Medicare Data Reveals Services Docs Provide and Their Pay
Data allowing comparisons of 880,000 healthcare providers who have received $77 billion in Medicare Part B payments in 2012 has been released by the Department of Health & Human Services (HHS)....
View ArticleGuidelines? What Guidelines?
Make it known: Guidelines drive coding, compliance, reimbursement, and quality of healthcare. By Ken Camilleis, CPC, CPC-I, CMRS, CCS-P You rely heavily on a variety of guidelines to assist in your...
View ArticleNew vs. Established: Brush Up on the Basics
Understand new and established patient requirements and how to apply them. By G.J. Verhovshek, MA, CPC Most professional coders—even relative beginners—are familiar with the “three-year rule” to...
View ArticleConfirmed: Billing Provider Must Document the HPI
Question: Is it acceptable for ancillary personnel to obtain and record elements of the history of present illness (HPI) portion of the history component? Chapters 12 and 15 of the CMS web manuals do...
View Article“Reserve 99205 for the Sickest Patients” Redux
Several months ago, we published a tip entitled “Reserve 99205 for the Sickest Patients” that asserted, in summary: Level 5, new patient E/M code 99205 is appropriate to report services for only the...
View ArticleQuick Tips: Radiology Report Requirements
Radiology reports must meet specific requirements to accurately assign CPT® codes and to receive proper, timely reimbursement. You must retain, as part of the medical record, the actual radiology...
View ArticleDetermining the Time of Observation Care
Question: Proper coding for observation services (e.g., initial observation care 99218-99220 and observation care, including discharge, 99234-99236) depends upon the time the patient spends under...
View Article5 Focus Areas to Improve E/M Documentation and Reimbursement
Evaluation and management (E/M) services comprise a significant portion of most providers’ billable services. To ensure that coding (and therefore, reimbursement) reaches optimal levels, providers must...
View ArticleSuccessfully Report Preventive Medicine Services
Here are three tips to help you report preventive medicine services successfully. Tip 1: Diagnosis Must Reflect the Reason for Visit Always match preventive medicine codes with an appropriate...
View ArticleAMA Releases CPT® 2014 Updates
The American Medical Association (AMA) released on June 6 a handful of new or revised CPT® Category II codes. A change to an existing code under Patient History was implemented January 1, 2014: 1040F...
View ArticleSeparately Billable Services/Procedures with Preventive Medicine Visits
Preventive medicine visits (99381-99387 for new patients and 99391-99395 for established patients) include routine screenings, such as a tuning fork hearing assessment and a visual acuity screening....
View ArticleWhy Medical Decision-Making Is the Best Predictor of E/M Service Level
Medicare’s Claims Processing Manual, section 30.6.1.A, stipulates, “Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code.”...
View ArticleSpinal Bone Grafts, as Easy as 1, 2, 3
If you can master basic terminology and identify within documentation the answer to three key questions, you can accurately apply spinal bone graft codes. 1. Is the Bone Graft from the Patient’s Own...
View ArticleTreating Complications for Medicare Patients
Medicare rules for treating complications during the postoperative period differ from CPT® guidelines. Specifically, to separately report treatment of complications to Medicare payers, that treatment...
View ArticleCoding for Biopsy with a Related, More Extensive Procedure
Although you may not separately report (or receive reimbursement for) a biopsy following a more extensive procedure, such as an excision, at the same anatomic location and patient encounter, you may...
View ArticleCMS Proposes Coverage of Colorectal Cancer DNA Test
An easier colorectal screening method may be reimbursed by Centers for Medicare & Medicaid Services (CMS) related programs if support for a proposed decision memo succeeds. CMS is proposing...
View ArticleWeigh in on Proposed MPFS
If you want to weigh in on the next few years’ physician fee schedule, do it before September 2. On July 3, the Centers for Medicare & Medicaid Services (CMS) placed the 2015 Physician Fee Schedule...
View ArticleSurgery Arthroscopy Includes Debridement (with an Important Exception)
In most cases, per CMS rules, surgical arthroscopy will include arthroscopic debridement of the same joint; therefore, you may not report the debridement separately. For example, you should not...
View ArticleUnderstanding the Multiple Procedure Rule
When providers report more than a single (non-evaluation and management) procedure during a single encounter, payers typically will reimburse only the highest-valued procedure at full fee schedule...
View ArticleLaparoscopic-to-Open Surgery Coding
When a procedure begins by laparoscopic approach, but for any reason must be converted (and completed) by open approach, you should report only the open approach. As described in Chapter 1 of the...
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