When Clock Strikes Midnight, Switch Up Observation Coding. Calendar days pace observation service coding.
The rules for observation coding are typically pretty straightforward. Pick 99218-99220 for the first day when the patient is in observation for multiple days; pick 99234-9236 if the observation lasts more than eight hours on a single day. Monkey wrench: Are you prepared, however, for an observation visit that spans two days but only lasts a few hours? We asked Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting in Lansdale, Pa., for her take on these types of observation services.
Nuts and bolts: Regardless of what time of day you admit the patient, it’s the date on the calendar that matters, Falbo says. So if the patient is admitted late one night and discharged a couple of hours later the next morning, you’ll report 99218-99220 for the initial observation service and 99217 for the discharge. Consider this clinical example: Key on Components for Accurate ROS Count. Higher-level E/Ms possible with complete ROS.
When your physician provides an evaluation and management (E/M) service, a vital part of the history component is the review of systems (ROS). In short: There are three levels of ROS, and your level of ROS coding will need to be spot on if you’re to choose the proper code. Put 26 to Work for Many Off-Site Services. When you’re only claiming the code’s professional portion, include this modifier.
If your physician performs a service in a location where he doesn’t pay the rent, you should be on the lookout for a potential modifier 26 (Professional component) coding situation. Why? Often, a CPT® code’s relative value units (RVUs) are broken down into a technical component and a professional component; you’ll append modifier 26 when your physician only provides the professional component, explains Suzan (Berman) Hauptman, MPM, CPC, CEMC, CEDC, senior principal of ACE Med, a medical auditing, coding and education organization in Pittsburgh, Pa. Coders employ modifier 26 most commonly in “office or outpatient facilities when the equipment is the property of the clinic or facility, and not [your] physician,” Hauptman explains.
Avoid Denials for Unrelated Postop E/Ms with Modifier 24. Modifier separates E/M from normal surgical aftercare.
When you’re coding for your provider’s surgical services, you’ll need to be familiar with modifier 24 in case the same provider performs an unrelated E/M service on the same patient during the postoperative (global) period. Avoid E/M denials during the postop period with this expert advice on what to do when a patient reports for a problem unrelated to a recent surgery. Append 24 to Unrelated Postop E/Ms During Global Use modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period)) if the physician who performed a surgical procedure “sees the patient during the postoperative period for an [E/M] service unrelated to the surgery,” says Suzan (Berman) Hauptman, MPM, CPC, CEMC, CEDC, director of PB Central Coding at Allegheny Health Network in Pittsburgh, Pa.
Let This Example Guide Your Arthroscopic Injection Coding. You might need multiple modifiers to make fluoroscopy/injection claim fly.
Coding for arthroscopic injections can become a maze of confusion quickly if you don’t sort out the details before you start; you have to check for codeable procedures that the physician might perform for each injection. If you want to squeeze every ounce of reimbursement out of these injection claims, check out this real-world case study from a coder in Nevada: “Our physician recently performed multiple arthroscopic injections. The documentation indicates that she performed two separate injections: one on the patient’s left finger and one on the right elbow.
“The notes also state that the physician used fluoroscopic guidance for both injections. Use AJ/AH to Capture CSW/CP Services. Payer preference drives decision to use modifiers.
If you’ve ever gotten a puzzling denial for a psychotherapy session provided by a clinical psychologist (CP) or clinical social worker (CSW), you’re not alone. There is many a coder who has been flummoxed by payer peculiarities for these services. The problem could have been as simple as a missing modifier. Orthopedic Coding and Billing Alert Newsletter. We deliver in 7-10 business days.
Orthopedic-Specific Advice for Correct Coding, Reimbursement and Compliance! Orthopedic coding and billing is no walk in the park, but knowing your fundamentals can help. ICD-10 Coding Alert - Updates, Implementation & Guidelines. We deliver in 7-10 business days.
Prepare Now for Sweeping ICD-10 Coding Changes. ICD-10 implementation is coming in 2015 and it’s not too early to learn what those changes will mean for your commonly-coded diagnoses. Pain Management Coding Alert: Latest News, Guidelines, & Expert Insight. We deliver in 7-10 business days.
Tips, Strategies and Guidelines for Accurately Coding Pain Management Procedures! ICD-10 implementation is on every healthcare professional’s mind, but don’t forget about another important round of changes you need to master: CPT® updates for 2016, HCPCS changes, modifier updates, and the latest NCCI edits. Q&A: Set Firm, But Flexible, Policies for No-Shows. Experts recommend making exceptions for emergencies.
How to deal with no-show patients. It’s a frequent problem for many medical practices, and no-show best practices are a matter of constant debate. Dilemma: On one hand, you want be fair to the patient. Practices have to be firm with patients as well, however, or no-shows will only increase. To get a handle on how to deal with no-shows in the most balanced way possible, we checked in with Cyndee Weston, CPC, CMC, CMRS, executive director of the American Medical Billing Association (AMBA) in Davis, Ok. Keep Consistent Copay Policies to Reduce Headaches. Experts: Get a financial agreement form on file ASAP If you work in a medical office that hasn’t ever had any trouble collecting copayments for some patients, consider yourself lucky.
“My [office] goes through [copay] issues every day, says James P. Bartley, MS, Med, practice administrator for Women’s Healthcare of New England, an ob/gyn practice in Norwalk, Conn. And each issue has its own unique challenges. “There’s never a black and white answer for the situation,” Bartley continues. Check out these best practices on collecting copays and avoiding patient ire. Responding to Patient Records Requests? Follow This Expert Advice. Be as accommodating as you can with patients who want to access their info. Patients requesting access to their medical records should be a top priority for any practice that wants to stay compliant and trustworthy. The basics: A patient has every legal right to her medical records, and if you don’t provide access ASAP, not only could you run afoul of the law — you could erode patient trust in the process. Maria V. Are You Sure About that ‘Simple’ FBR? It Could Be an E/M.
Payers require specific criteria for 10120. A patient steps on a splinter from a holiday tree, or some other foreign body (FB), and your physician performs a foreign body removal (FBR). You should choose an FBR code for the service, right? Well … maybe: The service might not qualify for the CPT® definition of FBR, and in these cases you’ll have to choose the appropriate E/M code instead. Check out this primer on coding basic FBRs to make sure your claims don’t splinter at the payer’s door. Can’t Prove Incision? Want to Max Out Lesion Coding Returns? Measure Specimens Pre-Path. Remember: Include healthy tissue provider excises in final tally. When faced with a lesion excision claim, you’ll need to follow a couple of specific guidelines to carve out all your deserved reimbursement.
The basics: Obtain the proper excision measurements — and properly ID the pathology of the lesion — and you’ll be on your way to a proper claim for these procedures. Get ahead of the game with a couple of tips on these vital components in your lesion coding machine. Measure Margins, Wound Area When a provider performs lesion removal, he will remove the lesions as well as margins of healthy tissue around the wound. Ignore Anatomy in Favor of Depth on Multiple Debridements. With these services correct coding is all about the wound type. When the physician performs multiple skin debridements for the same patient, you’ll need to know what separates a “surface” debridement from a deeper one, as it is the most important factor when coding these services.
The basics: Most physician practices will perform two types of debridement in-office. Report 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less) if notes indicate that the physician debrides a “surface” wound (down to the epidermis or dermis). Opt for 11043 (Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less) when the notes indicate that the debridement extended to the muscle/fascia.
Check Out How Separate Diagnoses Can Result in an E/M-25. Leave E/M-25 off the claim unless you can prove E/M components separate from the procedure. Coders will need to use modifier 25 on the E/M code when the provider performs a procedure or service, and also treats an entirely different problem with an E/M during the same encounter. Rely On Modifier 54 When You’re Breaking Up Fracture Care. If physician provides operative care only, you’ll need modifier to clarify claim. When your physician provides fracture care for a patient, but does not follow up with any postoperative care, coders need to be ready to append modifier 54 (Surgical care only) to the fracture care code in order to code the encounter correctly.
Make E/M Decision First to Plug Nosebleed Coding Holes. If provider furnishes separate E/M before repair, remember 25.