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Pulmonology Coding Alert

Eliminate VAP Uncertainty With Clear Diagnosis Parameters and E/M Options
Tip: Other conditions 'mimic' ventilator-associated pneumonia and can lead to misdiagnosi... Read more
Avoid Unnecessary Ire from CMS:
Don't Overuse VAP Diagnosis
While not yet a 'non-event,' CMS has its eye on VAP. Ventilator-associated pneumonia (VAP... Read more
Master Pulmonary Diagnoses Coding With These Proven Tips
Focusing on acute conditions, exacerbations can whip these claims into shape. Correctly r... Read more
Don't Overlook 3 Key Coding Opportunities for Pulmonology Claims
You could be turning away your rightful reimbursement for scores of services. Medicare co... Read more
READER QUESTIONS:
Learn How to Code Multiple Xolair Injections
Question: Often, asthma patients must receive multiple administrations of Xolair and I am... Read more
READER QUESTIONS:
Don't Get Stumped by Observation Care
Question: I am not sure when to use observation care versus subsequent hospital care. Can... Read more
READER QUESTIONS:
Can You Bill Incident To Using 1 NPI?
Question: Is there any circumstance in which a group can bill all services and all provid... Read more
You Be the Coder:
Rest Home Service Versus CPO
Question: A new patient who resides in an assisted living facility was treated for emphys... Read more
Spirometry Coding:
Testing, Global Modifiers, Bundling, and More
Tip: Consider appending modifier 59 when reporting a six-minute walk. Your practice perfo... Read more
Expedited CPT Codes Now Available for H1N1 Immunizations
New codes from CMS help speed the reimbursement process. You won't find two newly release... Read more
Become a Master of Time With These 2 Critical Care FAQs
Beware: CPT, CMS differ on 'family discussion' parameters. When the physician treats a pa... Read more
READER QUESTIONS:
Understand 'Constant' Attention for 99291 Coding
Question: A pulmonologist recently attended to a patient with chronic asthma in the inte... Read more
READER QUESTIONS:
Pinpoint What Makes Modifier 59 'Distinct'
Question: Recently, I have received denials for services to which I appended modifier 59.... Read more
READER QUESTIONS:
Ensure Correct Sleep Study Diagnosis, Equipment
Question: We have reported an unattended home sleep study with 95806 with place of servic... Read more
READER QUESTIONS:
Is Inpatient Code OK for Observation Patient?
Question: I've been told to use a standard outpatient consult code (99241-99245) for a pa... Read more
You Be the Coder:
Identify Split Visits by Spotting Shared Effort
Question: The pulmonologist admits a 78-year-old established Medicare patient suffering f... Read more
Ventilator Management vs. E/M Codes:
This Guide Helps You Make the Call
Boost reimbursement by 70% on subsequent care days with 9400x in lieu of low-level E/M. P... Read more
Connect the Dots:
Recognize the Diagnosis Codes That Spell Ventilator Management
If you're wondering if you have covered all your diagnosis possibilities when coding a pat... Read more
Service Doesn't Meet Incident-To Rules? Report Under Non-Physician Practitioner's NPI
Don't take unnecessary risks for 15 percent more pay. Incident-to rules don't always appl... Read more
Do Admit Codes and Admission Have to Show Same DOS?
Overlook this rule and risk leaving E/M dollars on the table. When the physician admits a... Read more
Reader Questions:
Know CMS Criteria for PSG Pay
Question: Can you explain CMS's criteria for covering sleep studies, whether they occur i... Read more
Reader Questions:
Unwind PFT Coding Distinctions
Question: Can you help delineate the difference among the different types of pulmonary fu... Read more
Reader Questions:
OK if Hospital/Physician E/Ms Don't Match
Question: If the physician performs tube or catheter removals in a hospital exam room, sh... Read more
Reader Questions:
Prevent Concurrent Care Denials
Question: An internist treats an established patient with controlled type II diabetes wit... Read more
You be the Coder:
DOS Matters for Repeat Bronchoscopies
Question: If a patient has an initial and a subsequent therapeutic bronchoscopy on the sa... Read more
Sail Through ICD-9 2010 Updates With This 3-Step Approach
Chronic embolism and new flu codes top the list of respiratory coding changes. Starting O... Read more
That's Not All:
ICD-9 2010 Unveils 4 More Code Types You Should Know
More specificity for bronchial valve replacement and thrombosis location. The 2010 ICD-9 ... Read more
Eliminate NPP and Support Staff Coding Errors
Proper incident-to and shared consult reporting prevents errors. If you glean anything fr... Read more
3 Steps Prep Your Pre-Op Consult Claims for Success
Here's why listing V codes may be OK -- but watch your documentation. If you fear a ... Read more
READER QUESTIONS:
Pinpoint Asthma's Cause Before You Assign Diagnosis Code
Question: We have been unable to find a code for exacerbation of mild, intermittent asthm... Read more
READER QUESTIONS:
Don't Forget To Report Steroid Therapy History
Question: I see that ICD-9 2010 introduced a new code for personal history of inhaled ste... Read more
READER QUESTIONS:
Brace for Potential End to 99241-99255
Question: I'm hearing that consultation codes may go away in 2010. How could this affect ... Read more
READER QUESTIONS:
Avoid AQ Mod if You're in CMS's Automated File
Question: I'm confused about whether to apply modifier AQ on my claims that qualify for H... Read more
You Be the Coder:
Diagnosis Trumps Length of Sleep Recording
Question: A patient slept for less than six hours and had polysomnography recording of le... Read more
Avoid Auditor Review:
Get Up to Speed On CCI 15.2 Edits
Subsequent IV push coding is the biggest change for pulmonology practices. If you are int... Read more
Don't Overlook Modifier 59 When Reporting 31625
While not part of the CCI 15.2 edits, you should be alert to a hidden coding opportunity i... Read more
Review -- But Don't Dwell On -- CCI 15.2 Column 2 Updates
Stay in the loop with new anesthesia, nursing home discharge, and observation care rules.... Read more
488 for H1N1? Watch Your Date, Final Digit
These updates keep your swine flu coding on track -- now and in the fall. Before you... Read more
Does Prolonged or High-Level E/M Represent Your Work?
This checklist deters payback requests for insufficient +99354 time. After spending almos... Read more
Reader Questions:
Document Necessity, IgE Level With Xolair
Question: Can you clarify which injection code to use with Xolair administration and what... Read more
Reader Questions:
Base Critical Care On Condition, Not Location
Question: I reported critical care (99291-+99292) for two encounters the pulmonologist ha... Read more
Reader Questions:
Count HPI to Choose Right E/M Level
Question: I am having some trouble understanding the elements of history of present illne... Read more
Reader Questions:
Graduate Nurses Limited By 30-Day Rule
Question: I have a question about the 30-day rule for new providers. The sequence in our ... Read more
You Be the Coder:
Fight Denials On Office Visits With PFTs
Question: Recently, several insurance plans denied coverage for an office visit when repo... Read more
Don't Miss These Coding Opportunities With Your Pulmonary Rehab Program
This Q&A gets you up to speed on correct coding and documentation for PR payments. Wh... Read more
Rely on CPT Codes to Bridge the PR Payment Gap
When G codes are off limits, consider coding for inhalation treatments and chest manipul... Read more
9922x versus 9923x:
Initial Care Isn't Always A Shoo-In On Same-Day Postdischarge
Tip: Find out the reason for readmission before you code. Myth: Once you discharge a pati... Read more
PR Relief:
New NCDWill Promote Increased Access and More Consistent Reimbursement
2009 came and went without national PR coverage, but many hold high hopes for 2010. If yo... Read more
Reader Questions :
Opt For E/M Over Ventilation Management
Question: Through a recent denial I learned that I cannot report both a ventilation thera... Read more
Reader Questions :
Use Visit Length to Determine Subsequent Care Code
Question: My pulmonologist frequently provides care in the nursing home setting -- a... Read more
Reader Questions :
Observe Smoking Cessation Counseling Frequency Limits
Question: Do I still need a plan and referral to support smoking cessation counseling? Wh... Read more
You Be The Coder :
Clarify Multiple Lobe Modifier Use
Question: Can I append 59 (Distinct procedural service) to 31625 if the pulmonologist bio... Read more
Forge Ahead on Allergy Management With These Concurrent Care Tips
Your pay hinges on differentiating pulmonologists role from allergists. ... Read more
ReviewThese Keys to Concurrent Care Reimbursement
These codes tell you when care justifies 2 specialists. Before you brace ... Read more
CheckYour E/M Coding Skills With This Quick Quiz
This family visit reporting advice will help you apply the right regulations. ... Read more
How DidYou Fare in Testing Your E/M Coding and Billing Skills?
If you answered all 3 questions correctly, youre a Part B ace. Now ... Read more
Watch Out:
E/M Codes Top the List of CERT Mistakes
Physicians documented their  subsequent hospital care poorly. ... Read more
READER QUESTIONS :
Organize Flu Vaccines by Method and Payer
Question: We currently have an onslaught of patients requesting flu vaccines a... Read more
READER QUESTIONS :
Append 22When Physician Goes Extra Miles
Question: I have appended modifier 22 (Increased procedural services) to some ... Read more
READER QUESTIONS :
Consider ConsultationsWhen Reporting Discharge
Question: A family practice physician admitted a patient for treatment of seve... Read more
READER QUESTIONS :
Prepare Now for Proposed Respiratory ICD-9 Codes
Question: I heard recently that the Federal Register released new proposed ICD... Read more
You Be the Coder :
Code for PFTs With Signs and Symptoms
Question: Im wondering if other offices report pulmonary function tests (PFTs)... Read more
Claim Your Share of the Sleep Study Pie With This CMS Policy Rundown
Medicare promises to cover facility and home-based testing -- as long as you meet t... Read more
You're Not Home Free -- Sleep Studies Still Under Scrutiny in '09
Watch for more treatment criteria from CMS on the horizon. While so... Read more
Top-Notch Diagnosis Coding Key to Concurrent Care Claims
$$$ can fly out the door if ICD-9 overlap afflicts claim. Getting t... Read more
Overwhelmed by More Than 300,000 New CCI Code Pair Edits? Don't Be
Dont worry: CCI changed little for pulmonologists. While many pract... Read more
Follow These FAQs to Maximize 99291 Coding
Physician preventing further deterioration is key to valid critical care claim... Read more
READER QUESTIONS:
Do Not Unbundle Plethysmography and Airway Resistance
Question: Has anyone heard any definitive information regarding a respiratory ... Read more
READER QUESTIONS:
Consider Payer Preference for Cessation Counseling
Question: My pulmonologist wants me to make sure we are capturing the time he ... Read more
READER QUESTIONS:
Capture Injection With 2 Items
Question: The physician I work for has the nurse routinely give shots such as ... Read more
READER QUESTIONS:
Tread Carefully When Coding Locum Tenens
Question: When you report locum tenens (stand-in physician) services,should yo... Read more
You Be the Coder:
Bronchoscopy Through Established Tracheostomy Leaves Questions
Question: How do you code a bronchoscopy that is done through an established t... Read more
Achieve Full Payment for Dispensing Advice with These Consultation Coding Tips
Don't make this common post-op consult coding error. Consultation coding -- with all... Read more
Use Observation Coding Steps to Capture 'Patient Limbo' Period
Deciding on admission? That's your signal to look at observation family. You can quickly ... Read more
Steer Your Incident To Coding Using These 2 Questions
100 percent pay is possible if NPP follows physician's plan of care. If you do not consid... Read more
Use Inside Info to Prevent HPI Rule Hunt
In CMS's eyes, this element is your pulmonologist's duty. Although support staff might wa... Read more
READER QUESTIONS :
Critical Care Time Not Limited to Bedside
Question: I've heard that the pulmonologist doesn't need to be in the room with a critica... Read more
READER QUESTIONS:
Use 94664 for Advair Tutorials
Question: Should you use 94664 for education/training with the Advair Diskus? Wisconsin S... Read more
READER QUESTIONS :
Identify Split Visits by Spotting Shared Effort
Question: A 78-year-old established Medicare patient suffering from chronic obstructive p... Read more
You Be the Coder:
Infusion Codes Necessitate Constant Supervision
Question: We recently received a denial of infusion code +96366 even though it was a mult... Read more
Protect Your Sleep Study Pay by Minding These Documentation Essentials
Know your most cost-effective options and how to stay off of Medicare's hit list. You sho... Read more
Nail E/M Levels With ROS Documentation Skills
Beware: Multi-system reviews must exceed system elements in HPI. Don't open your practice... Read more
Recognize Incident-To Services or Pay the Price
Hint: Doctor's schedule will be the key. Under incident-to rules, qualified nonphysician ... Read more
READER QUESTIONS:
Call On Respiratory Diagnosis for Wheezing
Question: Concerning the coding of acute bronchospasm (519.11), when is it appropriate to... Read more
READER QUESTIONS:
Code Carefully on E/Ms With Coumadin Tests
Question: If a qualified nonphysician practitioner (NPP) performs a finger-stick Coumadin... Read more
READER QUESTIONS:
Combination Codes Mark COPD With Other Conditions
Question: The pulmonologist treats a patient with shortness of breath and coughing. The p... Read more
READER QUESTIONS:
2 Hospital Visits: 1 E/M Service or 2?
Question: A private payer representative informed my physicians that they can bill for mo... Read more
READER QUESTIONS:
Know Your Once-in-a-Lifetime Medicare-Covered Vaccinations
Question: We have several average-risk Medicare patients scheduled to come in for pneumon... Read more
You Be the Coder:
Before Coding 94664, Check Off These Items
Question: Under the direction of my pulmonologist I recently submitted 94664 for reimburs... Read more
Sail Through Multiple Endoscopy Coding Hurdles with this Surefire Advice
These modifier tips tell you how to ratchet up reimbursement. With frigid temperatures ex... Read more
Advise Smokers to Quit to Score Preventive Points
It's not as hard as you think to start benefiting from CMS's incentive plan. Encourage pa... Read more
Watch for Preservatives, Payer on Flu Shots or Risk Denials
G codes will ensure that your Medicare claims process smoothly. Remember the different re... Read more
READER QUESTIONS:
Dispel PQRI Participation Mysteries With These FAQs
Question: Reporting on these measures sounds complicated and I am not sure my office has ... Read more
READER QUESTIONS:
Coding 'Probable' Dx Will 'Likely' Mean Trouble
Question: A new patient reported to the pulmonologist complaining of wheezing and shortne... Read more
READER QUESTIONS:
Think Twice Before Filing for Interpreter Service
Question: Which diagnosis code should I use with T1013 for using an interpreter with a Me... Read more
READER QUESTIONS:
Include Central Line Placement Code on Critical Care Claim
Question: A 22-year-old motor-vehicle accident victim reports with multiple injuries, and... Read more
You Be the Coder:
ICD-9 Coding for COPD/Bronchitis
Question: A new patient reports to the pulmonologist complaining of shortness of breath a... Read more
Zero In on These 2 Quality Measures to Earn Your CMS Bonus Check
You can even get credit for reporting that a patient did not meet criteria.All coding conf... Read more
Prevent Shot, Hydration, IVIG Code Denials With This Guide
Overlooking Synagis treatment change will delay $21 per claimYou can save countless hours ... Read more
Never Assign E/M Codes Based on Length of Documentation
Instead, base your code choice on the documentation's content.Coding an E/M visit based on... Read more
Sleep Test or Polysomnography? Here's How to Tell the Difference
They may seem similar, but there's a big difference between your physician conducting a "s... Read more
Reader Questions:
What Are CMS's Proposed Guidelines for Non-Credentialed Physicians?
Question: I've heard how practices can hold a physician's claims while waiting for Medicar... Read more
Reader Questions:
Combat FluMist Denials by Following This Rule
Question: We have begun administering FluMist along with well checks and other immunizatio... Read more
Reader Questions:
Get CLIA Waiver, and You Can Bill for Simple Labs
Question: During a practice meeting last week, the subject of Clinical Laboratory Improvem... Read more
You Be the Coder:
Discern When to Code Presenting Symptoms
Question: An established patient reports to the pulmonologist complaining of trouble breat... Read more
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