OIG Auditors to Cardiologist: You’re Billing Medicare Properly

Posted on 20. Oct, 2009 by in Provider News.


Report reveals what he and his billing staff did right. Does your practice have the right stuff?

Turns out the old saying is true: If you haven’t done anything wrong, an OIG audit is nothing to worry about.

A New York cardiologist who collected over $1.3 million over a three-year period for 5,061 claims caught the OIG’s eye due to a “high volume of Medicare claims in comparison to other cardiologists throughout New York state,” according to the OIG’s report on the topic, which was released on Oct. 14.

The OIG reviewed the cardiologist’s records for the three-year period, but found that the physician, who specialized in non-invasive procedures, complied with Medicare reimbursement requirements. Therefore, the OIG made no recommendations and did not request any fund recovery from the physician.

What your practice can learn: If you have a physician who specializes in…

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Service Doesn’t Meet Incident-To Rules? Report Under NPP’s NPI

Posted on 20. Oct, 2009 by in Hot Coding Topics.


Heads up: These vaccine admin codes are excluded from incident-to requirements.

Incident-to rules don’t always apply to diagnostic services, but many medical practices aren’t aware of that.

And based on a new wave of scrutiny directed toward incident-to claims, you should know physician supervision rules inside and out.

A recent audit from the HHS Office of the Inspector General audit found that unqualified nonphysician practitioners performed 21 percent of incident-to services examined, and that’s sure to have Medicare scrutinizing your incident-to claims even more thoroughly than in the past.

The presumption: Many practices believe that as long as they meet the minimum requirements of incident-to (the physician is on-site and sees patients for any new problems), they can report all types of NPP services incident-to and collect their extra 15 percent of Medicare reimbursement.

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What’s the Correct Diagnosis Code for a Urine Drug Test?

Posted on 20. Oct, 2009 by in Coding Challenge, Hot Coding Topics.


Question: What is the proper ICD-9 code when the lab performs a urine drug test?

Answer: ICD-9 does not provide one specific code for a urine drug test. The correct diagnosis code to report when billing for the lab test depends on the signs, symptoms, patient condition, or other reason for the test, such as screening. The ordering physician will assign a narrative diagnosis or ICD-9 code when requesting a urine drug test from the lab.

For example: A high school student previously diagnosed as marijuana dependent is doing poorly in school. Suspecting marijuana use again, the physician orders a urine drug screen. In this case, the most appropriate code is 304.30 (Cannabis dependence, unspecified).

In another case: A physician might order a general screening urine drug test such as 80100 (Drug screen, qualitative; multiple drug classes chromatographic method, each procedure) for an  elderly patient prior to admission to a…

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Coders: Watch Out for Claim-Denying Computer Glitches

Posted on 18. Oct, 2009 by in Hot Coding Topics.


Don’t wait for your MAC to alert you to an error — be on the lookout for them.

If you’ve been losing reimbursement to computer hiccups at your carrier, you’re not alone. Earlier this year, thousands of Medicare recipients in one state were wrongly told their benefits were being cut by $300 — but the state decided not to notify those affected with a letter. Instead, the state only told those who called in to complain that the notification of benefit cuts they received was the result of a computer glitch.

Glitches can cause erroneous denials, unnecessary rejections, lost crossover claims, and frustrating delays. But if you don’t notice the glitch, you could kiss your reimbursement goodbye. That’s because the MAC won’t always alert you to a mistake that its computers made.

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OB or Not OB: That’s the Ultrasound Coding Question

Posted on 18. Oct, 2009 by in Coding Challenge, Hot Coding Topics.


Question: For an ultrasound, the radiologist documented measurements of the uterus, endometrial complex, and ovaries. She noted no evidence of intrauterine pregnancy, no free fluid in the cul-de-sac, physiologic follicle formation, and positive Doppler flow in the ovaries. The patient had syncope but no confirmed pregnancy. Should I report an obstetric or nonobstetric ultrasound?

Answer: Because the patient has no confirmed pregnancy before the ultrasound, you should report a nonobstetric ultrasound.

The AMA’s CPT Assistant (October 2001) states that when a female patient presents with no confirmed pregnancy, you should report a nonobstetric ultrasound, regardless of whether the ultrasound confirms pregnancy.

On the flip side, if the patient had a confirmed pregnancy and presented for an ultrasound that might be pregnancy related, but the ultrasound does not demonstrate a pregnancy, you would report an obstetric ultrasound code.

ICD-9: Because you don’t have a confirmed diagnosis, you should report the symptom that led to the ultrasound: 780.2 (Syncope and collapse).


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ASC Coding Education: Knee Diagnoses & Procedures

Posted on 18. Oct, 2009 by in Hot Coding Topics.


Choose this ICD-9 code if you see ‘jumper’s knee’ in the orthopedic surgeon’s note.

Here’s a handy introduction to common ICD-9 codes related to the knee, along with examples of CPT codes for procedures physicians perform to treat knee diagnoses.

Chondromalacia Patella

Chondromalacia patella (717.7) is also known as “patellofemoral syndrome” or “runner’s knee.” This condition results when the cartilage under the patient’s patella becomes damaged and causes pain particularly when the patient climbs stairs or bends his knee.

This is a common condition among runners or other athletes who jump, squat or climb. But chondromalacia patella can also be associated with arthritis, so the condition affects patients in all age groups.

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Toolkit: Chart Cardiology’s CCI 15.3 Changes At-a-Glance

Posted on 15. Oct, 2009 by in Toolkit.


Hang on to this handy table to avoid cath placement coding temptations.

Correct Coding Initiative (CCI) 15.3 offered long lists of new edits, but we’ve boiled them down to the ones that affect cardiology coders and billers most.

Cardiology Coders: A CCC™ Exam Prep Training Camp is coming to a city near you.

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5 Lessons Radiology Coders Should Learn From CCI 15.3

Posted on 15. Oct, 2009 by in Hot Coding Topics.


Wonder if there’s a method to the 76001 madness? Here’s where to look for answers.

The silver lining to the 18,000 Correct Coding Initiative (CCI) that just came rumbling in with CCI 15.3. Analyzing them can help you master radiology coding essentials — including follow-up CTs, fluoro, and more. Apply these five lessons to keep your claims looking their best.

Remember: The latest round of edits, version 15.3, went into effect Oct. 1. You can download the updates at the beginning of each quarter from the CMS Web site, suggests Alice E. Wonderchek, CMBS, CPC, billing and coding specialist with Franklin & Seidelmann Subspecialty Radiology in Beachwood, Ohio. You can download the CCI manual here, as well.

1. Proceed With Caution When Coding 76380

Randomly choose a code for computed tomography (CT) or computed tomography angiography (CTA), and odds are that CCI 15.3 bundles 76380…

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A Physician Coder’s Guide to the 2010 OIG Work Plan

Posted on 13. Oct, 2009 by in Provider News.


If your practice does lab panels, sleep studies, hospice visits and more, take heed.

The HHS Office of Inspector General has published its 2010 Work Plan, which should give us all a heads up on what the watchdog agency will be auditing and evaluating this year.

Why you should care: The 115-page document is like a map for what regulators will be looking at this year, and what potential problems they’ll be passing to MAC, RAC and private payer auditors. Don’t worry. Physician issues are clustered around page 15. However, if you code for other things in your health system besides physician services, you should have a look at the table of contents.

Here’s a summary of what the OIG wants to know about physician reimbursement:

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How Do You Code Sigmoidoscopy with Anoscopy, Biopsy?

Posted on 13. Oct, 2009 by in Coding Challenge, Hot Coding Topics.


Question: Notes indicate that the gastroenterologist performs a rigid sigmoidoscopy; during the encounter, he also performs an anoscopy without anesthesia and three biopsies of the mucous membrane. How should I report this episode? Can I report the exam separately with 46600?

Answer: You can report a single code for these three services. On the claim, report 45305 (Proctosigmodoscopy, rigid; with biopsy, single or multiple) for the sigmoidoscopy, the anorectal exam, and the three biopsies.

Why: When the gastroenterologist performs an anoscopy (46600 [Anoscopy; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) or mucous membrane biopsy during a sigmoidoscopy, the services are bundled into 45305.

AUDIO TRAINING EVENT: Colonscopy Coding Clinic with Jill Young. How to code screening-turned-diagnostic colonscopies, documentation musts, modifier musts, compliance heads up & more.

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