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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EM CODING: Don’t Bill High-Level E&M Codes Until You Read This

Posted on 26. Apr, 2010 by Editor.

Sicker patients may not always mean higher MDM.

If your physician bills a lot of high-level office visits, he may be at risk of an audit — which may not be cause for concern — if his documentation justifies his code choices.

“Some physicians believe their patients are sicker than others’, so they feel they’re justified using more 99215s, when in fact that may not be the case,” says Crystal S. Reeves,CPC, CPC-H, consultant with Coker Group in Alpharetta, Ga. “The CPT manual outlines the requirements of the E/M codes, there are clinical examples in the back of CPT, and CMS publishes a Table of Risk that can help guide you, so use all of those resources to determine whether you’re billing properly,” she advises.

Training is Key: If you advise your physician that he is overbilling the high-level codes and he says, “But all of our patients are really sick,” show the doctor CMS’s Table of Risk, “which can be an eye opener for physicians,” Reeves says.

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Oncology Billing Toolkit: Factor 8 HCPCS Changes Into Your Superbill

Posted on 07. Jan, 2010 by .

Watch those Taxotere units, or kiss 95 percent of your reimbursement goodbye.

A brand new list of HCPCS codes — including docetaxel and bevacizumab updates — goes into effect Jan. 1 and our 8-step superbill maintenance plan will stop denials in their tracks for 2010.

Not using the proper codes will lead to claim rejection, which means “not receiving the proper reimbursement. And no one wants to start out their new year that way,” points out Lisa Martin, CPC, CIMC, CPC-I, who oversees the charge operations for a large, independent community cancer center in central Illinois and is an active instructor for the AAPC’s Professional Medical Coding Curriculum.

1. Docetaxel Do: Swap J9170 for J9171

The most widely used of the new chemotherapy HCPCS codes may prove to be J9171 (Injection, docetaxel, 1 mg), says Martin. Oncologists may prescribe docetaxel (Taxotere) for breast cancer, non-small cell lung cancer, prostate cancer, gastric cancer, and head and neck cancers.

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