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Don’t bill arthroscopy separately when doing an open shoulder procedure

Question: Can we bill separately for diagnostic arthroscopy (29805) with an open procedure code? Answer: Usually not. Both are done inside the joint so the arthroscopy code would be bundled into the open code. The exception would be if the two procedures were done on opposite shoulders.  

New primary care-based psych codes offer opportunity, challenges in 2017

Building on the CoCM model makes sense because “there’s a lot of practice experience with this model,” says Harbin. As proposed, the new G codes related to CoCM rely on three pillars that practices should focus on when treating a patient with a diagnosed psychiatric disorder: Frequent and ongoing consultations with a psychiatric consultant “to […]

Select a HCPCS code when reporting common vaccine administrations

Double check the administration code you’re reporting for vaccines and injections that you deliver frequently and think twice about choosing a common CPT code that is tied to a large number of denials for Medicare’s covered services. Ultimately, Medicare discourages the use of CPT code 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; […]

Compliance update: When a service is bundled, don’t bill the patient separately for it

Not all types of Medicare denials are created equal. In certain cases, it may be appropriate for a provider to have the patient sign an advance beneficiary notice (ABN) and recoup payment. In others, particularly bundled service situations, a practice can get in a lot of trouble by attempting to skirt around the rules and […]

Quick coding chart: Minimally invasive S/I joint (MIS) fusion – 27279

Download File Some Medicare carriers and private payers will now pay for minimally invasive fusion of the sacroiliac (S/I) joint. But the coverage requirements are tough and at least one carrier – First Coast Service Options – will conduct a case-by-case review before it will pay. Here are some more facts about this treatment for […]

Ask Terry: Here’s how to report lead revision within 90-day global

Question: How many times can you bill for a lead revision during the 90-day global period? Answer: There are no frequency guidelines, per se, but the first time you’d report 33215 (Repositioning of previously implanted transvenous pacemaker or implantable defibrillator [right atrial or right ventricular] electrode) with modifier 78 to reflect an unplanned return to […]

You can separately bill intraoperative radiographs when fully documented

Question: I’m looking at procedures that a surgeon’s coders want to code, including a ligament reconstruction tendon interposition (LRTI) (25447) and an ORIF of carpal scaphoid (25628). At the end, they also billed 73110-26 (Radiological examination, wrist; complete, minimum of three views). For the imaging, the report states the following: “Multiple views including antero-posterior (AP), […]

Dispel 4 common E/M coding myths to enhance core coding compliance

Do away with preconceived notions you may have about E/M coding, such as the required number of elements you must document for established patients, to lower your audit risk and get those frequently issued claims through the door. Office visit claims with codes for new patients (99201–99205) and established patients (99211–99215) are in the crosshairs […]

Append modifier 52 for ‘limited’ stress echocardiography for TAVR

Question: Our clinic’s echocardiography department has started doing limited echoes with Dobutamine for stress with patients who have severe aortic stenosis to see if they qualify for a transcatheter aortic valve replacement (TAVR) procedure. Our head echo tech wants to know how to bill these. Answer: There is no code for a limited echocardiogram. Instead, […]

Common coding challenges: Use 4 post-op block FAQs to strengthen your coding, protect your revenue

Post-op blocks are a major source of revenue for anesthesia practices, but the rules confuse providers and coders, putting their claims at risk. Share the following four questions from a recent APCPS post-op blocks webinar to prevent denials that can’t be appealed: Question: Is medical direction broken when an anesthesiologist performs a post-operative block? Answer: […]