VAD Interrogation and Programming
Patients with a previously implanted ventricular assist device (VAD) require periodic interrogation of the device, as reported with 93750 Interrogation of ventricular assist device (VAD), in person,...
View ArticleWhat CMS Means by “Access to Documentation”
Providers and suppliers who furnish durable medical equipment (DME), clinical laboratory services, imaging services, or home health services to patients on Medicare should be aware of a clarification...
View ArticleWatch for Common Documentation Deficiencies
Documentation supports reimbursement; therefore, you must be certain that the information is straightforward and accurate, and that it “flows” in chronological order. Be mindful that clinical...
View ArticleClaims Follow up Is Crucial
One of the most common mistakes practices make is to set up an automatic rebill of unpaid claims without researching claim status. This will cause duplicate claim denials. Most payers provide the...
View Article5 Quick ICD-9-CM Coding Tips
Always document and code to the highest specificity of the diagnosis for the services rendered. The ICD-9-CM Manual describes guidelines for outpatient/office visit diagnosis coding, as follows:...
View ArticleFuture Proof: Why Alternative Payment Models Will Make Skilled Coders Even...
by John Verhovshek, MA, CPC As policy makers and payers push healthcare toward “pay for performance” reimbursement models, coders may feel some anxiety about the future of their chosen profession. Fear...
View ArticleOIG: Hospitals Incorrectly Billing for IMRT
The Office of Inspector General (OIG) indicates in its mid-year update to the 2015 Work Plan that it will review Medicare outpatient payments for intensity-modulated radiation therapy (IMRT), beginning...
View ArticleCode from the Operative Note
By Brenda Edwards, CPC, CPB, CPMA, CPC-I, CEMC Have you ever planned a project, and when you begin you find that it isn’t going to work out as planned? You run into a snag that make it take twice as...
View ArticleASCs: New Quarter, New Payments
July is right around the corner, and you know what that means: The Centers for Medicare & Medicaid Services (CMS) is updating its payment systems for the second quarter. The July 2015 update of the...
View ArticleThe Radiologist’s Role Depends on Location
by John Verhovshek, MA, CPC The Centers for Medicare and Medicaid Services (CMS) designates two sets of rules regarding radiology services, depending on where the services are provided. The ““Ordering...
View ArticleChoosing a Qualified External Auditor
by Peggy Stilley, CPC, CPC-I, COBGC When hiring an auditor for your practice, consider the following: Is the individual or entity credentialed? Verify credentials with the entity issuing the...
View ArticleCrucial Documentation Components of the Operative Note
by John Verhovshek, MA, CPC A surgeon’s operative notes should stand alone to provide all the necessary documentation to describe the procedure(s) performed. Every operative note should include:...
View ArticleOverpayments Are an Obligation to Refund
by John Verhovshek, MA, CPC As part of an active compliance program, your practice should take steps to identify and, where appropriate, return overpayments. Obligations and timeframes to return...
View ArticleEligible for Bilateral Payment? Here’s How to Tell
by John Verhovshek, MA, CPC Not every code is eligible for payment with modifier 50 Bilateral procedure appended. How do you know if you should append the modifier or leave it off? Maybe you should...
View Article4 “Must Haves” to Append Modifier 25
by John Verhovshek, MA, CPC To append modifier 25 with confidence, your claim must meet four criteria. 1. The same provider must provide an E/M service and another procedure or separate for the same...
View ArticleServices You Should Never Code Separately
by John Verhovshek, MA, CPC Medicare bundles (includes without separate payment) certain services and supplies when they are provided with other, more comprehensive services. According to the National...
View ArticlePost-op Care Reporting Requires Attention to Detail
Q: A Medicare patient visits his primary care physician for dressing changes two weeks after a major surgery, which a surgeon performed. How would you code the PCP’s services? A: It depends. If the...
View ArticlePass the “Midpoint” Before Billing a Time-Based Service
by John Verhovshek, MA, CPC If a code describes the “first hour” of service, you must provide and document at least 31 minutes of service. Likewise, if the unit of service is 30 minutes, you must...
View ArticleUpdate Your CPT Codebook with Latest Changes
The American Medical Association (AMA) released this month errata and technical corrections to its CPT® 2015. It also released new and revised vaccine codes, scheduled to appear in the CPT® 2016. 2015...
View ArticleCMS Proposes Changes to Hospital “Two Midnight Rule”
by John Verhovshek, MA, CPC The Centers for Medicare & Medicaid Services (CMS) is proposing a change to the “Two-Midnight Rule” enacted Oct. 1, 2013. The rule requires that providers admit patients...
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