Q. My staff keeps telling me that my documentation will have to change in order for them to properly choose an ICD-10 diagnosis code. Is that true? A. Documentation practices should not have to change but it will be helpful to understand the granularity of the new codes. There is greater specificity including laterality, temporal factors, contributing factors, symptoms, manifestations, and anatomic location. Thus, if you currently gloss over details in the medical record, you …
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Identifying Risks and Finding Shelter in an Urgent Care Compliance Program
Urgent message: The escalating pressure on the industry to decrease health care costs has resulted in an increase in audit activity from government and private payors for everything from billing and coding to HIPAA and kickbacks. Therefore, it’s more important than ever for urgent care centers to build a culture of compliance. DAMARIS L. MEDINA The health care industry is in the throes of a dynamic regulatory enforcement climate. Federal and state regulators and third-party …
Read More2014 CPT Changes, Suture Removal, Place of Service Code
DAVID STERN, MD (Practice Velocity) Q. I understand that we will be able to bill for cerumen removal for both ears in 2014. Is that true? A.Yes. In 2014, you will be able to bill CPT code 69210, “Removal impacted cerumen requiring instrumentation, unilateral” with modifier -50, “Bilateral procedure.” Keep in mind, Medicare will typically not cover simple, non-impacted earwax removal. CMS requires that physicians meet the following criteria for reimbursement of the removal of …
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December 2013
Coding Intravenous Infusions with Hydration; Medical Decision Making
DAVID STERN, MD (Practice Velocity) Q. We perform a lot of IV infusions in our urgent care facility. Sometimes we also perform IV pushes and hydration at the same time as the infusion. We have been billing CPT codes 36000, 96365 -59, 96360 -59, and 96374 -59. Medicare pays for these codes when we append the -59 modifier but I am concerned that this may not be the correct way to bill after reviewing some …
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October 2013
Supervising Physician, Physician Rotation, Critical Care
DAVID STERN, MD (Practice Velocity) Q. Can a Physician Assistant (PA) bill a claim under a supervising physician even when the supervising physician is not physically present during the patient visit? A.A PA can render services when the physician is not on site. Incident-to billing (a specific CMS method for billing midlevel services with the physician as rendering provider) would never apply in this case. Services rendered in this situation should be billed with the …
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September 2013
Preventive Medicine, Preventive Medicine Counseling
DAVID STERN, MD (Practice Velocity) Q. How do you code for a Sexually Transmitted Diseases (STD) screening visit in a patient who has no symptoms? Can you use a preventive medicine code (99387-99397) and still receive reimbursement? A.You would code based on the service provided. If you performed a physical and collected the specimen to send to the lab, then you would bill the appropriate preventive medicine Evaluation and Management (E/M) code. If the only …
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