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CMS Will Soon Issue Consult Code Replacement Advice, According to Open Door Forum

Plus: You can now download a list of all practitioners who can order/refer.
If you’ve been confused about how to report low-level hospital visits now that consult codes are gone, you aren’t alone. CMS intends to tackle this problem by issuing more specific guidance on the topic in the near future.
That’s according to a Feb. 2 […]

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AMA Chimes In On How to Report Consults for Non-Medicare Patients

Beware: Don’t use the CMS consult crosswalk for billing purposes.
You may be seeing light at the end of the tunnel. The AMA just published an article to clarify the use of the consultation codes for non-Medicare patients, and talks about their efforts to get CMS to delay their new policy. You can find the article […]

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E/M Challenge: Can I Report 99214 and +99354?

Counseling representing more than 50 percent of E/M visit? Choose level based on time.
Question: I have a family physician who documented 60 minutes on an established patient’s office visit. The FP diagnosed the patient with morbid obesity (278.01). Since the patient was newly diagnosed and had some difficulty understanding the doctor’s orders, the FP spent […]

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Want to Integrate PQRI Measures Into Your Practice? Look Here.

Participation can put extra bread in your basket.
Back again for 2010 is Medicare’s incentive-driven physician quality reporting initiative (PQRI), aimed at tracking quality metric or patient care services that physicians provide. When the practice treats enough patients in the same category, some PQRI dollars might be only a few codes away.
If you know the basics […]

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CMS at AMA Chicago: We’re Reducing Consult Request Requirement

CMS auditors will look for 1 less thing in consult documentation.
With Medicare’s invalidation of consultation codes 99241-99255 in 2010, your ICD-9 codes better prove why two MDs are necessary on the same patient’s hospital care or the physician better specify why in his note.
Separate ICD-9 codes will help substantiate the medical necessity for providing consultative […]

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Medicare Changes to 2010 CPT Inpatient Consultation Codes

Prevent 99251-99245 denials in 2010 with this checklist.
Multiple physicians using the same hospital codes sounds like a recipe for denials, but that’s what Medicare is instructing physician inpatient consultants and care coordinators to do.
Whether carriers will kick out these submissions as coordination of care or inpatient admit limiting admit edits is contractor specific, Charles […]

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Medical Office Billing: 7 Ways to Escape Computer Claim Casualties

Pay attention to EOBs and keep talking to your MAC.
You could be losing money to a computer glitch and not know it, experts say.
If you don’t nip a computer glitch in the bud, you may be plagued with improper denials and other claim holdups. Here are seven things you can do to seek out and […]

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Medicare Forms: Are You Ready for HIPAA 5010?

New, standardized reports will show you why your claim was rejected and how to fix it.
You’ve got a few years to implement the HIPAA 5010 form, but CMS wants to make sure you’re completely ready by the time it takes effect on Jan. 1, 2012.
The 5010 form, which will make way for the ICD-10 code […]

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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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Medicare Will Pay for Some Telehealth Services: The Lowdown on How to Report Them

If you’re confused about whether Medicare covers telehealth services, look no further. CMS recently released a MLN Matters fact sheet on the topic that can help guide the way.
Keep in mind: CMS notes that Medicare beneficiaries “are eligible for telehealth services only if they are presented from an originating sitelocated in a rural health professional shortage area or in a county outside of a […]

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