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Part B Insider (Multispecialty) Coding Alert

Part B Revenue Booster:
Can A Typo Cost You Tens of Thousands?
Yes it can, this billing pro says. With 2016 right around the corner, now is the time ... Read more
Teaching Physicians:
CMS Offers 2 Telehealth Examples for Teaching Physicians
Get to the bottom of when you can—and cannot—report telehealth to Part B. ... Read more
Cardiology:
Check Out These New, Revised 2016 HCPCS Codes to Keep Your Income Flowing
Plus: Get Varithena coding tips from the HCPCS committee preliminary decision. With al... Read more
Part B Coding Coach:
Follow These 5 Tips to Improve Your Endoscopic Injection Income
Don’t miss opportunities to code multiple injections despite restrictions. If yo... Read more
Physician Notes:
EHR Incentive Payments Are Valuable--But Not This Valuable
Plus: RACs could face limits very soon. Medical practices and facilities that used ele... Read more
Reader Question:
Don't Change POS for SNF Patient in Office
Question: Thank you for your recent article about audits on E/M services performed ... Read more
Part B Revenue Booster:
This One Tip Can Boost Your Practice's Income by Thousands
Make 2016 your highest income year ever. As you close the books on your 2015 billings,... Read more
Compliance:
OIG Recovered $3.35 Billion in 2015, Plans Scrutiny of Ophthalmology Services
Place of service errors also continue to be on the agency’s radar screen. Any am... Read more
Pain Management:
Neurolytic Destruction Options Vary Based on Dx
You’ll access a wide range of codes for these services. The descriptors for nume... Read more
Part B Coding Coach:
Scope Out EO Coding Guidelines, or Risk $28 Each Time
Know when you can – and can’t – report this procedure separately. Is... Read more
Physician Notes:
ICD-10 Glitch Sinks Some Foot Care Claims
Plus: Yes you can translate your own handwriting for MAC review. Although most ICD-10 ... Read more
Reader Question:
Sort out Aftercare Options
Question: Our doctors sometimes see patients for follow-up visits after evaluating ... Read more
Reader Question:
Don't Take Chart Amendments Lightly
Question: One of our physicians made mistakes on several charts and printed out new... Read more
Billing:
This MAC Offers 10 Methods to Avoid Appeals
Hint: Modifiers are your friends. If you spend a lot of your valuable time processing ... Read more
Face-to-face Physician Certs:
Expect 'Probe & Educate' Claims Reviews for Face-to-Face Rules
CMS finally sheds light on audit program. The other shoe is finally dropping on the ne... Read more
Survive Probe & Educate F2F Review With These 4 Steps
You may have some hard choices ahead. Under Medicare’s new “Probe & Ed... Read more
Part B Coding Coach:
Expect 2-Tier Drugs-of-Abuse Reporting for Medicare
Continue to ignore CPT® drug codes. The two proposed “G” codes for Med... Read more
Toxicology:
Understand Screening vs. Confirmatory Testing
Grasp ‘definitive’ terminology, too. If your lab performs toxicology testi... Read more
Physician Notes:
Home Robbery Prompts $90,000 HIPAA Settlement
Plus: Medically unnecessary urinalyses could lead to jail time for Kentucky lab owners. ... Read more
Compliance:
OIG: 43 Percent of Physical Therapy Claims Didn't Pass Muster
Recent audit showed that just 57 percent of claims were Medicare-compliant. When it co... Read more
Recovery Audit Contractors:
This RAC Sets Sights on E/M Services Performed in SNFs
3 FAQs can help you avoid running afoul of the law. Do your physicians meet with patie... Read more
Biopsy Coding:
Adopt This 3 Step Approach for Accurate Bone Biopsy Claims
You can report biopsy with excision, destruction, removal, repair or fixation procedures... Read more
Part B Coding Coach:
Dodge These Vein Treatment Myths for Blemish-Free Claims
Tip: Treatments can be the same for spider veins and varicose veins, but be familiar wit... Read more
Physician Notes:
Part B Deductibles Inch Higher
After two years of Part B deductibles that stood at $147.00, CMS has decided to have Med... Read more
Reader Question:
How Should You Report Echo With Ablation?
Question: I am researching the use of 93312 before an EP AFib ablation to rule out ... Read more
Reader Question:
Know How to Identify Thoracentesis
Question: A patient with shortness of breath reports to the ED. The physician obtai... Read more
Part B Payment:
CMS Sets Payment Rates for Advance Care Planning
However, conversion factor goes down. The codes have been in your CPT® book since ... Read more
Compliance:
OIG to Scrutinize Prolonged Services, Home Visits and More in 2016
Plus: Agency still has chiropractors in its crosshairs. Starting Jan. 1, you’ll ... Read more
Part B Payment:
MA Reimbursement Could Change Dramatically Thanks to VBID Testing
Model focuses on treatment of most expensive and common chronic diseases. As the Medic... Read more
CMS to Scrutinize VBID Participants
The new Value-Based Insurance Design (VBID) model for Medicare Advantage (MA) Plans appe... Read more
Part B Coding Coach:
New EBUS Codes Lead These Pulmonology Code Additions, Revisions, and Deletions
You also need to strike these four codes from your manual, or you’ll face denials.... Read more
Physician Notes:
This Payer Identifies Issue with ICD-10 Code Z86.010
Plus: Massachusetts ob-gyn accused of trading free meals and cash for prescribing medica... Read more
Part B Mythbuster:
Non-Par Provider? Yes You Can Get Audited
These 3 myths may surprise you. Practices that decide to become non-par providers in t... Read more
E/M Coding:
Make Your Documentation Problems Ancient History
3 payers share tips on what you should do if you can’t obtain a history from a pat... Read more
Stomach Surgery:
3 Tips Lead You to Seamless Gastro Clip Coding
Cut out unnecessary steps when reporting endoscopic marking clips. Has your gastroente... Read more
Clip And Save:
Don't Forget Negative Responses in ROS Documentation
Coding a patient’s visit can be difficult when the beneficiary can’t share h... Read more
Part B Coding Coach:
Follow These Steps to Code Spinal Bone Grafts
Graft source and extra services are your keys to correct codes. Coding for spinal bone... Read more
Physician Notes:
CMS: 90 Percent of ICD-10 Claims Have Been Accepted So Far
Plus: Even Obamacare is at risk of fraud. ICD-10 has only been in effect for a month, ... Read more
ICD-10:
Practices Report Mostly Smooth Sailing Through ICD-10 Transition
Some potential issues, however, may remain to be seen. If you asked medical practices ... Read more
NGS Makes 'Mass Adjustment'
After Donelle Holle reported that she was seeing instances of Z23 (Encounter for immuniz... Read more
Compliance:
CMS: Use Modifiers to Show That Claims Aren't Duplicates
Plus: Watch the calendar when it comes to Medicare screenings. Most practices are awar... Read more
CPT® 2016:
Get Ready for Corneal Ring Segment, Collagen Cross-Linking Codes
New and revised procedure codes reflect improving technology. Along with the changing ... Read more
Vaccinations:
Ensure Flu Vaccine Coding Success with These Three Expert Tips
From immunizations to diagnoses, get the lowdown on flu patients. It’s that time... Read more
Part B Coding Coach:
Ask 3 Questions Before Coding for Split Sleep Study
Plus: Watch date of service for reporting bundled codes such as 95811. Patients suffer... Read more
Physician Notes:
Doctor in Hot Water for Billing Massage Therapist's Services As PT
Some people might consider time with a massage therapist their own personal form of ther... Read more
Appeals:
Good News: You Now Have Better Appeal Chances for Certain Denied Claims
But make sure you pay attention to the many limitations on the new guidance. In a refr... Read more
How The New Guidance Is Especially Positive for Therapy Appeals
Understand how review limitation will affect your over-cap therapy claims. If you&rsqu... Read more
Inpatient Billing:
Get the Lowdown on the 2-Midnight Rule
Safeguard your facility from RAC audits. If patients receiving identical services are... Read more
CPT® 2016:
Rev Up Your General Surgery Coding for Next Year
Anticipate changes for cholangiography and biliary drainage. Ignorance isn’t bli... Read more
Part B Coding Coach:
Capture CCM System Services With 'Early Release' Codes 0408T-0418T
Get a grip on the guidelines with three examples. If you’re researching coding f... Read more
CPT® 2016:
Preview Your Code Changes for Lab and Pathology With These 5 Highlights
Grasp changes for immunology, molecular studies, and more. The waiting is over &mdash... Read more
Drug Coding:
CPT® 2016 Pares Down Chromatography Choices
Changes compliment 2015 drug overhaul.  By now, you should have adjusted to la... Read more
CPT® 2016:
These General Surgery Changes Could Overhaul Your Laryngoplasty Coding
Plus: Look for thrombectomy changes. The final touches on CPT® 2016 are under... Read more
ICD-10:
Did You Follow These ICD-10 Essential Tips Implementation Tips? Find Out
Embrace more combination codes and seventh digits. By now, you should have transitione... Read more
Part B Coding Coach:
Don't Miss How Closures and Grafts Can Change Your Lesion Coding
Tip: You’ll still start with lesion size plus margins. Lesion excisions might be... Read more
Physician Notes:
CMS Dedicates Tens of Millions to Reducing Hospitalizations in Newest Funding Push
Plus: This MAC wants signatures on appeals. A new funding push to reduce hospital read... Read more
CPT® 2016:
Get to Know Two New Prolonged Services Codes You Can Use Next Year
You’ll now be able to report more than just physician time. ‘Tis the seas... Read more
CPT®2016:
Here's Your Sneak Peek at Otolaryngology Coding Changes That Take Effect in January
Don’t miss the latest update to cerumen removal. September brings football seaso... Read more
Part B Coding Coach:
Ensure Painless Reporting of Hammertoe, Tenotomy Together With This Guide
Choosing the right combo of modifiers is as crucial as the right code. Hammertoe surge... Read more
Physician Notes:
CMS: Using Our Free Billing Software Doesn't Excuse You From ICD-10
If your claim submission software is preventing you from submitting ICD-10 codes on your... Read more
In other news...
If you thought the government went after medical practitioners for fraud, think again. ... Read more
Reader Question:
Use Appropriate Policy to Justify Modifier 59 Usage
Question: I have a Medicare patient that keeps coming back to see the doctor for treatme... Read more
Reader Question:
Differentiate Biopsy From Other Services
Question: Our physician routinely performs biopsies along with other procedures. How do ... Read more
Compliance:
Ophthalmology Providers in WV, NJ Logged High Error Rates
OIG report shines spotlight on questionable billing for wet AMD, cataract surgery. Mos... Read more
Neurology:
CPT® Adjusts Time Designation for Neurostimulations Effective Jan. 1
Heads up: You won’t always worry about time for neurostimulator analysis. ICD-10... Read more
Dermatology Coding:
Check These Answers to Your Top Skin Grafting Questions
Tip: Graft size has nothing to do with code selection, say experts. Whether it’s... Read more
Part B Coding Coach:
CPT® 2016 Makes These 7 Key Ob-Gyn Updates
Ovarian sclerotherapy changes will get your attention. While the October change to IC... Read more
Reader Question:
Determine When to Report CPAP vs. E/M
Question: A patient had a sleep study done and came to our office afterwards for an... Read more
Patient Privacy:
Report: Data Breaches Increase in Early 2015
  Breaches rose by 10 percent in first half of this year versus last year’s... Read more
Check Out This Sample Social Media Testimonial Authorization
If your HIPAA compliance stops with the standard form you printed off the internet, you ... Read more
ICD-10:
Master Your Pathologic/Traumatic Fracture Code Diagnoses With 2 Scenarios
Discover this new tool to help you ‘build’ a traumatic fracture code. If y... Read more
Here Are Your Seventh Character Possibilities for Fracture Codes
Your physicians need to document according to the Gustillo classification. The first c... Read more
Part B Coding Coach:
Update Your Percutaneous Nephrostolithotomy Coding For the New Year
Stop reporting radiology codes with renal catheter insertions. Labor Day marks the un... Read more
Audits:
NGS Medicare: "TMI" Does Not Apply to Documentation
Additional notes can be helpful, this MAC’s reps say. If a claims reviewer asks ... Read more
ICD-10:
MediCal: We'll Convert ICD-10 Claims to ICD-9 Before Processing
California’s Medicaid payer isn’t quite ready to accept ICD-10 codes. Alth... Read more
ICD-10:
5 FAQs Lead You to Last-Minute ICD-10 Answers
If you don’t know the diabetes type, you should default to this. You’ve g... Read more
Part B Coding Coach:
Xolair Injection Payments Hinge on Local Payer Policy
Always check your insurer’s rules before reporting 96401. If you dread choosing ... Read more
Physician Notes:
Car Break-in Leads to $750,000 HIPAA Settlement for One Practice
White House: CMS not making enough effort to fix errors. An Indiana oncology practice ... Read more
Reader Question:
Routine Additions of 99211 Are Bad Idea
Question: Our practice’s physicians want to report 99211 with 85610 for proth... Read more
ICD-10:
WEDI: 29 States Not Prepared to Convert Workers' Comp Claims to ICD-10
WC insurers aren’t required to switch to ICD-10, but 21 states are doing so. If ... Read more
Practice Management:
Insurance Cheat Sheets Can Be a Practice Life Saver
Make these for your top five most frequently-submitted codes to save time down the road.... Read more
Tricare Claims:
5 Tips Lead You to Tricare Billing Success
Have other insurance? This insurer is typically the secondary payer. Odds are your pra... Read more
Urology:
Tackle TURP Coding With 3 Expert Tips
Forget the ‘once in a lifetime’ mantra. While transurethral resection of t... Read more
Part B Coding Coach:
Fracture Care Spans Multiple Providers? Try These Modifiers
When you divide fracture claims, providers engage in a 70/30 split. Let’s face i... Read more
Physician Notes:
Dermatologist Faces 7 Years in Prison
Plus: Kmart to pay millions in False Claims Act fines. An Illinois dermatologist is he... Read more
Reader Questions:
Prep ABN for Skin Tag Removals
Question: An established patient requested skin tag removal during another service.... Read more
Diagnosis Coding:
CMS Reps: All Systems Go for Next Month's ICD-10 Launch
You can continue to participate in acknowledgement testing until Oct. 1. You’ve ... Read more
CMS Names Rogers ICD-10 Ombudsman
Anyone who has participated in a CMS open door forum is familiar with the name William R... Read more
Endoscopy Coding:
AMA Announces New Category III Endoscopy Codes
Caution: You won’t be able to report them until 2016. Practices seeking new nasa... Read more
Part B Coding Coach:
Master Colonic Polypectomy Codes With These Quick Tips
Study these polyp removal codes for quick and accurate reimbursement. It’s easy ... Read more
Frequency Rules and Risk Categories Call the Shots in Colonoscopy Screenings
Watch out: Medicare has specific requirements other payers might not follow. The U.S. ... Read more
Physician Notes:
Observation Care Will Require Notice to Patients
Plus: Hospital comes down on 14 staffers after HIPAA violation. Observation care can b... Read more
Coding Errors:
CMS: Improper E/M Coding Remains a Growing Problem
Part B error rate is worse this year than last. No matter where you look, you’re... Read more
Electronic Health Records:
Report: Doctors Remain Frustrated With EHRs
Use these tips to quell your practice’s EHR issues. When your electronic health ... Read more
Pulmonary Coding:
3 PFT Focused Cases Show You How to Report Lung Testing
Bill 94010 and 94060 together at your own peril. Dealing with pulmonary function test ... Read more
Part B Coding Coach:
3 Key Factors Lead You to Casting Pay
Tip: The cast is billable if you are not coding fracture care. Whether you specialize ... Read more
Physician Notes:
Unsupervised PA Billing Lands Doctor in Prison
Plus: You can keep using DSM-IV and V under ICD-10. Asking your physician’s assi... Read more
Physical Therapy:
This MAC Offers 10 Quick Tips for Clean PT/OT Claims
Hint: Progress reports have a ten-day window. If you want to perform multiple therapy ... Read more
Modifiers:
These 3 Obscure Modifiers Could Clarify Your Services
These modifiers may not be common, but they could be helpful. Sure, you’ve got m... Read more
Part B Mythbuster:
Bust These 4 Psychotherapy Myths When Treating Patients in Crisis
Hint: Check when to overlook CCI edits for better reimbursement. The following four co... Read more
Part B Coding Coach:
Can You Code This Cardiac Cath Case?
We break the study down into four important questions so you can choose the right codes ... Read more
Physician Notes:
Family Physician Could Face 10 Years in Prison Over Fabricated Charts
If you’re planning to bill Medicare for visits with patients, ensure that you actu... Read more
Allergy Immunotherapy:
95165: This Payer Cites Ongoing Problems With Allergy Shot Coding
Hint: Limit number of units you bill to the size of the vial. Although you might think... Read more
Compliance:
Auditors Question E/M Visits With Pulmonary Services
Plus: Hydration therapy goes under the microscope. You may not have seen a Recovery Au... Read more
ICD-10:
Boost Your Coding For Benign Neoplasms of Central Nervous System
Beware: Not all ICD-9 codes have a one-to-one match. Reporting benign neoplasms of the... Read more
Part B Coding Coach:
CMS Proposal Would Dramatically Alter Drug Testing Codes
Agency fears overpayment for drugs-of-abuse testing. Billing for Medicare-beneficiary ... Read more
Watch For Continued Molecular Test Expansion
Check with CMS for final pricing decisions. You can get the scoop on what new 2016 cl... Read more
Physician Notes:
Physician Kickbacks Lead to Jail Time
The feds continue to crack down on home care and hospice fraud, with kickbacks often servi... Read more
ICD-10:
5 FAQs Quell Confusion on CMS's Latest ICD-10 Announcement
The one year grace period for ICD-10 claims applies to Medicare only. If CMS’s I... Read more
Part A Funding:
Report: Medicare Part A Could Go Broke in 2030
CMS is working on solutions to fix the problem, the agency says. The latest Medicare T... Read more
Ophthalmology Coding:
Contact Lens Coding Goes Beyond 92310
Get your deserved reimbursement for medically necessary lenses. Seasoned ophthalmology... Read more
Part B Coding Coach:
3 Tips Lead You to Successful Spirometry Claims
Hint: Double check the “medically necessary” codes allowed by your payer. ... Read more
Physician Notes:
Questions Abound for Hospital After ESPN Publishes NFL Star's Records
Although Americans may feel they have the right to know whether their favorite football ... Read more
Part B Payment:
January Could Bring Changes for Incident to Services, Gastro Pay
Plus: You could see advance care planning payments in 2016. For the first time in year... Read more
CMS Dips Toe Into MACRA Shift
As most practices know, CMS is planning to overhaul the Medicare payment system by 2018,... Read more
Surgical Coding:
Perfect Your ACL Claims With These Quick Tips
Hint: Unlisted procedures may be your friend for some aspects of surgery. As many as 3... Read more
Part B Coding Coach:
Avoid Bundling Pitfalls for Clean Tonsillectomy Claims
Take this modifier 50 tip to the bank. When billing tonsillectomy and/or adenoidectomy... Read more
Physician Notes:
CMS' Analytics System Caught $820 Million in Fraud
Plus: Hospital settles for $218,400 over HIPAA violation. CMS uses many approaches to ... Read more
Reader Question:
Payers May Dictate Fluoro Rules
Question: Can we report fluoroscopy separately when reporting epidural in... Read more
ICD-10:
CMS: For First Year, We Won't Deny Claims With Wrong ICD-10 Codes
As long as you use an ICD-10 code from the right “family,” the MAC will ... Read more
Patient Privacy:
This is the Single Biggest Source of HIPAA Breaches
Hint: Most breaches are due to passive errors, not deliberate disclosures. Based on ev... Read more
Part B Coding Coach:
Capture Correct MMK Pay With These Quick Tips
Modifier missteps could cost you over $800. If your urologist documented that he perfo... Read more
Physician Notes:
Doctor Faces Over Five Years in Prison for Taking Bribes from Lab
Exchanging cash for referrals is never a good practice—and has blown up in the fac... Read more
Reader Question:
Don't Let Separate DOS Confuse Your Paracentesis Claims
Question: The gastroenterologist performed paracentesis on a patient to drain fluid... Read more
Reader Question:
Payer May Have Opinion on Laceration Repair Method
Question: If our provider used a tissue adhesive instead of placing a suture, can t... Read more
RAC Audits:
This RAC Illuminates 2 Commonly-Miscoded Services
Stay on top of these issues to keep your claims flowing smoothly. Although most of the... Read more
Therapy Claims:
OIG: 62 Percent of PT Claims Billed Incorrectly
This audit showed $1.4 million billed improperly by just one practice. If you’re... Read more
Billing Quiz:
9 Questions Help You Achieve Billing Success
You may be an ace at Part B billing—but check out these outliers. The provider d... Read more
Part B Coding Coach:
Does Your Documentation Support More Extensive Plantar Fasciitis Treatment?
Here’s how to justify every level of treatment.  Heel pain affects nearly t... Read more
Anatomy of Plantar Fasciitis Key to Correct Coding
Knowing the structure helps you be a better coder.  The more you know about plant... Read more
Physician Notes:
Medicare Opt-Outs Now Auto-Renew Every 2 Years
If you’ve been opting out of Medicare every two years, CMS has either great news o... Read more
Reader Questions:
Confront Potential Coding Discrepancies
Question: We disagree with our emergency physician’s documented level of care... Read more
Reader Questions:
Avoid Revision Codes for Removal
Question: A Medicare patient wants us to remove his SCS leads and battery because t... Read more
Medicare 101:
Can You Differentiate NCDs From LCDs?
CMS explains this and other pressing issues that impact your reimbursement. If you&rsq... Read more
ICD-10:
CMS: Your Payments Are Tied to CPT® Codes, Not ICD-10 Codes
Yes, you must transition to ICD-10, but not for procedure coding. Among the many ICD-1... Read more
CPT® 2016:
These 7 Cardiology-Related Code Changes Could Be Reality Next Year
Your IVUS coding may be in for an overhaul. While the October change to ICD-10 is grab... Read more
Part B Coding Coach:
Ensure Medical Necessity Before Leveling Your E/M Services
Key: MDM and medical necessity are not the same. If you are reporting high level E/M c... Read more
Physician Notes:
Feds Charge 243 People in Medicare Strike Force Takedown
Government officials were quite busy last week, crossing the country to charge 243 diffe... Read more
ICD-10:
Uncertainty is Okay Under ICD-10
When you look forward to Oct. 1, you’ll be looking back at your existing signs/sym... Read more
Appeals:
Medicare Appeals Could Change Dramatically
Early stage appeals need to be more accurate. Nearly everyone agrees that Medicare&r... Read more
Are Medicare Appeal Fees In Your Future?
OMHA proposals to shorten appeals timeframes could restrict your appeal rights, advocate... Read more
Appeals Timeframes Continue to Lengthen
Expect typical processing time for appeals decisions to exceed 540 days. Due to the ove... Read more
Part B Coding Coach:
Don't Let Faulty Coding Cut Into Your Laceration Repair Reimbursement
Find the right answers to these clinical scenarios. Laceration repairs are among the... Read more
Physician Notes:
Physician Pays $105,000 to Settle Accusations That Staff Performed E/M Services
A doctor in Oklahoma is in hot water after the government accused him of letting unlicen... Read more
Modifier 50:
CMS Takes Bilateral Billing Denials up A Notch
Multiple line items could be the death knell to your claims. If you’re reporting... Read more
Compliance:
OIG Launches Review of IMRT, Laboratory Claims
Latest Work Plan update reveals new audit areas. The OIG is expected to release its 20... Read more
ICD-10:
Latest ICD-10 Testing Results Show Positive Progress
CMS systems are ready,” the agency says. If you had any doubt that CMS is seriou... Read more
Part B Coding Coach:
4 Tips Guide Your Lower GI EUS Coding
Consider the new Medicare-allowed codes before you report these services. Because CPT&... Read more
Physician Notes:
Congress to Vote on IPAB Repeal
Plus: No family history? Explain why. Most Part B practices have gotten the hang of th... Read more
Reader Questions:
Consider Your Options for Abnormal Pap Smear
Question: In a patient who had an abnormal Pap smear, a cervical biopsy was done. I... Read more
Reader Questions:
Multiple IOP Tests Don't Require Multiple Codes
Question:  How would I code for four appointments for a single patient to map intra... Read more
Reader Questions:
Code Endoleak With These Quick Tips
Question: The patient had endovascular repair of a descending thoracic aorta aneury... Read more
Code Additions:
CMS Announces Debut of 5 New Codes
Look to your MAC for payment information. Although most practices don’t typicall... Read more
Compliance:
OIG: Just 6 Line Items Caused $1.7 Million Overbilling
Pay special attention to the codes you assign to drugs and biologicals. If you got a c... Read more
Patient Interaction:
Handle These 3 Medicare Patient Questions Like A Pro
If beneficiaries have Part B questions, you’ll need to have answers. You can pro... Read more
Injections:
3 Tips Lead You to Antibiotic Injection Pay
Medicare typically does cover these shots for certain conditions. It’s a common ... Read more
Part B Coding Coach:
CMS Radically Adjusts Ob-Gyn CCI Edits
Here’s what to do if you have a retroactive claim these changes impact. Remember... Read more
Physician Notes:
Government Fights EHR 'Information Blocking'
Plus: No family history? Explain why. On the one hand, the government is pushing all m... Read more
Reader Question:
Modifier 50 May Not Apply to All Bilateral Claims
Question: Our specialist administered several facet joint injections and appended m... Read more
Compliance:
MACs to Seek Sleep Study Refunds in Wake of OIG Report
Medical records were sorely lacking in this audit. Your polysomnography documentation&... Read more
Part B Mythbuster:
Your Practitioner's Signature Could be Worth $3,800-Or More
Avoid the most common Part B signature myths to avoid denials. Although you might not ... Read more
Where There Is A Rule, There Are Exceptions
Although Medicare’s signature regulations are set in stone, there are specific exc... Read more
Correct Coding Initiative:
New Coding Edits Could Impact Your Tonsillectomy Claims
Tip: Scrutinize descriptor details to know what you can’t submit together. The l... Read more
Part B Coding Coach:
Inject New Life Into Your Inhaler Service Claims by Answering 3 Questions
Judicious use of modifiers 25 and 59 will pay you more -- if you know how to navigate th... Read more
Physician Notes:
This MAC Warns Against Vague Unlisted, NOC Claims
Plus: Wrong surgery on a patient? There’s a modifier for that. Sometimes it&rsqu... Read more
Chronic Care Management:
Don't Bill CCM for Inpatients, Unless You Meet This Exception
CMS reps finally shed further light on new code 99490. The last time CMS staff members... Read more
Place Of Service Coding:
MACs to Start Eyeing Your POS Line Items
Place of service errors cost CMS over $33 million. The OIG’s 2015 Work Plan indi... Read more
Use This Quick Guide to Pinpoint POS Codes
If you think you might be at risk of making place of service (POS) errors like the OIG f... Read more
NCCI Edits:
3 Essential CCI Changes That You Should Study Right Now
Fortunately, some of them can be separated with modifiers. The latest round of CCI (Co... Read more
Part B Coding Coach:
Perfect Your IVC Filter Coding With These 3 Steps
Capture steps for insertion, repositioning, and removal. When your general surgeon man... Read more
Physician Notes:
CMS Debuts Four New HCPCS Codes
Plus: House calls pay far too much in this case. Although you’re probably busy p... Read more
Part B Mythbuste:
10 Compliance Realities That You Can't Afford to Ignore
Check out these misconceptions and why you shouldn’t keep believing them. Think ... Read more
ICD-10:
Find Your Way Around the ICD-10 Manual With These Quick Tips
The book may be a little thicker than your ICD-9 book, but don’t let that discoura... Read more
Patient Privacy:
HIPAA Compliance Isn't Always Foolproof
Take 5 steps to go beyond Security Rule standards to protect your data. The most recen... Read more
Part B Coding Coach:
Discontinued Procedures: Watch the Clock to Know When Modifier 53 Might Apply
Plus: Document the specific reason for case cancellation. The descriptor for modifier ... Read more
Physician Notes:
ACOs Saved Medicare $317 Million in Two Year Study
Plus: Your MAC doesn’t want a preauthorization request. You may be aware of the ... Read more
Privacy:
8 Steps to Take Right Now to Avoid Medical Identity Theft
Beneficiaries aren’t the only potential victims of this problem. As a medical pr... Read more
Billing Errors:
This MAC's Audit Finds That Some Practices Could Be Collecting More
Downcoding errors mean that these providers are selling themselves short. When you hea... Read more
Part B Coding Coach:
Answer 3 Questions to Ace Your Upper GI EUS Claims
Report the EGD EUS only if your gastroenterologist has documented this procedure. Do y... Read more
Physician Notes:
Performing CT Scans? Don't Make These Mistakes
Plus: Almost 40 percent of providers saw pay slashed by 1.5 percent due to PQRS non-part... Read more
Reader Questions:
Your Practice Bears Cost of Interpreter
Question: A deaf patient recently selected our practice for his care. The patient n... Read more
Reader Questions:
Know the Bluetooth Risks
Question: Our clinicians use smartphones and tablets. Some of these devices have Bl... Read more
Modifiers:
This MAC Provides 3 Quick Modifier Tips for Optimal Claim Approval Rates
Hint: More than four modifiers? Modifier 99 could be your friend. You might not be abl... Read more
Preventive Services:
Have You Seen the CDC's Sample HRA Assessment Form?
Use the government’s form as a springboard to creating your own tailored document.... Read more
Mental Health Coding:
Avoid Billing Add-on Codes With Other Add-on Codes
Mental health services have very precise rules—find out what they are with these F... Read more
Part B Coding Coach:
Capture Cannula Services for ECMO Patients
Your surgeon may be part of the life support team. If you thought you could ignore CPT... Read more
Physician Notes:
New Medicare Cards Will be SSN-Free
Plus: CMS halts coverage for vacuum erection devices. Most practices are quite aware o... Read more
Reader Question:
You Can Collect for Electrode Placement, Removal
Question: In a patient with bilateral leg pain, our surgeon placed two electrode ar... Read more
Part B Payment:
Congress Votes to Overhaul Part B Payments
You’ll no longer face potential payment drops at the beginning of each New Year. ... Read more
Modifier:
CMS: 'No Benefit' to Using X{EPSU} Modifiers Over -59 at This Point
Until the agency offers specific advice on how to use the ‘X’ modifiers, you... Read more
Privacy:
HIPAA Audits on the Way-After This Quick Station Break
Expect more comprehensive audits instead of desk reviews. The HHS Office for Civil Rig... Read more
Don't Relax Your HIPAA Standards
Audit delay doesn’t mean you can forget about privacy. Ignore the HHS Office ... Read more
Part B Coding Coach:
Make Sure Your Extended Ophthalmoscopy Claims Stand Up to Audits
Review this FAQ and get to know some of the common extended ophthalmoscopy tripping poin... Read more
Physician Notes:
CMS Hasn't Established Lung Cancer Screening Code Yet
Plus: Don’t forget the legible signature rule. If you’re interested in bil... Read more
Reader Question:
Watch Modifiers for Bilateral Thyroid Lobectomy
Question: My physician performed surgery on both the right and the left lobes of th... Read more
Compliance:
Medicare Auditors Target ESRD Coding Errors
Plus: One-third of TAVR claims audited were improperly paid. If you’re hungry fo... Read more
Diagnosis Coding:
These ICD-9 Tips Will Improve Your Histoplasmosis Coding Accuracy
Ignoring symptoms could cost you $172. Reporting diagnoses for histoplasmosis patients... Read more
Reader Questions:
Don't Report Multiple Units of 90847 Per Family Member
Question: Our psychiatrist recently counseled the family members of a patient. He t... Read more
Reader Questions:
Know Path Storage Rules
Question:Could you please explain the CMS date of service policy, especially the impact ... Read more
Part B Payment:
Senate Takes Recess Before Voting on SGR Reform
MACs to hold claims for services that took place on April 1 or thereafter. Congress ma... Read more
Part B Mythbuster:
Are You Making This Medical Decision-Making Mistake?
This MAC clears up 6 pressing issues. If you’re under the impression that only c... Read more
Part B Coding Coach:
Keep Your H. pylori Test Coding on Track With These Quick Tips
Tip: Keep in mind that payers may vary widely on this topic. If you gastro reports H. ... Read more
Physician Notes:
OIG Recommends Removing SSNs From Medicare Cards
Plus: This MAC spells out ‘high risk’ MDM component. It’s a common c... Read more
Reader Questions:
Abnormal Results Typically Support Further Testing
Question: If an abnormal pap smear prompted our clinician to undertake a cervical b... Read more
Reader Questions:
Edits May Go Beyond CCI
Question: We are billing an evaluation and management (E/M) code 99212 along with a... Read more
Compliance:
OIG Revisits Recommendation to Pursue EHR Fraud
Plus: The government is leaning on CMS to collect more overpayments. When the OIG talk... Read more
E/M Coding:
99239: This Payer Finds Issues With Discharge Code
Tip: Be sure time is documented before you report discharge. CPT® only includes tw... Read more
Imaging:
Strengthen Your Claims for Intraluminal GI Imaging With Capsule Endoscopy
Do not report 91111 in conjunction with 91110, 0355T. Gastrointestinal imaging has und... Read more
Part B Coding Coach:
Focus on 65205-65222 and 65270-65286 for Eye Injury Claims
Tip: Foreign body removal can be included in the corneal repair. Although it’s n... Read more
Physician Notes:
Proposed 'Doc Fix' Could See Congressional Vote
As most Part B practices know, you’ll face a 21 percent reimbursement cut on April... Read more
Reader Question:
New Joint Injection Codes Carry Specific Guidance Rules
Question: The new joint injection codes 20604, 20606, and 20611 specify an injectio... Read more
E/M Coding:
3 Ways Comparative Billing Reports Can Rescue Your Coding
Use the CBRs as springboards to gauge your accuracy. Your MACs are reviewing the most ... Read more
Use This Chart to Determine the Most Commonly-Billed Code in Your Specialty
Your MAC’s Comparative Billing Reports can show you a massive amount of informatio... Read more
ICD-10:
AMA Among 100 Specialty Associations With ICD-10 Concerns
So far, Congress appears to support Oct. 1 implementation date. You may be furiously p... Read more
Neoplasm Coding:
3 FAQs Help You Hone Your Uncertain vs. Unspecified Diagnoses
Hold claims for pathology report when possible. You may not always be able to narrow d... Read more
Part B Coding Coach:
4 Tips Ensure You Don't Forfeit Pay When Treating SNF Payments
Hint: Make sure you have the right POS for consolidated billing. You perform services ... Read more
Physician Notes:
Unnecessary Services Lead to $5.3 Million Repayment for NY Doctor
When coding and billing experts continually remind practices to “put medical neces... Read more
Part B Revenue Booster:
10 Tips Ensure You Aren't Losing Thousands This Year
Coordinate back office and front desk staff to keep cash flow positive. From ABNs to Z... Read more
Hospice:
Hospices the Target of Fraud Investigations
Whistleblowers rake in nearly $700K in one fraud settlement. Hospices’ efforts t... Read more
Part B Coding Coach:
Ignore Massive CPT® 2015 Drug Coding Changes for Medicare
Choose from 28 new ‘G’ codes instead. Learning about the CPT® 2015 tox... Read more
Physician Notes:
Keep Working Toward Meaningful Use Thanks to Extension
If you were busily trying to prepare your meaningful use attestation for the 2014 report... Read more
ICD-10:
CMS Accepts 81 Percent of ICD-10 Test Claims
Biggest denial reason had nothing to do with diagnosis coding. It appears that ICD-10 ... Read more
Part B Revenue Booster:
Take This Quick Quiz to Ensure You're Bringing in Your Allowable Revenue
Performing these services? They may be a source of lost income. Can your medical pract... Read more
Incident To:
Appropriate Incident-To Billing Requires Keen Understanding of 'New Medical Condition
Remember that not all payers follow the same rules. A new condition to you may not be ... Read more
Revenue Boosting Quiz Answers:
Are You Collecting Every Billable Dollar? Check Your Quiz Answers Here
Hint: Don’t write off those unrelated post-surgical E/M visits. Answer 1: If the... Read more
Terminology Check:
Brush Up on These Familiar Neck Dissection Terms
Understanding anatomy always helps you code more accurately.  Because neck dissec... Read more
Physician Notes:
Are You Being Double-Penalized for EHR Non-Participation?
As if taking a one percent hit on your Medicare payments isn’t painful enough, som... Read more
Reader Question:
Fight Back on 'Separate Dx' Demands
Question: One of our payers is taking back payment for 99291 and 99292, stating the... Read more
Chronic Care Management:
9 Factors Your CCM Records Must Include
Referring doc isn’t online? You may not be able to collect for CCM. Although you... Read more
Who Can Provide Chronic Care Management?
If you’re wondering which of your practitioners can provide chronic care managemen... Read more
Privacy:
Watch Out For These HIPAA Trends In 2015
Prediction: State law claims will continue to facilitate breach lawsuits. What does 20... Read more
Part B Coding Coach:
Know How to Mix HPI/Exam for E/M Calculations
Some payers now allow you to use crossover elements. Calculating the level of evaluati... Read more
Physician Notes:
ICD-10 Still on Track for October, Despite Congressional Hearing
Plus: Differentiate preventive medicine visit from IPPE. If you’re ready to make... Read more
In other news
When CMS first started allowing coverage for the initial preventive physical exam (IPPE)... Read more
Part B Coverage:
Medicare to Cover Lung Cancer Screening Scans
Patients with long history of smoking can now qualify for LDCT. Although CMS usually s... Read more
Part B Revenue Booster:
3 Facts You May Not Know About Incident to
And one that you probably do know—but aren’t following properly. As most p... Read more
Pulmonology Coding:
4 Tips Lead You to VQ Study Reimbursement Every Time
Look for references to “inhalation” or “gases” for vent study do... Read more
Get to Know the VQ Scan Specifics
A lung ventilation/perfusion scan, or VQ scan, is a test that helps a pulmonologist meas... Read more
Part B Coding Coach:
Achieve Sigmoidoscopy Accuracy With 3 Quick Tips
Knowing the correct situations to report control of bleeding will help avoid denials. ... Read more
Physician Notes:
This MAC Updates Its Modifier 51 Rules--Reminding You NOT to Use It
Plus: Don’t take ‘credit’ for toxic drug management if you aren’... Read more
In other news
As most E/M coders are aware, drug therapy requiring intensive monitoring for toxicity i... Read more
Reader Question:
Be Ready to Send Documentation With Unlisted Code
Question: I’ve read that we should report 64999 for radiofrequency of the lum... Read more
Part B Revenue Booster:
5 Services You Shouldn't Offer for Free--And 3 That You Should
Not everything will be a ‘freebie’ in your practice. Everyone likes free i... Read more
Home Health Certification:
Don't Delay When Completing Home Health Certifications
Your best bet is to fill out the eligibility record at the time of hospital discharge ... Read more
Compliance:
Do You Know How to Avoid These 5 Types of Medicaid Fraud?
Medicaid auditors could be reviewing your files—make sure you aren’t violati... Read more
Part B Coding Coach:
Collect Every Time for Chemotherapy Administration With These Tips
Keep an eye on time of infusion and earn for sequential drugs, if any. When coding for... Read more
5 Pearls of Wisdom for Chemotherapy Administration
Here are five important tips that will serve as a guide for your chemotherapy administra... Read more
Physician Notes:
More Modifier X{EPSU} Examples Trickle Forward
Plus: Modifier 90 is not your friend—unless you work at an independent lab. It c... Read more
In other news
Although your CPT® manual may list every available modifier in it, that doesn’... Read more
Modifiers:
This MAC Offers Long-Awaited Modifier X{EPSU} Examples
Use these case scenarios to help guide your modifier 59 alternatives. CMS has been slo... Read more
Part B Payments:
CMS Launches Plan to Reform Medicare Payment Model
You could be tying half of your pay to quality within three years. Although Medicare&r... Read more
Billing:
5 Tips You Need to Know for Clean 2015 Claims
This MAC illuminates several of the most challenging coding issues. Your MAC has been ... Read more
Billing:
4 Steps Help You Collect From Personal Injury Payers
Doing your homework up-front will save you from headaches later.  You might compl... Read more
Part B Coding Coach:
Avoid Losing $35 Per Visit By Correctly Choosing Between 99213 and 99214
Knowing what to look for in documentation is the key to deciding outpatient visit leveli... Read more
Physician Notes:
Opting Out? Treat All Medicare Patients Equally, CMS Says
If the thought of opting out of Medicare piques your interest, you might be in need of a... Read more
Compliance:
RAC Auditors Frustrated Over Duplicate Claims, Facet Joint Injections
Don’t resubmit a claim without checking why it was denied the first time. Curiou... Read more
Billing:
This MAC's Top 5 Most Common Denial Reasons May Surprise You
Trying to reconcile why you’re facing denials? This list might help. Sometimes y... Read more
CPT® 2015:
Make Specifics of U/S-Guided Arthrocentesis Part of Your Permanent Record
These new codes have very specific documentation requirements. You’re aware of t... Read more
ICD-10:
Straightforward Crosswalk Helps Pinpoint Actinic Keratosis Diagnoses
Under ICD-10, L57.0 will be your go-to code. When your clinician diagnoses actinic ker... Read more
Part B Coding Coach:
Don't Miss the Details That Will Lead to Full Flexible Laryngoscopy Payment
Know every detail your physician should be writing. Physicians often perform diagnosti... Read more
Physician Notes:
CMS Administrator Tavenner on the Way Out
Prepare to say goodbye to CMS Administrator Marilyn Tavenner. The former nurse who has b... Read more
Reader Question:
Change Your Epidural Injection Guidance Rules
Question: I have read that Medicare increased the fee schedule for 2015 so that ima... Read more
Modifiers:
CMS Stays Mum on X{EPSU} Modifier Examples
Noridian Medicare appears poised to offer advice, however. If you’re already pre... Read more
Compliance:
CMS: Initial Hospital Visit Claims Riddled With Errors
The agency also points to 99214 as a sore spot. Nobody likes to be told that they&rsqu... Read more
Part B Coding Coach:
Update Your UroLift® Coding or Face 2015 Denials
New codes 52441, +52442 will be your go-to answers. You haven’t had a code to ac... Read more
Focus on the UroLift® Reimbursement Impact
Determine whether in-office performance is profitable enough for your practice. Now th... Read more
Physician Notes:
CMS: No Extensions on ADR Requests
When you get a documentation request from your MAC or another Medicare entity (such as a... Read more
Reader Question:
Watch For the Bundle In 36147 And 75791
Question: How can we code for AV dialysis graft imaging and embolization? The pro... Read more
Reader Question:
Look for Combo Codes When You Can
Question: One of our physicians is trying to bill for a bunionectomy with 28292 (Co... Read more
Reader Question:
85610 Works for Coumadin Monitoring
Question: A patient with deep venous thrombosis (DVT) is on Coumadin for blood thin... Read more
Reader Question:
Second Surgical Group Doesn't Warrant Repeat Modifier
Question: Our patient’s hip prosthesis got infected and he presented to the O... Read more
MACs Are Holding 2015 Claims Through Jan. 14
Plus: CMS has already changed the conversion factor for 2015. With the New Year comes ... Read more
ICD-10:
CMS Invites Practices to Join Upcoming ICD-10 Testing Rounds
Each MAC will choose 50 participants per session. If you were overlooked for the curre... Read more
Patient Privacy:
Follow HIPAA Requirements--Even in Emergencies
Know what information you can legally share, and who can receive it. Do you know your ... Read more
Part B Coding Coach:
Differentiate Good vs Bad Documentation With 2 Hysterectomy Op Notes
Save these on-the-go documentation tips to ward against big mistakes. You should never... Read more
On-the-Go Documentation Tips
You’ve read about what makes a good and bad Ob report, but here’s what you c... Read more
Physician Notes:
Ever Feel Like Auditors Are on A Witch Hunt? CMS Responds
If you get frustrated over auditors’ reviews of your claims, you aren’t alon... Read more
Reader Question:
Bleeding Drives Gastric Varices Code Choice
Question: How should I report a surgeon’s treatment of gastric or esophageal ... Read more
Reader Question:
Differentiate 'Unspecified' From 'Other Specified' in ICD-10
Question: I have seen lots of great ICD-9 to ICD-10 crosswalks, but it seems like t... Read more
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