JAMA: Coordination of Care Doesn’t Save Medicare Any Money
Posted on 20. Feb, 2009 by in Provider News.
Here’s how it’s supposed to happen: Patients with chronic, difficult-to-manage conditions like heart disease and diabetes meet regularly with nurses or other physician extenders, in addition to their doctor visits. This coordination of care is supposed to save Medicare money by preventing costly hospitalizations.
Another myth busted? A recent study from the Journal of the American Medical Association found no correlation between coordination of care programs and Medicare cost savings … More …
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Op Note Decoder Ring: IVR & ‘Roadmapping’
Posted on 20. Feb, 2009 by in Hot Coding Topics.
Interventional radiology coders: If you see the term ‘roadmapping’ in a note, that means the physician has superimposed a stored image upon a current image, explains Coding Institute speaker Betty Johnson.
Roadmapping helps doctors view blood vessels, because a stored image of a vessel filled with contrast material can be superimposed on a catheter image made during fluoroscopy.
Don’t Get Lost: Some physicians use the term ‘roadmapping’ much more generally. In their notes, ‘roadmapping’ doesn’t involve superimposing one image upon another, but simply looking around with the fluoroscope to get the lay of the land, warns Johnson. Make sure you understand exactly what your interventional radiologists mean when they use the term.
Betty Johnson’s Guide to Anatomy, Terminology & Physiology for IVR coders.
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Watch Your Back: Bust These 5 Spinal Instrumentation Myths
Posted on 20. Feb, 2009 by in Hot Coding Topics.
Same-session arthrodesis errors? Read on to discover where you might be going wrong.
Myth #1: When coding instrumentation, you need to know the type of device before anything else.
Reality: When you choose CPT codes for instrumentation, location — rather than the type of device — is the most important selection criterion. “I would first look at the approach: anterior versus posterior,” confirms Rebecca Woodward, CPC, coding representative for MedVentures, LLC in High Point, N.C.
Instrumentation may be described as anterior (attaching to the front portion of the spine or vertebral segment, toward the “center” of the body) or posterior (attaching to the back of the spine or vertebral segment, facing toward the back), and can consist of rods, cages, plates, wires, and/or other mechanical devices, says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Lawrenceville, Ga.
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PFS Treasure Chest: Read Medicare’s Mind
Posted on 19. Feb, 2009 by in Hot Coding Topics.
It seems like dry reading, but the physician fee schedule is a treasure chest of tools that help you prevent denials and save time filing appeals when you might as well beat a dead horse, says Coding Institute speaker Betty Johnson.
Take the PFS status indicators as just one example. “If you see a ‘C’ you know you’re going to have to wait awhile for payment because the code is carrier-priced,” Johnson explains. You’ll often see ‘C’ next to new procedures.
If you see ‘I,’ you know Medicare doesn’t every want to see that code on a claim, Johnson adds. Example: Codes involving the pelvis. CPT says the pelvis is bilateral. Medicare argues that the pelvis is one structure. “So when you’re billing Medicare for pelvis stuff, you’ll need to use their G codes,” Johnson advises.
Stay tuned to Coding News for more jewels from Betty’s PFS treasure chest.
Unlock all the secrets to good coding with Betty Johnson’s Everything You Always Wanted to Know About Coding … But Were Afraid to Ask.
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Drug Waste Denials? Carrier Admits Modifier JW Glitch
Posted on 19. Feb, 2009 by in Provider News.
You may not have to waste any time appealing rejected claims that contain modifier JW, according to a recent carrier update.
National Government Services, a Part B payer in 25 states, announced on Feb. 3 that its system was inappropriately rejecting claims appended with modifier JW (Drug amount discarded/not administered to any patient).
AUDIO EXTRA: Easy steps to properly report multiple wasted drugs per claim with Brenda Chidester.
“The JW modifier was inappropriately hitting our system with a termination date of December 31, 2008,” the notice said. “MCS is being updated to remove that termination date. Once the system is corrected we will identify the claims that were rejected inappropriately. Those claims will then be adjudicated to process properly.”
Codes affected by the edit included J0000-J9999, Q3025, Q3026, Q4079, and Q9955-Q9957.
Get the NGS press release at the SNM.
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Glide Through Neoplasm Coding With This At-a-Glance Glossary
Posted on 19. Feb, 2009 by in Toolkit.
Understand primary and secondary malignancies before coding biopsies.
Next time you flip to the neoplasm chart in your ICD-9 manual, keep this list of terms close at hand to choose the code that proves medical necessity and prevents denials.
Discover why the ICD-9′s neoplasm table is your secret anatomy know-how weapon in a CPC exam.
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Get Those Injections Paid: 4 Tips for Peripheral Nerve ICD-9 Accuracy
Posted on 19. Feb, 2009 by in Hot Coding Topics.
350.1 or 729.2? Here’s where your doctor’s terminology will throw you off track.
You are coding a peripheral nerve procedure performed by your neurologist, but her documentation mentions only the trigeminal nerve — a type of cranial nerve. Do you know the right diagnosis code? Clear up any diagnosis code confusion with these inside secrets.
Marvel Hammer’s Pieces & Parts: Must-Know Anatomy Coding Tips for Office-Based Injections.
Tip 1: Note Differences In Physician’s/Coding Terms
The nervous system is divided into two parts: the central nervous system (or CNS), which consists of the brain and spinal cord; and the peripheral nervous system (or PNS), which consists of spinal nerves and cranial nerves.
Full Article & Comments
The ABI Blunder That Blows Away $120 Per Cardiology Claim
Posted on 17. Feb, 2009 by in Hot Coding Topics.
5 essentials help keep your noninvasive study codes watertight.
Your practice may use ankle/brachial indices (ABIs) to help diagnose some of the 8 million Americans who have peripheral arterial disease. But if you miss CPT’s guidance on hardcopies for noninvasive arterial studies, you could be headed for trouble.
Just posted: The agenda & speakers for our 2009 cardiology coding conference!
Work your way through these 5 important rules to keep your accuracy rate at its best.
1. Single vs. Multiple Matters
Take a close look at the descriptors for these noninvasive arterial study codes:
Full Article & Comments
Cardiac Cath Reimbursement Trap: Balloon Angioplasty & Stenosis
Posted on 17. Feb, 2009 by in Hot Coding Topics.
IVR Coders: If you see the term ‘high-grade stenosis’ or ‘high degree of stenosis’ in a balloon note, query the physician about the specific percentage of stenosis involved, warns Dr. David Zielske.
That’s because most insurers will deny a balloon for a stenosis less than 60 percent, Dr. Z explains. If it’s not specifically documented, insurers will assume lack of medical necessity.
Full Article & Comments
Stimulus Package Crash Course for Health Care Providers
Posted on 17. Feb, 2009 by in Provider News.
If your head is swimming trying to figure out what the $789 billion economic stimulus package means to health care reimbursement, the Kaiser Family Foundation has done some of your homework for you.
The House and Senate passed the bill late last week, and President Obama is expected to sign it into law this week.
What health care providers can expect: More insurance will become available for patients, with federal subsidies for COBRA coverage and increased Medicaid … More …
$19 billion for HIT? Here’s what you need to know NOW about health information security.
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