Advanced Search

Outpatient Facility Coding Alert

OPPS 2014:
Get Ready for These OPPS Changes From CMS That Will Affect You in 2014
A single outpatient clinic code will change your reporting strategy. Packaged service ... Read more
CPT® 2014:
Prepare Now for Changes to ENT Related Endoscopies
Hint: You’ll add 8 new codes to your repertoire. If ENTs perform endoscopies or ... Read more
CPT® 2014:
Don't Miss These 3 Important Updates to the CPT® 2014 Manual Introduction
Hint: Actual codes aren’t the only things you need to focus on. Most coders get ... Read more
ICD-10:
Look Ahead to More Options and Better Specificity for Diverticulosis
Hint: Hemorrhage and anatomical location still play a role in code selection. When you... Read more
Reader Question:
Don't Fret Over ICD-9 Procedure Codes ED Claims
Question: Should we be capturing ICD-9 procedure codes for ED facility coding? I underst... Read more
Reader Question:
Leave No Doubts Regarding Who Makes Amendments
Question: If and when the patient’s electronic health medical records needs to be ... Read more
Reader Question:
There's No Need for 49659 When Same Mesh Covers Two Hernias
Question: I’m coding for a laparoscopic inguinal hernia repair (right side) for a ... Read more
Reader Question:
Heads Up for Changes to Complex Repair Codes
Question: Are there any changes to the dermatology CPT® codes that we should be awar... Read more
Reader Question:
Submit 20605 for Sacrococcygeal Injection
Question: What’s the proper way to code a sacrococcygeal joint injection? Michig... Read more
Reader Question:
Choose Between 28296 and 28306 for Crescentic Osteotomy
Question: How should I code a crescent shelf osteotomy for a hallux valgus case? New Y... Read more
You Be the Coder:
Extra Payment for J0171
Question: Medicare has been denying our claims billing epinephrine code J0171 when the d... Read more
Procedure Spotlight:
3 Steps Help You Determine Whether Modifier 22 Is Merited
Tip: Clues in the op note can give you the boost you need. Little-known fact: You can&... Read more
Dermatology:
Don't Fall for the DSAP Diagnosis Trap When Coding Porokeratotic Lesion Excision
Know that misdiagnosis can be common up front. Your surgeon treats a patient with a fa... Read more
Workers' Compensation:
Plan for Up-Front Work to Prevent Reimbursement Delays
Streamlining processes and doing some ground research can help reduce hiccups. Claims ... Read more
Reader Question:
Need ASC Coverage Resources? Look Here
Question: I might be transferring to our hospital’s ASC location and want to learn... Read more
Reader Question:
Check Latest Instructions Before Reporting Modifier 59
Question: We were just notified that modifier 59 is no longer accepted by Medicare payer... Read more
Reader Question:
Hold Your Codes Until Path Report Is In
Question: Is there a hard-and-fast billing rule that requires us to wait for the patholo... Read more
Reader Question:
Consider A4300 or A4301 if Payer Prefers HCPCS Codes
Question: Is there a HCPCS code to correlate with CPT® code 36556? Our payer denies ... Read more
Reader Question:
Select 52601 for First Round TURP
Question: If you see a patient who had a laser vaporization of a portion of the prostate... Read more
You Be the Coder:
Checkpoints for Filing 76975 With Endoscopic Procedure
Question: If we document the endoscopic ultrasound and supervision, can we report 76975 ... Read more
CPT® 2104:
One New Code Will Stop Your 52332 /52353 Combo Coding
  Plus: Hospital based coders, say good-bye to 50021 and 58823. CPT® 2014, ... Read more
CPT® 2014:
Don't Miss These Changes to Breast Localization Procedure Coding
Here’s your easy guide to knowing differences between guidance. Accurately codin... Read more
ICD-10:
Knowing Column Meanings Will Prepare You for Expanded Rib Fracture Choices
Tip: Remember your “bilateral” option for a multiple rib fracture situation.... Read more
Compliance:
Prepare Now for Inevitable HIPAA Audits - Before It's Too Late
Heads up: HHS says all covered entities and business associates are targets. HIPAA is ... Read more
Reader Question:
Don't Try to Split 28296 and 64450
Question: I billed 28296 for a bunion correction with metatarsal osteotomy, and 644... Read more
Reader Question:
Watch the Surgical Approach for 00840 vs. 00944 Decision
Question: In the Anesthesia Crosswalk, CPT® code 58550 crosses to 00944, with 0... Read more
Reader Question:
Learn Your Terms for Successful Hemorrhoidectomy Coding
Question: We have an op note for a hemorrhoidectomy that states that the surgeon &l... Read more
Reader Question:
Focus on Type, Not Depth, When Classifying Ulcers
Question: Is there a method of correlating Wagner’s ulcer classification to I... Read more
You Be the Coder:
Coding Tactics for Ambulatory EEG
Question: We normally report video EEGs with codes 95951. Now our physician has ord... Read more
Procedure Coding:
Pinpoint 3 Things for Complete Fine Needle Aspiration Claims
Hint: Confirm units and check for biopsy. When coding fine needle aspirations with 100... Read more
Urology:
The Key to Avoiding Repeat TURP Denials? Knowing When 52601 Applies
Know when you need modifiers 58 and 78. Coding the first transurethral resection of p... Read more
ICD-10:
Prepare for ICD-10 by Focusing on 6 Big-Picture Differences
Here’s the lowdown on main changes from ICD-9. October 2014 and the implementati... Read more
Surgical Assists:
Follow 4 Steps for Success When PAs Assist at Surgery
Differentiate modifiers AS and 80 for billing success. When PAs serve as first assista... Read more
Reader Question:
Reporting Same Session Ablation and Snare Techniques? Not So Fast
Question: Are there specific times when a physician can use the ‘45383’, rat... Read more
Reader Question:
Consider This Before You Earmark SNF Patients For Outpatient Care
Question: Our hospital offers outpatient therapy and owns a skilled nursing home. The ph... Read more
Reader Question:
Verify Tactic Before Coding Rigid Mallet Toe Treatment
Question: A patient came to our facility because of a rigid mallet toe. How will our phy... Read more
You Be the Coder:
Counting for Intra-articular Facet Nerve Blocks
Question: I’m coding for bilateral intra-articular facet nerve blocks to L1, L2, a... Read more
Coding Strategies:
Corral Your Heel Spur Denials With These Tips
Round up these 3 items for a winning claim. You could be forfeiting deserved pay if y... Read more
ICD-10 Update:
Crack Your Patellar Fracture Diagnosis Challenges
One key factor could make or break your dx code choice accuracy.  When your phys... Read more
Pain Management:
Don't Let Vertebroplasty Policy Differences Sideline Your Coding
Your first move is to identify vertebral locations. The AMA and Medicare’s rece... Read more
Coding Basics:
16000-16036: Avoid Burns Coding Meltdowns With This Advice
Map your way to accurate skin percentages with the “Rule of Nines.” If yo... Read more
Reader Question:
Know How to Handle Same Day Office And ER Visits
Question: If a patient was seen for an office visit (99214) first and then later on the ... Read more
Reader Question:
Don't Compromise On Time When Reporting Aphasia
Question: Our neurologist assessed a stroke patient for aphasia and reported ICD-9 code ... Read more
Reader Question:
Don't Report Oxygen Administration As A Separate Entitiy
Question: A patient was administered oxygen per nasal cannula for a severe migraine for ... Read more
Reader Question:
Approach Governs The Type Of Code For Herniated Intervertebral Disc
Question: Which would be more appropriate - 63056 or 63030? Dx. Far Lateral Disk ... Read more
Reader Question:
Discern Location for Scrotum and Epididymis Surgery
Question: What is the difference between 54700 and 55100? Answer: In 54700 (Incisi... Read more
You Be the Coder:
Assess Tenotomy and Debridement Coding
Question: Is it true that we cannot bill 23405 (Tenotomy, shoulder area; single tendon) ... Read more
Spinal Coding:
Remember This Tip When Coding Bone Biopsies With Vertebroplasty
Your code choice depends on one location detail. If your surgeon performed a bone biop... Read more
Rehab Services:
Don't Skip the ABN, or You Could Be Stuck With the Therapy Bill
Exception: Steer clear of an ABN when modifier KX applies. If you haven’t heard ... Read more
ICD-10:
Focus on These Details as the ICD-10 Transition Draws Near
CMS staff advise using partial code freeze to your advantage. ICD-10 implementation is... Read more
HIPAA Compliance:
Follow Our 5 Expert Tips to Successfully Survive a HIPAA Audit
Tip: Learn about HIPAA audit protocols and use them to your advantage. As random and t... Read more
Reader Question:
Return for Bleb Needling Is Reportable With 66250
Question:  The ophthalmologist performed a needling procedure during the postoperat... Read more
Reader Question:
Don't Miss the Column 2 Edits for 64450 With 77002
Question: I have looked, but cannot find information regarding whether you can bill 6445... Read more
Reader Question:
Base Lesion Coding Size on Surgeon's Measurement
Question: Our surgeon removed three skin lesions from a patient’s back and neck. I... Read more
Reader Question:
Keep These Points in Mind When Choosing MPM Software
Question:  We’re in the process of researching various practice management so... Read more
You Be the Coder:
Distinguishing Between Melanoma and Soft Tissue Tumors
Question: The surgeon re-excised a melanoma of the upper arm, removing a 2.9 cm lesion w... Read more
Orthopedics:
Check All Possible Procedures to Reach Hands-Down Wrist Arthroscopy Success
Tip: Payer guidelines show when you can report multiple repairs. Coding for wrist arth... Read more
Sleep Studies:
Learn the Differences Between Sleep Studies and Polysomnography
Age, stage, and parameters all point you to the best codes. If you code for facility-... Read more
Urology:
Understand What 'Stent' Really Means in Multi-Physician Urology Encounters
Hint: Don’t automatically turn to 52332.  Urologists routinely place stent... Read more
ICD-10:
Look for More Detailed Pneumothorax Code Choices in 2014
Say good-bye to ‘unspecified’ diagnoses. Several treatments are available ... Read more
Reader Question:
Know Whether to Select 715, 716, or Another Dx for Knee Arthritis
Question:  Our physician wrote “knee pain” and “arthritis left kn... Read more
Reader Question:
Understand Thickness for Lip Border Repair
Question: One of the physicians in our urgent care center reported a 2.5-3 cm mucosal po... Read more
Reader Question:
Yes, Reporting 77003 With 62310 Is Acceptable
Question:  Do payers allow you to report fluoroscopy in conjunction with an interla... Read more
You Be the Coder:
Check This Code for Intervertebral Disc Biopsy
Question: Which code should we use for intervertebral disc biopsy for discitis? I’... Read more
Podiatry:
Stamp Out Heel Spur Treatment Denials With These 3 Checkpoints
Don’t miss your chance to add other services to the claim. You’re likely ... Read more
Therapy Services:
Get Ready for RAC Manual Reviews for Therapy Claims Over $3700
Experts concerned that RACs get paid extra for every claim they deny. If you thought y... Read more
HIPAA:
Fool-Proof Your BA Contracts As They Go Under Scrutiny
Here’s why your agreement details are more important than ever. Federal authorit... Read more
ICD-10:
Learn These Foundational Phrases That Build ICD-10 Code Sets
Good news: Many go-to terms will be familiar to your staff. The focus for many physic... Read more
Reader Question:
Penalties Could Be Coming for Illegible Documentation
Question: My physician’s handwriting really is difficult to read sometimes, a... Read more
Reader Question:
Ask for More Details Before Submitting 31256 for Nasal Endoscopy
Question: During a nasal endoscopy, the ENT dictated that the patent maxillary antrostom... Read more
Reader Question:
Closing Wound With Dermabond
Question: One of the wound clinic physicians treated a patient with traumatic wounds. Th... Read more
Reader Question:
Remember Modifier 26 for Hand-Off X-Ray Interpretation
Question: I bill for both our urgent care center and the Emergency Department. An urgent... Read more
Reader Question:
Separate Charges for Pilonidal Cystectomy and Z-plasty Could Apply
Question:  A proctologist treated a patient for pilonidal cystectomy. A plastic sur... Read more
Reader Question:
Simple Wart Excisions for Multiple Locations Still Mean 17110
Question: Our physician performed two wart excisions (one from the elbow, the other from... Read more
Reader Question:
Watch for Different Payer Policies on Billing Drugs With Anesthesia Service
Question: Our GI group owns its own endoscopic suite where colonoscopies are performed i... Read more
Reader Question:
Yes, You Can Report 2 Codes for Repairs of Both Shoulders
Question: Our surgeon wants to report two units of 23410 for repairs done in same should... Read more
You Be the Coder:
Non-Infected BB Pellet Removal From Hand
Question: A patient presented to our clinic for excision of a foreign body from his left... Read more
Reimbursement:
Don't Miss These New Opportunities for Procedure Payments
Check out these OPPS and ASC changes that could affect your reporting.  Having p... Read more
Procedures:
Hospital Facilities Build Bone Density Claims on 3 Tips
Know when you can legitimately report 77080. The restrictions Medicare sets for bone d... Read more
Freestanding vs. Hospital-Based Facility Determines DEXA Payment
Location drives your bottom line. Coding and reimbursement for bone density scans 770... Read more
ICD-10:
Dig Deeper for More Detailed Back Wound Choices in 2014
S21.1_ family will add options to existing 876.0. Coding wound closure requires ident... Read more
HIPAA Compliance:
Learn the Basics of a Complete Risk Analysis Plan
Take 8 steps to secure your ePHI — and ward off compliance woes.  How cert... Read more
Reader Question:
Question Medicare for 17003 Claims
Question: We recently reported codes 17000 and 17003 to Medicare for reimburse... Read more
Reader Question:
Reporting Anesthesia for Colonoscopy
Question: I bill the anesthesia for a GI physician, and lately he’s been aski... Read more
Reader Question:
Turn to Unlisted Code for Contracture Procedure in Toe
Question: Our podiatrist documented the following: Diagnosis: 2nd Metata... Read more
Reader Question:
Use Add-On +22522 for Multilevel Vertebroplasty
Question: Our pain management physician performed a three-level vertebroplasty at T... Read more
You Be the Coder:
Avoid Coding Confusion for Same Day Stent Removal and Insertions
Question: Our gastroenterologist recently preformed an ERCP procedure to remove the orig... Read more
Radiology:
Learn These Rules for Diagnostic vs. Screening Mammography
Tip: Extra views don’t automatically change your coding. Facilities sometimes ha... Read more
Reimbursement:
Think Twice About Billing Infrared Therapy Treatments
Heed what CMS says about reimbursing 97026. Providers with some therapy clinics tend t... Read more
ICD-10:
Verify 3 Points to Break Down Jones Fracture Code Options
You’ll need more details for success in ICD-10. If an orthopedic surgeon treats ... Read more
Auditing:
Follow This 10-Point Checklist for Successful Self-Audits
Tip: Start searching your records now, not when you hear from OIG. Auditing your facil... Read more
Reader Question:
Payer Rejecting New Codes? Report to AMA
Question: We already have payers that are rejecting the new CPT® codes. They are not... Read more
Reader Question:
Always Have a Written Order for 76376
Question: Does the ordering doctor need to request the use of 3D reconstruction codes? W... Read more
Reader Question:
Lack of Details Leads to 780.57 for Sleep Apnea
Question: What is the best diagnosis code for complex sleep apnea? Texas Subscriber ... Read more
Reader Question:
Situation Dictates Margin Re-Excision Coding
Question: The surgeon performs a lesion re-excision for margin removal because the patho... Read more
Reader Question:
Try Reporting 99070 for 'GI Cocktail'
Question: The gastroenterologist noted that he administered a GI cocktail. What is this,... Read more
Reader Question:
Watch New Guidelines for Chemodenervation
Question: Can you please clarify if we can still use the chemodenervation codes 64612 an... Read more
You Be the Coder:
Coding for Tissue Welding Tonsillectomy
Question: What CPT® code is appropriate for tissue welding tonsillectomy? Can I use ... Read more
Pain Management:
Follow These 4 Steps to Successful Spinal Epidural Coding
Start with a clear understanding of anatomy. When it’s time to report an epidur... Read more
ICD-10:
Change Your Coding Mindset for Gastric Ulcers Under ICD-10
Chronicity and hemorrhage will outweigh obstructions in code choices. When you report ... Read more
Documentation:
Verify That Your Record Amendments Meet New CMS Guidelines
Heads up: Single-line corrections are fine. No practice -- or physician -- i... Read more
Reader Question:
Code 24342 Is Allowed With Other Procedures
Question: The orthopedic surgeon performed several procedures on a patient’s right... Read more
Reader Question:
Start Claims by Verifying Correct Anesthesia Code
Question: We billed 00140 for eye surgery 15823 and modifiers QS, LT with a total of 3.5... Read more
Reader Question:
CAP Diagnosis Should Be 486
Question: The discharge diagnosis is "CAP bilateral." What does this mean? I&r... Read more
Reader Question:
CMS Is Looking for Better Legibility
Question: I have heard payers are cracking down on illegible provider documentation. My ... Read more
Reader Question:
Codes 28725 and 38220 Can Be Reported Together -- But Not Re-injection
Question: Our podiatrist will be performing a subtalar arthrodesis and aspirating bone m... Read more
Reader Question:
Be Aware of When to Use Modifiers for Polyp Removal
Question: The gastroenterologist recently performed a polyp removal, using the snare tec... Read more
You Be the Coder:
Modifiers for Elective Cancellation
Question: I know you shouldn’t report modifier 73 for elective cancellation of a p... Read more
Spinal Procedures:
Follow 3 C's to Capture Radiological Supervision During Vertebroplasty
This detail helps separate vertebroplasty from kyphoplasty. If surgeons in your facili... Read more
Chemotherapy:
Don't Miss These Key Revisions to 96401-96549 Guidelines
One coding example specifically applies to facilities. CPT® 2013 includes nearly h... Read more
Reimbursement:
Know Your Patients' Payers to Capture Legitimate Post-Op Revenue
Don’t automatically skip billing for post-surgical infection care. Wondering whe... Read more
ICD-10:
Salivary Gland Denervation Brings Simple ICD-10 Changes
Prepare to replace 527.2 with K code in 2014. When you report code 64611 (Chemodenerv... Read more
Reader Question:
Look to Category 320 for Diagnostic Radiology
Question: What is the appropriate revenue code (for UB-04 billing) for CPT® codes 73... Read more
Reader Question:
Documentation Is Crucial to Reporting Bilateral Injections
Question: One of the pain management specialists submitted the following documentation: ... Read more
Reader Question:
Dig Deeper for Type of Manifestation in Diabetic Neuropathy
Question: The physician’s notes included documentation that a patient has diabetes... Read more
Reader Question:
Toe the Right Line With Osteotomy and Reconstruction Modifiers
Question: The surgeon completed Mitchell osteotomy on the left foot first metatarsal, an... Read more
Reader Question:
Verify Date of Eligibility for Patients With New Insurance
Question: A patient who is scheduled for surgery says she has new coverage, but hasn&rsq... Read more
Reader Question:
Code 25111 Covers Both Synovectomy and Ganglion Excision
Question: In a patient diagnosed with synovitis with first dorsal compartment tendinitis... Read more
You Be the Coder:
Choose a Diagnosis for Postoperative Swelling
Question: I cannot locate "post-operative swelling" under the status choices f... Read more
Available Years:  2013  2012