Internal Medicine Coding Alert
What Makes a Clean Claim?
PDF
Question: We are having problems in our internal medicine practice with the number of claims we have had to appeal lately. More often than not, the reason for the denial is our office's insufficient initial reporting. What are the most important things to remember for filing clean claims?
Make sure the policy number and ID number are accurate.
Obtain insurance eligibility verification.
Verify other patient information (proper name, birth date, address, etc.).
Confirm the info the provider gave you for posting charged entries.
Check that CPT and ICD-9 codes are up-to-date and as specific as possible.
Make sure, if applicable, that you have the referral authorization number on the form and, if required, a referring doctor's UPIN or HPI.
California Subscriber
Answer: Send clean claims the first time by using this checklist to guide your office. Check it before sending every claim to ensure accuracy:
- Reader Question and You be the Expert were reviewed by Catherine Brink, CMM, CPC, president of Healthcare Resource Management in Spring Lake, N.J.
Internal Medicine Coding Alert
- CPT 2004 Update:
Report Multiple Vaccines With 90698 and 90715
3 new codes simplify your vaccine coding CPT 2004 introduces 90698 and 90715 to reflect [...] - CPT 2004 Update:
New Injection Descriptors Make Your Coding Easier
Although CPT revised injection codes 20550-20552 to clarify injection site and physician administration, the revisions [...] - CPT 2004 Update:
Think You Can Bill 11100 with 11400? Think Again
Use 11100-11101 for specimens You can avoid denials the next time you report the internist's [...] - CPT 2004 Update:
CPT Gives Starred Procedures An Overhaul
After Jan. 1, 2004, if you report your internist's incision, excision and repair services using [...] - CPT 2004 Update:
Ensure Payment With Revised Venipuncture Code
Use 36410 for physician's services If you want to get your internal medicine practice paid [...] - 3 Strategies Improve Your ECG Reporting
Tip #1: Don't attach modifiers to 93000 When you code electrocardiogram (ECG) services, know how [...] - You Be the Coder:
Unlisted MIP and MEP Tests
Question: Recently Medicare denied my claim for 94799, which I used when my internist performed [...] - Reader Question:
Complete Well-Woman Exam Requires G0101
Question: After our internist performed a Pap smear and pelvic exam on a Medicare patient, [...] - Reader Question:
Choose Between Malignant and Benign
Question: Do you have any advice on how I should differentiate between benign or malignant [...] - Reader Question:
Use 99231-99233 for Post-Op Consult
Question: A surgeon asked me to perform a pre-operative cardiac clearance consult. Following the surgery, [...] - Reader Question:
Bill Workers' Compensation Visit
Question: Our internist saw a patient as a follow-up for a workers' compensation claim. The [...] - Reader Question:
Patient's Status Drives Component E/M Coding
Question: During an office visit, my internist performed an expanded problem-focused history, a problem-focused examination, [...] - Reader Question:
New Category Tracks Office Performance
Question: I heard that there's a new code section coming in CPT 2004. What is [...] - Restructure Appeals With These 6 Steps
Get organized for easier, more productive appeals When your practice receives a denial on a [...] - Read EOBs Before Responding to Denials
What 'noncovered service' really means to your office You can't streamline your appeals process unless [...] - You Be the Expert:
What Makes a Clean Claim?
Question: We are having problems in our internal medicine practice with the number of claims [...] - Reader Question:
Bridge the Communication Gap ASAP
Question: The physicians and billers in my office don't practice open communication, and it's leading [...]