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2 New HCPCS Codes for H1N1 Vaccine Administration

Plus: New Bevacizumab code is effective Oct. 1.
If you’re planning to administer the vaccination for H1N1 — also known as the “swine flu” (488.1) — the odds of collecting for the vaccine administration just improved. On Aug. 28, CMS released MLN Matters article MM6617, which introduces two new codes that apply to the H1N1 vaccine, as follows:
• G9142 — Influenza […]

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Botox Wastage: How Do I Code It Correctly?

Question: My pain management physician treated a patient’s migraine by injecting 70 units of Botulinum type A into the muscles of the patient’s brow, forehead, and temporal region, with 30 units discarded. How do I bill the correct number of units injected?
Answer: Report a single line item of J0585 (Botulinum toxin type A, per unit) […]

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4 Coding & Billing Steps Boost Your Flu Prevention Pay by $38

Do you know how old the patient is? If you don’t, here’s how you’re losing reimbursement.
A pediatric practice recently asked Pediatric Coding Alert for money-making tips as staff gear up for flu season. “In the past, we have had difficulty in just breaking even for the cost of the influenza vaccine,” wrote the subscriber. “How […]

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Medical Billers: Test Your Collections Know-How Here

This nifty tool tells you if collections cluelessness is hurting your practice’s bottom line.
You know that solid collections knowledge is the key to bringing in patient co-pays, deductibles, and balances, as well as payer reimbursement. Are you wondering where you should focus your time and energy? This quiz will help you determine whether you’re on […]

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Steer Clear of This Modifier 22 Mistake

Question: Our orthopedist did a right knee arthroscopy with extensive tricompartmental synovectomy, partial medial menisectomy, and chondroplasty of patella and femoral trochlea. I’m using 29876, 29881, and G0289 — but I’m not sure if G0289 is right. Also, when the doctor states “extensive,” should I use modifier 22 on 29876?
Answer: You should report only 29876 (Arthroscopy, knee, […]

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Colorectal Cancer Screening: A Medicare Coding & Billing FAQ

Steer clear of G0121 denials with these tips.

If you slip up on screening colonoscopy claims’ frequency guidelines and eligibility requirements, Medicare will pay you zilch. But our colorectal cancer screening FAQ provides you the coding the know-how you need to soar through your coding duties with the greatest of ease.
Q: Who’s Eligible for Average-Risk Test?
Any Medicare patient […]

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99460- 99465 Alert: Protect Your Hospital Well Care Pay With EOB Check

Are you receiving one-third less for 99460- 99465? Here’s what to do.
You know insurers aren’t Flash Gordons when it comes to implementing coding changes but recent cuts on the normal newborn hospital care CPT 2009 codes take the cake.
“Monitor your statements to make sure you’re getting paid appropriately for 99460-99465,” says Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville. “We […]

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Watch the Mail If You’re Part of the BCBS Settlement

If your physician was part of the Blue Cross Blue Shield settlement, you should expect a check by the end of August.
BCBS began sending checks on July 22. The payer will be sending out more than $131 million as part of this settlement.
If your practice properly filed a claim and you either don’t receive a […]

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Medicare Coverage for Bariatric Surgery: Do You Know These BMI Guidelines?

Question: I heard that Medicare made some changes about diabetic patients’ eligibility for bariatric surgery. Do we have to pay more attention to the patient’s BMI?
Answer: A few months ago, Medicare did implement some new regulations for bariatric procedures for diabetic patients.
The rule: If your physicians perform bariatric surgery procedures on diabetic patients you need to take […]

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