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Improve your billing of 4 highly denied codes that might surprise you

Don’t let your guard down when you bill some of the most frequently used services — such as electrocardiogram, urinalysis and hemoglobin testing — or you might contribute to the tens of millions in denied payment that providers incur annually. A handful of testing and injection services account for some of the highest denial rates […]

Here’s the 7th character rule for nonunions and malunions

Question: We had a patient who presented two months ago with a closed fracture of the right radial shaft. The surgeon treated the patient with closed treatment with manipulation, applied a cast and coded it as S52.324A (Nondisplaced transverse fracture of shaft of right radius, initial encounter). However, in follow-up visits, X-rays showed the fracture […]

Watch out for coding defaults when valve disorder origin is unspecified

Advise your cardiologists that when they don’t specify a cardiovascular condition, it may result in coding of a condition they didn’t intend. Valve disorders are a primary example of this. If the physician does not specify whether a patient’s valve mitral or tricuspid valve disorder is rheumatic or nonrheumatic, the default code is rheumatic, according […]

Ask the Expert: Check policies for routine cesarean follow-ups by anesthesiologists

Question: Is it appropriate to bill a post-operative visit when the anesthesiologist checks on a patient who had a labor epidural the day after a cesarean delivery (01961)? If so, would the visit be reported with 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration), or a subsequent hospital care code such as […]

Append modifier 22 to shoulder scope code when repairing these 2 lesions

Question: What is the appropriate CPT code(s) to report the repair of a Bankart lesion and a Hill-Sachs lesion performed via an arthroscopic technique? Answer: For the Bankart repair, you’d report code 29806 (Arthroscopy, shoulder, surgical; capsulorrhaphy). There is no distinct code for repair of a Hill-Sachs lesion, which is an indentation fracture of the […]

Document correct language, exact time before billing time-based E/M

Question: A physician submitted documentation for what looks like a medical team conference and wants to bill time-based E/M for counseling/coordination of care. The documentation says the team “discussed the patient’s treatment course to date, the progress of the patient and barriers to discharge and goals for the next week.” The documentation includes detailed barriers […]

Ask Terry: For Holter date of service, OK to report date patient received monitor

Question: If a patient is given a Holter monitor on 8/1/2015, and the doctor reads the results on 8/2/2015, what date do we put on the claim? Answer: There’s no clear guidance from Medicare on how to select the date of service for diagnostic tests. But if you are billing the global service (code 93224), […]

Diagnosis coding corner: Match the diagnosis to the reason for anesthesia care on radiology claims

Anesthesiologists provide care for patients during a variety of imaging services. But to get paid their documentation must support the medical necessity for each case, and the diagnosis code they select can make the difference between payment and eating the cost of the service. Payers continue to tighten their requirements for anesthesia with radiology services […]

6 steps to correctly code common gastro conditions in ICD-10

Use extra codes when necessary and gather comprehensive documentation to choose the right ICD-10 combination codes for patients with complications to the digestive system. Implement the following tips to boost your coding compliance, as shared by Betsy Nicoletti, president, Medical Practice Consulting in Northampton, Mass.: Code gastric ulcers fully, starting with site. For the K25-K28 […]

Therapists should use hip fracture + ‘D’ even post arthroplasty

Here’s an ICD-10 scenario that is causing confusion for orthopedic practices: Patient suffers a fractured hip and the surgeon treats it with a partial hip replacement, then sends the patient to physical therapy. What ICD-10 code(s) should the therapist report? Correct answer: The original fracture code with a seventh character for subsequent encounter (e.g., “D”). […]