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.
3 Ways to Ease Modifier 25 On Your Medical Billing Claims
The AMA provides some helpful clarification on when to append modifier 25 in CPT 2006, but you might still need a little more information on how to ace those claims. Here are three tips to help you out. Report only significant services. In order to gain separate payment for an E/M service, the physician provides at the same time as he or she provides another service or procedure, the E/M service must be significantly and separately identifiable. All procedures include an inherent E/M component according to CMS guidelines. Any E/M service you report beyond that must be above and beyond what is normally included with that procedure or service. Always …
How to Dx More Than One Severity Level on Your Medical Billing Claim
Example: a patient presents with both first and second degree burns on their face. You should report only the more severe (in this case second degree) burns when assigning diagnoses for burns in the same anatomical location. For example, the codes beginning with 941 describe the face, head and neck burns. For burns to the trunk, you would use the 942 series, and codes 943, 944, and 945 are for burns to the arms, hands, and legs, respectively. Remember that you should never report a first degree burn separately with the 941-946 series if there are more severe burns on any other part of the body, except when treatment is …
Medical Billing News -AMA Eliminates Modifier Hyphen
You may have noticed in recent coding alerts that there is no hyphen included before a modifier. The AMA has done away with using hyphens before modifiers. This change occurs in CPT’s coding manuals and CPT assistant as well. The AMA used the hyphen as a formatting convention in order to ensure that people realized that an upcoming number was a modifier. The symbol avoided numerical confusion as well. The hyphen would alert a reader that the last two digits, such as “-25” were not a part of the CPT code. This should not be a huge change, since most people are most likely used to looking at modifiers without …
Three Rules for Observation Medical Billing Coding
There are three rules that govern observation coding. Let’s use for example a case in which a surgeon admits a patient for observation at 9 p.m. and releases the patient the next day, at 1 a.m. Follow these three rules, and you will be all set. 1. If a physician admits a patient for observation and releases the patient on a different date of service, if the total duration of the observation stay is more than eight hours, you should report 99218-99220 with 99217. If a stay lasts multiple days, you may report one unit of 99218-99220 for each date of service, except the date when they physician discharges the …
Apply a Flat Fee for Sedation Codes
A provider that is not an anesthesiologist, such as a pediatrician, should use the new moderate sedation codes (99143 – 99150) to capture the charge for the procedure’s base units. These codes eliminate any need to bill extra units. You should ignore billable units and use new time-based codes instead. For example, a 4 year old presents for an MRI performed by a radiologist. A pediatrician provides moderate sedation throughout the procedure. The sedation lasts for thirty minutes. Before, you would have coded this sedation by with anesthesia code 01922. Because this procedure has seven base units and 2 time units, you would have billed 01922 x 9. On new …
E/M Might be the Answer to BCP for Acne
Birth control pills for acne can be a perplexing coding problem. Occasionally, we come across a case in which a patient obtains birth control pills because her dermatologist recommended them to help clear up an acne problem. Some people say that we should not even code the birth control pills (oral contraception), but if this is the only problem that the patient presented to the OB-GYN for, does that mean that we should still not code for it to keep with specificity? E/M might be the answer to this particular problem you may come across. If an OB-GYN prescribes birth control pills (BCPs) to a patient for acne problems, that …
Modifier 51 Not to be Used by Hospitals
The multiple procedure code Modifier 51, causes some confusion among medical billing because it relates to multiple procedures performed but what many medical coders miss is the fact it only applies to multiple procedures performed by physicians and imaging centers. Carriers already assume during a hospital stay that multiple procedures will already be performed therefore designation of the exact nature and type of services rendered by the attending physician will still suffice for hospital medical billing claims. The CPT manual designates modifier 51 (Multiple procedures) exempt codes with a “circle with a slash” symbol to the left of the code. Pay close attention to those codes which don’t need modifier …
Have You Considered Medical Billing As Your Career?
Sometimes you feel you’re not in the right job or you have been out of the workforce and you’re ready to jump back in and you want some training that will benefit you, consider medical billing as a career. First of all, beware. There are some online services that will promise you a medical billing career and will charge you a large amount of money for a list of places to go obtain your learning from. This is a scam and don’t fall for it. There are legitimate places to get a good education in processing medical billing and it can be a profitable and rewarding career. In the 2005 …
Extended Office Hours Code Added
If you are a physician who keeps longer office hours or you have a 24-hour clinic, a new CPT code has been created to identify those services. The old coding method was to use 99050 when services were rendered by a physician outside of regular office hours but with more and more doctors and clinics extending their hours and 24-hour clinics becoming the norm, a code to designate those services rendered was needed. Now when a doctor provides care on evenings, Saturdays, and holidays; the code 99051 should be used to designate “”provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service.” …
The Controversy about 99058
In the latest revision for 2006, CPT has revised one code (99050) for after hours services performed by physicians and hospitals and added several more codes to designate specific times and places of services rendered. There is one code in the new listing, that is already causing some controversy as to when it is the proper time to use. It is 99058 and it is Schedule Disruption” due to an emergency situation. By the very nature of health care, there are many emergency situations and the code caused confusion from its debut. The AMA has amended the definition to mean that an emergency is defined by any event that disrupts …
