Archive for The Month of April, 2006

Archive for the Month of April, 2006

Welcome to the medical billing blog archive for the month of April, 2006.

Here you will find links to every article added to the Outsource Management Group web site during the month of April, 2006.

You can browse this month's archives by clicking the "More" button from any of the excerpts below.

Changes in Maryland Medical Billing for Medicare

If you are a physician located in Maryland, be aware that as of April, Medicare is now approving a broader coverage for the use of home oxygen for individuals that are enrolled in a federally approved clinical trial that is sponsored by the National Heart, Lung and Blood Institute. Under the current Medicare statutes, Medicare only pays benefits for individuals that have a partial pressure measurement at or below 55mmHg or an oxygen saturation that measures in at or below 88 percent. If another disease or medical condition is present, Medicare will provide benefits if the partial pressure and oxygen saturation are raised one percent. So partial pressure would begin

By: Melissa Clark, CCS-P, RT - CEO
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Correct Coding=Ob-Gyn Medical Billing Claims Paid

Recent studies showed a large number of errors in the medical billing claims submitted for patients suffering from eclampsia and preeclampsia. Because multiple procedures are common with ob-gyn patients, billing errors happen frequently. The number one reason for coding error is usually due to a physician being rushed and missing a procedure that should have been billed. Most staff in a physician’s office are trained to handle patients, not make sure each and every line on a medical billing form is filled in correctly and with a logical flow of services. This means many doctors are not receiving the maximum reimbursements for the services they perform for their patients and

By: Melissa Clark, CCS-P, RT - CEO
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Medicare-No Pay For Certain Gastric Procedures

If you are a physician that does regular gastric by-pass procedures, you need to know that as of March 17th, Medicare will no longer reimburse the code 37216 which is transcatheter placement of intracatheter stents according to their latest transmittal from the Centers for Medicare & Medicaid Services. Other changes that are coming soon will be to the physician reimbursement fee schedule. New medical billing claims need to show code 37216 to have the status code of “R,” and carriers should adjust their systems to “reflect a non-coverage status” for this particular code. Another change in the gastric medical billing category will be to restrictive procedure code 43842 that will

By: Melissa Clark, CCS-P, RT - CEO
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Watch Your Usage of Sedation Codes In Medical Billing

In the new 2006 release, CPT introduced six new codes for moderate sedation (99143-99150, Moderate (conscious) sedation) and the six new codes replaced the two previously used conscious sedation codes (99141-99142). For the moment, the six new codes have been assigned by Medicare a status of “C”, which means that the codes are carrier priced. In many instances carrier priced often means no reimbursement for the physician. Certain Medicaid programs will pay for moderate sedation for children. For example, if a child comes in with a high fever and the doctor suspects an illness like meningitis, the doctor may need to give the patient a spinal tap under moderate sedation

By: Melissa Clark, CCS-P, RT - CEO
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Combining History with Illness In Your Medical Billing

Combining history of present illness and review of systems is possible when doing medical billing. Many medical billers think this practice is breaking a rule or impossible. However, documenting an element once to account for HPI and ROS is perfectly legal when done correctly. The CMS states that physicians absolutely do not need to document an element two times just so the person performing medical billing knows it is meant to be used both for review of systems and history of present illness. It is perfectly acceptable to use an element for both. The only time an element cannot be used twice is when you attempt to use it in

By: Melissa Clark, CCS-P, RT - CEO
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Medicare Halts Reimbursements on Fecal Occult Blood Testing

If you are a physician that does FOBT testing, you need to make sure that the updated CPT coding is being used on your medical billing claims along with complete documentation or Medicare will no longer reimburse your medical billing claims submitted for this procedure. As of April 1, 2006, Medicare will no longer accept fecal occult blood code 82270 under the fecal occult blood test coverage policy for reimbursement. The new code that should be used for this service refers to blood occult peroxidase code 82272. If your practice has grown to the point you’re finding it difficult to keep up with the lightning fast changes in the medical

By: Melissa Clark, CCS-P, RT - CEO
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Include Evaluation with Scheduled Procedure

Here is a perplexing problem. When a surgeon meets with a patient an recommends a breast biopsy, we report a consult for this particular visit. On the day of the biopsy procedure, the surgeon will re-examine the patient, answer questions, an so on. The time that is spent prior to the procedure is ten minutes. In a case like this, you will not report a separate E/M with the biopsy. It is important to remember that all procedures include an inherent E/M component, according to CPT and CMS guidelines. In order to qualify as a separately billable service, any E/M the physician provides must be both signifigant and separately identifiable

By: Melissa Clark, CCS-P, RT - CEO
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Three Questions Solve IM Injection Medical Billing Challenges

CPT 2006 injection administration coding instructions require that you verify the OB-GYN’s involvement in order to report 90772, or in order to submit the non physician performed procedure as 99211, or it could depend on the payer’s incident-to policies, and possibly be returned to you as a no charge. To determine which code applies to injection administration, you need to ask yourself three questions. 1. Is the Doctor in the office and available during the injection? If the answer is yes, the OB-GYN provided direct supervision throughout the subcutaneous or intramuscular injection, then you can report 90772 (which is therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or

By: Melissa Clark, CCS-P, RT - CEO
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