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Ophthalmology Coding: GDX, VF, & Temp Plugs — How Many Modifiers?

Question: A patient came in for a GDX and visual field (VF) tests. During the same visit, the ophthalmologist put in temporary plugs. Can we get paid for all services on the same day? I know the office visit needs a modifier. Do I need to put one on the GDX & VF, too?
Answer: Provided the […]

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  3. Ophthalmology Coding: See Your Way to Clear Reimbursement for Eye Exams and Cataract SurgeryChoose the Right E/M or Eye Code to Optimize Reimbursement…
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Does My E/M Coding Have to Match Hospital’s E/M Coding?

Question: My physician removed a catheter in an outpatient hospital exam room. Should I include this removal as part of the E/M? If E/M is appropriate, will the hospital also report an E/M? And, if so, do the physician and hospital E/M codes need to match?
Answer: You should include simple Foley catheter removal as part […]

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E/M Coding Education: Does ‘No SOB’ Fall Under HPI or ROS?

Question: For a chart with a chief complaint of resolving pneumonia, a note indicates, “No coughing, SOB.” Should I give the pediatrician credit for this ‘no coughing & no shortness of breath’ statement under history of present illness (HPI) or as a review of systems (ROS)?
Answer: This is a gray area of E/M coding that […]

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Watch Out for 3 Telephone Service Coding Pitfalls

Caution: You may need to incorporate the call into an in-office E/M service.
If you’re reporting services your physician provides over the phone, but you’re not getting paid, the reason might be one of two things — you’re not following the coding rules surrounding the codes or your payer just isn’t paying for those services. Check out these […]

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OB Coding Education: Pregnant Patient Transfer Codes

More than 7 visits? Don’t make this compliance-busting coding mistake.
A pregnant patient moves out-of-state mid-pregnancy. Do you know how to report the services your ob-gyn provided up to the date of the move? Prepare for these situations by adopting the following approaches based  on the number of visits.
For 1-3 Visits, Rely on Office E/M Codes
If your ob-gyn […]

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How Do I Code Blood Draw Plus E/M?

Question: An established type II diabetic patient comes in for a blood draw for glycohemoglobin. After the draw, the patient reports a sore left shoulder; she says it is a 4 on the 10 pain scale, with pain diminishing in the past few days. The nonphysician practitioner (NPP) takes a history related to shoulder pain, […]

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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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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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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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Sort Out This ER, Then Assumed Care Scenario

Question: My orthopedist treated a patient who was first seen in the ER for an open fracture with laceration overlying the distal finger phalanx. The ER physician sutured the wound. When the patient arrives in our office, the orthopedist does an E/M service and assumes the care of the wound in addition to the fracture […]

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