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. (more…)
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. (more…)
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 medical issues for their minor child it’s per missable to bill for the consultation. (more…)
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 …). (more…)
There has been growing confusion over exactly how to report the growing number of colonoscopies that become “diagnostic”. This procedure has become more and more commonplace and the debate continues. Sometimes the best answer is the most obvious, contact the carrier and ask them how they want the procedure reported on your medical billing.
Colonoscopies are part of a check up for most individuals over the age of 50, however when the colonscopy finds a polyp, you should normally use the polyp diagnosis in your medical billing claim and not the screening V code. The exception to this rule would be if the physician discovers a polyp during the screening, you should instead report a diagnostic colonoscopy (45380, Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple). (more…)
Remember when medical billing used to be a simple affair of matching the procedure done with a couple of medical billing codes to describe what was done, attaching your documentation and then submitting your medical billing claim for reimbursement?
Now we have codes for codes and modifiers and the need to when to bundle and when to not bundle with the goal being fair reimbursement for procedures done. Modifiers cause a lot of confusion for many medical billers. One such confusing modifier that is worth clarifying is Q6.
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When you have a procedure that can cover two close but distinctly different areas such as a facial and a dental nerve block, you need to make sure that your claim encompasses exactly the procedure that was done or you may wind up with a denial of your claim.
A common situation would be if the ED physician performed a diagnostic nerve block on a patient complaining of pain in the floor of her mouth and her bottom set of teeth. You would want to be certain that you chose 64402 (Injection, anesthetic agent; facial nerve) for facial nerve blocks, not blocks in the mouth or jaw. The determining factor is that the surgeon treated a branch of the trigeminal nerve, not the facial nerve. (more…)
For correct payment amount, accurate place of service codes are required. The failure to provide the correct place of service code with the correct current procedural terminology code for E/M services will cause your claim to get denied. One of the most important elements of medical billing is the place of service code. (more…)
More Q Modifiers were updated recently, make sure that your staff is up to date on the currently preferred to be reported when the physician is performing foot care. Modifiers Q7 (One class A finding), Q8 (Two class B findings) or Q9 (One class B and two class C findings) tell insurers why your physician is performing foot care. (more…)
There is nothing worse than finding different coding mistakes. One of the things that you can do in order to keep certain mistakes from showing up is keep your observation coding in check. Although you may think that you know all of the general rules in terms of observation services reporting in the ED, mistakes can still happen. When you are looking to smooth out any of the wrinkles found in your observation coding, you can keep several things in mind.
For starters, it is very important that you do not bill more than once for physicians that are from the same group. This is a situation that calls for a choice of only one. For example, even though you may have two individual physicians, if they are from the same group they cannot both be billed, even if the patient receive observation care from the both of them. (more…)
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