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Part B Insider (Multispecialty) Coding Alert

CCI EDITS:
5700 Drug Administration Edits Are Heading Your Way
Make sure your documentation justifies separate services Brace yourself for a new rou... Read more
CCI EDITS:
You Can't Use A Modifier To Unbundle Radiology Codes With E/M Visits
New nursing home, domiciliary care codes hit with hundreds of editsRadiologists will find ... Read more
CAPITOL HILL WATCH:
Heads Up--Budget Discussions May Continue Into 2006
And a pay freeze, not a pay hike, may be the best you can hope forYou could come back to w... Read more
CERT Program Not Consistent, OIG Says
If the Comprehensive Error Rate Testing auditor didn't do a good job of following up with ... Read more
MODIFIERS:
Prepare For Audits Of Modifiers 25 And 59
Pitfall:  A quarter of modifier 59 claims didn't have enough documentationThe HHS Off... Read more
E/M SERVICES:
You May See More Reimbursement For The E/M Coding You're Already Doing
MedPAC considers a 2.7 percent increase in your payments for 2006 and 2007 Think you&... Read more
RADIOLOGY:
Avoid These PET/CT Coding Pitfalls
Find out 3 important documentation must-haves You can expect claims denials if you do... Read more
OPHTHALMOLOGY:
Opt For Accurate OPT Coding With This Advice
Lesions' appearance will affect your claim alternatives Medicare recently changed... Read more
GYNECOLOGY:
You Be the Coder--Attain Vaginal Suspension Coding Victory With This Advice
Question: I have documentation that the ob-gyn performed a vaginal vault suspension at the... Read more
CARDIOLOGY:
Reader Question--Don't Have A Heart Attack Over Bundled Angioplasty Codes
Question: The recent National Correct Coding Initiative edits for angioplasty coding have ... Read more
Got something to say? Look who's talking...
The PBI Discussion Group is your resource for connecting with coding and billing peers. ... Read more
INTERNAL MEDICINE:
Lessen ABPM Coding Pressure With These Ideas
Key:  ICD-9 code 796.2 can get you $67The code you report for ambulatory blood press... Read more
NEUROSURGERY:
Uncover How 2 Non-Covered Services Can Pay Off
Hint:  ABN/modifier combo will guarantee payment--and protect youWhen it comes to rei... Read more
ORTHOPEDIC:
Make Sure You're Up To Speed On How To Report 29873
Bad news: Expect less payment than what you're used to As of July 5, 2005, Medicare implem... Read more
Part B Coding Coach:
Brace Yourself For 2006 Injection And Flu Shot Coding With 4 Need-to-Know Tips
Warning:  You may be over-reporting 99211 and sending up a red flag to MedicareA long... Read more
3 Steps Pinpoint the Right Flu Shot Code
Selecting the right codes for a flu shot visit is as easy as 1-2-3. Follow these simple st... Read more
PHYSICIAN NOTES:
Physicians 'Skeptical' Or 'Hostile' About Quality-Reward Systems
Not much money, lots of extra work, in pay for performanceThere's "lots of buzz," but not ... Read more
EVALUATION & MANAGEMENT:
Vague Body Part Descriptions Could Cost Your Practice Money On Appeals
Teach your doctors to be more precise in E/M documentation Sure, the carriers are com... Read more
MANAGEMENT:
Don't Let Test Results Slip Through The Cracks
10 tips on making sure patients, physicians see test resultsWhen your patients give up som... Read more
MEETINGS:
CMS May Remove Drugs From Physician Formula, But Not Retroactively
CMS move won't save you from steep cuts next yearIf Medicare goes ahead with the 4.4 perce... Read more
Flu Vaccine Shortages Should End Soon, CMS Says
If you treated undocumented aliens during May or June, you have until Jan. 11 to submit cl... Read more
COMPLIANCE:
Don't Roll Into Trouble With The Feds
Free local transportation may raise warning flags unless you're carefulSome larger multi-s... Read more
Part B Coding Coach:
How To Earn More For Complicated Nursing And Rest Home Visits In 2006
Get ready to master a whole slew of new nursing facility and domiciliary care codes that... Read more
PHYSICIAN NOTES:
Battle Of Wills Over Your Pay Cut Goes Down To Wire
Pay for performance is main bargaining chipWith time running out to save you from punishin... Read more
DERMATOLOGY:
Be Careful When Matching Products To New Skin Graft Codes
Try creating a "cheat sheet" to safeguard your reimbursementCPT 2006 takes a leap to catch... Read more
CARDIOLOGY:
'Hot Keys' Could Get You Into Hot Water
Beware of undercoding as well as upcoding heart catheterizations Your physician may f... Read more
PULMONOLOGY:
Ditch 780.x, Pick Up 327.x For Sleep Testing, Polysomnography
Old insomnia, apnea codes became 'unspecified' codes in October You think you... Read more
MedPAC Considers Setting Up Oncology Drug Copay Fund
Struggling oncologists could have a little extra help soon. If you've been routinely waivi... Read more
KICKBACKS:
7 Tips Keep Your Gift-Giving Nice, Not Naughty
If it looks too much like cash, it could put you in the hot seat'Tis the season to give gi... Read more
White House Supports Physician Pay Increase
Many observers have worried that the Bush Administration would throw up roadblocks in the ... Read more
GENERAL SURGERY:
Say Goodbye To Gastric Bypass Surgery For Over-65s
Medicare considers expanding coverage for clinical trialsYour older obese patients may be ... Read more
RACs May Soon Have Incentive To Find Underpayments
The so-called "bounty hunters" of health care may soon have a financial incentive to help ... Read more
Part B Coding Coach:
4 Must-Know Steps Keep You Ahead Of Appeals Process Changes
Medicare will now dismiss all incomplete appeals--but you have 3 options for addressing a ... Read more
PHYSICIAN NOTES:
HHS Could Be Giving Health IT Grants Soon
But House kills health IT bill The Senate passed a bill that would encourage you to ... Read more
FAMILY PRACTICE:
Don't Be Afraid To Bill 99211 For Interpreting TB Skin Tests
At around $20 a pop, payment for visits can add upPatients routinely come back to your off... Read more
APPEALS:
Everything Changes On Jan. 1 For Claims Appeals
Don't let the new time frames catch you nappingStarting Jan. 1, you'll have a new appeals ... Read more
APPEALS:
Iron Out Communication Between Departments In Your Office
You won't have much room for error after Jan. 1You'll have to submit all of your informati... Read more
Neurosurgery:
Medicare Won't Pay For New Intracranial Procedure Codes
Bad news: New intracranial surgery codes 61630-61642 have zero RVUs in the new Fee Schedul... Read more
10 Steps for Submitting A Clean Appeal
It's not a matter of if your carrier will audit you, but when, says Deborah Churchill, pre... Read more
EVALUATION & MANAGEMENT:
Make Your Voice Heard On E/M Coding Changes
CMS defends carriers' rights to make up their own E/M rulesIf you're concerned about Trail... Read more
BANKRUPTCY:
Beware--Medicare Can Still Freeze Your Payments
New law requires you to protect patient privacy in bankruptcyThe law governing bankruptcie... Read more
CARDIOLOGY:
Master The Art Of Coding For Interventions & Coronary Arteries
Use 92980 or 92981 depending on the number of stentsModifier 51 won't cut the mustard when... Read more
UROLOGY:
Reader Question--Catch These Catheter Removal Coding Clues
Question: How should I code for removal of a retained Foley catheter balloon when the offi... Read more
ONCOLOGY:
Don't Let 2 Operating Surgeons Cloud Your Judgement
Use modifier 80--not 62--to report an assistant surgeonYou know some surgical procedures r... Read more
RADIOLOGY:
You Be the Coder--High Or Low? That's The E/M-Level Question For Prostate Brachytherapy
Question: I have documentation for a prostate brachytherapy patient showing that the atten... Read more
ORTHOPEDICS:
Get 'Hip' To Bilateral MRI Coding
Do you know why 72195-72197 is a choice that will cost you? The hip joint can cause c... Read more
GYNECOLOGY:
Simplify Pap Smear Coding With V72.31
Important:  You don't have to emphasize V76.2 anymoreThis summer Medicare changed the... Read more
PODIATRY:
Brush Up On Your Medicare Modifier Knowledge
Clear up confusion about what situations require 57 and 25Medicare provides specific instr... Read more
Part B Coding Coach:
You're Losing Big On G0344 Claims If You Don't Report Diabetes & Cardio Screenings Separately
Plus:  Easy ways to reduce your "Welcome to Medicare" denialsThings aren't always as ... Read more
PHYSICIAN NOTES:
Welcome To The OIG's Hit List For WTM Exam
CPO study may discourage you from billing for legitimate oversight You’ve taken... Read more
SURGERY:
Miss Out On Lesion Excision, And Cut Out Your Own Payments
Sometimes a "punch biopsy" isn't really a biopsyDon't bill for a biopsy when your physicia... Read more
GASTROINTESTINAL SUGERY:
RVUs For New Codes Reward Attention To Additional Procedures
You can double your reimbursement for combined fistula approachYou'd better scan your surg... Read more
2006 RVUS:
Gain 1 Extra RVU For Documenting Postprocessing
But new intracranial procedures have no RVUs at all You can't count on your new CPT codes ... Read more
EVALUATION & MANAGEMENT:
Is Your E/M Coding Up To Par? Check CMS' Checklist
After three years, familiar faces are new again Heads up: The Centers for Medicare &a... Read more
Don't Throw Away Reimbursement On Thoracic Surgery
Keep your eyes peeled for coverage of left subclavian artery origin--it can make a big d... Read more
TRANSMITTAL ROUNDUP:
You Won't Pay The Price For Taking Bad Advice
Watch out for new remittance advice codes Are you up on the latest billing informatio... Read more
Part B Coding Coach:
Are These 5 Locum Tenens Myths Clouding Your Q5/Q6 Compliance?
Obeying the 60-day limit may be trickier than you think Attention all coders: You may h... Read more
PHYSICIAN NOTES:
Don't Rush Ahead With Quality Reporting Program
You won't receive any extra money for reporting new "G" codes, warns AMAThe Centers for Me... Read more
REIMBURSEMENT:
Start Preparing Now For Diagnostic Imaging Cuts
You have until 2007 to scuttle all non-compliant PET scan deals The Centers for Medicare &... Read more
REIMBURSEMENT:
CMS Puts Bundling Of Casting Supplies On Hold
PE-RVU changes delayed until 2007Oncology practices that have been depending on the $300 m... Read more
NEUROSURGERY:
New Add-On Codes May Reduce Your EMG Guidance Reimbursement
Shop using 95870 for needle placementUntil now you've billed needle electromyography (EMG... Read more
New Auditory Rehab Codes For 2006
Ears perked? New codes to bill auditory rehabilitation are on the way.There are two new co... Read more
SURGERY:
CPT 2006 Revises Coding For Vaginal Graft Revision
New codes cover renal pelvis catheter proceduresSoon you won't have to use unlisted code 5... Read more
New Pathology And Testing Codes For 2006
If your pathologist helps out during surgery, be sure documentation accurately reflects ... Read more
WASHINGTON UPDATE:
Now Is The Time To Call Your Member of Congress
White House threatens to veto Senate Medicare billYou have one chance left to avoid a 4.4-... Read more
Part B Coding Coach:
Hone Your E/M Skills For Hospital Services
Plus:  See what the crystal ball reveals about coding consults in 2006Do you shudder ... Read more
PHYSICIAN NOTES:
Beware--Your Carrier Doesn't Provide Enough Information On Corrective Action Plans
More scrutiny of your carrier may lead to more pressure on you Your carrier may be he... Read more
CPT 2006:
Don't Use 25 Modifier Unless You Can Back It Up
Follow-up, confirmatory consultation codes deleted as of January In the coming new ye... Read more
GASTROENTEROLOGY:
Heads Up--Laparoscopic Versions Of Open GI Procedure Codes
CPT plays catch-up with surgical techniques Is your surgeon performing a number of la... Read more
Humana Settles Physician Lawsuit
If you deal with private managed care payors, then you should welcome some changes in the ... Read more
RADIOLOGY:
Start Noting Who Performed 3D Reconstruction
You still need treating physician's order for CT reconstructionsThose of you who have been... Read more
Say Goodbye To Unlisted Codes For Patency Check, Radiofrequency Ablation
If you've been billing for a central venous access device assessment, known as a central l... Read more
SURGERY:
New Kyphoplasty Codes Mirror Vertebroplasty Codes
But existence of new CPT codes doesn't mean you'll get paid After  years... Read more
DERMATOLOGY:
Good News--Skin Grafts Section Of CPT Book Expands
You'll have new codes for autografts You used to employ codes 15100-15261 for aut... Read more
More Code Changes:
CPT 2006 also...
• replaces 99298-99299 for intensive care (low birth rate) with new codes for "continuin... Read more
CARDIOTHORACIC SURGERY:
Specify Whether Aorta Repair Includes Left Subclavian Artery
Alert: You can't bill for any stenting or balloon angioplasty separatelyNext year's C... Read more
CMS Releases New PMD Prescription Code
This month you can add a new code to your list for prescriptions of power mobility devices... Read more
Part B Coding Coach:
Leaf Through These Principles For Healthy CABG Coding
Bypass the temptation to code 33517-33523 aloneWhether you're coding for a cardiologist or... Read more
PHYSICIAN NOTES:
Hoping For A Pay Increase Next Year? You May Be Frozen Out Instead
Influential senator blasts chemotherapy demonstration projectBrace yourself. Next year may... Read more
MEDICAL REVIEW:
Have No Fear, Medical Review Will Last No More Than A Year
3 tips for getting off medical review as fast as possible Your carrier can still driv... Read more
RADIOLOGY:
Opportunity--You Can Still Bill For Multiple Units Of 36215-36217
Muster extra documentation to pass carrier scrutiny on catheterizationEffective Oct. 3, th... Read more
EVALUATION & MANAGEMENT:
Don't Let Go Of Payment For Same-Day Repeat Visits
But be prepared to fight for your reimbursement If your patients love you so much the... Read more
Oncology:
Another Nail in Coffin For Cancer Care Next Year
No matter how you protest that your payments for chemotherapy and other drugs are inadequa... Read more
REGUALATION:
Dermatologists Could Win Big, Radiologists Could Lose Out
Are you ready for a topsy-turvy new world of expenses? You soon may have a whole new ... Read more
Two Scans May Mean Less Reimbursement
The PE-RVU proposal was just one of the issues you commented to CMS about in the 2006 phys... Read more
COMPLIANCE:
Hospitals Can Pay Your Physician To Cut Costs
But tread carefully to avoid OIG hot buttonsYour physician could receive more money from l... Read more
Part B Coding Coach:
5 Tips Guarantee Top-Notch Chronic Condition Coding
Hint:  If the condition is irrelevant to treatment, leave it off your claimRecognizin... Read more
PHYSICIAN NOTES:
Go After Separate Payment For Screening Tests
Find out how to claim extra reimbursement for fasting glucose testsDid you know: If your p... Read more
EVALUATION AND MANAGEMENT:
Watch Out For Confusing New TrailBlazer E/M Guidelines
Use physician forums to make your concerns known Part B carrier TrailBlazer Health En... Read more
ORTHOPEDIC SURGEONS:
Be Sure To Collect Every Penny For Multiple Knee Compartments
Capture maximum payment on knee surgeries--and make up for upcoming $50 cutStarting Oct. 3... Read more
Tell Your Patients About New Drug Plan Choices
The Dept. of Health and Human Services has approved prescription drug plans and Medicare A... Read more
EVALUATION AND MANAGEMENT:
Don't Get Burned By Trailblazer's New E/M
Learn the new rules before an auditor uses them on your claims Part B carrier TrailBl... Read more
Legislation:
Keep Calling Your Representatives To Push For Relief From Cuts
You may still receive a respite from the 4.3 percent cut that's slated to devastate your p... Read more
NEUROLOGY:
8 Tips For Full Intraoperative Monitoring Payment
Hint:  Surgeon and monitoring physician can't be the same personIf you're befuddled b... Read more
E-Prescribing:
HHS Has the Prescription For Your Computer Blues
If your practice wants to prescribe drugs electronically, it may soon become a lot easier.... Read more
FECAL OCCULT BLOOD TESTS:
Cut Out 3 Common FOBT Coding Errors--And Avoid Denials
Don't mix up screening and diagnostic FOBTsAre you falling for the number one FOBT coding ... Read more
Part B Coding Coach:
Put The Brakes On High-Level E/M Fraud
A hospital admission waiting to happen may be a green light to 99215 You know the Off... Read more
PHYSICIAN NOTES:
Use Special Modifier For Disaster-Related Claims
You can use the new code regardless of where you’re located Don’t let you... Read more
SURGERY:
You Could Be Missing $100s In Abdominal Surgery Coding
Don't be afraid to bill 49002 when the surgeon reopens the woundIf your surgeon is re-exp... Read more
REIMBURSEMENT:
Watch Out For Claims-Eating Computer Glitches
System snags cause improper denials, delays If you’ve been losing reimbursement... Read more
REIMBURSEMENT:
Avoid Computer Claim Casualties With These 9 Tips
Pay attention to EOBs and keep talking to your carrierYou could be losing money to a compu... Read more
CARDIOLOGY:
Learn How To Capture Additional Catheter, Stent Codes
Don't get lost in the arterial system and miss important codesYou can lose up to 50 percen... Read more
WASHINGTON UPDATE:
Call Your Congressperson Or Senator Now To Save Your Payments
Medicare pay cut more likely in the wake of Katrina and RitaDo you want to take a pay cut ... Read more
Part B Coding Coach:
Reduce Your 'Reduced Services' Coding Headaches
Boost your bottom line by knowing when not to apply modifier 52Every time you conside... Read more
PHYSICIAN NOTES:
Beware Audits Of Your E/M Claims On 'Points System'
Your carrier may follow the example of TrailBlazerIf TrailBlazer Health Enterprises is you... Read more
HOSPITAL-BASED BILLING:
Don't Miss Out On Extra Cash For Hospital Visits
5 tips for capturing your rightful reimbursementPhysicians have a habit of forgetting to r... Read more
CORRECT CODING INITIATIVE:
CCI 11.3 May Become Your PET Peeve
CT scans bundled with tumor imaging codesIf you're performing PET tumor imaging, you may h... Read more
CORRECT CODING INITIATIVE:
CCI Version 11.3 Puts A Block On Nerve Blocks
But you no longer need a modifier for some neurology code pairsIf your physician performs ... Read more
More New CCI Edits
Evaluation and management codes 99239, 99298-99350, 99431-99440 and 99455-99456 will becom... Read more
CORRECT CODING INITIATIVE:
Step Carefully Around New Drug Administration Edits
CCI 11.3 unleashes more edits on injection codesThe Correct Coding Initiative isn't done w... Read more
CMS Wants To Move Providers To Electronic Remittances
If you're not receiving electronic remittance advice (RA) notices, then you could be wasti... Read more
STUDIES & SURVEYS:
Physician Offices Are Behind The Times On EHRs
To get up to speed, start looking under the sofa cushions for an extra $32,000Experts tout... Read more
Part B Coding Coach:
Guarantee Success With This Lap App Coding Roadmap
Don't throw money down the drain-know when to append modifier 22You face it everyday--the ... Read more
PHYSICIAN NOTES:
CMS Releases EHR Software For Physicians
But you'll need to contact a vendor to install itFor once, the Centers for Medicare & ... Read more
Anesthesia Billing:
You Could Be Throwing Away Hundreds Of Dollars With Incomplete Reports
Some anesthesiologists use surgical reports instead of their ownAs everybody knows, anesth... Read more
Electronic Claims:
Don't Get Too Attached To Paper Attachments
When new electronic standards finally arrive, they'll be more opportunity than compliance ... Read more
Orthopedics:
Practices Could Lose $1000 Per Week Under New Rule
 CMS wants to stop paying separately for casting supplies If your office provides a l... Read more
CMS Should Make Physicians Attend To DME Claims, OIG Says
The Centers for Medicare & Medicaid Services should do more to help physicians help th... Read more
Reimbursement:
CMS Wants To See Some Codes Slashed In 2007
Some procedures may cost less if performed in the office You may see sharp decreases ... Read more
You Get 2 Chances To Choose CAP Vendor Next Year
The Centers for Medicare & Medicaid Services clarified the timeline for implementing t... Read more
Medication Billing:
Ditch 90782, Reach For G0355 For Injections
If your practice provides in-office injections of Avonex for multiple sclerosis patients, ... Read more
Fee Schedule:
CMS Proposes Cutting Apheresis Up To 9%
Medicare may make a cutting-edge procedure to treat blood disorders impossible to provide.... Read more
Part B Coding Coach:
Your Top 7 Drug Waste Coding Questions Answered
Don't miss your chance to get paid for a full vial of Botox no matter how much you adminis... Read more
Physician Notes:
CCI 11.3 Adds 2,000+ Non-Mutually Exclusive Edits
Only 164 edits deleted in latest update Prepare yourself for one last round of Correc... Read more
DRUG ADMINISTRATION:
For First IV Push After Infusion, Bill A Subsequent Code
AMA adds category for hormonal agents to drug administration codesIf you're struggling to ... Read more
PRIOR DETERMINATION:
More Certainty About High-Cost Items Could Be On Its Way
Your carrier has 45 days to decide on pricey items, but may respond more quicklyWhen ... Read more
REIMBURSEMENT:
Listing 'None' Or 'Other' for Medigap Insurer Will Lead To A Denial
You don't have to submit primary payors' statements with secondary claimsMedicare Remittan... Read more
Carrier May Have More Info On File About Your Denials
If a carrier denies your claim before payment, it is possible the only thing you will see ... Read more
CODING UPDATES:
AMA Hints At Upcoming CPT Codes
CMS still wants to dispose of non-physician workpool You could soon have codes for wo... Read more
New HCPCS Codes Include Low Vision Rehab, Ventricular Assist Devices
But new surgical codes won't be billable to Medicare Watch out: You have less tha... Read more
DISASTER RELIEF:
CMS Loosens Rules So That Hurricane Victims Can Get The Help They Need
Many physicians and other medical professionals are donating their time and resources to h... Read more
Part B Coding Coach:
Fee Schedule School's Back In Session
Add columns U, V and X to your stock of skillsLast month's PBI showed you the ropes for tr... Read more
Download The Fee Schedule Database With Ease
To access the Physician Fee Schedule Database, use the "search" function on CMS' home page... Read more
PHYSICIAN NOTES:
Home Is Where POS 12 Is, CMS Reminds Providers
Don't bill for a home-based service using the wrong place of serviceIf your physician is b... Read more
REIMBURSEMENT:
Medicare Cuts Payment For Arterial Procedures
Beware bilateral changes this OctoberIf your practice does a lot of selective catheter pla... Read more
WHEELCHAIRS:
Say Goodbye To CMNs, Say Hello To Administrative Nightmares
You'll receive $21.60 extra for coping with documentation demandsAs of Oct. 25, your docto... Read more
MEETINGS:
Don't Let Drug Bidders Drive Down Our Prices, Physicians Say
Watch out for access problems after Medicare cuts, PPAC warnsThe Centers for Medicare &... Read more
MODIFIERS:
Look Twice Before Applying Bilateral Modifiers To Different Payors
Some payors phase out 50 modifier as "pricing modifier"In a perfect world, you'd be able t... Read more
COMPLIANCE:
If The Stock Can't Go Up, It Can't Corrupt, CMS Says
Non-profit physician group's stock plan wins CMS blessingStock plans without financial ben... Read more
Teaching Documentation May Soon Become Easier
The American Academy of Medical Colleges has been working with the Physician Regulatory Is... Read more
Part B Coding Coach:
3 Ways To Ease Coding Woes With The Fee Schedule Database
Proper modifier use, RVU information and more is just a download awayIf you are looking fo... Read more
PHYSICIAN NOTES:
Phase In P4P Over Time, Societies Urge Congress
Give doctors until 2010 to adjust to P4P, AMA advisesPay for performance (P4P) is incompat... Read more
HOME CARE:
Don't Be Afraid To Bill G0179 And G0180 For Home Care Certs/Recerts
30-minute requirement doesn't apply to these codes When the HHS Office of Inspect... Read more
ENROLLMENT:
When Should You Apply For An NPI?
Don't wait too long-or you'll be caught in the crushSure, all the cool kids are  doin... Read more
CONCIERGE CARE:
Extra Fees For Medicare Patients Don't Pose Problem, GAO Says
But snowballing trend of 'concierge care' could lead to crackdown laterThe federal governm... Read more
LOCUM TENENS:
Track Locum Tenens Billing Or Face Audits
Use computerization, special file for temp doctorA locum tenens physician may be a tempora... Read more
No Easy Answer To CRNA Substitution
Locum tenens physicians can be a great solution if one of your doctors is away or on mater... Read more
THERAPY:
Don't Use 97750 For Computerized Gait Analysis
For this time-based code, make sure therapist is physically present during tests If y... Read more
Part B Coding Coach:
Test Yourself-When Does Modifier 25 Apply?
Stay off the OIG's hit list while collecting well-deserved reimbursementIf you don't know ... Read more
PHYSICIAN NOTES:
Physician Incomes Rise, But Specialty Work RVUs Drop
General surgeons, hematology/oncology physicians see highest pay raise While physicia... Read more
COMPLIANCE:
CMS Proposes Self-Referral Ban For PET Scans, Nuclear Medicine
You may need to bail out of joint venturesYou could have a much harder time performing PET... Read more
COMPLIANCE:
Prepare Your Front Lines For Applying Ultrasound Rules To PET Scans
Restructuring your payment arrangements could be just around the cornerIf the Centers for ... Read more
DIAGNOSTIC IMAGING:
Brace Yourself For 50 Percent Pay Cut On Multiple Imaging Procedures
CMS seeking comments on sharp pay reduction for radiologistsRadiologists could face an ext... Read more
COMPETITIVE ACQUISITION:
CMS Pulls The Plug On Drug Bidding Program
Drugs may be available through vendors by July 2006If you've been looking forward to priva... Read more
CMS Could Save You From Exclusion From Medicare
A new proposal might play a big role in saving you from a harsh HHS Office of Inspector Ge... Read more
TRANSMITTALS:
Upcoming CCI Edits Will Hit All Providers Billing Part B
Smaller overpayments will lead to demand letters from carriersSoon other providers will ha... Read more
Part B Coding Coach:
Use This Guide To Get A Grip On Global Periods
Learn how modifier 78 breaks all the 'resetting' rulesIgnoring global periods can wreak ha... Read more
PHYSICIAN NOTES:
Medicare Coding Nightmares Prevent Patients From Receiving Diagnostic Tests
No updates expected until 2008, study saysIf you're feeling as though Medicare reimburseme... Read more
CPT 2006:
Modify Claims for GI Laparoscopy, FOBT And Moderate Sedation
And prepare for follow-up consult deletions, some sources warnThe American Medical Associa... Read more
CPT 2006:
Neurologists Welcome New Add-On Codes For Chemodenervation
New vignettes should help to illustrate proper use of 64612-64614In the spring of 2004, th... Read more
EDITS:
Say Goodbye To Nickname-Related Denials
Medicare gives up on name/Id edit-for nowPressure from thousands of providers has led the ... Read more
REIMBURSEMENT:
CMS Projects Steep Cut, But Johnson Proposes Increase Instead
89 Senators ask CMS to take drugs out of physician pay formulaThe Centers for Medicare &am... Read more
QUALITY:
Physcians Not Ready For P4P, Senate Panel Told
Take it slow, say surgeons, while CMS introduces roadmapThe steamroller of pay for perform... Read more
Part B Coding Coach:
4 Rules To Follow To Make The Best Of Breast Procedures
'Lumpectomy' is a general term, so proceed with caution when choosing excision, mastectomy... Read more
PHYSICIAN NOTES:
You Can't Hurry Quality, Surgeons Tell Congress
Start with the basics and then work up to outcomes, they insistA group of surgical special... Read more
STRATEGY:
Consider Going Direct To Patients With Second-Opinion Service
Cash-only business provides profitable sideline for specialistsIf your physicians are expe... Read more
MEETNGS:
CERT Contractors Halfway To Proper Contact System
Carriers can charge for running seminarsIf you've been trying to bill Medicare for new ste... Read more
STRATEGY:
Before Offering Second Opinions, Your Practice May Need A Checkup
6 tips for offering a second-opinion serviceYour practice can reap extra reimbursement by ... Read more
LEGISLATION:
New House Bill Would Repeal Physician Update Formula
Republicans, Democrats agree upcoming cuts are unacceptableInstead of seven lean years sta... Read more
INFORMATION TECHNOLOGY:
CMS Offers Free IT To Physicians
But some question Medicare on pushing one solution over othersIf spending $100,000 on a ne... Read more
Carriers Should Crack Down On CPO, OIG Says
If your physicians are overseeing the care of home health patients, you could find the car... Read more
Part B Coding Coach:
Afraid to Report Unlisted and Category III Codes? Capitalize on These 3 Tips
If you substitute Category III or unlisted-procedure codes with existing, but inexact, CPT... Read more
PHYSICIAN NOTES:
Medicare 'Bounty Hunters' Haven't Targeted Physicians-Yet
Physicians must supervise nurse anesthetists in New JerseyPhysicians have been bracing the... Read more
MODIFIERS:
Avoid Slicing Away You Reimbursement With Each Surgery
Don't throw away money using modifier 81 for NPPsIf your practice is routinely using modif... Read more
MODIFIERS:
Can't Decide on a Modifier: Check the Global Period
Handy tips for distinguishing the 58 and 78 modifiersThe American Medical Association plan... Read more
CODING:
CT Angiography Gains New Codes For 2006
But it's up to carriers to decide how much to reimburse codesCoronary computed tomographic... Read more
COMPLIANCE:
Physicians Can Provide DMEPOS-But Only With Personal Touch
Watch out for satellite offices that don't practice medicineAre you passing up the chance ... Read more
CMS Chooses 6 Organizations To Manage High-Risk Patients
The Centers for Medicare & Medicaid Services (CMS) has chosen six organizations to par... Read more
REIMBURSEMENT:
CMS Should Act To Save Physician Payments, Legislators Insist
Removing drugs from formula would help avoid steep cutsAvoiding an estimated 31 percent pa... Read more
Part B Coding Coach:
Determine Reason And Place To Help You Classify Consults
Key: Document request and rendering of opinionProblems differentiating office consultation... Read more
PHYSICIAN NOTES:
Sickest Medicare Patients Still Go To Physicians With Poor Technology
And most doctors only use technology for one out of five functionsMost Medicare patient vi... Read more
Pay for Performance:
AARP Comes Out In Favor Of Pay-For-Performance Bill
Collect quality data in 2007 if legislation passesThe powerful American Association for Re... Read more
Drug Acquisition:
CMS Puts On Its Thinking CAP - And Puts Off Providers
You'll have seven days, instead of one, to provide drugs The Centers for Medicare and Medi... Read more
Consider Bundling Services, Med PAC Advises
The Medicare Payment Advisory Commission doesn't expect the 4.3 percent estimate for next ... Read more
Drug Acquisition:
Dealing With CAP Vendors May Be More Trouble Than It's Worth
CMS refuses to recognize program's administrative burden The Centers for Medicare and Medi... Read more
Pay for Performance:
Will There Be Tit-For-Tat On Pay-For-Performance?
Even the AMA seems willing to make a dealWashington observers say it's increasingly likely... Read more
Bills Would Boost Health IT
Legislation aimed at boosting information technology seems likely to have a place in any M... Read more
Pay for Performance:
P4P May Lead To A Transfer From Some Specialties To Others
Neurosurgeons may lend themselves more to quality guidelinesPay for performance may well b... Read more
Part B Coding Coach:
Secure Allergen Immunotherapy Reimbursement That's Nothing to Sneeze At
Tip: Use unlisted code 95199 for food allergies If denials for allergy claims are getting ... Read more
Physician Notes:
Non-Compete Agreements Non-Enforceable In TN
Contracts that require a physician to stop practicing in a given area after leaving a prac... Read more
CHEMOTHERAPY PAYMENTS:
Drug Payments For These Commonly Prescribed Drugs Drop Up To 38 Percent In July
Overall drug payments face 2 percent cutIf oncologists were hoping for a break from third-... Read more
PAY FOR PERFORMANCE:
AMA Will Oppose Any P4P That Doesn't Meet Standards
And that includes proposals now before CongressPay-For-Performance (P4P) anxiety dominated... Read more
COVERAGE:
Stable Angina Patients Could Soon Have Access To ECP Therapy
And one carrier medical director weighs in for tumor assayIf you've got something to say a... Read more
MODIFIERS:
AMA Plans Modifier 25 Clarification
Plus: Modifiers 58 and 78 on the slate for clarificationWhen a patient comes in with a set... Read more
CRITICAL CARE:
Two Physicians, One Hour-Who Bills For Critical Care?
With many hospitals hiring critical care teams to handle critical cases,  physicians ... Read more
CMS Monitoring IVIG Access/Majority Og Chiropractic Claims Have Documentation Problems
CMS Monitoring IVIG AccessSome advocacy groups and providers have complained that patients... Read more
Part B Coding Coach:
Avoid V Codes And Risk Vaporizing Valuable Green
Fact: V codes can verify medical necessity and validate higher E/M levelsCoders often shun... Read more
Forget These Screening Codes And Forget Payment From CMS
V codes play a vital role in Medicare's screening services - and failure to use them can t... Read more
PHYSICIAN NOTES:
Information Technology May Be Available Soon
Two bills would standardize IT, provide grantsFor your information, the government may soo... Read more
NCCI 11.2 SPECIAL REPORT:
New Injection Codes Bundled With Thousands Of Procedures
Prepare now for NCCI version 11.2If you've been finding the new "G" codes for drug adminis... Read more
NCCI 11.2 SPECIAL REPORT:
Laryngoscopy Coding Becomes A Minefield In July
 When you can - and can't - legitimately unbundleCPT 2005 introduced two new codes fo... Read more
NCCI 11.2 SPECIAL REPORT:
Total Omentectomy Code Totally Surrounded With Edits
NCCI version 11.2 adds to edits from CCI version 11.0 Ob-Gyn coders rejoiced when CPT... Read more
Drug Administration Edits Revoked
As promised, the Centers for Medicare and Medicaid Services revoked troublesome drug admin... Read more
ONCOLOGY REIMBURSREMENT:
Tough Times Could Be Ahead For Oncologists In 2006
Demonstration project, add-on payment both due to phase out Most physicians face a dr... Read more
FRAUD & ABUSE:
Resident Supervision, Upcoded E/Ms Spell $1.9 Million Payback
Nail debridement, ASCs on OIG hit listIf you're skating close to the edge with some of you... Read more
Part B Coding Coach:
Ask These 5 Questions To Tunnel Your Way To The Correct Catheter Code
Patient age and insertion type are key factorsNavigating your way though CPT's thirteen ce... Read more
Gain Easy Access to Your Venous Access Placement Codes
Use this handy list to help you quickly locate and select the correct CPT Code placement... Read more
PHYSICIAN NOTES:
Forget About Applying To Own A Specialty Hospital This Year
CMS keeps the brakes on physician-owned hospitals for rest of year The moratorium on ... Read more
Hospital Discharge Coding:
Add $25 To Your Discharge Pay With Proper Documentation
Educate physicians to note time spent on discharge managementIf your physicians aren't doc... Read more
Reimbursement:
Name-Matching Requirement Could Shave 30% Off Payments
And Ban on Resubmissions of Denied Claims Causes Headaches Physicians are facing deni... Read more
Hospital Discharge Coding:
Watch Out For These Discharge Planning Pitfalls
6 mistakes that could cost you thousandsIf you manage to train your physicians to document... Read more
Documentation:
Keep An Eye Out For These Clues In Review Of Systems Documentation
 9 tips to capture every relevant system Sometimes your physician's review of systems... Read more
Surgery:
Advanced Nurse Practitioner Can Be Assistant At Surgery, Carrier Says
 But watch out for overlapping global periods Not only can a physician assistant... Read more
Part B Coding Coach:
Accurately Score Medical Decision Making To Maximize Reimbursement For Your E/M Claims
Hint: Assign 2 points for reading radiology resultsIf you're having trouble making decisio... Read more
Physician Notes:
Doctors Looking Forward To Competitive Drug Demo
Oncologists most likely to feel effects of new programSome physicians are optimistic about... Read more
ORGANIZATION:
Bring Patient's Together To Cope With Chronic Illnesses
Drop-In Group Appointments improve efficiency, patient satisfactionWhat if you could treat... Read more
SCHEDULING:
Cover More Educational Ground, Give More Support With Group Visits
Patients show higher satisfaction with group visits.Patients showed higher satisfaction wi... Read more
Study Two Different Models For Group Medical Appointments
In Drop-In Group Medical Appointments (DIGMAs), patients can come into disease-specific gr... Read more
REIMBURSEMENT:
Should Your Physicians Receive Rewards For Decreasing Hospital Spending?
'Pay For Performance' incompatible with physician pay limitsWhen physicians do a good job ... Read more
FTC Shoots The 'Messenger Model' In NM Antitrust Probe
Another independent practice association reached a consent order with the Federal Trade Co... Read more
COMPLIANCE:
Listen To Family Members With Pain Management Concerns
Ohio pain doctor winds up with pain of her ownThe State Medical Board of Ohio did the righ... Read more
AMA, MedPAC Clash At Specialty Hospital Hearings
Congress should end the moratorium on specialty hospitals, which stifles healthy competiti... Read more
LEGISLATION:
Bills Would Replace 4.3 Percent Cut With 2.7 Percent Boost
But a permanent solution to physician payment woes may have to wait Physicians could ... Read more
Part B Coding Coach:
Catch The E-Wave- Is Your Practice Wiping Out On Reimbursable Visits?
Medicaid and some private payers reimburse for e-visits and telemedicineWhen your physicia... Read more
PHYSICIANS NOTES:
Physicians Cuts Could Create Emergency Situation, ACEP Warns
Elderly beneficiaries seek care in ER instead of doctor's offices Emergency room ... Read more
CODING & REIMBURSEMENT:
You Can Keep Using CPT Codes For Selective Angiography
Rules return to 2004 version The Centers for Medicare and Medicaid Services caused a ... Read more
PRACTICE MANAGEMENT:
Open Up Your Office To Improve Communication
The more eye contact, the better the information flowAre your physicians and billing staff... Read more
ANTITRUST:
Doctors Should Join Together To Fix Patients, Not Prices
Your independent practice association should be truly integrated When physician practices ... Read more
You Can Receive Shortage Bonus Only For Professional Component
Notify your Medicare carrier if you choose to bill globally and forgo your physician scarc... Read more
HEARINGS:
Specialty Hospital Moratorium Bill Could Be DOA
Influential congressman promises to keep bill from leaving committeeA new bill could forbi... Read more
Unattended Sleep Testing Not Covered
Don't bill Medicare for polysomnography performed in the home or a mobile facility, becaus... Read more
HIPAA:
Home May Be Where The Privacy Violation Is
7 tips for dealing with work-at-home codersOff-site shouldn't mean out of mind when it com... Read more
Part B Coding Coach:
Document Diabetes Risk Factors - Or Risk Losing Deserved Payment
Recoup up to $17 for diabetes screening testIf your physician isn't documenting specified ... Read more
Clip and Save:
Reference This List To Bill Medicare Screening Benefits
Cheat sheet makes coding Medicare diabetes, cardiovascular tests a snapDon't let Medicare'... Read more
PHYSICIANS:
CMS Issues Technology Assessment For Kyphoplasty, Vertebroplasty
Results could erase current carrier coverage policiesThe Centers for Medicare and Medicaid... Read more
DIAGNOSIS CODING:
New Overweight, BMI Codes Useful For Bariatric Surgery
But most doctors don't list body mass index on patient's charts If you're... Read more
DOCUMENTATION:
Know How To Cope With Altered Documentation
6 tips guide your actions when someone makes unauthorized revisionsThere's no need to pani... Read more
What If An Outside Entity Changes Your Documentation?
If another entity that you deal with changes your documentation, your responsibilities may... Read more
DRUG ADMINISTRATION:
Can You Bill Concurrent Infusion For Two Drugs In One Bag?
The answer is hiding in carrier local coverage decisionsThe Centers for Medicare and Medic... Read more
MGMA Database Offers Benchmarking Opportunities For Doctors
If you're looking for data to compare your practice against, the Medical Group Manag... Read more
REIMBURSEMENT:
Medicare Issues New Smoking Cessation Codes
But acupuncture codes won't be coveredIf you're gearing up to provide smoking-cessation co... Read more
Medicare Clarifies Tricky Therapy Supervision Issue
For physicians confused about how to supervise therapists providing services to their pati... Read more
DRUG ADMINISTRATION:
Doctors Shouldn't Have To Promise Exact Date Of Drug Administration Under CAP
Associations object to 'radical' change in drug billing windowNow that the Centers for Med... Read more
Part B Coding Coach:
Test Your Suture Removal Savvy With 5 Expert Q&A's
There's no specific suture removal code, but that doesn't mean you can't bil... Read more
PHYSICIAN NOTES:
Plaintiffs Can Go After Physicians If Malpractice Insurer Goes Under
You're at risk if your insurer goes into liquidationFor already struggling physicians, lif... Read more
CORRECT CODING INITIATIVE:
Chemotherapy Edits Revoked Retroactive To April
Use -59 modifier to overturn edits before July 1 If you're billing additional seq... Read more
DOCUMENTATION:
Extra Scribbles Can Lead To Fines, Jail Time
Make sure doctors date all new entries on patient records If you suspect that someone... Read more
RECOVERY AUDIT CONTRACTORS:
Your E/M Visit Levels Are Safe From RAC Scrutiny
And physicians aren't the contractors' main target for nowGood news: Medicare's new "bount... Read more
ICD-9 CHANGES:
Capture Renal Disease Details Or Kiss Reimbursement Goodbye
Sleep disorders gain raft of new codes for different causes and types Diagnosis codin... Read more
New V Codes for 2006
The ICD-9 update also includes new V codes spelling out the reason a vaccination wasn... Read more
ASCs:
A Good Surgical Procedure Is One You Can Walk Away From, CMS Says
More procedures will be covered in ASCs, and planned cuts are canceledPressure from ambula... Read more
Spine Surgery Centers Drove New Procedures
As more and more physician-opened surgery centers pop up, the volume of surgeries increase... Read more
Part B Coding Coach:
Sleep Easy With These 4 Sleep Apnea Coding Steps
Hint: Obtain pre-authorization before the lights go outIf your practice doesn't manage car... Read more
PHYSICIAN NOTES:
NQF Proposes Objective Physician Quality Measures
Standards address chronic illnesses, testing and immunizationPart of the problem with rewa... Read more
CONSULTS:
CMS Clarifies-No Shared Visits For Consults
A consult is one doctor's opinion, not a consensusConsults are hard work, and physicians m... Read more
INFUSION:
CMS Eliminates Confusion About Short-Term Infusion
You can only use G0350 once per session Providers who have been trying to squeeze the... Read more
MODIFIERS:
Payers Deny Modifier -25 Claims Unless E/M Is Totally Unrelated
New book may be adding to the confusion Coders are reporting denials for evaluation a... Read more
No Re-Certification Without Practice Improvement
While payers talk about rewarding physicians for outcomes, the American Board of Internal ... Read more
REIMBURSEMENT:
Double-Digit Physician Spending Growth Bad Omen For 2006
What's behind the skyrocketing payments?Physician spending rose a startling 15.2 percent i... Read more
RVU Review Likely To Boost More Codes
The AMA's Relative Value Update Committee is conducting its third five-year review of RVUs... Read more
PHYSICIAN PAYMENTS:
Fixing 4.3 Percent Cut Shouldn't Raise Premiums, AARP Argues
Beneficiary pressure may doom physician rescueIf you're waiting for Congress to step in an... Read more
Part B Coding Coach:
2 Scenarios Give Your Depression Coding A Lift
Knowing your carriers' mental-health coverage limits is key for preventing denialsIf you'r... Read more
PHYSICIAN NOTES:
CMS Will Expand Coverage Of Abarelix For Prostate Cancer
And at least one carrier will now pay for Abraxane for breast cancer If you've be... Read more
APPEALS:
Evidence Submission Time Limit May Come With Loophole
But you can only resubmit denials for 'clerical errors'Good news: You may be able to submi... Read more
PRACTICE MANAGEMENT:
The Handwriting Is On The Wall For Illegible Doctors
Denials and lawsuits lurk, plus some states outlaw poor penmanshipIllegible handwriting is... Read more
APPEALS:
If Losing Thousands Doesn't Appeal To You, Streamline Your Processes
Prepare now for quicker appeals turnaround Starting this January, having your ducks i... Read more
Hospital Association Raises NPI Questions
While physicians have been wondering how the new national provider identifier (NPI) requir... Read more
HIPAA:
Don't Make A Million-Dollar Mistake On HIPAA Compliance
9 tips to comply with security rule, in effect April 20Even before the new HIPAA security ... Read more
APPEALS:
There's More To Know About New Appeals Process
The carrier won't have to notify you when it receives your appeal requestStarting in Janua... Read more
Part B Coding Coach:
Knock The Air Out Of Denials With A New Attack On Spirometry Coding
Hint: You can't report 94060 if the physician only performs one spirometry testYou may be ... Read more
PHYSICIAN NOTES:
CMS Increases Physician Scarcity Area Incentives
Get bigger bonuses if you work in a critical access hospitalIf your county qualifies as a ... Read more
Drug Payments:
Drugs In Doctors' Offices Will Stay Under Part B
But CMS will study whether to move a few drugs to new benefitNext year's new prescription ... Read more
Coverage:
CMS Wants Your Input On Coverage Process
Medicare will fine-tune coverage decision-makingNow is your chance to let the Centers for ... Read more
Medicare Will Cover FDG PET Scans For More Types of Cancer
If you have cancer patients who could benefit from positron emission tomography (PET) scan... Read more
Studies and Surveys:
AMA To Congress: If You Cut Doctor Pay, You'll Hurt Seniors
Nearly 1 in 5 physicians will decrease their current Medicare patient loadIf Congress does... Read more
Studies and Surveys:
Don't Blame Non-Radiologists For Imaging Surge
In-office imaging adds to convenience, improves outcomes, say doctorsIf Medicare imposes s... Read more
Practice Management:
Health IT Doesn't Solve Problems At 'Dysfunctional' Practices
40 percent of organizations fail to implement electronic solutionsIf you just install enou... Read more
Compliance:
Keep The Whistle From Your Workers' Lips With These 10 Tips
Think whistleblowers all work at healthcare giants? Think again. Your coders, billers... Read more
Part B Coding Coach:
Upgrade Your Lab Coding Knowledge With 5 Expert Tips
Do you know all the rules for modifiers -91 and -QW?If you can't figure out when to report... Read more
Physician Notes:
Dermatologists and Urologists Win Big Under Resource-Based System
But thoracic surgeons and gastroenterologists lose outThe move to resource-based Practice ... Read more
INCIDENT-TO-BILLING:
CMS Reverses Course On Incident-To Billing
Docs, coders left confused by unpublicized flip-flop If you've been relying on the Centers... Read more
SEPSIS CODING:
Never use Sepsis As Primary Diagnosis, CMS Says
Be sure to follow up with docs about confusing terminology You shouldn't have to... Read more
CONSULTS:
You Don't Need A Written Request To Prove A Consult
But CMS withdraws its article on the subject, to providers' confusionLast September's tran... Read more
REIMBURSEMENT:
Medicare Increases RVUs For 58356 By Tenfold
But venipuncture is no longer payable under physician fee schedule You'll see a h... Read more
POLITICS AND POLICY:
Doctor Spending May Make Medicare Part B Too Pricey For Patients
Canceling next year's 4.3 percent cut will only make it worseRunaway physician spending is... Read more
Medicare Launches Disease Management Demo Project
If you're frustrated by dealing with tough diseases such as diabetes and advanced-stage he... Read more
Part B Coding Coach:
Use Modifier -57 for Same-Day E/M and Major Surgery Services
Reserve modifier -25 for evaluations with minor surgical proceduresIf you're not appending... Read more
PHYSICIAN NOTES:
More Patients Will Hear Good News About Cochlear Implants
Triple-threat drug combo will target nausea and vomitingMedicare expanded its coverage for... Read more
Long Distance ESRD Care Made EZ
Medicare will start covering telehealth services for end stage renal disease patients imme... Read more
NCCI Edits:
Cardiac 'Pass Technique' Hit With Tough NCCI Edit
And new meniscal transplantation code includes debridement One new National Correct C... Read more
Politics & Policy:
McClellan To Doctors- Prepare Now For Efficiency Moves
Medicare must work smarter, spend less for better carePhysician spending is running out of... Read more
NCCI Edits:
New Infusion Code Bundled With 752 Other Codes
Urinary bladder residual study code hit with dozens of edits If you've been using... Read more
MedPAC Imaging Plan Meets With Skepticism
The Medicare Payment Advisory Commission ran into stiff opposition from doctors for its pl... Read more
Hospital Admissions:
Doctors Could Have 30 Days Before Admission To Perform Exam
Podiatrists may gain hospital admitting privilegesGood news: The Centers for Medicare and ... Read more
CPT Panel Will Resolve Tricky Drug Coding Issues
CPT 2006 should untangle several of your trickiest drug billing questions. The CPT Ed... Read more
Drug Payments:
Medicare Slashes Drugs By Up To 60 Percent
But a few drugs actually enjoy a payment increaseIf you figured the Medicare payments for ... Read more
Part B Coding Coach:
6 Steps Promise Definitive Diabetes Coding Success
Leaving out diabetic complication codes could hurt your cash flow If you're not r... Read more
Physician Notes:
Don't Bill For Septic Shock Unless You Show Sepsis First
You can never report any codes from subcategory 995.9 (Sepsis) as the principal diagnosi... Read more
RECRUITMENT AND RETENTION:
Want Your Coders To Stick Around? Show Your Appreciation
But don't pay them more based on upcodingA good coder is a wonderful resource and a treasu... Read more
VENOGRAPHY:
Don't Bill Separately For Venography With Pacemaker Or ICD Implantation
But do bill for blockages or complications If you're trying to bill for venograph... Read more
RECRUITMENT AND RETENTION:
Give Good Employees A Shot At Becoming Coders
A receptionist or scheduler already familiar with your practice will bring more value to... Read more
Expense Indexes May Not Reflect Your Real Costs, Says GAO
If you are frustrated by the geographic practice cost indices (GPCIs), a March 11 Governme... Read more
COMPLIANCE:
Don't Charge Patients For Services Medicare Already Covers
Beware gray areas of services Medicare may or may not reimburseIf your practice charges pa... Read more
PRACTICE MANAGEMENT:
Have Your Doctors Gone Fishing And Left Patients Fuming?
4 tips to deal with providers who chronically cancel appointmentsIf a physician in your pr... Read more
Part B Coding Coach:
Save Your MVA and Workers' Comp Claims With a Simple E Code
These codes may help you speed up claims processingInsurers may not always accept or requi... Read more
PHYSICIAN NOTES:
HIPAA Security Rule Deadline Looms
Are you ready to face the HIPAA music next month?The April 20 deadline for compliance with... Read more
Politics and Policy:
DRG Changes Could Slash Physician-Owned Hospital Payments
Moratorium likely to last until 2007Do physician-owned hospitals that focus on one narrow ... Read more
Appeals:
New Appeals Rule Will Make You Dizzy With Complex Procedures
Decide in advance what kind of representation to offerAppealing claims next year could bec... Read more
Meetings:
Local Carriers Are Your Best Bet For Fixing
PPAC urges CMS to take drugs out of update formula retroactivelyLeast costly alternative (... Read more
Carriers Will Notify You Of HIPAA Errors
Starting July 5, Medicare contractors will issue special automated notices to physicians, ... Read more
Practice Management:
Consider Charging Patients Who Stall On Copays, Deductibles
A monthly "statement fee" can be an alternative to interestEvery practice has had patients... Read more
Non-Compete Can Only Keep Doctor Off Certain Streets
A court did the right thing in enforcing a non-compete agreement that York, PA neonatologi... Read more
Coverage:
CMS Expands Defibrillator Coverage
Medicare HMO patients get defibrillators on fee-for-service basisPatients should be able t... Read more
Part B Coding Coach:
4 Nebulizer Coding Tips Help Ensure Maximum Payment
Don't miss out on E/M, drug, and training reimbursement You may watch valuable re... Read more
Physician Notes:
'Medically Unbelievable' Edits Put on Hold Indefinitely
No explanation for revocationThe "Medically Unbelievable" edits appear to have suspended t... Read more
AUDITS:
Audit-Proof Your MDM With Beefed-Up Documentation
Make providers describe the decision-making, or your audit could be a tragedy When Me... Read more
CODING:
Providers Celebrate PET Coding Move
CMS clears up deadline mystery Providers are cheering the Centers for Medicare and Me... Read more
AUDITS:
Look For Signs Of MDM Thought Process
7 tips to boost your E/M levels and improve documentation Your records may have a his... Read more
Tysabri Pulled From Market
Physicians have been optimistic about the possibilities of using Tysabri to treat multiple... Read more
MEDICATIONS:
Neurologists Face Challenge Covering Cost Of Apokyn Injections
3 options for easing the cost of tricky first dose Sometimes when a new miracle drug ... Read more
COMPLIANCE:
Don't Take OIG Opinions as License to Go Nuts With Gainsharing
The HHS Office of Inspector General has now issued three more opinions approving gainshari... Read more
Part B Coding Coach:
4 Q&A's End Your Exasperation With E/M Guidelines
A CMS policy official shares the answers you need When choosing an E/M level, many co... Read more
PHYSICIAN NOTES:
MedPAC Pushes Pay-For-Performance
But not unless providers receive recommended 2.7 percent pay boostAs expected, the Medicar... Read more
ONCOLOGY:
Split Chemo Claims Tear A Hole In Your Reimbursement
Cancer providers need to bill more codes than one claim can handleA software glitch could ... Read more
Don't Resubmit Denied Claims Starting July 5
Starting July 5, you won't be able to resubmit denied claims. Transmittal 104 instru... Read more
COVERAGE:
Carriers Advance Coverage For Kyphoplasty, Vertebroplasty
You shouldn't bill for bone biopsy alongside kyphoplastyIf you've been trying to bill for ... Read more
ONCOLOGY:
Chemotherapy Payments Trickling In? Here Are A Few Tricks To Help
5 successful tips put the claims-splitting nightmare to restJust as a house divided can't ... Read more
CODING EDITS:
I Can't Believe It's Not Medically Necessary - Edits, That Is
Brand new edits could cut back the number of times you can bill each code You could s... Read more
Studies & Surveys:
Chemo Reimbursement Not Covering $144 Million Cost
If your oncology practice is feeling short-changed, it could be for a reason. Chemoth... Read more
RADIOLOGY:
Associations Protest CCI Edits, Modifier Guidance
Carriers smack down interventional radiologists billing for angiograms If your physic... Read more
Part B Coding Coach:
Can You Place the Proper Place of Service Code in Box 24B?
6 expert Q&A's will prevent the wrong POS from causing you denials or incorrect ... Read more
PHYSICIANS NOTES:
CMS Finally Junks "G" Codes For PET Scans
The Centers for Medicare and Medicaid Services finally bowed to provider pressure and repl... Read more
STROKE CODING:
If The Doc Says 'Stroke,' You Can List 434.91
But double check whether the patient had a hemorrhageGood news: A change in the 2005 ICD-9... Read more
INFUSION:
CPT 2006 May Clarify Infusion, Chemotherapy Questions
New CPT codes should replace problem-ridden G codes next year If you're confused ... Read more
Make Docs Say TIA When They Mean TIA
If you don't encourage physicians to write the correct terminology in their records, you c... Read more
PHYSICIAN PAYMENTS:
Lawmakers Finally Ready To Grapple With Looming Physician Pay Cuts
But are they willing to spend enough to prevent a 31-percent shortfall?If you've been hold... Read more
COPAYMENTS:
If You Waive Copays Too Much, You Could Be Waving A Red Flag
11 tips for avoiding indigent patient woesWith health care costs skyrocketing, demanding 2... Read more
STEREOTACTIC NEUROSURGERY:
Confused About Gamma Knife Spine Surgery? Try New Category III Code
Bill for 0082T and 0083T on a per-day basis, not based on fractions For years, radiat... Read more
Part B Coding Coach:
Master Infusion Codes G0345-G0350
But new CPT codes will replace G codes in 2006 If you want Medicare to reimburse you ... Read more
PHYSICIAN NOTES:
Patients Regained Lost Ground In Medicare Physician Access Struggle
But patients may be getting used to long waits for treatmentMedicare patients lost the abi... Read more
Counseling:
Can You Bill For A Get-To-Know-You Visit?
Don't bill the patient for a marketing service, expert warnsA new patient is thinking of m... Read more
Fracture Care Coding:
Choose One Fracture Billing Technique And Stick To It
Can you explain your doctor's fracture care  decisions to auditors? Flexibil... Read more
Stereotactic Radiosurgery:
Are Gamma Knife Mistakes Cutting Into Your Profits?
Surgeons, radiation oncologists must stick to their separate areasWhenever doctors collabo... Read more
Medicare Is Failing Docs, ACP Says
The Centers for Medicare & Medicaid Services talks a good reform game, but the America... Read more
Compliance:
Ordering DME Becomes Easier - But More Fraught With Danger
Make sure you know who has control over the certificate stamp in your officeCMS has decide... Read more
Incident-To Billing:
Court Upholds Incident-To Supervision Requirement
Medicare has the right to require a physician to personally supervise non-physician practi... Read more
DME Changes Could Make Life Easier
Some of the Centers for Medicare & Medicaid Services' proposed changes to DME paperwor... Read more
Part B Coding Coach:
3 Tips Bolster Your Diabetic Wound Care Coding
You can prevent denials with correctly ordered diagnosis codesPhysicians in many specialti... Read more
Physician Notes:
AMA Could Develop Its Own Correct Coding Initiative
Are you ready for another layer of coding oversight? The CPT guidelines have always s... Read more
Screening Exams:
Don't Let 'Welcome To Medicare' Exam Wear Out Its Welcome
3 tips guard against glitches when you provide this new service Medicare's new initial exa... Read more
Coverage:
'Off-Label' Cancer Drug Trials May Run Off Rails, Providers Worry
Some think that expansion will actually derail 2000 advanceA Medicare coverage decision to... Read more
Infusion:
Check With Your Carrier About Tysabri Coding
Some advise J3590 for new miracle MS drugThe Food and Drug Administration approved a revol... Read more
E-prescribing:
CMS Puts A Rush On Electronic Prescriptions
Seven months ahead of the deadline set by the Medicare Modernization Act, new Health and H... Read more
Debridement:
Don't Use New Debridement Codes For Physician Claims
You can make up to $250 extra per claim by using the existing codesWhen CPT 2005 included ... Read more
Pay-For-Performance Is Here, CMS Says
While policymakers continue to debate ways to reward providers for achieving certain stand... Read more
Transmittals:
CMS Improves Pap Smear Coding Options
But normal Pap smear after abnormal pap still not coveredYou can look forward to easier cl... Read more
Part B Coding Coach:
4 Tips Make For Flawless Neoplasm Coding
Haste makes waste-wait for the pathology report and cut out claim denial It may be ea... Read more
Understand Uncertain, Unspecified and In-Situ
If the many categories of neoplasms have you confused, you're not alone. Knowing the basic... Read more
Physician Notes:
Is Medicare Hurting Your Business?
New survey reports disturbing numbers on Medicare impactAnesthesia practices should keep t... Read more
Reimbursement:
Multiple Reductions, One Cast: How Many Codes Can You Bill?
Provide justification if you bill more than one codeThis little piggy has a stress fractur... Read more
Joint Ventures:
'Under Arrangement' Deals Offer Better Payment, Fewer Fraud Risks
But don't pay docs more than their share of what the business is worthWarning: Don't rush ... Read more
Reimbursement:
Brace Yourself For A New Layer Of Audits
New contractors will have you in their crosshairsIn case you didn't think you were bearing... Read more
Congress Won't Have Time To Fix Physician Payment Mess
To avoid a looming 5 percent cut to physicians' payments, Congress will have to pass anoth... Read more
Incident-To Billing:
Can You Prove Where Your Doc Was Two Year Ago Today?
Some carriers require physician signature on incident-to claimsIf your doctor is supposed ... Read more
Drug Coverage:
Medicare Will Start Drug Coverage Within A Year
The final edition of Medicare's rule for the 2005 prescription drug benefit went on displa... Read more
Joint Ventures:
Don't Go Into Business With An Ignorant Partner
Watch out for these physician-hospital joint venture pitfallsIn recent years physicians ha... Read more
3 Tips Will Pump Out Stress-Free Stress Test Coding
Know your component codes by heart to code correctlyDon't stress over trying to figure out... Read more
Clip & Save:
Keep Stress Tests Modifier-Free
Let definitions guide you when choosing the right code If your carriers are stopping your... Read more
Physician Notes:
Doc Faces 30 Years In Prison For Alleged Double Billings, False Claims
And "pay for performance" quality care incentives are in the pike Pleasanto... Read more
Pronouncement of Death:
You May Be Able To Bill A Discharge Code For Death Pronouncement
Carriers disagree about the appropriateness of post-mortem billingWhen a patient dies, a p... Read more
Incident-To Billing:
Incident-To Compensation Is Just What The Doctor Ordered
Make sure you know who is your supervising doc on dutyCoders are applauding a recent clari... Read more
Formulary Leaves Out Crucial Drugs
The guidelines for the drug formulary in next year's Medicare prescription drug benefit co... Read more
Transplantation:
Bill New Backbench Codes - And Then Hold Your Breath For Payment
And don't bother to bill new wound vacuum assisted closure codes Before you bill ... Read more
Where There's Smoke, There's Medicare-Covered Counseling
Medicare may finally be getting serious about tackling one of the deadliest killers of its... Read more
More Carrier-Priced Codes For 2005
You'll have to appeal to your carrier for pricing on several other codes that CMS assigned... Read more
Reimbursement:
Imagine New Red Tape Around Imaging Services
New standards, self-referral rules could stymie non-radiologists You've got a pow... Read more
Coding:
Doctors Are Managing More Complex Patients, But E/M Payments Remain Stingy
Old-school E/M levels short-change docs in today's world Medicare is doling out 1... Read more
Part B Coding Coach:
Prevent 'Welcome to Medicare' Problems With 4 Simple Steps
Go with new G codes for proper reimbursementThe Centers for Medicare and Medicaid Services... Read more
Physician Notes:
CMS Will Call The Tune, You'll Give The Performance
Prepare to feel the pinch if care doesn't meet efficiency standardsThe Medicare Payment Ad... Read more
CPT 2005:
Acid Reflux Test Codes Shrink From 2 To 1
But new codes for Bravo probe, esophageal impedance tests win ravesSometimes clarity comes... Read more
Chemotherapy:
One Clinic Stands To Lose $150,000 On Drugs In 2005
Take stock of your losses soon to avoid shocking shortfallThe Centers for Medicare & M... Read more
Frustrated By Flu Vaccine Shortage? Try Antiviral Meds
In the wake of recent flu vaccine shortages, a new Medicare demonstration project will cov... Read more
Reimbursement:
Don't Bill Unless Patient Info Is Correct - And Complete
 Some carriers are asking for middle initials and other dataFrequently, physicians ma... Read more
Congress To Seek $100 Billion In Medicare Savings
While physicians are hoping Congress will repair their broken payment formula and avert cu... Read more
Coverage:
Don't Run Out And Invest In Stretta Procedures
Carriers also waver on virtual colonoscopyProviders may have rejoiced when CPT 2005 includ... Read more
Compliance:
With HIPAA Deadline Coming Soon, Crack Down Now On Cyber-Dalliance
Spyware, viruses pose risks to sensitive health informationYour medical office staff may a... Read more
Part B Coding Coach:
Don't Stand for a Breakdown in Your Fracture Care Coding
Follow these 3 tips for frustration-free care claims.If carriers are finding fault with yo... Read more
Physician Notes:
Malpractice Insurance Subsidy Passes OIG Muster
 Skyrocketing malpractice costs require drastic measuresA hospital facing a severe sh... Read more
Evaluation & Management:
Docs Kissed Nearly $1 Billion Goodbye In 2004
But the AMA doesn't want to tinker with E/M coding againYou could be losing thousands of ... Read more
New Codes:
Open Door Laminoplasty Code Still Leaves Open Questions
CPT Codes 2005 includes two new spinal surgery codes, but an important new technique is ... Read more
CMS Seeks Ethnic Cancer Care Proposals
The Centers for Medicare & Medicaid Services posted a new $25 million demonstration pr... Read more
Downcoding:
You Could Be Selling Yourself Short 14.4 Percent Of The Time
For 14.4 percent of claims processed by the carriers, the documentation supported a higher... Read more
What's One E/M Level Between Auditors?
When a physician upcodes or downcodes an evaluation and management claim, most of the ti... Read more
New Codes:
CMS Gives An Extra 50 CM To Gastric Bypass Surgeons
The addition means fewer denials for procedures Not only did CPT Codes 2005 include t... Read more
Coverage:
Medicare Pumps Up Insulin Coverage
Older patients can now benefit from stem cell transplantsThe Centers for Medicare & Me... Read more
Studies & Surveys:
No Easy Culprits For Skyrocketing Doc Costs, Report Says
Congress asked the Medicare Payments Advisory Commission to look into a couple of physic... Read more
Part B Coding Coach:
Don't Drop The Ball When Doing Discharge Documentation
Use these 3 tips to improve your 99238 and 99239 reimbursementIncorrectly using hospital d... Read more
Physician Notes:
Physician Pay Formula Is Broke - Will Congress Fix It?
Don't hold your breath, say Washington insiders To physicians, the danger is abou... Read more
Chemotherapy:
Drug Administration Codes Hit With Thousands Of Edits
Prepare to justify using E/M codes with hydration or chemotherapyThe new drug administrati... Read more
CCI Edits:
Size-Based Wound Care Codes Face Hundreds Of Edits
 Needle electromyography code edits can't be overriddenFor Medicare providers, the Gr... Read more
Reimbursement:
Carriers Can't Punish You For Self-Disclosing Problems - But There's A Catch
Don't go straight to the carriers if the problem looks seriousThe Medicare Modernization A... Read more
OIG Saves Medicare $30 Billion In 2004
Despite a slew of new responsibilities under the Medicare Modernization Act, the HHS Offic... Read more
Pay For Performance:
Brace Yourself For Quality-Based Payments
But diverse specialties may doom programChances are strong that policymakers will try to p... Read more
Gastroenterologists Stomach Massive Loss From PE-RVUs
The move to Practice Expense Relative Value Units created clear winners and losers among p... Read more
Compliance:
Don't Treat Non-English Speakers Like LEPers
Assess your patients' language needs and come up with a plan Many physicians have... Read more
Part B Coding Coach:
Find the Fee Schedule Before Billing Bilateral
Modifier -50 may not apply as often as you thinkIf you've been having difficulty determini... Read more
Physician Notes:
Sustainable Growth Rate Has Outgrown Its Usefulness
You could be paying the price for CMS' errorsAccording to the Government Accountability Of... Read more
Available Years:  2005  2004  2003