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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Medical Billing For Breast Biopsies To Avoid Denials
Medical Billing For Breast Biopsies To Avoid Denials When performing medical billing on a breast biopsy, it is necessary to follow correct protocol. Failure to do so could result in a returned claim or a denial of payment. The key to any question of medical necessity lies in the diagnosis code (ICD-9 code). Many medical billers have gotten into the lazy habit of only using a 3 digit ICD-9 code. This is because the only payer who seemed to care what the diagnosis code was, happened to be Medicare. Now-a-days most payers require an accurate and complete diagnosis in order to pay a claim. If you are doing medical billing …
Reporting the Right HCPCS Codes For Devices
Reporting the Right HCPCS Codes For Devices When doing medical billing it is very important to report the correct HCPCS codes. Failure to do so could result in a returned claim or partial payment. Both of these outcomes are unacceptable for medical billing companies. Businesses cannot run without begin paid. HCPCS stands for Healthcare Common Procedure Coding System. These codes, similar to Current Procedural Terminology codes, report what medical devices are used for health care when doing medical billing. If the hospital submits a claim that supports a device code or two, that hospital is required to report at least one of the HCPCS codes on a medical billing claim. …
When To Use Modifier -91
When To Use Modifier -91 Medical billing has certain nuances that billers should be aware of when submitting claims to insurance companies. One nuance is a modifier. A modifier adds additional information to a current procedural terminology code that the code itself does not present. Modifier 91 is frequently misused when doing medical billing. Modifier 91 is used to report when multiple diagnostic tests are done during the same day. For example: If a patient is rushed into the emergency room and is given a stat glucose test which determines he has hypoglycemia, he will be given glucose gel. Then the emergency staff will need to test him fifteen to …
How Proper Use of 99231 For Medical Billing Claims Can Boost Your Earnings
How Proper Use of 99231 For Medical Billing Claims Can Boost Your Earnings Unsure of the correct medical billing procedures, physicians frequently downcode 99231 for quick payment. There are so many rules and regulations associated with medical billing, physicians tend to downcode whenever there is a questionable decision. A frequent downcode is 99231. Properly billing 99231 can save practices thousands of dollars. There are three codes that are often misused: 99231, 99232, and 99233. 99231 means problem-focused interval history and exam, straightforward or low-complexity medical decision making. 99232 means expanded problem-focused interval history and exam, moderate-complexity medical decision making. 99233 means detailed interval history and exam, high-complexity medical decision making. …
Medical Billing For Multiple Same Day ED Visits
Medical Billing For Multiple Same Day ED Visits Double-dipping is a medical billing myth that is costing many physicians money each year. This double-dipping myth directly relates to a patient having two emergency department visits on the same day. Here I will try to discredit that medical billing myth. The medical billing double-dipping myth states that one physician statement should account for two elements. In the case of an emergency department visit, it means that one physician statement should apply towards two visits on the same day, even if they were at separate times. This should not be the case. If a patient is seen in the emergency department on …
What Is The Difference Between Modifier -25 and -57 When Filing Medicare Medical Billing Claims?
What Is The Difference Between Modifier -25 and -57 When Filing Medicare Medical Billing Claims? Modifier 25 and modifier 57 are sometimes difficult to differentiate between when doing medical billing. It is important to understand the differences between these two modifiers to ensure correct medical billing practices. In medical billing Modifier 25 means when doing an evaluation and management, a physician decides a MINOR surgical procedure needs to be done on the same day. It means the evaluation and management should be paid for separately and not bundled with the surgical reimbursement. In medical billing, Modifier 57 means when doing an evaluation and management, a physician decides a MAJOR surgical …
Code Those Nursing Home Visits Correctly
Code Those Nursing Home Visits Correctly Places of service have brought on many headaches when medically billing claims. The place of service, nursing home, is probably the most confusing location. There are certain guidelines when medically billing to ensure nursing home locations are coded correctly. The biggest question that comes up when dealing with nursing homes is whether it should be coded as an outpatient facility or inpatient facility when medically billing for consultations. The codes 99241 through 99245 are outpatient consultation codes reserved for the following locations: office, hospital clinic, facility providing custodial services, emergency room, observation room in the hospital, home, or nursing home. The codes 99251 through …
Emergency Medicine Medical Billing
Emergency Medicine Medical Billing Emergencies can not be planned and they can’t be scheduled. There are no preapprovals and a lot of times documentation is sparse and these are among the hardest medical billing claims to get paid. Emergency procedures are performed in a fast paced environment and there can be several people performing multiple duties and not all those procedures get noted on the documentation. When it comes time to compile the medical billing form. The coding will have to considered carefully. You obviously can’t have certain procedures done without others being included. For example there may not be the suturing procedure listed as it might have gotten missed …
Reasons For Medical Billing Reversals
Reasons For Medical Billing Reversals Reversals can happen for a myriad of legitimate and not so legitimate reasons. In a recent study, the top reasons for medical billing reversals are as follows: 1- Incorrect payable diagnoses codes, the biggest offenders in this category were: Modifier 59 – distinct procedural serviceModifier 76 – repeat procedure by same physician Modifier 24 – unrelated evaluation and management service by same physician during postoperative periodModifier 25 – significant separately identifiable evaluation and management service by same physician on the day of a procedure. 2-Provider Billing Errors – As long as medical billing is coded by humans, there will be errors, that’s just a fact …
Payers Treat Group Practices as 1 Provider
Payers Treat Group Practices as 1 Provider Medical billing rules can get hazy when dealing with group practices. It is difficult to determine if physicians within a group should bill separately for follow up care if another physician performed the actual surgery. There are rules to follow in this type of situation that make medical billing easier to understand. When there is a group of physicians in the same practice, usually one does surgery. With surgery there is usually follow up care that is bundled in the CPT code for medical billing. This means that surgeons cannot bill separately for follow up care and for the surgery. This also goes …
