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Betsy Nicoletti

Betsy Nicoletti

Betsy Nicoletti is the founder of Codapedia.com. She is also the author of “A Field Guide to Physician Coding.” She believes all physicians can improve their compliance and increase their revenue through better coding. She may be reached at betsy.nicoletti@gmail.com or 802 885 5641.

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Changing patient behaviors isn't easy. Changing any behavior — one's own or someone else's — isn't easy. It takes more than willpower and sideline cheering.

Medical practices need to focus more attention on the specificity and completeness of their diagnosis coding in order to be compensated fairly.

Before deciding to provide and bill for chronic care management, a practice should make sure it has the necessary staff and support structures first.

Over the summer CMS added four new modifiers that will require a much greater degree of specification when coding surgical procedures.

Reporting vaccine administration can be tricky. Practices should review most recent updates and be aware of differences between commercial and federal payers.

Reviewing the definitions of modifiers first will ensure that applying a modifier goes from a game of chance to a sure thing.

Claims are paid based on the CPT code submitted to the payer. The diagnosis code supports medical necessity and tells the payer why the service was performed.

Sometimes patients show up for preventive care and an urgent problem. Should you eat the cost for one service? Or bill for both?

The ICD-10 transition will require a significant change in mindset for practice administrators and staff alike. The time for excuses is past.

But if the facts on the use of modifier 25 are clear, why are practices and hospital systems paying back millions of dollars for the incorrect use of modifier 25?


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