Advanced Search

Part B Insider (Multispecialty) Coding Alert

Part B Revenue Booster:
6 Surefire Tips Boost Your Bottom Line
If you're not up to date on codes, you could be losing cash.Facing hard times in your prac... Read more
Part B Coverage:
Medicare to Cover Tobacco Cessation Counseling for All Smoking Beneficiaries
New coverage announcement is triumph for physicians who haven't collected in the past.If y... Read more
Electronic Health Records:
Meet One of 7 CMS Requirements to Qualify for $44,000 Per-Provider EHR Incentive Payment
You'll be able to register for the EHR incentive program starting in January.Eligible prof... Read more
What About 'Meaningful Use?'
Check out CMS's Final Rule to get the scoop on meaningful use requirementsEver since CMS r... Read more
Auditing:
Weigh Surgical Risk to Select Correct E/M Level
These definitions take the mystery out of moderate vs high surgical management options.You... Read more
Part B Coding Coach:
4 Steps Unlock Ethical Unlisted Procedure Coding Payments
Referencing the nearest equivalent CPT code could be your key to getting paid.When CPT for... Read more
Physician Notes:
Medicare Overpaid Providers $13 Million in 2007 Due to Place-of-Service Errors
Plus: Medicare Wastes Millions On Capped Rental Repairs.Entering your place-of-service (PO... Read more
In other news...
Getting claims for repair of DME capped rental items to go through could become a lot hard... Read more
Reader Question:
Set Up A Benefits Eligibility Verification Plan
The best time to confirm a patient's eligibility is before she walks into your practice.Qu... Read more
Billing and Collections:
Test Your Collections Skills With 5 Questions
Know what your options are for non-par patients.You know that solid collections knowledge ... Read more
Collections Quiz Answers:
Find Out Where You Need to Hone Your Collections Skills
Check your answers from the collections quiz on page 225.You know that solid collections k... Read more
Diagnosis Coding:
ICD-9 2011: Prepare for New Fluid Overload and Seizure Codes
Confirm documentation before you report the new morbid obesity codes.Come October 1, you m... Read more
Physician Reviews:
Face-to-Face Rule Brings New Round of Physician Headaches for Those Who Certify Home Health
Physicians must see patient 30 days before or two weeks after start of care -- and so... Read more
Physician Notes:
Magic Number for Medical Record Retention is 6 Years, CMS Says
Plus: HHS believes Medicare Trust Fund will stay solvent through 2029.Medical practices of... Read more
In Other News...
There's good news and bad news about the Medicare Trust Fund this week.The good news? The ... Read more
Reader Questions:
The Hard Truth about Phone Call Pa
Question: Another physician told my doctor that he's receiving payment from his contractor... Read more
Reader Questions:
Follow Signature Rules or Risk Payments
Question: One of our physicians likes to sign everything with just his initials, or someti... Read more
Reader Questions:
Check If Exceptions Exist in Fracture Modifiers
Question: A parent brings her 14-year-old son to the emergency department with an injured ... Read more
Reader Questions:
Medicare Won't Cover Trays
Question: How do I code products like laceration trays for minor wounds, suture trays, fac... Read more
Reader Questions:
Check Rules for Injection + E/M
Question: A payer denied our claim for an established patient office visit in addition to ... Read more
Reader Questions:
No Inpatient Contact = No E/M Service
Question: I read "When reporting discharge day management service, you must provide and do... Read more
CCI Edits:
CCI to Reverse Edits Involving Vestibular Testing
Effective Oct. 1, you'll be able to use a modifier to separate these services when they ar... Read more
What Is a CCI Edit?
Every quarter, the Correct Coding Initiative (CCI) puts out a list of code pairs that Medi... Read more
Consolidated Billing:
3 Simple Steps Put You on the Path to Capturing Payment for Your Nursing Facility Services
Determining whether a patient is in a Part A or Part B stay is your key to proper reimburs... Read more
Compliance:
Reference 3 'G' Codes for Early HIV Screening
Don't miss out on rapid test pay for high-risk beneficiaries.You can now show medical nece... Read more
HIV "high risk" factors:
HIV "high risk" factors:
Men who have had sex with men after 1975 Men and women having unprotected sex with multipl... Read more
Part B Coding Coach:
Follow These Tips to Feel Certain About Coding Uncertain Neoplasms
Mastering uncertain vs. unspecified is an oncology coding essential.Unless you've got the ... Read more
Physician Notes:
CMS Clarifies New 'Timely Filing' Rules
Plus: Physical therapists in physician offices: prepare for more pressureThis past March, ... Read more
In other news...
Physician office-based PTs may face stress, if a new MedPAC recommendation comes to fruiti... Read more
Reader Question:
Limit Prolonged Services to Highest Category in 1 Instance
Question: Can the prolonged codes (+99354, Prolonged physician service in the office or ot... Read more
Self-Audits:
Know What Benchmarking Against 'Bell Curves' Can Do For You -- And What It Can't
Remember: Chart audits are still your most powerful weapon in the war against miscoding al... Read more
Modifiers:
E/M Services Call for Modifier 25, But Only When Necessary
You'll be putting your practice in the crosshairs if you misuse this modifier.Knowing when... Read more
Three Conditions Warrant Modifier 25
There are three basic conditions under which an E/Mservice might qualify for a 25 modifier... Read more
Check Out the Most Recent CMS Stats to Get Started
Follow the benchmarking guidelines to use this data responsibly.Now that you've read the s... Read more
Audiology Coding:
CMS Clarifies How to Report Audiology Services
Look for a physician order for diagnostic audiology tests.If you thought CMS's May transmi... Read more
Physician Notes:
Physician's Assistant Accused of Ordering Unnecessary Tests That Clinic Fraudulently Billed to Medicare
Plus: CMS clarifies RAC discussion period vs. rebuttal/redetermination processThe Dept. of... Read more
In other news
If you aren't used to dealing with recovery audit contractor (RAC) requests, you're not al... Read more
Reader Questions:
Catch Up on Incomplete Claims
Question: Our surgical practice has a few claims that have missing or incorrect informatio... Read more
Reader Questions:
Base Dx Code on Reason for Test
Question: A patient comes into the emergency room for a fall from a ladder, and the ER doc... Read more
Reader Questions:
Modify Eye Codes Just Like E/M Codes
Question: I just started working in an ophthalmologist's office and I have a question abou... Read more
Reader Questions:
Keep Same HTN Code for Uncontrolled/Controlled
Question: Does ICD-9 distinguish controlled and uncontrolled hypertension (HTN)?Answer: No... Read more
Reader Questions:
Clarify Temp Services Using Modifier Q6
Question: Our regular internist is taking some time off, and a temporary internist takes h... Read more
Reader Questions:
Get the Scoop on Billing Before Credentialing
Question: Our practice has a new physician coming on board to replace a retiring doctor. W... Read more
Compliance:
Focus on Your Compliance Plan Now Or Pay Later
Enhanced fraud-fighting atmosphere makes your plan more important than ever.If the feds sh... Read more
Part B Coding Coach:
3 Steps Erase Coding Mishaps From Your Myomectomy Claims
Find out how the weight of myomas means more than the number of them.Deciding which myomec... Read more
Modifiers:
Learn the Tricks to Untangling Differences in Modifiers 58, 78, and 79
Don't miss out on extra pay when global period resets.Just because you routinely append mo... Read more
PQRI:
CMS Proposes Making PQRI Reporting Easier in 2011
Plus: CMS reveals common errors from previous PQRI quarters.Collecting your PQRI bonus cou... Read more
Physician Notes:
DOJ Arrests 94 People in One Day for Medicare Fraud Totaling Over $250 Million in Alleged False Billing
Plus: OIG Estimates $137 Million In KX Overpayments For DMEWhen the Medicare Fraud Strike ... Read more
In other news...
When the HHS Office of Inspector General audited a sample of 2006 DME claims with the KX m... Read more
Reader Question:
Counting Nerve Conduction Test Per Limb Will Result in Denials
Question: I coded my physician's diagnostic testing recently that included nerve conductio... Read more
Electronic Health Records:
CMS Nails Down EHR 'Meaningful Use' Requirements
You could benefit from incentive bonuses by next year.Your practice could be edging ever c... Read more
Compliance:
Physician-Owned Business Settles Stark and Anti-Kickback Allegations for Over $7 Million
Plus: Stark under-arrangement law changes may alter how you can do business.Trading cash p... Read more
Recovery Audit Contractors:
RACs ID Insufficient Documentation As Weakness Among Practices
Stay on top of RAC requests so you're able to meet all request deadlines.Recovery audit co... Read more
Medicare payment:
CMS Reps Outline Impact of PPACA on 2011 Fee Schedule
Plus: Medicare enrollment Web site adds additional resource files.The ink is barely dry on... Read more
Physician Notes:
CMS Clarifies Substance Abuse G Code Guidance
CMS Clarifies Substance Abuse G Code GuidancePractices providing alcohol and substance abu... Read more
In other news...
If you think coding to the highest level of specificity only applies to outpatient claims,... Read more
Reader Questions:
I&D Area Can Deflate 10060 Option
Question: Our physician performed a level-four E/M service in the emergency department for... Read more
Reader Questions:
Severe Asthma Control Depends on Who Administered Services
Question: I'm looking at notes from my anesthesiologist for an encounter with a patient wi... Read more
Reader Questions:
Multiple Procedures Across Multiple Spinal Levels
Question: During an operative session, my neurosurgeon performed the following procedures:... Read more
Reader Questions:
Use This Critical Info to Key to TP E/Ms
Question: One of our physicians and a resident performed a levelthree emergency room E/M s... Read more
Part B Payment:
Proposed 2011 Fee Schedule Offers Vast Benefits for Primary Care Practices
CMS incorporates PPACA regs into next year's fee schedule -- but proposes deeper cuts... Read more
Medicare Participation:
Non-Par Practitioners Have Two Weeks to Switch Over to 'Par'
If you've been waiting for the opportunity to become a participating practitioner, now's y... Read more
Enrollment:
CMS Won't Reject Claims Based on PECOS Edits This Month
Despite the fact that the PECOS deadline is near, you needn't worry about denials -- ... Read more
Medicare Forms:
Test Your 5010 Readiness With At Least 25 Claims, CMS Says
No word yet from CMS on whether the 1500 form will change soon.If you're considering testi... Read more
Part B Coding Coach:
FAQs: Double Your E/M Payout on Some Counseling 'Domination' Claims
Here's when you can code past the three E/M component levels.The physician provides an E/M... Read more
E/M Best Practices:
Master New Patient E/Ms or Leave Cash on the Table
Financial fallout can be considerable if you eschew new patient codes too often.For medica... Read more
Physician Notes:
CMS Releases Collagen Implant Code
Plus: CMS still hasn't confirmed an administrator.It may be the middle of the year, but CM... Read more
Reader Question:
Assess HPI Level to Help Narrow E/M Choice
Differentiate brief history of present illness from extended with these tips.Question:Our ... Read more
Medicare Pay:
Congress Halts Medicare Cuts After MACs Processed Claims With 21 Percent Discount
After a week of paying claims at 1994 levels, CMS will begin giving you a 2.2 percent fina... Read more
CCI:
Steer Your Way Clear Through CCI 16.2's Injection, Oncology Edits
Not all news is bad news, however, with several code pair deletions coming your way.Effect... Read more
PQRI:
Not All Doctors in Your Practice Must Participate in PQRI to Collect Incentive
Plus: Look for 2009 incentive payments this fall, CMS says.If all of your physicians are g... Read more
Electronic Health Records:
At Long Last, CMS Issues Temporary Certification Program for EHRs
Want a piece of the $44,000 per-physician incentive payment? You can now review the tempor... Read more
Physician Notes:
Check Out These New CPT Codes That Will Take Effect Next Year
Plus: Stolen laptop leads to potential HIPAA breach notificationsYour 2011 CPT book isn't... Read more
In other news...
You'd better make sure your HIPAA breach policies and procedures are up to snuff, because ... Read more
Reader Questions:
For Complete ROS, Check at Least 10 Systems
Question: A new patient reports to our physician with heartburn, stomach ache, and nausea.... Read more
Reader Questions:
Save 99238-99239 for 0-Day Globals
Question: My physician admitted a patient and performed a procedure on the 23rd of the mon... Read more
Reader Questions:
Depth Drives Foreign Body Removal
Question: A patient presented with a metal filing embedded in his shoulder from an earlier... Read more
Reader Questions:
Patient Becomes 'Established' After First Visit
Question: A patient came to our office and saw one neurologist, but when the patient came ... Read more
Reader Questions:
Be Confident in Coding for Teaching Physicians
Question: A resident in our office sees a new patient complaining of heartburn. The reside... Read more
Part B Payment:
Part B Claims Remain in Holding Pattern Through June 17
MACs won't process June claims until June 18, in hopes that Congress acts by then.The Sena... Read more
Diagnosis Coding:
The 2013 Date for ICD-10 Implementation Won't Change, CMS Says
Plus: CMS has proposed freezing the ICD-9 codeset after next year. If you were hoping ... Read more
Compliance:
OIG Has Recovered Over $3 Billion So Far in 2010
Audits and investigations brought in big money for the government over a six-month period,... Read more
Government Accountability Office Identifies CMS's 5 Major Challenges in Fighting Fraud
Resolving these roadblocks may be the key to collecting additional funds, new testimony in... Read more
Hospice:
Hospice Use May Grow If Concurrent Care Demo Takes Off
PPACA isn't all bad news for hospice providers.Many terminally ill patients refuse to elec... Read more
Part B Coding Coach:
Cataracts: Break Down Your Coding for Best PC-IOL Payments
Medicare won't cover the full cost, but splitting the bill into covered and non-covered po... Read more
When Is Cataract Removal 'Complex'?
Don't miss these 66982 coding clues that could earn your practice over $270.When an ophtha... Read more
Physician Notes:
Look for New CLIA-Waived Tests Effective July 1
Plus: OIG zeroes in on inappropriate Neulasta payments.You'll have 12 new tests that you'l... Read more
In other news...
coding for this drug during a recent audit, so ensure that you aren't making these mistake... Read more
Red Flags Rule:
FTC Delays Red Flags Rule Until December
Amidst an AMA lawsuit, the FTC appears to take a wait-and-see approach.After a year's wort... Read more
Diagnosis Coding:
Your Physician's Notes Reveal Diagnosis Codes -- You Just Have to Know Where to Look
If the doctor does not circle a diagnosis, it may be up to you to find one. Don't let... Read more
Avoid This Common Chiropractic Documentation Mistake
Treatment plans are a must, experts say.You've treated your chiropractic patient, you've s... Read more
Part B Mythbuster:
Know the Ropes to Collect for Chiropractic Treatment
Give your claims the backbone they deserve by properly documenting and billing accurate di... Read more
Billing:
Speed Up New Patient Registration With 5 Tips
A smart billing capture process can prevent claim-submission headaches.If you're trying to... Read more
Physician Notes:
MACs Still Keeping Medicare Claims in Holding Pattern
Plus: Texas-based doctor nailed for billing Medicare for dates of service when he was actu... Read more
In other news...
A Texas-based podiatrist was caught defrauding Medicare when investigators discovered his ... Read more
Reader Questions:
No Way Around Carrier's Standby Policy
Question: One of our anesthesiologists monitored a patient's vital signs during excision o... Read more
Reader Questions:
Examine X-Ray and Fluoro on Same Date
Question: When, on the same date, the radiologist places a central venous access device us... Read more
Reader Questions:
Solve Lab's PhD Interpretation Dilemma
Question: We have a PhD performing molecular diagnostics and molecular array testin... Read more
Reader Questions:
Add Modifier 24 for New Service During Global
Question: Our doctor completed an L5 laminectomy on a patient. Two weeks later, the patien... Read more
Reader Questions:
Modifier 57 Isn't for Consults Only
Question: In our office we used to apply modifier 57 to inpatient consult codes. Now that ... Read more
Medicare Payment:
21 Percent Cut Continues to Loom, With May 31 Deadline Nearing
CMS instructs MACs to hold claims for ten business days while Congress mulls bill.Impendin... Read more
Medicare Payment:
Medicare Officials Urge Advanced Imaging Providers Toward Accreditation
Plus: CMS won't say for sure whether your claims will actually face rejection if you aren'... Read more
Compliance:
In 2009, Senior Medicare Patrol Project Collected Triple Its 2008 Amount
Despite fewer volunteers, the project continued full steam ahead into 2010.The government ... Read more
By the Numbers:
Discover Where the Senior Medicare Patrol Project is Most Active
New York and Michigan have beefed up their SPM rosters, while other states, such as S. Car... Read more
PQRI:
Medicare Advantage Plans May Disburse PQRI Bonuses
Plus: You still have time to get in on this year's PQRI bonus incentive program.If you're ... Read more
Part B Coding Coach:
Get Your Cut for Soft Tissue FBRs by Looking for Incision Evidence
Complicated FBRs, though rare, pay twice as much as simple ones.Ah, spring. The birds, the... Read more
Don't Let Foot FBR Definition Fool You
Survey says: Incision required for foot FBR.A girl limps into the ED with a splinter in th... Read more
Physician Notes:
OIG Enters 21st Century With New Online Fraud Hotline Site
Plus: CMS begins to build its ICD-10 Web site to help providers prepare for the 2013 chang... Read more
In other news...
While some practices have tucked ICD-10 readiness into the backs of their minds, CMS wants... Read more
Reader Question:
Don't Overlook Shared Visit Billing for Inpatients
Question: I know I cannot bill services incident-to in the hospital setting. Is there... Read more
Recovery Audit Contractorst:
RACs Can No Longer Keep Fees After Losing Appeals, CMS Says
Plus: You'll soon be able to review the most common errors that the RACs find.CMS is attem... Read more
Recovery Audit Contractors:
Know These RAC Fast Facts
RACs are just another tool in the government's arsenal to collect improper payments.You've... Read more
Enrollment:
Get Ready for July 6 PECOS Ordering/Referring Date
If you're waiting to get into PECOS, delay no further, CMS says.CMS recently updated the p... Read more
Fraud and Abuse:
Look for Big Compliance Changes Thanks to Healthcare Reform
One guilty-until-proven-innocent provision could shutter some blameless providers, expert ... Read more
Cardiology:
MACs Differ on Response to CMS's Cardiology Payment Adjustments
Don't look for a raise just yet, in most cases.CMS may talk, but MACs don't always listen&... Read more
Physician Notes:
Cost of Freezing Conversion Factor is Over $6 Billion -- Just for 2010
Plus: The OIG recovered over $1.5 billion in fiscal year 2009, and is on the lookout to co... Read more
In Other News...
Combating health care fraud proved may cost the government resources and money, but it als... Read more
Reader Questions:
Choose 25 or 57 With These Guidelines
Question: I'm confused about the distinction between modifiers 25 and 57. Could you please... Read more
Reader Questions:
Depth Drives Foreign Body Removal
Question: A patient presented with a metal filing embedded in his shoulder from an earlier... Read more
Reader Questions:
Use 3 Code-Pairs to Ace This X-Ray Claim
Question: A 38-year-old patient presents to the emergency room with complaints of wheezing... Read more
Reader Questions:
Interpretation Does Not Equal Established Patient
Question:Our doctor performed the interpretation and report of a patient's ECG for another... Read more
Reader Questions:
Face Time Is Essential to Established Patient
Question: Our practice performed a test on a patient who was referred to us by another doc... Read more
Reader Questions:
Tune in to Video-Conference Cat. III Code
Question: Our doctor, a neurologist, has agreed to be a specialty resource for a small rur... Read more
Part B Payment:
CMS Changes Conversion Factor Yet Again
Plus: Look for an increase in your DEXA scan reimbursement. The bad news: Your carrier wo... Read more
Patient Privacy:
Outsourcing Security on Patient Privacy Could Be Helpful -- If You Know These Essential Truths
Get the scoop before you nail down your HIPAA plan with a consultant. You may be relieved ... Read more
Compliance:
Study These Compliance Basics Before You Run Afoul of the OIG
Practice size does not matter when dealing with compliance -- even solo practitioners... Read more
Health Care Reform and Medicare:
Free Annual Physicals? You Bet! Health Care Reform Law Makes It Happen
Plus: Timely filing rules will change, giving you less time to submit your claims. In Marc... Read more
Billing:
Optimize Your Billing Department's Efficiency With These Quick Tips
Be proactive -- not reactive -- to A/R changes. With Medicare payment changes up... Read more
Part B Coding Coach:
Part B Coding Coach: Nail Down Your Payments When Reporting 99211
Don't leave $19 per visit on the table -- follow these rules to collect what's due to... Read more
Nix 99211 Errors With This Challenge
Beware: Some payers include nurse visit with venipuncture code. Think you've learned how t... Read more
Physician News:
Ordering/Referring Providers Must Be in the PECOS System by July 6
Plus: OIG encourages Medicare contractors to seek overpayments after discovering that it o... Read more
PART B AUDITS:
Auditors Review Your Notes Based on the Regs As of the Service Date
If you performed a consult in 2006, the auditor will use 2006 guidelines -- not toda... Read more
DISCARDED DRUGS:
CMS: Document Discarded Drugs
But, not all payers want modifier JW appended. CMS allows you to bill for discarded porti... Read more
COMPLIANCE:
Don't Let Financial Ties to Manufacturers Create Legal Woes for Your Physicians
3 ways to navigate increasing transparency of prescriber-supplier relationships. With the... Read more
BILLING:
Has a Broken Payment Agreement Come to Dismissal?
Take these steps to end a practice/patient relationship without creating drama to the pa... Read more
PART B CODING COACH:
3 Sample Situations Boost Your Migraine Treatment Smarts
Acute episodes, check-ups are both routine for these patients. When migraine headache cod... Read more
PHYSICIAN NOTES:
California-Based HIPAA Violator Sentenced to Jail Time
Plus: OIG finds that over 70 percent of high-dollar payments resulted in overpayments. Ju... Read more
READER QUESTION:
Differentiate Between Debridement and Wound Care Management Codes
Active wound therapy requires different documentation than debridement. Question: When th... Read more
DIAGNOSIS CODING:
CMS Announces Over 100 New ICD-9 Codes, Effective Oct. 1
Get ready for new jaw pain, BMI codes, among others. If you've got high hopes that you'll... Read more
DIAGNOSIS CODING:
Get A Sneak Peek At the New ICD-9 Codes You'll Use This Fall
Say hello to new diagnosis codes for gastro, ob-gyn, cardiology, orthopedics, and more. I... Read more
ELECTRONIC HEALTH RECORDS:
Keep These EHR Issues At Top-of-Mind to Ensure You're Staying Compliant
An EHR can make your life easier, if your staff training is comprehensive. Your electroni... Read more
MEDICARE FORMS:
CMS: Abbreviate Patient Name "John Doe, Jr." to "John Doe" And You'll Face Denials With New 5010
5010 form could change everything from your claims submission processes to your patient r... Read more
HOSPICE:
CMS Issues New Face-to-Face Requirement for
The new health care reform package will require the physician to see the patient in perso... Read more
YOUR PART B QUESTIONS ANSWERED:
Consider All Aspects for Hypothyroidism Dx
Question: An established patient who recently had surgery and radiation therapy to treat ... Read more
PHYSICIAN NOTES:
At Least 1 MAC Processed Part B Claims Using 21 Percent 'Pricing Error'
Plus: New analysis offers tips on migrating your ICD-9 system over to an ICD-10 based str... Read more
In Other News:
• When you're working out your plan to transition to ICD-10 diagnosis coding, don't expect to do it in one leap.
"It's not practical to cut over to the new coding system all at once," advises technology ... Read more
E/M CODING:
Don't Bill High-Level E/M Codes Until You Read This
Sicker patients may not always mean higher MDM. If your physician bills a lot of high-lev... Read more
ACRONYMS QUIZ:
Nail Your Acronym Deciphering Skills to Code Claims Accurately
Know the universal acronyms, then keep an eye out for regional acronyms as well. Do you k... Read more
AUDITS:
Take These Steps if You Find Out You'll Soon Be Paid a Visit From an Auditor
Prepare your compliance plan before an auditor strikes if you can -- but don't panic... Read more
ACRONYM QUIZ ANSWERS:
Can You Decipher the Acronyms In Our Quiz? See How You Fared With These Solutions
Hint: When in doubt, check with the practitioners rather than guessing. For most coders, ... Read more
PHYSICIAN NOTES:
Even Non-Insulin Dependent Diabetics May Qualify for Blood Glucose Testing Equipment Coverage
Plus: OIG alleges that a California oncologist fraudulently billed Medicare and other pay... Read more
In other news ...
• A California cancer specialist was charged last week with billing Medicare and othe... Read more
READER QUESTION:
E Codes Help Define Cause of Injury
Also: Keep incident-to rules in mind when NPP performs the service. Question: A 68-year-o... Read more
MEDICARE PAY:
Congress Puts Off 21 Percent Pay Cut Until June 1
But because legislators missed the cutoff by one day,some claims were processed using a l... Read more
HEALTH REFORM AND MEDICARE:
These 3 Q&A Answers Can Help You Grasp Benefits of Reform
Could preventive visits be payable by Medicare? The Patient Protection and Affordable Car... Read more
SPLIT/SHARED VISITS:
CMS Clarifies Split/Shared Visit Rule Now That Consults Are No Longer Payable
Plus: CMS reps cite current Medicare law and advise that practices should report just one... Read more
RECOVERY AUDIT CONTRACTORS:
Don't Rack Up Unfair RAC Denials: Follow These 6 Rules for Appealing Payment Recoups
Even if you're wrong on an issue, check out this often overlooked escape hatch. RAC denia... Read more
RAC APPEALS:
Don't Let RACs Shoot Down Your Whole Claim for A Small Error
These examples show how you may be able to recoup part of your denied claim, even if you ... Read more
YOUR PART B QUESTIONS ANSWERED:
Keep Flaps Straight for Proper Code Selection
Question: Our surgeon performs an abdominal closure using left and right myofascial advan... Read more
PHYSICIAN NOTES:
President Obama Reveals Details of Expanded 'Payment Recapture Audit' Program
Plus: Get on board with CMS's RAC conference calls to get the lowdown on up-to-the-minute... Read more
MEDICARE PAY:
21 Percent Pay Cut Kicked in April 1 -- But MACs Are Holding Claims
No legislative wrangling can take place until Apr. 12. Unless Congress steps in soon,you ... Read more
BILLING:
Know 2 Ways the New Health Care Law Impacts Medicare Pay
Hint: Timely filing rules will change, giving you less time to submit your claims going f... Read more
COMPLIANCE:
Learn These Essential Compliance Truths Before You Run Afoul of the OIG
Practice size does not matter when dealing with compliance -- even solo practitioners have... Read more
CMS FORMS:
Start Preparing Your Software Systems to Get Ready for the HIPAA 5010 Form
CMS reps offer advice on how to ensure that you're prepared for the new "universal claim f... Read more
PART B CODING COACH:
Four Q&As Help You Fall in Line With Heart Disease Screening Criteria
Don't forget the appropriate E/M code if the patient presents with a separate complaint. ... Read more
PHYSICIAN NOTES:
Health Care Legislation Extends Therapy Cap Exceptions Process and Lab Billing Moratorium
Plus: CMS issues comprehensive guidance regarding the ordering/referring provider edits. ... Read more
In other news ...
'CMS has issued scores of documentation regarding the fact that ordering/referring provi... Read more
PART B CODING COACH:
Build Bone Density Scan Success With These 3 Coding Keys
Stronger claims come from choosing correct scan types and diagnoses. Paying attention to ... Read more
READER QUESTION:
Base Diagnosis Coding for Bruises on the Patient's Symptoms
Look for the cause of the bruising before you select the appropriate ICD-9 code from your ... Read more
CORRECT CODING INITIATIVE:
CCI 16.1 Scraps Cardiology Bundle
One troublesome, confusing edit is no longer an issue. You may still be getting to kn... Read more
ENROLLMENT:
Public Health, VA Practitioners Can Enroll in PECOS
But if they are accepted into PECOS to order/refer only, they can't use that NPI to bill M... Read more
ICD-10 :
CMS, AHIMA Reps Aim to Bust ICD-10 Myths With Expert Answers
Hint: You will be able to find hard copy ICD-10 books, CMS confirms. The ICD-10 impleme... Read more
99211 VISITS:
Nix 'Nurse Visit Code' Errors By Taking This Quick Quiz Regarding 99211
Should you bill for 99211 along with your injection codes? See if you can answer this an... Read more
CORRECT CODING INITIATIVE :
Get to Know the New CCI 16.1 Code Bundles, Or Risk Unexpected Denials
New edits in spine, urology, catheterization, pathology, and other specialties could chang... Read more
YOUR PART B QUESTIONS ANSWERED:
Think Twice Before Reporting
Question: Is it appropriate to report both a CT and CTA of the same anatomic area performe... Read more
PHYSICIAN NOTES:
New Health Care Legislation May Be A Boon to Some Practices, But Fails to Address SGR Formula
Plus: New Jersey hospital faces over $6 million in settlement charges after allegations of... Read more
In Other News:
• Investigators have their eyes on hospital outlier payments, and are ready to strike if it looks like something's amiss
A New Jersey hospital agreed to pay $6.35 million last week "to settle allegations that th... Read more
Privacy:
New Red Flags Clarification May Exempt Physicians As 'Creditors'
But you should still make an effort to safeguard patient confidentiality, experts say. In ... Read more
Correct Coding Initiative:
62310 Billed With Arthroscopy? Not Anymore, Thanks to CCI 17.0
New edition of bundling edits target 2011 codes. You may just be digging in to your 2011 C... Read more
Documentation Challenge:
Can You Code This 'Consult' Note?
With consult codes no longer recognized by Medicare, this type of note puts your coding sk... Read more
PQRI Update:
If You Aren't E-Prescribing in 2011, You'll Face Cuts in Pay in 2012, CMS Says
Get your plan in place ASAP to avoid payment penalties. E-prescribing is technically cons... Read more
Part B Coding Coach:
3 Expert Tips Help You Code Ear Diagnoses With Ease
From otitis media to cerumen removal, we've got all the answers to your ear coding questio... Read more
Clip And Save:
Handle Your Ear Diagnoses With Care by Pinpointing Anatomic Site
Here's how to differentiate your pinna from your cochlea. Doctors who treat ear condition... Read more
Physician Notes:
CMS Reinstates Orthosis Codes to HCPCS
Plus: Medicare won't deactivate your enrollment for inactivity if you're only enrolled as ... Read more
In other news…
Medicare contractors are bound to deactivate providers' enrollment records if they've had... Read more
Reader Question:
Save 368.8 for Secondary Dx
Question: Many of our ophthalmology patients claim general reasons for their visit, such ... Read more
Part B Payment:
Congress Passes 1-Year Medicare Pay Fix
New legislation ensures that you'll avoid the scheduled 25 percent drop in Medicare pay ne... Read more
Annual Wellness Visits:
G0438-G0439: Medicare Puts Details of Annual Wellness Visit in Writing
Medicare creates new denial codes that will apply when you bill AWV incorrectly.CMS has fi... Read more
CPT 2011:
99224-99226: Never Report New Subsequent Observation Codes on the Same Day As Other E/M Code
Plus: CPT clarifies how you should calculate time when using it to pick an E/M code.Effect... Read more
CPT 2011:
11042-11047 vs. 97597-97602: CPT Differentiates Between Debridement and Active Wound Care
Just one documentation bullet separates these two items.If you were confused about when to... Read more
Electronic Health Records:
Avoid These EHR Coding Pitfalls -- And Collect Your Share of the $44,000 Per-Physician Federal Incentive Bonus
If your EHR is prompting you to check one more exam area so you can upcode to a higher E/M... Read more
Physician Notes:
Remember Timely Filing Rules Going Forward
Plus: Hire someone who the OIG considers 'excluded' and you'll pay dearly.Remember: You ha... Read more
In other news...
Don't forget to check the HHS Office of Inspector General's exclusion list when you hire n... Read more
Reader Questions:
Can Provider Change Tax ID?
Question: One of our physicians wants to stop billing under the group's tax ID and start b... Read more
Reader Questions:
38221 + E/M -- Here's How
Question: Sometimes our doctor sees a patient for the first time; performs an E/M complete... Read more
Reader Questions:
Know the Rules for 'Calming Shots'
Question: One of our patients was on his way to have an MRI at the hospital. He stopped by... Read more
Part B Payment:
Congress Votes to Boost Conversion Factor Through Dec. 31
At nearly the last minute, lawmakers ensure that you won't lose 23 percentAlthough the gov... Read more
Mln Matters Roundup:
90658 Will No Longer Be Payable for Flu Shots Effective Next Month
Plus: CMS debuts new specialty codes for sports medicine, cardiac EP specialistsJust last ... Read more
2011 Payment:
95992: CRP Code Wins Payable Status
Medicare still won't reimburse audiologist-billed Epley.After two years of battles with CM... Read more
Medicare Policy:
New CMS Center Wants Your Advice on Changing Its Payment Policy
Center for Innovation seeking input on improvements in healthcare deliveryCMS has branched... Read more
Part B Coding Coach:
94002-94003: 3 Signals Point You to Encounter Note Gems
Higher level E/M pays more than vent management; don't lose out on the potential $221.When... Read more
Correction:
Only Report 99211 With Injection Code if the Nurse Provides Separately Identifiable E/M Service
In our article "Know These 4 Myths About 99211" (Insider, Vol. 11, No. 32), we indicated t... Read more
94664:
Have You Mastered the Do's and Don'ts of Inhaler Service Claims?
Inhaler demo could pay you $14 or more -- if you know how to navigate the rules.Three... Read more
Physician Notes:
CMS Delays PECOS Denial Deadline
Plus: RACs are also being watched.Good news: You won't face claims denials in January due ... Read more
In other news…
Add yet another government audit contractor to your list, and this one may have slipped in... Read more
Reader Question:
99212 May Apply to Med Check
Question: The physician started an established patient on a new drug. Two weeks later... Read more
Part B Payment:
Practices to Lose 23 Percent in Pay Next Week Unless Congress Intervenes
Once again, conversion factor is set to drop like a rock, and lawmakers are still waiting ... Read more
Diagnosis Coding:
6 Steps Pave the Way to Audit-Hardy Coding
Precise coding doesn't require an overly-detailed coding policy.An ICD-9 coding policy can... Read more
Hospice:
Physicians' Face To Face Encounters of Hospice Patients Start In Just A Few Weeks
At least you can sometimes bill for the visits.Hospices soon will begin taking a financial... Read more
CPT 2011:
99224, 99225, 99226 Solve 'Middle Day' Code Dilemma
Observation services expansion eliminates payer coding variation.In 2011, coders will have... Read more
Physician Notes:
Look for New CLIA-Waived Tests Thanks to CMS Transmittal
Plus: CMS finds that insufficient documentation and medically unnecessary services are the... Read more
In other news…
If there was any question about whether the government's efforts to accurately account for... Read more
Reader Questions:
Look to Wound Margins for Debridement Clues
Question: The physician performs a level-three E/M service in the emergency room, and then... Read more
Reader Questions:
Can You Bill Under the 'House' Doctor?
Question: The doctors I work for asked me to bill a radiology procedure under the "on call... Read more
Reader Questions:
Keep Focus Strong to Find Your Weakness Code
Question: How do we know which ICD-9 code to list for generalized weakness in the Medicare... Read more
Reader Questions:
CMS Spells Out MD's Role in E/M
Question: I've heard that for an E/M visit, the physician is responsible for certain parts... Read more
Part B Payment:
Radiology Payment Cuts in 2011 Could Hurt Many Specialties
Multiple imaging procedure reduction will impact all practices that perform imaging.If you... Read more
Medicare Enrollment:
10 Steps Help You Avoid PECOS Rejections Come January
Even Incident to Claims Will Require Ordering/Referring Doc's NPI, Medicare SaysIt's time ... Read more
E/m Coding:
Some Payers Allow 99214 With Exam of Only Two Body Areas Or Systems
But don't assume you have a 99214 just because you have 5 or moreAre you a victim of "deta... Read more
Documentation:
Extra Scribbles Can Lead To Fines, Jail Time
Make sure doctors date all new entries on patient recordsIf you suspect that someone in yo... Read more
Physician Notes:
OIG Offers 'Roadmap' for Avoiding Fraud and Abuse
Plus: Medicare payment suspension is serious business. The OIG recently asked medical ... Read more
Reader Questions:
38221 + E/M -- Here's How
Question:Sometimes our hematologist sees a patient for the first time; performs an E/M com... Read more
Reader Questions:
Two Flu Tests, Three Coding Options
Question:A nurse tests a patient for both influenza A and B. She uses testing that involve... Read more
Reader Questions:
Distinguish Diagnostic From Therapeutic Nerve Block
Question:Can you explain the difference between "diagnostic" and "therapeutic" injections ... Read more
Reader Questions:
76880 Takes Place of 76881-76882 in 2011
Question:I heard that CPT is doing to delete 76880 for 2011. Which code should we report i... Read more
Reader Questions:
94640 + J Code: Go Full Circle with Albuterol Treatment
Question:My physician performed an albuterol treatment in the office. Can I bill for it?An... Read more
2011 Fee Schedule:
CMS Slashes 2011 Conversion Factor by Over 30 Percent Vs. Current Rates
Plus: Pay for Radiology, Urology, and Cardiology will drop even more.Get ready for another... Read more
Reimbursement:
5 Tips Help You Keep the Money Flowing Into Your Practice
Medicare conversion factor changes mean it's essential to collect every penny you can.With... Read more
HIPAA Compliance:
Just Because Lawyers Request Records Doesn't Mean You Must Send Them
3 steps help you avoid violating HIPAA laws in these situations.Picture this: An attorney ... Read more
Physician Notes:
Intermediaries Won't Field ZPIC Questions
Plus: Feds bust organized crime Medicare fraud scheme.The lines may get blurry when it com... Read more
In other news…
The feds have taken down one of the huge Medicare fraud schemes of the type that is making... Read more
Reader Questions:
Look for Local Treatment to Report Sunburn Pay
Question: A patient presented to our office with swelling and minor blisters on the tops o... Read more
Reader Questions:
Use 33212-33213 for Pacemaker Battery Change
Question: Which CPT and ICD-9 codes apply to changing a pacemaker battery? Answer: A p... Read more
Reader Questions:
49080 Lavage is Part of Catheter Insertion
Question: A surgeon places a peritoneal dialysis catheter (49421) and at the completi... Read more
Reader Questions:
Symbols and Chart Explain V Code Order
Question: What rules apply to reporting V codes with E/M office visits?Can we report scree... Read more
Reader Questions:
99214: Take into Account Discussion with Patient
Question: As a pulmonologist and sleep specialist, I spend a lot of time discussing manage... Read more
Reader Questions:
G0121 Accepts No Other ICD-9 But V76.51
Question: A 73-year-old established Medicare patient with average risk for colorectal canc... Read more
Reader Questions:
Focus on Bone, Not Joint, for 'Fracture'
Question: Is there a diagnosis code for an SI joint fracture?Answer: Not exactly. A patien... Read more
Part B Mythbuster:
Modifier 57 Alone Should Preclude the Need for Modifier 25
Medicare carriers don't require you to append both modifiers.Myth: Payers "don't like"R... Read more
Pulmonology Coding:
493.2x Doesn't Have to Confuse You--If You Have the Right Documentation
When does status asthmaticus supercede COPD? Find out.Your physician's notes may be your b... Read more
Privacy:
Don't Let Disaster Recovery Wipe You Out
Expert guidance for a quick, cost-effective recovery plan.You've written HIPAA privacy and... Read more
Clip 'n' Save:
Handle Your Pulmonary Diagnoses With Care by Pinpointing Anatomic Site
Here's how to differentiate the trachea from the bronchi.Doctors who treat lung conditions... Read more
Physician Notes:
CMS Releases Payment Amounts for Flu Shots
Plus: Illinois pediatrician sentenced after billing for vaccines she received for free.For... Read more
Reader Questions:
Modifiers 53, 73, or 74 Mean Failed Procedure
Question: Can we code for failed attempts at line placement? If so, what documentation do ... Read more
Reader Questions:
Don't Turn Your Nose Up at These FBR Codes
Question: A patient reports to the emergency department (ED) with a crayon stuck in his le... Read more
Reader Questions:
Use NOS Codes to Report Unknown Skin Rashes
Question: We recently treated a patient for a skin rash that seemed to be an allergic reac... Read more
Reader Questions:
Stop Omitting 25 Because of Same Dx
Question: I was recently told in a class that you do not need different diagnosis codes to... Read more
Reader Questions:
Learn HIV Risk Factors
Question: I understand that Medicare has an expanded HIV screening policy for patients in ... Read more
E-Prescribing:
Carriers Only Accept G8553 for E-Prescribing in 2010, CMS Reminds Practices
Using the 2009 e-prescribing G codes will lead you to face claims rejection, CMS reps say.... Read more
Diagnosis Coding:
Think 'Likely' Diagnosis Trumps Symptoms? Think Again
Look for these phrases in your physician's documentation.Typically, your first-listed ICD-... Read more
Part B Revenue Booster:
Boost Your Bottom Line With These 3 E/M Documentation Steps
Tip: Don't miss the endocrine system when you're tallying ROSOne missed documentation elem... Read more
Billing:
Use This Advice to Avoid Patient Run-Ins When Collecting Deductibles
Navigate your way when carriers give you conflicting advice about deductibles, but use bus... Read more
Physician Notes:
Nearly Half of Medical Students Are Trained in Fraud and Abuse Prevention
Plus: Senator Wants Medicare Contractors To Get ToughCoders often wonder why medical schoo... Read more
In other news:
In other news:
Obtaining the Medicare payments that are rightfully yours may get even tougher if one infl... Read more
Reader Questions:
Hernia Terminology Key to Code Selection
Question: What is the difference between umbilical hernia and ventral hernia? What do I ne... Read more
Reader Questions:
Add Modifier 24 For Treatment Discussion During Global
Question: A patient came in for the biopsy report after a 90-day global procedure. The doc... Read more
Reader Questions:
93015 Plus E/M May Equal Denial
Question: May I report an E/M service in addition to a stress test?Answer: The answer depe... Read more
Reader Questions:
99211 May Apply to Med Check
Question: The physician started an established patient on a new drug. Two weeks later, t... Read more
Self-Audits:
Your Audits May Be Making Your Coding Worse, Not Better
Does your auditor know the score? Find out before it's too late.Myth: Any coder can perfor... Read more
ICD-9 Coding Quiz:
Ensure That Your 2011 Diagnosis Coding Skills Are Up to Par
5 questions reveal whether you need an ICD-9 brush-up.October 1 has come and gone, and tha... Read more
Part B Revenue Booster:
69990: Bill Operating Scope Once Per Session - Not Per Level
Medicare is finicky about reimbursing operating scope, so be carefulJust because your surg... Read more
Coding Quiz Answers:
Find Out Whether Your 2011 ICD-9 Coding Skills Pass Muster
After you calculate your score, consider studying any diagnosis coding areas where you s... Read more
Carpal Tunnel Syndrome:
Bust 4 Myths to Safeguard Yourself Against Carpal Tunnel Denials
You won't find specific guidelines for moving to the next treatment level.When a patient's... Read more
Clip 'n' Save:
Handle Your Hand, Wrist Diagnoses With Care by Pinpointing Anatomic Site
Here's how to differentiate the tiquetrum from the trapezium.Doctors dealing with hand pro... Read more
Part B Coding Coach:
Cut Your Ovarian Cyst CPT Confusion Down to Size
Bonus: Here's the documentation you need for cyst removals.Coding for the removal/excision... Read more
Physician Notes:
Just Over 1 Month Left Until Medicare Payments Drop By 23 Percent
Plus: New Anti-Fraud Law Could Delay Your Medicare PaymentsLast June, Congress voted to no... Read more
In other news...
A provision buried in the Small Business Lending Act could slow your Medicare cash flow to... Read more
Compliance:
Practices Collected Over $8 Million in Part B Pay for Services Rendered After Patients Died
OIG identified massive overpayments for services rendered after patients' dates of death.P... Read more
Starting in January, You Can Enroll in EHR Incentive Program
Plus: CMS clears up flu shot coding confusionYou've heard the advantages of participating ... Read more
Pain Management:
Avoid These Top Interlaminar Injection Pitfalls
Distinguish region from level to prevent denials. The next time you're faced with ... Read more
Laboratory Coding:
83718 Reporting: Maximize Lipid Screening Pay
Acknowledge diagnosis restrictions to collect for lipid screening.Medicare covers lipid sc... Read more
Physician Notes:
OIG to Scrutinize E/M Coding Errors in 2011
Plus: Make sure you're using the 2011 ICD-9 codesThe OIG has once again set its sights on ... Read more
In other news...
October 1 is already in the rear-view mirror, which means you should be using diagnosis ... Read more
Reader Questions:
Count All Relevant Time on Discharge Day
Question: The physician admitted a patient and then discharged the patient five days later... Read more
Reader Questions:
The Hard Truth about Phone Call Pay
Question: Another physician told my doctor that he's receiving payment from his contractor... Read more
Reader Questions:
Document Vitals Even If Not Required
Question: Does our provider need to document vital signs before we can charge an [injectio... Read more
Reader Questions:
E/M Code Keys Your PQRI Claim
Question: Our ED wants to report on the physician quality reporting initiative (PQRI) meas... Read more
Reader Questions:
No Inpatient Contact = No E/M Service
Question: I read "When reporting discharge day management service, you must provide and do... Read more
Reader Questions:
Resolve Secondary Payer Issues With Conversations
Question: Our doctor performed surgery on a patient 11 months ago. We just learned that th... Read more
CPT 2011:
CPT 2011 to Debut Codes for Hip Arthroscopy, Subsequent Observation Care
Check out this sneak peek to get a glimpse of the codes you'll be using in January.If... Read more
E/M Coding:
Knock Out Questions on New/Established Patient E/M
Remember, what used to be a consultation is now likely a CPT 99201 -99215 service.Suppose... Read more
Part B Mythbuster:
Overcome Medically-Unlikely Edit Denial Challenges by Busting 4 Myths
If you ignore the medically unlikely edits, you're asking for a denial.If you're receiving... Read more
Physician Notes:
CMS Offers Tool to Determine When Medicare is Secondary
Plus: OIG blasts suppliers' modifier KX claims.When a patient has no other insurance cover... Read more
Reader Questions:
Look for Causes Before Coding Sleep Apnea
Question: What ICD-9 code should I report when the physician performs a level-two E/M on a... Read more
Reader Questions:
Bilateral Done On 1 Side Means 52
Question: A patient underwent a hysteroscopy. The code 58565 represents a bilateral proced... Read more
Reader Questions:
'Diagnostic' and 'Therapeutic' Defined
Question:Can you explain the difference between "diagnostic" and "therapeutic" injections ... Read more
Reader Questions:
Stick With Correct Code, Even if Non-covered
Question:Our payer included codes 64470-64476 on the 2009 physician fee schedule, but drop... Read more
Reader Questions:
'Joint Fracture' Is a Misnomer
Question: Which diagnosis code should I use for an SI joint fracture?Answer: When looking ... Read more
Diagnosis Coding:
CMS to Freeze ICD-9 Code Set Next Year
2011 will be the last time ICD-9 is updated in entirety.CMS has followed through on its pr... Read more
Payment Plans:
Request A Reasonable Patient Payment Plan
Nominal payments don't create any obligation for you.Myth: If a patient is sending you $5 ... Read more
Part B Coding Coach 3 Ways to Do Diagnosis Coding Right
Signs and symptoms may sometimes be your best choice.Choosing the right CPT procedure code... Read more
Part B Mythbuster:
How to Make Your E/M Documentation Bullet-Proof -- Even With Few Symptoms
You may still be able to bill a level-four E/M visit for a patient with abnormal test resu... Read more
HCPCS Coding:
Don't Forget About Q Codes With Your Casting Claims
Think Q4050 is out of your reach? Think again.If you aren't billing Q codes to Medicare fo... Read more
Physician Notes:
Don't Expect to Use PECOS During These 5 Days
Plus: Payment cuts are poised to impact Part B therapy claims.If you're one of the people ... Read more
In other news...
Practices that furnish Part B outpatient therapy can't afford to ignore physician fee sche... Read more
Reader Questions:
Tackle Consultations on a Payer-By-Payer Basis
Question: I am still a little confused about the consultation codes 99241- 99245 and 99251... Read more
Reader Questions:
Simplify DEXA Screening Issues
Question: If a patient has had DEXA exams for years and our doctor treated her for osteope... Read more
Reader Questions:
Bilateral Done On 1 Side Means 52
Question: A patient underwent a laparoscopic total pelvic lymph node dissection. The code ... Read more
Reader Questions:
Altering Coding Just to Get Paid Is a Big No-No
Question: When coding a mastectomy for gynecomastia in a male, what CPT code should I use?... Read more
Reader Questions:
Beware Tacking on Additional Patient Charges
Question: Can you charge a processing fee or a "statement" fee to pastdue patients when we... Read more
Compliance:
Get the 'Rest of the Story' About 5 Common Compliance Beliefs
True or false? Being unaware of accidental overpayments can't invoke false claims liabilit... Read more
Part B Mythbuster:
Start Prepping for ICD-10 Now With 3 Mythbusters
You'll need to implement the new 5010 claim form first to be ready for ICD-10. While the f... Read more
Screening Vs. Diagnostic:
Base Your Colonoscopy Exam Coding on Diagnosis
G-codes are handy if the screening doesn't turn diagnostic. You know the deal: If your ph... Read more
Physician Notes:
CCI 16.3 Includes Over 19,000 New Edit Pairs
Plus: Work ICD-10 costs into your budget Effective Oct. 1, a new edition of the Correct C... Read more
In other news...
You'd better start figuring ICD-10 transition costs into your ever-shrinking budget. "The... Read more
Reader Questions:
Consult Your Doc For Clot Procedure Details
Question: My physician performed an excision due to a painful clotted vein in the lower e... Read more
Reader Questions:
Resolve Secondary Payer Issues With Conversations
Question: Our doctor performed surgery on a patient 11 months ago. We just learned that t... Read more
Reader Questions:
Watch 36430 Units -- RACs Are
Question: If we give two units of blood, should we report 36430 twice? Answer: No. You sh... Read more
Reader Questions:
Check Instruction Before Submitting 98960
Question: My physician wants to teach his patients how to give themselves Imitrex injecti... Read more
Reader Questions:
Watch Bilaterals and Limits on 20550 With 64450
Question: Medicare denies our claims with codes CPT 20550 and 64450, stating that the nu... Read more
Reader Questions:
Stick With Correct Code, Even if Non-covered
Question: Our Medicaid carrier included codes 64470-64476 on the 2009 physician fee sched... Read more
Billling:
Know Your State's Prompt Pay Laws -- And Appeal When Necessary
Medicare requires contractors to pay your clean claims within 30 days, but private payers ... Read more
Part B Mythbuster:
Know These 4 Myths About 99211
Hint: The 'nurse visit' code isn't just for nursesIf you are one of the many coders confus... Read more
X-rays:
Sidestep These 3 X-Ray Scenario Pitfalls
Supercharge your skills by knowing which guidelines to keep handy.Medical coders must be m... Read more
E/M Coding:
3 Tips Are Key to Deciphering 99213 From 99214
Avoid these upcoding mistakes.Do you recognize when your physician documents a 99214 but o... Read more
Physician Notes:
Physician Convicted in $2.3 Million Medicare Scheme
Plus: Don't forget ZPICs when it comes to your compliance program.Clinics billing Medicare... Read more
In other news...
Keep your eye on ZPICs, as their audits may be more liable to close your doors than any ot... Read more
Reader Questions:
Discover True Meaning of 38792 Note
Question: The physician performed a sentinel node injection with lymphoscintigraphy. A not... Read more
Reader Questions:
Pay Attention to Individual State WC Rules
Question: We had a patient who was injured on the job (workers' compensation) in Virginia ... Read more
Reader Questions:
If Cancer's Still Present, Ignore 'History of' Codes
Question: At what point should I report a "history of" code instead of the actual cancer d... Read more
Reader Questions:
CMS Spells Out MD's Role in E/M
Question: I've heard that for an E/M visit, the physician is responsible for certain parts... Read more
Reader Questions:
Medicare Won't Recognize +99100
Question: We use CRNAs in our ambulatory surgery center to provide anesthesia during upper... Read more
Reader Questions:
No CCI Bundle? Here's Where to Find Modifier Details
Question: Sometimes I cannot find my two-code pair in the CCI edits. How do I know which c... Read more
Documentation:
Watch Out: Nurse's History Note Might Be Audit Bait
The physician must indicate that he or she reviewed any nurse's notes.Warning: Don't let y... Read more
Modifiers:
Mind Your Modifiers When Your Physician Acts As Co-Surgeon
Coordinate surgeon claims or chance missed reimbursementWhen coding surgical claims, pay s... Read more
Part B Mythbuster:
Failing to Report X-Rays During the Global Will Cost You Money
Depending on how many x-rays you write off, you could be losing thousands.Myth: X-rays tha... Read more
Part B Revenue Booster:
Scope Out Potential Level 4 and 5 E/Ms by Knowing Crucial HPI Facts
Watch out for CPT/Medicare differences when counting HPI elementsIf you're not accurately ... Read more
Physician Notes:
EHR Products Can Now Get Certified, HHS Says
Plus: Look for new CLIA-waived tests effective October 1.With the upcoming $44,000 per-phy... Read more
Reader Questions:
Call on 24 for New Px at Post-Op Visit
Question:Our physician saw a patient in follow-up for a tympanoplasty (69436, Tympanostomy... Read more
Reader Questions:
Stop Omitting 25 Because of Same Dx
Question:I was recently told in a class that you do not need different diagnosis codes to ... Read more
Reader Questions:
Anatomy Offers Obturator Block Clues
Question:What codes should we submit for an obturator nerve block and obturator muscle inj... Read more
Reader Questions:
MCPM Answers Modifier GG Questions
Question:What is the proper way to use modifier GG? Do I append it to a diagnostic mammogr... Read more
COMPLIANCE:
OIG Revisits Recommendation to Review Modifier 59 Claims
Modifier 59 misuse led to millions in overpayments. When the OIG talks, not everyone list... Read more
COMPLIANCE:
Facet Joint Injections, Ultrasound Services on OIG's Radar Screen
Know what the OIG's watching to make sure you're billing properly. The OIG makes recommen... Read more
PATIENT PRIVACY:
Outsourcing Security on Patient Privacy Can Be Helpful -- If You Know These 5 Essential Truths
Learn these facts before you nail down your HIPAA plan with a consultant. You may be reli... Read more
THERAPY:
Put Your Rehab Coding Knowledge to the Test
This quick quiz will show you where your therapy coding and billing skills fall. Want to ... Read more
PART B CODING COACH:
Stay Out of These Common Biopsy Coding Pitfalls and Boost Claims Accuracy
Go beyond 11000 to 'site' specific codes, which can net your practice upwards of $25. If ... Read more
PHYSICIAN NOTES:
Senate Votes to Delay Medicare Pay Freeze Until October -- But It's Not Final Yet
Plus: CMS offers new products to help you make sense out of how to maximize your PQRI bonu... Read more
In other news ...
• CMS aims to help you decipher the ins and outs of the PQRI program with new educat... Read more
READER QUESTION:
Consider Immediacy on Critical Care Claims
Know what constitutes a 'critical illness or injury.' Question: I've experienced some den... Read more
PART B PAYMENT:
Legislators Offer New Year's Gift With Temporary Medicare Pay Fix
Plus: You’ll face a 10-day payment delay from MACs as they update their claims s... Read more
Consultations:
CMS's Refusal to Pay Consults Makes MSP Claims a Headache
Don’t even think about billing a consult to Medicare -- even if it’s on... Read more
Part B Payment:
Ire Toward Medicare Grows With Elimination of Consults, Cuts in Pay for Some Specialties
Plus: Know these facts if you’re considering opting out of Medicare. You might... Read more
Electronic Health Records:
At Long Last: CMS Proposes 'Meaningful Use' Definition -- Meet These 25 Criteria to Qualify
New definition lets you know what you must do if you want to be considered a meaningful ... Read more
Part B Coding Coach:
Dig Into Details to Decipher How to Report Lesion and Tumor Codes
Growth characteristics, size, and depth can offer you handy clues that will lead to accu... Read more
Physician Notes:
Make These Corrections to HCPCS 2010
Plus: CMS gives hospices extra time to comply with new requirements.    ... Read more
Reader Question:
V Codes Can Cover You During 'Injury-Free'
V Codes can help you in this scenario, but like all ICD-9 codes, they don’t guaran... Read more
PART B PAYMENTS:
Lock in New Ways to Improve Your Practice's Bottom Line
Tap these resources to optimize payment during Medicare's period of indecision. With Medi... Read more
MODIFIER CODING QUIZ:
Do Your Services Warrant Use of Modifier 25?
Take our quick quiz to determine whether you're appending modifier 25 appropriately. Your... Read more
MODIFIER QUIZ ANSWERS:
Check These Quiz Answers to Determine Whether You're Using Modifier 25 Properly
Check out this expert advice to find out how you fared in our modifier 25 quiz. Do your m... Read more
APPEALS:
Use This Sample Appeal Letter As Ammo in Your Fight Against Modifier 25 Denials
Attach your procedure notes and the OIG's report to pack extra punch. Even if you follow ... Read more
HOSPICE:
6 Steps Help You Prep for A Hospice RAC Attack
Get specific with your patients' diagnoses. Region D Recovery Audit Contractor HealthData... Read more
YOUR PART B QUESTIONS ANSWERED:
Coding for Supplies Depends On Place of Service
Question: Can I use 99070 to report the use of supplies at our office? Answer: The AMA an... Read more
PHYSICIAN NOTES:
CMS Offers Vaccine Updates, With FDA Approval Status for 90670 And Release of 90644
Plus: CMS plans March 23rd conference call to educate providers on how to prepare for ICD... Read more
In other news ...
• Want to get a leg up on ICD-10? CMS is offering an introduction to the new diagnosi... Read more
MEDICARE PAY:
Congress Halts 21.2 Percent Pay Cut -- Until March 31
1-month extension of pay freeze was official March 2. Although Feb. 28 came and went witho... Read more
BILLING:
3 Tips Help You Optimize Your Billing Department's Efficiency
Be proactive -- not reactive -- to A/R changes. With Medicare payment changes u... Read more
CONSULTATION ELIMINATION:
You Can Report Subsequent Hospital Care Codes for Initial Visits, CMS Says
New CMS policy puzzles many practices, makes others nervous. CMS has finally cleared up h... Read more
ENROLLMENT:
Not In PECOS Yet? Expect A Letter From Your MAC Or From CMS Pushing You Toward Enrollment
Plus: CMS will require you to participate in electronic funds transfer, referring to it a... Read more
PART B CODING COACH:
3 Criteria Nail Down Your Payment When Reporting 99211
Don't leave $19 per visit on the table -- follow these rules to ensure you collect w... Read more
PHYSICIAN NOTES:
HHS Starts the Process of Establishing EHR Certification Program
Plus: CMS changes DME phone rules -- again Medical practices that are eager to get i... Read more
In other news ...
• CMS intends to clear up some murky waters with a new clarification on whether DME ... Read more
READER QUESTION:
Consider Using Incident-To Guidelines When Billing Follow-Ups
Know the rules before you try to bill incident-to. Question: One of our non-physician pra... Read more
PART B PAYMENTS:
Congress Mulls Short-Term Fix to Avert 21.29 Percent Pay Cut
Cuts to take effect in late March if proposal passes. If a new bill introduced in the&nbs... Read more
BILLING:
Avoid These 2 Pitfalls When Trying to Maximize Income
Collect all that you can -- ethically. With uncertainty surrounding your Medicare pa... Read more
COMPLIANCE:
RACs Succeed at Collecting Overpayments, But Could Use Improvement in Identifying Fraud
Take these steps to ensure that you won't face any surprises if and when a RAC calls on y... Read more
EHR INCENTIVE PROGRAM:
Non-Physician Providers Aren't Considered 'Eligible Professionals' in Medicare EHR Incentive Program
But non-physicians may be able to collect incentive payments from Medicaid. CMS reps want... Read more
THERAPY:
Occupational Therapists Get Their Own Piece of the EHR Pie
Look for electronic health records tailored toward OTs, thanks to a new licensing agreeme... Read more
YOUR PART B QUESTIONS ANSWERED
Hang Up On Using Telephone Codes Within 7 Days Question: Our ob-gyn office does backup fo... Read more
PHYSICIAN NOTES:
CMS Publishes Long-Awaited Q&As Regarding Services Previously Billed As Consults
Plus: CMS offers new tips for dealing with the Medicare appeals process, thanks to a broc... Read more
In other news ...
• Need some guidance in structuring your appeals? CMS steps in with a valuable new re... Read more
ICD-9 CODING:
Stop Asking 'Which Diagnosis Code Will Get My Claim Paid?'
Instead, code directly from the medical record. Medical coders face a lot of questions ea... Read more
FRAUD AND ABUSE:
Ignore Internal Audit Findings At Your Own Risk
Sweeping dirt under the rug could be costly. A recent whistleblower lawsuit at a health s... Read more
AUDITS:
Can You Spot These 7 Red Flags in Your Charts?
Notice the trouble signs before they turn into disasters. When you're auditing your chart... Read more
ENROLLMENT:
CMS Delays Ordering/Referring PECOS Regulation Until 2011
Take the extra time to get your practice registered in PECOS -- don't wait until the... Read more
PART B CODING COACH:
Beef Up Your Diagnosis Know-How for Medical Necessity
Keep these guides in mind to help prove your case. With payers tightening the reins on re... Read more
PHYSICIAN NOTES:
Congress Pulls Conversion Factor Freeze From Jobs Bill, Leaving 21 Percent Cut Scheduled for March 1
Plus: CMS assigns 'CLIA-waived' status to five additional lab tests, including a Rapid St... Read more
In other news ...
• You'll have five lab services that you'll be able to report as "CLIA-waived," than... Read more
READER QUESTION:
Two Codes Are Too Many When Treating Two-Sided Nosebleeds
Keep bilateral procedure guidelines in mind when you're dealing with bleeding conditions ... Read more
DOCUMENTATION:
CMS Clamps Down on Physician Signature Requirement
CERT results reveal that contractors are now denying claims that would have squeaked past... Read more
ICD-9 CODING QUIZ:
Can You List All Applicable Diagnoses -- in the Right Order?
Do you know which ICD-9 code you should list first? Take our quiz to find out. Your patie... Read more
CONSULTATION ELIMINATION:
Forget to Append Modifier AI to Inpatient Hospital Visit Claim? This MAC Will Still Reimburse You
Plus: You no longer need to list the ordering/referring physician as item 17 on your clai... Read more
ICD-9 CODING QUIZ ANSWERS:
Can You Sequence Your Diagnosis Codes Properly on Your Medicare Claims?
Check out the answers to our ICD-9 coding quiz to find out how you fared. You know that y... Read more
HOSPICE:
Ward Off Hospice Audits By Helping SNF Partners
SNF patients on hospice are a trouble spot for both providers. You may find your relation... Read more
YOUR PART B QUESTIONS ANSWERED:
Remember to Represent Pressure Ulcer's Stage
Question: An established elderly patient reports to our physician for inspection of sores... Read more
YOUR PART B QUESTIONS ANSWERED:
Code the Highest Level for Counseling
Question: I read your article on coding E/M services based on time from last week's Insid... Read more
YOUR PART B QUESTIONS ANSWERED:
Modifier 55 Goes on Original CPT Code
Question: One of our patients went to the emergency department (ED) for a laceration to h... Read more
YOUR PART B QUESTIONS ANSWERED:
PFSH Tips Scales on Some E/Ms
Question: I am having trouble deciding between E/M levels for this encounter: The notes c... Read more
PHYSICIAN NOTES:
Congress Mulls Extending Temporary Conversion Factor Pay Fix Through the Autumn
Plus: CMS creates a downloadable booklet that can help you navigate the waters of the NPI... Read more
In other news ...
• It seems like every time you have your NPI facts down straight, CMS changes the pla... Read more
PART B MYTHBUSTER:
OIG Requests $40+ Million More Funds to Beef Up Fraud Detection
Ratchet up your documentation skills now. The OIG has been on a roll over the past year, ... Read more
ELECTRONIC HEALTH RECORDS:
EHRs Can Earn You $44,000
You can collect incentive payments by participating with either Medicare or Medicaid ... Read more
PART B REVENUE BOOSTER:
Want to Code Your E/M Based on Time? Counseling/Coordination of Care Must Dominate Visit
Tighten up your documentation before you code based on time spent with patient. Time can ... Read more
E/M CODING:
CMS 'Very, Very Close' to Issuing More Guidance on Consult Code Replacement Codes
Plus: You can now download a list of all practitioners who can order/refer. If you've bee... Read more
PART B CODING COACH:
Coding Quiz: Pick the Right Diagnosis Code for Postmenopausal Abnormalities
Do N95.0 and N95.2 look foreign? Get your ob-gyn ICD-10 equivalents now. Spare yourself d... Read more
PHYSICIAN NOTES:
CMS Spells Out How You Should Calculate Medicare Payment Amounts
Plus: Unless you have a formal waiver in place, it's time to stop using the DR condition ... Read more
In other news ...
• You may have gotten used to treating H1N1 cases at your office , but one habit you... Read more
READER QUESTION:
Halt Confusion Between Modifiers 25 And 59 With These Quick Tips
Equate modifier 25 with significant and separately identifiable E/M service, and append i... Read more
NURSING FACILITY CARE:
Prepare Now: One MAC Institutes Pre-Pay Edit for Code 99310
87 percent error rate leads to drastic measures. If you think CMS is only watching your E... Read more
ICD-9 CODING:
Differentiate NOS Versus NEC When Selecting Diagnosis Codes
Your Medicare payments could be at stake if you don't report the right ICD-9 code. Are yo... Read more
INPATIENT CARE:
Watch Out for These Hospital Discharge Pitfalls
Note five mistakes that could cost you thousands. Even coders who have a firm grasp on co... Read more
HCPCS CODING:
Avoid Audit Scrutiny by Billing J Codes Properly
Check out these errors -- and how to steer clear of them. When you think of MACs aud... Read more
DURABLE MEDICAL EQUIPMENT Suppliers Blast OIG For 'Unworkable' Fraud Alert
Feds show lack of understanding in interpretation, industry says. Suppliers may have to c... Read more
YOUR PART B QUESTIONS ANSWERED
Editor's note: Due to popular demand, Part B Insider will now be alternating the "Part B ... Read more
PHYSICIAN NOTES:
Medicare Strike Force Nails Physical Therapist Who Helped Overbill Medicare by $2.375 Million
Plus: CMS debuts new Medicare tool that helps you spell out confusing terms, enrollment i... Read more
In other news ...
• Is HIPAA 5010 a thorn in your side? You might benefit from an upcoming CMS seminar.... Read more
PART B MYTHBUSTER:
CPT Doesn't Include 'Admit' Codes
Codes 99221-99223 refer to inpatient care. Myth: If your physician admits a patient ... Read more
HOSPICE:
Remember Doc Attestation for New Hospice Narrative
Part of your Medicare payments could be at stake. If you wait for medical reviewers to fe... Read more
INPATIENT CARE:
2 Facts Every Practice Must Know About Hospital Care Codes
Collect every penny of your hospital care services. Now that Medicare has stopped paying ... Read more
MODIFIERS:
Learn the Truth About These Three Modifier Myths
Hint: Modifiers 22 and 52 don't take the place of using an unlisted code. Correct modifie... Read more
PART B CODING COACH:
Ensure Your Fair Share of Routine Exam Reimbursement by Playing by Medicare Rules
Ophthalmologists take note: No complaint may mean no coverage. Often, ophthalmologists do... Read more
PHYSICIAN NOTES:
MedPAC Recommends 1 Percent Physician Payment Update for 2011
Plus: Recovery audit contractors post additional target areas that they plan to review go... Read more
In other news ...
• Recovery audit contractors (RACs) are working hard to expand their lists of approv... Read more
READER QUESTION:
Nail Down Whether to Report Foreign Body Removal Versus E/M
Know whether your documentation meets the descriptors of 65205 or 65210 or if you should ... Read more
PQRI:
Get Ready For the PQRI 'GPRO' -- Group Practice Reporting Option
You have until Jan. 31 to self-nominate your practice for this designation, but know the ... Read more
CONSULT CODING QUIZ:
Test Your E/M Coding Skills Now That Consult Pay is Gone
Do you know how to report those services you used to code as consults? Take this quiz to ... Read more
REHAB CODING:
Wake Up to a New Wound Care Code That You Can Use This Year
Here's what you need to know about CPT code 29581. New CPT codes for rehab practic... Read more
CONSULT CODING QUIZ:
Check Your E/M Coding Skills With These Quiz Answers
Hint: Only look to unlisted E/M codes when your MAC specifically tells you to. How did yo... Read more
PART B CODING COACH:
Aim for AMI Diagnosis Perfection by Applying These Official ICD-9 Guidelines
Non-ST-elevation myocardial infarction evolves to STEMI? Here's what to do. If you haven'... Read more
PHYSICIAN NOTES:
One MAC Reports PECOS Glitches
Plus: OIG finds massive power wheelchair errors. If you're having trouble navigating the ... Read more
In other news ...
• You may think the seat can't get any hotter for durable medical equipment supplier... Read more
READER QUESTION:
Understand Your Obligations for Overpayments
Can insurers deduct overpayments from your checks? Find out here. Question: Some insurers... Read more
Available Years:  2010  2009  2008  2007  2006  2005  2004  2003