Physician Notes: CMS: Submit Requested Documentation Within 45 Days, or Face Denials

Posted on 25. Feb, 2015 by in Provider News.


Plus: CMS releases 2015 therapy cap amounts

If your payer is performing a pre-payment audit of your claims, the MAC will typically ask you for additional documentation. In the past, some MACs would say you had 30 days to submit the documentation, while other insurers might not have given you a timeframe. CMS has cleared the air on this topic, confirming that you have 45 days to respond to an Additional Documentation Request (ADR), CMS says in MLN Matters article

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ICD-10: Screening Drug Test Orders Use Many Diagnoses

Posted on 25. Feb, 2015 by in ICD-10.


Get ready for new options later this year

When your lab performs a screening drug test, you can’t expect to get the same diagnosis code every time.

Instead, the reasons clinicians order a drug screen are as varied as the drugs themselves — and your code choices are about to get even more varied when ICD-10 goes into effect on Oct. 1.

Check Out These Crosswalk Options

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Reader Question: Demonstrate Distinct Multiple Procedures to Unbundle CCI Edits

Posted on 25. Feb, 2015 by in Coding Challenge.


Question: Our podiatrist visited an established patient at a nursing home but noted an infection and tinea pedis not previously seen. His notes describe an I&D on the left hallux, and he also wrote orders for the tinea pedis. Additionally, he performed nail care 11721 with Q8. How should I code this encounter? Please share some info on the I&D procedure.

Missouri Subscriber


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Practice Management: Avoid Brutal HIPAA Fines with These 3 Steps

Posted on 25. Feb, 2015 by in Hot Coding Topics.


Take HITECH lessons to heart, and protect your bottom line.

They might look like a barrage of random numbers, but two recent reports about HIPAA breaches actually contain nuggets of wisdom that you can use to protect your patients’ private health information.

Make sure you apply the following important lessons from the Health Information Technology for Economic and Clinical Health (HITECH)-mandated reports to keep your general surgery practice out of the penalty zone.


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ICD-10: Ebola Diagnosis: A Code You Hope You Never Need, But Should Know How to Report

Posted on 12. Feb, 2015 by in ICD-10.


Contact with and suspected exposure codes are also relevant in Ebola outbreaks

Ebola Virus cases have been everywhere in the news recently and focusing a lot of attention of emergency departments. The medical team has to get the diagnosis right to appropriately treat the patient and prevent widespread exposure to the community. As a coder, you must get the diagnosis code right, as well, for both tracking purposes and accurate payment for services rendered.

Consider this scenario: A 42 year-old health care worker comes to the ED because of a low grade fever. He had recently returned from a medical mission where he was caring for patients who had Ebola Virus Disease (EVD). There are no other symptoms and the patient is medically stable. Based on current Centers for Disease Control and Prevention and your local health department’s guidelines, the patient will be admitted to a special quarantine unit. What…

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Reader Question: Document Donor Site to Code Advancement Flaps

Posted on 12. Feb, 2015 by in Coding Challenge.


Question: Our surgeon closed a deep abdominal wall defect that was approximately 440 sq. cm. using 300 sq. cm. flaps on each side. Should I report just the repair, or can I separately code the advancement flaps?



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E/M Coding: Can you Spot the Problem With This E/M Code Assignment?

Posted on 12. Feb, 2015 by in Provider News.


A thorough read is all it takes to identify the most glaring issue.

Sometimes, we’re so quick to review a physician’s documentation that we can gloss over important facts within the records, which can lead to assigning the wrong code. Read through the following documentation example and see if you can identify the problems with the physician’s code assignment.

Date of service: Dec. 8, 2014

Chief complaint: The patient presents today to assess the status of his left shoulder abscess, on which we performed an I&D on Dec. 1.

HPI: This 77-year-old male is improving with no further problems and there are no stitches that need to be removed. He is back to his normal activities of daily living and his urination and bowel movements are normal. He is not using pain medication and he reports that the incision is healing well.

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News Flash: Look Ahead to New Global Periods Coming Your Way in 2017

Posted on 12. Feb, 2015 by in Hot Coding Topics.


Plus: If CMS prevails, you may get paid less for surgical procedures.

Global periods affect every provider’s coding, billing, and reimbursement, whatever the specialty and place of service might be. Figuring out when you can and can’t bill office visits for patients who have recently had a procedure performed may get easier, thanks to a proposed rule from CMS for the Medicare Physician Fee Schedule (PFS).

Read on for the scoop about CMS’s plan to eliminate global periods for surgical procedures and how the changes could affect your practice’s bottom line.

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Latest CPT® Assistant Reveals Sigmoidoscopy and Colonoscopy Changes for 2015

Posted on 11. Feb, 2015 by in Hot Coding Topics.


The December 2014 CPT® Assistant is chock-full updates for the lower gastrointestinal (GI) endoscopy code set. Find out how the revisions made to terminology, definitions, and guidelines will impact the reporting of codes for ileoscopy, flexible sigmoidoscopy, colonoscopy through stoma, and colonoscopy in CPT®2015. The issue also briefs you on how to appropriately report percutaneous coronary intervention (PCI) procedures.

Reviewing the latest issue will also improve your understanding about a new sub-section CPT® added to the E/M section titled advance care planning. You’ll also benefit from a comparison between ICD-9-CM and ICD-10-CM structure and format. To get spot-on guidance, simply type a code or keyword into’sCode Connect to see the December article that suits your needs:

  • Advance Care Planning: 99497-99498
  • Coronary Therapeutic Services and Procedures:  92920-92944, 92973-92974, 92978-92979, 93454-93461, 93563-93564, 93463, 93571-93572
  • ICD-10-CM Seventh (7th) Character
  • Sigmoidoscopy and Colonoscopy Changes: 44380-44408, 45330-45347, 45339, 45345, 45346, 45347, 45349, 45350,

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ICD-10: Get to Know CMS’s ICD-10 Guideline Updates

Posted on 28. Jan, 2015 by in ICD-10.


Some revisions may actually seem very familiar. 

Even though you still have another year before ICD-10 goes in to effect, that doesn’t mean CMS has stopped preparing for the new diagnosis coding system. In fact, the agency recently released a transmittal that should help you clarify some of the rules surrounding how you’ll report these codes when insurers start requiring them on Oct. 1, 2015.

Changes Match ICD-9 Guidelines

CMS issued Transmittal 3020 on Aug. 8, and it announces revisions to the official ICD-10 Coding Guidelines which put them more in line with the current ICD-9 rules. For example, CMS revised the ICD-10 regs to now say, “Do not code diagnoses documented as ‘probable,’ ‘suspected,’ ‘questionable,’ ‘rule out,’ or ‘working diagnosis’ or other similar terms indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reasons…

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