Pulmonology Coding Alert
Must You Always Follow NCCI Edits?
We follow NCCI for Medicare, Tricare and Medicaid. When billing commercial payers, do we have to follow NCCI edits or CMS guidelines? Virginia Subscriber Because payers do not use the same claim edits, some coders prefer to code per insurer These practices either employ large billing staff who can focus on various regulations or are small and handle a low volume allowing this specificity. If the edits contradict specialty-society guidelines, you should work with the society, such as the American Thoracic Society or the American College of Chest Physicians, and the payer to alert them to the inappropriate edit. Before reporting two bundled codes, make sure documentation justifies billing them separately.
Pulmonology Coding Alert
- Look for This $125+ Boosting Phrase in Diagnostic Scope Notes
Error averted: Drop 31575 when biopsy occurs Reporting 31575 when your pulmonologist actually performed 31525 [...] - You Be the Coder:
How to Weigh Vent Management Vs. E/M
Question: A pulmonologist visits a patient with acute respiratory failure in the medical intensive care [...] - 6 Tips Keep Your Inpatient E/M Coding On The Up-And-Up
Medicare overspends millions on upcoded inpatient visits Carriers are scrutinizing your inpatient hospital visits more [...] - OIG Is Watching Your Doctor's Nursing Home Visits
Part B payments 'vulnerable to fraud,' watchdog says Nursing homes could be hotbeds of inappropriate [...] - Reader Question:
You Can Refer to MD-Owned Sleep Lab
Question: We are a pulmonology clinic plus a sleep lab with two beds, and we [...] - Reader Question:
Stick With Nonspecific Code for MIPs & MEPs
Question: What is the correct way to bill for maximum inspiratory pressures (MIPs) and maximum [...] - Reader Question:
Must You Always Follow NCCI Edits?
Question: When specialty society guidelines differ from National Correct Coding Initiative edits, a commercial payer [...] - Reader Question:
Report Bilateral 32002 on One Line
Question: I submitted documentation with a line-itemized claim for three same-day services/procedures as follows:
--99233-25 (Hospital [...] - Reader Question:
Look Beyond HPI for Chronic Condition:
Question: The 1997 audit guidelines state that I can reach an extended history by updating [...] - Reader Questions:
Use This Diagnosis for Asthma With Croup
Question: An established patient with a history of asthma who is now taking Albuterol presents [...] - Prove Patient Is 'Critical' When You Report 99291
CPT considers many services part of the critical care package When deciding whether your pulmonologist [...]
