Medical Billing Blog: Section - Medical Coding
Archive of all Articles in the Medical Coding Section
This is the archive containing links to all articles written in the Medical Coding 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.
Questions About NCCI Edits for Unusual Situations
There have been questions regarding the use of carotid Doppler (93880) being performed on the same day as venous Doppler (93965, 93970, 93971); some insurance companies do not want to reimburse both procedures as it is unusual to perform both with one service period. National Correct Coding Initiative edits don’t prevent you from reporting these codes together, but the payer may be questioning the medical necessity of performing both services on the same day. Doctors don’t usually order both of these exams for the same patient on the same date of service. If there was a reason and you can show hard documentation as to the necessity of having both …
Correctly Coding the Top 4 Pediatric Parent Consultations
No one has to tell you that the world of pediatric medicine is fast paced and along with unpredictable kids come unpredictable medical billing situations. If you process medical billing for pediatric physicians, you may or may not have run across a situation for determining what diagnoses would apply when parents come in to discuss their child’s health issues. If you’re wondering if there is a single code, the answer is yes. A parent conference falls under V65.19 (Other persons seeking consultation; other person consulting on behalf of another person). In other words, the code describes a person seeking “advice or treatment for non-attending third party.” Since a parent has …
Sick Visit Claims Could Be Costing Your Practice
Did you know you might have a cash flow leak and not know it? It’s not uncommon for practices to file medical billing claims without meeting requirements for the use of Modifier 25 in bundled sick claims and doing so could very well be costing your practice valuable reimbursement revenue. Fortunately, there are some simple rules to follow to ensure that you’re getting the best reimbursements for your claims. First of all, make sure that you know exactly what the payer requires for reimbursement on these claims. Next, make sure you document exactly what caused the encounter and what the outcome was. This shows a logical flow of information and …
Neonatal Dilemma – Should You Have Separate Charges for Separate Procedures?
The smallest patients can present the largest and most confusing problems in medical billing. There can often be confusing scenarios that occur during neonatal procedures that many medical billings can find confusing. It could be due to the fact the patient is so tiny that many of the procedures seem related to split out but in many cases, claims for neonatal services are incorrectly bundled together. A good case in point would be if a neonatal patient presented with a fever. The physician then did a urine catheterization (51701) and a spinal tap (62270) in the office. In many cases, the medical biller might have bundled these claims together but …
The Truth About Pediatric PHI
Patient history, or PHI is an aspect of medical billing that has a myth attached. Contrary to popular belief, it is safe practice to allow any permanent office member to take the review of systems and the family social history. These two evaluation and management history elements can actually be taken by absolutely anyone that is employed by the practice. It is ok in medical billing for even a parent or a secretary to take down this information as long as the information is reviewed and signed off on by the acting pediatrician. The only part of an evaluation and management visit that the physician or nurse practitioner must complete …
Tips for Getting Open Repair Medical Billing Right
When a patient presents with an abdominal aneurysm, there is usually a graft repair procedure performed. This usually involves exposing the affected portion of the aorta with a large incision (via a transabdominal or retroperitoneal approach), temporarily occluding (stopping) the blood flow, opening the aneurysm, and inserting a tubular prosthesis. The wound technically remains open during this time and should be handled as an open repair. The medical billing code to use for this type of open procedures is 35081 (Direct repair of aneurysm, pseudoaneurysm, or excision [partial or total] and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta) for repairs confined …
Taking the Pain Out of Handling Pregnant Patient Transfers
Medical billing for pregnant patients is a fairly cut and dried process. It’s easy to create medical necessity for the visits and it’s easy to show the reasons for the continued visits. That is, unless the patient transfers practices in the middle of her prenatal care. Pregnancy transfers scare many medical billing personnel, however you can use three easy tips and make your maternity patient transfers a breeze. How you do medical billing for a maternity transfer all depends on how many times she was seen in the clinic. If she was seen 1-3 times you always want to code those visits as evaluation and management visits. One thing to …
Coding Follow Up Office Visits
Patient history is valuable any time you’re building up your documentation to show medical necessity for reimbursement of any procedure. Any time you are coding for problem visits that a patient has, it is important that you take into consideration any other office visits that they may have recently had. Basically, you are going to want to look to see if there is a connection between visits for preventative medicine as well as current health issues that may be in place, which also needs some attention. Many times, a physician will end up seeing a patient that shows up in search of a visit to fall into the category of …
Ending Confusion Over 99000 Series Codes in Your Medical Billing
There were two new codes issued in 2006 that continue to confuse many medical billers still over halfway into 2007. These two codes were created to specifically address the after-hours and red-eye services for procedures done by physicians outside the normal hours. Previously when compiling the medical coding for medical billing, a coder would have used 99050 as a “catch-all” coding. Now CPT has revised the original code and added new codes. 99053 is ” “for services between 10 p.m. and 8 a.m. in 24-hour facilities,” and will be used by both physicians on call and hospitals. Please note that code 99053’s wording to include “24-hour facility” will put a …
Compiling Your Medical Billing for Specific Injections
B-12 injections are a very common procedure. If you’re only receiving partial payments or experiencing rejections of your claims, you may need to tighten up your handling of these claims as the codes and procedures for filing criteria have undergone changes in the past year. To eliminate potential medical billing problems, there are five steps to follow to ensure smooth B-12 reimbursement for your claim. The first medical billing step is to replace the injection administration codes for the B-12. These codes include the current procedural terminology codes 90782, 90788, and G0351. These medical billing codes were deleted from the 2006 CPT list and should no longer be used. The …
