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.
Varicose Vein Repair Reporting Tips
Varicose vein treatments are becoming more and more frequent as more patients are urged to get them treated to stave off the possibility of blood clots and other issues that can crop up later if they are left unaddressed by the patient. However reporting the varicose vein treatment procedure on the medical billing may be a little confusion for some; once you know the basics for setting it up – it’s easy! A good example would be if a patient with varicose veins in her left lower leg presents to the ED and is stating she has severe pain in her leg. One of the veins is clearly bleeding so …
Using Modifier 25 in Medical Billing
When claims require modifier 25, there are some simple tips you can use to know the modifier’s details, such as which code to append it to, as well as when to use the modifier. It is important to identify the claim makeup in order to solve the problem of which code to use modifier 25 with. Modifier 25 is a significant, separately identifiable evaluation and management service by the same physician on the same day as the procedure or other service. Do you attach modifier 25 to the well visit or to the sick code? Modifier 25 can be applicable on either code. Therefore, the answer depends on the claim …
Team Procedures
All too often, the problem in the case of team procedures, where multiple physicians are involved, is that the first physician’s claim that gets submitted wins. This is especially true when another provider takes credit for radiology services. Let’s take a look at a few examples, to help you figure out how to code your claims to make sure you get a radiology claim to your payer quickly. Example 1: Do both a radiologist and a speech language pathologist need to be present to code a modified barium swallow procedure? They may both need to be present. Guidelines recommend that the service be provided in a team setting. Note the …
E/M and Repair on Laceration Claims
Let’s say an otherwise healthy man reports to the ED with lacerated index and middle fingers on the palmar surface, but there is no significant bleeding. The patient cut himself on a table saw. There is a 1.5cm jagged laceration with protruding fat located on the pad of the distal phalanx of both fingers. The physician uses Marcaine to apply digital blocks to both fingers, explores the wounds and finds no foreign bodies, and then closes the wounds. This encounter should be coded with a pair of E codes, in order to identify the cause of injury. Report this claim as follows: Report 12002 for the wound closure (this is …
Medial Dislocation – Billing it Right
A common occurrence in the emergency is the dislocation of various joints. They are sometimes incorrectly handled as breaks but shouldn’t be and you could be setting your practice up for a denial at best and audit at worst if you report these procedures incorrectly on your medical billing. Even if the reduction of the dislocation fails, the attempt should be reported on not only the medical billing as a procedure but also in the documentation as another procedure will have to be tried to relocate the elbow to its proper placement and you can show the timeline for the necessity of other and more involved treatments. On the claim …
Ready for the New NCCI Edits Coming in July 2007?
The new edits coming in July 2007 will mainly affect ER room practicioners and physicians and nurses that treat patients in nursing home facilities. These updates will be items you need to know in order to avoid denials and get maximum reimbursements on your medical billing claims. The codes that were changed in the upcoming release were codes 99281-99285 (Emergency department services) are considered component codes of the more global 99304-99306 codes (Initial nursing facility care). This means if a single physician provides a level-two ED service along with a level-two initial nursing home service, you should only report 99305 (Initial nursing facility care, per day, for the evaluation and …
When New Billing Codes Aren’t Recognized
In medical billing, code recognition is not the only reason for denial. If a claim containing a new code is denied, go through your medical billing claim and make sure it is absolutely accurate. Then you can probably narrow down the reason to simply a matter of the carrier not recognizing the CPT code. When new medical billing codes are introduced there is a lag period that lets coders and payers get adjusted for that specific code. HIPPAA sets an effective date for all medical billing codes that states when companies must begin using the codes or accepting the new codes. It is illegal to deny claims for no recognition …
Making Inpatient Reporting Easy
One of the most difficult medical billing feats is inpatient consultation coding. There are many instances when a follow-up inpatient consult should be replaced by a subsequent hospital care visit. To eliminate these medical billing errors, there are four facts to consider when coding for inpatient consults. The first fact is very obvious. If your report an inpatient consultation exam, the patient must be inpatient, not outpatient. Very often physicians see patients on a consultation basis when they are outpatient. Medical billing mistakes can be made easily. Double check your work. It is important in medical billing to always report one initial consultation. This code will correspond with the very …
Medical Billing Once or Twice for Certain Codes
Patient evaluation codings can be very confusing. The patient initial evaluation code is 97001 (also, 97003, 92506, 92610) however if the patient is reevaluated (97002- patient reevaluation) within a 12 month period only one unit of service may be billed to Medicare Part B patients no matter how much time was spent actually servicing the patient. If you make a mistake and bill the carrier for the evaluation and a unit of service for the reevaluation, your claim will be denied based on incorrect coding no matter how much medical documentation you provide showing the necessity of the reevaluation of the patient. Keeping up with the fast paced changes of …
Coding Pediatric Injections For Max Return
Therapeutic and antibiotic injections went through some changes in 2006 and make sure that your medical billing claims reflect those updates or you might be suffering from partial payments or rejections of your medical billing claims. In the past there were separate injection administration codes for a therapeutic, prophylactic, diagnostic, and antibiotic injections. Instead of choosing to report administration of a prophylactic Synagis treatment (90378) with a 90782 (Therapeutic, prophylactic or diagnostic injection , you now simply use 90772 as a universal injection code. On E/M coding, you will generally still need to attach modifier 25 to insure your claim is handled. Modifier 25 states that this procedure or other …
