aware of or are following this policy. This may be because, until January 1, 2006, the injection codes were classified as global period codes (which meant that they could not be billed with an E & M service without the use of modifier-25). JCAAI was successful in getting Medicare to change this so that you are allowed to bill an E & M service (including 99211) with allergy injection codes without meeting the requirements for modifier-25. The primary reason for this change was to allow a physician to bill 99211 when dealing with clinical issues surrounding allergy injection administration (e.g., directing a nurse giving injections as to what the nurse should do if a patient was ill, had missed an injection, had a large, local reaction or mild unreported systemic symptoms after their last injection). Medicare agreed that since there was no physician work built into the injection code payment, that it was appropriate to allow payment of a separate E & M service. Although this change technically only applies to Medicare, most commercial payers follow Medicare policy in this area.

Therefore, if commercial payers or Medicare are rejecting claims for E & M services billed on the same day as an injection, JCAAI would like to be notified. In particular, we need to know the identity of the payers and the geographic area. We would also like to know whether you have appealed the denials and the results. Please fax the information to the JCAAI office: (847-934-1820) or email it to and include the name of the carrier, the state where they are located, and the EOB’s (be sure to remove the patient identifying information). JCAAI will use this information to make sure payers and Medicare carriers are informed of the 2006 policy change. We will not release your name or other identifying information to any payers, including Medicare, without your specific permission.

In the meantime, if you think you meet the criteria for modifier-25 (e.g. you have provided a separately identifiable service distinct from the injection), you may want to try resubmitting rejected claims with modifier-25 (even though we do not believe this is required). We believe you would probably meet the modifier-25 criteria when billing for higher level office visits which are not related to the injection administration. However, you should make sure you have appropriate documentation. If you are billing 99211 because you were involved in providing clinical advice related to the injection, as described above, do not use Modifier-25 because it is unnecessary and does not apply in this situation. If you have billed both and have been rejected, we believe your next step should be an appeal.

We are aware that billing for an E&M service may trigger a co-pay. In these cases, you may reasonably decide not to bill for the E&M service. JCAAI is developing a plan to try and deal with the high co-pay issue.

We will continue to work diligently to ensure that legitimate billing practices are recognized by both Medicare and third-party payors.

Remember – JCAAI offers allergy specific online learning for socio-economic issues at <> .

Robert A. Nathan, MD
President of Joint Council of Allergy, Asthma and Immunology

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ICD-10: Catch a Glimpse of Diagnoses Changes for Hematuria BPH, and More

Posted on 14. Nov, 2010 by .


Get used to using letters in your diagnosis coding.

Take a look at some of the ways your urology diagnosis coding will change in 2013 by reviewing this chart of some common diagnoses you see in your urology practice.

This rundown, based on the ICD-10 2010 files, will help give you an idea of what to expect.

Beware: Remember, your final ICD-10 code choice will depend on the codes and guidelines in effect at that time, as well as the physician’s specific documentation.

Smoothly transition to ICD-10 with the expert advice provided every month in Urology Coding Alert.

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Handle Your Hand, Wrist Diagnoses With Care by Pinpointing Anatomic Site

Posted on 28. Oct, 2010 by .


Here’s how to differentiate the tiquetrum from the trapezium.

Doctors dealing with hand procedures don’t only treat carpal tunnel syndrome, and it’s up to you to link the correct diagnosis to the upper-extremity repair codes.

Use this anatomic drawing to locate (more…)

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Billing Specialist Knowledge Assessment Answer Key

Posted on 16. Sep, 2010 by .


Name: _____________________________________________  Date: _______________

1. A CPT code has ___5_____ digits and an ICD-9-CM code has ___3-5____ digits.

 2. Explain the difference between a CPT code and an ICD-9-CM code.

CPT (Current Procedural Terminology), standardized numeric system (5 digits without modifiers) is used to report WHAT medical services and procedures are done to the patient. 

ICD9 (International Classification of Diseases – Ninth Edition) a Universal coding system is used to describe WHY a service was performed.  Codes range from 3-5 digits.  

3. What is the purpose of a modifier?

To identify in certain circumstances that a service or procedure has been altered by some specific circumstance but it has not changed the basic definition or code  (this is the literal CPT book definition, but anything remotely close to this is acceptable).

4. What are E&M codes? (more…)

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Billing Specialist Knowledge Assessment

Posted on 16. Sep, 2010 by .


Before you hire a biller, you need to make sure he or she is qualified for the position. The following test coupled with a math test will assess whether the candidate will be successful in the role — and an asset to your company.

Name: _____________________________________________  Date: _______________

  1. A CPT code has _______ digits and an ICD-9-CM code has _______ digits
  2. Explain the difference between a CPT code and an ICD-9-CM code
  3. What is the purpose of a modifier?
  4. What are E&M codes?
  5. What does “COB” stand for?  
  6. What insurance information do you obtain when the patient (more…)

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