Archive for the Week of April 20, 2006
Archive for the Week of April 20, 2006
Welcome to the medical billing blog archive for the week of April 20, 2006.
Here you will find links to every article added to the Outsource Management Group web site during the week of April 20, 2006.
You can browse this week's archives by clicking the "More" button from any of the excerpts below.
Three Questions Solve IM Injection Medical Billing Challenges
CPT 2006 injection administration coding instructions require that you verify the OB-GYN’s involvement in order to report 90772, or in order to submit the non physician performed procedure as 99211, or it could depend on the payer’s incident-to policies, and possibly be returned to you as a no charge. To determine which code applies to injection administration, you need to ask yourself three questions. 1. Is the Doctor in the office and available during the injection? If the answer is yes, the OB-GYN provided direct supervision throughout the subcutaneous or intramuscular injection, then you can report 90772 (which is therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or …
3 Ways to Ease Modifier 25 On Your Medical Billing Claims
The AMA provides some helpful clarification on when to append modifier 25 in CPT 2006, but you might still need a little more information on how to ace those claims. Here are three tips to help you out. Report only significant services. In order to gain separate payment for an E/M service, the physician provides at the same time as he or she provides another service or procedure, the E/M service must be significantly and separately identifiable. All procedures include an inherent E/M component according to CMS guidelines. Any E/M service you report beyond that must be above and beyond what is normally included with that procedure or service. Always …
How to Dx More Than One Severity Level on Your Medical Billing Claim
Example: a patient presents with both first and second degree burns on their face. You should report only the more severe (in this case second degree) burns when assigning diagnoses for burns in the same anatomical location. For example, the codes beginning with 941 describe the face, head and neck burns. For burns to the trunk, you would use the 942 series, and codes 943, 944, and 945 are for burns to the arms, hands, and legs, respectively. Remember that you should never report a first degree burn separately with the 941-946 series if there are more severe burns on any other part of the body, except when treatment is …
Medical Billing News -AMA Eliminates Modifier Hyphen
You may have noticed in recent coding alerts that there is no hyphen included before a modifier. The AMA has done away with using hyphens before modifiers. This change occurs in CPT’s coding manuals and CPT assistant as well. The AMA used the hyphen as a formatting convention in order to ensure that people realized that an upcoming number was a modifier. The symbol avoided numerical confusion as well. The hyphen would alert a reader that the last two digits, such as “-25” were not a part of the CPT code. This should not be a huge change, since most people are most likely used to looking at modifiers without …
Three Rules for Observation Medical Billing Coding
There are three rules that govern observation coding. Let’s use for example a case in which a surgeon admits a patient for observation at 9 p.m. and releases the patient the next day, at 1 a.m. Follow these three rules, and you will be all set. 1. If a physician admits a patient for observation and releases the patient on a different date of service, if the total duration of the observation stay is more than eight hours, you should report 99218-99220 with 99217. If a stay lasts multiple days, you may report one unit of 99218-99220 for each date of service, except the date when they physician discharges the …
Apply a Flat Fee for Sedation Codes
A provider that is not an anesthesiologist, such as a pediatrician, should use the new moderate sedation codes (99143 – 99150) to capture the charge for the procedure’s base units. These codes eliminate any need to bill extra units. You should ignore billable units and use new time-based codes instead. For example, a 4 year old presents for an MRI performed by a radiologist. A pediatrician provides moderate sedation throughout the procedure. The sedation lasts for thirty minutes. Before, you would have coded this sedation by with anesthesia code 01922. Because this procedure has seven base units and 2 time units, you would have billed 01922 x 9. On new …
E/M Might be the Answer to BCP for Acne
Birth control pills for acne can be a perplexing coding problem. Occasionally, we come across a case in which a patient obtains birth control pills because her dermatologist recommended them to help clear up an acne problem. Some people say that we should not even code the birth control pills (oral contraception), but if this is the only problem that the patient presented to the OB-GYN for, does that mean that we should still not code for it to keep with specificity? E/M might be the answer to this particular problem you may come across. If an OB-GYN prescribes birth control pills (BCPs) to a patient for acne problems, that …
