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Internal Medicine Coding Alert

Avert Cardiology Test Denials With This Medicare Coverage Round-Up
Watch out: Stress test is not part of Medicare's preventive service package.Avoid making c... Read more
CPT Update:
CPT Retires Modifier 21, Alters +99354-+99357
AMA ushers in more specific way to report prolonged services.Have you tried adding modifie... Read more
CPT Update:
Expert Cheers Revisions to +99356, +99357
Medicare still to comment on 'beautiful' revision to inpatient prolonged service codes.The... Read more
Reader Questions:
Base Your CPO Coding on Time, Location
Question: An elderly Medicare patient suffers a carpal right wrist sprain and right ankle ... Read more
Reader Questions:
CMS Offers You an ABN Reprieve
Question: Our practice has struggled to implement Medicare's new advance beneficiary notic... Read more
Reader Questions:
Nail Hematoma Treatment With These Key Terms
Question: An established patient presents to the internist after a golfing accident; he cr... Read more
Reader Questions:
Physician 'Face Time' Determines Patient Status
Question: Dr. B sees a 68-year-old patient, who has generalized osteoarthritis in her shou... Read more
YOU Be the Coder!:
PA Monitoring and Allergy Treatment Claims
Question: An established patient with a peanut allergy reports to the internist. The physi... Read more
Relax Your Medicare Well-Woman Requirements With New CMS Info
Your internist might not need to provide breast exam to report G0101A new transmittal from... Read more
Prove Separate Nature of Service, and Add E/M to Preventive Screening Claims
Two examples show you when issue is related, separate You could be missing out on deserved... Read more
Avoid Denials by Separating Rules for Sequential, Concurrent Infusions
Multiple substances mixed in same IV bag mean single infusion codeWhen your internist perf... Read more
Reader Questions:
Remember Modifiers on CLIA-Waived Tests
Question: An established Medicare patient complain-ing of sore throat reported to the int... Read more
Reader Questions:
Hematuria Codes Get More Specific in October
Question: An established patient presented to the internist complaining of pain during uri... Read more
Reader Questions:
Coding 'Probable' Dx Will 'Likely' Mean Trouble
Question: A new patient reported to the internist complaining of wheezing and shortness of... Read more
Reader Questions:
Payers Typically Accept NPP Performing 69210
Question: An established Medicare patient reported to the internist with "painful" wax bui... Read more
Reader Questions:
Extend Fever Dx to 5th Digit, or Land in Hot Water
Question: One of our Medicare patients came to us yesterday with a high fever, along with ... Read more
YOU Be the Coder:
Trigger Point Injections for Back Pain
Question: An established patient with a history of back problems reported to the internist... Read more
Record Consult Request or Face Claim Denials
Your internist usually provides pre-, post-op consultsCoders who don't want their consult ... Read more
Requester Separates Second Opinions From Consults
Everybody who's watched a hospital TV drama knows the term "second opinion." But when your... Read more
Use These HPI Tips to Clean Up Your Physician Documentation
With others involved, you can deliver the best possible claimHelping your internist become... Read more
Reader Questions:
Forget Pap Risk Category, and Denial Could Come
Question: An established 67-year-old Medicare patient reports for a Pap smear. How should ... Read more
Reader Questions:
Get CLIA Waiver, and You Can Bill for Simple Labs
Question: During a practice meeting last week, the subject of Clinical Laboratory Improvem... Read more
Reader Questions:
Exceed Single A1c Reading for PQRI Success
Question: We are in the middle of our year of reporting for the Physician Quality Reportin... Read more
Reader Questions:
Medicare Considers Interpreter Service 'Incidental'
Question: Which diagnosis code should I use with T1013 for using an interpreter with a Med... Read more
You Be The Coder:
Choosing the Correct Coma Code
Question: The internist meets an established patient at the hospital who is in a hypoglyce... Read more
Code Same-Date E/M, Critical Care With Caution or Risk Audit
Medicare warns of possible 'discretionary reviews' on 99291 claimsYou'll need to be sure t... Read more
File Cleaner 99291 Claims by Keeping Up With Transmittals
CMS' latest missive excludes critical care and an ED E/M on same dateCMS has released a fl... Read more
Coding Quiz:
Test Your Hypertension Dx Coding to See if You're Assuming Too Much
Tip: What your physician documents is keyIf you incorrectly dig into hypertension ICD-9 co... Read more
Reader Questions:
Answer Preservative Question, Then Choose Code
Question: The internist's physician assistant (PA) performed a level-one E/M service for a... Read more
Reader Questions:
Look to CPT When Patient History Is Unobtainable
Question: Our physician had to intubate a patient prior to being able to obtain a complete... Read more
Reader Questions:
Code Differently for 'Alterations' and 'Blackouts'
Question: A 55-year-old new patient reports to the internist for his initial visit. He say... Read more
Reader Questions:
Antibiotic Doesn't Cinch 99214
Question: The risk management table for E/M services lists prescription drug management as... Read more
Reader Questions:
Don't Code Built-In Service as Separate E/M
Question: A nurse practitioner (NP) sees a 65-year-old established patient for a pneumon... Read more
You Be The Coder:
Complex or Simple Nosebleed Treatment?
Question: An established 60-year-old established patient reports to the internist with a b... Read more
Heed New Transmittal When Documenting, Compiling Critical Care Time
Medicare clarifies rule for family counseling, concurrent care If coders can learn to ... Read more
Use This FAQ to Nail Down NPP Critical Care Coding
Warning: Rules prohibit split/shared visit billing There are some specific reporting r... Read more
On the Cutting Edge:
Protect Incident-to Pay With This Added Phrase
Hassle-free option: NPP can report service directly without satisfying criteriaYour intern... Read more
Count Lab Reviews Toward Total CPO Time
Question: The internist traveled 45 minutes to perform care plan oversight (CPO) for a hos... Read more
Reader Questions:
1 Code Represents 3+ Injections
Question: When a physician injects more than three muscles on each side of the upper back,... Read more
Reader Questions:
Use Modifier 51 on Some Multiple Surgeries
Question: A patient reports to the internist with two cuts on his right forearm: a deep 6-... Read more
Reader Questions:
V Code Vital for TB Test Claim
Question: When the internist's staff applies a purified protein derivative (PPD) tuberculo... Read more
Reader Questions:
It's Not Too Late to Participate in PQRI
Question: Our IM practice did not begin the Physician Quality Reporting Initiative (PQRI) ... Read more
You Be the Coder:
Check Cause, Then Choose Insulin Illness Code
Question: Encounter notes indicate a patient with uncontrolled type II diabetes had nausea... Read more
Stop Lumping Inhalation Solution Drugs by Reverting to 'Crossed-Out' Codes
Your albuterol, levalbuterol pay hinges on returning to more specific J codes Although... Read more
On the Cutting Edge:
Ask 2 Questions to Pin Down J7611-J7614 Inhalation Coding
You can crosswalk brands, deleted code with this flowchartA year and a half has passed sin... Read more
ICD-9 2009 Update:
Show Diabetes Due to Another Problem With New Series
Changes allow more specific coding for blood in urine, pressure ulcersYou can head off fal... Read more
ICD-9 2009 Update:
Use Headache Details to Wrap Your Head Around New Subsets
Learn the terms that help with tension, post-traumatic and cluster categoriesAlthough the ... Read more
Reader Questions:
NPPs Should Note These Incident-to Updates
Question: There was recently some discussion on a professional coding listserv about a new... Read more
Reader Questions:
Use Same Dx for Procedure, E/M
Question: A new patient presents to the internist complaining of a new painful mass on his... Read more
Reader Questions:
Check Calendar Date When Coding Observations
Question: At 11 p.m. Thursday, the internist admits an established patient to observation.... Read more
Reader Questions:
Wait for Cards Before Reporting Take-Home FOBT
Question: An established patient receives a level-two E/M service from the internist, who ... Read more
You Be The Coder:
Critical Care PQRI Scenarios
Question: Our practice is reporting for the Physician Quality Reporting Initiative (PQRI).... Read more
CCI 14.1 Update:
Limit Nebulizer Treatment to 94640 or 94644
These 3 must-have edits prepare you for strapping, nebulizer, E/M denials No fooling: ... Read more
Shared Visits Can Net 15% More on Some E/Ms
Medicare allows NPP, internist to combine forces for some hospital servicesIn the office s... Read more
On the Cutting Edge:
This FAQ Gives You Unna Boot Ins and Outs
Catch this: CPT code 29580 has 0 global days To find out the precise guidelines for cod... Read more
Reader Questions:
ICD-9 Code Choice Depends on Apnea's Cause
Question: The internist performs a level-two E/M on a new patient. The medical record indi... Read more
Reader Questions:
Check for Other Screenings, Then Code G0121
Question: We've scheduled a 68-year-old Medicare patient for an average-risk colonoscopy s... Read more
Reader Questions:
Code Well Portion, Asthma Treatment Separately
Question: After receiving a preventive medicine service, an established patient has an ast... Read more
Reader Questions:
E/M Not Possible When Session Is for Training Only
Question: An established patient with acute bronchitis reports to the internist's office f... Read more
Reader Questions:
Separate Certain Services From Critical Care
Question: The physician provides 80 minutes of critical care for a patient in cardiac arre... Read more
Reader Questions:
Count on These PQRI Resources
Question: We are trying to code for the Physician Quality Reporting Initiative (PQRI), b... Read more
YOU Be the Coder!:
Use G Code for Some Dermabond Repairs
Question: The internist treats an established patient with a cut on her lip. Using Dermabo... Read more
Get More Money With 2 PQRI Coding Details
Are you in? Medicare's second reporting period began in JanuaryThanks to PQRI's renewal, y... Read more
Append Modifiers When Measure Isn't Met
Surprise: 'No action' still counts toward PQRI totalTo successfully participate in the Phy... Read more
Update Your IVIG Codes to Avoid Swimming in Denials
Medicare still pays for immune globulin shots -- under new guidelinesIf you haven't notice... Read more
Clarification
In Vol. 11, No. 2 of Internal Medicine Coding Alert, the answer to "You Be the Code... Read more
Reader Questions:
Zoom In on 'Targets' Before Coding Sedation
Question: An established 64-year-old patient complaining of rectal pain and abdominal cram... Read more
Reader Questions:
2 Codes Possible on E/M-Urinalysis Claim
Question: The internist performs a level-two E/M for a new patient. The results of the eva... Read more
Reader Questions:
Payers Sometimes Put Wraps on Strapping Codes
Question: An established patient who fell out of his bed while sleeping reports to the int... Read more
Reader Questions:
E/M Trumps Ventilator Management
Question: I have a tough coding choice to make. The internist performs initial-day ventila... Read more
Reader Questions:
Deduce Angina Type Before Coding
Question: What is the proper diagnosis code for"angina pectoris"?Missouri SubscriberAnswer... Read more
Reader Questions:
Test Reason Can Lead You to FOBT Code
  Question: A commercially insured patient with rectal bleeding reports to the in... Read more
You Be The Coder:
Surgery, Biopsy in Separate Areas
Question: The internist destroys an actinic keratotic lesion on a patient's left wrist usi... Read more
Figure Frequency Into Your Colonoscopy Screening Coding -- or End Up With Denials
2-year rule applies to high-risk patientsIf you fail to observe frequency guidelines for M... Read more
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Look to Screening LCDs for High-Risk Clues
Watch out: Medicare carriers may differ on some ICD-9 codesWhen you are coding for your Me... Read more
Tally Your Risk the Way the Auditors Do
5 must-have answers will aid you in MDM selection You can quantify your internist's m... Read more
Reader Questions:
Include V Code on Bladder Scan Claim
Question: A new patient presents to the office with complaints of abdominal cramps and pai... Read more
Reader Questions:
Roll Earlier E/M Work Into Initial NF Code
Question: An established patient with benign essential hypertension reports to the interni... Read more
Reader Questions:
Consider Payer Differences on Flu Shot Claims
Question: A 58-year-old established patient reports to the internist for a flu shot. The i... Read more
Reader Questions:
Opt for E/M on Staple Removal Encounter
Question: An established patient reported to the practice for surgical staple removal. A p... Read more
Reader Questions:
Extra Procedure Time Could Mark Complicated I&D
Question: Would you explain the difference between a simple and complicated incision and d... Read more
Reader Questions:
Confirm Internist's Role Before Coding Stress Test
Question: How should we report our internist's services when he provides interpretation an... Read more
Reader Questions:
New Physician Doesn't Mean New Patient
Question: We have a new physician in our group whose patients from his previous group foll... Read more
Reader Questions:
Remember Differences in CMS, CPT Consult Criteria
Question: It is my understanding that if a requesting physician asks for an opinion about ... Read more
You Be The Coder:
Spirometry/Volume Loop Encounters
Question: The internist sees an established Medicare patient who is complaining of breathi... Read more
Check Instrumentation for Clues to Accurate 69210 Coding
All cerumen removal services are not created equalFailure to recognize impacted cerumen re... Read more
Look for E/M Evidence on Cerumen Claims
Think: 'Separate E/M is possible' when service involves internistPatients who report to th... Read more
Make Pathology a Prime Issue When Choosing Excision Code
Benign or malignant? Here's why you should never decide on your ownIf you follow the prope... Read more
Reader Questions:
Choose ABPM Code Based on Internist's Role
Question: The internist performs ambulatory blood pressure monitoring (ABPM) on a Medicare... Read more
Reader Questions:
Use V Codes for Very Accurate Education Claims
Question: An established patient with type II diabetes reports to the internist for initia... Read more
Reader Questions:
Draw Complete ROS Picture
Question: There are three review of system (ROS) levels: problem-pertinent, extended and c... Read more
Reader Questions:
Bandages Typically Mean No Repair Code
Question: An established patient who had an accident during a bicycle race reports to the ... Read more
Reader Questions:
Location Matters When Coding Ultrasound Service
Question: Our internist took a thyroid biopsy using ultrasound to guide needle placement i... Read more
Reader Questions:
Ear Wick Insert Doesn't Warrant Separate Code
Question: An established patient complaining of pain in her inner left ear reports to the ... Read more
You Be The Coder:
Watch the Clock for Accurate Infusion Coding
Question: An established patient with Crohn's disease of the large intestine reports to th... Read more
Advanced ICD-9 Lesson:
3 Steps Keep Your Diabetic Neuropathy Coding on the Up-and-Up
Solve the 337.1-versus-357.2 conundrum with this easy-to-reference guide You're going to ... Read more
Prove Patient Is Critical Before Coding 99291
Remember to count bundled services toward critical care time When your internist treats a... Read more
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Chart Critical Care With This Checklist
Certain patient conditions could indicate 99291 service Establishing critical illness or i... Read more
Reader Questions:
Look to Patient's Diagnosis for High-Risk Clues
Question: A 70-year-old established Medicare patient with regional enteritis of the duode... Read more
Reader Questions:
Check Type I Codes First for Diabetic Ketoacidosis
Question: A new patient with diabetes reports to the internist for an initial evaluation.... Read more
Reader Questions:
Carry Hypothyroidism Dx to 4th Digit
Question: An established patient who recently had surgery and radiation therapy to treat ... Read more
Reader Questions:
EKG Essential on 'Welcome to Medicare' Claims
Question: I am confused about coding for "Welcome to Medicare" (WTM) exams. How can I tel... Read more
Reader Questions:
Foot FBRs Differ From Soft-Tissue FBRs
Question: Our physician performed a foreign-body removal (FBR) on a patient with a wood s... Read more
You Be The Coder:
Choosing Initial Infusion Type
Question: A patient presents to the internist's office for chemotherapy treatment. The in... Read more
Mind Your Gs and Qs, or Face Medicare Denials on Well-Woman Exams
When your internist provides a Medicare patient with a well-woman examination, you'll need... Read more
CPT Update:
Choose Test Code After Checking Panel Type
You must treat metabolic panels, infusions and FOBTs differently next year This winter, y... Read more
Avoid Auditor's Crosshairs With These E/M Truths
Securing the correct history level is easy with this element-by-element study You don't h... Read more
Reader Questions:
Report Every Diabetic Manifestation
Question: An established patient with type II uncontrolled diabetes reports to the intern... Read more
Reader Questions:
Watch Out for Critical Care Bundles
Question: The internist provides 54 minutes of critical care for one of his patients. Dur... Read more
Reader Questions:
Call on Locum Tenens Rules for Sub Physicians
Question: One of our internists is taking December and January off (an extended holiday).... Read more
Reader Questions:
Report Skin Biopsies Per Lesion
Question: A new patient reports to the internist for an initial E/M. During the course of... Read more
You Be The Coder:
Coding CGMS Insertions
Question: An established patient undergoes a continuous glucose monitoring system (CGMS) ... Read more
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