Wound Care Tip: CPT 29580
Posted on 02. Mar, 2009 by in Hot Coding Topics.
The CPT descriptor for 29580 mentions an Unna boot, but clinicians aren’t UNanimous on their UNna boot terminology, warns wound care coding expert Annette Grady.
‘Dynflex,’ ‘Profore,’ & ‘Multi-Layer Compression’ are other terms you might see in a note documenting a 29580 service, Grady says.
AUDIO EVENT: Wound Care Coding Essentials with Annette Grady.
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How Obama’s Medicare Cuts Hit Physician Reimbursement
Posted on 27. Feb, 2009 by in Provider News.
The budget released Thursday suggests we cut $300 billion from Medicare & Medicaid reimbursement over the next 10 years.
Where will the savings come from, even as more and more Americans become eligible for Medicare? The answers lie within the bowels of the budget outline (Table S-6 on page 127), points out The Wall Street Journal.
Highlights of cuts that will affect physician practices, plus potential pitfalls doctors should watch out for, given what we know now:
The budget says: ”Drive down hospital readmission rates for Medicare patients to save $8.43 billion.”
Coding News Prediction: Expect more physician profiling of clinicians who do high-risk procedures or operate on the sickest patients. Start sharpening your V-coding skills now.
The budget says: “Use radiology benefit managers for Medicare to save $260 million.”
Coding News Prediction: Required pre-authorization for diagnostic radiology procedures on Medicare patients, or a diagnostic radiology cap?
The budget says: Use “private sector enhancements” to ensure that Medicare “pays accurately” to save $2.04 billion.
Coding News Prediction: RAC audits are here to stay.
ON-DEMAND AUDIO: Deb Grider shows you how to survive the RACs.
To read the budget, click here and go to page 127.
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Stark Snag = False Claims Liability?
Posted on 27. Feb, 2009 by in Provider News.
Physician practices looking to steer clear of anti-kickback, Stark, and even false claims liability should take a close look at a recent decision from the 3rd U.S. Circuit Court of Appeals involving a ‘safe harbor’ arrangement between an anesthesiology group and a hospital.
Some lessons learned from the case …
Don’t rely on the hospital for contract revisions that keep you in the safe harbor: A 1992 contract between the anesthesiology group and the hospital was an issue. While the original agreement had been in a safe harbor, it didn’t cover pain management services the anesthesiologists later added.
The Stark violation surfaced in a whistle-blower’s false claims complaint: The connection between Stark and FCA is “probably something that’s here to stay,” an attorney tells American Medical News … More …
2009 Audio Update with Stark attorney Wayne Miller.
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Observation Coding Do’s and Don’ts
Posted on 27. Feb, 2009 by in Toolkit.
What’s the POS for an ED hallway? Answers to 5 FAQs
When coding observation services, knowing the proper code choice is often only part of the task. Even if you are schooled in the coding conventions for observation, you might find yourself with a question or two when it comes time to file your claim.
ICD-9 coding tips especially for ED coders.
Keep this FAQ list handy for your observation claims:
• What should I do if the ED physician provides observation service in a non-traditional setting, such as an ED hallway area? Code the service just as you would normally. Observation is a type of service, not a place of service.
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5 Steps Ensure Correct Observation Care Coding
Posted on 27. Feb, 2009 by in Hot Coding Topics.
To prevent ED denials, code service only when doc makes admission decision.
Although CPT offers two observation code sets, and encounters that look like observations may actually be other E/M services, your observation coding can be spot-on every time simply by following this five-step plan.
Step 1: Confirm Type of E/M Service
Before coding, be sure that the service qualifies as an observation. “Observation is a hospital-based outpatient service used to determine if a patient needs inpatient care. Most payers limit the time a patient may be in observation status to 23 hours, though some (Georgia Medicaid, for example) allow as long as 48 hours,” explains Jeffrey Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance at Emergency Pediatric Group Children’s Healthcare of Atlanta at Egleston.
One code or two for observation? Kenneth Engel shows you how to decide.
So when you’re reviewing the notes, ensure claim correctness by checking the encounter specifics against Linzer’s observation definition.
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Dawn of a New ARRA
Posted on 27. Feb, 2009 by in Hot Coding Topics.
Did you know that ARRA, the new stimulus package, is predicted to drive 90% of physicians to adopt certified electronic health records within the next 10 years? And, that EMR can actually help you with the ICD-10 implementation you need to accomplish over the next 5 years?
Kick-start your EMR & ICD-10 action plan with the AAPC’s Sheri Poe Bernard.
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Spot the Newborn Code You Need in a Snap
Posted on 26. Feb, 2009 by in Toolkit.
This crosswalk helps you navigate CPT’s 2009 newborn E/M section.
The work of overhauling your normal newborn care ticket will go so much faster, thanks to this cheat sheet.
All newborn care and pediatric critical and intensive care services follow each other in this new-for-2009 streamlined system. You’ll need to update these codes … Click here for chart …
Don’t be a babe in the woods when it comes to pediatric coding. Specialty conference in Orlando.
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Know What Separates FBR From E/M or Lose $80 in Pay
Posted on 26. Feb, 2009 by in Hot Coding Topics.
Here’s why ‘incision’ with non-scalpel instrument could be an FBR.
If you cannot spot simple or complicated foreign body removal (FBR) qualifiers, you could end up costing the ED more than $80 for a simple removal, or more than double that per complex episode. Galvanize your soft-tissue FBR coding skills with this expert advice.
Follow CPT for FBR Definition
Coding for soft-tissue FBRs seems simple enough: A patient reports to the ED with an FB, the physician removes it, and you choose an FBR CPT code.
Not so fast: The above scenario might be an FBR, but it might also be an E/M service. To report one of the soft-tissue FBR codes, the encounter should fit the following description, from Joshua Tepperberg, CPC, EMT-D: The provider makes an incision to the overlying skin, and then removes the FB.
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Incorrect Coding Time Bomb: 37202
Posted on 25. Feb, 2009 by in Hot Coding Topics.
Make like MacGyver and defuse this coding disaster in your practice.
Physicians all think they can code 37202 on cardiology claim, and it’s almost always wrong, warns Dr. David Zielske, who spoke at a recent Coding Institute conference.
“37202 is for chemo infusion, stroke patients with vasospasm in the head, or for vassopressin for small bowel or colonic bleeding–these are all procedures that cardiologists don’t do,” Dr. Z. explains. The only time a cardiologist might be using 37202 appropriately? There’s a brand new procedure where they’re injecting the renals with sustained drug therapy, Dr. Z says.
Full Article & Comments
RAC Appeals Run Up ALJs’ Caseloads
Posted on 24. Feb, 2009 by in Provider News.
What to expect when you take a reimbursement dispute to an ALJ
A crucial decision from an administrative law judge could make or break your practice’s reimbursement, so let’s look at some highlights from a new report from the HHS Office of Inspector to learn how the ALJ process is working since its move from the Social Security Administration to HHS in 2005.
In the old days under SSA: ALJs didn’t have any deadline for decisions. They conducted most hearings in person.
The ALJ LowdownToday:
- The ALJs are deciding most cases faster than ever, the OIG says. For cases subject to the 90-day deadline, the ALJs decided 94 percent on time in 2008, compared to 85 percent before the transition from SSA to HHS. That improvement is despite the ALJs’ 37 percent caseload increase during that time.
- One-third of ALJs’ increased caseload, which has jumped 37 percent since 2005, is due to appeals related to Recovery Audit Contractors (RACs).
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