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Part B Insider (Multispecialty) Coding Alert

Surgery:
CMS Gives ASCs Covered Procedures - And CMS Also Takes Away
100 procedures will be kosher in offices, but no longer in ASCs, if CMS gets its wayThe Am... Read more
New Codes:
Hemorrhoidectomy vs. Hemorrhoidopexy
Medicare introduces new code for innovative hemorrhoid treatmentIf your patients have comp... Read more
Flu Shortage May Ease With Glaxo Approval
A little more flu vaccine will be making its way into the U.S. system. The Food and Drug A... Read more
Fraud & Abuse:
No Good Gift Goes Unpunished - If It's Too Good
Feds aren't the 'pizza police,' but too much caviar could set off their alarmsIf you don't... Read more
Studies & Surveys:
Wrong Answers, Confused Beneficiaries Bedevil New Medicare Programs
And providers aren't too clear on Medicare laws eitherMedicare's call line needs a  l... Read more
Double Counseling Could Cost Hospices $55 Per Patient
If your physician wants to perform an initial consultation with a patient who is going int... Read more
Neurology:
Don't Let Docs Provide Stroke Care For Free
Neurologists confused by non-paying t-PA code One sure way to throw away valuable reimburs... Read more
Part B Coding Coach:
Don't Ditch the Last Digit - It Helps Deflect Denials
Care in diagnosis coding will maximize your claims success If you're not taking I... Read more
Physician Notes:
Accountability Office Can't Count, Claims ASCO
But GAO insists cancer care won't suffer next yearOncologists should be able to afford the... Read more
Meetings:
'Least Costly Alternative' Could Cost You A Bundle Next Year
And 'pool leakage' soaks surgeons for $60 millionSome carriers are going haywire with over... Read more
Reimbursement:
Battle Denials For E/M With Joint Injections
Sometimes carriers decide that they're just not going to pay for a medically necessa... Read more
Same Diagnosis OK With -25 Modifier
If you're billing an evaluation and management visit on the same day as another serv... Read more
Pay-For-Performance:
Quality Is Job Two, After Figuring Out What 'Quality' Means
You could see a steep cut to make room for 'incentives'Everybody wants to reward physician... Read more
Medications:
Medicare Should Raise Prices Retroactively For Pricey Drugs, Docs Say
Docs don't understand difference between observation, inpatient admissionThe Centers for M... Read more
Imaging, Diagnostic Procedures Swarm To Docs' Offices, Study Shows
The Medicare Payment Advisory Commission is preparing a report on the reasons for the gr... Read more
Compliance:
Goodies In Fee Schedule Could Leave You A Fat Target For OIG
Watch out for pitfalls in new demo project, PT provisionThe 2005 Physician Fee Schedule ... Read more
Part B Coding Coach:
Reporting Related Codes? Use Modifiers -59 and -51 to Keep Claims Clear
Append -59 to show separate sessions, sitesIf you're not up to speed on when to use modifi... Read more
Physician Notes:
Cystoscopy, Lesion Removal Codes See Drastic Increases
 Will you be able to keep these new non-facility rates?The 2005 Physician Fee Schedul... Read more
Studies & Surveys:
Don't Sell Yourself Short
Physicians systematically undercode their services, survey shows Family doctors manag... Read more
Fee Schedule:
New Codes Split Components of Flow Cytometry
CMS slashes roughly $200 from interpretation codeChanges to the physician fee schedule cou... Read more
Don't Count On End Of Face-To-Face DME Requirement
A proposed requirement for doctors to see patients face-to-face before prescribing items o... Read more
New Technology:
Medicare Carriers Refuse To Catch The Shock Wave
But you can improve your chances of payment with savvy documentationSometimes it seems the... Read more
Durable Medical Equipment:
Are You Throwing $200 K Away?
Gain reimbursement for items that you already provideIf your practice already sends patien... Read more
Coverage Patchwork Caused By CMS Overwork
The fact that carriers have clashing policies for procedures such as ESWT comes from the f... Read more
Oncology:
Medicare Asks Cancer Patients To Hand Over Info - And $26
Some fear patients will rebel against copayment Physicians will have a hard time conv... Read more
Slash Denials On Modifier -22 And Unlisted Procedure Claims With These 4 Tips
Documentation is key to reimbursement, but first you need to know when - and when not - ... Read more
Providers:
Drug Payments Aren't As Bad As Docs Expected... They're Worse
Physicians backed up against the wall by rock bottom rates Now that providers have se... Read more
Critical Care:
Are You Leaving Cash On The Table For Critical Care Services?
Quick test will say for sureWhen your physician performs critical care services, it's crit... Read more
Consults:
When 2 Docs Collide, One Admits Patient and One Admits Defeat
Warning: the distinction is not always obviousWhen two physicians each have reason to beli... Read more
Reap New Opportunities for COP
If you have patients in home health care, billing Medicare for keeping tabs on them is eas... Read more
Co-Management:
Keep Diagnoses Separate For Inpatient Concurrent Care
'Don't tread on me,' say co-managing physician's toesRecognizing which doctor is admitting... Read more
Injections:
Contrast Study Is The Key To Myelography
At least one carrier is cracking down on improper myelography billing You should pay ... Read more
Consult Or Subsequent Visit? 3 Scenarios For Concurrent Care
Suppose a patient who has diabetes is admitted to the hospital for an infection. An endo... Read more
Reimbursement:
Get Ready For Some Big Changes In 2005
If you're in a shortage area, you could receive a nice boostThe conversion factor for 2005... Read more
Part B Coading Coach:
4 Tips Clear Your Confusion About Hospital Transfer Coding
If you're stumped by physician transfers, you're not aloneWhen a physician transfers a pat... Read more
Physician Notes:
Feds Demand $1.9 Million To Cleanse Temple
Straying from the right PATH could cost millions If your doctors claim they're tr... Read more
Reimbursement:
Wave Goodbye To $200 Million Next Year
Jump on the demonstration band-wagon to add to your payments Good news: You'll be... Read more
Physical Exams:
Will 'Welcome To Medicare' Exams Be A Welcome Addition?
Split codes mean you can outsource EKG testsIf you're worried about having to perform a va... Read more
CMS Makes 'Welcome' Concessions
CMS did agree to make a few changes to the "Welcome to Medicare" exam. The agency changed ... Read more
Appeals:
10 Denials You Should Always Appeal - No Matter What
Make sure you're getting your fair share by paying attention to the basics If you... Read more
Immunize Yourself Against Losses With New Vaccine Payments
Physician fee schedule contains good news on other drug payments as wellThink oncologists ... Read more
Studies & Surveys:
Sticker Shock May Scare Congress Out Of Saving Docs From Cuts
Brace yourself for seven years of nightmares Enjoy that 1.5 percent increase in Medic... Read more
Durable Medical Equipment:
No Pointless Visits Without Reimbursement Next Year
CMS scraps much-criticized face-to-face DMEPOS requirement... for nowDoctors who prescribe... Read more
Part B Coding Coach:
Suffering From Repeated Denials On Your Repeat Procedures Claims? Here's Help
Fine-tune your use of modifier -76 and -77 with these expert tips and examplesDon't be foo... Read more
Physician Notes:
Purchasing Tests Outside Your Carrier's Region Won't Be A Problem Soon
But be careful to avoid excluded providers You'll be able to bill your local carr... Read more
NEW MEDICATIONS:
Denied For Unlisted Drugs? List Other Therapies You Tried First
Don't forget crucial information when billing for new MDS drug A new therapy offe... Read more
APPEALS:
Say Goodbye To FHOs And Hello To A New Voice On Your Appeals
But will the new QICs provide an easier process?Many providers believed Fair Hearing Offic... Read more
Fee To Be You And Me
GAO backs providers gasping over cuts to inhalation If you've been worried about sharp cut... Read more
DRUG REIMBURSEMENT:
Good News: You Soon Can Use 14 New Anti-Cancer Drug Codes
Bad news: New payments replace just 1/5 of what you're losingThe Centers for Medicare and ... Read more
Respond To CERT Requests Or Face Claims Denials
Last year's 8 percent non-response rate to Comprehensive Error Rate Testing (CERT) record ... Read more
COMPLIANCE:
Better A Flat Fee Than A Round Target On Your Back
Can you see the danger signs in your Medical billing company contracts? If you're... Read more
FRAUD & ABUSE:
Are Your Billing Staff Presenting Place Of Service Accurately?
You could be reaping thousands you're not entitled to Warning: If you're not ... Read more
Part B Coding Coach:
Turn your Physician's Time Into Money With This Coding Catch
Proper documentation of time spent on counseling can increase your level of service Y... Read more
PHYSICIAN NOTES:
Let Doctors Help With Flu Shot Crisis, Association Calls
Doctors should be in the loop on the government's plans to distribute scarce flu vaccine, ... Read more
Coverage:
Is It Time To Take A Second Look At Virtual Colonoscopy?
New policy making the procedure reimbursable in some cases could start a trend.One payer h... Read more
Coding:
Warning: Carrier Guidance May Lead To Overbilling
What the carriers leave out could be as important as what they sayIf you're relying on you... Read more
Billing:
Don't Wait For The Midnight Hour To Bill For Admission
3 simple rules for getting inpatient visits rightEven the carriers are confused about the ... Read more
Compliance:
OIG Scare Tactics Aim To Keep Your E/M Levels Down
Home health supervision caught in Catch-22 Is your billing company helping you upcode... Read more
More OIG Probes On The Way
According to its 2005 Work Plan, the HHS Office of Inspector General plans to investigat... Read more
Epidemics:
Make Sure You Document Potentially Deadly Staph Strain
Use V09.0 in addition to 041.11 for MRSA Researchers and epidemiologists are seeing a... Read more
Part B Coding Coach:
Tackle Any Foreign-Body Removal With This Expert Guidance
4 case studies show you how to secure FBR reimbursementIf you always report a 20000-series... Read more
Physician Notes:
New Carotid Stent Technique Wins Medicare Coverage
But it must be part of an FDA-required study If your practice is performing percutane... Read more
Drug Payments:
Christmas May Come In November For Docs Who Dispense Drugs
But it's up to CMS to decide whether you get coal or candyYou could see a major increase i... Read more
Orthopedics:
New Knee Arthroscopy Codes Spark 'Sports Medicine' Debate
Many orthopedists welcome CPT's new knee surgery codes with open arms, but some rega... Read more
CMS Announces Demo Project For High-Cost Benes
The Centers for Medicare & Medicare Services wants to help the costliest Medicare pati... Read more
CPT 2005:
Some Doppler Studies Require Extra Work - And Now There Are Codes To Match
Start learning the difference between vasoreactivity and emboli detectionNeurologists will... Read more
Acupuncture Gains Codes, But Reimbursement Questions Persist
Medicare has always refused to pay for acupuncture (97780-97781) but CPT Codes 2005 dele... Read more
Billing:
Don't Remain In The Dark On Billing Trends
A monthly report can make the difference between failure and successRecently, Phyllis... Read more
Fee Schedule:
Let Docs Choose Level For 'Welcome to Medicare' Exam Codes, AMA Urges
With the Centers for Medicare & Medicaid Services planning to issue its final 2005 Phy... Read more
Part B Coding Coach:
Keep Auditors Out With This Modifier -59 Checklist
You can avoid overusing -59 by simply consulting the CCI If you treat modifier -59 as... Read more
Physician Notes:
CMS Official: 'Welcome to Medicare' Not A Problem For Most Docs
While many physician groups have become vocal in their belief that a level-three office vi... Read more
CPT 2005:
Stymied By Endovenous Ablation?
Transcatheter stent placement codes clarify coding muddleOnce again, the wheels of coding ... Read more
CPT 2005:
Start Rethinking Osteochondral Procedures Coding Today
You'll have more options for PET tumor imaging claimsIf you've been feeling your OATS, the... Read more
Interventional Radiologists Welcome New Pelvic Instillation Code
Another new code in 2005 that interventional radiologists welcome is 50391 (Instillation[s... Read more
E/M Coding:
Boost Your Practice's E/M Levels With One Tiny Scribble
Warning: SOAP notes won't hold waterYour doctor doesn't have to be a poet to generate winn... Read more
OIG Will Be Busy In 2005
The HHS Office of Inspector General's to-do list in 2005 could be lengthy - and the money ... Read more
Drug Reimbursement:
Ease Your Drug Cuts Worries By Focusing On Basics
Follow the rules and you can hang on to more of your chemotherapy payOncology practices wo... Read more
CMS Expands Coverage For ICDs
The Centers for Medicare & Medicaid Services announced a draft plan to expand coverage... Read more
Coding updates:
New Abdominal Debridement Codes Simplify Coding
Learn the new codes now and reap the benefits in JanuaryIf your practice sees a lot of nas... Read more
Part B Coding Coach:
Don't Let Injection Coding Errors Leave A Hole In Your Reimbursement
Denials are a sure thing if you don't report 90782, 90471, and vaccine G codes appropriate... Read more
Physician Notes:
You May See Expanded Definition Of Chemotherapy In 2005
But no new codes for reaction managementThe CPT Editorial Panel made some far-reaching dec... Read more
CPT 2005:
Prepare Now For New Backbench Transplant Preparation Codes
This sneak peek puts you a step aheadTime is running out! With just over three months to g... Read more
Legislation:
Neurosurgeons Gain Victory In Senate Committee
But language won't have any reimbursement impact, say oncologistsNeurosurgeons who feel as... Read more
Senators Push For Oral Cancer Coverage Sooner Than 2006
The Senate report also urged CMS to address the "unintended consequences" of current reimb... Read more
CPT 2005:
Confused About How To Bill For APBI? Help Is Here!
New codes could end APBI reimbursement woesMany carriers issued Local Coverage Determinati... Read more
Local Papers Warn Of Cancer Patient Exodus To Hospitals
Cuts to cancer drug payments next year could force Euclid, OH oncologist David Fishman to ... Read more
Shared Visits:
Save The 'Shared Visits' Rule For The Hospital Ward
Don't try to combine NPP/physician visits in the office settingSome things are better not ... Read more
Incident-To Billing:
Supervising Physician Doesn't Have To Be The Plan Of Care's Author
The Centers for Medicare & Medicaid Services clarifies in Change Request 3460, dated S... Read more
New Codes:
No More Unlisted Codes For Laparoscopic
The days of blind billing have passed you byThe wait is over for laparoscopic gastric bypa... Read more
Start Organizing Dementia PET Clinical Trials Now
The Centers for Medicare & Medicaid Services budged an inch or so on the issue of cove... Read more
Part B Coding Coach:
Don't Let Burn Coding Singe Your Reimbursement
Keep your burn coding cool with these 7 expert stepsConfused by the number of burn coding ... Read more
Physician Notes:
Welcome To Medicare' Wins Warm Welcome In Congress
Medicare should cover preventive services such as smoking cessation and weight loss counse... Read more
Correct Coding Initiative:
76003 And 76942 With Percutaneous Procedures? Think Again
CCI 10.3 closes the door on ultrasound and fluoroscopic guidance with dozens of codesIf it... Read more
Correct Coding Initiative:
Beware New Bundles For
Important changes are coming down the pike for inpatient consultation codes.All codes for ... Read more
Pelvic Exam Code Bundled With 109 Codes
CPT code 57410 (Pelvic examination under anesthesia) will become a component of 109 codes,... Read more
Screening Tests:
'Welcome To Medicare' Exam Could Make Docs Into Doormats
Level 3 office visit reimbursement not enough for difficult service, docs complainFar from... Read more
Consolidated Billing:
Don't Bill Your Carrier For Services You Know Are Bundled
You don't have to obtain a denial from Medicare Part B for a service that you know is incl... Read more
Documentation:
Documentation-Savvy Docs Decry Simplified Guidelines
AMA will not replace E/M documentation guidelines with clinical examplesThe 1995 and 1997 ... Read more
Drug Pricing:
2005 Drug Rates Will Be A Surprise - Even To CMS
Nobody will know in advance the numbers on which Medicare will base drug payments in 2005,... Read more
Enrollment:
Will CMS Pay Interest On Claims Held Up By PECOS?
Stay tuned for more enrollment bottlenecks in 2005With providers waiting months before the... Read more
Part B Coding Coach:
Dispel This Common E/M Myth: Initial Hospital Care Codes Are Not For Admits Only
Follow these 4 easy steps to ensure you don't report admits incorrectlyAre you sure you're... Read more
Physician Notes:
Prepare For More Flexibility When Billing Spinal Surgery Codes
Good news! Starting in October, you can bill for a whole range of spinal surgery codes alo... Read more
Coding Update:
Don't Count On All Payors To Be Up-To-Date On New Codes
Here's how to ensure smooth sailing while payors adjustJust because Medicare expects you t... Read more
Evaluation & Management:
When Is A New Problem Not A New Problem?
The real question is, when is an E&M service more complex?Think identifying a problem ... Read more
Most Physicians Omit Information That Could Increase Pay
Despite the carrier's warnings against trying to game the system and obtain a higher E/M l... Read more
Coding Updates:
No 90-Day Leeway? No Problem!
Follow these 8 tips and master the new codes sooner Many offices say they're hoping f... Read more
Home Health Care:
Docs Must See DMEPOS Patients Face To Face
But you won't get paid for these visitsA new Medicare requirement places physicians square... Read more
PPAC Meeting Erupts In DMEPOS Controversy
Doctors are already telling CMS how they feel about the face-to-face requirement.  Th... Read more
Coverage:
Electrocardiography Isn't Just For Standing Still Any More
Ambulatory monitors, 24-hour attendance, gain Medicare paymentsYour doctors could be recei... Read more
Part B Coding Coach:
5 Steps To Find The Correct
Tip: Don't forget to report intermediate or complex closures separatelyIf you think knowin... Read more
Physician Notes:
NPPs Can Bill For Care Plan Oversight, CMS Clarifies
Starting next year, your non-physician practitioner staff can keep track of home health ca... Read more
Coding:
Prepare For New Transcatheter Extracranial Placement Codes
AMA has released Category III codes, and more carotid catheterization codes are coming dow... Read more
Oncology:
Oncologists Lack Information To Prepare For The Worst
You probably won't know details of looming treatment cuts until late this yearThe suspense... Read more
Coding:
Learn These New Codes For Mesh Insertion, Vaginal Colpopexy
9 new, revised codes affect a variety of Ob/Gyn proceduresIf your Ob/Gyn physician is bill... Read more
New Codes Could Be Coming For Kyphoplasty, Image-Guided X-Ray KV
There will be over 750 coding changes in the CPT 2005 book, according to the American Medi... Read more
Studies & Surveys:
Don't Count On Carrier Call Center For Answers, GAO Charges
But GAO answers its own questions wrong as wellCarrier customer service representatives (C... Read more
Docs Overdo Surveillance Colonoscopies
Physicians appear to be performing surveillance colonoscopies at frequencies higher than t... Read more
Enrollment:
Providers Could See PECOS Mess Within 60 Days
But provider reps frustrated by slow progressAre you upset by the snail's pace of the Prov... Read more
Part B Coding Coach:
Can You Identify Critical Care Without A Doubt? 3 Expert Q&As Will Increase Your Certainty
You shouldn't report 99291 and 99292 just because the patient is in the ICUDo you jump the... Read more
Physician Notes:
Carrier Does Coverage Backflip, Will Reimburse 86141
Part B Carrier NHIC California reversed its previous decision and said it would cover high... Read more
New CPT Codes:
Prepare To Feel The Coding Squeeze At Year's End
AMA doesn't plan any rush to compensate for loss of grace period When the America... Read more
Incident-to:
"Incident-To" Means Employees, Services - Not Other Doctors
Definition of "incident-to" is no accident, says carrierThe party may be over for physicia... Read more
Create New Claims Center For Non-Credentialed Claims
Luckily, Medicare allows you to hold onto claims for a new physician and send them once th... Read more
Modifiers:
Don't Use The -59 Modifier For A Repeat Procedure
Append -76 for repeats, but not for multiple select catheterizationsNot all multiple proce... Read more
-59 Modifier Under Scrutiny, Expert Warns
The -59 modifier may get your claims paid, but you could be storing up a world of hurt for... Read more
Drug Reimbursement:
Your CHF Clinic May Lose One Treatment Method Soon
 Carriers remove coverage for Natrecor in office settingIf your office is running a c... Read more
Billing Company Pays For Fraudulent Claims
Think your billing company is immune to fraud charges? Think again. New York-based bi... Read more
Oncology:
Last, Best Hope For Avoiding Cancer Cuts: Coding Changes
 ASCO hopes AMA, CMS adopt new codes to save oncologistsTime is running out for oncol... Read more
Part B Coding Coach:
3 Steps Take The Guesswork Out Of Hypertension Coding
 401.9 doesn't always cut it - and improved documentation is the key to more specific... Read more
Physician Notes:
Sell Free Samples, And You Could Be Sampling Prison Food
Cranston, RI physician Wallace E. Gonsalves admitted to regularly selling Anthony Albanese... Read more
Medications:
Separate Botulinum Types For Optimum Reimbursement
Practice loses money with Botox, makes $139 with MyoblocThe Food and Drug Administration m... Read more
Fraud & Abuse:
Income Guarantees For New Recruits Only Guarantee Pain
Wave goodbye to non-compete clauses for new docsIf your practice partnered with a hospital... Read more
Get Ready To Revise Contracts
Many physician employment contracts violate new self-referral regulations, and practices m... Read more
Fraud & Abuse:
Stark II Regs Spell Changes For Physician Recruitment Practices
Prepare to bring contracts into complianceIn the past, physicians and hospitals have signe... Read more
Diagnosis Coding:
New ICD-9 Codes Bring Pap Smear Coding Up To Date
Remember fifth digit for 11 new codesTired of fumbling for an appropriate code for pap sme... Read more
More New ICD-9 Codes
ICD-9 2005 introduces three new codes for venous embolisms, which offer more specificity t... Read more
Diagnosis Coding:
Specify Type Of Diabetes More Accurately With These Codes
New gastroenterology codes will aid your E/M coding Diabetes diagnoses have been a comple... Read more
Part B Insider Coding Coach:
Don't Sacrifice $22 Per Nurse Visit - Know When To Report 99211
Proper documentation is the key to nurse-visit codingA "nurse-only" visit may seem simple,... Read more
Physician Notes:
Outpatient Pay Rule Boosts Digital Mammogram Pay
Other preventive screenings also see increased reimbursement The Centers for Medicare &am... Read more
Prescription Medications:
Medicare Drugs Slashed Up To 90 Percent Next Year
Administration fees soar from 2003, but plummet from 2004If your practice provides prescri... Read more
Physical Exams:
What You Need To Know About 'Welcome To Medicare' Exams
Benes eligible for 6 months after start of Medicare coverage The new physician fee sch... Read more
CARDIOVASCULAR TESTS COVERED EVERY 5 YEARS
Starting January 1, the Medicare Modernization Act also calls for Medicare to cover cardio... Read more
Drug Reimbursement:
2 Hopes For Saving Drug Payments In 2005
New codes or new legislation could rescue practices It's going to take a minor mi... Read more
New Codes:
Learn These New Codes For Biopsies, Venous Mapping
But telemedicine won't be expanded much at allIf your physician performs cutting-edge bone... Read more
Diabetes Tests Covered
Medicare will start covering diabetes screening tests next year, including a "fasting plas... Read more
Inhalation Drugs:
Prepare For Drastic Cuts To Albuterol And Ipratropium Reimbursement
Payments for nebulizer drugs were nebulous at best, OIG insistedMany physicians' offices, ... Read more
Part B Coding Coach:
Do You Know the Difference Between Modifiers -52 and -53?
Hint: Uncovering why the physician halted the procedure is the key to defining reduced ser... Read more
Physician Notes:
If Your Area's Deprived Enough, You Could Reap 15 Percent Bonus
But shortage areas may not overlapRural doctors could gain as much as 15 percent extra on ... Read more
EVALUATION & MANAGEMENT:
You Can Still Bill 99211 With Coumadin Tests
But make sure to justify medical necessity Many physicians'offices have set up "anticoa... Read more
COVERAGE:
Carriers Set Limits On New Technique
APBI policies follow physician society's recommendations A new technology is revolution... Read more
AFTER 50, CANCER SPREAD LESS LIKELY
"We chose 50 as the age cutoff because the incidence of intraductal spread of cancer decre... Read more
COUMADIN CLINICS:
Tailor Your 'Flow Sheet' To Specific Patients
Carrier bulletin offers clues on tailoring your documentation If your practice has a do... Read more
MEDICARE:
Prepare Now For 'Welcome To Medicare' Exam Next Year
6 tips to pave the way for initial Medicare physical exam Starting next year, Medicare ... Read more
Carrier Will Cover Home PT Test, Incident-To Heparin Drugs
For patients with mechanical heart valves on Coumadin, Medicare will cover a home test for... Read more
OBSERVATION CODING:
When Billing Observation, Observe These Rules
Documentation can mean $90 extra for observation Billing observation coding can be con... Read more
Part B Coding Coach:
Coding MRIs? Here's 5 Need-To-Know Tips
If a patient gets claustrophobic,you may be able to bill for an incomplete MRI with modifi... Read more
PHYSICIAN NOTES:
Osteoarthritic Knees Don't Live On Arthroscopic Lavage Alone
For patients with knee osteoarthritis, arthroscopy offers a way to look inside the joint. ... Read more
RADIOLOGY:
Interventional Radiologists May Be Punished by Stark Crackdown
SIR 'caught in the middle' between treating docs, radiologists The law of unin... Read more
SURGERY:
Stereotactic Radiosurgery Must Wait Until 2006 for Freestanding Reimbursement
Doctors trapped by Medicare reimbursement limits Physicians providing stereotactic rad... Read more
WHAT DOCS CAN BILL
Currently, physicians performing stereotactic radiosurgery can bill 99201-99245 for the in... Read more
RADIOLOGY:
Imaging Crackdown May Require New Legislation
CMS can intervene, but there's a limit to its powers It may require legislation to... Read more
EPO POLICY GETS A CHECK-UP
Get the lowdown on proposed changes to monitoring procedures A draft revised policy from ... Read more
EVALUATION & MANAGEMENT:
Debunk the 99211 Myth - It's Not Just for Nurses
If a visit warrants CPT 99211 , you can recoup an additional $20 or more Although 99211... Read more
Mark Your Calendar for New HIPAA Regulations
The Department of Health and Human Services revealed its semiannual regulatory agenda in t... Read more
INJECTIONS:
3 Tips Add Almost $50 to Your Trigger Point Pay
If you're in doubt whether to reap payments for office visits or extra muscle-injections w... Read more
Part B Coding Coach:
3 Easy Steps Lead to 93784-93790 Reimbursement
Why assigning 796.2 is key for Medicare claims You can get paid for the physician'... Read more
PHYSICIAN NOTES:
What's on Deck for the Annual Fee Update
One formula can't meet all doctor payment goals Come fall, you can expect Congress... Read more
RADIOLOGY:
Imaging Interpretations - Turf War or Patient Safety Issue?
Uncontrolled spending could lead to restrictions A battle is brewing over who has the r... Read more
DEMENTIA ASSESSMENT:
Don't Let History and Physical Drag Down Dementia Assessment Coding
Dementia is a broad diagnosis, and can come from a number of causes, including cardiovascu... Read more
CONSIDER BILLING BASED ON TIME
If the physician is talking to family members with a demented patient present, it may be... Read more
RADIOLOGY:
Bar 'Self-Referrals'of Imaging Tests, ACR Urges CMS
Can the Centers of Medicare & Medicare Services staunch the flood of imaging services ... Read more
BALL "IN AMA'S COURT" ON E/M CODING
The Centers for Medicare & Medicaid Services isn't officially working on any new plan ... Read more
INCIDENT-TO BILLING:
Your Incident-To Services Could Spark An Unpleasant Incident
6 tips for avoiding $150 K payback Incident-to billing is on the HHS Office of Inspect... Read more
Research on Imaging Self-Referrals
According to an New York Times op-ed by radiologist David Levin, nonradiologists do poorly... Read more
INFORMATION TECHNOLOGY:
Information Technology Will Lower Costs, Say Feds, MedPAC
Using information technology to push down costs and improve quality will be at the top o... Read more
Part B Coding Coach:
3 Expert Tips Upgrade Your Chest X-Ray Coding
Radiologists report 71010 more frequently than any other code -- make sure that your pract... Read more
PHYSICIAN NOTES:
Help Your Patients Sign Up For Do-It-Yourself Drug Coverage
The Department of Health and Human Services unveiled a demo program June 24 that plans t... Read more
REIMBURSEMENT:
You Could Be Throwing $1400 Away
Downcoding just two E/M visits a week can cost an arm and a leg It may not seem like a... Read more
INCIDENT-TO BILLING:
Group Practices Performing Diagnostic Tests Should Beware
Tests won't be incident-to any longer, CMS officials say For decades, physician practices... Read more
INSTEAD OF CLINICAL EXAMPLES, TRY MDM EXAMPLES
Now that the American Medical Association's push towards "clinical examples&quo... Read more
FRAUD & ABUSE - Separate Tests Vs. Incident-To:
A Stark Difference
Individual physicians could lose out under new CMS interpretation At first glance, the ... Read more
HEALTH CARE SPENDING SLOWS, BUT STILL SKYROCKETS
The growth rate of health care spending may have eased up a bit, but the growth still rema... Read more
EVALUATION & MANAGEMENT:
How To Improve MDM Documentation
Boost your E/M levels by fixing your decision-making Is medical decision-making the re... Read more
Carrier Lists MDM Mistakes
Part B carrier National Heritage Insurance Co. lists problems with medical decision making... Read more
CLINICAL EXAMPLES:
AMA Goes Back To The Drawing Board With Clinical Examples
But "average payment" idea dead on arrival, AMA says Happy with the status q... Read more
Part B Coding Coach:
Get Suture Removal Pay Without Using a Procedure Code
4 coding tips you should implement You can correctly report suture removal if you choos... Read more
PHYSICIAN NOTES:
EMRs Saved Practice Nearly $1 Million In One Year
Wondering whether electronic medical records will save money for your practice? Now there'... Read more
COVERAGE:
Most Physicians Will Be Out Of Luck With Dementia PET Scans
But more expansion may be on the way Medicare issued a draft of the long-awaited decis... Read more
MODIFIERS:
For Pre-Operative E/M Visit, Intent Determines Your Modifier
Use -57 modifier only if the visit was directly related to the surgery If your surgeon ha... Read more
URINE CULTURE ICD-9 CODES MAY CHANGE
The Centers for Medicare & Medicaid Services has opened a new tracking sheet on its pr... Read more
ENROLLMENT:
CMS Promises PECOS Problems Resolved By Fall
But a new slew of enrollment problems is on the horizon Promises, promises. Providers h... Read more
ALL ABOUT NPIs
The HIPAA deadline to use NPIs is May 23, 2007, but providers should be able to apply for ... Read more
INFUSION:
Are You Throwing Away Reimbursement For Infusion Add-On Codes?
Understand the difference between chemotherapy and pain management Oncology practices a... Read more
OIG Targets Drug Payments
The HHS Office of Inspector General has tallied a record recovery for the first half of fi... Read more
CORRECT CODING INITIATIVE:
Observation Care Edit Causes Confusion
Coordination with inpatient departments on observation is important Of the thousands of... Read more
Part B Coding Coach:
3 Questions You Must Ask When Coding Decubitus Ulcers
Poor documentation could cost you $150 per debridement You won't always use an exc... Read more
PHYSICIAN NOTES:
CMS Provides $100,000 For Electronic Records
Family physicians and others may soon have more guidance on moving over to electronic medi... Read more
CCI DELETIONS:
Come July, You Can Bill Separately For Colpopexy, Catheter Insertion
CMS removes burdensome edits from dozens of codes When the Centers for Medicare & ... Read more
NEW CCI EDITS:
New Septal Defect Repair Edits Make 95380-95381 More Confusing
Observation care,swallowing test interpretation also hit hard The Centers forMedicare &am... Read more
CCI PUTS MRI CODES 70558-70559 THROUGH THE WRINGER IN JUNE
Magnetic resonance imaging is one of the fastest growing services for Medicare, and the ... Read more
DIGESTIVE SURGERY:
Avoid Billing For Esophagoscopy, Endoscopy With Digestive Surgeries
Colonoscopy, laparoscopy become part of stomach procedures If your physician is perfor... Read more
USE LIDOCAINE ONLY FOR CARDIAC ARRHYTHMIAS AND BIER BLOCKS
A new code for 2004, J2001 (Injection, lidocaine HC1 for intravenous infusion, 10 mg) ma... Read more
STEREOTACTIC RADIOSURGERY:
New Code Reimburses $5,250 - But Only If You Can Navigate New CCI Edits
Stereotactic radiosurgery becomes more difficult after July 1 Now that you've gott... Read more
Carrier Requirements For Stereotactic Radiosurgery
According to a local coverage decision by Part B carrier Blue Cross & Blue Shield of A... Read more
SURGICAL PROCEDURES:
Craniectomy And Craniotomy Codes Become Entangled With Edits
Surgical procedures become more complicated to bill this summer Anesthesiologists will... Read more
Part B Coding Coach:
Diabetes Complications Got You Confused? Not Anymore.
5 tips help your diabetes diagnosis codes justify higher-level E/M services Reporting... Read more
PHYSICIAN NOTES:
Dialysis Drugs Overpriced, Underdocumented
Watch out for possible ESRD cuts next year If you're providing dialysis services, watch... Read more
EVALUATION & MANAGEMENT:
No E/M Coding Changes Until 2006
Clinical examples are too subjective to please CMS auditors Don't throw away your calcu... Read more
PRESCRIPTIONS:
Beware Of Compliance Hurdles In Brave New E-Scrip World
The Medicare Modernization Act calls for the Centers for Medicare & Medicaid Services ... Read more
BEWARE OUT-OF-STATE PRESCRIPTIONS
Beware of writing a prescription for a patient living in another state, especially if you'... Read more
DIAGNOSIS CODES:
Use New Decubitus Ulcer ICD-9 Codes For 15999 Claims
At last,a way to explain ulcers that aren't bed sores Billing for excision of decu... Read more
HIGH-END BILLING PUTS YOUR MEDICAL RECORDS ON THE LINE
Feds see through alleged cover-up at KY clinic If your billing patterns stick out from th... Read more
MODIFIERS:
Don't Throw Away E/M Reimbursement On Last-Minute Decisions
Follow these guidelines to get paid for -57 modifier Surgeons are throwing away reimbur... Read more
Steer Clear Of Keeping Payers In The Dark
Biller faces fraud charges for allegedly skewing the facts on claims Fraud fighters keep ... Read more
MODIFIERS:
Consider Using Time-Based Billing For E/M Visits With Modifier -57
Remember the 50-percent rule and you'll come out ahead. An evaluation and manageme... Read more
Part B Coding Coach:
Want To Make $43 More Per E/M Visit?
4 steps help you avoid unnecessary downcoding If you underestimate your physician'... Read more
PHYSICIAN NOTES:
Non-Compliant CMNs Place You At Risk
Latest physician-supplier scam allegedly billed Medicare $3.7 million Before you sign a... Read more
DIAGNOSIS CODING:
Tell CMS Where Decubitus Ulcers Hurt Starting October
You have until Oct. 1 to implement, but no grace period   Coders, take notice: ... Read more
REIMBURSEMENT:
CMS Wants To Try Pay-For-Performance Instead Of Cuts
New administrator stresses alternative ways to control spending The Centers for Medicare ... Read more
MORE PPAC DISCUSSION TOPICS
At its May 17 meeting, PPAC also discussed: How to keep tabs on the move to revise doc... Read more
CONSOLIDATED BILLING:
Don't Bill Medicare First For Part A SNF Patients
A 20-page contract isn't necessary for SNF referrals Physicians can't afford to provide... Read more
HIPAA Compliance Soaring:
HIPAA Compliance Soaring:
Roughly 83 percent of claims are now compliant with the Health Insurance Portability and... Read more
EVALUATION AND MANAGEMENT:
Separating ROS and HPI In The Chart May MakeCoding Easier
But it could also lower your E/M levels and reduce reimbursementShould a physician keep th... Read more
Brace Yourself For OIG Crackdown On Doc CPO
The HHS Office of Inspector General promised in its fiscal year 2004 work plan to scrutini... Read more
E/M Coding:
When It Comes To ROS And HPI, The Carrier's Whim Rules Your Fate
If you're trying to reach the requirement of 10 organ systems in the Review of Syste... Read more
Part B Coding Coach:
4 Tips Help You Master The 'Multiple Scope' Rule
Use caution for scopes in the same family, experts say When your surgeon performs seve... Read more
PHYSICIAN NOTES:
ICD-9 Codes May Come Out Twice Yearly
The ICD-9 codes are still coming out in annual updates, but the Centers for Medicare &am... Read more
Appeals:
CMS Requires Independent Carrier Hearing Officers
Changes help level playing fieldA formerly insignificant legal argument may soon become th... Read more
Chemotherapy:
Oncologists To CMS: Give Us The Bad News First
Legislators write to CMS asking for payment rate informationIf your office provides chemo-... Read more
Drug Reimbursement:
Physicians Face Seven Lean Years Starting 2006
Can Congress agree on a way to avert $90 billion in cuts?Congress built this house, now do... Read more
CMS Struggling To Fix PECOS System
The Provider Enrollment and Chain/Ownership System, implemented November 2003, isn't worki... Read more
Insurance:
Should Coders And Managers Obtain Personal Liability Insurance?
It depends on your employment status and your employer's coverageYou can't get behind the ... Read more
ALJs Now Work For HHS
WARNING: Fraud hawks have finally won their fight to limit the independence of Administrat... Read more
Insurance:
How To Choose Personal Liability Insurance
Look for coverage that addresses coding and billing problems What happens if the spot... Read more
Part B Coding Coach:
3 Steps For Co-Surgery Can Mean The Difference Between 62.5% Payment and Nothing
Successful claims require modifier -62 and physician-to-physician cooperationWhen reportin... Read more
PHYSICIAN NOTES:
Don't Close Off All Off-Label Uses For Oral Chemo Drugs, ASCO Urges
The Centers for Medicare & Medicaid Services proposes to limit coverage for oral che... Read more
Electronic Medical Records:
Can You Boost Your E/M Levels With Electronic Records?
It depends on whether your doctor is undercoding Documentation is the bane of your existe... Read more
Fracture Care Coding:
A Global Code Doesn't Necessarily Mean The World To Medicare
Just because emergency physician bills it, doesn't mean you can'tSometimes a code is first... Read more
Senate Considers Power Wheelchairs
In an April 28 hearing, the Senate Finance Committee considered new reports from the Gener... Read more
Electronic Medical Records:
Beware "Canned Documentation," Coding By Numbers, With EMRs
EMR may cause problems with documenting services, proving necessityIf you're considering o... Read more
Meridian Offers On-Site Server, Regular Backups
Consultant Barbara Cobuzzi  particularly recommends one electronic medical record pro... Read more
Electronic Medical Records:
8 Factors To Evaluate In An Electronic Record
Do a cost-benefit analysis and look into leasingElectronic medical records can help you to... Read more
OIG OKs Radiation Therapy Practice Split
You have to be careful when billing for radiation therapy management services (see "Bill F... Read more
Radiation Therapy:
Bill For Extra Fractions With Radiation Therapy
But beware the long arm of the OIGProviders often misunderstand the rules for billing prof... Read more
Part B Coding Coach:
4 Tips Improve Your Respiratory Diagnosis Coding
Ensure payment with these ICD-9 coding strategies Are you up to speed on 2004's new ... Read more
Physician Notes:
No Overnight Stays In ASCs For Patients, CMS Tells Surveyors
Sleepovers may be great for teenagers, but not for ambulatory surgery centers. In a l... Read more
Reimbursement:
Don't NOC It Until You Try
If the physician did extra work, consider modifier before unlisted code Doctors go ab... Read more
Modifiers:
Use -58, Not -78 When Open Reduction Follows Closed
Document that the physician discussed risks the first timeWhen you're providing global fra... Read more
Use -76, -77 Modifiers for Repeat Closed Reductions
If the same physician has to go back and perform a closed reduction a second time during t... Read more
Unlisted Procedures:
NOC Versus -22 Modifier: Controversy And Judgment Calls
We'll show you the "most correct" code for every situation If you'r... Read more
NOC Or -22:
Send Letter, Documentation
When you're billing with the -22 modifier or a Not Otherwise Classified (NOC) code, ... Read more
Anatomy :
Look For Bovine Arch, Other Anomalies In Cardiac Patients
Scan operative report for clues to bovine archThe bovine arch is fairly common, occurring ... Read more
CMS Clarifies Chemotherapy, E/M Billing
Billing for chemotherapy and drug infusions just became a bit simpler. In Transmittal... Read more
Add-On Codes:
4 Pointers Make 'Add-On' Codes Easy
Don't accept payment reductions, or you could lose up to 50% on every claim When ... Read more
Part B Coding Coach:
4 Tips Improve Your 51701
Combat E/M and catheterization denials with documentation, diagnoses and modifierWhen bill... Read more
Physician Notes:
It's Good To Be Unusual -- But Not In Your Billing Practices
Abnormal patterns trigger scrutiny by OIG, other watchdogs If your claim submissions ... Read more
Temporary Balloon:
You Can Bill Angioplasty Separately With Temporary Occlusion
But bill separate catheterization only for separate vessel If a patient has a tumor o... Read more
Professional Courtesy:
When Is It Better To Be Professionally Rude?
New Stark II reg makes picture more complicated for physiciansProfessional courtesy. You w... Read more
Billing Insurance, But Not Physician Patient, Also A Dangerous Game
Many physicians no longer offer totally free care, but they may waive only copayments for ... Read more
Occlusions :
Bill For Separate Catherization With Permanent, Not Temporary, Occlusion
One major cause of confusion for coders is the fact that you can't bill for catheterizatio... Read more
Tough Times Ahead For CMS
Two former heads of the Centers for Medicare & Medicaid Services warned April 8 that t... Read more
Fracture Care Coding :
Do Your Fracture Patients Come Back Again And Again? Use Itemized Bills
But pay attention to the physician's intentionTwo right ways to bill, and the differences ... Read more
HIPAA Compliance Starts To Take Off
After a rocky start, Health Information Portability And Accountability Act compliance is t... Read more
Demonstration Projects:
CMS Launches Chronic Care Demonstration Project
Look for your ESRD, CHF or diabetes patients to receive a little extra helpYour patients w... Read more
Part B Coding Coach:
Want to Make an Extra $8 Each Time You Report 99213?
Follow 5 requirements and earn 100 percent NPP reimbursementIf you know whose identificati... Read more
Physician Notes:
Congressional Thomas Push For SGR Payment Boost
Will docs see more money in 2006? House Ways and Means Chair Bill Thomas (R-CA) is pu... Read more
CHEMOTHERAPY:
One Carrier Pushes Defunct Code For Zevalin, Bexxar
Don't treat draft local coverage decisions as gospel   If you're using mo... Read more
COMPLIANCE:
CERT Slip Will Bring You OIG Attention
Don't let a non-response mar your record If you fail to respond quickly to a reco... Read more
Reimbursement
If your practice provides enteral nutrition, you could be in for a nasty cut. The HHS Offi... Read more
CHEMOTHERAPY:
Bill One E/M Service Before 78804 And 79403
But don't bill separately for administration of infusionApart from a few hold-outs most of... Read more
Compliance:
Don't Risk It With Power Wheelchair Prescriptions
As power wheelchair fraud investigations continue full throttle, physicians could end up o... Read more
Coverage:
Pacemaker Implantation Is No Longer Experimental
But renal failure no longer justifies urine culture If your practice treats patients ... Read more
Fraud & Abuse:
Double-Dipping Could spell double trouble
If you are receiving extra contractual charges from Medicare patients outside of the usual... Read more
Practice Management:
Bring Office Manager Into The Process
When your practice brings on a new physician, your office manager should be intimately inv... Read more
Part B Coding Coach:
2 Questions To Ask Yourself When Reporting Postoperative Infections
If you're treating Medicare and private-payer claims the same, you could forfei... Read more
Physician Notes:
McClellan Is To Docs As Scully Was To Hospitals
What the new CMS chief's background means for youIn one of his first public presentations ... Read more
Spine Surgery:
Look For Corpectomy In Addition To Arthrodesis With New Approach
You can bill 63101-63103 for more than "minimal diskectomy" If your surgeon... Read more
Drug Reimbursement:
FDA Approves Two New Cancer Drugs
Use J9999 to bill for Avastin and Erbitux,  but document carefullyMartha Stewart... Read more
Medicare Makes Minor Corrections
In the March 26 Federal Register, the Centers for Medicare & Medicaid Services makes... Read more
Spine Surgery:
Tumor Or Bone Fragment Can Justify Billing For Vertebral Corpectomy
Lateral extracavitary arthrodesis includes many other proceduresIf your surgeon uses the l... Read more
News You Can Use:
MEDICARE FINANCES SLIP
Annual report says insolvency is closer than previously estimatedA gloomy financial foreca... Read more
Practice Management:
Make Sure Personalities, Health Plans Mesh Before Hiring New Doc
8 tips for bringing a new doctor to your practice  Define an evaluation period in ad... Read more
Fraud & Abuse:
Supremes Stay Mum On Limits For False Billing Penalties
The lack of a word from the Supreme court sends a message loud and clear to providers char... Read more
Colostomy Coding:
Gain $200 By Noting Colectomy And Anastomosis
But beware billing separately for colectomyWhen your surgeon takes down a colostomy, he ma... Read more
Part B Coding Coach
4 Rules Repair Your Laceration CodingExperts reveal when to report intermediate repair cod... Read more
Physician Notes:
CMS Mulls Taking Drugs Out Of Update Formula
Massive increases on the way unless changes happenRemember the 4.5 percent cut you almost ... Read more
Bariatric Surgery:
New Codes Coming For Laparoscopic Bariatric Surgeries
Carrier loosens red tape on stomach-stapling and  bypass operations If your... Read more
Compliance:
CMS Allows Some Percentage Compensation Deals For Docs
New Stark II regulation loosens some of the payment rules There's good news for d... Read more
Bariatric Surgery:
Check The Operative Report For Extra Procedures Alongside Bariatric Surgery
Physicians frequently perform other operations, extra testsNot only has it gotten easier t... Read more
Some Insurers Cut Bariatric Surgery
While some insurers and Medicare carriers are liberalizing payment policies for bariatric ... Read more
Drug Reimbursement:
CMS Boosts Payments For Nine Drugs
Verteporfin, Octreotide among the biggest gainersPhysician practices that have been strugg... Read more
Neurostimulators:
Hours Of Programming, Weeks of Wrangling
Complex neurostimulators can be tricky to billAny time a procedure or visit has a time-bas... Read more
Part B Coading Coach:
3 Field-Tested Tips Improve Your "Unlisted-Procedure" Claims
Receiving fair reimbursement requires adequate  preparation and documentation If... Read more
Physician Notes:
"Clinical Examples" Showdown Scheduled For Late April
How do you quantify a subjective description? The American Medical Association contin... Read more
Correct Coding Initiative:
8,000 Edits Hit 16 Testing Codes Hard
You can use a modifier to override these edits, but you probably shouldn't I... Read more
Cystourethroscopy:
CCI 10.1 Makes 52281 Component Of Many Cystourethroscopy Codes
Harder to bill for dilation of urethral stricture or stenosis separatelyCPT code 5228... Read more
CCI Deletions:
Screening Culture And Blood Culture No Longer Anathema
CCI 10.1 deletes 3 mutually exclusive edits, 5 component editsIt just got easier to bill f... Read more
Fight Against Edits Continues
With the vast majority of CCI Edits this time around targeting a mere 16 testing codes (... Read more
ESRD:
ESRD Codes Hit With New Mutually Exclusive Edits
CMS introduced a number of new end-stage renal disease codes for 2004, G0308-G0327. With C... Read more
Orthotics/Prosthetics:
New Code Hit With Mutually Exclusive, Bundling Edits
Billing for CPT 97755 just became much more complicatedIt's been a source of  confus... Read more
Reinstated Semen Code Target of Many Edits
The Centers for Medicare & Medicaid Services reinstated semen analysis G0027 as of l... Read more
Gastroenterology:
Intubation And Sample Collection Bundled With Slew Of Endoscopy Codes
Don't try to bill separately for esophageal dilation If your physician routinely ... Read more
Part B Coding Coach:
Recoup $105 Extra Per Visit For Extended E/M Services
Your physician's time isn't free -- use prolonged service codes to bill for extra services... Read more
Physician Notes:
Consultation Payments May Come With Snares Attached
If you're not 100 percent sure the consultation services you're billing meet all the corre... Read more
Chemotherapy:
Don't Bill Level 1 Office Visits With Chemo
But you can bill higher level visits for unrelated conditionsIf a patient comes in ju... Read more
Facet Joint Injections:
Don't Bill 64470-64476 Without Imaging Codes
Bill for bilateral procedure to maximize your reimbursement Can you get in troub... Read more
Keep Billing 99211 With Non-Chemo Injection Codes
The rules haven't changed for non-chemotherapy drug injection codes 90782-90788 -- if you ... Read more
Facet Joint Injections:
Bigger Problems Justify More Injections
Be prepared to appeal denials if you bill trigger points alongside nerve blocksIf you're p... Read more
Reimbursement:
Docs Could Receive $600 Million More in 2005
MedPAC tells Congress current physician payments are "adequate"Patients aren't dropping de... Read more
Ambulatory Surgery Centers - MedPAC To Congress:
End Surgery Center Payment List
Pushes payment freeze alongside move to expand categoriesIf your physician practices out o... Read more
Mammography Site Gets Upgrade
Improved design may make fact-finding easier for providers and suppliersIf you need a quic... Read more
Arthroscopy:
Multiple Arthroscopies Don't Have To Mean Major Headaches
How to bill G0289 for chondroplasties in separate compartmentsAfter a host of flip-flops o... Read more
Part B Coading Coach:
Consult Vs. Transfer Of Care - Distinguish The Differences
6 steps to increase your referral reimbursement With physicians using the word "... Read more
Part B Coding Coach - Check Out These Examples:
Part B Coding Coach - Check Out These Examples:
Consult: A general practitioner sees a patient for an annual preventive exam. During the e... Read more
Physician Notes:
Gastroenterology Societies Raise Consciousness On Sedation
Conscious sedation should be included in endoscopy codesConfused about how to bill conscio... Read more
Physician Office Labs:
5-Year Freeze Could Chill Your POL Business
Trimming tests, reaching out may save your labIf you're one of the thousands of physician ... Read more
Total Hip Replacement - Revisions:
More Effort, But Is The Reimbursement There?
New Category III codes may boost payments for imagingRoughly 14,000 Medicare patients rece... Read more
Nail Debridement:
Show "Sick Foot" Symptoms, Boost Nail Care Reimbursement
Understand difference between G0127 and 11719The HHS Office of Inspector General has warne... Read more
Lagging On HIPAA Will Soon Hit Providers Where It Hurts
Delayed payments slated to go into effect this JulyIt's not quite sink or swim time, but i... Read more
Off-Label Drugs:
Medicare May Slash Coverage For Off-Label Chemotherapy Drug Uses
Your claims for high-price and off-label drugs may come under scrutinyAccording to recent ... Read more
ASCs:
Better Pay For IntraOcular Lenses Overdue?
Set your sights on sending in a request for review If your office also operates an ambula... Read more
Coding:
Code Confusion Hits Endovenous Ablation Therapy
Some payors accept S2130, others require unlisted codeAn increasingly popular treatment fo... Read more
Part B Coading Coach:
Keep An Eye On Observation Coding To Avoid Blurry E/M
Many coders have no trouble following CPT rules for hospital observation services, but t... Read more
Physician Notes:
Carrier Will Cover Telephone Or Internet Defibrillator Monitoring
If you're sending a patient home with an implanted cardiac defibrillator, you won... Read more
Appeals:
They Can't Collect Until They Make Their Case
But will carriers let your appeals keep running up the flagpole?In the past, the carriers ... Read more
Modifiers:
When 2 Surgeons Collaborate, Make Sure To Communicate
How to handle fear of the -62 modifierIt strikes terror into physicians' hearts and slashe... Read more
Statistical Sampling:
Carriers Have More Leeway To Use Smaller Sample Sizes
One reason why carriers don't always play it safe with overpayments: the standards are lax... Read more
Transmittals:
Prepare To Lose RVUs When You Perform
Multiple cystourethroscopy procedures receive massive pay cutOnce again, the Centers for M... Read more
Eye Exam Codes Raised
Transmittal 45 from the Centers for Medicare & Medicaid Services includes pay boosts f... Read more
Unlisted Codes:
Use 22899 For Kyphoplasty, But Make Your Case For Extra Pay
Boost your reimbursement by scanning carrier policiesOften, many of the fastest-growing pr... Read more
LEGISLATION:
Chances of Medicare Reform Bill Limited
Some are predicting that 2004 will see yet another giant Medicare bill, partly aimed at fi... Read more
Coding & Reimbursement:
Reassignment Of Benefits Will Become Possible Soon
Use per-diem codes for ESRD services if patient is hospitalized during month A provis... Read more
PART B CODING COACH:
2004 ICD-9 Update: Use New V Codes For All Your Insulin Pump Visits
If your physician is using insulin pumps for Type I diabetics, you should know how to us... Read more
Physician Notes:
Non-Compete Keeps Physician From Setting Up Office Across The Street
Court rules that doctor can't work within 25 miles of old stomping groundIf you're hiring ... Read more
Catheterizations:
Radiologists, Cardiologists Fight Catheter Bundling Edits
CMS insists 36140/31620 'not supported' for selective catheterization A Natio... Read more
Diagnostic Tests:
Your Equipment, Their Payment - How to Get Paid for Tests in SNFs
SNFs stiff physicians on technical-component reimbursementFrustrated by skilled nursing fa... Read more
SNF Bundling Guidance Online
A good run-down of what services are covered separately in SNFs appears on Part B carrier ... Read more
Skull Base Surgery:
Can You Code for Two Approaches in One Surgery?
Find out what the other surgeon billed before you start coding Billing for approaches... Read more
Drug Cards on the Way
Starting in early May, beneficiaries can begin enrolling in a Medicare-endorsed drug disco... Read more
Teaching Physicians:
A Year Later, Coders Still Nervous About Documentation Rules
Documentation requirements changed, but performance requirements still strictIt's been mor... Read more
You Could Soon Face a Turbo-Charged OIG
With new Medicare legislation stepping up the number of providers and contractors - a... Read more
Low Osmolar Contrast:
Yet Another Coding Flip-Flop Leads to Reinstatement
It makes you wonder how the Centers for Medicare & Medicaid Services will cope once ... Read more
Use the Right Diagnosis to Justify Frequent Lipid Testing
A national coverage determination from CMS (40-12) said in January that Medicare would nor... Read more
Part B Coding Coach:
4 Questions to Ask Yourself About Modifier -25
If you want to recoup reimbursement for your modifier -25 claims, make sure that you can... Read more
Physician Notes:
Denials Due to Invalid Modifiers Are Number One With a Bullet
Carrier lists top-seven denial reasons for first quarter 2004Part B carrier Blue Cross/Blu... Read more
Pulmonary Function Tests:
Unbundling Is a Constant Danger With Spirometry Claims
Pay attention to NCCI edits, common senseBilling for pulmonary function tests, also known ... Read more
Documentaton:
The Denial Is in the Details for Routine EKGs
Documentation doesn't have to be separate, but it must be identifiableWhen an emergency ph... Read more
No Time Limit to Change Charts
Some providers believe that they have a limited time, such as 30 days after discharge, to ... Read more
Routine EKGs:
Two Readings, One EKG - Who Bills?
Cardiologists and emergency physicians tussle over paymentsA patient comes into the emerge... Read more
Separate but Not Looseleaf
Don't send documentation back just because you're not on the same pageThe biggest misunder... Read more
Invasive Line Placement:
Separate Billing for Invasive Line Placement Requires Documentation
Check state laws, carrier policies for 36555, 36620, and 93503If your anesthesiologist pla... Read more
Physician Services Not Bundled in SNFs
Billing for separate services in a skilled nursing facility can be tricky - especiall... Read more
Transmittals:
Kiss Grace Period for New Codes Goodbye
HIPAA kills 90-day safety zoneFeeling tied up in knots by new coding requirements? Now you... Read more
Part B Coding Coach - 3 Strategies Guide Your 'Late Effects' Coding
If you're overlooking late effects when assigning ICD-9 codes, you're providing ... Read more
Physician Notes:
Clinical Studies May Be at Risk for Kickback Attacks
Watch your copayment collection to avoid getting whacked The intersection of clinical... Read more
NCCI Edits:
New Ultrasound Guidance Code to Be NCCI-Approved by April 1
Capture an image to seize reimbursement for 76937If you've been having trouble billing for... Read more
Arthroscopy:
Use Modifier -22 With 29888 for ACL Revisions
Send letter explaining how procedure differed from normal reconstruction Another surg... Read more
Carriers Kick Out New CVA Codes
Some providers have complained that carriers have been denying the new codes for removal o... Read more
ACL Reconstructions:
Expect the Unexpected With ACL Revision
Original surgeon may have missed posterolateral corner instability There's no suc... Read more
Regulations:
Got a Beef With a Medicare Reg? Take to the Web
New online submissions make it easier than ever before to give your two cents on CMS' regu... Read more
Pacemakers:
Replacing a Pacemaker and a Lead? Follow Our Lead
Bill 33233, 33235 and 33206 for removal and replacementIf a physician replaces both a gene... Read more
New Shoe Codes Take Effect April 1
New HCPCS Codes for therapeutic shoes will take effect April 1, and so will edit changes... Read more
ASC's:
Keep Financial Statements Separate for Related ASCs
Check your state's laws before setting up an on-site centerIf you're running an ambulatory... Read more
Part B Coding Coach - Untangle Admissions From Office Visits:
4 Scenarios Show You the Way
Get the pay you deserve for 2-day servicesHow can you earn your fair share of reimbursemen... Read more
Physician Notes:
CMS Rolls Back ASC Procedure Rates to 2002 Configuration
Group 9 ASCs receive $1,339 group payment ratesA little-noticed provision of the recently ... Read more
Cardiac Stress Testing:
Boost the Patient's Heart Rate Without Giving Yourself a Heart Attack
Carrier cracks down on Adenosine claims with poor documentation If you're not putting hear... Read more
Coding Descriptors:
Changes Make It Easier to Bill for Multiple Bronchoscopy Sites
The 2004 CPT book updates the descriptors for several bronchoscopy codes, and the change m... Read more
ICD-9 Codes improve Adenosine Billing
Luckily, this year's ICD-9 code updates actually made it easier to choose a diagnosi... Read more
Fraud and Abuse:
Program Safeguard Contractors Create Havoc for Physicians
Now an extra hand stirs the pot, but are the watchdogs talking to each other?If you though... Read more
Coverage:
CMS Announces TEB Decision
In Transmittal 6, issued Jan. 23, the Centers for Medicare & Medicaid Services announc... Read more
Part B Coding Coach:
4 Steps Reduce Denials for Teaching Physician Services
Use these tips to clarify confusing Medicare guidelines You can ensure that your phys... Read more
Debridement:
Don't Confuse 97601 and the 11040-11044 Series, Carrier Says
One is an NPP code, the other requires more certification Getting to the bottom of de... Read more
PSC Background
The Health Insurance Portability and Accountability Act of 1996 created the Medicare Integ... Read more
Newsbites:
Carrier Considers Easing the Way for Overnight Pulse Oximetry Studies
Carriers clarify genetic testing, post-op epidural policies If you're confused ab... Read more
Physician Notes:
LA Dodgers Team Physicians Hit With False-Claims Act Settlement
If you find compliance problems through internal audits, you'd better take action on... Read more
Screening or Diagnostic? Medicare Has Huge Gray Area
Certain conditions can call for either type of colonoscopyA patient comes in with a pre-ex... Read more
Drug Coding:
CMS Throws Practices a Curve Ball With J0880 Reversal
You have two choices of codes for non-ESRD Aranesp claimsThe Centers for Medicare & Me... Read more
Aranesp Chart May Help
Confused about billing for Aranesp? You're not alone. "There does seem to be a bit of shor... Read more
Colonoscopies:
3 Examples Clarify Difference Between Screening And Diagnostic
Differences among 45378, G0105 and G0121 can be trickyKeeping straight the differences amo... Read more
When Is a Screening Colonoscopy High-Risk?
Keep track of anniversaries to avoid low-risk screening denialsWhen can you bill for a hig... Read more
Patient Census:
Rabbit Season or Duck Season - Understand Changes in Patient Demand
Demand may fluctuate, but understanding the patterns helps you copeSo you have a pretty go... Read more
Scheduling:
Patient Backlog May Be Due to Lack of Communication
Front desk, back office need to be in contact If your waiting room is full of patients wh... Read more
Coverage:
Electromagnetic Therapy Now Covered for Wound Healing
But CMS kicked the ball down the field on blood-derived productsIf your practice provides ... Read more
Physician Notes:
Cardiac Rehab Is Compliance Minefield, OIG Warns
Physician documentation, 'incident-to' are common pitfallsThe HHS Office of Inspector Gene... Read more
Modifiers:
Use Modifier -51 When Surgeries Share Significant Work
Use modifier -59 when procedures are totally separate Two procedures, one day. Which ... Read more
Ambulatory Surgery Centers:
Keep On-Site ASCs Totally Separate From Offices
Mix your practice with your ASC, and you risk damaging both It seems so tempting to o... Read more
Biggest Mistakes With Modifiers -51 and -59
Coders mistakenly apply both modifiers -51 (Multiple procedures) and -59 (Distinct procedu... Read more
Modifiers:
Examples Illuminate Differences Between Modifiers -51 and -59
Use -59 if procedures are separated by time or by locationConsultant Ken Lobo with Lobo So... Read more
Regulations Under Development
The Centers for Medicare & Medicaid Services put another six-month delay on the effect... Read more
Botox Coding:
Botox Used for More Than Just a Pretty Face
Use 64614 instead of 64640, coder saysIt summons images of movie stars getting injections ... Read more
CMS Plans Regulatory Push for the Coming Quarter
The Centers for Medicare & Medicaid Services published its quarterly Medicare update, ... Read more
Scheduling:
Running Behind? Use the .75 Percent Solution
Figure out which patient demand your practice can controlHow do you figure out your patien... Read more
Physician Notes:
Physician Practices Can Merge With Hospitals
Stark concerns remain unresolvedA merger between a physician practice and a hospital recei... Read more
Reimbursement:
Docs Receive Happy New Year From Medicare
Pay hike replaces pay cut at the last moment Good news for physicians - the Medicare ... Read more
Medicare News:
January Brings Many Changes to Coding and Reimbursement
Pay hike is not the only improvement to the picture The 1.5 percent pay hike that to... Read more
Unlisted-procedure Codes:
Use 99499 as a Last Resort Only
Exhaust all other E/M options before reaching for unspecified code When you don't kno... Read more
LMRPs a Thing of the Past
Doctors can say goodbye to local medical review policies and hello to local coverage deter... Read more
Neurostimulator Coding:
Neurostimulator Trial, but No Error
Treat the trial and final implantation as staged proceduresA patient comes in with chronic... Read more
Use 63660, 63688 for Revision or Removal of Neurostimulator Leads
Sometimes the neurostimulator electrodes move from the area that needs to be stimulated an... Read more
Incontinence:
How to Bill for Sacral Nerve Stimulation
Sacral stimulation needs different codes than spinal neurostimulationSacral nerve stimulat... Read more
Physician Notes:
Clinical Examples for E/M Put On Hold by Medicare Reform Law
HHS must work with doctors, plan improvements and run pilot projectsThe plan to replace th... Read more
Available Years:  2004  2003