Office E/M + Inpatient Admission = One Code
Occasionally, a physician may see a patient in the office and send that patient immediately to the hospital for admission. In such a case, you may consider the history and physical (H&P) taken in...
View ArticleSplit Billing Is Risky Business
Danger is imminent if the chief complaint and unique documentation don’t support separately billed services. An example of so-called “split billing” is when the provider performs a physical exam and...
View ArticleVisit the Facility Side of ED Coding
Improve your coding acumen by understanding the differences between ED facility and ED physician coding. When coding for the emergency department (ED), there are differences in how facility and...
View ArticleSkin Lesion Excisions
Three answers in the report will help you piece together the coding puzzle. To accurately code for excision of a skin lesion, you need to be able to extract from the documentation the answers to three...
View ArticleOmental Pedicle Flaps
Recognize the procedure, learn about it, and code it right. It isn’t uncommon for one or two lines to be buried within an abdominal surgery operative report documenting a procedure involving the...
View ArticleQ&A: Selecting a Follow-up Excision Code
Question: A patient had a biopsy done at another facility by a different provider. The biopsy showed squamous cell carcinoma, and our dermatologist performed a further excision to obtain clear margins...
View ArticleCMS Proposes “One Code Fits All” for ED and Hospital Outpatient
By Jim Strafford, CEDC, MCS-P The Center for Medicare & Medicaid Services (CMS) has proposed a landmark change to emergency department (ED) and Clinic Facility coding methodology. If enacted, the...
View ArticleObserve Documentation Requirements for Proper Modifier 62 Reimbursement
If two surgeons act as co-surgeons, they must likewise coordinate their documentation and billing to ensure that each receives proper reimbursement. When two surgeons work together to perform distinct...
View ArticleAMA Releases CPT® 2013/2014 Errata
The American Medical Association (AMA) released, Nov. 11, errata and technical corrections updates for CPT® 2013 and 2014. To ensure accurate medical coding, you will need to update your codebooks with...
View ArticleCanalith Repositioning/Epley Maneuver Update
Question: Our therapist recently saw a patient for whom she performed an Epley maneuver for the treatment of benign paroxysmal positional vertigo (BPPV). In researching how to code for this, I came...
View ArticleProper Coding for Tissue Adhesives
Tissue adhesives, such as Dermabond®, may be used alone or in combination with other methods (e.g., sutures or staples) for laceration repair or to close surgical wounds. The adhesive is applied...
View ArticleCMS Adopts “One Code Fits All” for Hospital Clinic Visits
This past summer, the Center for Medicare & Medicaid Services (CMS) issued notice that it was considering a radical change for emergency department (ED) and hospital clinic evaluation and...
View ArticleEssentials of CMS’ New “Two Midnight” Rule
As part of the 2014 Inpatient Prospective Payment System (IPPS) final rule, the Centers for Medicare & Medicaid Services (CMS) redefined the meaning of “inpatient” vs. “outpatient” in the facility...
View ArticleModifiers 25 and 57: A Quick Lesson
When a patient is seen for a new condition/diagnosis and a procedure is rendered that day, you should report the evaluation and management (E/M) visit with modifier 25 Significant, separately...
View ArticleOpen Vs. Closed Fracture Care
Open fracture care is reported when the provider creates an opening to expose the bone to treat the fracture. Open fracture care is not performed in the emergency department; instead, the patient is...
View ArticleStraight Up Coding for Sacroiliac Joint Injections
Proper reporting requires modifier and radiological guidance knowledge. by Thangaraj Arunachalam, CPC Sacroiliac (SI) joint injection, or SI joint block, is used primarily either to diagnose or to...
View ArticleCure What Ails Your Physician Documentation
Three common cases illustrate how to match presenting problems with documentation and coding. Providers are in the midst of the hustle and bustle of cold and flu season. To meet the challenge with a...
View ArticleMedical Necessity Audits Rise for Hospitals and Physicians
Be sure providers are aware of medical necessity criteria and DRG 470 reviews. In March 2013, Noridian Healthcare Solutions introduced an especially challenging service-specific probe review of...
View ArticlePILD for LSS Remains Non-covered Under Medicare
In a decision memo released Jan. 9, the Centers for Medicare & Medicaid Services (CMS) announced its national coverage determination for percutaneous image-guided lumbar decompression (PILD) for...
View ArticleCPT 97610 Makes the “Sometimes Therapy” List
Replacing Category III code 0183T, new CPT® medicine code 97610 Low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and...
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