Part B Records: Auditors ‘Vexed’ by Providers’ Lack of Documentation

Posted on 18. Dec, 2014 by in Provider News.


Want your audit to be over quickly? Hand over the records.

If you’ve ever wondered what gives auditors the biggest headache, you might be surprised at the answer. Although your first instinct might be that auditors find messy records or illegible documentation, the reality is that they frequently deal with providers who can’t produce any documentation at all.

Find What the Auditor Is Missing

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Shoulders: Don’t Let Tissue Scaffolding Procedures Complicate Your RCR Claims

Posted on 18. Dec, 2014 by in Hot Coding Topics.


Scrutinize the op report to determine whether the physician used a tissue scaffolding device.

If your orthopedic surgeon documents using a tissue scaffold such as the GraftJacket, Conexa or another similar implant during rotator cuff repairs, you may find yourself in a coding quagmire — CPT® does not include a code for the tissue scaffolding procedure, but the physician thinks that the extra work is worth more than a standard rotator cuff repair.

You can code RCRs with tissue scaffolding like a pro, even if you’re a first-timer. Read our experts’ advice, and find out just how to get your coding on the straight and narrow.

Recognize Tissue Scaffolding in the Documentation

The first step in determining whether your surgeon performed a tissue scaffolding procedure is to examine the op note. For example, the physician might refer to an “acellular dermal matrix,” “GraftJacket,” “GJA,” “Restore implant,” or “tissue scaffold” when…

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ICD-10: Look to H10 Series for Conjunctivitis in 2015

Posted on 10. Dec, 2014 by in ICD-10.


Hint: In many cases, an additional digit will specify which eye is infected.

When ICD-9 becomes ICD-10 in 2015, you’ll have to be prepared for changes across the board when it comes to diagnosis coding. Often, you’ll have more options that may require tweaking the way you document services and a coder reports it. Check out the following examples of how ICD-10 will change your coding options.

Get ready now: The deadline for using ICD-10 is Oct. 1, 2015.

Nail Down These Upcoming Eye Infection Coding Changes

Conjunctivitis is an eye infection that can affect patients of all ages, and your practice is probably familiar with the signs and symptoms of this condition. But, like all other conditions, conjunctivitis will fall under new codes under ICD-10.

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Reader Question: Stick with 52282 for Permanent Stent

Posted on 10. Dec, 2014 by in Coding Challenge.


Question: I saw your article on new 2015 codes 52441 and 52442. Is there a specific code for a permanent intra-urethral urethral stent or prostatic stent? Will I be able to use 52441 and 52442 for those stents?

New Jersey Subscriber


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Part B Documentation: New MAC Tip Reminds Practices What the Nurse Can–and Cannot—Document

Posted on 10. Dec, 2014 by in Provider News.


Hint: Documenting HPI is the job of the doctor or NPP.

Your nurse might be quite adept at recording your documentation—but if she documents too much, your notes might not be applicable to your coding choices. That’s the word from a new E/M Tip that Part B MAC Palmetto GBA issued last week, reminding doctors what ancillary staff members can document in your Medicare records.

“Ancillay staff may only document the Review of Systems (ROS), Past, Family, and Social History (PFSH) and Vital Signs,” the latest tip, published Sept. 23, indicates.

As for the history of present illness, leave that to the physician or NPP, Palmetto says. “Only the physician or NPP that is conducting the E/M service can perform the history of present illness (HPI). This is considered physician work and not relegated to ancillary staff. The exam and medical decision making are also considered physician work and not…

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Medicare Incentives: Avoid Pay Cuts with PQRS

Posted on 10. Dec, 2014 by in Hot Coding Topics.


Deadlines rush your lab clients to EHR, too.

With more than enough pay cuts to go around, nearly anything your lab can do to hold on to earnings is a step worth taking.

Read on to make sure you know what’s happening with certain Medicare program options, such as the Physician Quality Reporting System (PQRS), that could impact your bottom line.

Look for PQRS Penalty Notifications

The 2013 PQRS incentive program feedback reports are currently available if you’re interested in reviewing yours, said CMS’s Christina Phillips during a recent Open Door Forum call. “There are two different types of reports you can access—one is the NPI identifier level report,

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Streamline Your Care Management Services with new 2015 E/M Changes

Posted on 09. Dec, 2014 by in Hot Coding Topics.


The October 2014 CPT® Assistant is jam-packed with updates for the newly-created Care Management Services in the E/M section. Get the inside scoop on services that care management includes and what’s involved when calculating total time. Evaluate provider requirements for care management and additional E/M services you can report with care management codes.

Nail down correct codes for endovascular treatment for lower extremity venous incompetency and positive airway pressure (PAP) therapy. Sharpen your skills for coding trigger point injections using dry needling technique, and much more. Put’s Code Connect code and keyword search to good use to deepen your understanding of these topics:

  • Care management services: 90951-90970, 98960-98962, 98966-98968, 98969, 99071, 99078, 99080, 99090, 99091, 99201-99215, 99324-99328, 99334-99337, 99339-99340, 99341-99345, 99347-99350, 99358-99359, 99363-99364, 99366, 99368, 99374-99380, 99441- 99443, 99444, 99487-99490, 99495-99496, 99605-99607
  • Endovascular treatment for lower extremity venous incompetency: 29581, 29582, 36000-36005, 36410, 36425, 36478, 36479, 37241-37244, 36468-36479,

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ICD-10-CM: Ask Cardiologist to Specify Insufficiency, Prolapse, or Stenosis for Your Mitral ICD-10 Code

Posted on 26. Nov, 2014 by in ICD-10.


Not sure whether to use the ‘insufficiency’ or ‘other’ code for incompetence NOS? Here’s the answer.

ICD-10 is ousting the simplicity of a single code for nonrheumatic mitral valve disorders. Check out the five new options you’ll need to know.

ICD-9-CM Code

424.0, Mitral valve disorders

ICD-10-CM Codes

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Reader Question: Don’t Make This $104 Mistake

Posted on 26. Nov, 2014 by in Coding Challenge.


Question: Our surgeon removed a mass from a patient’s nose (1.3 cm, including margins), and the pathologist diagnosed it as a dermoid cyst. Should we report 11442 for the service?

Nevada Subscriber


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Part B Coverage: Medicare Launches New Code for Hepatitis C Screening

Posted on 26. Nov, 2014 by in Provider News.


CMS now provides coverage for these tests in certain populations.

After several months of wrangling, CMS has confirmed that it will pay for hepatitis C virus screenings administered to Medicare patients who meet specific criteria. The agency also debuted a new HCPCS code to describe the preventive test and offered diagnosis coding tips, all thanks to Transmittal 174, issued on Sept. 5.

The specifics: Effective for dates of service June 2, 2014 and afterward, CMS will pay for hepatitis C screenings if patients meet either of the following two requirements:

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