Relying on the physician’s encounter form could be a big mistake.
Question: I used 491.9 to report a patient’s bronchitis, but the payer denied my claim and requested additional information. What was wrong?
Vermont Subscriber
Answer: Your claim may have…
Understand ‘significant’ and ‘separate’ to earn a gold star.
Knowing when to report modifiers and choosing the best one for each situation can be an easy trip-up for coders. If you find yourself especially befuddled…
No severe problems? You may have trouble with reimbursement.
Question: The ob-gyn performed and OB ultrasound (US) on a patient. Can I bill 76376 in addition to the ultrasound if the ob-gyn used 3D?
Montana Subscriber
Answer: Yes. You can report a 3D procedure with 76805 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, […]
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Differentiating between GV and GW is your first step.
If your urologist sees and treats hospice patients, you probably feel like you have to jump through hoops to get paid. The key to bringing in every hospice-related dollar your urologist deserves is ensuring you append the right modifier.
Base Modifier GV or GW Choice on Diagnosis
When reporting […]
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Here’s the key to concurrent infusion coding.
Question: What are the appropriate codes for the first day of the FOLFOX4 regimen?
Answer: You should base your final coding decision on the documentation and the exact services your practice provides. But as a starting point, the FOLFOX4 regimen typically involves the patient receiving Oxaliplatin and folinic acid concurrently […]
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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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Keep these additional test rules at your fingertips if your want to keep auditors out of your hair.
The Office of Inspector General and Recovery Audit Contractors are out to audit non-compliant ultrasound claims, so knowing the rules is more important than ever. And we’ve got a link and a handy checklist to keep you out […]
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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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