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Pulmonology Coding Alert

Prevent Sleep Study Denials With This Easy-to-Use Checklist
We’ll show you how to avoid a 95810-26 rejection due to a POS-DOS mismatch You ... Read more
Modify Your Flu and PPV Reporting After Oct. 1
CMS offers new guidance on billing for the vaccine and the administration Effective Oct. 1... Read more
Call on 22 if Your Pulmonologist Goes the Extra Mile
Modifier may mean more work for coders, but the payoff is worth it With appropriate docume... Read more
NEWS BRIEF:
Look Beyond CMS Web Site for NPI Applications
CMS removed the NPI PDF from its Web site, but you have other options This list makes obta... Read more
READER QUESTION:
Marshfield Auditor's Sheet Is Not a CMS Tool
Question: What exactly is the Marshfield Clinic Auditor's worksheet? I have heard that it ... Read more
READER QUESTION:
Use Modifier to Bill Portion of These PFT Codes
Question: How should I code for the professional component (the interpretation of the test... Read more
READER QUESTION:
Avoid Faxing Consult Requests to Referrals
Question: We are a small pulmonary practice, and we often refer patients to a local allerg... Read more
READER QUESTION:
2 Details Ensure You Don't Overlook 31624
Question: A patient had massive bleeding in the right upper lobe. After the pulmonologist ... Read more
You Be the Coder:
Is 31622 per Lobe?
Question: A pulmonologist performed a bronch/wash, thoracentesis with tube and chemical in... Read more
Watch Out for 3 CMS Changes That Will Affect Your Practice
You aren't responsible for the requesting physician's files, CMS says CMS lets pulmonologi... Read more
Hone Your Modifier 25 Policy With These Guidelines
Private payers may drop the modifier requirement for medicine/service claims You final... Read more
Coding Checkup:
Take 5 Minutes to Nail Down Your Fall ICD-9 Changes
Take 5 Minutes to Nail Down Your Fall ICD-9 ChangesWarning: 519.1 won't be all you need fo... Read more
Reader Question ~ Assign Priority to These Conditions
Assign Priority to These ConditionsQuestion: Our physicians are treating a patient's respi... Read more
Reader Question ~ Current Clients Can Be Consultation Subjects
Question: Can I perform a consult on my own patient?Florida Subscriber Answer: Yes and no.... Read more
Reader Question ~ Adhere to Inclusion/Exclusion Instructions
Question: When looking up codes in the tabular list of my ICD-9 manual, I often see &ldq... Read more
Reader Question ~ Use 52 on Incomplete Sleep Study
Question: How should we report a polysomnography when the patient decides to discontinue t... Read more
Reader Question ~ Make Bronchitis Diagnosis as Specific as Possible
Question: When I use 491.9 to describe a patient's bronchitis, payers often deny the code ... Read more
You Be the Coder ~ Procedures Does Critical Care Include?
Procedures Does Critical Care Include?Question: A pulmonologist spent 80 minutes providing... Read more
Here's How to Get the Most Out Of Smoking Cessation Sessions
Use G0375 for shorter counseling encountersWhen your pulmonologist counsels a patient on s... Read more
Follow These Steps For Multiple-Substance Infusions
If staff infuses saline solution with medication, report a single code When your pulmonolo... Read more
Remember 3 Pointers For Sound Critical Care Billing
The physician's documentation is your key to success When you receive a denial from a pay... Read more
Reader Questions:
Determine Likelihood of Post-Transplant E/M Pay
Question: A patient underwent a lung transplant two weeks ago. Yesterday, the pulmonologis... Read more
Reader Questions:
Remember Whose Equipment You're Using On Spirometry Claims
Question: Our pulmonologist ordered a spirometry on one of our patients at the hospital. I... Read more
Reader Questions:
Can an Airway Obstruction Lead to Respiratory Acidosis?
Question: What is respiratory acidosis, and what ICD-9 codes should I use to represent the... Read more
Reader Questions:
Teaching Physician's Presence Not Necessarily Required for Intern's E/M
Question: A physician in our practice recently started supervising a resident's services. ... Read more
Reader Questions:
Nurse Visits Allowed for Some Flu Shot Claims
Question: When an established non-Medicare patient reports to the office for a flu shot, c... Read more
You Be the Coder:
Prove Separate Service When Physician Gives Nebulizer Instructions
Question: An established patient with unspecified extrinsic asthma reports saying he is sh... Read more
Here's Why You Shouldn't Report Xolair With Chemo Codes
CPT moves to make 90772 the only choice for these shotsAfter years of confusion and confli... Read more
Challenge Yourself to Answer These Common NCCI Queries
Don't override another NCCI edit until you read thisNational Correct Coding Initiative (NC... Read more
Coding Quiz:
Determine Your NPP Coding Know-How
Can new patients get treatment incident-to the physician?You might think you've got nonphy... Read more
READER QUESTIONS:
Note Differences in Medicare Rules for Post-Surgical E/M
Question: A surgeon in our physician group performed a lung transplant on a female patient... Read more
READER QUESTIONS:
Polysomnography Code Choice Depends On Study's Scope
Question:  What is a polysomnography, what types of patients need it, and how do you ... Read more
READER QUESTIONS:
Be Careful With Your Respiratory Failure Dx
Question: My pulmonologist treats a patient suffering from respiratory failure with contin... Read more
READER QUESTIONS:
Get Elemental When Determining HPI
Question: An internal chart audit of our evaluation and management (E/M) claims showed tha... Read more
READER QUESTIONS:
After-Hours Code Not Always Reimbursed
Question: Our normal office hours are 8 a.m. to 5 p.m. Monday through Friday. Our pulmonol... Read more
You Be the Coder:
Choosing the Proper Antigen Therapy Code
Question: When a patient receives antigen therapy from our pulmonologist, what CPT code[s]... Read more
Ensure Your Pulse Oximetry Claims Don't Send Off Red Alerts to the OIG
Safety net: You may want to adopt an all-payer modifier 59 policy The Office of Inspe... Read more
News You Can Use:
Find Out if Your Modifier 25 Claims Make the Grade
Carriers may soon crack down -- are you prepared? Knowing when you should append modifier ... Read more
Category III Update:
Performing Chest X-Ray With CAD? Zero In on 0152T
New computer-aided detection (CAD) technology means new codes that you have to report corr... Read more
Reader Questions:
Caution--A New Problem Does Not Make a Consult
Question: A patient originally came to our office based on a referral for a procedure. The... Read more
Reader Questions:
Check Out 0074T for Online Consults
Question: I've heard that we can charge insurance for our physician's online consultations... Read more
Reader Questions:
Meet Requirements for This Albuterol Admin
Question: What codes should I report when a patient presents with acute exacerbation of ex... Read more
Reader Questions:
Avoid V03.2 for PPD TB Test
Question: Which ICD-9 code should we report for the purified protein derivative (PPD) tube... Read more
Reader Questions:
Remember E/M for This Emphysema Encounter
Question: What CPT code should we report when an established patient with emphysema (492.8... Read more
Reader Questions:
Topple Your Neoplasm Table Troubles
Question: How should I choose from among the various categories (primary malignant, second... Read more
Reader Questions:
Double-Check Documentation for 795.5 Claim
Question: We had a patient with a positive Mantoux (PPD) test and a negative chest x-ray. ... Read more
Reader Questions:
Submit Paper Claims on Time
Question: Do you have any suggestions for filing paper claims for unlisted-procedure codes... Read more
You Be the Coder:
Should You Challenge Peak Flow Denial?
Question: An insurance company told me that the code we are using for peak flow (94250) is... Read more
Capture Asthma Education Using These 3 Codes
If you're not using patient self-management codes, you could be missing reimbursement oppo... Read more
Take Advantage of More Specific Pain Codes Starting Oct. 1
Good news: Pulmonology won’t face many diagnosis code changes Every year, you&rs... Read more
Ensure You're Using Modifier 26 Flawlessly Every Time
Don’t rely solely on who owns the equipment When your pulmonologist orders certa... Read more
Revamp Your Coding, Reduce Denials With 4 Surefire Steps
Hint: Get acquainted with your carriers' LCDs One of the biggest challenges coders face is... Read more
Reader Questions:
Limit Consultation Coding to Once per Stay
Question: If a patient is repeatedly readmitted to the hospital for acute COPD by her prim... Read more
Reader Questions:
Follow 3 Steps to Correct Fluarix Coding
Question: Our office is expecting a shipment of the Fluarix TIV influenza vaccine. When a ... Read more
Reader Questions:
Report 95149 for a Patient in 5-Venom Therapy
Question: When our physician prepares 36 doses of three stinging insect venoms on the same... Read more
Reader Questions:
Use Caution With Locum Tenens
Question: My multi-specialty group is using a locum tenens to fill in at the hospital whil... Read more
You Be the Coder:
Should You Report 32002 and 32020 Together?
Question: Our physician performed thoracentesis and inserted a tube for a pneumothorax. He... Read more
Avoid Reporting Critical Care Codes When The Patient's Condition Isn't Life-Threatening
Time and documentation are the keys to getting reimbursement for your pulmonologist's crit... Read more
HCPCS 2006 Puts a Halt To Your J7616, J7617 Claims
Remember modifiers KP, KQ for compound preparationsHave you had insurers denying payment o... Read more
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Get a Grip on Critical Care Time With This Simple But Useful Reference Chart
Learn when to report 99292 more than onceMake reporting critical care easy with this simpl... Read more
New Special Service Codes Capture Extended-Hours Pay
Find out which of these new codes you should use to gain reimbursementIf your pulmonology ... Read more
READER QUESTIONS:
Discharge Code Depends on Patient Status
Question: My pulmonologist performed a diagnostic bronchoscopy and then discharged the pat... Read more
READER QUESTIONS:
Don't Let ICD-9 Descriptor Limit Diagnosis Coding
Question: My physician noted that a patient has "acute exacerbation of emphysema." The pul... Read more
READER QUESTIONS:
Pneumonia Vaccine Code Depends on Patient Age
Question: What codes should I report for pneumonia vaccinations given in our office?New Ha... Read more
READER QUESTIONS:
Oxygen Administration Doesn't Have Separate Code
Question: When an office patient requires oxygen, what CPT code should I use for administe... Read more
READER QUESTIONS:
Use Caution With Observation Codes
Question: My pulmonologist saw a Medicare patient on Thursday night while he was the atten... Read more
READER QUESTIONS:
NCCI Limits Number of Stress Tests
Question: What are the coding differences between a cardiac stress test and a pulmonary st... Read more
You Be the Coder:
When Are 31622, 31623 Both Appropriate?
Question: My doctor wants me to bill 31623 and 31622, but I don't think I can bill both. W... Read more
3 Surefire Tips Improve Your Ventilation Management Coding and Reimbursement
Watch out for NCCI bundles when your pulmonologist provides both E/M and vent servicesYou ... Read more
Quick Quiz:
Find Out How Confident You Are in Your Coding Knowledge
Test your overall pulmonology coding know-howAmidst changing codes, bundling edits, and ... Read more
Tackle the New-vs.-Established Dilemma With These Pointers
Tip: Count the years since the patient's last visit before choosing an E/M codeWhen y... Read more
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Don't Report a Consultation Code Unless You Have Proper Documentation
Use this form to save yourself time, effort and denialsDocumentation--or lack thereof--can... Read more
READER QUESTIONS:
Add Up Same-Day, Different-Physician E/M Services
Question: Sometimes patients see two of our physicians on the same day. Can I report both ... Read more
READER QUESTIONS:
Weekend Visit Justifies Your Use of 99050
Question: My pulmonologist saw a patient in the office on a weekend. How should I report t... Read more
READER QUESTIONS:
CPT Doesn't Offer Laryngoscopy With Brushings
Question: My pulmonologist performed a laryngoscopy with brushing, but I don't see a code ... Read more
READER QUESTIONS:
You Won't Have to Resubmit 2006 Claims
Question: Will I need to resubmit the claims I have submitted in 2006 to obtain the correc... Read more
You Be the Coder:
Understand Teaching Physician Regulations
Question: My physicians work at a teaching hospital. What should I look for in the documen... Read more
Want to Report Same-Specialty Consultations? Experts Show You How
Warning:  CMS won't allow you to report a consultation code for shared or split visit... Read more
Add Another 'R' to Your Consultation Coding Checklist
Tip:  Develop a request form to ensure you meet all the coding requirementsIn additio... Read more
3 Steps Ensure You Choose the Right Drug Administration Code
Don't ignore chemo codes just because your physician doesn't see cancer patientsYou won't ... Read more
Correction
In the January 2006 issue of Pulmonology Coding Alert, the article "Reporting 90780-90784 ... Read more
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Review This Chart to Solidify Your Drug Administration Coding
Don't confuse deleted codes with new 2006 codesWith so many new injection and infusion cod... Read more
READER QUESTIONS:
Code Descriptor for 94620 Causes Confusion
Question: In your October 2005 issue, the answer to a reader question has me confused beca... Read more
READER QUESTIONS:
NCCI Limits Pulse Oximetry Coding
Question: We bill for sleep study 95807 with overnight pulse ox 94762. Medicare denies the... Read more
READER QUESTIONS:
You Can Separately Report Some Bronchoscopies
Question: One of our thoracic surgeons performed a diagnostic bronchoscopy. Based on the r... Read more
READER QUESTIONS:
Change Your Thinking on Tracheotomy Tubes
Question: Our doctors periodically change patients' tracheotomy tubes. I'm not clear on wh... Read more
READER QUESTIONS:
Avoid Unspecified Bronchitis Codes
Question: When I use 491.9, payers often deny the code and request additional information.... Read more
You Be the Coder:
Cut Through the Smoking Cessation Coding Haze
Question: We're not having much success getting payment for smoking cessation counseling. ... Read more
NCCI 12.0 Update:
Don't Report CPT's New Drug Administration Codes With Bronchoscopies or Thoracentesis
NCCI also adds a 'standard' bundling edit between the new codes and spirometry code 94060C... Read more
4 Steps Guarantee You'll Choose The Right Flu Shot Codes
Use this guide to determine the correct vaccine and administration codesWith different rul... Read more
NCCI Update:
Version 12.0 Says You Can't Report Nurse Visits With Immunizations
The good news is this edit won't have dire effects on your pulmonology practiceIf your pul... Read more
Don't Pick Up the Patient Tab For Noncovered Procedures
Tip:  ABNs are your solution for payment on services Medicare won't coverIf you aren'... Read more
READER QUESTIONS:
Spirometry Determines 94070 vs. 95070
Question: What is the difference between 94070 and 95070?Indiana Subscriber Answer: The fi... Read more
READER QUESTIONS:
Report 32020 for Chest Tube Insertions
Question: Is there a code for insertion of a chest tube using the c-arm? Does it matter ho... Read more
READER QUESTIONS:
Peak Flow Rate Challenges Coders
Question: How should I report a peak flow measurement taken in the office prior to an alle... Read more
READER QUESTIONS:
Take the Sting Out of Venom Injections
Question: When my physician administers two separate venoms (for example, honeybee and yel... Read more
READER QUESTIONS:
Nebulizer, Vaccine Include Inherent Supply
Question: May we bill private payers for a syringe code with a vaccine administration code... Read more
READER QUESTIONS:
Use 94799 for Maximal Respiratory Pressure Measurements
Question: What CPT codes, if any, should I use to report maximum inspiratory pressure and ... Read more
You Be the Coder:
Bronchoscopy With Removal of Foreign Body
Question: Can I report 31622 and 31511 together? My physician states he did a bronchoscopy... Read more
Don't Miss Out:
Learn When You Can Report Both a Procedure and a Separate E/M
Don't forget to append modifier 25 when you report multiple services When your pulmonologi... Read more
Don't Let Multiple COPD ICD-9 Codes Confuse You
Be sure you appropriately code exacerbations in asthma and COPD Your key to correctly... Read more
Identify What Makes a Consultation
A consultation is a request for an opinion or for advice. There are three criteria, also k... Read more
Quick Quiz:
Get Up to Speed on the 2006 CPT Changes
Test yourself with these 5 questions about the edits, deletions, and additions If you&... Read more
CPT 2006 Update:
Add 1005F and 4015F to Your Asthma Reporting Arsenal
Use these codes to describe patient history, pharmacological therapy CPT 2006 adds two ast... Read more
Reader Questions:
Report Services Regardless of Expected Payment
Question: Should we bill exactly the same group of codes to all payers or can we submit th... Read more
Reader Questions:
Use 327.23 for Specified Organic Sleep Apnea
Question: What is organic sleep apnea? My physician has been using 780.57 to report sleep ... Read more
Reader Questions:
You Can Report 36556 and 93503 Together
Question: Can I report 36556 and 93503 together on the same day?Texas Subscriber Answer: N... Read more
Reader Questions:
Don't Need a Modifier for Overnight Oximetry
Question: Can I bill 94762 when a patient does this at home? Our office owns the equipment... Read more
You Be the Coder:
Location Doesn't Change Six-Minute Walk Coding
Question: My doctor has always performed six-minute walk tests in the hospital and reporte... Read more
CPT 2006 Update:
AMA Clarifies When You Can and Can't Report Conscious Sedation
Appendix G is your key to understanding which services include CSIf you've struggled with ... Read more
CPT 2006 Update:
Learn the Ins and Outs of Your New Conscious Sedation Codes
Use intraservice time and patient age to determine which of the 6 codes you should reportC... Read more
CPT 2006 Update:
AMA Deletes Follow-up and Confirmatory Consult Codes
You'll see higher payments as a resultIf your pulmonologist provides consultations, take n... Read more
CPT 2006 Update:
Reporting 90780-90784 for Drug Infusions? Not Anymore
AMA replaces these codes with several more-specific codesIf your pulmonologist performs dr... Read more
CPT 2006 Update:
Getting to Know Your New Injection Codes
The American Medical Association CPT Editorial Board deleted seven injection and infusion ... Read more
READER QUESTIONS:
Use Documentation to Support 32000 and 32002
Question: When my pulmonologist does a pleural tap with both diagnostic and therapeutic in... Read more
READER QUESTIONS:
NCCI Bundles 94657 With 99251-99255
Question: Since the code descriptors for 94656 and 94657 do not specify examining the pati... Read more
READER QUESTIONS:
Don't Count on Electronic Download Reimbursement
Question: My physician is beginning to do electronic downloading of patient information fr... Read more
You Be the Coder:
Reporting Subsequent Therapeutic Bronchoscopies
Question: Should I use 31646 when my pulmonologist performs a therapeutic bronchoscopy on ... Read more
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