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Welcome to the medical billing blog containing news and articles relating to medical billing, medical coding, ICD, HIPAA and practice management functions.
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Medically Unbelievable Units Not a Worry- For Now
The Centers for Medicare and Medicaid Services (CMS) were due to implement an additional restriction on the reporting of units of service that was to begin on July 1st. The CMS has decided to not to use the “Medically Unbelievable Edits” (MUEs) that would have restricted the units of service you could report on your medical billing claims. Based on concerns from physicians and medical billing and coding professionals alike, the CMS has pulled the planned implementation of this program for further review. This change to MUEs reimbursements would have affected roughly 1,000 laboratory and pathology CPT/HCPCS codes. The MUEs would have limited the number of times you could bill …
How to Bill MRI Claims for Maximum Reimbursements
In many instances, when a patient receives both an IAC and brain MRI, many practices mistakenly bill only for one service or the other. However, in most cases, both procedures can be reimbursed. The criteria for both procedures to be reimbursed are contingent in the fact that they must be performed in the same session. The requirement to code for both services is that they need two separate and distinct exams. Each exam is required to have distinct findings and you must have a medical necessity and documentation to back up both claims completely. If you find this situation confusing, you’re not alone. The fast changing world of medical billing …
Medical Billing Tips to Reign In Your Global OB Coding
The following tips will help to ensure success for your global ob packages every time. Make sure that you are getting the maximum reimbursement for your medical billing claims. 1. Make certain that all of your ICD-9 selections for OB billings have been chosen from the 640-678 range of diagnoses. 2. Always code to the highest specificity when you must add a fifth number to denote the episode of care (as in a case of complications mainly related to pregnancy, 651-659)a. Unspecified = 0b. Delivered, with or without a mention of an antepartum condition =1c. Delivered, with mention of a postpartum condition = 2 d. Antepartum condition or complication =3e. …
Proper Use of ED Injection Codes
When to use code 90784 when processing medical billing claims for emergency room injections can raise a lot of questions. If you fail to follow the exact criteria for reimbursements of these types of claims, you risk only receiving partial reimbursement for the services or an outright rejection of the claim. The question of when to use this code comes up when a hospital supplies an injection or antibiotic to a patient in an emergency department visit situation. Many medical billers believe 90874 should not be used in this situation because the physician has not actually purchased the drug, just administered. In all actuality, 90784 means- therapeutic, prophylactic, and diagnostic …
History of Present Illness and Your Medical Billing
When to combine history of present illness and review of systems causes a lot of confusion among many practices. However it is possible to do and is perfectly acceptable to document an element once to account for HPI and ROS. In many instances, a physician will leave a medical billing company with tons of documentation for a review of systems, but not enough information for the history of present illness. The physician is missing out on some additional revenue by not documenting the ROS. The CMS states that physicians do not need to document an element two times for medical billing purposes. It is perfectly acceptable to use one element …