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ICD-10 update: Ombudsman named plus new testing results, clarified guidance

09/14/2015

When you have questions or concerns about your transition to ICD-10 after Oct. 1, CMS now has an ombudsman to report them to: William Rogers, M.D., a practicing emergency room physician who until now has headed up the CMS Physician Regulatory Issues Team (PRIT) in the agency’s communications office.

Reverse shoulder arthroplasty doesn’t automatically use modifier 22

09/14/2015

by: Laura Evans

I think the appropriate CPT code for this procedure is 23472 with possible modifier 22. Another coder thinks that we should be using an unlisted CPT code (23929) with modifier 22. Who's right?

Moderate conscious sedation — read the descriptor closely before you bill

09/14/2015

by: Julia Kyles, CPC-A

My pain management doctor who performs lumbar facet joint injections (64493-64495) wants to bill for moderate conscious sedation (99144). Can he?

Established E/M claims drop but payments go up anyway

09/14/2015

by: Richard Scott

Providers submitted approximately 2.4 million fewer claims for established-patient office visits between 2013 and 2014, yet total payments increased by $124 million.

CMS will limit the scope of review on appeals of certain post-payment denials

08/31/2015

by: Joshua Poltilove and Richard Scott

Wave goodbye to a frustrating source of denials now that auditing bodies, including Medicare administrative contractors (MAC) and recovery auditors (RACs), can’t provide a new reason for claims denials during the first two levels of the appeals process.

Use assistant-at-surgery payment indicator to guide how much documentation you need

08/31/2015

by: Scott Kraft

Pay attention to whether an assistant-at-surgery must be medically necessary to determine how much documentation you need to provide.

Social media not working? Look at page rank, other benefits before pulling the plug

08/31/2015

by: Roy Edroso

Social media for physician practices can be frustrating because an increase in Web traffic doesn’t always deliver an obvious boost in foot traffic — but consider what it can do for your practice before giving up on it.

OIG opinion: Free cancer drug for patients through specialty pharmacy OK

08/31/2015

by: Roy Edroso

The Office of Inspector General (OIG) indicates that a specialty pharmacy may give free drugs to patients — but only under limited circumstances.

Document correct language, exact time before billing time-based E/M

08/31/2015

by: Roy Edroso

Question: A physician submitted documentation for what looks like a medical team conference and wants to bill time-based E/M for counseling/coordination of care. The documentation says the team “discussed the patient’s treatment course to date, the progress of the patient and barriers to discharge and goals for the next week.”

Assistant-surgeon use falls for most-billed surgical procedures

08/31/2015

by: Richard Scott

Providers are billing for assistants less frequently for commonly performed procedures such as knee replacement surgeries and coronary artery bypass despite, in some instances, rising rates of total surgical episodes.

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