Archive for 'Toolkit'

Want to Integrate PQRI Measures Into Your Practice? Look Here.

Posted on 28. Jan, 2010 by .


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 .


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 .


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 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 .


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 .


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 .


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 .


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 .


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 .


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 .


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.

Page 1171 will help you be in the know for awhile, but what about all the other stuff in the Fee Schedule. Get all you need to know — and only what you need to know — in this upcoming audio training event.

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