Medical Billing Blog: Section - General Info
Archive of all Articles in the General Info Section
This is the archive containing links to all articles written in the General Info 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.
Coding Dual Procedures
If you have a core biopsy and an FNA (Fine Needle Aspiration) performed on the same day, your CMS manual states you cannot report fine needle aspiration (FNA) codes 10021 and 10022 with another biopsy procedure code for the same lesion. A good example of this is when a physician performs an FNA and core biopsy for the same breast lesion during the same encounter, but does not document that the FNA sample was inadequate for diagnosis. The physician performed the services described by 10022 (Fine needle aspiration; with imaging guidance), 19102 (Biopsy of breast; percutan-eous, needle core, using imaging guidance), and 76096 (Mammographic guidance for needle placement, breast [e.g., …
The Importance of DME Preapproval
Durable Medical Equipment refers to wheel chairs, braces, shower chairs and other assisted living equipment. And are generally purchased as an outpatient. It really does not matter if your patients are insured through Medicare, Medicaid, Workers’ Compensation or through a private insurance carrier, nearly all DME claims must be preapproved prior to submission of the medical billing claims. Many of these policies have strict guidelines that must be followed in order for the DME medical billing claim to be paid. Some providers will require that the DME be purchased through their own sources and have a listing of specified providers. Many HMOs are very narrow about the DME they will …
The Trickiness Coding Radiology Services
Medical coding for radiology services can be very tricky. Most radiology procedures, unless emergency, normally need pre-approvals in order to receive reimbursement for services rendered. Failure to get a pre-approval can result in your medical billing claims for radiology being denied and rejected. Make sure you have a pre-approval on file before the services are rendered. Contact the carrier, note the date and time that you called. Get the first and last name of whoever approves the services. You may very well need this information in the future if your medical billing claim is denied. There are also CPT coding changes that happen often in the field of radiology. Keeping …
How is Auditory Rehabilitation Billed?
Medical billing changes occur each and every year in America. 2006 has brought many changes to the forefront. Aural Rehabilitation is one major area of confusion. Medical billing changes to Aural Rehab CPT codes have wrongly caused many people to believe Aural Rehabilitation is not covered. 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. There are several other medical professionals that could possibly …
Is Outsourcing Your Medical Billing Claims Secure?
In a word, absolutely. There are a lot of pros to outsourcing your medical billing. Don’t let confidentiality concerns stop you from outsourcing your medical billing. A reputable firm will provide a confidentiality agreement and rest assured your records are handled with the utmost care. Confidentiality and accuracy are part of a billing company’s standard business practice. Your practice will benefit from outsourcing because with the burden of medical billing handled outside your office, you and your staff will have more time to run your business. It will allow you time to develop relationships with new patients and more time for marketing your practice. Using an outside firm to handle …
Look Into Separating Payments on Separate Tests Performed
Did you know that you can actually bill separate tests performed from your practice for separate payments? Certain practices have been taking advantage of larger reimbursements by doing just that. Say that you have a patient that is new to your practice and they are coming in for an exam. You can both bill for that exam and then bill separate for any other tests or screenings that they will be having performed. Although you may feel as though you are doing something wrong when it comes to medical billing practices such as these, but the Centers for Medicare and Medicaid services have been doing a good amount of research …
Sutures-Get Your Reimbursements
If you have had V58.3 denials in the recent past, it’s probably due to your method of reporting the procedure on your superbill instead of an unnecessary procedure. Make sure that you report V58.3 as a two-line entry. Instead of “dressing change/suture removal”. Additionally, the coming ICD-9 2007 changes that will go into effect on October 1st will also have more specifics for reporting in this series. This will include three aftercare types. Remember that V58.3 is no longer a catchall coding for these procedures. The new codings will be as follows: * Nonsurgical wound dressing change or removal–V58.30 * Surgical wound dressing change or removal–V58.31 * Suture removal–V58.32. Payers …
Correctly Using Modifier 59
Modifiers can be a helpful addition to medical billing. However, there are certain modifiers that are constantly used incorrectly. The contractors for the Centers for Medicare and Medicaid Services are now keeping an eye out for suspicious modifiers. The medical billing modifier 59 is on the list of modifiers to flag for review. Recently, the U.S. Office of Inspector General released a report that showed some daunting medical billing news. Modifier 59 has been the cause of over $59 million in overpayments to nursing homes and providers. Due this large number of overpayments, Medicare contractors will be closely scrutinizing each medical billing submission that contains the modifier 59. To prevent …
Correct Medical Billing for Family Meetings
If you have a meeting with the family members of an assisted living facility patient (patient was not present) to discuss any aspect of the individual’s healthy status, such as memory loss or personality changes, you can bill Medicare but this scenario would not qualify for CPO (Care Plan Oversight) services. Instead this would fall under the realm of code range 99324-99337,(Domiciliary or rest home visit for the evaluation and management of a … patient). By the way, when you do report CPO services for a private-pay assisted living facility patient in the near future, you would assign new 2007 codes 99339-99340 (Individual physician supervision of a patient [patient not …
Correct Usage of 99336
Rest home care medical billing can be very tricky. Many coders bill for at home services or nursing home services when rest home care is performed. Incorrect medical billing coding such as this, could get you into trouble. Make sure your staff is up to date on the new medical billing coding regulations that addresses the specific guidelines for rest home coding. The place of the service is a big issue when dealing with the rest home services. Rest home, or custodial care facility is labeled as a POS 33. This is defined as a facility that provides room, board and other personal assistance services generally on a long-term basis. …
