When the physician admits a patient from another site of service on day 1, but doesn’t see the patient in the hospital until day 2, choosing the date of service for your claim can raise some questions. Knowing the answers not only keeps your date of service accurate, but also may add to your bottom line.
Audio Training Event with Jill Young: When good payments go bad. Must-know fraud-proofing tips for hospital physician services billers.
Consider the following scenario offered by Dolly Cooper, CMC, and Brenda Mantia, CMC, who work with a 10-physician practice in Shreveport, La.
Scenario: The patient is admitted at 11:57 p.m., May 1, to the physician. The physician sees the patient in the hospital for the first time at 2:00 a.m. on May 2.
What would you do? Would you choose May 1 or May 2 as the date of service (DOS) for the physician’s visit?
Posted on 31. Jul, 2009 by in Toolkit.
Orthopedic surgeons dealing with hand procedures don’t only treat dislocations — they also treat fractures, and it’s up to you to link the correct diagnosis to the upper-extremity fracture repair code.
Use the anatomic drawing here to locate the site that your surgeon addressed, and match that to the sampling of applicable ICD-9 codes in the chart at the bottom of this page.
Question: Our nonphysician practitioner (NPP) discovers a pair of benign lesions on a patient’s right hand. One of the lesions was 0.5 cm, and the other was 0.3 cm; the injuries were 1.0 cm apart. Using a scalpel, the NPP removes both lesions with a single excision. Should I report one or two excision codes?
Answer: Since the NPP performed both excisions with a single incision, you should group the excisions together and report one code for both. Add the lengths of the two excisions to the margin between the lesions, and choose a code based on that length. (In your scenario, 0.5 + 0.3 + 1.0 = 1.8 cm.). On the claim, report 11422 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm) for the excision.
AUDIO: Lesion Excision Coding Made Easy, with Betty Johnson.
Good news: You can report a higher-level (and higher-paying) E/M in this annual-visit situation.
Annual visits often lead to confusion when it comes to establishing a patient’s pregnancy. Take this 3-part challenge by deciding if the ob-gyn package begins based on these scenarios:
• a patient’s annual visit leads to a diagnosis of her pregnancy,
• she arrives knowing that she is pregnant, or
• the ob-gyn eliminates other possible diagnoses.
Hint: In the majority of circumstances, you should not begin counting antepartum visits for the global maternity codes (59400, 59510, 59610, 59618) until the next full visit, coding experts say.
AUDIO: The #1 mistake providers make when choosing the level of antepartum service. Melanie Witt shows you how to fix it for good.
Still Report Annual When Visit Leads to Pregnancy Dx
Scenario 1: If the ob-gyn diagnoses pregnancy (V72.42, Pregnancy examination or test, positive result) during a patient’s annual exam (99384-99386 for new patients, or 99394-99396 for established patients), you…
Question: We received a mastectomy specimen based on a prior cancerous biopsy but find no residual tumor. How should we code the mastectomy (procedure and diagnosis)?
Answer: The final diagnosis for a mastectomy specimen doesn’t change your procedure coding. You don’t mention lymph nodes, so you should report the pathologist’s mastectomy examination as 88307 (Level V –Surgical pathology, gross and microscopic examination, breast, mastectomy – partial/ simple), regardless of the final diagnosis.
Diagnosis coding rules require you to report the most specific diagnosis available at the time. Here’s 3 steps that ensure you do just that:
1.If you have the pathologist’s report and it includes a definitive diagnosis, you should use that diagnosis.
Physician practices collect only half of the money patient owe them out of pocket, reports American Medical News. And those failed collections caused practices to carry between $14-30 billion in bad debt in 2007.
A big part of the problem: Front desk personnel and billing office don’t understand what the patient owes the practice beyond the co-pay, AMNews says, so they don’t collect for non-covered procedures, for example. Once the patient leaves the office, the odds of collecting money owed from the patient plummet … More from American Medical News …
Go chase that A/R, Sister! Use the appeals process like a pro. An audio training event with Barbara Cobuzzi.
Posted on 27. Jul, 2009 by in Hot Coding Topics.
There are some real gems back there that can save you a ton of time, says Betty Johnson, who taught a ‘Back to Basics’ coding class at the recent The Coding Institute conference in Orlando.
If you’re pressed for time in December (and who isn’t?) and want to know real fast what has changed since last year, check Appendix B, recommends Johnson. And when it’s time to update your encounter forms, a trip to Appendix M will simplify the task. That’s where you’ll find a list of all the current year’s codes and decriptors that you can crosswalk into the next year’s codes.
What’s up with that lightening bolt? Those…
In just a few months, you’ll be faced with more than 350 ICD-9 changes. If you don’t incorporate the changes into your coding that day, your practice could face denials and lost revenue. There are 311 new, 22 invalid, and 45 revised ICD-9 codesthat take effect on Oct. 1, 2009.
Every dollar – and every productivity hour – counts these days, so we’ve scoured the diagnosis code changes for you. Here are 3 changes urology coders need to understand in order to code properly after Oct. 1.
Incorporate New Pouch Codes
If your urologist uses the intestines for urinary diversion, there are two new ICD-9 diagnostic codes that you should pay attention to. “These two codes may relate to problems with urinary diversions such as an ileal conduit or abdominal pouches, the Kock, Indiana, or Miami pouches,” says Michael A….
CMS is adding some sizzle to your summer with three exciting physician fee schedule changes. Sacroplasty, renal tumor ablation, and stereoscopic x-ray guidance for radiation therapy all have news you need to know now or you could risk leaving hundreds or even thousands of dollars on the table.
Effective date: CMS transmittal 1748 reveals the changes. The implementation date, when carriers must execute the changes, is July 6. But the effective date is Jan. 1, 2009, meaning that the changes actually apply to services performed as far back as Jan. 1. And that means retroactive cash.
AUDIO: Do you understand the latest Stark law rules? Wayne Miller tells radiology practices how to restructure IDTF shared office and staff arrangements.
1. CPT Says 72291, 72292 for Sacroplasty
The AMA announced new spine-related Category III codes, implemented July 1. CMS added them…