Question: An established patient complains of trouble breathing and frequent coughing; she also says that “it hurts when I breathe.” During a level-three E/M service, the physician diagnoses obstructive chronic bronchitis without exacerbation, prescribes antibiotics, and sends the patient home. Do you need to code the patient’s presenting symptoms, or just the bronchitis?
Answer: You’ll append a single diagnosis code to the E/M. Since the physician reached a diagnosis during the encounter, there is no need to code for the patient’s presenting symptoms.
On the claim, report the following:
• 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity …) for the E/M.
• 491.20 (Obstructive chronic bronchitis; without exacerbation) appended to…
Clip and save these 5 simple questions and code E/M correctly every time.
New or established? Getting it wrong can cost you reimbursement dollars or set you up for audits.
So don’t sweat it. Take the AMA’s advice and follow this simple flow chart to correctly code your evaluation and management claims.
1. Has the patient ever received any professional services from any physician in this group?
Yes: go on to question 2
No: The patient is New
2. Has the patient received any professional service from a particular physician within the past three years … Get the complete flow chart here.
Learn about new revenue opportunities for “Welcome to Medicare” in this on-demand E/M coding update for 2009.
Don’t miss how physician review can earn you an extra $25.
Ask three different people how to code mobile cardiovascular telemetry in 2008, and you’re likely to get three different answers — with various opinions on the number of units to boot.
Good news: CPT 2009′s “Cardiography” section adds two new … More …
Special On-Demand Audio: Jim Collins’ 2009 CPT Update.
Did you know that auditing for overpayments is a great investment for payers?
For every $1 Medicare and carriers spend looking for overpayments, they get $18 from providers that have to pay the money back. Protect your billing from mistakes that can cost you thousands in returned overpayments. Learn what federal, carrier and RAC auditors are looking for …
Posted on 30. Dec, 2008 by in Provider News.
They’re from the government, and they’re here to help you.
If your practice is still looking for the best way to hop on the e-prescribing bandwagon — and start collecting your 2 percent bonus from Medicare — CMS has published a guide to get you started … more…
Question: When you use a chemo admin code for a drug that isn’t chemo (such as Remicade or IVIG), should you still report V58.11?
Answer: No. You should report V58.11 (Encounter for antineoplastic chemotherapy) only for patients receiving chemotherapy. If you report a chemotherapy code for antineoplastic immunotherapy, you may report V58.12 (Encounter for antineoplastic immunotherapy) instead. If you use a chemotherapy code for a substance that is not antineoplastic, such as Remicade, you should not use either V58.11 or V58.12.
Got more questions on oncology coding? Get two audioconferences — and two CEUs — in one package.
Posted on 30. Dec, 2008 by in Hot Coding Topics.
How to lower A/R with RTCA.
Rising costs and increased patient payment responsibility is hitting some practices where it hurts — their incomes. But some payers, such as Highmark in Pennsylvania, are offering you a tool to help you bring in every dollar.
Lower Your A/R: Highmark has introduced a real-time tool that will allow billing and collections departments to estimate the cost of services for specific patients. In turn, the hope is that patients will gain a better understanding of their individual payment responsibility and that the tool will allow the practice to set up financial arrangements when necessary. The cost estimate takes into account the individual patient … More…
Question: A urologist wants to bill for an ultrasound on the bladder to check volume, done in a clinical setting. Which ultrasound code is best?
Answer: You should report 51798 (Measurement of postvoiding residual urine and/or bladder capacity by ultrasound, non-imaging) for this service. If your urologist does the bladder sonogram primarily to determine the postvoid residual urine (PVR), use 51798 no matter what equipment the urologist uses and whether or not he derives an image from the equipment.
Pitfall: If the urologist uses the sonogram primarily to view the anatomy or architecture of the bladder, and the PVR is only part of–but not the main reason for–the study, bill 76857 (Ultrasound, pelvic [nonobstetric], real time with image documentation; limited or follow-up [e.g., for follicles]).
This is the only circumstance in which you should bill 76857. Most urologists, however,…
Posted on 26. Dec, 2008 by in Toolkit.
Trapped in a SNF consolidated billing maze? We’ve got the way out.
A set contract with the skilled nursing facility boosts your chances of receiving payment for the technical aspects of diagnostic services your physician performs on SNF patients … More …
Yes. $236 million. That’s how much medical practices in all specialties lost due to undercoding in Medicare’s latest Comprehensive Error Rate Testing (CERT) period.
Example: One medical oncology practice billed Medicare for 5 mg of dexamethasone sodium phosphate (J1100), but the documentation revealed that the practice actually dosed 20 mg. This means the practice shorted itself for 15 mg worth of reimbursement.
Are you selling yourself short by undercoding prolonged services? Barbara Cobuzzi’s seminar explains the latest changes to those codes, and how to optimize your reimbursement.