Coding Tips

Medicare Changes to Three-Day Payment Window Rule Will Impact Physician Billing Members Only Document

The expansion of the three-day payment window rule to include wholly-owned physician offices and clinics and a new HCPCS modifier may complicate current billing and coding processes.

Modifier 25—The Good, the Bad, and the Ugly Members Only Document

To guide physicians, the U.S. Department of Health and Human Services Office of Inspector General has identified key areas of concern for modifier 25, which deals with a significant, separately identifiable E/M service by the same physician on the same day of a procedure or other service.

ICD-10 Documentation Assessment – Getting Ahead of the Game Members Only Document

The importance of consistent and complete documentation in ICD-10 can’t be overemphasized. Incomplete or inconsistent documentation can lead to a lack of data integrity and result in reimbursement problems.

Never Underestimate the Power of Denial Members Only Document

Claim denials and rejections cost practices valuable time and money. To reduce or eliminate errors and ensure you submit claims correctly the first time, here are a few prevention tips to some of Medicare’s top claim denials.

Billing for Care of the Hospice Patient: Part 2 Members Only Document

When you care for Medicare Advantage patients who need hospice care, getting appropriate reimbursement can be complicated. It’s important for physicians and practice administrators to understand the proper billing procedures for services provided to these patients.

Tips for Physicians Billing Medicare for Care Plan Oversight Members Only Document

Physicians often don’t bill for the ongoing care they provide to their patients who need home health or hospice services and require complex or multi-disciplinary care. Billing these services can be tricky, but getting reimbursement for the service justifies taking some time to learn and understand the rules.

Surgical Modifiers 54 and 55 – Use Them Correctly to Avoid Issues with Reimbursement Members Only Document

Obtaining reimbursement for providing postoperative services for patients whose surgery was performed by another physician can be a little challenging. If the appropriate modifier is not used, physicians may experience significant problems with reimbursement.

Tips to Avoid EHR Documentation Pitfalls Members Only Document

EHRs are a great tool, but the ease of using this technology can quickly lead to some documentation pitfalls. PAMED offers tips on ways to avoid them.

Billing of High-Level Initial Inpatient Services—History is the Bottom Line Members Only Document

Since Medicare eliminated the use of consultation service codes, the initial hospital care codes have been getting a lot more use, which in turns leads to a lot more scrutiny by payers. The number one mistake many physicians make is falling short on documenting the history elements.

Prolonged Services Codes – Timing is Everything Members Only Document

Your practice may be able to take advantage of additional reimbursement for prolonged services codes. It’s a good idea to review the rules carefully to make sure you don’t overuse these codes and invite unwanted scrutiny from payers.

How to Accurately Code Based on Time Spent with the Patient Members Only Document

There are no specific documentation requirements for the history, exam, or medical decision making when using time as the controlling factor to determine the level of care. However, it is strongly recommended that the physician record pertinent information about these items.

Use Modifier 22 Appropriately and Successfully Members Only Document

Appending modifier 22 (increased procedural service) can help increase your reimbursement if your documentation supports a greater-than-usual effort during a surgical service. But if you don’t use modifier 22 correctly you are unlikely to get paid.

What Physicians Need to Know About Medicare’s Annual Wellness Visit Members Only Document

Since the new Medicare benefit called an “annual wellness visit” (AWV) took effect Jan. 1, some physician practices may have questions about how to handle patients who are calling for these visits.

Take a Look at Your Cardiology Coding Options in 2011 Members Only Document

Be aware of the numerous changes and additions to cardiology coding for 2011.

Medically Unlikely Edits – Why you should care Members Only Document

Have you ever received a claim denial from Medicare or a commercial payer based on the number of times you billed a particular CPT code for the same patient on a single date of service?

Removal of Impacted Cerumen and Office Visit Same Day Members Only Document

It may seem that coding the removal of impacted cerumen is almost as tricky as this common procedure.

Modifier 59: How to Correctly Assign Members Only Document

Use Modifier 59 to override NCCI edits and be paid for procedures normally bundled together.

How to Code for Bilateral Procedures Members Only Document

When reporting a bilateral procedure, is it more appropriate to use modifier 50 or modifiers LT and RT?

Coding for Tick or Splinter Removal Members Only Document

If you automatically bill an evaluation and management (E&M) service code for removing a tick or splinter, you may be shortchanging yourself.

Billing CPT 99211 for a Nurse Visit Members Only Document

Make sure you use good documentation when billing CPT 99211.

Billing for the Care of the Hospice Patient: Part 1 Members Only Document

The first step in coding properly for care of hospice patients is differentiating between the two types of modifiers for hospice services—GW and GV.

Billing for Preoperative Histories and Physicals Members Only Document

How do you bill for preoperative histories and physicals?

Referencing a Past Review of Systems in E&M Documentation Members Only Document

Do you need to re-record a past review of systems or past, family, and social history?

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