Archive for The Month of June, 2007
Archive for the Month of June, 2007
Welcome to the medical billing blog archive for the month of June, 2007.
Here you will find links to every article added to the Outsource Management Group web site during the month of June, 2007.
You can browse this month's archives by clicking the "More" button from any of the excerpts below.
Team Procedures
All too often, the problem in the case of team procedures, where multiple physicians are involved, is that the first physician’s claim that gets submitted wins. This is especially true when another provider takes credit for radiology services. Let’s take a look at a few examples, to help you figure out how to code your claims to make sure you get a radiology claim to your payer quickly. Example 1: Do both a radiologist and a speech language pathologist need to be present to code a modified barium swallow procedure? They may both need to be present. Guidelines recommend that the service be provided in a team setting. Note the …
Multiple Angiographies
It can sometimes be perplexing when a physician performs angiography on both legs and one arm. Which CPT codes should you use when reporting these procedures? You should report 75710 (which is Angiography, extremity, unilateral, radiological supervision and interpretation) as well as 75716 (angiography, extremity, bilateral radiological supervision and interpretation). Append modifier 59 (which is distinct procedural service) to code 75710. This will show that the procedures were in fact performed on different areas (the arm using the unilateral code and the legs using the bilateral code). The reason for this is that the National Correct Coding Initiative edits bundle unilateral angiogram code 75710 into bilateral angiogram code 75716 with …
E/M and Repair on Laceration Claims
Let’s say an otherwise healthy man reports to the ED with lacerated index and middle fingers on the palmar surface, but there is no significant bleeding. The patient cut himself on a table saw. There is a 1.5cm jagged laceration with protruding fat located on the pad of the distal phalanx of both fingers. The physician uses Marcaine to apply digital blocks to both fingers, explores the wounds and finds no foreign bodies, and then closes the wounds. This encounter should be coded with a pair of E codes, in order to identify the cause of injury. Report this claim as follows: Report 12002 for the wound closure (this is …
Why it is Necessary to Demonstrate Medical Necessity
Some physicians and coders believe that CPT guidelines allow for reporting 99215 for any established patient based on a comprehensive history and examination, even if the MDM is low risk. By this reasoning, you may report 99215 for any E/M visit where the physician documents a comprehensive physical and exam, even if he or she only treats a minor problem. However, this is a myth. CPT E/M guidelines do not offer a legal loophole allowing them to ignore medical necessity. The nature of the problem for which the patient presents is the measure of medical necessity for E/M services. This is included for every level of service. If medical necessity …
How Depth Affects Excision Claims
Depth is very important when choosing the appropriate code for coding excision claims. For example, a surgeon excises a lipoma from a patient’s back, and the excision measures 5.0 cm x 4.0 cm x 2.0 cm. In this situation, should you select code 21930 or code 11406 for the procedure that was performed? The key to deciding which code is the correct code is the depth of the excision that the physician performed on the patient. Assuming that the depth, in this example, is 2.0 cm (20mm), is much greater than the average thickness of the skin (2-3mm), so you are justified to report code 21930 (which is excision, tumor, …
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