Author

Chris Boucher
Chris Boucher has nearly 10 years of experience writing various newsletters and other products for The Coding Institute. His blog will cover several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance and ICD-10 coding.

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    If provider furnishes separate E/M before repair, remember 25.
    When your physician stops a nosebleed, should you report an E/M service or CPT® code? The answer: It depends. If the patient reports to the physician with complaints of a nosebleed, and the provider stops the bleed with conventional methods such as ice or pressure, you   Read more..
    Posted on 3 Jan, 2016
    By Chris Boucher
    Make E/M Decision First to Plug Nosebleed Coding Holes
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    Medicare, private payers might differ on coding shorter 1-day observations.
    When it comes to coding observations, you need to know your code descriptors in order to ensure that you report your physician’s services correctly. Put simply, there are different code sets based on the amount of time the patient spends in observation. Check out this quick   Read more..
    Posted on 1 Jan, 2016
    By Chris Boucher
    Let Length of Stay Dictate Observation Coding Choices
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    Payers require specific criteria for 10120.
    A patient steps on a splinter from a holiday tree, or some other foreign body (FB), and your physician performs a foreign body removal (FBR). You should choose an FBR code for the service, right? Well … maybe: The service might not qualify for the CPT®   Read more..
    Posted on 30 Dec, 2015
    By Chris Boucher
    Are You Sure About that ‘Simple’ FBR? It Could Be an E/M
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    Patient won’t sign ABN? Be sure to document it.
    In certain situations, it might prove difficult to get a signed advance beneficiary notice (ABNs) from a patient when appropriate. Make every effort to get the ABN for any service that Medicare might not pay for, however, or your office could be financially responsible for   Read more..
    Posted on 28 Dec, 2015
    By Chris Boucher
    Get Signed ABN When Possible To Cover Potential Non-Payment
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    When you’re only claiming the code’s professional portion, include this modifier.
    If your physician performs a service in a location where he doesn’t pay the rent, you should be on the lookout for a potential modifier 26 (Professional component) coding situation. Why? Often, a CPT® code’s relative value units (RVUs) are broken down into a technical component   Read more..
    Posted on 26 Dec, 2015
    By Chris Boucher
    Put 26 to Work for Many Off-Site Services
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    Experts: Get a financial agreement form on file ASAP
    If you work in a medical office that hasn’t ever had any trouble collecting copayments for some patients, consider yourself lucky. “My [office] goes through [copay] issues every day, says James P. Bartley, MS, Med, practice administrator for Women’s Healthcare of New England, an ob/gyn practice   Read more..
    Posted on 24 Dec, 2015
    By Chris Boucher
    Keep Consistent Copay Policies to Reduce Headaches
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    Leave E/M-25 off the claim unless you can prove E/M components separate from the procedure.
    Coders will need to use modifier 25 on the E/M code when the provider performs a procedure or service, and also treats an entirely different problem with an E/M during the same encounter. Dilemma: When a patient has a pair of unrelated problems that the provider   Read more..
    Posted on 23 Dec, 2015
    By Chris Boucher
    Check Out How Separate Diagnoses Can Result in an E/M-25
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    You might need multiple modifiers to make fluoroscopy/injection claim fly.
    Coding for arthroscopic injections can become a maze of confusion quickly if you don’t sort out the details before you start; you have to check for codeable procedures that the physician might perform for each injection. If you want to squeeze every ounce of reimbursement out   Read more..
    Posted on 21 Dec, 2015
    By Chris Boucher
    Let This Example Guide Your Arthroscopic Injection Coding
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    ABNs can also help build rapport with patients.
    If your practice doesn’t obtain signed advance beneficiary notices (ABNs) when necessary, it could be letting deserved reimbursement fly out the window. Reason: Whenever your practice provides a service that Medicare might not cover, or cover completely, the ABN notifies the patient of that fact. Having   Read more..
    Posted on 19 Dec, 2015
    By Chris Boucher
    Think Medicare Might Not Pay? Get an ABN
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    Higher-level E/Ms possible with complete ROS.
    When your physician provides an evaluation and management (E/M) service, a vital part of the history component is the review of systems (ROS). In short: There are three levels of ROS, and your level of ROS coding will need to be spot on if you’re to   Read more..
    Posted on 17 Dec, 2015
    By Chris Boucher
    Key on Components for Accurate ROS Count