Ask An Expert: billing
| Q: | My PCP documented and coded breast cancer (ICD-10-CM code C50.-) for a patient who had a mastectomy three years ago and is receiving Tamoxifen. He was told that if the patient was receiving treatment, he could code active cancer. Is this correct from an MRA standpoint? |
| A: |
Yes and no. When a patient has an active cancer, regardless of whether he or she is receiving treatment, the primary cancer ICD-10-CM code is used. The scenario you presented isn’t quite so clear. Breast cancer has a treatment phase … Read Full Post |
| Q: | The PCP documented “aortic atherosclerosis.” How do I code this for MRA purposes? |
| A: |
Atherosclerosis of the aorta is a common condition in the elderly and the ICD-10-CM code is I70.0. However, it’s important to distinguish between atherosclerosis of the vessel (which is a risk adjusted diagnosis) and a valve (ICD-10-CM code I35.8, which … Read Full Post |
| Q: | Two years ago, I saw Mrs. Jones as a new patient. I took a detailed history and developed a treatment plan for her HTN, CAD and other health issues. My office has attempted to schedule additional appointments and Mrs. Jones is either a no-show or cancels the appointment at the last minute. Mrs. Jones had a recent hospital stay where CHF and valvular heart disease were diagnosed. I haven’t seen her in two years and she has come to my office to continue outpatient treatment. I basically have to start from scratch due to her long absence and new health problems. Can’t I bill her visit as a new patient? |
| A: |
The answer is no. Mrs. Jones may be a noncompliant patient, but she is an established, noncompliant patient. CMS guidelines specifically define a new patient as someone who has not received services from this physician or another physician in the … Read Full Post |
| Q: | I attended a workshop where I was told that we need more than one lab value to diagnose a condition. Is this correct? |
| A: |
It depends on the value and as always, the physician’s clinical judgment and documentation as well as the condition guidelines. Most of the time, laboratory tests are repeated after a few months to ensure the value was not an aberration … Read Full Post |
| Q: | Our practice just hired a new physician, but she doesn’t have her Medicare provider number yet. Our biller has applied for it and told me that in the meantime, we can bill my new physician’s office visits under my provider number. Is this legit? |
| A: |
The answer is no. This behavior is termed ‘knowing misuse of a provider identification number’ and could be considered a false claim, subject to fines and sanctions. Provider claims must identify the actual practitioner who performed the service. In fact, … Read Full Post |
| Q: | What is an ABN? |
| A: |
The Advanced Beneficiary Notice of Noncoverage, or ABN for short, is a waiver of liability that is provided to all Medicare patients if the provider believes an item/service may not be covered by Medicare or considered medically necessary. Now that … Read Full Post |
| Q: | My PCP documented and coded breast cancer (ICD-9-CM code 174.9) for a patient who had a mastectomy in 2008 and is receiving Tamoxifen. He was told that if the patient was receiving treatment, he could code active cancer. Is this correct from an MRA standpoint? |
| A: |
Yes and no. When a patient has an active cancer, regardless of whether he or she is receiving treatment, the primary cancer ICD-9-CM code is used. The scenario you presented isn’t quite so clear. Breast cancer has a treatment phase … Read Full Post |
| Q: | The PCP documented “aortic atherosclerosis.” How do I code this for MRA purposes? |
| A: |
Atherosclerosis of the aorta is a common condition in the elderly and the ICD-9-CM code is 440.0. However, it’s important to distinguish the difference between atherosclerosis of the vessel (which is a risk adjusted diagnosis) and a valve (ICD-9-CM code … Read Full Post |
| Q: | A specialist’s consultation report came back three weeks after our patient had a face-to-face visit with the PCP, and revealed some new risk adjusted diagnoses. Can my PCP make an addendum and report them? |
| A: |
Probably not. An addendum is used when the patient was assessed for a condition during the visit and the PCP needed some additional information, to be received very timely, in order to make a definite diagnosis. Addenda are not used … Read Full Post |