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    Dermatology Superbill / Charge Slip

    Does anyone have a dermatology superbill they would be willing to share? Please email to ashleigh@samedical.net Thank you in advance!
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    coding inpatient consults

    If you're the admitting physician for a medicare patient, you continue to use initial hospital care codes 99221-99223 but now must append modifier AI 99221-99223 have always been called "admit codes" because traditionally they were only used by the admitting physician.now we just have to forget...
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    Preventative Exams

    Preventative codes should be utilized. New/est visits are for problem oriented encounters. Insurances may pay this, but it is still incorrect coding and they could recoop that money once they catch the error. Additionally, they're probably being overpaid. For example...one of my payers...
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    Newsletter has gone out

    The first newsletter has gone out -- be sure to check your spam folders. Thank you.... we look forward to future growth of this newsletter project to benefit fellow coders and auditors.
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    Cpma

    The AAPC partnered up with NAMAS. As of 1/1/2010, the CPMA is officially an AAPC credential. All of those who have successfully completed the CPMA prior to 12/31/09 and is in good standing, will be grandfathered in. The AAPC will be the administrator for the credential.
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    95' E/M Guidelines "updated" ?????

    I'm pretty sure this is an interpretation.. not an update. 5-7 may be detailed but what happens if you have 2 organ systems examined and you go into great depth about one? Is that not considered detailed? Well actually it very well may be ... It all comes down to the power of your argument...
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    Layered, Intermediate, Complicated Closure, when do you use this kind of code?

    Whenever an excision is performed, i.e. a lesion, a simple closure is always included. A simple closure can also be called a nonlayered closure. In this instance, only the excision code would be coded. An immediate repair involves: Closure of contaminated single layer wound Layer closure...
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    Conflict of interest?

    If someone is performing billing functions, can they also audit the medical records? or is this a conflict of interest? I'm looking for specific sources. Thank you!!
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    Encoder software programs

    I have encoder pro, just renewed for the second year. Individual license pricing is different then group pricing. Talk to Chad Holder if you're interested. Another new product similar to encoder pro, was just published by Decision Health. They showed us a free demo, which we really liked, but...
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    Review of systems- have a fellow

    Remember the ROS is an expansion on the HPI asked by a series of questions by the provider. I often times see something like "patient complains of ear pain, fever, and nasal congestion" Ear would get location, fever associated signs and symptoms. and then nasal congestion would be a ROS for...
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    E&M codes on superbills by physician

    Just wanted to add that undercoding can spark an audit as well. So commonly we hear about overcoding and fraudulent charges. It's important that together as a team every service provided is coded correctly. Undercoding is usually (though not always) deliberate which can be seen as an inducement...
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    M/S Exam 1997 DG's

    Thanks that's what I was defaulting to.
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    M/S Exam 1997 DG's

    What bullets would you credit for: "Painless range of motion of all major muscle groups and joints" The patient has hip pain. It doesn't specifically state which ones, so if I gave full credit for every area, I'd wind up with lots of bullets which will dramatically impact the level of exam. I...
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    E/M against medical advise

    Nothing except the admission, given documentation supports. Just because a patient leaves, doesn't void out the encounter. If the service was rendered, you report it
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    EMR - Copy & Paste

    I have a practice who for every patient, no matter what their presenting problem is, is copying and pasting the entire comprehensive history "because it helps them get a higher level visit" (quoted by the office manager) The history should be a direct reflection of the nature of presenting...
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    Post chart audit,RE: Diagnosis for MDM

    2,4,5 is just extra information to support risk factors (my opinion) 1 is new problem with work up ... so you have 4 points and that's the highest you can get anyway then we have a point for a radiology test and a medicine test ..2 points Risk is high, cardiovascular imaging w/ risk factors...
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    Prior Auths for inpatient surgeries

    Yeah this happens sometimes. Sometimes the hospital will also get the wrong dates so the auth doesn't match the surgery date or admission date. I know if we get denials for Blue Cross for no preauth, 8 times out of 10 either the pre auth date is wrong or the date of service provided by the...
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    ICD-10 if you don't pass the exam will you lose the Certifcation??

    I don't understand what all the hype is all about ICD-10. I want to take the test. Why wouldn't you? As coders, we are the go-to, the ones who know some pretty important stuff. Think about it, if coders/billers DID NOT exist, would your practice fail? Yes, it would. Each and everyone of you...
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    Location of status of 3 chronic conditions in note

    I agree. Even if it's in the A&P though, it could possibly help towards "RISK" for Medical Decision Making. So your HPI - you have "hyperlipidemia" On the plan - he states "hypertension and hyperlipidemia, ordering labs to check levels, no issues to report" Hypertension wouldn't count...
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    chart auditing classes

    I've been lucky to take both courses. I have the CPMA credential and the CHCA I am awaiting the results (just took a week ago) I preferred the Intensive Chart Practicum vs. the NAMAS course. They had multiple speakers, more information as a whole about auditing (not just E/M) and more detailed...
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    2nd Request - Profesional Liability Insurance

    I'm insured as an individual. I've never had to use it. (Thankfully:)) I think your organization can get coverage for all employees including non-certified staff for errors/ommissions, though the premimum much higher... mine is only $97 per annum paid by my employer. The other certified coders...
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    Need help auditing this chart ROS?

    Complete Why isn't a complete fair? The patient is nonverbal and on a ventilator. The ROS is pulled from the HPI, expanding on the present illness by positive and negative responses. The provider documented the patient's state and why he couldn't obtain any additional information from the...
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    Modifier 58 versus 78

    For the re-do ... did they know or plan on re-doing it?? If so, use 58. I don't consider it more extensive... If it was not planned, use 78. The closure is definitely 58.
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    97 exam bullet

    Laura, it depends and I dislike this as well. If I see HEENT: negative. Who knows what exactly they examined -- it could have ONLY been ears but they still state "HEENT". You will see that some people will give full credit because the 1997 DG's state "you may examine and state negative" for an...
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    Healthcare maintinance

    Providers call things whatever they want ... even if it's not really what it is. Things often get mistitled as well. It is up to us to decipher what the note really is and code it accordingly!:)
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    ROS question/auditing

    Check with your contractor. Trailblazer doesn't allow it. There are 14 systems .... if you say 10 system review -- what systems are you reviewing? This is why Trailblazer wants you to list them individually. You also have a liability here ... providers may just be saying "all reviewed" to get...
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    Who discharges????

    normally a hospitalist sj is the admitting and acts as the attending unless the patient's primary care comes to the hospital and takes over care. Less and less primary cares are coming to the hospital for numerous reasons but that's why we have hospitalists. Is there a discharge NOTE anywhere...
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    Who discharges????

    Typically the attending assumes primary responsibility of the patient's care. It could be a dictation error. May want to check.
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    Big misconception

    CPC-P is NOT an AHIMA credential. It is an AAPC credential. CCS-P, however, is an AHIMA credential. AHIMA is predominently facility-based coding, most employers such as hospitals or other facilities do require AHIMA credentials due to the setting. AAPC is outpatient facility and physician...
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    Healthcare maintinance

    I see quality of care issues here. There is a difference between your "annual check up on your issues" and a "preventative encounter". This doesn't seem like a preventative encounter to me but rather a problem oriented encounter poorly documented. The patient has several illnesses...
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    Breast implant

    Good catch, Anthony ..... 19371 would be appropriate. My apologies. I missed the "otomy" and "ectomy" parts :)
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    Breast implant

    I would go with 19370 + 19328. No CCI edits exist for the code pairs and they are not mutually exclusive.
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    Question

    To me I think this would be more history ... modifying factors.
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    Breast Tissue Expander

    Filler How far is the needle going? If subq ... what about 11950-11954, the code varies based on CC's. Just a suggestion. Otherwise, I'd stick to the unlisted.
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    Just a question??? Please respond

    Me, personally, sure why not. Make a joke out of it -- laughter is always a good start : ) Sometimes I tend to speak fast, then faster, then really fast. I always start out by saying .... just tell me to slow down!!! : )
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    Consults

    Right, it is CMS. I'm not sure what the AMA's stance is ... I'll try to dig around.
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    Consults

    Laura, I'm like you. I totally agree with what you are saying. Last week in my conference, the speaker said during another one of her presentations, primary care physicians sat on one side of the room and specialists on the other. The specialists were arguing about how "every time they get a...
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    Stuck

    I agree with Laura. I would like to think physicians know an admit from an admit and "think" they know a consult from a consult. They tend to steer clear of subsequents. If they marked admit but didn't admit, I would more likely think subsequent because I figure they would mark consult. Either...
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    Legal Question

    Go to the back of the CMS1500 form and read the attestation that the provider is signing their name to EVERY time they file a claim. "Any person who knowingly files a statement of claim containing any misrepresentation or any false, incomplete or misleading information may be guilty of a...
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    Certification For Auditing

    I attended the Intensive Chart Auditing Practicum by AHCAE last week ... I've got to say, it was very informative and the presenters were wonderful ... Susan Thurston was hilarious. I was very impressed by their presention and the materials. They offer the "CHCA" credential that you have the...
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    Level of E/M service for child with fever

    Well, I can't tell you what "level" because I don't know what the rest of the documentation looks like. (history and exam) or if this is a new or established patient. I can, however, point you in the right direction for the medical decision making piece. Otitis media is normally acute, unless...
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    Reimbursement for Nurse Practitioners

    If a NP is seperately enrolled into the Medicare program, and you bill as such, the reimbursement is 85% of the fee schedule. If you are billing incident-to, granted all documentation supports, you are paid 100% because you are billing under the physician's name and provider numbers. Laura is...
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    CPC-H practice exam?

    So this year they are giving out percentages? That's interesting. I wish I knew for my CPC and CPC-H. I'm taking the CPC-P next month so I'm excited to see!
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    Coding an Abscess

    As long as the physician feels that it was complicated, for whatever reason, and the documentation supports it -- and actually states complicated because of ..... -- then it's legit.
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    Ratio of billing Staff to Claims Filed?

    You have to take an average of claims for each physician, add it up, and figure out your productivity standards for your billers. If you have on average 320 claims to file per day, and you feel like your billers should put in 100 per day, you would need roughly 3 full time employees... just an...
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    Intensive Chart Auditing Practicum by AHCAE

    Hey guys, just wondering if anyone has taken the intensive chart auditing practicum put on by AHCAE?? I will be attending the next week long class in Arlington next week and just wanted to hear what others had to say! :) If anyone else is attending, I would love to meet up!!!
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    Medical Records Auditor Available

    I don't think this is a job opportunity. Sounds to me like this poster is advertising themselves as a consultant looking for auditing work.
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    Charge capture checks and balances

    Our facilities provide a complete listing of all cases each week. For hospital charges, we just go into the web based system and pull down the census for a given day and start pulling notes, etc... If the physician is doing his own coding then we'll just check against the listings to be sure...
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    Global billing issue

    Told ya;) Just remember ... when it comes down to a provider and their "personal money" ... pull that contract !!! :D Everything is usually clearly defined. So thankfully no action needs to be taken! Stressing out over nothing! Happy Friday!
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    Global billing issue

    I wouldn't refund anything either. It's apart of leaving a practice, a surgical one at that. Anytime you leave a practice to start a new clinic or join a new clinic there is loss of revenue -- and that's just one source.
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