Medical Billing Blog: Section - Medical Coding
Archive of all Articles in the Medical Coding Section
This is the archive containing links to all articles written in the Medical Coding section of our blog.
Click any of the article links below to read the entire article or browse another section to the right to read articles on another subject.
Making Inpatient Reporting Easy
One of the most difficult medical billing feats is inpatient consultation coding. There are many instances when a follow-up inpatient consult should be replaced by a subsequent hospital care visit. To eliminate these medical billing errors, there are four facts to consider when coding for inpatient consults. The first fact is very obvious. If your report an inpatient consultation exam, the patient must be inpatient, not outpatient. Very often physicians see patients on a consultation basis when they are outpatient. Medical billing mistakes can be made easily. Double check your work. It is important in medical billing to always report one initial consultation. This code will correspond with the very …
Medical Billing Once or Twice for Certain Codes
Patient evaluation codings can be very confusing. The patient initial evaluation code is 97001 (also, 97003, 92506, 92610) however if the patient is reevaluated (97002- patient reevaluation) within a 12 month period only one unit of service may be billed to Medicare Part B patients no matter how much time was spent actually servicing the patient. If you make a mistake and bill the carrier for the evaluation and a unit of service for the reevaluation, your claim will be denied based on incorrect coding no matter how much medical documentation you provide showing the necessity of the reevaluation of the patient. Keeping up with the fast paced changes of …
Coding Pediatric Injections For Max Return
Therapeutic and antibiotic injections went through some changes in 2006 and make sure that your medical billing claims reflect those updates or you might be suffering from partial payments or rejections of your medical billing claims. In the past there were separate injection administration codes for a therapeutic, prophylactic, diagnostic, and antibiotic injections. Instead of choosing to report administration of a prophylactic Synagis treatment (90378) with a 90782 (Therapeutic, prophylactic or diagnostic injection , you now simply use 90772 as a universal injection code. On E/M coding, you will generally still need to attach modifier 25 to insure your claim is handled. Modifier 25 states that this procedure or other …
Revisiting Modifiers 25 and 57
If you have a number of medical billing claims getting rejected, once you rule out any larger reasons, you might start looking for the key in the use of; or rather the lack of not using modifiers as a part of your medical billing claims. Two of the main modifiers that get people in trouble with their medical billing claims in the forms of rejections are modifiers 25 and 57. Modifier 25 reads , “Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service” is kind of a catch all modifier for procedures that may not have an exact …
Outsourcing Makes Reimbursements Happen Faster
Think about it, would you ever think that sending your medical billing claims outside of your office could actually get them paid quicker? It doesn’t sound logical at first glace, but it’s very true the outsourcing your medical billing claims will usually get them paid faster. Think about how often your in-house staff gets interrupted, how often the crisis of the moment rears its ugly head and day to day managing of the office prevents them from filing, double checking accuracy, and following up on your submitted claims. Time is also lost re-submitting claims when they get kicked back for the smallest of errors in coding. As you know, Medicare …
Ending Confusion on Multiple Procedures
When you have a patient that has had multiple procedures performed, make sure that the group of procedures that were performed actually require modified 51 before you attach it. The CPT has a list of certain coding that are exempt from modifier 51. The CPT manual designates modifier 51 (Multiple procedures) exempt codes with a “circle with a slash” symbol to the left of the code for the services rendered. There is usually a complete listing of modifier 51 exempt codes in an appendix. The list is “a summary of CPT codes that are exempt from the use of modifier 51 but have NOT been designated as CPT add-on procedures/services,” …
Understanding Review of Systems 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 …
Medical Necessity Can Make or Break Your Claim
Along with documentation, medical necessity is one of the most important parts of medical billing. You tell exactly how the procedure was performed, be sure to meet the criteria for medical necessity of the procedure by telling why the procedure needed to be performed. It used to be that Medicare was the only payer that cared what ICD-9 code was used. Now all payers, including insurance companies, are looking for any reason not to pay the bill or at least delay it. ICD-9 codes have become the target for close scrutiny. ICD-9 codes range anywhere from a three-digit code to a five-digit code. Obviously, a five digit code is more …
Coding for Oxygen Administration
Coding a medical billing claim for oxygen administration can be a tricky beast because there is not a specific oxygen administration code assigned. Normally the administration of oxygen is bundled into an emergency visit. When a doctor prescribes the oxygen, you should use the appropriate office visit code that describes the procedure and services performed by the physicians that necessitates the need for oxygen. Full documentation of the medical billing claim will insure that your bundled oxygen administrations codings get full reimbursement. For example if you have a physician who performs a detailed examination on a patient and decides to administer oxygen to a known patient who is in the …
Breaking Down a Breast Biopsy
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 …
