Medical Billing Blog with Medical Billing & Coding Info & Articles
Our blog contains news and articles relating to numerous healthcare sectors including revenue cycle management, medical billing, medical coding, ICD, HIPAA, practice management functions and more.
2 Types of NCCI Edits
NCCI contains two types of edits: mutually exclusive and comprehensive/component edits. Knowing the difference between these types of edits can benefit your practice. Mutually exclusive edits pair procedures or services that the physician would not reasonably perform at the same session, at the same anatomic location, on the same beneficiary. A good example is using 76828 (Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study) is a component of 76820 (Doppler velocimetry, fetal; umbilical artery) and 76821 (… middle cerebral artery), thanks to an NCCI mutually exclusive edit. However, if you were to report two mutually exclusive codes for the same patient during the …
Top Notch Coding Strategies for Radiology
There are a number of changes in the niche of Intervention Radiology that many radiologists are not taking full advantage of, and that is costing them in the form of lower reimbursements. Many radiologists avoid billing for E/M services even when they are warranted as until recent times, many carriers would not consider the intervention radiology as part of an individual claim and it was bundled into other services. With careful documentation and proper coding, you can get reimbursed for several services you currently perform and even perhaps perform for free. Another way to get reimbursed for certain services you may not currently receiving payment for is to phase them …
Proper Coding for Cervical Vertebroplasty
Some of the confusion about preparing medical billing is that the CPT does not always provide an exact code for a particular procedure, in this case we’ll use percutaneous vertebroplasty of cervical vertebra(e). It’s not a common procedure but it does occur and until recent years did not have its own designation and even today, some payers aren’t up to date on the proper coding to use to report this procedure. Before CPT added percutaneous vertebroplasty codes 22520-22522 in 2001, most payers recommended that coders report all vertebroplasty procedures using 22899 (Unlisted procedure, spine). Most payers still recommend using 22899 code for cervical vertebroplasties, as many carriers aren’t aware of …
Catching Medical Billing Denials Before They Happen
The biggest medical billing problem is getting denied payment for a claim. A service for which many patients are denied is counseling to quit smoking or the cessation of other tobacco product related use counseling. Since this is a voluntary activity, many payers have a hard time reimbursing for this service. The patient either has no coverage for the counseling under their plan or is only allowed a certain amount of counseling sessions for the smoking cessation purpose. What happens if another physician has already done medical billing for these counseling sessions? Chances are, you would not get paid. In many cases you won’t find out until you have already …
Medical Billing When There Isn’t An Exact CPT Code
Certain areas of the body do not have CPT codes for procedures, such as an MRI done on a hip of a patient. You need to use the codes 73721-73723 (Magnetic resonance imaging, any joint of lower extremity). The hip joint falls into this medical billing category because it is a lower extremity joint. Doing medical billing for bilateral hip MRIs is also a bit more complicated. Different payers require different modifiers for payment. For example, Medicare prefers that bilateral MRIs be reported with LT (Left side), and RT (Right side), along with the medical billing modifier 76 (Repeat procedure by same physician). You should check with the various payers …
Denials Due to Code Non-Recognition
In some cases you may get a medical billing denial due to non-recognition of the coding used. In a lot of cases, this is due to the medical biller jumping the gun and using a code that was due to be released too early for reimbursement. Normally when a new code is introduced, an effective date will be set and that is the given date for all service providers to begin using that particular billing code. It is not permissible for carriers to deny claims for no recognition if the code effective date has passed. There are instances in medical billing where code no recognition is acceptable. A payer can …
To Bundle or Not to Bundle That is the Question
In medical billing, there are many Ob-Gyn codes that should be bundled, while others should not be bundled. The current procedural codes 58720 and 57283 frequently bring up this “to bundle or not to bundle” question in medical billing. It is important to know when to bundle certain Ob-Gyn medical billing codes and when to bill them separately. The current procedural terminology code 58720 (Salpingo oophorectomy, complete or partial, unilateral or bilateral) can be billed completely separately from a colpopexy (57283). This means that if your physician does both of these services at the same time, you can do medical billing for both procedures. There is no bundling. Separate reimbursement …
Why Use OMG?
Medical billing is a complex process that if not done correctly, can lead to a loss of revenue and underpayment on your claims. Outsourcing your medical billing can help eliminate some of these losses. There are several benefits to using a medical billing company. Studies have shown that nearly one-third of all medical services are never reimbursed to the health care provider. This is due to poor follow-up to insurance companies and to patients themselves for medical practices. Too often, medical office personnel are stretched to their limits. They are responsible for medical billing, advertising, scheduling, and customer service. Medical billing companies can alleviate some of this stress by taking …
Real World Rehabilitation Medical Billing Reimbursements
The medical billing world has a new way of performing therapy for patients. Baton Rouge General Medical Center is changing the face of rehab therapy. The new rehab facility, “Around Town”, is helping patients adapt to the more practical aspects of life. While traditional therapy helps patients move their bodies again once again, this new therapy helps them adjust to real life situations. Payers may see a lot more of these types of medical billings come through their offices. The “Around Town” facility looks like the inside of a house or a home. It is equipped with a working kitchen, bedroom, living room with a chair and couch, and a …
Prior Authorization Can Get More Medical Billing Claims Paid
More and more often, medical billing claims that include saphenous vein ablation are getting very close scrutiny by carriers before reimbursements will be allotted. One of the biggest red flags is that most payers, including Medicare, will only cover payment for a very limited number of specific varicose-vein diagnoses. Samplings of the commonly and correctly reported procedures covered are as follows: * 454.0–Varicose veins of lower extremities; with ulcer* 454.1–… with inflammation* 454.2–… with ulcer and inflammation* 454.8–… with other complications. However, when these are reported correctly, you should have detailed documentation to why the procedure was needed and documentation of the failure of non-surgical treatments that were used previously …
