How Do I Code Defibrillator (AICD) Firing?

Question: A patient presented in our office and said that his defibrillator was firing. What diagnosis code is appropriate for this?

Answer: You’ll need a little more information on the cause of the firing to choose the proper code. Here are some specifics you need to ask about or look for in the note.
If the firing resulted from […]

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5 Rules Pinpoint Date of Service for Laboratory Claims

Tip 3: Here’s DOS advice for archived samples.
You can’t afford to get the date of service (DOS) wrong on claims that undergo CMS edits — mistakes could mean you’ll face fraud charges. That’s because Correct Coding Initiative (CCI) edits and Medically Unlikely Edits (MUEs) control payment for procedures on the same DOS.
But for pathologists, choosing the date […]

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Got Multiple Modifiers? How To Sequence Them on the Claim

Coders like to say that modifiers help them tell the story of what happened in the operating room, hospital, or doctor’s office. But what if the story you have to tell is very long and complicated?
Bookmark these 4 modifier ordering tips from Becki Geraud, CPC, CEMC, RCC, who presented at the Otolaryngology Specialty Coding Conference […]

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Which HCPCS Code Should I Use for Eovist MRI contrast?

Question: Which HCPCS code should I use to report Eovist MRI contrast?
Answer: You should verify the appropriate code with your payer, but the most likely option is A9579 (Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified [NOS], per ml).
Here’s why: HCPCS doesn’t currently offer a specific Eovist (gadoxetate disodium) code for physician claims. (Code […]

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4 Tips Position Your ‘Multiple Scope’ Codes Perfectly

Ortho coders: Here’s what you should do when there’s no ‘base’ procedure.
This week is the 400th anniversary of Galileo’s telescope, so let’s celebrate in our own small coding way and get our own scope coding correct.
If your physician performs several knee arthroscopies on the same patient on the same day, you’ll need to understand the […]

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MAC Auditors Will Stick It To Facet Joint Injection Claims

We hook you up with CMS instructions for when to use +64472, +64476 and when to use modifier 50.

Thanks to a 2006 OIG audit, MACs are on the lookout for incorrectly-billed facet joint injections, so it’s time to scrutinize your claims. Medicare guidelines are very strict about when you can append modifier 50 (Bilateral procedure) to a facet joint injection code — so […]

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Do I Use a Chemo Code for Zevalin Therapy?

Question: When I looked up Zevalin, I found out it’s a monoclonal antibody. Does that mean I should report a chemotherapy administration code for Zevalin therapy? CPT guidelines say chemo admin codes are correct for monoclonal antibodies.
Answer: Zevalin is a monoclonal antibody, and CPT does say chemotherapy administration codes are correct for “certain monoclonal antibodies.” […]

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A Coder’s Guide to Health Care Reform

Quick way to show your practice you’re prepared for the unknowns ahead.
If anyone should be able to understand the complicated health care reform debate raging in Washington, it should be us coders and billers, right? After all, we’re closest to what’s at the center of the debate: dollars and cents.
So, if you’re like me, you’ve […]

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New From CPT Assistant: Help with Trunk Ultrasound Coding

Do you know exactly what’s in the mediastinum? Your US coding depends on it.
Current payer policy on imaging guidance is especially strict, so you don’t want to miscode any ultrasound (US) services your ED physician provides. CPT Assistant has recently published a Q&A set that will help you get all the reimbursement you deserve for US […]

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87324 Alert: Capture Extra $17 for C. Diff Toxin A & Toxin B

Question: We’ve gotten denials when we bill 87324 x 2 for two EIA tests for C. diff toxin A and toxin B. Can our lab code for tests for both toxins if we use the same lab method for both tests?
Answer: Yes, you can bill for both Clostridium difficile toxin A and toxin B if a physician orders the […]

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