Get to Know 3 E/M Myths That Could Affect Your Practice

Posted on 27. Jun, 2011 by in Hot Coding Topics, Provider News.

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Hint: Just because your doctor visits the ICU doesn’t mean he can report critical care.

Most medical practices report outpatient E/M codes (99201-99215) every day, but some Part B providers are still falling victim to several of the most common E/M myths. Button up your coding processes by dispelling these three commonly-held misunderstandings.

 

Myth 1: When reporting 99211 “incident to” a physician, you should bill it under the name of the physician on record for that patient.

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E/M + Bronchoscopy + PFT: Unlock the Secrets to Signs and Symptoms Coding

Posted on 24. Jun, 2011 by in Hot Coding Topics, Provider News.

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Keep your CCI edits in mind for PFT bundles.

When a patient presents with common respiratory conditions, your pulmonologist should perform an extensive history and examination, and may order several diagnostic tests before he can settle with a definite diagnosis to report in the claim. Along with the primary diagnosis (if achieved), you should report the patient’s signs and symptoms or else risk an audit.

Consider this scenario: The pulmonologist sees a patient for fever, shortness of breath, chest pain, weight loss, and fatigue. After undergoing a detailed history and examination, the patient becomes suspect for hypersensitivity pneumonitis, otherwise known as extrinsic allergic alveolitis (495.x). The physician orders a diagnostic bronchoscopy with fluoroscopic guidance, as well as a spirometry to verify the patient’s condition. To justify each service performed by the same provider or group, you might be accumulating payer inquiries or denials. This 2-step technique should carry you through…

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Deem Time Essential for 493.02 Treatment Services

Posted on 24. Jun, 2011 by in Hot Coding Topics.

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Learn when prolonged services should not apply.

Reporting your pulmonologist’s asthma attack treatments can be crafty business, as you can be confused about what, how and when to choose from the E/M and treatment codes that describe different situations.

Learn a few secrets of the trade from these scenarios:

Scenario 1: A patient suffering from hay fever with exacerbated asthma (493.02, Extrinsic asthma; with [acute exacerbation) requires two nebulizer treatments and 55-minute treatment time. What coding option would you report?

Scenario 2: A child patient with asthma experiences active wheezing and shortness of breath. The patient’s parent brings the child to the office, and demands the physician to see her child right away because the child is restless and screams in pain.

Dodge a Bullet by Putting Modifier 76 in Its Right Place

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Modifier 57 Remains Handy Post Removal of Consult Codes

Posted on 24. Jun, 2011 by in Hot Coding Topics, Provider News.

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Take a hint from a CPT®’s global period when choosing between modifiers 25 or 57

Contrary to popular thinking, modifier 57 does not apply exclusively for consultation codes only. Medicare may have stopped paying for consult codes, but this doesn’t mean you have to stop using modifier 57. Here are two tips on how you can use this modifier to suit your practice’s needs.

Background: Starting January 1, 2010, the Centers for Medicare and Medicaid Services (CMS) eliminated consult codes from the Medicare fee schedule.

Non-Consult Inpatient Codes Keep Modifier 57 Alive

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CMS Offers Great News With Fee Schedule Changes

Posted on 24. Jun, 2011 by in Hot Coding Topics, Provider News.

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Boost co-surgery, multiple surgery, and bilateral surgery pay for these select procedures

You’ll no longer have to eat the cost of your services if your physician acts as co-surgeon on spine revisions. Thanks to several Fee Schedule changes that CMS recently enacted. CMS had good news in MLN Matters article MM7430, which had an effective date of Jan. 1, 2011 and an implementation date of July 5, 2011.

Look for Potential Co-Surgery Payment for These Codes:

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Qualedix, Inc. Partners with the Coding Institute to Bring Enhanced Quality and Education to its Managed Services Solution for ICD-10 Testing

Posted on 22. Jun, 2011 by in Hot Coding Topics.

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Naples, FL (June 15, 2011) –Qualedix, an advanced healthcare testing organization, today announced it has partnered with the Coding Institute, LLC, a company dedicated to offering accurate healthcare solutions, that will provide native ICD-10 coding expertise and educational services to the industry leading Simplicedi testing platform.

The combined market offerings enable greater accuracy, speed and a true clinical approach to tackling the arduous task of testing thousands of new ICD-10 codes for providers and payers alike.

“At Qualedix, we strive for excellence in our data solutions for the industry and clinical knowledge is paramount to effectively remediate and test ICD-10 changes across the healthcare industry. The Coding Institute brings to a new echelon of quality and expert knowledge to better effectively serve the market through our testing managed services,” said Mark Lott, CEO of Qualedix. “Also, all of our clients need education to assist in the transition period and we…

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CMS Proposes New Glaucoma, Skin Cancer, Dementia Codes

Posted on 22. Jun, 2011 by in Hot Coding Topics.

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Many new codes abound in final update to proposed ICD-9-CM code set

If you’ve felt that your skin cancer diagnoses could use a bit more specificity, ICD-9 will deliver this October if the proposed list of new, deleted, and revised diagnosis codes becomes final. The list of ICD-9 changes was recently posted to the CMS Website, and includes the final full set of changes that the agency will make to ICD-9 codes. After the new codes take effect on Oct. 1, CMS will only add new ICD- 9 codes on an emergency basis as it prepares to switch over the diagnosis coding system to ICD-10.

 

Seek Out Skin Cancer Changes

You’ll find a significant expansion to the 173.x (Other malignant neoplasm of skin) categories, including changes to 173.0x (…Skin of lip), 173.1x (Eyelid, including canthus), 173.2x (Skin of ear and external auditory canal), 173.3x (Skin of other and unspecified

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HPI Know-How Helps You Catch Level 4 and 5 E/M Visits

Posted on 22. Jun, 2011 by in Provider News.

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Beware of CPT® and Medicare differences when counting HPI elements.

Not accurately accounting for the history of presentillness (HPI) documented by your oncologist could result in missing appropriate opportunities to report level 4 or 5 E/M visits. Ensure you’re not missing higher paying possibilities by reviewing this guide to capturing HPI elements.

Brush Up on What Qualifies as an HPI Element

HPI is one of the three parts comprising an outpatient E/M history. It describes the patient’s present illness or problem, from the first sign/symptom to the current status, and typically drives a provider’s decisions about the physical examination and treatment.

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Pick Up on PIN III’s Trail in Index

Posted on 22. Jun, 2011 by in Coding Challenge.

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Question:

I have a path report that says “PIN III.” My problem is that the report also says “carcinoma was not identified,” so I’m confused about what to report. Which ICD-9 code is best?

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Improve Your Tennis Elbow Claims Score: Make Reach, Repair, and Reattachment Your Winning Strategy

Posted on 17. Jun, 2011 by in Hot Coding Topics, Provider News.

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Tactics help you recoup deserved pay for 24357-24359.
Tennis elbow claims faults can wreak havoc on your reimbursement for these services.  But you can clean up your method if you can spot in the note how the surgeon reached the elbow tendon and whether the tendon was released or repaired.  By doing so, you stand to gain your full earned pay for codes 24357, 24358, and 24359, which is $437.27, $514.74, and $647.59, respectively.
 

Review Structures Treated
When you are confident in your elbow anatomy knowledge, you’ll have a better chance of understanding where the operative note is directing you.   The codes are simple and can easily be applied if you are reading correctly. “Coding these procedures became much easier when CPT condensed the codes from the previous five down to the current three,” confirms Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, New…

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