Accelerated Medical Practice Blog

As anyone in the coding world knows, modifiers are a critical component for accurate billing and maximum reimbursement. The notorious complexity of modifier rules creates considerable lag when it comes to the forms review and editing process. The questions below highlight key factors that must be taken into account when applying modifiers to procedures.  What does your practice management system allow or require? The first challenge for posting claims correctly to the practice management (PM) system...

On April 20, the Office of Inspector General (OIG) published a report explaining the use of the KX modifier. Seen most often with physical and occupational therapy billing, providers add a KX modifier to CPT® or HCPCS codes in order to show there is documentation on file justifying the need for that procedure, service, or supply, and the documentation meets Medicare coverage criteria. Of the claim samples reviewed, the OIG found less than 50 percent of...

When it comes to lab tests, one common area of missed revenue occurs with Rapid Flu tests. Doctors can purchase test kits for the Rapid Flu Test (87804) which tests for both A & B strains. Swabs are taken from the patient’s respiratory tract and the claim is coded based on the test results. If positive for 1 strain, bill 87804 once. If positive for both strains, bill 87804 on two separate line items with a...

In the AAPC article “Diagnosis Code Overload,” Jeremy Reimer discusses the problem of over-coding that sometimes appears when reviewing medical records. His example is a case where a patient had sustained injuries in a relatively minor motor vehicle accident.  The provider filed a claim with fourteen (14) diagnosis codes. Reimer brings to light several unspecified and ill-defined codes from category 780-799 that were inappropriately used to describe symptoms for a known medical condition. Physicians often end...

In the ICD-10 world, the definition for many diagnostic conditions have been revised or expanded to include additional information. In some cases, the definitions are more detailed than what the condition described in ICD-9. In other cases, ICD-10 introduces new coding conventions that previously did not exist. Here are some examples: Granularity In ICD-10, the diagnosis “Edema” (782.3) has been revised to include the following more specific definitions: R60.0 – Edema, Localized R60.1 – Edema, Generalized...

Providers are fighting to be reimbursed for every dollar. Getting reimbursed properly requires back office staffs to diligently pay attention to changes in payor rules.

Every year, physicians start to sweat when the Centers for Medicare and Medicaid (CMS) releases the final rule on the Medicare Physician Fee Schedule (MPFS) reflecting the financial impact the Standard Growth Rate (SGR) adjustment will have on their business in the upcoming year. 

The American Academy of Professional Coders (AAPC) and the Centers for Medicare & Medicaid Services (CMS) have announced over 430 changes will be present in the 2012 HPCS II Code Books. Many medical practices can now begin to revise their encounter forms in preparation for 2012.