Tag Archives: Medicare Patient
If you’re just plodding though nerve surgery claims, you could be stepping over a great deal of well-earned reimbursement. Coding and billing peripheral nerve surgeries for conditions such as tarsal tunnel and diabetic neuropathy can involve a frazzling number of codes. Podiatry coders often struggle to navigate the various coding guidelines that payers use for these procedures. Use these five tips to maximize payment for your podiatrist’s hard work on nerve surgeries:
Tip 1: Check CCI edits and your local Medicare guidelines
If you’re billing codes that the Correct Coding Initiative bundles together — and your documentation and diagnosis codes can’t justify breaking the bundle — you’re not going to see one extra cent for that bundled procedure code.
Example: A California Medicare patient injures his foot when he falls off a ladder and requires peripheral nerve surgery to correct the damage the injury caused. The podiatrist performs the following:
28035 — Release, tarsal tunnel (posterior tibial nerve decompression)
64712 — Neuroplasty, major peripheral nerve, arm or leg, open; sciatic nerve
64704 — Neuroplasty; nerve of hand or foot
+64727 — Internal neurolysis, requiring use of operating microscope (List separately in addition to code for neuroplasty) (Neuroplasty includes external neurolysis)
64708 — Neuroplasty, major peripheral nerve, arm or leg, open; other than specified.
If you report all these codes, you’re bound to get a denial on 64704 — this is one of the codes the Correct Coding Initiative (CCI) bundles into 28035. Unless you can justify billing 64704 separately (and if that’s the case, append modifier 59, Distinct procedural service, to the code), you shouldn’t list it all.
Unbundling is not automatic: Be aware that you can’t automatically override a CCI edit with modifier 59 just because documentation supports a separate site,…
During an office visit, our nurse administered a B12 injection and a flu shot to an established patient. Can we code for both injections in addition to the office visit? (Illinois Subscriber)
The answer depends on the circumstances. … Continue reading
Get ready to change your flu vaccine product code 90658 to one of four Q codes.
For 2010, report 90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use) to signify that your physici… Continue reading
Before you hire a biller, you need to make sure he or she is qualified for the position. The following test coupled with a math test will assess whether the candidate will be successful in the role — and an asset to your company.
Name: _____________________________________________ Date: _______________
- A CPT code has _______ digits and an ICD-9-CM code has _______ digits
- Explain the difference between a CPT code and an ICD-9-CM code
- What is the purpose of a modifier?
- What are E&M codes?
- What does “COB” stand for?
- What insurance information do you obtain when the patient contacts our office with new insurance?
- If the patient has Medicare, Tricare and Medicaid, which insurance would you bill first, second, last?
- Patient is 65; has BCBS through employer w/ 100+ employees and has Medicare Part A only. Which insurance would you file first?
- What does HIPAA stand for? And what does it mean to you?
- What is a CMS 1500 used for?
- What is the difference between HCFA and CMS 1500?
- How would you handle each of the following EOB rejections?
- Procedure not a covered benefit
- Patient not eligible on the date of service
- Applied to deductible
- Bundled Service
1. A “crossover” claim is:
a. When Medicare forwards a claim electronically to a secondary insurance carrier
b. When duplicate claims are sent and the same claim is returned for more information. (essentially the two claims are “crossing” in the mail)
c. When a claim is sent that has more than one box “crossed out”
d. Sending the claim to the secondary insurance first for administrative purposes, “crossing” the normal procedural policies.
2. An EOB is:
a. End of Balance
CMS announcement is triumph for physicians who haven’t collected in the past.
If you’ve been writing off tobacco cessation counseling as non-payable, it’s time to change your tune.
In the past, CMS only covered 99406-99407 (Smoking and tobacco us… Continue reading
Getting Medicare to pony up for colorectal cancer screenings is not difficult provided you follow its frequency guidelines and eligibility requirements to the letter. A coding slip up on one of these items will knock you out of the saddle, and Medicare won’t accept the claim at all.
Rope in all the coding info you’ll need via this Medicare colorectal cancer screening FAQ.
Who’s Eligible for Average-Risk Test?
If the Medicare patient is 50-plus years old, he is eligible for a covered Medicare screening, confirms Dena Rumisek, CPC, biller at Michigan’s Grand River Gastroenterology PC.
However: These patients are considered average risk, and can have a colorectal cancer screening only once every 10 years, says Cheryl Ray, CCS, CPMA, of Atlantic Gastroenterology in Greenville, N.C. Ignore Medicare’s frequency guidelines at your peril, experts warn.
“Medicare is very stringent on the date … it has to be 10 years or longer — it can’t be 9 years and 360 days,” between covered screening colonoscopies, assures Rumisek.
Example: A 68-year-old established Medicare patient reports for a screening colonoscopy on Dec. 5, 2009. The patient’s records indicate that he last had a covered screening on Sept. 15, 1998. On the claim, you should report G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk).
What ICD-9 Codes Are In Play for G0121?
Just one, provided there is no need for any therapeutic intervention during the colonoscopy. Medicare requires V76.51 (Special screening for malignant neoplasms; colon) on all G0121 claims. You might list other identified conditions secondarily, including diverticulosis (562.10) or hemorrhoids (455.0).
Always list the V code first for an average-risk screening, however.
What if the Patient Had a Recent Flexible Sig?
The frequency rules differ depending on whether other related…