Medical Coding Pro - CMS Makes Key Changes to ABN Modifiers

Published: Sun, 11/22/09

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CMS Makes Key Changes to ABN Modifiers

2009-11-10 11:01:35-05
We’ve got the new instructions you’ll need to follow. CMS will update the ABN modifiers effective April 1, according to MLN Matters article MM6563, dated Oct. 29. The ABN descriptors will read as follows: Modifier GA — Revised to read, “Waiver of liability statement issued as required by payer policy.” You’ll use this when a required ABN was issued. Modifier GX — [...] Related articles:

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From the AMA in Chicago: CPT 2010 Out of Order Codes

2009-11-11 23:22:36-05
Here’s where you can find a full list of resequenced codes. Notice that new sign in your CPT book? No, that hash mark’s not to delete a message or to sign into a conference; it’s to alert you to an out of order code. The “#” works like a flashing yellow light: Slow down, there might be [...] Related articles:

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Is 30901 Your Nosebleed Code? Not So Fast?

2009-11-12 01:28:30-05
Hint: Look for these keywords in the note to select the correct nosebleed code. Question: The internist stops a patient’s nosebleed. Is this always a procedure? Answer: No, if a patient reports with a nosebleed and the physician stops the bleeding with basic methods, you’ll typically opt for the appropriate-level E/M code. E/M methods: Code minimal attempts at [...] Related articles:

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Medicare 2010 CPT Consultation Code Changes

2009-11-12 13:44:08-05
New rules for consult coding straight from the AMA Meeting in Chicago — plus where your practice will gain and lose reimbursement. If you can’t figure out how to match a low level consult to an initial hospital care code, you’re not alone. Code 99251 doesn’t crosswalk to 99221, agreed William J. Mangold, Jr., MD, JD, Noridian [...] Related articles:

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2010 Tumor Excision Coding: Lesion Vs. Chunk Size

2009-11-13 11:01:08-05
Straight from the AMA in Chicago — answers to your lesion excision coding questions for 2010. Question: A thigh lesion measures 2 cm but requires a resection down to the subcutaneous layer of 4 cm. Which lesion excision code should I use? Answer: “You should use the larger of the subcutaneous codes,” says Albert E. Bothe, Jr, [...] Related articles:

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Medicare Changes to 2010 CPT Inpatient Consultation Codes

2009-11-13 11:17:21-05
Prevent 99251-99245 denials in 2010 with this checklist. Multiple physicians using the same hospital codes sounds like a recipe for denials, but that’s what Medicare is instructing physician inpatient consultants and care coordinators to do. Whether carriers will kick out these submissions as coordination of care or inpatient admit limiting admit edits is contractor specific, Charles [...] Related articles:

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PQRI: No Coumadin Due to Fall Risk

2009-11-13 14:21:34-05
Plus, experts at the AMA meeting in Chicago tell you what to do if you can’t get H1N1 vaccine for PQRI Measure 110 or other vaccine measures. Question: My internist decided not to put a patient on Coumadin because the patient has a higher risk of falling than from having a stroke. Our group participates in [...] Related articles:

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CMS at AMA Chicago: We’re Reducing Consult Request Requirement

2009-11-13 14:26:59-05
CMS auditors will look for 1 less thing in consult documentation. With Medicare’s invalidation of consultation codes 99241-99255 in 2010, your ICD-9 codes better prove why two MDs are necessary on the same patient’s hospital care or the physician better specify why in his note. Separate ICD-9 codes will help substantiate the medical necessity for providing consultative [...] Related articles:

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Pain Management Coding: Endoscopic Lumbar Nerve Decompression

2009-11-15 01:38:19-05
Hint: Think ‘unlisted procedure.’ Question: One of our physicians is looking into “endoscopic lumbar spinal nerve decompression.” One of the medical device representatives indicated he could bill it like the lateral extraforaminal approach for lumbar decompression, but I haven’t found much information. What’s your advice? Answer: Despite what you physician might have heard, your most appropriate choice [...] Related articles:

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Neonatal Critical Care Coding: CPT 2010 Clarifies Resuscitation Guidance

2009-11-15 23:56:21-05
Question: There’s a notation in the CPT 2009 manual that the neonatal critical care codes include delivery room resuscitation. Is this true? Answer: No, a parenthetical note following 99465 (Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output) incorrectly stated that resuscitation could not [...] Related articles:

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ED Coding Question: Observation or Other E/M Code?

2009-11-17 01:39:11-05
Question: A 42-year-old patient reports to the ED early on Tuesday morning for evaluation of uncontrollable shaking in her extremities and severe pain in her neck. The EP admits the patient to observation at 7 a.m. and orders blood tests and a CT scan — however, the shaking continues to worsen. The EP consults with a [...] Related articles:

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Medicare’s Consult Rule Trickle Down Effect

2009-11-18 14:05:20-05
And what it means for pediatric practices. A report from AMA in Chicago. Although CPT clarifies the transfer of care definition, the fix came too late for Medicare, meaning your private payers may follow suit. Continued Errors Result in E/M Boon The Office of Inspector General found a high error rate on consultation codes. Different opinions on when [...] Related articles:

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AMA Symposium Report: Low-Level Consult Reporting in 2010

2009-11-18 14:14:44-05
Hey, Coding News readers! It’s your turn to weigh in on the consult controversy. Question: What should you do for Medicare 2010 coding if an inpatient consult on a patient’s initial hospital day does not support 99221? Answer: Kenneth Simon, MD, MBA, FACS, CMS, senior medical officer at the CPT symposium was very adamant that you [...] Related articles:

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Lab Fee G Codes Crosswalk to CPT

2009-11-18 14:28:07-05
Question: Did you get any info at the CPT 2010 conference about the “Table of Drugs and the Appropriate Qualitative Screening, Confirmatory, and Quantitative Codes” on page 386 CPT? This is brand new, and I need to learn about it. Answer: CMS created lab fee G codes to substitute for CPT codes due to concern [...] Related articles:

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