Archive for the Week of June 9, 2006
Archive for the Week of June 9, 2006
Welcome to the medical billing blog archive for the week of June 9, 2006.
Here you will find links to every article added to the Outsource Management Group web site during the week of June 9, 2006.
You can browse this week's archives by clicking the "More" button from any of the excerpts below.
Expanded Service Codes Prove Good for Pediatricians
There are two new care plan service codes that are hopefully going to solve the telephone billing problems and the care plan review for children that are not under a home health agency’s care. On January 1, 2006 the new CPT updates went into effect and pediatricians have seen three basic E/M changes. 1) The patient is not required to be under the care of a home health care agency, nursing home or hospice. 2) Supporting documentation must support use of modifier 25. 3) Confirmation consultation codes are 99271-99275. The CPO codes will no longer have the rule that a hospice, home health agency or nursing facility has to supervise …
Quick Submission Equals Quick Reimbursement
There are many issues that can affect your medical billing claim turn around time. ED visits are notorious for having slow claim submissions and incomplete records. And there are some factors you simply cannot manage. Electronic filing versus paper filing is one thing you can control. Medical billing is much quicker if electronic charts are used. As soon as your patient presents in your clinic, the medical billing clock begins to tick. Every piece of information that is gathered from the time of arrival, until a treatment is successful is put into a file. These medical records are used for medical billing many times. Incomplete medical records or the lacking …
Correct Medical Billing Reimbursement For 77470
There are some cases when certain medical billing practices can get your office more financial reimbursement. The use of the current procedural terminology code 77470 is one of those instances. This code, however, cannot be used all of the time. There are certain things you must keep in mind before using the medical billing code 77470 for your claims. Sometimes the physicians in your clinic can see patients with special needs. For instance, an oncologist may see a patient that has a pacemaker. The pacemaker can make visits and treatment plans more time consuming for the physician. In this instance, the medical billing code 77470 may be used. 77470 in …
Proper Usage of Modifier 59
The HHS Office of Inspector General (OIG) found that there is an enormous amount of claims in which modifier 59 is being misused. The misuse is completely unintentional and is largely due to the confusion this modifier causes with many practices when the medical coding is being generated. A random sample of 350 code pairings of samples was taken by the OIG. These random samples were ones that had bypassed the NCCI (National Correct Coding Initiative) edits by using the modifier 59. The OIG also found that about 40 percent of the code pairs they examined didn’t meet the requirements of the program. This translates to roughly $59 million dollars …
Correctly Using Modifier 22 in Your Medical Billing
In medical billing, modifiers can be just as important as the CPT codes they append. A simple mistake such as miss sequencing these codes could lead to incorrect reimbursements. There is one modifier that is known as being the most incorrectly used modifier: 22. Modifier 22 (Unusual procedural services) is used to indicate a substantial amount of extra work a physician needs to do for a specific procedure. As a matter of fact, there are some procedures that never get separately reimbursed unless modifier 22 is used in medical billing. The lyses of adhesions are one example of this. The lyses of adhesions are a procedure that is always bundled …
Medically Unbelievable Units Not a Worry- For Now
The Centers for Medicare and Medicaid Services (CMS) were due to implement an additional restriction on the reporting of units of service that was to begin on July 1st. The CMS has decided to not to use the “Medically Unbelievable Edits” (MUEs) that would have restricted the units of service you could report on your medical billing claims. Based on concerns from physicians and medical billing and coding professionals alike, the CMS has pulled the planned implementation of this program for further review. This change to MUEs reimbursements would have affected roughly 1,000 laboratory and pathology CPT/HCPCS codes. The MUEs would have limited the number of times you could bill …
How to Bill MRI Claims for Maximum Reimbursements
In many instances, when a patient receives both an IAC and brain MRI, many practices mistakenly bill only for one service or the other. However, in most cases, both procedures can be reimbursed. The criteria for both procedures to be reimbursed are contingent in the fact that they must be performed in the same session. The requirement to code for both services is that they need two separate and distinct exams. Each exam is required to have distinct findings and you must have a medical necessity and documentation to back up both claims completely. If you find this situation confusing, you’re not alone. The fast changing world of medical billing …
Medical Billing Tips to Reign In Your Global OB Coding
The following tips will help to ensure success for your global ob packages every time. Make sure that you are getting the maximum reimbursement for your medical billing claims. 1. Make certain that all of your ICD-9 selections for OB billings have been chosen from the 640-678 range of diagnoses. 2. Always code to the highest specificity when you must add a fifth number to denote the episode of care (as in a case of complications mainly related to pregnancy, 651-659)a. Unspecified = 0b. Delivered, with or without a mention of an antepartum condition =1c. Delivered, with mention of a postpartum condition = 2 d. Antepartum condition or complication =3e. …
