Coder’s Anatomy Double-Take: What is NERD?

Posted on 11. Jun, 2009 by in Coding Challenge, Hot Coding Topics.


Question: In the doctor’s notes, it states the patient has NERD. What does this mean? The patient was in for an EGD.

Answer: NERD stands for nonerosive reflux disease. Essentially, it’s gastroesophageal reflux disease (GERD), or heartburn, without damage to the mucous membrane. 

The correct code is 530.81 (Other specified disorders of esophagus; esophageal reflux). 

Don’t confuse it with another code commonly used for GERD, 530.11 (Esophagitis; reflux esophagitis), which indicates damage to the esophagus.

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Hurricane Ike Baby Boom Challenge: 99238 & 99239

Posted on 10. Jun, 2009 by in Coding Challenge, Hot Coding Topics.


Pediatric coders from Houston, Louisville, or anywhere else Hurricane Ike wrecked havoc 9 months ago: Get ready for a storm surge of new pediatric patients and neonatal coding challenges.

Ob-gyn practices are steeling themselves for a 25% increase in deliveries from mid-June to mid July, reports The Houston Chronicle. Why? You do the math. It’s nine months after weeks-long power outages left people with nothing to do but make new pediatric patients.

So, let’s all take a newborn coding challenge to show our solidarity with the coders and billers left in Ike’s path.

Question: Sometimes our pediatricians tell a new mom she can take her baby home the next day provided the newborn continues to stool and feed normally, and to have normal vital signs. The patient is then discharged from the hospital the next day without the physician seeing the

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Get These ICD-10 Transition GEMs

Posted on 10. Jun, 2009 by in Provider News.


CMS unveils these ICD-9/ICD-10 Crosswalk Tools

For medical practices confused or even frightened by the ICD-10 transition, CMS has some advice. Coding News has highlights from a May 19 open door forum about leaving ICD-9 behind.

A murky grace period? The implementation date for ICD-10 remains Oct. 1, 2013, but after that date, carriers will accept ICD-9 codes for services with dates of services prior to Oct. 1, 2013 “for a period of time,” noted Pat Brooks, senior technical advisor with CMS, during the call. However, CMS has not revealed how long after the ICD-10 implementation date it will accept those codes.

AUDIO ON-DEMAND: ICD-10 Prep & What You Must Know NOW.

What this means: “When the time comes, practices will want to submit their claims for dates of services prior to Oct. 1, 2013 as quickly as possible,” notes coder Liza Shuman with Health Care Consultants in Boston. “The…

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Bust 4 Myths About Pediatric Critical Care Services

Posted on 10. Jun, 2009 by in Hot Coding Topics.


MYTHBUSTER: Codes 99291, +99292 apply to infants, young pediatric patients in these situations.

You’ve got to expand your 99291 and +99292 use, or you’ll join other pediatric practices that waste money appealing denials for legit per diem critical care.

“Currently, we are being denied [on claims for 99468, Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or less] and having to send records and request a review … which is very time-consuming and costly,” reports Tommie Angel, practice manager at Sanford Pediatrics PA in North Carolina.

Coding and Cash: Frontline Pediatric Coding Tools You Need to Succeed. Part of our Pediatric Specialty Coding Conference in Orlando this summer.

Strategy: Consider additional factors such as setting and time, before choosing 99291, +99292 (Critical Care Services: Adult [Over 24 Months of Age]) or

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Use This Incident-To Checklist to Breathe Easy During an Audit

Posted on 08. Jun, 2009 by in Toolkit.


You don’t need to second-guess the way you bill your NP’s services anymore.

Pin down Medicare’s criteria for billing your nurse practitioner’s (NP) services “incident-to” your physician — and you can nab an extra 15 percent in reimbursement on each claim.

The basic guidelines for billing Medicare under the incident-to provision are:

__ Your NP must be the physician’s employee or leased employee;

__ The services are within the NP’s scope of practice;

Split-share billing: Does your practice’s NPP reimbursement break the rules? Jill Young has answers.

__ The NP must provide the services in a private office setting;

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Answers To Your Hospital Admission, Subsequent Care Coding Questions

Posted on 08. Jun, 2009 by in Hot Coding Topics.


Revenue Booster: Here’s when you can claim a consult rather than an admit/subsequent care code.

Did you know if your neurosurgeon manages the patient’s head injury while another physician takes care of everything else, then you should hold off on reporting an admission service? Insurers are eager to audit hospital admission codes (99221-99223), as well as subsequent care codes (99231-99233). So you should learn all you need to know to correctly code co-management situations.

These 4 hospital admission coding FAQs help you stay out of auditors’ crosshairs.

1. What Does Hospital Admission Entail?

You may report a hospital admission (99221-99223) for a neurosurgeon (or any other specialist) as long as the neurosurgeon assumes full responsibility for the patient’s care, says Dianne Wilkinson, RHIT, compliance officer and quality manager with MedSouth Healthcare in Dyersburg, Tenn.

Example: From the emergency department the neurosurgeon admits a patient with head

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Fetal Non-Stress Test Coding & Billing

Posted on 06. Jun, 2009 by in Hot Coding Topics.


 Question: What do fetal non-stress tests (NSTs) entail? Are reading NSTs for pregnant mothers who are inpatients a separately billable service?

Answer: A NST is a discrete test that takes 20-40 minutes to complete and requires a notation of fetal movement as part of the test.

If the patient is simply hooked up to a monitor during her hospital stay and the ob-gyn occasionally looks at the strip, you should consider that part of her exam and not a separately billable test.

To separately bill this service with 59025 (Fetal nonstress test), your ob-gyn must document a clear indication for doing the NST (for instance, to measure fetal wellbeing).You must have a report with the findings and a recommendation for further testing or treatment. You should also have a hard copy of the tests strip.

Keep in mind: If the ob-gyn performed this service in the hospital using hospital equipment, you can bill only the

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How Do You Code COPD With Acute Bronchitis?

Posted on 05. Jun, 2009 by in Coding Challenge, Hot Coding Topics.



Question: An established patient with chronic obstructive pulmonary disorder (COPD) with acute bronchitis reports to the physician for a scheduled spirometry. What is the proper diagnosis coding for this encounter?

Answer: Code with caution on COPD patients; report a single diagnosis code for the patients COPD even when it occurs along with certain conditions, such as bronchitis, emphysema, or asthma.

On the claim, report the following:

• 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[ s], with or without maximal voluntary ventilation) for the spirometry

• 491.22 (Obstructive chronic bronchitis with acute bronchitis) for the COPD.

Explanation: You dont have to report 466.0 (Acute bronchitis) for the obstructive chronic bronchitis because the code descriptor for 491.22 specifies acute bronchitis.

Don’t Miss this AUDIO TRAINING EVENT: Jen Godreau gives you 10 tips to improve your critical care coding.

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The First Medicare Bene Ever, Plus a PFS RVU Math Crash Course

Posted on 05. Jun, 2009 by in Hot Coding Topics.


Yeah, I’ve got a problem. I’m a Medicare history geek, and look what I just found! A picture of the very first Medicare beneficiary ever. In this 1965 photo, Mr. Tony Palcaorolla of Baltimore submits the first Part B application from the general public. LBJ is there to process it personally. Check out Mr. P’s snappy bow tie.

Hang up this snapshot in your cubicle, coders, and for even more excitement, let’s learn some more stuff about the Physician Fee Schedule! Today’s topic: Facility and Non-Facility RVUs. Once you read this little post, you’ll ‘GET’ THE MATH. I promise.

The Physician Fee Schedule establishes different values for codes depending on the setting/site (facility or non-facility) in which the provider performs the service or procedure. For some services, the total RVUs for a given procedure are the same regardless of whether the physician performs the procedure in a facility or a non-facility. In…

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Concurrent Care Coding Tips: Pulmonologist & Allergist

Posted on 05. Jun, 2009 by in Hot Coding Topics.


Allergy season often presents the dilemma of when and how both an allergist and pulmonologist can report services for the same patient. Reimbursement for concurrent care to treat conditions like extrinsic asthma, acute bronchitis is possible

Familiarize Yourself With Medicare’s Slant

Medicare reimburses for concurrent care when physicians provide services more extensive than consultations and when both physicians play an active role in the patient’s ongoing care.

To get paid in a concurrent care scenario, you must be able to justify having two related specialties on board, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.

Follow these 2 rules of thumb to help ensure payment for concurrent care:

1) Diagnosis: Verify that the diagnosis or diagnoses support the medical necessity of involving two specialists in the patient’s care; and,

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