Billing Compliance

Coding answers from our September 2011 journal.

With so much else changing in healthcare, it's understandable that you'd want to avoid thinking about transitioning to the coming ICD-10 code set. But the longer you wait to start, the tougher it will be to make the switch, and the more likely you are to lose money. Here's what you need to know to avoid claims denials and ensure a smooth conversion.

Bartering is a concept that is generally not practiced in today's times. In years past when patients had no money to pay their physician, it was common for them to bring an object other than money for payment: a chicken, a barrel of vegetables, etc.

The HITECH Act significantly strengthened aspects of the HIPAA Security Rule. If you are a 'Covered Entity' or 'Business Associate' it's time to get serious!

With government incentive dollars flowing and new tech tools like tablet computers and patient portals emerging, more practices are embracing a digital future. But for many, the old barrier to adoption - money - remains.

Learn when and what CPT codes to use with prolonged services codes 99354 and 99355 at your medical practice.

Coding questions? We've got the answers

Use technology to free your staff and patients from non-urgent phone calls

The feds have aggressively stepped up their fraud and abuse efforts. Your practice may play by the rules, but that doesn't guarantee it will escape federal scrutiny.

This pediatric cardiologist thinks that all his patient visits should be coded as level 5s. Is he right?

This administrator wonders if his physician needs to be physically present in order to bill a 99212 for infertility blood work.

I have a physician who saw a patient for a preventive visit and also charged a 99215 for this patient on the same date of service. He used the same documentation for both visits. Should he have documented each service separately?

Questions pertaining to the new Medicare Annual Wellness Visit.

Here's some guidance on using the new Medicare G0438 and G0439 codes.

Level 5 codes based on "breadth of management" need to clearly explain "why" the reported illnesses pose significant risk to patients. Should the physician add a statement to to her assessment that explains why the combination of multiple chronic illnesses pose a risk to the patient's morbidity/mortality?

A discussion arose between the auditors in my office regarding "double dipping" and I am wondering if you would mind clarifying something for us. One auditor says that it is permissible to obtain a review of systems (ROS) from the CC of "arm pain" - using arm as the location in the HPI and pain as the ROS under MS. I have never audited in this manner and would appreciate any advice or direction you can offer.

This doc wonders if he can mix and match body areas and organ systems for an expanded problem-focused exam.

When counting points for the data reviewed in E&M, do you count "independent review of image, tracing, or specimen" (two points), for example, when a cardiologist sees a patient, interprets an EKG, and provides an E&M service?

I know that there are going to be significantly more codes with ICD-10, but will the rules change regarding how codes are assigned?

I keep hearing about the new modifier 33 but it's not in the CPT manual. Am I supposed to be using it?

Repeating documentation for the HPI and ROS, is it allowed?

Have the rules changed for CERT (Comprehensive Error Rate Testing) reviews?

Did the definition of healthcare fraud change?

How can I avoid an audit finding of "insufficient documentation" for medical decision making?

Can Medicare require documentation that includes the full physician's note for 99204s and 99205s?

Is there a new modifier for CPT in 2011?

My providers seem really confused about using consult codes for Medicare patients in the hospital. Is the use of admission codes confined to the day the patient is admitted?

It seems the traditional understanding of modifier 59 has changed. Here's information for your medical practice.

The feds are cracking down on (even accidental) violations of data security rules. Here's how to avoid serious financial and administrative penalties.

It used to be that you examined the patient. But from your credentials to your use of technology, patients are increasingly examining you. Here's how to deal with this new generation of engaged, informed, and demanding patients.