Stop Forfeiting Level Four and Five E/Ms With 3 PFSH Tips

Posted on 08. Jun, 2011 by in Hot Coding Topics, Provider News.

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Make your physician’s job easier by letting the patient or nurse document the history.

If your physician glosses over a patient’s past, family, and social history (PFSH), you may be missing out on up to $69 per E/M.  Accurately counting the number of PFSH items could result in more money for an encounter, because the top-level E/M codes require PFSH elements in addition to an extended history of present illness, and more than 1 system reviewed. Learn these three quick tips to ensure your physician is capturing, and you’re recognizing, every history component the patient mentions.

1. Determine the Level of PFSH

For coding purposes, the history portion of an E/M service requires all three elements — history of present illness (HPI), review of systems (ROS), and a past, family and social history (PFSH).  Therefore, the PFSH helps determine patient history level, which has a great effect on the…

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Know the Ropes for Problem Discovered During Well-Visit

Posted on 08. Jun, 2011 by in Coding Challenge, Hot Coding Topics.

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Question:

We have a Medicaid patient that came in for a ten year-old physical and was found to be sick, so we would like to append modifier 25 to report the well turned-sick visit. Is that accurate?- Virginia Subscriber

Answer:

Yes. In this situation, you’ll report 99393 (Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; late childhood [age 5 through 11 years]) with the diagnosis code V20.2 (Routine infant or child health check).

This requires that all of the elements of the preventive visit are met, even though the child is ill.  In addition, you’ll report 9921x-25 (Office or other outpatient visit for the evaluation and management of an established patient; Significant, separately identifiable evaluation and management service by the same physician on the same day of

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Considering Gilenya Administration? Answers to Top 3 FAQs are Here.

Posted on 20. May, 2011 by in Hot Coding Topics.

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Staying with basic 99211 might be safest option.

If you’re shaky on how to report Gilenya (fingolimod) as a first-line treatment for relapsing forms of multiple sclerosis (MS, ICD-9 code 340), you’re not alone. Gilenya questions have circulated ever since the FDA approved the drug in September 2010. Check our answers to three of the most common questions coders have so you’ll be ready when your neurologist offers the initial treatment dose to patients.

1. What’s the Best HCPCS Code?

“Gilenya is newly approved by the FDA, so there’s no HCPCS code for the drug,”says Catherine Nolin, CPC, a specialty based coder with Central Main Medical Center in Lewiston.

Result: Your only HCPCS choice currently is J3490 (Unclassified drugs), but

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Learn the Keys to Properly Coding MACE, Mitrofanoff, and More

Posted on 20. May, 2011 by in Hot Coding Topics.

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You’ll be able to report anastomosis with some procedures and not others.

If your urologist sees pediatric patients you may occasionally run across some procedures that you’re not used to coding.  When your urologist performs a Malone antegrade colonic enema (MACE), a Mitrofanoff procedure, or a Monti procedure, you might be left scratching your head over the proper code choice.  Follow this expert guidance to ensure you’re reporting the proper codes for every pediatric surgery your urologist performs.

Differentiate MACE and Mitrofanoff Before Coding

The MACE and Mitrofanoff procedures are similar, as both are used mainly in pediatric patients and involve similar anatomy, which makes coding for them a challenge.

MACE: For the MACE procedure, the physician uses the appendix or other small section of bowel to create an opening attached to the skin (a cutaneous stoma) to be used to irrigate antegrade with a catheter fecal matter from the…

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$56 Question—Are You Downcóding Your E/M Visits?

Posted on 20. May, 2011 by in Hot Coding Topics, Provider News.

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You’re not only losing revenue—you’re also coding improperly.

CMS data from previous years shows that medical practices undercodè E/M claims to the tune of over $1 billion annually—that’s money that physiciáns could have collected based on their documentation, but forfeited because they reported a lower-level codè than they should have. But remember that your responsibility as someone who submits claims to Medicarè is to codè based on the documentation—anything else is incorrect coding.

If you’re one of the practices that’s downcoding claims, take note of the following reasons that you should codè based on your documentation rather than undercoding.

Could You Be Triggering an Audit?

The number one reason that many practices undercodè is because they don’t want to “trigger an audit.” However, coding all low-level E/M codès is sure to get a payer’s attention, because the claims reviewers will be wondering why you never offer high-level evaluations to your…

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10120 or Beyond: Site, Depth, Complexity Drive Códe Choice

Posted on 20. May, 2011 by in Hot Coding Topics.

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Follow 3 pointers to snag maximum pay.

From just under the skin to deep within the bowels, your general surgeon might perform a foreign body removal (FBR) that calls on a wide range of coding know-how. Zero in on the right codè every time by implementing these four principles:

1. Use 10120-10121 for Any Site Under Skin

If your surgeon makes an opening to remove any foreign body, such as a glass shard or a metal filing, but doesn’t indicate an anatomic site or depth in the op report, you’ll probably choose 10120 (Incision and removal of foreign body, subcutaneous tissues; simple). You can’t choose a more specific codè if the surgical report doesn’t provide any more documentation.

Caveat: Because the codè requires incision, look for a sharp object when considering 10120. If the documentation doesn’t include this detail, use an E/M service codè (such as 99201-99215, Office or Other

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Adjust Your Codès Easily When Diágnosis Changes During A Patient’s Hospital Stay

Posted on 20. May, 2011 by in Hot Coding Topics, Provider News.

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Educate your physicián to keep you in the loop on patients’ development.

Just because a patient enters the hospital with one diágnosis doesn’t mean she’ll have that diágnosis for her entire stay. And if you bill for your physicián’s hospital visits with an out-of-date diágnosis, you could lose money or face fraud charges.

The problem: Diagnoses can change in the hospital due to various reasons, including the following, among others: The physicián may narrow down the patient’s problem. For example, a patient may be admitted with chest páin, and the doctor may rule out myocardial infarction and decide the problem is actually gastrointestinal in nature.

The patient may develop other problems. The patient may be admitted for dehydration problems but may start having chest páins.  The patient may experience complications that lead their original complaint to worsen significantly.  You can’t wait for the hospital to send you medical…

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Overcome 3 Myths and Claim Reimbursement Opportunities using Modifier 22

Posted on 20. May, 2011 by in Hot Coding Topics, Provider News.

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Don’t fall for these common body habitus, time, and fee traps.

If you overuse Modifièr 22 (Increased procedural services), you may face increased scrutiny from your payers or even the Office of Inspector General (OIG). But if you avoid the modifièr entirely, you’re likely missing out on reimbursement your cardiologist deserves.

How it works: When a procedure requires significant additional time or effort that falls outside the normal effort of services described by a particular CPT® codè — and no other CPT® codè better describes the work involved in the procedure — you should look to modifièr 22. Modifièr 22 represents those extenuating circumstances that do not merit the use of an additional or alternative CPT® codè but do land outside the norm and may support added reimbursement for a given procedure.  Take a look at these three myths — and the realities — to ensure you don’t fall victim…

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11400s Max Out With Margin Measurements

Posted on 20. May, 2011 by in Coding Challenge, Hot Coding Topics.

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Question:

If our surgeon removes a sebaceous cyst from the back  that measures 2.5 x 1.75 x 0.5 cm, should we add up all the dimensions or should we just use the biggest dimension of 2.5? Is the answer the same if this were a tumor instead of a cyst?  – Kansas Subscriber

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Specialists’ Non-Physicián Practitioners Can Collect Primary Care Incentive Bonuses

Posted on 20. May, 2011 by in Coding Challenge, Hot Coding Topics.

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Question: Our cardiology practice employs a non-physicián practitioner (NPP) who performs a lot of E/M services for our patients, and that NPP received a bonus payment as part of the Primary Care Incentive Payment Program, which surprised us. We wanted to double-check this — is a non-physicián practitioner working for a specialist eligible to collect primary care incentive bonuses that are being distributed as a result of the Affordable Care Act rule?

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