Medical Coding and Billing - Books, Coding Alerts, Tools

Furnish complete details of the procedure being performed to avoid payment loss.

You can secure complete reimbursement for routine foot care services only under specific circumstances. Don’t forget to check whether systemic conditions were present prior to submitting your claim.

CPT® Codes for Nail Treatment Procedures

When your podiatrist treats ingrown nails, you’ll normally report the procedure with one of these CPT® codes: 11730, 11732, 11750, and 11765. Remember: These codes are not confined to just toenails. Use these codes to report either a toenail or fingernail, whichever applies. If it gets too confusing for you, keep a podiatry coding book handy.

Routine Foot Care?

Some ingrown toenail treatments are considered part of routine foot care, and therefore billable only with G0127, and 11720-11721 for some payers. If the doctor treats simple uncomplicated or asymptomatic in growing nail by removal of the offending nail spicule, which does not require local anesthesia, it’s called routine foot care. Routine foot care is covered only when certain systemic conditions exist.

ABCs of Nail Procedures

Procedure codes 11730 and 11732 describe a single, simple, avulsion (removal) of the nail plate. The podiatrist administers a standard digital block, and utilizes a nail elevator, iris scissors or nail cutters to segregate the nail plate from the nail bed. Small wounds, if any, are restored with a simple repair.

Here’s an Example:

A patient has five ingrown toenails. Your clinician conducted simple avulsion on both sides of the great toe on each foot and the second digit on the left foot. Here, you’ll report 11730 for the first avulsion and +11732 for each of the two additional avulsions. In case you want to indicate to the payer which toes are involved, you can apply HCPCS modifiers TA (left foot, great toe), T5 (right foot, great toe), and T1. Since +11732 is an add-on code, there are no CCI edits between 11730 and +11732, and you need not apply any modifiers.

Documentation Best Practices

For CPT® codes 11730, 11732, 11750, and 11765, as per Medicare, an operative report or complete detailed description of the procedure being performed is required. If you do not include any of the below listed information in the patient’s medical record, you could be in for denials:

·         Chief complaint of the patient (for instance painful toe)

·         Procedure being performed

·         Method of obtaining anesthesia and if not used, the reason for not using it

·         Detailed procedure description

·         Postoperative observation and treatment of the surgical site

·         Postoperative instructions provided to the patients and any follow-up care

Reduction in Payment for New Off Campus Provider-Based Clinics. 

If you work for providers offering services in clinics, provider-based or hospital-based off-campus, these newly-introduced and revised POS modifiers could play a key role in the claims process. Section 603 of the Bipartisan Budget Act of 2015 mentions a reduction in reimbursement for ‘new’ off campus provider-based clinics, and this has taken the hospital community by surprise. 

Are you in Sync with the Latest HCPCS Level II codes and Modifiers? 

You will use the PO HCPCS modifier with every code for outpatient hospital services provided in an off-campus PBD of a hospital. The reporting of this new modifier has become mandatory effective January 1, 2016. 

Note: This modifier cannot be used for remote locations of a hospital/satellite facilities of a hospital/services for services provided in ED. 

Updates to POS 19 & 22 

Providers can heed this. The existing POS code set introduces new POS code 19 for Off Campus Outpatient Hospital and revises POS code 22 language to ‘On Campus Outpatient Hospital (previously ‘Outpatient Hospital’). Both these indicators will affect the SOS differential in RBRVS that will lead to decrease in physician, professional payment. Local contractors will create policies as required to adjudicate claims containing new POS code 19 and revised POS code 22 as per Medicare national policy, and treat both the modifiers in the same way. Moreover, the three-day payment window applies to services billed with POS code 19 as well. 

Collect Provider-Based Clinic Data, Says CMS 

The Centers for Medicare and Medicaid (CMS) also wants to start gathering data relative to these clinics, and most likely, other off-campus provider-based operations. Note that hospitals also have provider-based clinics on-campus and often inside the hospital. The agency is keen on finding out whether such provider-based operations are more expensive as compared to their freestanding counterparts. This is because OIG has always emphasized that payments for provider-based clinics and freestanding clinics should be equivalent. What’s more, MedPAC has also pointed out that reimbursement should be same for E/M codes. 

Note that CMS is collecting information on provider-based clinics supposedly because of the pressure coming in from OIG and MedPAC. 

Although it’s been a few months since the new CPT® codes were unveiled, most practices still seem to be struggling to ramp up for the changes in claims reporting with the new and revised guidelines. Furthermore, keeping up to date with the incessant updates, and CCI edits, relating to countless pain management codes can prove to be a daunting task.

Do you need authoritative guidance for coding your pain management services to ensure that payers accept your claims on your first claims submission itself? The stakes are set high, and ignorance may cost you heavily. You can trust The 2016 SuperCoder Illustrated for Pain Management as your go-to expert companion - to help you maximize your productivity, by enabling you to process more number of claims, more accurately, in the same amount of time.

 This book has an exhaustive collection of codes and procedures related to pain management. The book is systematically divided into various body systems, so that it is becomes easy for you to zero in on the procedure you are searching. In every section, the book lists out important pain management procedures, that you usually come across in your practice, and then opens up the doors to comprehensive, up-to-date information related to the procedure with a 360-degree perspective.

Within a procedure, the CPT® code is mentioned along its official code descriptor, and an easy-to-follow lay term explanation. The book also depicts alongside detailed illustrations; so that even a basic level coder understands the concept behind the procedure fairly quickly. You also get to read hundreds of coding tips which you may utilize in your own claim scenario, including expert coding advice for the CPT® 2016 revised and new codes. What’s more - you also have accurate RVU and Fee Schedule information to guide you in your claim. At the end of the book, there is an appendix listing the medical terms mentioned within the procedure descriptions, along with their explanations, as a ready reference for you.

Practice management can be overwhelming, given the multispecialty and diverse needs of your practice, and requirement of umpteen different skills to keep your practice afloat. Whats’ more, negligence can cost your practice heavily.

Whether you are facing revenue challenges, — from contract negotiations with payers to streamlining your accounts receivable processes to finding ways to bring in new patients, its time now to take control with The Coding Institute’s Practice Management handbook that serves an appropriate mix of guided knowledge, quick learning and expert advice, be it revenue challenges, contract negotiations, or streamlining your accounts receivable processes, and more.

To get the most trustworthy, accurate, up to date billing coding and practice management instructions, turn to the Practice Management Handbook. This is your evergreen indispensable companion for step-by-step, accurate, and authoritative opinions and advice diverse areas such as public relations, marketing,  EMR implementation, coding, compliance to name a few.

The Practice management handbook helps you learn and implement regulatory concepts from healthcare reform, market your practice, increase the patient footfalls, sharpen your leadership skills, and implement risk and denial management tactics. Take a look at a few of practice essentials covered:

 - Boost your confidence with chart sampling

 - Glen 3 key HIPAA lessons from 2 HITECH reports

 - Pay attention to the OIG’s hit list

 - Help employees avoid faux pas

Stay surprised. To help you stay in tune with the ever-changing billing and reimbursement rules,  TCI brings you  a 2016 supplement to the handbook, completely equipped with vital information and reimbursement updates, covering  latest of CPT® 2016 updates, such as:

 - CPT 2016 pairs down chromatography choices

 - Keep this table close to aid ABN related modifier choice

 - Check out these new revised 2016 HCPCS codes to keep your income flowing

 - Beware of stark pitfalls affecting your professional service arrangements

That’s not all. In our brand new Practice Management Handbook 2016 Supplement, you’ll have a treasure trove of strategic information making sure your practice stays ahead of the latest 2016 coding and reimbursement changes, new codes for placing a sinus implant, 50 surgical code changes and more; not to mention the HCPCS changes and CMS volume to value payment shift.

Stay focused and emphasize on coder-provider coordination to ease into the new system.

ICD-10 implementation has come and gone but your ob-gyn practice still needs to continue to train and improve ICD-10 coding accuracy and comfort. As ICD-10 is new, ob-gyn coders and providers will learn the nitty-gritty of ICD-10 while concurrently using the new system.

Here are some tips from ICD-10 trainers your ob-gyn practice can use to ensure it’s ready to continue its ICD-10 growth.

Providers Should Pay Attention to Coders’ Documentation Advice Communication between coders and providers – including ob-gyns, clinical nurses, physician assistants (PAs) is highly essential for ICD-10 compliance. Normally, coders and clinicians will understand all the aspects that go into a claim. However, obtaining this knowledge will not happen immediately. It’s essential to have an information pipeline between coders and providers to get the ICD-10 codes right. 

Coders are the ones with comprehensive ICD-10 know how since they are at the forefront of the coding game. For instance: When your physician diagnoses a urinary tract infection, you cannot just write ‘UTI’. There has to be a higher level of specificity. And coders are well-placed to know what payers will expect on the claim.

Stay Focused on Your ICD-10 Learning & Keep Practicing Coders should keep learning ICD-10 and stay in touch with fellow coders. If you are not sure of something, you need to ask other people who have sound knowledge of ICD-10. You should refer any resource you can find to improve your ICD-10 know how. For instance, your ob-gyn practice could consider using a specialty-specific handbook such as TCI’s Ob-Gyn ICD-10 Handbook (you could get it now for a special Christmas discount) that includes advice on mastering your thorniest ICD-10 ob-gyn coding and documentation challenges.

You could also consider these to stay updated on ICD-10: • Get onboard online ICD-10 forums • Invest in good ICD-10 codebooks and charts • Organize ICD-10 training seminars in your office • Conduct ICD-10 quizzes and games in  your practice • Attend off-site ICD-10 conferences and seminars • Talk with other ob-gyn practices about their ICD-10 experiences • Get ICD-10 advice from Medicare and private payers

Rely on The ‎Coding Institute‬'s 2016 manuals as your go-to resource for your procedural and diagnosis coding needs. Effective sources for 2016 medical coding books just at The Coding Institute.

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