Medical Billing Blog: Section - Medical Billing
Archive of all Articles in the Medical Billing Section
This is the archive containing links to all articles written in the Medical Billing 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.
Medical Necessity Can Make or Break Your Claim
Along with documentation, medical necessity is one of the most important parts of medical billing. You tell exactly how the procedure was performed, be sure to meet the criteria for medical necessity of the procedure by telling why the procedure needed to be performed. It used to be that Medicare was the only payer that cared what ICD-9 code was used. Now all payers, including insurance companies, are looking for any reason not to pay the bill or at least delay it. ICD-9 codes have become the target for close scrutiny. ICD-9 codes range anywhere from a three-digit code to a five-digit code. Obviously, a five digit code is more …
Coding for Oxygen Administration
Coding a medical billing claim for oxygen administration can be a tricky beast because there is not a specific oxygen administration code assigned. Normally the administration of oxygen is bundled into an emergency visit. When a doctor prescribes the oxygen, you should use the appropriate office visit code that describes the procedure and services performed by the physicians that necessitates the need for oxygen. Full documentation of the medical billing claim will insure that your bundled oxygen administrations codings get full reimbursement. For example if you have a physician who performs a detailed examination on a patient and decides to administer oxygen to a known patient who is in the …
Breaking Down a Breast Biopsy
Here is a perplexing problem. When a surgeon meets with a patient an recommends a breast biopsy, we report a consult for this particular visit. On the day of the biopsy procedure, the surgeon will re-examine the patient, answer questions, an so on. The time that is spent prior to the procedure is ten minutes. In a case like this, you will not report a separate E/M with the biopsy. It is important to remember that all procedures include an inherent E/M component, according to CPT and CMS guidelines. In order to qualify as a separately billable service, any E/M the physician provides must be both signifigant and separately identifiable …
Getting Your Moderate Sedation Medical Billing Codes Straight
In late 2006, the CPT added some new codes in their revision. Previously there would have been a need to bill for extra units to capture a procedures base units. With the release of the new moderate sedation codes (99143-99150). The need to bill extra units to capture the procedure’s base unit amounts. Therefore, you should ignore billable units and instead use new time-based codes. A good example would be if a doctor did a procedure that involved 30-minutes of sedation. Previously you would have use 01922 anesthesia designation, you would have used 7 base units and 2 time units (15 minutes = 1 time unit) and you have used …
Oh, Those Feelings of Rejection!
When your medical billing claims get rejected, one claim can put your staff behind on everything they are supposed to be doing. The patient’s folder will have to be pulled, the notes will have to be re-read and researched, the claim will have to be compiled again and the coding will need to be double checked again to make sure you are using the latest codings and modifiers for the claim. In some cases the carrier will need to be contacted which is more time lost from servicing your practice and the claim will have to be submitted once again and the will take more time away from your day …
Documenting for Chiropractors and Podiatrists
In 2007, Medicare is going to continue their close scrutiny of chiropractors and podiatrists. The claims submitted by these fields will continue to get looked over due to the extreme amount of fraud that has occurred in these two branches of medicine. Additionally, the stringent guidelines that are currently in place for chiropractors and podiatrists in order to meet payment requirements for certain procedures and debridement services will be getting looked at very closely and continue to be required in order to get their medical billing claims paid. If you perform these services or you are a medical billing company that does claims for these types of practices, check and …
A Common Reason for Rejection
One way that many medical billing claims get rejected for the smallest of errors. In many cases it can be something as simple as an incorrectly used modifier causing your claim to be rejected by the carrier. There are two modifiers that get a lot of people in to trouble in the form of rejected claims as they can be confusing and those are modifier 25 and 57. Modifier 25 which reads , “Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service” is kind of a catch all modifier for procedures that may not have an exact coding …
How Cyber Secure Is Your Medical Billing?
The protection of medical billing personal health information is a priority. Criminals are constantly trying to access the information, while health care professionals try desperately to protect it. Computers and electronics may be a medical billing time saver, but when it comes to security, some practices fall a little short. There are many examples of good practices. A good example is found at The Rehabilitation Institute of Chicago. This facility has recently solved this electronic medical billing security problem with an innovative new system. PostX is the program of choice at the Rehabilitation Institute of Chicago. This is a messaging system that was developed for seamless integration and extremely secure …
Confused About Flu Shots?
During flu season, flu shots are common in the medical billing world. Like everything else, there are many different flu current procedural terminology codes from which to choose. There are three steps to follow to ensure your flu shot medical billing is completely accurate. The first step is to figure in the age of the patient. Any patient who is age three and above should be given one of two medical billing codes: 90656 or 90658. The medical billing code 90656 stands for: influenza virus vaccine, split, virus, preservative-free, for use in individuals 3 years of age and above, for intramuscularly use. The code 90658 in medical billing means: Influenza …
Caution When Using Modifier 59 in 2007
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. Another medical …
