Question: One of our physicians likes to sign everything with just his initials, or sometimes an illegible scrawl. Do we need some type of documentation to support what an auditor might not be able to read?
Don’t miss out on extra pay when global period resets.
Just because you routinely append modifiers to your claims doesn’t mean you’re filing correctly and getting the most appropriate pay. Brush up on your modifier know-how with these tips for three of the trickiest choices: modifiers 58, 78, and 79.
Selecting between these modifiers can be carrier-specific in some situations, says Jacqui Jones, office manager for Benjamin F. Balme, MD, PC in Klamath Falls, Ore.
Remember All Possible Uses for 58
The descriptor for modifier 58 seems self-explanatory: Staged or related procedure by the same physician during the postoperative period. Coders sometimes trip, however, when they forget that modifier 58 actually applies to subsequent procedures that fall into one of three categories:
Planned or anticipated (staged): A good example might be an infected hand that has to be debrided several times over the course of a couple of weeks. You won’t use a modifier on the first procedure, but will add modifier 58 on the subsequent procedures.
New CPT to ICD-9 ‘cross walk’ tool is available to members Nov. 1.
We’ve had so many requests for a CPT to ICD-9 “cross walk” that we moved up our implementation date for this popular denial combating tool to Nov. 1. Advantage members will be able to access the feature under Tools.
Coders are working weekends to bring to you live on Nov. 1, the surgical CPT procedure code to ICD-9-CM CrossRef. By Dec. 1, SuperCoder CPT to ICD-9-CM CrossRef will also include CPT radiology, pathology, and medicine codes. “The CrossRef lets a coder look up a surgical CPT procedure code and see which ICD-9 diagnosis codes Medicare and private payer allow,” explains Jen Godreau, CPC, CPEDC, content director for SuperCoder.com.
Denials for mismatched CPT and ICD-9 codes cost practices thousands of dollars every year. SuperCoder CrossRef will help
CMS clears up flu shot coding confusion.
You’ve heard the advantages of participating in CMS’s Electronic Health Record (EHR) Incentive Program (including $44,000 per-physician bonus incentives over a five-year period), but you may not be sure how to enroll.
CMS staffers cleared up that confusion during an Oct. 5 open door forum, where CMS’s Rachel Maisler indicated that you must register on CMS’s EHR incentive program’s Web site, which will open in January 2011 for the Medicare program.
In addition, you must be enrolled in CMS’s PECOS system and have an NPI, and you must use certified EHR technology. You can find details on how to determine which EHR systems are certified
Make sure your postop office visit documentation measures up.
The OIG has once again set its sights on several new targets to go with the upcoming new year, and this time the feds will be double- and triple-checking your E/M documentation.
On Oct. 1, the OIG published its 2011 Work Plan, which outlines the areas that the Office of Audit Services, Office of Evaluations and Inspections, Office of Investigations, Office of Counsel to the Inspector General, Office of Management and Policy, and Immediate Office of the Inspector General will address during the 2011 fiscal year. When the OIG targets an issue in its Work Plan, you can expect the agency to carefully review and audit sample claims of those services.
The Work Plan “describes the specific audits and evaluations that we have underway or plan to initiate in the year ahead considering our discretionary and statutorily mandated resources,” the document indicates.
On the agenda for next year, the OIG has indicated that its investigators will “review the extent of potentially inappropriate payments for E/M services and the consistency of E/M medical review determinations.” The OIG also plans to hone in on whether payments
Question: What codes would you use for lower anterior resection with anal anastomosis and divered ileostomy with mobilization of splenic flexure, which was converted to an open procedure?
Medically unlikely edits ignorance could be causing you medical coding claim denials.
Ensure you’re not letting medically unlikely edits (MUEs) wreak havoc on your urology practice’s coding and reimbursement by uncovering the truth about four aspects of these edits.
Myth 1: MUE Edits Don’t Affect Your Practice
Some practices feel that they don’t need to worry about MUEs.
Reality: “They limit the frequency a CPT code can be used,” says Chandra L. Hines, business office manager at Capital Urological Associates in Raleigh, N.C. “With our specialty of urology, we need to become aware of the denials and not let every denial go because the insurance company said it was an MUE. We should all be aware of MUEs as they occur, and we cannot always control whether or not we will receive payment.”
The MUE list includes specific CPT or HCPCS codes, followed by the number of units that CMS will pay. CMS developed the MUEs
BC/BS UHC, tell coder to halt 96110-59 denials with 96110-79.
If you’re ready to bill 96110 and 96110-59, think again.
One office was billing 96110 (Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report) with modifier 59 (Distinct procedural service). BlueCross/BlueShield (BC/BS), UnitedHealthcare (UHC), and other insurers were denying the 96110-59s. “I called BC/BS on 8-19-2010 and was told that we should be using a
You can sit back and enjoy the fall foliage spectacle — SuperCoder.com’s got your ICD-9-CM 2011, National Correct Coding Initiative 16.3, and October Medicare Physician Fee Schedule medical coding updates covered.
Go ahead and search for the new H1N1 code: 488.1x — it’s there in SuperCoder.com. Check out the code’s detail page for the red dot that signals a new code. Facility coders: SuperCoder Codesets now include ICD-9-CM Volume 3.
But ICD-9-CM 2011 isn’t the only Oct. 1 change. The National Correct Coding Initiative version 16.3 is effective the same date. Plus, the October 1 Medicare Physician Fee Schedule Release is out.
2991x, 9922x medical procedure CPT 2011 codes added.
If you’ve been frustrated about the lack of arthroscopic hip surgery codes that CPT offers, CPT 2011 will change that, with three new codes that debut on Jan. 1.
In fact, CPT will introduce over 200 new codes in 2011 to help keep your coding more specific than ever, spanning several categories, from dermatology to orthopedics to cardiology, and beyond.
In orthopedics, you’ll benefit from the following three hip arthroscopy codes, which will be excellent additions to CPT.
- 29914 – Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion)
- 29915 – Arthroscopy, hip, surgical; with acetabuloplasty (ie, treatment of pincer lesion)
- 29916 – Arthroscopy, hip, surgical; with labral repair
Check out New Observation Codes
CPT adds to your E/M coding options with the introduction of three new observation codes