The word "outsourcing" has become a dirty word for many physicians that have been burned by medical billing companies that either outsourced their claims to medical billing companies that use neither secure networks nor adhere to HIPAA regulation in order to maximize their profits; or the outsourcing company just turned out to not be reliable and it wound up costing the practice money to utilize their services.

Don't let a bad experience keep you from partnering with a legitimate medical billing company that can not only help you get your reimbursements faster but also realize great profits by maximizing every single medical billing claim that is filed to make sure that all services and procedures are counted by the carrier and reimbursed.

If you've been hesitant about outsourcing your medical billing because you aren't sure it would actually help your practice or you've been burned; do a little research on your own and ask for references. Ask the medical billing company what they will do for you. OMG will not only help you get the best reimbursements on your medical billing, they will also help you manage your practice by keeping your and your staff informed of coming CPT coding changes that will affect your practice as well as helping keep your patient accounts organized and you can log in and see where a patient's account stands for insurance payments versus out of pocket. This is a very efficient way to run your practice and when you have the extra time due to partnering with a competent medical billing partner, you will finally be able to help your practice really grow!

Labels: audit, consulting, denials, hipaa, injections, mastectomy, medical-billing, medical-coding, medical-data, modifier-51, modifiers, nurses, outsourcing, paper-trail, physician-credentialing, security

When the surgeon removes lymph nodes during a partial mastectomy, it may be confusing as to how to the mastectomy and the lymph excision. A common point of confusion is whether they should be bundled or reported separately.

The answer is pretty cut and dried. In most cases, with partial mastectomy, the surgeon will perform an axillary lymphadenectomy to remove the lymph nodes between the pectoralis major and the pectoralis minor muscles. The surgeon may also remove the nodes in the axilla through a separate incision at the same time.

When this occurs, you should not report the mastectomy and lymphadenectomy (38745, Axillary lymphadenectomy; complete) separately. Instead, you should use a single, combined code to report the work of both procedures. CPT eliminated partial mastectomy with lymphadenectomy code 19162 for 2007 and has replaced it with 19302 (Mastectomy, partial [e.g., lumpectomy, tylectomy, quadrant-ectomy, segmentectomy]; with axillary lymphadenectomy).

With the updated CPT codes that went into effect on Jan. 1, 2007, you should report 19302 only for most combined partial mastectomy lymphadenectomy procedures. The exception to that rule will be if there is a "staged" exception: Following some partial mastectomies (19301), the surgeon may return during the postoperative period to see if there has been any lymph node involvement and, if so, may choose to remove the nodes at that time. You will want to add the lymphadenectomy as a staged procedure using 38745 with modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) appended to the claim.

Labels: mastectomy, medical-billing, medical-coding, medical-data