OIG: Many Outpatient PT Claims Fail to Comply
The Office of Inspector General (OIG) did a study of physical therapy claims and documentation for Medicare patients and issued a report this month in March. Their findings are of great concern for the PT and rehabilitation specialty. The OIG reviewed… For more,...
E/M Update Opinions Shared at Listening Session
A representative from the Hospital and Ambulatory Policy Group at the Centers for Medicare & Medicaid Services (CMS) held a listening session regarding proposed updates to the documentation guidelines for evaluation and management (E/M) services o… For...
Medical Coding Tissue Transfer or Rearrangement
I often see incorrect medical coding for “flaps”, which were adjacent tissue transfers, 14000-14350. Coders do not always understand that you can only code for the closure of the primary and secondary defect, but not for each flap that is created. Sur… For more,...
Post-Operative Complications in the Global Period
Is the caring for, and treatment of post-operative complications in the global period coded and billable? To answer this question, You first must know who the third-party payer is because different payers have different rules. What’s the Globa… For more, read...
Anthem Rescinds Modifier 25 Payment Reductions
Anthem has sent a letter to the AMA to announce they are rescinding the policy reducing payment for physicians when billing an E/M with a modifier 25 and a procedure that has zero or 10 global days. Anthem was planning on taking a 25 percent reductio… For more,...
Modifier 58 Versus 78; Which Should You Use?
Sometimes coders are confused when they should apply modifier 58 Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period and modifier 78 Unplanned Return to the Operating… For more,...
How to Code Flu – from Prevention to Care
Flu season is here, prompting a great deal of confusion about how to code. I decided to spend some time on the Centers for Disease Control and Prevention (CDC) website and other resources to try to clarify the murky in this very sick flu season. Car… For more,...
Case Studies: Modifier 59 and X[ESPU] Use
When I last wrote “Modifier 59 – To Use or Not to Use”, I promised to follow it up with some real-life examples of when we should be using the 59 or the new Medicare X[ESPU] modifiers. Let’s look at some clinical examples and first determine if the … For more,...
AMA Updates Flap and Turbinectomy Codes For 2018
Other than the FESS CPT® changes for 2018, there are a few more CPT® updates to note for the upcoming year. The first changes have to do with Flaps (skin and/or deep tissues). Additional instructions were added to these codes, stating: “The regions … For more,...
Modifier 59 – To Use or Not to Use
I often call Modifier 59 the prednisone of modifiers. That is because it is very powerful and can do a lot for you, like prednisone is for the patient. But at the same time, it is a two-edged sword, the modifier 59 is exceptionally dangerous when used… For more,...
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