Medical Billing Blog with Medical Billing & Coding Info & Articles
Our blog contains news and articles relating to numerous healthcare sectors including revenue cycle management, medical billing, medical coding, ICD, HIPAA, practice management functions and more.
Tips to Get Your Consultation Medical Billing Reimbursed
Since consultation requirements have increased in the last year as far as criteria for getting them reimbursed in your medical billing claims, there are some criteria you must be certain that your claims meet in order to justify using codes 99241-99255. It used to be simple and medical billing consultant merely had to meet the three “R’s” in order to justify medical billing claims for consultations. However the criteria for what does and does not constitute a consultation has changed and in order to make sure that your medical billing claims are paid, you need to reacquaint yourself with the three R’s of medical billing for consultations. The three R’s …
Tips for Coding Emphysema Visits
When you’re compiling the medical billing for an established patient with active emphysema (492.8, Other emphysema) and they present and are complaining of shortness of breath (786.05); the physician provides inhalation treatment, trains the patient on using the nebulizer at home, and provides an expanded problem-focused examination and medical decision-making of low complexity, how would you report this? There will be multiple codes for this visit as the emphysema was the reason for the visit however the physician also provided services and consulted regarding the nebulizer so there will need to be additional codings on the medical billing to take all the services rendered into consideration. Be sure and capture …
Varicose Vein Repair Reporting Tips
Varicose vein treatments are becoming more and more frequent as more patients are urged to get them treated to stave off the possibility of blood clots and other issues that can crop up later if they are left unaddressed by the patient. However reporting the varicose vein treatment procedure on the medical billing may be a little confusion for some; once you know the basics for setting it up – it’s easy! A good example would be if a patient with varicose veins in her left lower leg presents to the ED and is stating she has severe pain in her leg. One of the veins is clearly bleeding so …
Using Modifier 25 in Medical Billing
When claims require modifier 25, there are some simple tips you can use to know the modifier’s details, such as which code to append it to, as well as when to use the modifier. It is important to identify the claim makeup in order to solve the problem of which code to use modifier 25 with. Modifier 25 is a significant, separately identifiable evaluation and management service by the same physician on the same day as the procedure or other service. Do you attach modifier 25 to the well visit or to the sick code? Modifier 25 can be applicable on either code. Therefore, the answer depends on the claim …
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, …
2 Code Claims Complex Closures on Excision Claims
When closures become complicated, it is possible to have a two code claim. If the ED physician removes a lesion, he or she will also need to close the site prior to releasing the patient to go home. If the closure is a simple repair, then the work is combined into the lesion excision code. If the repair is more complicated then that though, then you can report the closure separately. If an intermediate closure is performed by the ED physician, then you will choose a code from the 12031 – 12057 set, but for complex closures, then you will choose a code from the 13100 – 13153 set. These …
