Diagnosis Coding: Here’s How To Decode Your Physician’s Notes

Posted on 16. Jun, 2010 by Editor.

If the doctor does not circle a diagnosis, it may be up to you to find one.

Don’t let an incomplete superbill damage your chances of submitting an accurate claim. If the doctor in your office fails to indicate the ICD-9 code for the condition that he treated, you should read through his documentation to find which diagnoses you should report.

Open the Notes When You Have to — and Even When You Don’t

Suppose your physician hands you a superbill with the procedures circled and the diagnosis left blank.

You could ask the physician which diagnosis to report, or you could examine the documentation yourself. If your office has a policy that includes “coding by abstraction” by certified/qualified coders, then

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Use Shared Visit to Capitalize on NPP/Physician Teamwork

Posted on 25. Mar, 2010 by Editor.

Forget about incident-to in the facility, but consider this similar billing technique.

ED coders that have never heard of “incident-to” billing have nothing to worry about, as you cannot code for “incident-to” services in the hospital. Coders that don’t understand shared visit billing, however, could be costing their ED practices.

Follow this advice on the “what’s” of shared visit billing.

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Coding Generalized Bronchitis? Prepare for Denials

Posted on 24. Mar, 2010 by Editor.

Relying on the physician’s encounter form could be a big mistake.

Question: I used 491.9 to report a patient’s bronchitis, but the payer denied my claim and requested additional information. What was wrong?

Vermont Subscriber

Answer: Your claim may have been denied because you chose an unspecified chronic bronchitis code (491.9, Unspecified chronic bronchitis) instead of a more specific ICD-9 code.

Here’s how to avoid “diagnosis coding” denials next time:

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CMS Delays Ordering/Referring PECOS Regulation Until 2011

Posted on 24. Feb, 2010 by Editor.

Take the extra time to get your practice registered in PECOS — don’t wait until the end of the year, CMS reps say.

Practices that were busily struggling to find out whether their ordering/referring physicians’ national provider identifiers (NPIs) were in the PECOS system can relax a little bit — at least until next year.

If your physician performs a service as the result of an order or referral, your claim must include the ordering or referring practitioner’s NPI, and that number must be in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) or the payer’s computer system.

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CMS Will Soon Issue Consult Code Replacement Advice, According to Open Door Forum

Posted on 10. Feb, 2010 by Editor.

Plus: You can now download a list of all practitioners who can order/refer.

If you’ve been confused about how to report low-level hospital visits now that consult codes are gone, you aren’t alone. CMS intends to tackle this problem by issuing more specific guidance on the topic in the near future.

That’s according to a Feb. 2 CMS-sponsored Physicians, Nurses, and Allied Health Professionals Open Door Forum, where one practice asked the CMS reps when the agency plans to issue instructions on how to report initial hospital visits when the documentation doesn’t meet the criteria for the lowest level visit, a 99221.

CMS is currently working with the medical community to create such guidance, which will “hopefully be out shortly,” noted CMS’s Whitney May during the call.

One caller indicated that her MAC (WPS Medicare) instructed her to use the unlisted E/M code 99499 when the visit doesn’t meet the criteria of 99221 — but the MAC also said …

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