Primary Care Coding Alert

Family Practice Coding Alert - 2010; Volume 12, Number 12

Vaccines:
Delete 90658 for Medicare Patients in Favor of New Q Codes
2011 brings changes to flu vaccines and counseling codes.Your vaccine coding in 2011 will ... Read more

E/M Coding:
99213 to 99214: 4 Tips Help You Look Toward Correct Service Levels
Teach your physicians to write iron-clad MDM notes.You can't get inside your physician's h... Read more

Clip & Save:
Which Elements Stack Up to Moderate Complexity? Find Out Here
Save this chart as your MDM breakdown guide.You can easily calculate the correct number of... Read more

Foot Coding:
735.0 or 727.1? Tackle This Condition Terminology for Foot Claims Success
Have these modifiers handy to distinguish areas of the feet and toes.Don't let anatomic te... Read more

Reader Questions:
Yes, 99241-99245 Can Still Be Valid
Question: How should we code for surgical clearance of an established Medicaid patient?Ans... Read more

Reader Questions:
Stop Omitting 25 Because of Same Diagnosis
Question: I was recently told in a class that you do not need different diagnosis codes to... Read more

Reader Questions:
Emergency Could Justify 99058
Question: A Medicare patient came to the office on an emergent basis with several lacerati... Read more

You Be the Coder:
Choosing 94640 or 94664 for Emphysema Visit
Question: Which CPT code should we report when an established patient with emphysema prese... Read more

Family Practice Coding Alert - 2010; Volume 12, Number 11

Vaccines:
90655-90660: Learn the Best Ways to Navigate Flu Codes
Answer 4 questions to keep your claims on track during flu season.With flu season getting ... Read more

Medicare:
Keep Flu Shot Billing Simple With These Reminders
Don't bill separately for vaccination supplies, intermediary warns. With fall come... Read more

2011 Fee Schedule:
CMS Slashes 2011 Conversion Factor by Over 30 Percent Vs. Current Rates
Good news: New wellness visit codes get covered.Get ready for another year of nail-biting ... Read more

Documentation:
Watch Out: Nurse's History Note Might Be Audit Bait
The physician must indicate that he or she reviewed any nurse's notes.Caution: Don't let y... Read more

Reader Questions:
Counting 99211 for Unexpected BP Check
Question: A patient came to our office for a flu shot. The physician ordered the LPN to ch... Read more

Reader Questions:
Yes, "Calming Shot" Fee Allowed
Question: One of our patients was on his way to have an MRI at the hospital. He stopped by... Read more

Reader Questions:
Checklist for Sports Physical Components
Question: Most of our insurance companies won't pay for a sports physical after the patien... Read more

Reader Questions:
V76.2 Your Best Diagnosis for Routine Pap Smear
Question: Medicare denied our claim using Q0091 and diagnosis 616.0 for Pap smear collecti... Read more

Reader Questions:
Insurer Rules 99354 OK for Interpretive Services
Question: A level four office visit with an established patient took 55 minutes of physici... Read more

You Be the Coder:
J0559, J0696 Calculations
Question: We have a difficult time getting paid when our physician administers CR Bicillin... Read more

Family Practice Coding Alert - 2010; Volume 12, Number 10

CPT 2011:
New 90660 and Related Codes Expand Your Flu Vaccine Choices
Plus: Subsequent observation codes apply to longer hospital stays.CPT 2011 is just around ... Read more

E/M:
Check Out New Subsequent Observation Codes
Look for them in "Hospital Care" section.CPT 2011 adds a new section to your E/M options: ... Read more

CCI:
0228T, 0230T Play Big Role in CCI 16.3 Edits
Only report primary procedure -- except for 99455 edits.The latest version of Correct... Read more

Compliance:
Practices Collected Over $8 Million in Part B Pay for Services Rendered After Patients Died
OIG identified massive overpayments for services rendered after patients' dates of death.P... Read more

Reader questions:
294.11 Not Always Best for Dementia, Behavioral Disturbance
Question: Our coder reports 294.11 and 294.8 when our physician notes dementia with behavi... Read more

Reader questions:
15850 With S0630 Leads to Denials
Question: An ER physician placed sutures that our family physician later removed. The gove... Read more

Reader questions:
Consider 692.xx for Surgical Tape Reaction
Question: Our physician documented that the patient had an allergic reaction to surgical t... Read more

Reader questions:
Submit 99211 for Blood Pressure Check
Question: An established patient came to our office for a blood pressure check because he ... Read more

Reader questions:
Yes, 94664 for Nebulizer Education Is Legit
Question: Should we be reporting 94664 when a nurse provides nebulizer education/demonstra... Read more

Reader questions:
Apply 'Birthday Rule' to Double-Covered Patients
Question: If a married couple has a baby who becomes our patient, what insurance do we bil... Read more

You Be the Coder:
Medicare Stance on B12 Coverage
Question: Medicare denies our claims for B12 injections. Do they only allow one unit, or a... Read more

Family Practice Coding Alert - 2010; Volume 12, Number 9

Medicare:
Prepare for Medicare to Cover Tobacco Cessation Counseling for All Smoking Beneficiaries
New coverage announcement brings good news for physicians who haven't collected in t... Read more

ICD-9:
New 'Attention Deficit' Choices Will Help Fill Your Diagnosis Coding Gap
2011 edition brings more specificity for ADD and retained fragments.The 2011 ICD-9 codes g... Read more

Casts and Splints:
Avoid the Cast Trap of Coding Within the Global
Tip: Remember you can always report supplies, if you meet one simple test.Football season ... Read more

Reader Questions:
Watch Procedure to Determine 25 With E/M
Question: An established patient came to our office because of knee pain. Our physician x-... Read more

Reader Questions:
Document Vitals Even If Not Required
Question: Does our provider need to document vital signs before we can charge an [injectio... Read more

Reader Questions:
Code Symptoms Over 'Worried Well Check'
Question: A mother brought her child to our office because her sixmonth-old child was "act... Read more

Reader Questions:
Symbols and Chart Explain V Code Order
Question: What rules apply to reporting V codes with E/M office visits? Can we report scre... Read more

Reader Questions:
Coding for Gyn and Pap Smear Depends on Circumstances and Payer
Question: What procedure codes should we submit for a gynecology exam and Pap smear?Montan... Read more

Reader Questions:
Wart Removal Without Cryo Equals 17110
Question: The family practice physician documented, "Dermatology treatment rendered in the... Read more

Reader Questions:
Beware Tacking on Additional Patient Charges
Question: Can you charge a processing fee or a "statement" fee to past due patients when w... Read more

Reader Questions:
The Hard Truth about Phone Call Pay
Question: Another physician told my doctor that he's receiving payment from his contractor... Read more

You Be the Coder:
Is Seeing SNF Patients Allowed?
Question: One of our longtime patients now lives in a skilled nursing facility. She wants ... Read more

Family Practice Coding Alert - 2010; Volume 12, Number 8

ICD-9 2011:
Avoid H1N1, Fecal Incontinence Denials With 5th Digit Savvy
488.1x Cheat sheet makes fast work of snagging correct code.Don't let rumors of few ICD-9 ... Read more

ICD-9 2011:
V49.8x, V13.2x Expand FPs' Status, History Options
This fall indicate a do not resuscitate order using new V code.Struggling to find a V code... Read more

ICD-9 2011:
Make Your Superbill 2011 Compliant Using This Quick Guide
The headache-free solution to getting your ICD-9 codes up to date. Space crunched on yo... Read more

Pediatric Coding Corner:
Protect Your 99211 With 90471-90474 Pay With 4 Affirmatives
Don't code a nurse visit at a scheduled flu shot unless you can check off these items.Alth... Read more

Reader Questions:
2 Lesion Treatments: Is 11400 + 17000 OK?
Question:A physician destroyed a premalignant lesion on a patient's arm and excised a beni... Read more

Reader Questions:
Does Modifier SA Mean NP Pay Reduction?
Question: Please verify the correct way to bill for a nurse practitioner. When the NP prov... Read more

Reader Questions:
90669, 90670, or 90732 for Pneumococcal Vaccine
Reviewed on May 22, 2015 Question: Medicare and private payers are denying ... Read more

Reader Questions:
No CCI Bundle? Here's Where to Find Modifier Details
Question: Sometimes I cannot find my two-code pair in the CCI edits. How do I know which c... Read more

Reader Questions:
Is 69210 Allowed for Partial Removal?
Question:Documentation states that the physician personally removed a small portion of imp... Read more

You Be the Coder:
What Caused 81001 Denial?
Question: A mom brought her 4-year-old daughter in for painful vaginal area. The FP provid... Read more

Family Practice Coding Alert - 2010; Volume 12, Number 7

Money-Making Procedures:
5 Principles Take the Tricky Out of FBR Coding
Snag $100 more for removal from foot -- Codify shows you how.If you automatically loo... Read more

Coding Changes:
ICD-9 2011 Solves Partial Removal Stumper
Squeeze these V90 retained fragment codes onto fall tickets.When you can't get all of a sp... Read more

Auditing:
Check Your HPI, Risk IQ With Pre-op Exam Case Study
Hint: Your FP's recs are the ones to count under mgt options.When a patient needs preopera... Read more

Auditing:
MDM Weigh Surgical Risk to Snag the Correct E/M Level
These definitions take the mystery out of moderate vs high surgical management options.If ... Read more

Reader Questions:
3 Ways to Handle Trays
Question: How do I code products like laceration trays for minor wounds, suture trays, fac... Read more

Reader Questions:
The Hard Truth about Phone Call Pay
Question: Another physician told my doctor that he's receiving payment from his contractor... Read more

Reader Questions:
Unplanned Departure = No 99315-99316
Question: A patient leaves a nursing facility (NF) against medical advice (AMA). Can the F... Read more

Reader Questions:
Drug Index Requires Generic Code Name
Question: I can't find the HCPCS Level II codes for Ethyol, Treanda, Trisenox, and Zoladex... Read more

You Be the Coder:
SI Joint Area: Hunt for the Correct Injection Code
Question: FP dictates, "Injection (L) sacroiliac joint, depo medrol 80mg, lidocane 4 ml, m... Read more

Family Practice Coding Alert - 2010; Volume 12, Number 6

Family Practice Coding Alert:
Bone Density Scans Boost Revenue If You've Got the Correct Combo
DEXA, SEXA, CT: Use a unique code for each to firm up pay.Paying attention to three detail... Read more

Auditing:
Is the Problem New to a Partner's Patient?
You've hunted for new problem specifics; we've found the details for you.Your FP gets more... Read more

MPFS:
Up 2, After Down 22
After a week of 1994 rates, CMS increases conversion factor.MACs distributed substantially... Read more

Fast Tips:
Jen Godreau's Top 3 AAPC Takeaways
Thousands of American Academy of Professional Coders members gathered in Jacksonville, Fla... Read more

Reader Questions:
Change to '70' Code for New Prevnar Vaccine
Question: We started receiving Prevnar 13 vaccine instead of Prevnar 7. Do I use the s... Read more

Reader Questions:
Limit Prolonged Services to Highest Category in 1 Instance
Question:Can the prolonged codes (+99354, Prolonged physician service in the office or oth... Read more

Reader Questions:
Autism Screenings Falls Under 96110
Question:Is there a CPT code for administering the M-CHAT screening? Do we need to include... Read more

Reader Questions:
Any PFSH Item Fulfills Category
Question:When a new patient is seen in our office, the patient is required to fill out a r... Read more

Reader Questions:
Look for Local Txt to Up Sunburn Pay
Question:A patient comes in with swelling and minor blisters on the tops of his feet. The ... Read more

You Be the Coder:
Cyst Expression: I&D or Excision?
Question: Documentation reads, "The cyst was excised after performing a central ... Read more

Family Practice Coding Alert - 2010; Volume 12, Number 5

ICD-9 2011:
Get the Early Skinny On These New Head Injury, BMI Diagnoses
ICD-9 beefs up traumatic brain injury code set to make TBI treatments easier to explain.Co... Read more

FAQs:
Double Your E/M Payout on Some Counseling 'Domination' Claims
Here's when you can code past the 3 E/M component levels.The FP provides an E/M service fo... Read more

Big RVU Change:
Feds Fortify DEXA RVUs, Downgrade Conversion Factor
Midyear switch means about 1 RVU more for bone density study. According to a recent CMS ... Read more

Reader Questions:
Remember V Code for Suture Removal
Question: An established patient hit his forehead on his surfboard while on vacation in Ha... Read more

Reader Questions:
NOPP Knowledge Can Ease E/M Coding Anxiety
Question: A 13-year-old established patient reports to the FP for treatment of his acne. D... Read more

Reader Questions:
Ease Counseling Codes Acceptance With Distinct Dxs
Question: A 60-year-old established Medicare patient with a confirmed diagnosis of vanishi... Read more

Reader Questions:
Include E/M for 'Monitoring' Only If It Exceeds Injection Package
Question: An 18-year-old patient with a severe seafood allergy reports to the FP for an al... Read more

You Be the Coder:
Know Supervision Definition for More Incident-To Opportunities
Question: An established Medicare patient with a plan of care in place for his uncontrolle... Read more

Family Practice Coding Alert - 2010; Volume 12, Number 4

3 Situations Boost Your Migraine Treatment Smarts
Acute episodes, check-ups are both routine for these patients. When migraine headache cod... Read more

Clip and Save:
Use This J Code List to Prevent Supply Headaches
Scan claims for any injectable anti-nausea meds, too. If a patient reports to the FP for ... Read more

News You Can Use:
Avoid Denials With This Lowdown on Newborn CCI Bundles
These edits took effect April 1, so start observing them yesterday. The latest version of... Read more

New or Established? Answer Wrong and It Could Cost You
Remember, what used to be a consultation is now likely a 99201-99215 service. Dr. FP prov... Read more

Reader Questions:
Make Sure Your EHR Passes PQRI Muster
Question: We have been participating in the physician quality reporting initiative (PQRI)... Read more

Reader Questions:
Get Specific to Make X-Ray Claims Sail
Question: A 38-year-old established patient reports to the FP with complaints of wheezing... Read more

Reader Questions:
Remember Modifier When FP Only Interprets Ultrasound
Question: The FP meets a 28-year-old established patient who is 24 weeks pregnant at a lo... Read more

Reader Questions:
Separate Dx Keys This E/M-Injection Combo
Question: A 75-year-old established Medicare patient with a plan of care in place for her... Read more

You Be the Coder:
Outpatient Service or Observation?
Question: The FP meets a 46-year-old established female patient at the local hospital at ... Read more

Family Practice Coding Alert - 2010; Volume 12, Number 3

Earwax-E/M Encounter Equals $47 More Per Removal Claim
Check for tools, impacted' cerumen for 69210 evidence. When a patient reports to the fami... Read more

Consider Observation Codes for Patients In Apparent Limbo
Medicare clears up confusion surrounding '8-hour rule.' Reporting your FP's observation s... Read more

ID NPP/FP 'Team-ups' for Shared-Visit Billing
Forget about incident-to in the facility, but consider this option. So you have all of Me... Read more

Reader questions:
Check If Exceptions Exist in Fracture Modifiers
Question: An established patient reports to the FP with an injured right finger he suffer... Read more

Reader questions:
Consider All Aspects for Hypothyroidism Dx
Question: An established patient who recently had surgery and radiation therapy to treat ... Read more

Reader questions:
Remember Primary Dx Code for These Diabetics
Question: I have a puzzling claim in front of me. The notes indicate that the nonphysicia... Read more

Reader questions:
Anemia Could Lead to H1N1 Admin
Question: An 18-year-old female established patient reports to the FP complaining of weak... Read more

Reader questions:
Bust Myth About Breast Exam Requirement
Question: The FP performs a well-woman examination with Pap smear for a low-risk 67-year-o... Read more

You Be the Coder:
Hammer Hematoma Treatment Down With Terms
Question: An established patient presents to the FP after an accident; he crushed the tip... Read more

Family Practice Coding Alert - 2010; Volume 12, Number 2

3 Cases Cut to the Chase on Nosebleed Treatment Coding
Here's how to ID nosebleed repairs that only amount to E/Ms. When a patient reports to th... Read more

Ensure ROS Success With This 'On the Level' FAQ
CPT or CMS? Be sure you know whose ROS rules private payers follow. A lack of E/M coding ... Read more

Never Surrender:
Use P Modifier When PQRI Measure Is Not Met
Remember, noncompliant patients are PQRI people, too. Your family physician (FP) performs... Read more

READER QUESTIONS :
Visibility Matters When Choosing Hematuria ICD-9
Question: Encounter notes state that the FP diagnosed a patient with hematuria. That narr... Read more

READER QUESTIONS :
V Means Victory on 'No Injury' Claims
Question: A 68-year-old established Medicare patient reports to the office for a visit st... Read more

READER QUESTIONS :
Most Med Checks Merit 99211
Question: An established patient with a plan of care in place for her gastroesophageal re... Read more

READER QUESTIONS :
Number of Muscles is What Matters on TPI Claims
Question: A 39-year-old new male patient reports to the FP for treatment of severe back s... Read more

You Be the Coder :
Identifying I&D Complexity
Question: A 38-year-old new patient presents to the FP complaining of pain and swelling i... Read more

Family Practice Coding Alert - 2010; Volume 12, Number 1

Marginal Removal Smarts Might Mean Missed Money
Guess what you need to add to total removal area before coding? Lesion excision codes del... Read more

Guess what you need to add to total removal area
Find out where to find F codes and how you'll use them. Back again for 2010 is Medicare's... Read more

News You Can Use:
Conversion Rate Gets Slight … and Temporary … Hike
Also ... if your MAC payments are coming in late, don't stress about it. Remember that hu... Read more

READER QUESTIONS:
2 Codes s Is Too Many on 2-Sided Nosebleeds
Question: An established patient reports to the family physician after sustaining injurie... Read more

READER QUESTIONS:
Scalpel Use Cuts Swath to I&D
Question: A 48-year-old established patient with a plan of care in place for her type II ... Read more

READER QUESTIONS:
Remember to Represent Pressure Ulcer's Stage
Question: An established elderly patient reports to the family physician (FP) for inspect... Read more

READER QUESTIONS:
PFSH Puts Added Value on Some E/Ms
Question: I am having trouble deciding between E/M levels for this encounter: The notes c... Read more

You Be the Coder:
Eye Irrigation and E/M Services
Question: A new patient who had been taking down Christmas tree lights from his house the... Read more

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