Mid-Level E/M Coding Breakdown
Posted on 09. Mar, 2009 by in Toolkit.
Our chart shows you how to choose among 99212, 99213 & 99214.
You can’t use just history and examination to boost an established office visit from a level two to a level three, or a level three to a level four.
Medical necessity should serve as the overarching criteria that steers the key components of history and exam that the pediatrician performs.
You also need documentation of two of the listed three key components of history, examination, and medical decision making. (Or, when the physician spends the majority of the encounter’s face-to-face time on counseling and/or coordination of care, she can use time as the controlling factor in selecting the E/M service level.)
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99000 Lab Specimen Handling: More Than Just a Messenger Fee
Posted on 09. Mar, 2009 by in Hot Coding Topics.
The AMA changed its mind — and you should change your policy.
If you reserve 99000 for incurring charges, you need a primer on the code’s musts to collect this fee from private payers.
“I am under the impression that the code can only be used if you collect the specimen then send it to an outside lab,” says Jamie Kurrasch, CPC, with Primary Care Partners, PC in Junction City, Colo. She’s looking for a code her lab can use for the specimen collection for the flu and RSV test that the practice runs at its in-house lab.
Check out these 99000 guidelines.
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Coder’s Anatomy: Tongue Base Suspension
Posted on 06. Mar, 2009 by in Hot Coding Topics.
If you have trouble visualizing what happens in the operating room during surgical procedures to fix sleep apnea, here’s the scoop on 41512 from Dr. Charles Koopmann, an otolaryngologist and reimbursement expert at the University of Michigan Medical Center.
Tongue Base Suspension is performed under general anesthesia. (You’ll understand why as you read more; it sounds like it hurts.) It used to be reported with an unlisted code, but now it has its own. Don’t confuse this procedure with 41500 or 41510, the good doctor warns.
“The procedure involves placing sutures through the tongue to pull it anteriorly, especially the tongue base,” Dr. Koopmann told attendees at the recent Coding Institute conference in Las Vegas. The “suture is fixed to screw on the inner table of the mandible, intraoral or submental approach.”
Results the surgeon is aiming for: Enlarge the retrolingual airway to prevent obstruction during sleep.
AN AUDIO MUST-LISTEN: Modifiers for Otolaryngology, with Barbara Cobuzzi.
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New Tool Can Help You Slash A/R for Cigna Patients
Posted on 06. Mar, 2009 by in Provider News.
In April, Cigna will launch its new ‘Cost of Care Estimator’ nationwide, reports American Medical News.
How it works: When the patient comes in, a biller enters CPT codes associated with the plan of care. The tool breaks down what Cigna will pay, and then estimates the patient’s portion.
Cigna tested the tool at 13 hospitals and with 250 physicians, AMNews reports. Pilot phase participants report that, without the tool, they underestimate what the patient will owe and are left with the task of collecting the difference later … More …
WEBINAR: Telephone Triage Tips for the Front Office, with Jill Young.
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10 Carrier Contract Negotiation Tips
Posted on 06. Mar, 2009 by in Toolkit.
Carrier contract negotiation is often a long, difficult process. If you don’t ask the right questions, you could end up in a binding contract that doesn’t work well for your practice. Don’t sign a new carrier contract without reviewing the following 10 items first:
• Speak up. Don’t let carriers make you feel intimidated. Negotiate for what will help, not hurt, your practice.
Going mano-a-mano with Medicare? You’ve got to know these rules.
• Avoid boilerplate text. Standard contracts don’t work for all practices. Make sure you read each word, and don’t skip over “standard” wording.
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Anesthesia & Pain Management Denials: Sweep Them Away Now
Posted on 06. Mar, 2009 by in Hot Coding Topics.
‘Good Housekeeping’ tips that reduce denials.
Tip 1: Beware Messy Bundled Anesthesia Services
Most anesthesia services are bundled with other services. According to Cindy Lane, CPC, CHCC, with Advanced Coding Solutions LLC in White House, Tenn., you need to stay up to date with the most recent Correct Coding Initiative (CCI) edits. Currently, anesthesia includes services such as:
• Transporting, positioning, prepping, draping of the patient for satisfactory anesthesia induction/surgical procedures
Training Event: Secrets for getting paid for endoscopic anesthesia.
• Placement of external devices necessary for cardiac monitoring, oximetry, capnography, temperature, EEG, CNS evoked response, Doppler flow
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Modifier 25 vs. Modifier 57: Here’s an Easy Way to Choose
Posted on 05. Mar, 2009 by in Hot Coding Topics.
If choosing between modifier 25 and modifier 57 is a head scratcher, check out this easy way to remember the difference from John Verhovshek at the AAPC.
“Modifier 25 applies to E/M services separately provided with minor procedures–those having 0-day, 10-day, or no global period,” he writes in the March issue of Coding Edge. Modifier 57 is for E/M services that prompt a major surgical procedure with a 90-day global period.
Check out our 2009 Modifier Coding Survival Guide.
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ARRA Sharpens HIPAA’s Teeth
Posted on 05. Mar, 2009 by in Provider News.
If you’ve been lax on overseeing your practice’s privacy compliance, now is the time to shore up those processes.
The government’s stimulus bill,known as the “American Recovery and Reinvestment Act of 2009″ (ARRA), strengthens the HIPAA requirements that practices face, increasing penalties for privacy breaches, and creating restrictions on how you can share protected health information (PHI).
Important: The bill will require your practice’s business associates to implement policies that establish administrative and technical safeguards; those associates could face fines or penalties if they breach the HIPAA rules.
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Worksheet: Visual Field Exam Coding & Documentation
Posted on 05. Mar, 2009 by in Toolkit.
If your ophthalmologist isn’t following the extensive documentation requirements for you to code visual field tests, you’re setting yourself up for medical necessity questions and an audit.
ON-DEMAND AUDIO: Eye code or E/M code. Deb Grider shows you how to tell for sure.
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Audit-Proof Your ‘Incident To,’ 99211 ‘Nurse Visits’
Posted on 05. Mar, 2009 by in Hot Coding Topics.
Safeguard almost $20 per claim
With incident-to services on insurers’ radar, you’ve got to ensure documentation supports your 99211 claims to avoid facing huge paybacks.
Code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of the physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) pays approximately $18.75 (0.52 relative value units on the 2009 Medicare Physician Fee Schedule) per encounter.
AUDIO: Exact documentation requirements for 99211 visits, with Kim Garner-Huey.
To see if your 99211 charges will stand up on review, take this quiz.
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