Teaching Physician Rules Primary Care ExceptionNovember 24th, 2009 - Codapedia Editor
CMS has developed a specific set of rules for academic settings. These rules allow a teaching or attending phyisician to bill for services provided jointly by themselves and residents in approved Graduate Medical Education (GME) programs. Different services (endoscopy, E/M, major surgery) have...H1N1--New Codes from CMS for Sept 1 2009 Swine fluOctober 16th, 2009 - Codapedia Editor
On CMS's Open Door Forum call, today, 8/25/09, CMS said:
* Change request and MedLearn Matters articles will be coming soon
* There will be new codes for the administration/vaccine
* Vaccine will be available in mid-October, provider community will have access to it
* Vaccine will be FREE: do...Primary Care Billing ProfilesOctober 14th, 2009 - Codapedia Editor
For most primary care physicians, Evaluation and Management services comprise the highest percentage of services performed, and account for most of the revenue. Primary care physicians should regularly compare their profile with the norm for their specialty. These specialty norms are included as a...Observation initial services September 8th, 2009 - Codapedia Editor
Observation services are a status of admission to the hospital. Patients who are admitted to the hospital are admitted either to inpatient status or observation status. The status is determined by the physician, although often the case manager at the hospital will have significant input into the...Unna Boot ApplicationSeptember 2nd, 2009 - Codapedia Editor
Physicians bill for Unna Boot application using code 29580. The supply code is A6456, Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard. Notice that the code unit is 1 for one yard. Bill for both on the same...Minimal E/M service on an established patientAugust 10th, 2009 - Codapedia Editor
Nurse visits are services provided by nursing staff in a physician office under the general supervision of a physician. The physician does not typically have a face-to-face service with the patient. These services are billed with code 99211. The CPT® book defines 99211 as: Office or other...Prolonged services for office and outpatient visitsJuly 31st, 2009 - Codapedia Editor
This is an article describing using prolonged services codes in an office setting. There is a separate article in Codapedia about using prolonged services codes in an inpatient setting. There is an article describing using non-face-to-face codes, as well.
Prolonged services codes are add-on...Prolonged Services in an inpatient settingJuly 31st, 2009 - Codapedia Editor
This article will describe the coding for using prolonged services in an inpatient setting. The codes are 99356: Prolonged physician service in the inpatient setting, first hour and 99357 each additional 30 minutes. See the CPT® book for the complete descriptions.
These codes are used as add...G0101 Pelvic and breast examJuly 6th, 2009 - Codapedia Editor
Medicare does not pay for routine physical exams annually for patients--a sore spot for Primary Care Providers and Medicare beneficiaries alike. They do pay for an initial Welcome to Medicare visit. (See the Codapedia article about that topic.)
Medicare does pay for a screening pelvic and breast...Smoking cessation codesMay 19th, 2009 - Codapedia Editor
There are two CPT® smoking cessation codes that replaced CMS's temporary HCPCS codes (99406--99407). These are time based codes. The first requires up to three minutes of time spent in smoking cessation, and the second 3-10 minutes. The note must document the patient's tobacco use, the adverse...Services in an assisted living facilityApril 22nd, 2009 - Codapedia Editor
According to the CPT® book, assisted living services are reported with codes 99324--99337. Look at that series of codes for new or established patients. It is not correct to bill at an assisted living facility with office visit codes. These codes are used for services provided in: domiciliary,...E/M service with no examApril 13th, 2009 - Codapedia Editor
Does an E/M service require an exam? It depends on the category of service.
Established patients and subsequent hospital visits require two out of three of the key components, history, exam and medical decision making. Any two components at the level of documentation required determines the level...Psychiatric diagnoses in primary careApril 10th, 2009 - Codapedia Editor
Anyone who has tried to get an appointment with a psychiatrist can tell you how difficult it is to find the right mental health professional, and get an appointment. In fact, much of the frontline of psychiatric diagnosis and treatment happens in primary care offices. The problem is, how can they...Using denial tracking to improve collectionsApril 10th, 2009 - Codapedia Editor
Here are some examples of denials that a practice should track to be sure that they are paid correctly by the insurance company. Set up a denial type for each of these.
Fee Schedule Issues:
Wrong amount paid per the contracted fee schedule. May be too high or too low
Modifier 80...Department of Transportation DOT examsMarch 31st, 2009 - Codapedia Editor
How does a physician report performing a Department of Transportation physical? With CPT® code 99455 and ICD-9 code V70.5, 99455 is for a work related or medical disability examination by the treating physician. (9945 is for this examination by other than the treating physician.) See the...Do headings matter in an E/M noteMarch 30th, 2009 - Codapedia Editor
When documenting the history components in an Evaluation and Management service, the clinician is not required to use the headings that the Documentation Guidelines define. That is, the history section does not need to be labeled: History of the Present Illness, Review of Systems, and past medical,...Is time the trump card in selecting an E/M service?March 29th, 2009 - Codapedia Editor
Is time a trump card in selecting an Evaluation and Management service?
Sometimes. Isn't that too frequently the answer in coding?
If the visit meets the criteria for using time ot select the code, and if time is a descriptor in the CPT® definition, then yes.
The criteria are:
...Can I bill for coumadin management over the phone?March 10th, 2009 - Codapedia Editor
A physician asks: "Can I bill for coumadin management for patients in the nursing home? I sometimes get 25 calls a month with PTINR results, and have to make decisions about the patient's coumadin dose. Can I bill for that?"
Medicare considers this part of the pre...Nurse visit and flu shotsFebruary 18th, 2009 - Codapedia Editor
Both CPT® and CMS (Medicare) has made it clear that it is not appropriate to report a nurse visit when giving a flu shot. That is: do not bill a nurse visit when the patient presents to the office for a flu shot. Bill only for the administration of the vaccine and for the serum, if the...Welcome to Medicare VisitJanuary 29th, 2009 - Codapedia Editor
Welcome to Medicare
Initial Preventive Physical Examination (IPPE)
A new benefit under the Medicare Modernization Act
Effective date 1-1-05, changes for 2009
Eligibility: Any Medicare beneficiary who enrolls in Medicare on or after January 1, 2005
Time limits: Eligible for benefit in the...