Learn 2 New CMS Appeal Thresholds Before Filing

We’ve got a handy chart to help you keep everything straight, plus quick links to all the rules & forms.
The time has come yet again to update your appeals know-how. CMS announced several changes to the appeals process effective Aug. 3, 2009, in Transmittal 1762.
Focus on Higher Dollar Amounts
CMS has changed the dollar amount in […]

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Skull Biopsy, No Burr Hole: 61500 or 61563?

Question: Our surgeon biopsied a lesion from the skull, but did not perform a craniectomy or create a burr hole for the procedure; he made an incision over the lesion and obtained the biopsy. How should I code this?
Answer: Your best option is 61500 (Craniectomy; with excision of tumor or other bone lesion of skull) […]

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Clinch E/M Plus Chemo Pay Using These CMS Guidelines

Here’s why 99211 flashes a bright red ‘audit me’ sign at payers.
At roughly $60 a pop, missing just one 99213 service a day could cost your practice more than $15,000 a year. Use these official rules from Medicare to be sure you know when you should —and shouldn’t — add an E/M code to your therapeutic drug and […]

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Coding Education: Simple, Intermediate or Complex Closure?

Correctly distinguish closure levels every time with this advice from the experts.
All closures aren’t created equal; one of the nuances of coding these procedures is knowing how to distinguish one type from another. Read on for our experts’ advice on how to assess the three closure levels and assign the best codes.
Remember ‘Simple’ Doesn’t Mean […]

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How Do I Code When My Doc Treats Nursing Home Patients?

Question: Our podiatrist treats many nursing home patients. One has foot pain and all her nails are mycotic, but her nails are not painful. How can we report our physician’s services for this patient when she doesn’t have nail pain or any systemic disease to give class findings?
Answer: Check your local carrier’s guidelines because some (such as […]

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Aetna Announces New Policy of Payment Refusal for ‘Never Events’

Make sure you know the extra steps your practice must take as well.
Many payers are jumping on the “never event” bandwagon, and Aetna is the most recent. The payer announced recently that it will no longer pay you for any care related to 28 preventable medical errors, such as wrong surgeries, wrong person surgeries, or […]

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Orthopedic Coder’s Anatomy: The Hip

These key terms make coding for hip procedures easier and more accurate.
If you think your hip is that thing jutting out at you in the mirror, your nomenclature needs a rehaul to ensure you’re nailing the correct codes. Coding for hip fractures and other procedures is easier when the coder is hip to the anatomy […]

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4 Coding Rules for Multi-Provider Modifiers

Check the work, not dictation, to prevent 42% or more in losses.
With carriers paying 62 percent on co-surgery cases, 20 percent on assistant surgeries, and 15 percent for non-MD assistants, the wrong modifier can cut your pay big time — meaning you better keep certain rules in mind.
The hang-up: “Choosing between the co-surgery and assistant surgeon modifiers […]

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Looking for Tonsil Biopsy Code?

Question: My physician did a punch excisional biopsy of the left tonsil, but I’m not seeing a code for this. What should I do?
Answer: You don’t see a code, because no specific code exists for a biopsy of the tonsils.
You should instead report the code based on whether the otolaryngologist used a scope. If he […]

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3 Steps Win the Sports Physical Reimbursement Game

These useful strategies assure revenue despite scant insurer coverage.
Right now, a rush of young kids are looking to their family physicians for medical clearance to participate in sports. Commonly referred to as sports physicals, they present unique problems to coders, especially concerning their coverage by insurers. To avoid loss of revenue and to maximize the […]

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