Expect Payment for Wrongly Denied Part B SNF Claims
Best practices dictate that providers should appeal any claims believed to be wrongfully denied, but if your practice has received a string of claims denials for certain Medicare Part B services...
View ArticleCPT 2013 Errata Posted by AMA
CPT® 2013 codebooks are already shipping out of warehouses, and the American Medical Association (AMA) has moved quickly to post its annual corrections document. The corrections document is a vital...
View ArticleStart Using Cat. III Codes for TAVR Services
Since this past May, you’ve been able to report—and be paid for—transcatheter aortic valve replacement (TAVR) for Medicare patients. The Centers for Medicare & Medicaid Services (CMS) recently...
View ArticleInclude Gastric Band Adjustments in E/M Service
When billing for gastric band adjustments outside of the global period of 43843 Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty or...
View ArticleThe “Eyes” Have it: Routine vs. Medical Eye Exams
by Nancy Clark, CPC, CPMA, CPC-I Understanding the difference between routine and medical eye examinations will guide you to properly code these services and prevent your patient from receiving an...
View ArticleFormatting Special Reports
When you report a CPT® “unlisted procedure” code, or one of the new technology (Category III) codes, you may be required to enclose a special report with your claim. Additionally, the CPT® codebook...
View ArticleEHR Documentation Must Meet the Same Standards as Paper
by Ronda Tews, CPC, CHC, CCS-P Inadequate documentation is not new to coders, but as offices transition from paper to electronic health records (EHR) coders have a new opportunity to educate physicians...
View ArticleKnow When to Report Excision or Repair (or Both)
Your surgeon has excised three skin lesions from the patient’s left shoulder, and now must close the wounds. Should you report both the excisions and repairs? If so, which is primary? CPT® guidelines...
View ArticleCalifornia Medical Association: 2013 revisions of evaluation and management...
The American Medical Association (AMA) made a number of CPT® code changes in 2013 that affect evaluation and management services. AAPC’s Managing Editor G. John Verhovshek, MA, CPC, recently...
View ArticleAvoid Separate Imaging with Thoracentesis
Thoracentesis is a puncture made between the ribs into the pleural cavity to aspirate or remove accumulated fluid (pleural effusion) from the chest cavity. A needle attached to a syringe is introduced...
View ArticleMultiple Procedure Payment Reductions Now Applies to Ophthalmologic Procedures
by Nancy Clark, CPC, CPC-I Effective January 2013, reduced payment has been made for specific ophthalmologic diagnostic codes. These codes are identified in the Medicare Physician Fee Schedule with the...
View ArticlePayers Targeting 80101 Abuse for Drug Testing
Per AMA instructions, when coding for drug testing by any method other than chromatography for multiple drugs or drug classes, you should report 80104 Drug screen, qualitative; multiple drug classes...
View ArticleA Quick Guide to “Separate Procedures”
CPT® codes designated as “separate procedures” are considered to be incidental and bundled with any related comprehensive/major procedure when performed during the same session, through the same...
View ArticleInitial Hospital Service Matters More than Admission Date
Consider this hypothetical scenario: Your physician admits a patient to the hospital just before midnight on Friday, but doesn’t see the patient until early the following morning. Which is the proper...
View ArticleDocument 8 Items for Initial Chiropractic Services
Straighten any kinks in initial subluxation claims with good documentation. By Marty Kotlar, DC, CHCC, CBCS Question: I have been treating Medicare patients for the last three years and my office...
View ArticleA Quick Guide to Observation Services
The Medicare Claims Processing Manual (chapter 12, section 30.6.8) defines observation services as “… ongoing short term treatment, assessment, and reassessment … furnished while a decision is being...
View ArticleModifier 78 Claims Pay Only “Intra-operative” Values
Anytime you submit a claim with modifier 78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related...
View ArticleSuture Removal Is Rarely Reported Separately
Removal of sutures is usually not a separately billable service. An exception may occur if the patient must be placed under general anesthesia to remove the sutures (15850 Removal of sutures under...
View ArticleE/M History Component: A Quick Review
When considering the history component of any evaluation and management (E/M) service, keep in mind the following: A chief complaint is the reason the patient feels he or she needs care. Unless the...
View ArticleSeparate Biopsy Coding Depends on Order of Events
As a general rule, do not separately report a biopsy and a planned tissue excision at the same location for the same session. Rather, the biopsy is bundled with the excision. For example, you would not...
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