Medical Billing Blog: Section - Claims
Archive of all Articles in the Claims Section
This is the archive containing links to all articles written in the Claims section of our blog.
Click any of the article links below to read the entire article or browse another section to the right to read articles on another subject.
Neonatal Dilemma – Should You Have Separate Charges for Separate Procedures?
The smallest patients can present the largest and most confusing problems in medical billing. There can often be confusing scenarios that occur during neonatal procedures that many medical billings can find confusing. It could be due to the fact the patient is so tiny that many of the procedures seem related to split out but in many cases, claims for neonatal services are incorrectly bundled together. A good case in point would be if a neonatal patient presented with a fever. The physician then did a urine catheterization (51701) and a spinal tap (62270) in the office. In many cases, the medical biller might have bundled these claims together but …
The Truth About Pediatric PHI
Patient history, or PHI is an aspect of medical billing that has a myth attached. Contrary to popular belief, it is safe practice to allow any permanent office member to take the review of systems and the family social history. These two evaluation and management history elements can actually be taken by absolutely anyone that is employed by the practice. It is ok in medical billing for even a parent or a secretary to take down this information as long as the information is reviewed and signed off on by the acting pediatrician. The only part of an evaluation and management visit that the physician or nurse practitioner must complete …
With Code 21 – It’s Location, Location, Location!
As you know in processing medical billing for hospital based claims, location of services is everything and you must be certain that the correct place of service coding is used. That is where code 21 comes in handy. Place of service code 21 is used in medical billing for all inpatient hospital care. Code 23 is a lesser used code, but also useful. Admittance of a patient to the hospital will make it necessary to use the inpatient hospital POS code 21. Many medical billers get confused when the emergency department comes into play. They question whether or not they should use place of service code 23 for emergency room-hospital, …
Tips for Getting Open Repair Medical Billing Right
When a patient presents with an abdominal aneurysm, there is usually a graft repair procedure performed. This usually involves exposing the affected portion of the aorta with a large incision (via a transabdominal or retroperitoneal approach), temporarily occluding (stopping) the blood flow, opening the aneurysm, and inserting a tubular prosthesis. The wound technically remains open during this time and should be handled as an open repair. The medical billing code to use for this type of open procedures is 35081 (Direct repair of aneurysm, pseudoaneurysm, or excision [partial or total] and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta) for repairs confined …
Increase Your “Foreign Body Removal” Reimbursements
Most foreign body removal procedures are pretty black and white. Only on the rarest of occasions is there a complication and most of the claims can be handled in a similar manner. However in the even the physician is called on to perform soft tissue removal in a FBR procedure, you need to know how to code your medical billing claim s so your reimbursement won’t be paid only partially or denied. Make sure in this event you code the service with 10121 (Incision and removal of foreign body, subcutaneous tissues; complicated). Some giveaways that the FBR procedure was more complex than normal will be found in notes and procedurs …
Taking the Pain Out of Handling Pregnant Patient Transfers
Medical billing for pregnant patients is a fairly cut and dried process. It’s easy to create medical necessity for the visits and it’s easy to show the reasons for the continued visits. That is, unless the patient transfers practices in the middle of her prenatal care. Pregnancy transfers scare many medical billing personnel, however you can use three easy tips and make your maternity patient transfers a breeze. How you do medical billing for a maternity transfer all depends on how many times she was seen in the clinic. If she was seen 1-3 times you always want to code those visits as evaluation and management visits. One thing to …
Multi-Day Observation Claims Don’t Have to Mean Rejections
Confused about multi-day observations? Well, you’re not along. Multi-day observation medical billing claims can cause a lot of confusion. In order to get the correct reimbursements on your medical billing claims, you need to be sure that your multi-day observation billings are reported correctly – otherwise you’re practice isn’t receiving the maximum reimbursements for the services rendered and you’re in effect – losing money. A main rule of thumb when doing medical billing for multi-day observation is to report per day of service. This means that if a patient is admitted late at night and isn’t discharged until the next morning, you report both service dates. The two current procedural …
Coding Follow Up Office Visits
Patient history is valuable any time you’re building up your documentation to show medical necessity for reimbursement of any procedure. Any time you are coding for problem visits that a patient has, it is important that you take into consideration any other office visits that they may have recently had. Basically, you are going to want to look to see if there is a connection between visits for preventative medicine as well as current health issues that may be in place, which also needs some attention. Many times, a physician will end up seeing a patient that shows up in search of a visit to fall into the category of …
Ending Confusion Over 99000 Series Codes in Your Medical Billing
There were two new codes issued in 2006 that continue to confuse many medical billers still over halfway into 2007. These two codes were created to specifically address the after-hours and red-eye services for procedures done by physicians outside the normal hours. Previously when compiling the medical coding for medical billing, a coder would have used 99050 as a “catch-all” coding. Now CPT has revised the original code and added new codes. 99053 is ” “for services between 10 p.m. and 8 a.m. in 24-hour facilities,” and will be used by both physicians on call and hospitals. Please note that code 99053’s wording to include “24-hour facility” will put a …
Compiling Your Medical Billing for Specific Injections
B-12 injections are a very common procedure. If you’re only receiving partial payments or experiencing rejections of your claims, you may need to tighten up your handling of these claims as the codes and procedures for filing criteria have undergone changes in the past year. To eliminate potential medical billing problems, there are five steps to follow to ensure smooth B-12 reimbursement for your claim. The first medical billing step is to replace the injection administration codes for the B-12. These codes include the current procedural terminology codes 90782, 90788, and G0351. These medical billing codes were deleted from the 2006 CPT list and should no longer be used. The …
