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.
Medical Billing for Tissue Adhesives
One point that many medical billers find confusing is the correct procedure for coding the use of tissue adhesives when used for wound closures. The answer to this question will be different depending on which entity is paying the medical billing claim. When you code for the use of tissue adhesives, including Dermabond; Medicare has its own guidelines for reporting this procedure that you need to follow to be reimbursed. You should report G0168 for Medicare patients only. If you are reporting the procedure for a non-Medicare patient, you should use the CPT code that is the equivalent and that is 12001-12018 series (Simple repair of superficial wounds …). Another …
Medical Billing Claims for Tests That Are Normal
If you have a medical billing claim to file and the test that was performed on the patient comes back without any definite diagnosis, don’t discount the fact that you won’t be reimbursed for the medical billing, instead you need to determine whether the test result is normal, negative, or inconclusive and that final reading will determine how your medical billing claim should be handled. If your test comes back inconclusive, you shouldn’t report a diagnosis that the laboratory gives you after a pathology test. Many practices mistakenly report the lab’s diagnosis because they feel that claim will legitimately get paid. A good rule of thumb is to code the …
Wrong Place of Service Can Cause Denials
Check and double check your medical billing claims for the notorious wrong place-of-service (POS) code that can spell denials and delays in getting paid for your observation services. A good general guideline to follow is to use POS 22 (Outpatient hospital) only for observation codes 99217 (Observation care discharge day management …) and 99218-99220 (Initial observation care, per day …). Be sure not to use POS 21 unless the patient has been formally admitted. You will need to split out the time the patient was in observation before they were admitted and use codes 99211-99215 for any E/M services rendered on the second day and before the patient is discharged. …
The Three R’s of Medical Billing
If you’re seeing a lot of that other “R” word: rejection; in your medical billing claims – it might be a case of your medical billing claims not meeting the basic requirements for payment. Traditionally, to code a consultation (99241-99255), the encounter had to meet three requirements: *Request for opinion*Rendering of services*Report to the requesting source. Medicare’s new guidelines requires that a physician make the require or other appropriate source for ordering services and procedures. A good way to make sure that there is no denial of the claim, is to have a written reason and request showing a logical progression of the services from the necessity and nature of …
Correct Medical Billing for Parent Consultations
The world of pediatric medicine is fast paced and along with unpredictable kids come unpredictable medical billing situations. If you process medical billing for pediatric physicians, you may or may not have run across a situation for determining what diagnoses would apply when parents come in to discuss their child’s health issues. If you’re wondering if there is a single code, the answer is yes. A parent conference falls under V65.19 (Other persons seeking consultation; other person consulting on behalf of another person). In other words, the code describes a person seeking “advice or treatment for non-attending third party.” Since a parent has the right to discuss the treatment and …
Do You Report Separate Codes for Separate Excisions?
One daily dilemma that many in the medical billing industry face are when to bundle a claim for services rendered and group like services and when to report them separately. Ultimately you want fair reimbursement for all services rendered to patients and with the fee structures for repayment on medical billing claims, it can be confusing about when exactly to combine and when to split services out as individual procedures. A good example would be if a physician debrides two sites with infected decubiti, technically, it would be two procedures and in most cases could be reported as separate. A good rule of thumb would be to first look at …
Do You Know About the New Mandatory CMS-1500 Form?
Head’s up medical billers, by April 2007, it will be required that you start using the new CMS form that accommodates the new National Provider Identifier (NPI) numbers. “Because of the number and types of changes that the new CMS-1500 includes, you will need to update your billing software programs to print your claims correctly”, says Cyndee Weston, executive director of the American Medical Billing Association. That means now is the time to update your billing system software to ensure your office is ready. If you don’t already outsource your medical billing claims and you don’t want to spend the money for an upgrade – it may be time to …
Filing Locum Tenens Claims and When to Use Modifier Q6
Locum tenens is a confusing situation in the case where a physician takes a vacation or otherwise isn’t available and hires a physician to see patients on site, Medicare can deny the claim unless it is properly documented. The reason is that Medicare is very strict about seeing specific modifiers on medical billing claims that involve a substitute or locum tenens physician. Further, your medical billing claim must have the time limits observed for locum tenens doctors. Otherwise, Medicare won’t pay for their services rendered to patients. Also, you can’t hire a locum tenens as extra staff. This includes situations where the regular attending physician goes on vacation, has an …
Medical Coding for Estrogen Withdrawal
Put yourself in this medical biller’s shoes and see if you would file this claim correctly. A patient that recently had a hysterectomy presented to the ED with symptoms needing treatment. The physician noted that the patient was suffering from “estrogen withdrawal with menopausal symptoms.” A level three evaluation and management service was performed on the patient; what diagnosis code would you use? There’s no specific code for estrogen withdrawal. Stumped? In this case you should use more than one code as there is no specific code for this service. Break out the claim to show the patient’s main complaint and reason for the ED visit and then to show …
Are Your Sick Visit Claims Costing You?
If you don’t properly meet certain requirements for the use of Modifier 25 in your sick visit bundled medical billing claims, you could very well be losing money and not know it. There are some simple rules to follow to ensure that you’re getting the best reimbursements for your claims. First of all, make sure that you know exactly what the payer requires for reimbursement on these claims. Next, make sure you document exactly what caused the encounter and what the outcome was. This shows a logical flow of information and will better help the payer see that the services rendered will qualify for full reimbursements. Additionally, be aware that …
