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.
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 …
Medial Dislocation – Billing it Right
A common occurrence in the emergency is the dislocation of various joints. They are sometimes incorrectly handled as breaks but shouldn’t be and you could be setting your practice up for a denial at best and audit at worst if you report these procedures incorrectly on your medical billing. Even if the reduction of the dislocation fails, the attempt should be reported on not only the medical billing as a procedure but also in the documentation as another procedure will have to be tried to relocate the elbow to its proper placement and you can show the timeline for the necessity of other and more involved treatments. On the claim …
Ready for the New NCCI Edits Coming in July 2007?
The new edits coming in July 2007 will mainly affect ER room practicioners and physicians and nurses that treat patients in nursing home facilities. These updates will be items you need to know in order to avoid denials and get maximum reimbursements on your medical billing claims. The codes that were changed in the upcoming release were codes 99281-99285 (Emergency department services) are considered component codes of the more global 99304-99306 codes (Initial nursing facility care). This means if a single physician provides a level-two ED service along with a level-two initial nursing home service, you should only report 99305 (Initial nursing facility care, per day, for the evaluation and …
Reimbursements Can Be a Reality For Chronic Bronchitis Claims
If your medical billing claims for patients who present and are diagnosed with chronic bronchitis are getting denied payment by the carrier; take a very close look at the code you’re using to report this condition. One of the biggest reasons chronic bronchitis isn’t paid on a claim is because it is reported as a general chronic code using 491.9, Unspecified chronic bronchitis. The trick is to forego choosing the 491.9 as the ICD-9 will lead you to do. Instead look for the diagnosis of the possible cause of the chronic bronchitis such as chronic asthma which has its own specific code. If procedures were performed on the patient, note …
Deciding to Use Modifier 59 on Certain Procedures
Sometimes in medical billing it is difficult to decide when to use current procedural terminology codes 58661 and 49322-59. These codes, like many others seem similar, but in actuality, are quite different. When performing medical billing it is necessary to know when to use current procedural terminology code 58661 versus 49322-59. The medical billing code 58661 (laparoscopy, surgical; with removal of adnexal structures) is used when any part of the ovaries or Fallopian tubes are removed. For example, If a surgeon was doing a cystectomy of an ovarian cyst and ended up removing some of the ovary as well, they physician could do medical billing with 58661. The current procedural …
When New Billing Codes Aren’t Recognized
In medical billing, code recognition is not the only reason for denial. If a claim containing a new code is denied, go through your medical billing claim and make sure it is absolutely accurate. Then you can probably narrow down the reason to simply a matter of the carrier not recognizing the CPT code. When new medical billing codes are introduced there is a lag period that lets coders and payers get adjusted for that specific code. HIPPAA sets an effective date for all medical billing codes that states when companies must begin using the codes or accepting the new codes. It is illegal to deny claims for no recognition …
The 4 Big Myths of OB-Gyn Medical Billing
OB-Gyn medical billing can be very confusing and some physcians will under code their medical billing claims as they fear an audit so they don’t submit full claims but in fact, this practice will cost you money. In order to understand OB-Gyn billing fully, you must understand the myths associated. There are four medical billing myths associated with OB-Gyn medical billing that may be holding back your reimbursements. The first myth deals with the initiation of the ob record. If both the ob-gyn and the nurse see the patient for initial blood work, you should not report a minimal code for both instances. In OB medical billing, you should report …
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 …
