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Create Your Own Medical Necessity Quick Reference Tool

If you want to keep denials and compliance problems at bay, your claims must support medical necessity.
So retrofit your own, customized medical necessity quick power-reference tool with these tips from Sandy Nicholson, who taught some classes at the recent E/M Coding & Billing Conference in Orlando.
Step 1: Identify services which you provide for which CMS […]

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Spinal Surgery Coding Challenge: Is Hemilaminectomy Bundled With Fusion?

Question: Our orthopedic surgeon turned in a note that says, “Performed a bilateral hemilaminectomy with discectomy and foraminotomy for nerve decompression.Then I did a lumbar decompression with posterior lumbar interbody fusion and posterior lateral transverse fusion with pedicular screws.”
How should I report this? Is the hemilaminectomy bundled with the fusion?
Answer: No, you shouldn’t consider the […]

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Conquer In-Office Coumadin Coding, Easy as 1-2-3

Tip: Watch how you support medical necessity for warfarin therapy. Here’s where many coders make the wrong ICD-9 choice.
Don’t get stuck with the bill for your physician’s in-office monitoring of Coumadin use — instead, learn the Coumadin coding ropes. One surefire way is to follow these 3 guidelines.
1. Put Proper Code to Periodic PT Test
“Physicians often use […]

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Snag Lab Test Reimbursement With These Swine Flu Fast Facts

Experts reveal the best ICD-9 coding move, plus what you need to do beginning October 1.
If you’re one of the many labs performing influenza testing spurred by the World Health Organization’s (WHO) June 11 pandemic declaration for novel influenza A (H1N1), you need to read this.
Despite the Centers for Disease Control and Prevention (CDC) guidelines […]

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  3. Snag Summer Tick-Related Case Dxs With Insect Fast Facts Think a tick is venomous? That error will land…
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How Do You Code for a Metastatic Tumor?

Question: What is the difference between a primary and secondary neoplasm? I’m confused about which code to use for a metastatic tumor once the original tumor has been removed.
Answer: Continue to report the metastatic tumor as “secondary” even if the primary tumor has been eradicated.
Primary: A primary neoplasm code indicates the original tumor site.
Secondary: A secondary neoplasm indicates a site […]

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Assessment Tool: Is Your Practice Ready for EHR?

Be a hero. Figure out how you can get an extra $44K per physician in your practice.
As a coder, you’re where the buck stops when it comes to the practice’s bottom line. So, you’re no doubt wondering whether your practice should go for the $44,000-per-physician bonus payment available to practices that adopt electronic medical records […]

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Coding Challenge: Dermabond for Laceration Repairs

Question: The dermatologist treated an established patient with a cut on her lip and used Dermabond to close the 1.8-cm laceration. Should I use a laceration repair code when the only adhesive he used was Dermabond?
Answer: Your code choice will depend on the patient’s insurance. Check out these two coding options:
Patient has Medicare: If the […]

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Select the Correct V Code Every Time for Pediatric Well-Checks

Denials possible without separate ICD-9s for immunization admin, supply.
Do diagnosis coding choices for your FP’s preventive medicine services drive you batty?
Turns out there’s a one-stop solution for ICD-9 coding for a preventive medicine service with screenings or immunization administration — V20.2 for all. Save time assigning V codes by checking out these case studies.
Link Check, Screening to […]

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Think Your ASC Coding Skills Are Top-Notch? Take This Quiz

Some practices code for services performed in ambulatory surgery centers (ASCs) every day, while others are just getting started. To determine how much you know about coding and billing for ASC procedures, take this quick quiz. Then, click the ‘Full Article’ button to find out how you fared.
Question 1: Physician Performed A Non-Approved Service?
We recently learned that […]

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15% More Pay Awaits Coders Who Can Max Out NPP Benefit

Correctly code NPP’s hospital services, or you’ll sell the practice short.
If you don’t take advantage of all the E/M services a nonphysician practitioner (NPP) can provide, you are missing out on a serious revenue stream, as these providers can simultaneously lighten physicians’ loads and fatten the practice’s bottom line.
Check out these FAQs to get the […]

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