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.
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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. …
Proper Use of ED Injection Codes
When to use code 90784 when processing medical billing claims for emergency room injections can raise a lot of questions. If you fail to follow the exact criteria for reimbursements of these types of claims, you risk only receiving partial reimbursement for the services or an outright rejection of the claim. The question of when to use this code comes up when a hospital supplies an injection or antibiotic to a patient in an emergency department visit situation. Many medical billers believe 90874 should not be used in this situation because the physician has not actually purchased the drug, just administered. In all actuality, 90784 means- therapeutic, prophylactic, and diagnostic …
Radiology Claims Continue to Rise
Radiology claims are on the rise and there are two types distinct types of radiology claims, evaluation and management. Both are valid reasons for radiology and both need to be reimbursed, however you need to make sure that your documentation backs up the coding that is used in your medical billing claim. Radiologists can perform several types of services. One of these services is an evaluation and management session. When doing medical billing for a radiologist it is important to make sure a session meets three categories before coding it as evaluation and management session. The three categories are: request, render, and report. The first necessary element for a radiologist …
Using POS 21 In Your Medical Billing
When processing medical billing for hospitals, 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. 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, or place of service 21 for inpatient hospital if a patient is admitted from the …
Special Needs Indirect Supervision Procedures
When a staff member stands in for a pediatrician and performs a low level service also called a Care Plan Oversight, how that reimbursement works for those procedures can be confusing. In order to correctly bill services, there are certain policies that should be followed. The steps for billing indirect supervision can be broken down into the three basic steps. Getting the coding right is the first step. The medical billing current procedural terminology codes 99375-99380 should only be used in certain instances. These codes represent non face-to-face visits by pediatricians for special needs children. There are firm instances when it is acceptable to do medical billing for this care …
