Every CPT code has been assigned a relative value unit (RVU) and they are determined on the basis of the resources necessary to the physician's performance of the service. Assigning these services in the proper sequence based on a highest to lowest RVUs can ensure proper payment. When submitting the claims, listing the codes in the wrong order may lower your reimbursements. Here are some examples which illustrates how a change in sequence may affect the way you are reimbursed. Case 1: During … [Read more...]
When should CPT Modifier-52 be used ?
Modifier-52 is used to describe circumstances in which services provided were reduced in comparison to the full description of the service. When a physician does not complete a procedure in its entirety the procedure must be billed by appending modifier-52 or in other words if a physician elects to partially reduce or discontinue the procedure for reasons other than the patients well being being threatned, modifier-52 may be used. Note: For hospital outpatient reporting of a previously scheduled … [Read more...]
Correct Way to Code and Bill Brain Mapping
Surgically removing brain tumors adjacent to "eloquent" or functional regions of the brain poses significant risks for causing neurological impairments. Brain Mapping is performed for such eloquent cortex identification or to determine where the motor/sensory transition exists. CPT 95961( Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or depth electrodes, to provoke seizures or identify vital brain structures; initial hour of physician … [Read more...]
How to handle a denial by an Insurance carrier for Intraoperative Neuromonitoring services?
Once a denial is received, the first step should be to review the policy or LCD(Local Coverage Determination) by the carrier regarding the services in question to determine if the claim has been denied correctly or not. Once that is determined, the next step is to write an effective appeal letter clearly stating the medical necessity for that procedure. Include a copy of the Op Report, Copy of IONM interpretation report and a copy of the LCD/Policy from the insurance carrier highlighting the … [Read more...]
How to report EEG during Non Intracranial and Intracranial Surgery?
During non-intracranial surgery i.e carotid endarterectomy or stenting, cardiac surgery, CPT 95955[Electroencephalogram (EEG) during nonintracranial surgery] should be used. This code cannot be billed in conjunction with CPT 95920. Codes 95812 and 95813 are also used as EEG codes. CPT 95812 [Electroencephalogram (EEG) extended monitoring;41-60 min) and CPT 95813 [greater than 1 hour] can be used for intracranial surgery ( i.e. aneurysm clipping or coiling). These codes should only be billed … [Read more...]
Costly Coding and Billing Errors
Often in medical coding and billing , mistakes happens but if they are not addressed immediately or if they are overlooked, it could turn into a costly affair for the provider causing potential loss in revenue. In this series of coding and billing errors, we will try to highlight some of such common errors and their financial impact on the practice. CASE 1: A physician performed an arthrocentesis on the acromioclavicular joint bilaterally on a 74 year old female. The biller billed the CPT … [Read more...]
Should You Outsource Your Medical Billing?
This is a guest post by Chris Thorman from Software Advice. One of the many business questions physicians face is whether to outsource their medical billing to third-party medical billing services or do it in-house with medical billing software. Some physicians would assume outsourcing billing to a medical billing service makes the most sense. After all, they're the experts with the resources to properly process your claims, right? Others might want to maintain control of collections and do … [Read more...]
How to Bill Cataract Surgery with IOL Implant ?
When an opthalmologist performs extracapsular cataract removal with IOL insertion, the correct way to code the procedure is by using CPT code 66984 [Extracapsular cataract extraction removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique ( eg, irrigation and aspiration or phacoemulsification)]. However if there are any complications encountered during surgery such as removal of dense cataracts with application of indocyanine green or trypan blue … [Read more...]
How to Correctly bill Permanent Lacrimal Punctum Plugs?
CPT code 68761(closure of the lacrimal punctum; by plug, each) should be used to report the lacrimal procedure. This procedure is based on per puncta, not per eye so in situations where two puncta are treated in the same eye, multiple surgery rules apply. So report each service as a separate line item, adding modifier-51 to the second and any subsequent procedure. If performed in both eyes, bilateral payment rules apply, so report this procedure code with a modifier-50. This code is same whether … [Read more...]
How to Correctly Bill Deluxe Frames Post Cataract Surgery ?
Question: When a patient elects to upgrade his standard frame to a deluxe frame after cataract surgery, can a physician charge the differential even though he accepts assignment of benefits? Answer: Yes, you can. Medicare covers up to one pair of eyeglasses or one set of contact lenses after cataract surgery with IOL implantation. As such Medicare will only pay for the standard frames but if a beneficiary chooses to upgrade to a deluxe frame, the participating provider or supplier … [Read more...]