Medical Coder’s Modifier 25 Checklist

Posted on 01. Jun, 2009 by in Toolkit.


Append 25 with the greatest of ease …

Appending modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is a legitimate and effective method to obtain payment for a significant, separately identifiable E/M service provided on the same day as another service or procedure. To facilitate payment of your modifier -25 claims, check your claim against the following:

__ Have complete and separate documentation for the E/M service, apart from documentation for any other services/procedures the surgeon provides that day. Treat E/M codes as part of a different encounter. Documentation should independently support every code you claim.

E/M Coding doesn’t have to be a circus. Our experts make it simple.

__ Be sure the E/M service you report is significant (in other words, documentation should support at least a level-three patient encounter: 99203, 99213).

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What’s the Code for Lap Hiatal Hernia Repair?

Posted on 29. May, 2009 by in Hot Coding Topics.


Question: In accordance with the new laparoscopic hernia codes, does 49652 incorporate the hiatal hernia repair? I was told that epigastric hernia repair is the same, but our surgeon does not agree. What is the correct code to use for laparoscopic repair of hiatal hernia?

Answer: CPT does not contain a specific code to describe laparoscopic hiatal hernia repair, even with the addition of the new laparoscopic hernia repair codes this year. Therefore, to describe a procedure of this type, you must select the unlisted procedure code 39599 (Unlisted procedure, diaphragm).

If the surgeon performed an open hiatal hernia repair, however, you would select 39520 (Repair, diaphragmatic hernia [esophageal hiatal]; transthoracic) for a transthoracic approach, or choose between 39530 (…combined, thoracoabdominal) and 39531 (… combined, thoracoabdominal, with dilation of stricture [with or without gastroplasty]), as appropriate.

Clinical rationale: Your surgeon is correct that an epigastric hernia is not the same as a hiatal hernia. An epigastric hernia is usually through anterior wall fascia, above the umbilicus and below the zyphoid. The hiatal hernia is internal, at the esophageal hiatus where

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PFS Treasure Chest: How To Download the Fee Schedule From CMS

Posted on 29. May, 2009 by in Hot Coding Topics.


Today I found this picture of THE ONLY DAY MEDICARE WAS EVER SIMPLE–the day in 1965 when President Lyndon B. Johnson signed the Medicare bill into law. There’s Lady Bird in blue behind him. Former President Truman and his wife, Bess, look on.

Well, it’s 2009 & we all know Medicare has gotten a lot more complicated. Even downloading the Medicare Physician Fee Schedule from CMS can be tricky. Coding News has some tips for you.

CMS makes the Physician Fee Schedule available as a free download on its Web site.

To begin: Use your Internet browser to go here.

Tip: If you cannot access the page using this URL, go to the CMS home page, and use the “search” function in the upper right hand corner to find “Physician Fee Schedule.” The first search result

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Bone Up On ASC Orthopedic Coding With These Global Period, Modifier Tips

Posted on 29. May, 2009 by in Hot Coding Topics.


3 ways your physician claim better look different than a center claim.

Think the same post-op and incomplete procedure modifiers apply regardless of whether you’re coding for an ambulatory surgery center (ASC) or a physician? Save your claim from disaster by focusing on these variations.

Change Postoperative Surgery Coding After Day 1

Every procedure billed by the ASC has a “same-day” global period, which makes sense because the ASC is not reporting physician work services — only facility fees. This applies to the coder working for the ASC, but not the physician who performed the service, says Catherine Bowie, CPC, surgical and ASC coder for Central Maine Orthopaedics, PA in Auburn.

Before you read on, can you answer THIS orthopedic coding stumper? How do you code when a joint replacement needs a replacement. Don’t miss our joint replacement AUDIO

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Aetna EOB Makes New Mom Feel Like a Babe in the Woods

Posted on 27. May, 2009 by in Provider News.


If you’d like a glimpse of what your coding or billing job might feel like to a patient, check out Anna Wilde Matthews’ tale of trying to decipher her $36,625 bill after she vaginally delivered a healthy baby. “Bringing my newborn son home was a joy. Figuring out the hospital bill wasn’t,” Matthews writes in the Wall Street Journal.

Follow Matthews as she dissects her bill, wrangles with Aetna’s customer service system, and tries to understand why some seemingly incidental things are so expensive. ”The experience left me befuddled,” she writes.

I’m a little befuddled by some of the story’s details as well, such as a $530.29 epidural tray at Cedars-Sinai Medical Center … More …

Ob-Gyn coding and billing expert Melanie Witt is never befuddled. Get her top-notch diagnosis coding advice on-demand.

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Test Yourself: Doctor Slang 102

Posted on 22. May, 2009 by in Hot Coding Topics.


OK, coders. If you aced Doctor’s Slang 101 and think you’re IT, it’s time for Round 2.

If you see these in an note, do you know what they mean?

  1. A’s and B’s
  2. Banana Bag
  3. ROMI or ”romied”
  4. Swiss Cheese
  5. Tet Syndrome
  6. UA

Please click ‘read more’ for answers. (And a big thank you to Hazel Tank’s Word Lists.)

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Hysterectomy Coding Simplified: Look at Weight, Removal

Posted on 22. May, 2009 by in Hot Coding Topics.


Severing these ligaments clues you into whether ob-gyn removed the ovaries.

You’ll be able to distinguish a total abdominal hysterectomy from a laparoscopic supracervical hysterectomy thanks to these experts’ tips on mapping your ob-gyn’s hysterectomies documentation to these procedures’ definitions.

The ob-gyn may perform a hysterectomy (removal of the uterus including the corpus and cervix) using an abdominal, vaginal, or laparoscopic approach. Pay attention to these key terms to score 100 on your CPT code selection.

TRAINING EVENT: Melanie Witt and Peggy Stilley teach you the nuts & bolts of Ob-Gyn Coding. This July in Orlando.

Include Tubes/Ovaries in Abdominal Approach Codes

The ob-gyn may or may not remove the ovaries during an abdominal hysterectomy, but this does not impact the code you select. All CPT codes for the abdominal approach indicate “with or without” removal of tubes and ovaries, says Melanie Witt,

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Take Heart, Cardiology Coders: CCI Deletions Overturn 93296 Denials

Posted on 20. May, 2009 by in Hot Coding Topics.


Go back to the future. 3 months of denials add up at $36 a pop.

It’s no flux capacitor, but it’s the next best thing to time travel for coders and billers: CCI edit deletions!

Correct Coding Initiative 15.1 adds more than 300,000 edits, but the most exciting news for cardiology coders is among the deletions — which means good news for remote device check claims.

AUDIO TRAINING EVENT: Nix the Stress From Stress-Test Coding.

Here’s what you need to know about the key deletions effective April 1.

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141 New ICD-9 Codes Debut for 2010

Posted on 19. May, 2009 by in Provider News.


Like a passel of fresh-faced debutantes, the new ICD-9 codes are introducing themselves to coders & billers. And we’re pleased as punch–mostly.

The class of 2010 makes its official debut on Oct. 1, 2009.

CMS will publish the full listing of ICD-9 codes in the May 22 Federal Register, but released the list early, offering a few surprises.

Most of the new codes will offer additional specificity to existing diseases, which can help you code more accurately. “Any time we get diagnosis codes that provide additional specificity, I think that is great,” says Marvel J, Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO of MJH Consulting in Denver.

You’ll find new codes in most categories, ranging from oncology (such as the 209.31-209.36 series, Merkel cell carcinoma) to orthopedics (813.46-813.47, Torus fracture).

Marvel Hammer helps you end your pain ICD-9 coding misery, in 60 minutes flat.

However, orthopedic coders had hoped for a…

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Correct Coding Checklist Keeps Your Claims Engine Purring

Posted on 19. May, 2009 by in Toolkit.


Coding is part art form, part mechanics.

Successful coding requires creativity at times and a consistent attention for detail. By mastering certain basic practices – and making them second nature — you’ll be ahead of the game when it comes to beating the odds on reimbursements and appeals.

Use the 10-item checklist below to organize all the elements required for correct coding:

1. Keep charts neat and complete. Encourage all practice personnel to keep legible, clear charts. Maintain a “Most Wanted” file that highlights commonly used codes that require additional documentation or support materials – and make sure office personnel are aware of these.

2. Sweat the small stuff. Be aware of which modifiers to use. Why, where, and when do you need to use those little add-ons? Understanding your carriers’ rules about how to use modifiers can increase your reimbursement potential.


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