Question: A patient presents with a non-healing surgical wound from a past nephrectomy in 2006. The patient has diabetes. The doctor is going to do an exploration of a draining sinus of the left flank. Would 20102 be appropriate?
Answer: You should code this procedure according to what the doctor found, and what he did at the time of surgery. If he found and drained a chronic abscess located in the retroperitonium, then report code 49060 (Drainage of retroperitonel abscess; open). If the doctor just excised the fistula or draining sinus to its origins in the flank, you should then use code 11043 (Debridement; skin, subcutaneous tissue, and muscle) with the diagnosis of fistula to the skin (686.9).
Why not 20102? A code from the 20100-20103 (Exploration of penetrating wound [separate procedure] …) range will often be your best choice to describe exploration of “penetrating” wounds. Generally, explorations of this…
ICD-10 will more than quintuple the number of diagnosis codes — from approximately 13,000 to 68,000? Preparing for ICD-10 will take years, and if you wait any longer to get started, you won’t be ready when CMS pulls the plug on ICD-9. Get all the information you need during this audio learning session.
Posted on 08. Jan, 2009 by in Provider News.
Drug reps can create a backlog at the front desk. But at least they come bearing nifty swag, right?
Wrong. The pharmaceutical industry has pledged to stop giving away goodies at physician offices, starting Jan. 1, reports The New York Times.
“No longer will Merck furnish doctors with purplish adhesive bandages advertising Garadasil,” the paper reports. “Banished, too, are black T-shirts from Allergan adorned with rhinestones that spell out B-O-T-O-X.” More …
Are drug reps paining your scheduling system? Get these handy front desk management tips …
Question: Which CPT code is appropriate for PET performed to evaluate the brain?
Answer: You have a few different options to choose from, so you need to check your documentation to determine which code is appropriate.
If the physician performs a metabolic evaluation, providing information on oxygen, glucose, or drug metabolism, for example, report 78608 (Brain imaging, positron emission tomography [PET]; metabolic evaluation).
Note: For evaluating tumor response to therapy, the Society of Nuclear Medicine (SNM) suggests using 78608 instead of 78814 (Positron emission tomography [PET] with concurrently acquired computed tomography [CT] for attenuation correction and anatomical localization; limited area [e.g., chest, head/neck]).
Reason: SNM suggests the term “brain” in 78608 makes it more specific and therefore more appropriate than 78814, which is for any limited area, including a head/neck scan.
If instead, the physician performs a perfusion evaluation, using the tracer accumulation…
Posted on 08. Jan, 2009 by in Hot Coding Topics.
This directive stops the sending physician from committing an $860 global critical care error.
If both the sending and receiving physician bill for same-day global critical care, you could put your claim on the path to denial – costing one physician $860 in pay.
CPT 2009 throws neonatal inpatient coding a curve ball. Make sure your transport and discharge reporting skills are up to par with this 2-question quiz.
Question #1: One physician admits a newborn to a hospital. The newborn is then transferred to a different hospital where another physician sees the newborn. Both physicians used 99295.
The insurer paid the first 99295 but denied the second physician’s 99295 as duplicate. Does a modifier apply? Click for answer & full article.
Are you using CPT 2009’s newborn codes correctly? Learn how to take advantage of the revamped newborn and pediatric codes at our coding and reimbursement conference.
It’s not only federal payers nudging providers to install electronic medical records systems. New York City officials have hopped on the EHR bandwagon.
The city will foot more than 75% of the EMR installation tab for New York City medical practices that meet certain criteria. That means a system that would cost a typical doctor’s office $45,000 to install has only a $10,000 price tag under the new program. More …
Get the tools you need to decide whether EMR is a money-saver for your practice.
Question: A surgeon excised a carcinoma of the face. He closed the excision using adjacent tissue transfer. Can you report 14040 and 11643?
Answer: No. You should report 14040 (Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; defect 10 sq cm or less) for the closure using existing tissue transfer.
In this case, you should report 14040 only. The lesion excision (11643, Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm) is included in the tissue transfer.
Exception: There is one exception to this coding scenario. If your surgeon performed the excision on a separate (earlier) day from the tissue transfer, you may report the procedures separately. This may have occurred, for example, if the doctor wanted to wait for the pathology report to be sure the margins are clear before…
Time-Saver: Policies and Patient Letters You Can Implement Today
Missed appointments hurt a practice’s bottom line. If you’re tired of losing money on no-shows, try these tools that educate your patients about your financials policies-including charges for missed appointments.
It’s yours: Try this sample financial policy and two sample letters to help you communicate clearly to patients.
Purpose: To notify patients of a possible financial penalty for failure to cancel a scheduled appointment. Missed appointments have an impact on the physician’s schedule and can also pose a health risk to the patient. When a patient does not show up for an appointment or cancels an appointment on short notice, we will make a note in his/her medical record.
Failure to give 24-hour notice of cancellation of an appointment or not showing up for an appointment can result in a charge of…
Posted on 07. Jan, 2009 by in Toolkit.
100 percent pay possible if NPP follows internist’s care plan.
If you do not consider billing “incident to” the physician when a qualified non-physician practitioner (NPP) performs services for Medicare patients, you are letting deserved reimbursement fly out the door.
Bottom line: When you bill incident-to, you garner 15 percent more per service than if you bill under the NPP’s national provider identifier (NPI). Incident-to coding does have some strict rules, though. To ensure that all your incident-to claims are on target, answer these questions before billing.
1. Has Internist Established Plan of Care?
To qualify for incident-to billing, the internist must see the Medicare patient during the initial visit and establish a clear plan of care … More …
Posted on 06. Jan, 2009 by in Hot Coding Topics.
The next best thing to a Secret Decoder Ring is this Easy-Access Chart.
CMS uses lots of symbols and abbreviations in the Physician Fee Schedule, and hunting down what they mean can be a labor-intensive chore in your already-busy day. We’ve put the definitions for status indicators in the easy-to-use chart below.
The PFS status indicator tells you whether the CPT/HCPCS code is in the PFS and whether Medicare will pay the code separately.
Example: Injection and intravenous infusion chemotherapy codes 96401-96417 all have A (Active) status. But 96523 (Irrigation of implanted venous access device for drug delivery systems) has status indicator T, which means when you provide an infusion on the same day as the irrigation, Medicare will only reimburse you for the infusion.
• A — Active code. When these codes are covered, Medicare will separately pay them. You’ll see RVUs for these…