Pulmonology Coding Alert
E/M Coding:
Pinpoint HPI to Select the Right E/M Code
Knowledge of history of present illness is essential when coding these charts. When pulmo... Read more
Pinpoint HPI to Select the Right E/M Code
Knowledge of history of present illness is essential when coding these charts. When pulmo... Read more
ICD-10:
3 Facts Help Guide Your Bronchitis Coding
In many cases, age matters quite a bit. Bronchitis is a common pulmonology diagnosis, but... Read more
3 Facts Help Guide Your Bronchitis Coding
In many cases, age matters quite a bit. Bronchitis is a common pulmonology diagnosis, but... Read more
Denial Management:
Appeal Your Denials by Serving As Your Own Lead Investigator
By doing some digging before filing your appeal, you bolster your case. Maybe you've alwa... Read more
Appeal Your Denials by Serving As Your Own Lead Investigator
By doing some digging before filing your appeal, you bolster your case. Maybe you've alwa... Read more
Reader Question:
Coding Virtual Visits? Pinpoint Real Codes
Question: How do we document email exchanges between a patient and our pulmonologist? Can ... Read more
Coding Virtual Visits? Pinpoint Real Codes
Question: How do we document email exchanges between a patient and our pulmonologist? Can ... Read more
Reader Question:
Can Pulmonologists Bill 95004?
Question: Are pulmonologists allowed to bill for allergy testing using 95004? We received ... Read more
Can Pulmonologists Bill 95004?
Question: Are pulmonologists allowed to bill for allergy testing using 95004? We received ... Read more
You Be the Coder:
Get the Lowdown on Smoking Cessation Counseling
Question: Our nurse practitioner performed smoking cessation counseling on a patient who i... Read more
Get the Lowdown on Smoking Cessation Counseling
Question: Our nurse practitioner performed smoking cessation counseling on a patient who i... Read more
CPT® 2019:
New CPT® Edition Delivers Code Updates for PICC Line Insertions
Pulmonologists aren't facing scores of code updates in the New Year. As a pulmonology cod... Read more
New CPT® Edition Delivers Code Updates for PICC Line Insertions
Pulmonologists aren't facing scores of code updates in the New Year. As a pulmonology cod... Read more
Xolair Coding:
J2357 Is Pulmonologists' Sixth Most-Billed Code — Do You Know How to Code It?
Hint: Don't forget administration code when you report Xolair injections. When you think ... Read more
J2357 Is Pulmonologists' Sixth Most-Billed Code — Do You Know How to Code It?
Hint: Don't forget administration code when you report Xolair injections. When you think ... Read more
Medicare Documentation:
Avoid Claim Denials With 5 Quick Signature Tips
Thousands of claims are denied each year due to this issue — don't be a statistic. When... Read more
Avoid Claim Denials With 5 Quick Signature Tips
Thousands of claims are denied each year due to this issue — don't be a statistic. When... Read more
Reader Question:
Is Critical Care Billable in the Office?
Question: We got a lot out of your article last month regarding critical care coding, but ... Read more
Is Critical Care Billable in the Office?
Question: We got a lot out of your article last month regarding critical care coding, but ... Read more
Reader Question:
Are Multiple E/Ms Warranted Here?
Question: We are billing an office visit for a patient with COPD and asthma, coded properl... Read more
Are Multiple E/Ms Warranted Here?
Question: We are billing an office visit for a patient with COPD and asthma, coded properl... Read more
Reader Question:
Avoid Coding Based on Dx
Question: Which code should we report for evaluation of wheezing and chronic cough? We can... Read more
Avoid Coding Based on Dx
Question: Which code should we report for evaluation of wheezing and chronic cough? We can... Read more
You Be the Coder:
Could Free Samples Cause Problems?
Question: Our respiratory therapists frequently hand out free samples to patients – usua... Read more
Could Free Samples Cause Problems?
Question: Our respiratory therapists frequently hand out free samples to patients – usua... Read more
ICD-10:
Can You Code These Pediatric Breathing Conditions?
From cystic fibrosis to TB, find out how to code these diagnoses. Pediatric patients ofte... Read more
Can You Code These Pediatric Breathing Conditions?
From cystic fibrosis to TB, find out how to code these diagnoses. Pediatric patients ofte... Read more
Compliance:
Get Ready for Critical Care Audits
The OIG has added this issue to its current Work Plan. You've heard about private payers ... Read more
Get Ready for Critical Care Audits
The OIG has added this issue to its current Work Plan. You've heard about private payers ... Read more
Clip And Save:
Don't Forget The Services That Are Bundled into 99291 and +99292
The CPT® critical care preamble includes a specific list of services that are bundled in ... Read more
Don't Forget The Services That Are Bundled into 99291 and +99292
The CPT® critical care preamble includes a specific list of services that are bundled in ... Read more
Advanced Practice Providers:
This Payer Delivers Big Changes for E/M Services Performed by NPs, PAs
NGS Medicare announces new claim filing process that could impact your practice. If your ... Read more
This Payer Delivers Big Changes for E/M Services Performed by NPs, PAs
NGS Medicare announces new claim filing process that could impact your practice. If your ... Read more
Reader Question:
Heed This Recent Pulmonary Case When Hiring
Question: We had an opening at our practice for a business manager. One of the partners hi... Read more
Heed This Recent Pulmonary Case When Hiring
Question: We had an opening at our practice for a business manager. One of the partners hi... Read more
Reader Question:
Heed the Dates of Service
Question: We recently learned that if a procedure code was invalid on the date of service,... Read more
Heed the Dates of Service
Question: We recently learned that if a procedure code was invalid on the date of service,... Read more
You Be the Coder:
Does This Warrant 99204?
Question: A new patient presented to our office. Our pulmonologist documented an extended ... Read more
Does This Warrant 99204?
Question: A new patient presented to our office. Our pulmonologist documented an extended ... Read more
Part B Payment:
CMS Proposes Sweeping E/M Changes for 2019
Hint: Proposal causes one pulmonary practice in our sample to lose $93,000 in one year. P... Read more
CMS Proposes Sweeping E/M Changes for 2019
Hint: Proposal causes one pulmonary practice in our sample to lose $93,000 in one year. P... Read more
Part B Payment:
Check These Additional Fee Schedule Proposals
Plus: What's the proposed conversion factor for 2019? Although the potential E/M changes ... Read more
Check These Additional Fee Schedule Proposals
Plus: What's the proposed conversion factor for 2019? Although the potential E/M changes ... Read more
Patient Relations:
Your Patients Have EOB Questions – Do You Have Answers?
Know how you can help lead patients through the intricacies of EOBs. Your office staff me... Read more
Your Patients Have EOB Questions – Do You Have Answers?
Know how you can help lead patients through the intricacies of EOBs. Your office staff me... Read more
Find Out What Info You Need From Your RA
Use this info from the remittance advice to help your practice's bottom line. Your Remitt... Read more
Use this info from the remittance advice to help your practice's bottom line. Your Remitt... Read more
Reader Question:
Get to Know These Modifier 25 Facts
Question: We sometimes append modifier 25 to the breathing treatment code when bille... Read more
Get to Know These Modifier 25 Facts
Question: We sometimes append modifier 25 to the breathing treatment code when bille... Read more
Reader Question:
Understand Where Each Condition Counts in E/M Coding
Question: When coding an E/M chart, how do we know where the “current” conditions/symp... Read more
Understand Where Each Condition Counts in E/M Coding
Question: When coding an E/M chart, how do we know where the “current” conditions/symp... Read more
You Be the Coder:
Who Qualifies As A Business Associate?
Question: We recently hired a cloud storage outsourcing company for our medical records, a... Read more
Who Qualifies As A Business Associate?
Question: We recently hired a cloud storage outsourcing company for our medical records, a... Read more
ICD-10:
New Post-Procedural Infection Codes to Debut Oct. 1
The 2019 diagnosis codes include over 300 additions. Sometimes, pulmonology practices wis... Read more
New Post-Procedural Infection Codes to Debut Oct. 1
The 2019 diagnosis codes include over 300 additions. Sometimes, pulmonology practices wis... Read more
E/M Lightning Round:
Check Expert Answers to Three Reader-Submitted E/M Questions
Hint: New vs. established patient rules may be trickier than you think. Your pulmonology ... Read more
Check Expert Answers to Three Reader-Submitted E/M Questions
Hint: New vs. established patient rules may be trickier than you think. Your pulmonology ... Read more
Beginner's Guide To Medicare:
Know These 5 Keys to Medicare Pay
New to the Medicare program? Here's what you must know. When your pulmonology practice br... Read more
Know These 5 Keys to Medicare Pay
New to the Medicare program? Here's what you must know. When your pulmonology practice br... Read more
Reader Question:
Understand PA's Scope of Service
Question: I enjoyed your article last month about advanced practice providers. We are curr... Read more
Understand PA's Scope of Service
Question: I enjoyed your article last month about advanced practice providers. We are curr... Read more
Reader Question:
Does Your Practice Have An Appeal Policy?
Question: We were a solo practice for about 15 years, and our pulmonologist's wife was the... Read more
Does Your Practice Have An Appeal Policy?
Question: We were a solo practice for about 15 years, and our pulmonologist's wife was the... Read more
Reader Question:
OIG Begins Investigating MA Claims
Question: We've been seeing an increase in denials for Medicare Advantage lately. Has some... Read more
OIG Begins Investigating MA Claims
Question: We've been seeing an increase in denials for Medicare Advantage lately. Has some... Read more
Reader Question:
Consider Options for Pre-Op Visit
Question: We just performed a pre-operative visit for a COPD patient of ours who is gettin... Read more
Consider Options for Pre-Op Visit
Question: We just performed a pre-operative visit for a COPD patient of ours who is gettin... Read more
You Be the Coder:
Is Respiratory Failure A Primary Dx?
Question: We saw a patient who we had admitted to the hospital for a COPD exacerbation and... Read more
Is Respiratory Failure A Primary Dx?
Question: We saw a patient who we had admitted to the hospital for a COPD exacerbation and... Read more
E/M Coding:
Emergency During Office Visit? Consider Your Coding Options
When an office visit turns to an emergency situation, know which codes to report. Althoug... Read more
Emergency During Office Visit? Consider Your Coding Options
When an office visit turns to an emergency situation, know which codes to report. Althoug... Read more
ICD-10:
Know How to Report These 3 Pneumonia Cases
Hint: Some codes won't fall under the J15 section of ICD-10. Your pulmonology practice is... Read more
Know How to Report These 3 Pneumonia Cases
Hint: Some codes won't fall under the J15 section of ICD-10. Your pulmonology practice is... Read more
Advanced Practice Practitioners:
Are You Maximizing Your APP's Role?
Hint: You could be able to boost your practice's bottom line if you report the services ap... Read more
Are You Maximizing Your APP's Role?
Hint: You could be able to boost your practice's bottom line if you report the services ap... Read more
Reader Question:
Mind Modifiers for Repeat Chest X-Rays
Question: We performed a chest x-ray and then had to repeat it later in the day when the p... Read more
Mind Modifiers for Repeat Chest X-Rays
Question: We performed a chest x-ray and then had to repeat it later in the day when the p... Read more
Reader Question:
Know How the Stark Law Impacts You
Question: Several pulmonologists from our practice want to open an outpatient clinic toget... Read more
Know How the Stark Law Impacts You
Question: Several pulmonologists from our practice want to open an outpatient clinic toget... Read more
Reader Question:
Mind the Calendar for Medicare Claims
Question: We had a problem with a claim and didn't get it filed with Medicare until over a... Read more
Mind the Calendar for Medicare Claims
Question: We had a problem with a claim and didn't get it filed with Medicare until over a... Read more
Reader Question:
All Sides Must Understand Modifier 26, TC Rules
Question: In your article last month entitled "Can You Answer This Modifier Question? Your... Read more
All Sides Must Understand Modifier 26, TC Rules
Question: In your article last month entitled "Can You Answer This Modifier Question? Your... Read more
You Be the Coder:
When Can You Report Signs, Symptoms?
Question: Our pulmonologist frequently circles rule-out diagnoses on his charts and then d... Read more
When Can You Report Signs, Symptoms?
Question: Our pulmonologist frequently circles rule-out diagnoses on his charts and then d... Read more
Compliance:
Performing Vent Management? Heed These Tips to Avoid Auditor Scrutiny
Hint: Make sure medical necessity, bundling issues are handled. If you were submitting mo... Read more
Performing Vent Management? Heed These Tips to Avoid Auditor Scrutiny
Hint: Make sure medical necessity, bundling issues are handled. If you were submitting mo... Read more
Modifiers:
Can You Answer This Modifier Question? Your Spirometry Claims May Rely on It
Halt pulmonary function test denials by ensuring correct modifier use. If pulmonary funct... Read more
Can You Answer This Modifier Question? Your Spirometry Claims May Rely on It
Halt pulmonary function test denials by ensuring correct modifier use. If pulmonary funct... Read more
E/M Coding:
Tighten Your E/M Coding As MACs Boost Scrutiny of These Claims
CMS sees uptick in E/M claim problems. Pulmonologists report E/M codes throughout the day... Read more
Tighten Your E/M Coding As MACs Boost Scrutiny of These Claims
CMS sees uptick in E/M claim problems. Pulmonologists report E/M codes throughout the day... Read more
Reader Question:
Heed the Actigraphy Coding Ropes
Question: We recently started performing actigraphy - what is this, and can we report this... Read more
Heed the Actigraphy Coding Ropes
Question: We recently started performing actigraphy - what is this, and can we report this... Read more
You Be the Coder:
Know the Rules for Smoking Cessation Counseling
Question: We reported 99407 with 99213 and the claim was denied, even though we used modif... Read more
Know the Rules for Smoking Cessation Counseling
Question: We reported 99407 with 99213 and the claim was denied, even though we used modif... Read more
ICD-10:
Can You Code These 3 COPD Scenarios?
Choose the appropriate diagnosis after reading the case. Although most pulmonology practi... Read more
Can You Code These 3 COPD Scenarios?
Choose the appropriate diagnosis after reading the case. Although most pulmonology practi... Read more
Documentation:
3 Tips Help You Sharpen Your Imaging Orders
Help cut denials in half with this easy-to-implement advice. Diagnosing patients with com... Read more
3 Tips Help You Sharpen Your Imaging Orders
Help cut denials in half with this easy-to-implement advice. Diagnosing patients with com... Read more
Billing:
Could Your Medicare Secondary Payer Claims Use A Makeover?
Nail down these specifics before you submit your MSP claims. When a patient presents a va... Read more
Could Your Medicare Secondary Payer Claims Use A Makeover?
Nail down these specifics before you submit your MSP claims. When a patient presents a va... Read more
Use This Chart to Determine Primary Payer
There are myriad situations that you may see when you have to determine whether Medicare i... Read more
There are myriad situations that you may see when you have to determine whether Medicare i... Read more
Reader Question:
Look to 96160 for Asthma Control Test
Question: Our pulmonologist just saw a 13-year-old female patient who had recently been to... Read more
Look to 96160 for Asthma Control Test
Question: Our pulmonologist just saw a 13-year-old female patient who had recently been to... Read more
Reader Question:
Anthem Decides Not to Enact Modifier 25 Cuts
Question: When will Anthem start cutting its modifier 25 payment by 50 percent? We've hear... Read more
Anthem Decides Not to Enact Modifier 25 Cuts
Question: When will Anthem start cutting its modifier 25 payment by 50 percent? We've hear... Read more
Reader Question:
Know the Limitations for Lung Compliance Studies
Question: Our pulmonologist is interested in performing a lung compliance study on a patie... Read more
Know the Limitations for Lung Compliance Studies
Question: Our pulmonologist is interested in performing a lung compliance study on a patie... Read more
Reader Question:
Do You Know the Modifier Q6 Scoop?
Question: One of our pulmonologists is going out on sick leave and we are hiring a locum t... Read more
Do You Know the Modifier Q6 Scoop?
Question: One of our pulmonologists is going out on sick leave and we are hiring a locum t... Read more
You Be the Coder:
Can A Pulmonologist Refer for Chiropractic?
Question: A patient of ours keeps asking us to write a chiropractic referral because she b... Read more
Can A Pulmonologist Refer for Chiropractic?
Question: A patient of ours keeps asking us to write a chiropractic referral because she b... Read more
E/M Coding:
3 FAQs – And Answers – About Inpatient E/M Coding
Pulmonologists may not perform surgeries in the hospital often, but they certainly se... Read more
3 FAQs – And Answers – About Inpatient E/M Coding
Pulmonologists may not perform surgeries in the hospital often, but they certainly se... Read more
ICD-10 Quiz:
Can You Answer These Lung-Related Diagnosis Coding Questions?
Evaluate your ICD-10 knowledge with this quick quiz. It can be daunting to select an ICD-... Read more
Can You Answer These Lung-Related Diagnosis Coding Questions?
Evaluate your ICD-10 knowledge with this quick quiz. It can be daunting to select an ICD-... Read more
ICD-10 Coding Quiz Answers:
Check Out How You Fared in Our Diagnosis Coding Quiz
How did you fare in our ICD-10 coding quiz on page 27? Read on for the solutions to these ... Read more
Check Out How You Fared in Our Diagnosis Coding Quiz
How did you fare in our ICD-10 coding quiz on page 27? Read on for the solutions to these ... Read more
Recovery Audit Contractors:
Billing E/M Codes With Procedures? This RAC Is Watching
Never report modifiers 24, 25, and 57 interchangeably. You may think that modifier 25 is ... Read more
Billing E/M Codes With Procedures? This RAC Is Watching
Never report modifiers 24, 25, and 57 interchangeably. You may think that modifier 25 is ... Read more
Reader Question:
Know Where to Find EHR Specs
Question: I read your article on EHR tips for 2018 (Pulmonology Coding Alert, Vo. 19., no.... Read more
Know Where to Find EHR Specs
Question: I read your article on EHR tips for 2018 (Pulmonology Coding Alert, Vo. 19., no.... Read more
Reader Question:
Consider Time When Selecting Breathing Treatment Codes
Question: Is it true that if the physician performs continuous inhalation treatment (94644... Read more
Consider Time When Selecting Breathing Treatment Codes
Question: Is it true that if the physician performs continuous inhalation treatment (94644... Read more
You Be the Coder:
How Many Units of 95806 Are Acceptable?
Question: Our pulmonologist performed several studies on a patient during the same sleep s... Read more
How Many Units of 95806 Are Acceptable?
Question: Our pulmonologist performed several studies on a patient during the same sleep s... Read more
Part B Errors:
Pulmonologists Logged Among the Highest Subsequent Hospital Visit Error Rates
You can avoid their mistakes by following a few quick tips. Seeing patients in the hospit... Read more
Pulmonologists Logged Among the Highest Subsequent Hospital Visit Error Rates
You can avoid their mistakes by following a few quick tips. Seeing patients in the hospit... Read more
ICD-10 Coding:
Pinpoint Diagnoses for These 3 Rare Lung Disorders
From LAM to PAP, learn the acronyms and the codes. You may know the asthma and COPD diagn... Read more
Pinpoint Diagnoses for These 3 Rare Lung Disorders
From LAM to PAP, learn the acronyms and the codes. You may know the asthma and COPD diagn... Read more
Recovery Audit Contractors:
3 RACs Are Now Focusing on AWV Visits Billed Within 12 Months of IPPE
Ensure that you aren't exceeding the frequency guidelines with these services. It can be ... Read more
3 RACs Are Now Focusing on AWV Visits Billed Within 12 Months of IPPE
Ensure that you aren't exceeding the frequency guidelines with these services. It can be ... Read more
Modifiers:
Bust These 3 Modifier 25 Myths to Ensure Clean Claims
Remember: Only append this modifier to E/M codes - never to procedure codes. Most coders ... Read more
Bust These 3 Modifier 25 Myths to Ensure Clean Claims
Remember: Only append this modifier to E/M codes - never to procedure codes. Most coders ... Read more
Reader Question:
CMS: Don't Text Physician Orders
Question: Our physician recently texted an order for a chest x-ray and the radiology provi... Read more
CMS: Don't Text Physician Orders
Question: Our physician recently texted an order for a chest x-ray and the radiology provi... Read more
Reader Question:
Privacy Rules Don't Lapse When Patients Pass
Question: How long do I need to maintain a patient's private health information after that... Read more
Privacy Rules Don't Lapse When Patients Pass
Question: How long do I need to maintain a patient's private health information after that... Read more
Reader Question:
Know How to Document ROS
Question: What is the right way to document review of systems (ROS)? We known ancillary st... Read more
Know How to Document ROS
Question: What is the right way to document review of systems (ROS)? We known ancillary st... Read more
You Be the Coder:
Nail Down E/M Rules When Admission Occurs
Question: Our pulmonologist saw a patient in the office, then admitted her to the hospital... Read more
Nail Down E/M Rules When Admission Occurs
Question: Our pulmonologist saw a patient in the office, then admitted her to the hospital... Read more
E/M Coding:
Will Your Pulmonologist's E/M Hold up Against PAP Ordering Scrutiny?
Approval of PAP devices could hinge on that face-to-face visit. When it comes to providin... Read more
Will Your Pulmonologist's E/M Hold up Against PAP Ordering Scrutiny?
Approval of PAP devices could hinge on that face-to-face visit. When it comes to providin... Read more
Pulmonary Testing:
Get the Scoop on How to Report the New Pulmonary Testing Codes
Check out these quick tips on how to bill 94617-94618. Much of January is already behind ... Read more
Get the Scoop on How to Report the New Pulmonary Testing Codes
Check out these quick tips on how to bill 94617-94618. Much of January is already behind ... Read more
Electronic Health Records:
7 Quick Steps Help Fine-Tune Your EHR Program for the New Year
Hint: Bring in more revenue with well-trained EHR aficionados at your practice. Medical p... Read more
7 Quick Steps Help Fine-Tune Your EHR Program for the New Year
Hint: Bring in more revenue with well-trained EHR aficionados at your practice. Medical p... Read more
Reader Question:
Know How Patients Are Accessing Your Online Reputation
Question: We recently received a review online, and that is the only online review of our ... Read more
Know How Patients Are Accessing Your Online Reputation
Question: We recently received a review online, and that is the only online review of our ... Read more
You Be the Coder:
Differentiate Viral, Bacterial Pneumonias
Question: Can you advise on which diagnosis codes apply for bacterial vs. viral pneumonia?... Read more
Differentiate Viral, Bacterial Pneumonias
Question: Can you advise on which diagnosis codes apply for bacterial vs. viral pneumonia?... Read more
Sleep Studies:
3 FAQs Solve Your Sleep Study Coding Issues
Hint: Date of service is important when reporting codes like 95811. Sleep studies and pol... Read more
3 FAQs Solve Your Sleep Study Coding Issues
Hint: Date of service is important when reporting codes like 95811. Sleep studies and pol... Read more
Pinpoint the Right Dx Code When Reporting Sleep Studies
Sleep apnea diagnoses can trip up your claims if you aren't careful. When a patient repor... Read more
Sleep apnea diagnoses can trip up your claims if you aren't careful. When a patient repor... Read more
Reimbursement:
Secure Your QPP Year 2 Pay With These MACRA Updates
Could CMS finally be making it easier to collect? As CMS continues to tweak MACRA, the ag... Read more
Secure Your QPP Year 2 Pay With These MACRA Updates
Could CMS finally be making it easier to collect? As CMS continues to tweak MACRA, the ag... Read more
Reader Question:
Pinpoint EAA Coding Options
Question: We see a lot of patients who work in dusty environments and the doctor often dia... Read more
Pinpoint EAA Coding Options
Question: We see a lot of patients who work in dusty environments and the doctor often dia... Read more
Reader Question:
Is There An ICD-10 Code for Opacity?
Question: I'm coding a chest X-ray with an indication of shortness of breath, productive c... Read more
Is There An ICD-10 Code for Opacity?
Question: I'm coding a chest X-ray with an indication of shortness of breath, productive c... Read more
Reader Question:
Code This COPD Case
Question: A 55-year-old new patient who has been smoking for 30 years with shortness of br... Read more
Code This COPD Case
Question: A 55-year-old new patient who has been smoking for 30 years with shortness of br... Read more
You Be the Coder:
Evaluate Your Options for Reporting "the other CPT"
Question: Our pulmonologist often performs chest physical therapy (CPT) for patients with ... Read more
Evaluate Your Options for Reporting "the other CPT"
Question: Our pulmonologist often performs chest physical therapy (CPT) for patients with ... Read more