Medical Billing Blog: Section - Consulting
Archive of all Articles in the Consulting Section
This is the archive containing links to all articles written in the Consulting 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.
Servicing Hospitals? Know Your CCR
Your provider number has a strong impact on your medical billing cost to charge ratio (CCR). If your hospital is merging with another hospital, it is important to figure in the possibly new Cost to Charge Ratio medical billing payments you will receive. There are two avenues merging hospitals can take. The first method is when two hospitals merge together while one of the existing provider numbers is kept in tact. In this instance, one hospital keeps their medical billing number, while the other one drops theirs and joins the first. The hospital that drops their medical billing provider number will receive a new cost to charge ratio. The ratio …
Digit Removal Medical Billing Questions
Just when you got a handle of medical billing, another policy throws a curve ball at you. In some instances, the same CPT code is used for two different procedures. An example of this is when performing both and extra digit removal and a skin tag removal. The same medical billing CPT code, 11200, would be used in both of these instances. The medical billing code 11200 means, removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions. This means that if an individual needs an extra digit AND a skin tag removed, than you would use 11200 to report both. To let the payers …
Getting the Indirect Supervision Code Right in Three Steps
For help with performing the care plan oversight services if you are having a hard time with the 993xx series these steps should help to get you started. Step one is to count these care services as 99374-99380. The 993xx series codes allows pediatricians to bill for coordination of care of special needs children without face to face visits. You can report these care plan oversight CPO codes as 99374-99380 for Doctor supervision. This is only for when the patient is not present for the following doctors services, a) revision or development of care plans for multidisciplinary and complex modalities. b) related lab and other studes review c) patient status …
434.91 – Stroke – Hemorrhage or Both?
When using 434.91 make sure you take all of the specifics into account. When a doctor says that a patient has had a stroke make sure that you know all of the details of the situation or else some procedures can be hard to justify and therefore your medical billing reimbursement may be denied. In the past for diagnosis of a stroke the ICD-9 index listed 436, which is acute but ill defined cerebrovascular disease, as the code to use. Now the index has code 434.91 as the code to use. This is cerebral artery occlusion, unspecified with cerebral infarction. The new ICD-9 index automatically translates a doctors diagnosis of …
Get Top Reimbursements for Skin Graft Procedures
In 2006 several changes were made to the CPT regarding skin graft procedures and this included the retiring of several codes and the addition of 37 new skin graft codes to make identifying the procedures more exact for medical billing claims. The skin graft section was also renamed to Skin Replacement Surgery and Skin Substitutes. There are new codes for autografts, sections 15100 through 15261, allografts, sections 15170 through 15176 and xenografts, sections 15400 through 15431. These codes seem to have been created in order to represent some new procedures and techniques. Many of these new codes are also specific to a particular technology or product make sure that your …
Get Better Reimbursements on Common ER Procedures
Knowing when to use code 90782 in emergency department procedures can help with your medical billing reimbursements. For example, if a doctor examines a patient in the ED for an injury, and injects a preventative tetanus toxoid, your first instinct might be to use 90782 as a modifier for this procedure. But you would not receive a medical billing reimbursement because the incident to provision does not apply in the emergency department so you would not be able to justify having the doctor administer this injection. There would be no way to justify the medical necessity of such a shot. However, when you are in an office setting the CPT …
ICD-9 Updates Coming October 1, 2007
Are you ready for the updates coming on October 1? There are a number of changes that will affect that way Medicare reimburses your practice for the services rendered as well as adding and retiring other codings. All of these changes will be effective for service dates after October 1. You can avoid a lot of paperwork hassles and denials by making the jump to outsourcing your medical billing. Your third party partner will keep up with the ICD-9 coding changes, rules and regulations and if you choose, can even do an audit of your current medical billing methods and show you how you can realize a better reimbursement rate …
When to Use 90782
Knowing when to use code 90782 in emergency department procedures can help with your medical billing reimbursements. For example, if a doctor examines a patient in the ED for an injury, and injects a preventative tetanus toxoid, your first instinct might be to use 90782 as a modifier for this procedure. But you would not receive a medical billing reimbursement because the incident to provision does not apply in the emergency department so you would not be able to justify having the doctor administer this injection. There would be no way to justify the medical necessity of such a shot. However, when you are in an office setting the CPT …
Aural Rehab Not Reimbursed?
Medical billing changes occur throughout each and every year and keeping up with those changes can be confusing. Aural Rehabilitation has become one major area of confusion since the 2006 update. The medical billing changes to Aural Rehab CPT codes has wrongly caused many people to believe Aural Rehabilitation is no longer a reimbursable service. Medicare actually assigned status code “I” to all new medical billing codes for auditory rehabilitation. These codes are 92630 and 92633. This means that the Centers for Medicare and Medicaid Services will not pay for auditory rehabilitation, only diagnostic audiology. However, this is only true if an audiologist performs the service and the medical billing. …
Code Designations Determine When to Use Modifier 59
When do I use medical billing modifier 59? This is a great question. It is one that many don’t ask, but most don’t know the correct answer to. One of the most important things to know about the medical billing modifier 59 is which code on which to append it. There are some basic medical billing rules that can teach you which code to use with modifier 59. The general assumption about modifier 59 (Distinct procedural service) is that it should be linked to the lower-valued code of the pair. Although this may be true a lot of times, it is not always true. There is a much better rule …
