Medical Billing and Coding Online

Differences between Medicare Parts A, B, C and D

What are the differences between Medicare Parts A, B, C and D?There are four parts to Medicare: Medicare Part A, Hospital Insurance; Medicare Part B, Medical Insurance; Medicare Part C (Medicare Advantage), which was formerly known as Medicare + Choice; and Medicare Part D, prescription drug coverage. Generally, people who are over age 65 and getting Social Security automatically qualify for Medicare Parts A and B. So do people who have been getting disability benefits for two years, people who have amyotrophic lateral sclerosis (Lou Gehrig's disease) and receive disability benefits, and people who have permanent kidney failure and receive maintenance dialysis or a kidney transplant. Part A is paid for by a portion of Social Security tax. It helps pay for inpatient hospital care, skilled nursing care, hospice care and other services. Part B is paid for by the monthly premiums of people enrolled and by general funds from the U.S. Treasury. It helps pay for doctors' fees, outpatient hospital visits, and other medical services and supplies that are not covered by Part A. Part C (Medicare Advantage) plans allow you to choose to receive all of your health care services through a provider organization. These plans may help lower your costs of receiving medical services, or you may get extra benefits for an additional monthly fee.You must have both Parts A and B to enroll in Part C. Part D (prescription drug coverage) is voluntary and the costs are paid for by the monthly premiums of enrollees and Medicare. Unlike Part B in which you are automatically enrolled and must opt out if you do not want it, with Part D you have to opt in by filling out a form and enrolling in an approved plan.

Differences between Medicare Parts A, B, C and D

What are the differences between Medicare Parts A, B, C and D?There are four parts to Medicare:Medicare Part A, Hospital Insurance;Medicare Part B, Medical Insurance;Medicare Part C (Medicare Advantag…

Types of Medical Transcription

Medical transcription is essential to the billing and record-keeping process of medical faculties. Doctors and nurses need to keep notes on procedures, diagnoses and any additional information needed on patients. The transcription of recorded notes acts to secure information, of which some is forwarded to coding and billing departments. Significance Medical transcriptionists can opt to complete a two-year associate's degree or a one-year certificate course in order to qualify for a position, as a person must learn medical terminology and procedures as well as grammar and perfect typing skills. Types Medical transcription can be specialized into different departments. They are often seperated by medical departments, which include general practice, radiation, dermatology, neurology, pain management, pediatrics and more. Benefits If a person were to specialize into a specific department of medical transcription, such as neurology, payment for services from an average transcriptionist might increase from around $10.00 to $12.00 per hour to $14.00 to $15.00 per hour. Benefits Many medical transcriptionists in every department are able to work on a telecommute basis, some under a per piece rate instead of a per hour rate, and a fast transcription typist might earn significantly more per hour than an average typist. Tasks Transcriptionists might be required to work with audio prerecorded to a computer file and then typed under a deadline, or they might also have to work in real time, inside meetings or virtually via phone and typing as spoken, depending on the needs of different medical offices

Types of Medical Transcription

Medical Transcription vs Medical Billing

Not everyone who works in the medical field provides direct patient care, like doctors and nurses. Other jobs in health care exist in the form of medical transcription and medical billing jobs. Like other jobs in the field, medical transcription and medical billing require a specific skill set for success. 
<div class="separator" style="clear: both; text-align: center;"><a href="http://www.medicalbillingcodings.org/2011/04/medical-transcription-vs-medical.html" imageanchor="1" style="margin-left:1em; margin-right:1em"><img border="0" height="364" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTzGNIG19DrpsCub3VAKf1yxVzzR8O2Mknvd1UUtwpv-N3rahX8wZNNcyqIMrVYU4VUCw2hqJrEsj_8wttIjba2BqxMMjv91A_YDa3qVnoTz6M7Jml-jJryAM8Uksiq8rxKlDg4DKEumE/s1600/ace-process.jpg" width="452" /></a></div><h2>Medical Transcription vs Medical Billing: Basics</h2>As the name implies, medical transcriptionists listen to recordings made by physicians and other health care professionals and document them. This documentation comes in the form of patient discharge summaries, patient history reports, surgical reports or diagnostic imaging studies. Medical transcriptionists have to be well-versed in medical terminology, and employers look for individuals with a postsecondary degree in medical transcription, according to the Bureau of Labor Statistics. 
Medical billing involves working with patient health insurance claims. Since many hospitals and physicians' offices outsource billing and insurance claims to third parties, medical billers can find a reliable workload. They manage patient records, file insurance claims, prepare insurance forms and send bills to patients. Medical billers need to communicate with both insurance companies and physicians to ensure they properly code medical services. They need to understand medical coding so that insurance claims are processed accurately. 
<h3>Medical Transcription and Billing Process Similarities</h3>Both medical transcription and medical billing require specific knowledge in the medical field. While transcriptionists and billers do not have to know how to treat patients, they have to possess a specific set of medical knowledge--medical terminology for transcriptionists and coding for billers. 
Individuals in both Medical Transcription and Medical Billing can work in traditional health care settings in hospitals or physicians' offices or they can work for third parties or even for themselves from the comfort of home. 
<h3>Transcriptionist and Biller Differences</h3>Although both medical transcriptionists and medical billers provide services for hospitals and physicians' offices, their purpose is distinctly different. Medical transcriptionists work on the medical, patient-care side of health care, helping develop reports that physicians can assess and learn from. 
Medical billing is a part of the business side of health care. Medical billers help hospitals and physicians' offices ensure that their bills are paid, either by the insurance companies or the patients

Medical Transcription vs Medical Billing

How to Prepare for ICD-10 Medical Classifications

The time of the new ICD-10 codes is coming. Information on federal web sites indicates the ICD-10 category will soon be in use and the AHIMA (American Health Information Management Association) claims that legislative processes are under way to set up the required use of ICD-10 codes by 2010. The new ICD-10s as adopted by the World Health Organization provide for documenting many different types of diseases and conditions and will help to supplement the outdated ICD-9 system now in use at US hospitals and medical offices. Instructions 1- Start early. The AHIMA site recommends preparing for ICD-10s years in advance. Health care professionals are scrambling to identify, analyze and be aware of ICD-10 codes now so that they can include them in billing systems by 2010. 2- Prepare for clerical changes. According to AHIMA, the ICD-10 set will include changing alphanumeric codes and restructuring chapters or categories of the current ICD book. Look at how your office will change to fit in the wider range of ICDs. 3- Prepare for detail expansions. Along with clerical changes, the ICD-10s may expand the detailing of conditions to accommodate more specific varieties of illness or injury. Look at how the ICD-10 will expand current descriptions of conditions and the kind of conditions to which new codes will be relevant. 4- Get memorandums out to all departments relevant to your office including billing, reimbursement, coding, registration and all other areas where a contact person can train staff to prepare for the ICD-10s. All of the branches of a medical office will be affected by the change. 5- Talk to colleagues about how the ICD-10s will affect different types of care, from in-patient to out-patient visits, including psychological care, home health care and drug and alcohol services. 6- Continue to monitor developments through AHIMA's site and through federal sites that show how legislators are approaching a possible update

How to Prepare for ICD-10 Medical Classifications

What Is HCPCS? Identification, Types, History, Functions, Uses

HCPCS is used in the operation of medical office administration and billing. It is a code set up to help insurance providers and medical staff communicate more effectively when billing for medical services, products and procedures. There is specialized training for this type of work, which is often used by one or two office personnel to properly handle billing issues with third-party providers. 
 
Identification 
 
The letters HCPCS are the acronym for Heathcare Common Procedure Coding System. The name stands for a system used to organize and sort medical claims processed for payment in the United States each year. There are people working in medical offices who specialize in knowing this system. 
 
History 
 
Level I codes were created before the 1980s as a way for medical administration staff to standardize billing and other records for insurance payments. As new procedures and systems came into use, Level II was created during the 1980s to accommodate the newly added services and supplies. Level III came into existence around 2003 because of new procedures and medical tools becoming available to localized markets. This system was created by the director of Health and Human Services, which gave authority of the system to the Center for Medicare and Medicaid Services (CMS) under the 1996 Health Insurance Portability and Accountability Act (HIPAA) legislation. 
 
Function 
 
Level I of the coding system is used for medical treatments and tools when billing insurance companies. Level I is used for any in-patient or office visits where the treatment or supplies is used in the medical facility. Level II is used when billing for ambulance services, prosthetics, orthotics and other supplies used outside of the doctors office. Level II is mostly used by Medicare and other insurance to cover items outside of an office visit. 
 
Types 
 
There are three levels of HCPCS codes. These are known as levels I, II and III. The first level is used for Current Procedural Terminology (CPT) codes which are numbered codes of groups of five numbers maintained by the American Medical Society and are used for identification of medical services and procedures. Level II codes are used as a method to code services, supplies and other procedures not used in CPT code. Level II codes are made up of single letters followed by four numbers. Level III codes are used for local coding when the procedure or service is not listed within the other two levels. 
 
Use 
 
The oversight of the coding system is maintained by both the American Medical Association (AMA) and the CMS. The system is run as a clearinghouse for administration purposes to centralize and better organizes billing procedures. Questions and issues in dealing with this system are sent to the clearinghouse for clarification. These issues can include proper code use, new code issues, or insurance and billing claims using the system

What Is HCPCS? Identification, Types, History, Functions, Uses

How to Test for Medical Coding Certification

The AAPC provides worldwide medical coding certification. Since 1988 the American Association of Professional Coders has provided medical coding certification for medical coders in physicians' offices, outpatient facilities and provider facilities. You'll need to pass the Certified Professional Coder examination in order to be certified as a professional medical coder by the AAPC. You'll also need to provide the AAPC with proof that you have worked as a medical coder for two years without a degree, that you have worked as a medical coder for one year with a degree or certificate, or that you have completed an online coding course through the AAPC. Difficulty:Challenging Instructions Things you'll need: • $300 for exam fee • $125 for AAPC membership • No. 2 pencils • Government-issued photo ID • AAPC member ID • AMA CPT, ICD-9-CM, and HCPCS II coding manuals Experience Requirement 1. Work for two years as a medical coder. Obtain two signed letters of recommendation from your employer indicating you have two years of experience and furnish them to the AAPC. 2. Work for one year as a medical coder and obtain a degree or certificate. This requires at least 80 hours of coding training. You'll need a transcript on school letterhead and a single letter of recommendation from an employer. 3. Acquire virtual experience through the AAPC website in lieu of real world experience. You must pay $200 to enroll in an online coding course and must code at least 720 out of 800 cases correctly, an accuracy rate of 90 percent. If you don't pass the test on the first try, you will have two opportunities to re-code the incorrect cases and achieve a 90 percent score. Certification Exam 1. Locate an exam in your area through the AAPC scheduling website. Select the country or state you live in and click "Search." Review the list and choose the exam session you would like to attend. Click "Details" next to the session for more information. 2. Complete the registration form. For question one, indicate whether your AAPC membership is current or whether you need a new membership; memberships cost $125 or $75 for students. Next select the "CPC" examination from the drop-down menu. The exam costs $300. 3. Check the boxes indicating you will provide proof of experience and that you agree to the terms of service. Click the "Purchase" button and provide the AAPC with your payment details. 4. Attend the examination session you signed up for. Bring several No. 2 pencils, a government-issue picture ID and your AAPC member ID with you. You should also bring copies of the AMA CPT, ICD-9-CM and HCPCS II industry standard coding manuals. 5. Complete the examination. The exam contains 150 multiple choice questions and takes about 5 hours and 40 minute to complete. If you fail your first attempt, you can retake the test once for free

How to Test for Medical Coding Certification

The AAPC provides worldwide medical coding certification. Since 1988 the American Association of Professional Coders has provided medical coding certification for medical coders in physicians' offices…

Medical Coding Tips for Certification Test

Medical coding certification exams, like the CPC (Certified Professional Coder) tests administered by the American Academy of Professional Coders (AAPC), consists of 150 multiple choice questions. As noted on their website (aapc.com), the questions involve the correct application of CPT, HCPCS Level II procedure and supply codes and ICD-9-CM diagnosis codes used for billing professional medical services to insurance companies. In order to identify the accurate code and pass the examination, candidates must be proficient in anatomy and physiology, coding divisions & guidelines, medical terminology and practice management and reimbursement methodologies. Understanding the Basics Familiarize yourself with medical terminology and the linguistic formation it follows. This includes the word root, prefix, suffix and combining form/vowel. Combining forms (generally 'i' or 'o') are situated in between the word parts and assist with pronunciation. Since the exam measures a physician practice coder's knowledge of the body's structures, make certain you're adept when it comes to the following systems: digestive, endocrine, hemic & lymphatic, integumentary, musculoskeletal, nervous, reproductive (male/female), respiratory and urinary. For Reimbursement Methodologies, go over the various kinds of insurance plans (HMO, PPO, POS and EPO), the Health Insurance Portability and Accountability Act (HIPAA), fundamental health insurance (coinsurance, co-payment, covered expense, deductable, premium) and reimbursement procedures. Coding Systems Learn the different systems, when they are used, what they're used for and the specific criterion surrounding each. The American Medical Association (AMA) founded the CPT (Current Procedural Terminology) coding system; the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs (ama-assn.org). There are three different CPT Category codes: Category I CPT codes are employed by physicians and outpatient providers to depict a procedure or service identified with a five-digit CPT code and descriptor nomenclature. Category I CPT codes are divided into the following categories: evaluation and management, anesthesiology, surgery, radiology, pathology, laboratory and medicine. According to the AMA website, CPT Category II codes are supplemental tracking codes that can be used for performance measurement; using them is optional and they are not necessary for correct coding and can't be used as a substitute for Category I codes. As noted on ADVANCE for Health Information Professionals, Category II Codes are alphanumeric and consist of four digits followed by the alpha character 'F'; they're arranged according to the following categories: composite measures, patient management, patient history, physical examination, diagnostic/screening processes or results, and therapeutic, preventive or other interventions. Category III codes are for emerging technology and intended for data collection purposes in the FDA approval process or to substantiate widespread usage. The "International Classification of Diseases, Ninth Revision, Clinical Modification," ("ICD-9-CM"), is used to code and classify morbidity data from the inpatient and outpatient records, physician offices, and most National Center for Health Statistics surveys (cdc.gov). The "ICD-9-CM" includes a list of the disease code numbers in tabular form; an alphabetical index to the disease entries; and a classification system for surgical, diagnostic, and therapeutic procedures. HCPCS Level II (Healthcare Common Procedure Coding System) is a standardized coding system used to name supplemental medical equipment, products, and services that are not incorporated in the CPT codes. The Centers for Medicare & Medicaid Services, explains that Level II HCPCS codes were established so Medicare and other insurers could submit claims for items such as ambulance services, and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office

Medical Coding Tips for Certification Test

Healthcare Common Procedure Coding System (HCPCS) Guidelines

The Healthcare Common Procedure Coding System (HCPCS) refers to a standardized coding system used by Medicare and other health insurance programs to identify medical procedures, equipment and services. The HCPCS contains two subsystems: Level I and Level II. 
 
Level I 
 
Level I codes identify medical procedures and services. This system is also called Current Procedural Terminology and is defined and revised by the American Medical Association. Level I codes are composed of five numbers. 
 
Level II 
 
Level II codes identify medical supplies and products, such as prosthetics, ambulance services or orthotics. Level II codes contain one letter and four numbers. 
 
Considerations 
 
Level III codes, also called local codes, are codes developed by private insurers and state Medicaid programs to identify services or products that did not have a Level I or II code. These codes were eliminated on December 31, 2003.

Healthcare Common Procedure Coding System (HCPCS) Guidelines

United Health Care and HCPCS Codes for Varicose Vein Procedures

The Healthcare Common Procedure Coding System, or HCPCS, is a set of procedure codes for health care providers. 
HCPCS codes include and are based on the Current Procedural Terminology or, CPT, established by the American Medical Association. 
Since 1978, HCPCS has been used to describe specific medical procedures and is used by private health insurers as well as Medicare and Medicaid in determining eligibility and claims processing. 
 
The 1996 Health Insurance Portability and Accountability Act of 1996 mandated the use of HCPCS codes for health care transactions. The term "UHC codes" refers to the use of these HCPCS codes by United Healthcare, a major health insurance company in the United States. 
 
<h3>Surgical Excision</h3>Surgical excision is used to eliminate large and bulging varicose veins. Other terms for surgical excision include litigation and stripping or the newer phrase "stab phlebectomy." Tiny skin incisions are made and the varicose veins are grabbed and pulled out with small hooks or clamps. The HCPCS or UHC code for surgical excision CPT code is 37718 for the short saphenous vein andCPT code 37722 for the long saphenous vein. 
 
<div style="clear: both; text-align:center;"><a href="http://www.medicalbillingcodings.org/2011/04/united-health-care-and-hcpcs-codes-for.html"><img alt="United Health care and HCPCS Codes for Varicose Vein Procedures" border="0" height="185" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1uU8atjx2yqycuRDEXvlFbEdfJHPp2nzbSFrOIZbL4uqLKBWLaIIoS28ZvxJcNgKN2bbYO6ogv3UxHg3L-jjgQOzAcYeNggkqK5uwHo1yQMPkqaPvuLoLtPaTDG4IutDSB3Tb0MV5SsU/s1600/medical+billing.bmp" width="273" /></a></div> 
<h3>Endovenous Laser Ablation</h3>Endovenous laser ablation is used to treat large varicose veins in the legs. It is a relatively noninvasive procedure in which a laser fiber is inserted directly into the varicose vein. The laser then heats the vein's lining, causing it to shrink, collapse and ultimately disappear. The HCPCS or UHC codes for endovenous laser ablation CPT codes are 36478 for the first treated vein and 36479 for the second and subsequent veins. 
 
<h3>Radiofrequency Ablation</h3>Radiofrequency ablation works on the same principle as laser ablation of varicose veins. Radiofrequency waves are applied to cause heating and collapse of the varicose vein lining. In the radiofrequency ablation procedure, a small catheter is inserted at an incision by the knee and extended up to the groin before the application of radiofrequency waves. The HCPCS or UHC codes for radiofreqency ablation CPT codes are 36475 for the first vein and 36476 for second and subsequent veins

United Health Care and HCPCS Codes for Varicose Vein Procedures

The Healthcare Common Procedure Coding System, or HCPCS, is a set of procedure codes for health care providers. HCPCS codes include and are based on the Current Procedural Terminology or, CPT, establ…

Varicose Vein Procedures CPT-4 Codes: Treatment, Supplies and Evaluation

Learn CPT-4 Codes for Varicose Vein Procedures involved in Treatment Therapy, Supplies, Evaluation. 
 
Varicose veins are abnormally large veins that bulge through the skin, usually in the legs. They can be painful for many people, whether they're walking or staying still. 
 
Many treatment recommendations exist on how to reduce the swelling of varicose veins, including surgical options. For medical billing purposes, these procedures need to be coded, as do the supplies that may be used. 
 
For clarification purposes, procedures codes are called CPT-4 codes, although many people use that term and HCPCS interchangeably. HCPCS codes actually refer to what's known as Level II codes, which cover extended procedures and supply codes. Code descriptions can be very long; they are truncated here, so it's recommended you read through the manuals for complete descriptions. 
 
<div class="separator" style="clear: both; text-align:center;"><a href="http://www.medicalbillingcodings.org/2011/04/varicose-vein-procedures-codes.html" imageanchor="1"><img alt="Varicose Vein Procedures CPT-4 Codes: Therapy, Supplies and Evaluation" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvNMDedUkzveFz6FUeOZI-1DRIZGkAdd1c2s8CzIz3OjztRCXRs58OD2w1WYXsIExIEq0VsvcxVr6SsnHAoAbVgcQKyTpH5S9z9Kd2y_OI7D7k4X3jqgDBBvvHiALsapndTNaOItgK3hml/s420/Varicose_veins.jpg" width="420" /></a></div><ins class="adsbygoogle" style="display:block" data-ad-client="ca-pub-6428896324980307" data-ad-slot="4680777871" data-ad-format="auto"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script> 
<h2>CPT Codes for Varicose Vein Evaluation</h2>Before any treatment can begin, evaluations must be given to determine the type of treatment that needs to take place. The CPT-4 codes used for those determinations include the following codes. The initial one is a radiology code, while the other codes are categorized as Extremity Venous Studies. These codes are: 
<ol><li>CPT Code 76942 Ultrasonic Guidance for Needle Placement.</li>
<li>CPT Code 93965 Noninvasive Physiologic Studies of Extremity Veins.</li>
<li>CPT Code 93970 Duplex Scan of Extremity Veins.</li>
<li>CPT Code 93971 Duplex Scan of Extremity Veins.</li>
</ol><h2>Varicose Vein Procedures Types</h2>There are three main treatment categories for varicose veins. Though all of the codes are listed within the surgical category of CPT-4 codes, not all of the procedures are actually surgical procedures. Also, none of these codes are exclusive during a day of treatment. 
 
It means if a physician wishes to perform multiple procedures in one day, it can be done as long as the medical documentation supports it. However, some codes can't be billed together on the same day, so it's best to verify those codes through the coding manual. 
 
The least invasive of the three varicose vein surgical treatments introduces solutions into the veins, usually via a drip process to try to reduce the hardening that's taken place. 
<ul><li>CPT Code 36468 Single or Multiple Injections of Sclerosing Solutions.</li>
<li>CPT Code 36470 Injection of Sclerosing Solution; Single Vein.</li>
<li>CPT Code 36471 Injection of Sclerosing Solution; Multiple Veins, Same Leg.</li>
</ul><h3>Endovenous Ablation Therapy CPT Codes</h3>Ablation therapy means varicose veins will be treated by inserting a solution and then heating it up with an outside source. The source is indicated within the codes below: 
<ul><li>CPT Code 36475 
Ablation therapy of incompetent vein, percutaneous, radiofrequency; first vein treated 
<li>CPT Code 36476 
Ablation therapy of incompetent vein, percutaneous, radiofrequency; second and subsequent veins 
<li>CPT Code 36478 
Ablation therapy of incompetent vein, percutaneous, laser; first vein treated 
<li>CPT Code 36479 
Ablation therapy of incompetent vein, percutaneous, laser; second and subsequent veins 
</ul><h3>Vein Ligation Surgery CPT Codes</h3>These codes indicate actual surgical procedures. Hospitals might not use these codes for billing purposes, deciding instead to use surgical ICD-9, or diagnosis codes, but physicians will need to use at least one of these codes: <ul><li>CPT Code 37700 
Ligation and division of long saphenous vein at saphenofemoral junction. 
<li>CPT Code 37718 
Ligation, division, and stripping, short saphenous vein. 
<li>CPT Code 37722 
Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below. 
<li>CPT Code 37735 
Ligation and division and complete stripping of long or short saphenous veins. 
<li>CPT Code 37760 
Ligation of perforator veins, subfascial, radical. 
<li>CPT Code 37765 
Stab phlebectomy of varicose veins, one extremity; 10-20 stab incisions. 
<li>CPT Code 37766 
Stab phlebectomy of varicose veins, one extremity; more than 20 incisions. 
<li>CPT Code 37780 
Ligation and division of short saphenous vein at saphenopopliteal junction. 
<li>CPT Code 37799 
Unlisted procedure, vascular surgery. 
</ul><h3>HCPCS Procedure</h3>There is one last procedure that, unfortunately, isn't covered by most insurance companies because, as of mid-2009, they see it as an experimental procedure. That code is: <h3>CPT Code S2202 Echosclerotherapy Supplies</h3>Compression stockings are the most used supply item in the treatment of varicose veins. Not all insurance companies will pay for this item, as it's considered take-home equipment, which usually isn't covered. The range of HCPCS codes for this item is from A6533 through A6549, with the only difference being the size and length of the stocking.

Varicose Vein Procedures CPT-4 Codes: Treatment, Supplies and Evaluation

Learn CPT-4 Codes for Varicose Vein Procedures involved in Treatment Therapy, Supplies, Evaluation. Varicose veins are abnormally large veins that bulge through the skin, usually in the legs. They can…

New Ophthalmological (CPT) Services Codes 2011

The following new and revised codes will be listed in the 2011 CPT Coding Manual and are effective January 1, 2011. CPT Code 92135 has been deleted and replaced by the following: <ul> <li>CPT 92132 - Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral (Replaces 0187T) </li> <li>CPT 92133 - Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve </li> <li>CPT 92134 - Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina The Ophthalmoscopy codes have also been revised to include the following: </li> <li>CPT 92227 - Remote imaging for detection of retinal disease (e.g., retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral </li> <li>CPT 92228 - Remote imaging for monitoring and management of active retinal disease (e.g., diabetic retinopathy) with physician review, interpretation and report, unilateral or bilateral Additional changes/revisions address the following codes: </li> <li>CPT 66174 - Transluminal dilation of aqueous outflow canal; without retention of device or stent (Replaces 0176T) </li> <li>CPT 66175 - Transluminal dilation of aqueous outflow canal; with retention of device or stent (Replaces 0177T) </li> <li>CPT 65778 - Placement of amniotic membrane on the ocular surface for wound healing; self-retaining </li> <li>CPT 65779 - Placement of amniotic membrane on the ocular surface for wound healing; single layer, sutured </li> <li>CPT 65780 - Ocular surface reconstruction; amniotic membrane transplantation, multiple layers </li> <li>CPT 66761 - Iridotomy / iridectomy by laser surgery (e.g., for glaucoma) (per session) </li></ul>

New Ophthalmological (CPT) Services Codes 2011

The following new and revised codes will be listed in the 2011 CPT Coding Manual and are effective January 1, 2011. CPT Code 92135 has been deleted and replaced by the following: CPT 92132 - Scanning …

No more CPT 92135 code for Ophthalmologists

2011 CPT Addresses New Ophthalmological Services Codes The following new and revised codes will be listed in the 2011 CPT Coding Manual and are effective January 1, 2011. Code 92135 has been deleted a…

What Supplies can Podiatrists Bill to Insurance Companies?

I have been questioned on more than one occasion, what a Podiatrist can bill an insurance company for office supplies, or supplies used during office surgeries. This is pretty basic information, but it may help some: Supplies Associated With Office Surgery The majority of supplies related to office surgery are considered part of the surgical procedure. If a surgery performed in the office requires casting material, you may bill these supplies in addition to the surgical procedure code, on a separate line(s). When appropriate, you may use the following HCPCS codes to bill casting material: A4580.....................Plaster Cast A4590.....................Fiberglass Cast Q4037–Q4051........Cast/splint supplies (fiberglass or plaster, by age) Supplies Associated With an Office Visit Supplies are normally considered part of the office visit/surgery charge and should not be billed separately. Examples of supplies considered part of the office call/surgery include, but are not limited to: • cotton balls • facial tissue • tongue depressors • topical ointments • gloves • cotton swabs • gowns • paper sheets/towels Supplies should be billed only if they are “over and above those usually included with the office visit.” Wellmark considers nonprescription or over-the-counter drugs, vitamins, minerals, or nutritional supplements noncovered materials. Bill these materials with procedure code 99070. Noncovered services are the member's responsibility. Unna Boots Unna boots are commercially prepared, medically impregnated material used as a support dressing. Use CPT code 29580 to bill unna boots. Unna boots are a covered benefit when billed with one of these primary diagnoses: Primary Diagnoses for Unna Boots HCPCS casting codes 454.0 454.1 454.2 459.11 459.12 459.13 459.19 459.31 459.33 686.00–686.9 707.06 707.07 707.12 707.13 707.14 707.15 707.9 719.07 726.70 726.71 726.72 726.79 727.06 727.68 727.81 733.94 733.95 824.0–827.1 845.01 845.02 845.03 845.09 845.11 845.12 845.19 891.0 891.1 891.2 892.0 892.1 892.2 924.20 924.21 948.00 998.83

What Supplies can Podiatrists Bill to Insurance Companies?

I have been questioned on more than one occasion, what a Podiatrist can bill aninsurance company for office supplies, or supplies used during office surgeries.This is pretty basic information, but it …

Wound Care surgery codes

A newly introduced coding concept related to the reporting of wound débridements is also significant. The code range 11040–11044 has been completely revised; the major changes are as follows: <ul> <li>CPT codes 11040 and 11041 have been eliminated; they are replaced by CPT codes 97597 and 97598 as appropriate for débridement of dermal and epidermal skin layers. Check the manual for the new definitions. </li> <li>The reporting of wound débridement is now based on the depth of tissue débridement and the size of the wound in square centimeters. </li> <li>Surgeons must “sum” the surface areas of multiple wounds of the same depth; each wound should be reported separately if the tissue débridements are of different depths. </li> <li>New add-on codes (11045, 11046, and 11047 for each additional 20 sq cm, based on the depth of the debridement) were introduced </li></ul> As a result of these changes, CPT code 11042 now reads, “Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less.” The associated new add-on code 11045 should be reported for each additional 20 sq cm or part thereof. Additionally, the surgeon’s documentation must include the size of the wound(s) (eg, 4 cm x 5cm) and the depth of tissue débridement for each individual wound for which the procedure is performed. The guidelines for the repair (closure) codes were revised related to the definition of a complex repair, and the definition of débridement and services included have been added to the repair codes. Surgeons performing complex repairs are now allowed to report this work separately when done in conjunction with débridement codes, excision of benign or malignant lesion codes, excisional preparation of a wound bed codes, or débridement of an open fracture or open dislocation codes. Changes to the skin substitutes guidelines reinforce the range of codes that are “skin substitutes” and include specific instructions for using these codes. As an example, skin substitute codes should not be reported when the products are used as mesh or for internal reconstructive work such as a rotator cuff repair. These codes should only be reported when the product is used as a skin substitute.

Wound Care surgery codes

A newly introduced coding concept related to the reporting of wound débridements is also significant. The code range 11040–11044 has been completely revised; the major changes are as follows: CPT code…

Global Period Calculator: CPT Codes, Services and Package Information

Global Period is a time frame following surgery during which routine care by the physician i.e., all necessary services normally furnished by a physician [before (Pre-operative), during (Intra-Operative), and after (Post-operative) the procedure] are included in the reimbursement of the original surgery and they cannot be separately reported. 
 
Each CPT has a Global period status indicator as per the CMS Payment Policies. The list of such status indicators are listed below 
 
000 Endoscopies or minor procedure with preoperative and postoperative relative values on the day of the procedure only are reimbursable. Evaluation and Management services on the same day of the procedure are generally not payable. (For example: CPT 45378, 43235, 31622) 
 
010 Minor procedures with preoperative relative values on the day of the procedure and postoperative relative values during a 10-day postoperative period are reimbursable services. Evaluation and Management services on the day of the procedure and during the 10-day postoperative period are not reimbursable. (For example: CPT 10060, 11401, 46221) 
 
090 Major procedures with one day preoperative period and 90-days postoperative period are considered to be a component of global package of the major procedure. Evaluation and Management services on the day prior to the procedure, the day of the procedure, and during the 90-day postoperative period are not reimbursable. (For example: CPT 32100, 39000, 41520) 
 
<div style="text-align: center;"><a href="http://www.medicalbillingcodings.org/2011/04/global-period.html"><img alt="Global Period Calculator: CPT Codes, Services and Package Information" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxdlxnUgPNn3z8xsvF4BMa-JQq7dFd-ND1Pu2BzLulcaHGU0UB8NzOHtYL4srwxPve3zZZJL8bZ60GEpbk6iZNtnRDD7oLJd2QC4oTBGzOKLRhO3SXZ5btGyH-NFNT4ZQBJCvMagTcBHw/s1600/claim+processing.jpg" /></a></div> 
MMM Maternity codes; the usual global period concept does not apply. (For example: CPT 59610, 59620) 
 
XXX The global concept does not apply to this code. (For example: Evaluation and Management services, Anesthesia, Laboratory and Radiology procedures) 
 
YYY These are unlisted codes, and subject to individual pricing. (For example: CPT 29999, 32999. 42999) 
 
ZZZ These represent add-on codes. They are related to another service and are always included in the global period of the primary service. (For example: 17003, 26125) 
 
The Global period status indicators and the CPT's Relative Value Units are available <a href="http://www.cms.hhs.gov/pfslookup/02_PFSsearch.asp" target="_blank">here</a>. Click the link and select Payment policies indicator under Type of information to view the Global period of each CPT. 
 
<h3>Calculating Global Period Duration</h3>Each surgery CPT has a Global surgery status indicator in which the minor surgery has Global surgery status indicator of 10 days and the major surgery has Global surgery status indicator of 90 days. 
 
To determine the global period for minor surgeries: 
 
Count the day of surgery (Pre-operative and Intra-operative services would be on the same day of surgery) and 10 days immediately following the date of surgery. 
 
To determine the global period for major surgeries: 
 
Count 1 day immediately before the day of surgery (Pre-operative), the day of surgery (Intra-operative), and the 90 days immediately following the date of surgery (Post-operative / follow ups) 
 
Global period calculator for the major surgery is available <a href="http://www.medicarenhic.com/providers/billing/billing_calc_global_period.html" target="_blank" rel="nofollow">here</a>. 
 
<h3>Global Period Services and Package Information</h3>Medicare approved amount (based on the Resource Based Relative Value Scale) for the surgery (minor / major) includes following services when furnished by the physician who actually performs the surgery. The services included in the global surgical package may be furnished in any setting, i.e. in hospitals, ASC’s, physicians offices and such services / procedures / supplies related to the original surgery are not to be reported separately in the claim form since these are considered as a component of the approved amount. 
 
<h4>Services included in Global Period Package</h4>The following services are included in the global package: 
<ol><li>Pre-operative visits – Pre-operative visits after the decision is made to operate beginning with the day before the day of surgery for major procedures and the day of surgery for minor procedures. 
 
</li><li>Intra-operative services – lntra-operative services that are normally a usual and necessary part of a surgical procedure. 
 
</li><li>Complications following surgery / Post-Operative visits – Refers to 'Aftercare' following the surgery i.e. all routine additional medical or surgical services required of the surgeon during the post-operative period of the surgery. These services include complications that do not require additional trips to the operating room.</li>
</ol>Along with all of the above global package of a surgery includes Items such as dressing changes; local incisional care that includes removal of operative pack and dressing change, cutaneous sutures and staples (removals), lines, wires, tubes, drains, casts and splints, insertion, irrigation and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes, changes and removal of tracheostomy tubes. 
 
<h4>Services not included in Global Period Package</h4>Following are the services that are not included in the Global period package: 
 
In certain circumstances some of the services / procedures are also paid if performed in the Global period. Appending correct modifier is mandatory for reimbursement. The services / procedures that are not included and are reimbursable during the Global period are as follows. 
<ol><li>The initial consultation or evaluation of the problem by the surgeon to determine the need for surgery. The correct modifier is to be appended in case of minor and major surgery for a proper reimbursement. 
 
Minor Surgery with 10 day Global period - Modifier 25 (Significant, separately identifiable E & M service by same Physician on same day of procedure or other service) should be applied for an Evaluation and Management services rendered on the same day of surgery. 
 
For example: If a patient is encountered for a follow up office for his neck pain and in addition if the patients needs his / her leg abscess to be drained and if the physician does both on the same day then the claim would be billed as: 
CPT 99213-25 --------> (Follow up Office visit level 3 with Modifier 25) 
ICD 723.1 -----------> (Neck pain) 
CPT 10060 -----------> (Incision and Drainage of abscess; simple or single) 
ICD 682.6 -----------> (Leg Abscess) 
 
Since CPT 10060 has a global period of 10 days the services and the procedures performed including dressing change during this period would be considered as a part of global component and no separate reimbursement are made. 
 
Major Surgery with 90 days global period - Modifier 57 (Decision for surgery) has to be applied for an Evaluation and Management services to report that the decision for major surgery was made during the service either the day before the surgery or the day of surgery. 
 
</li><li>Visits unrelated to the original surgery i.e., if the physician encounters a patient for a different condition that was not related to the surgery. Modifier 24 should be applied for an E & M services to state that the service performed during a postoperative period for reason(s) unrelated to the original procedure. This applies for both minor and major procedures. 
 
</li><li>Diagnostic tests and procedures, that includes diagnostic radiological procedures performed in the post operative period to the operated site. No modifiers other than the informational modifiers (modifiers like RT / LT) are needed. 
 
</li><li>Distinct surgical procedures for a different diagnosis during the post-operative period which are not repeat operations or treatment for complications. A new post-operative period begins with the subsequent procedure. Modifier 79 (Unrelated procedure or service by same physician during postoperative period) should be applied to the newly performed surgery. 
 
</li><li>Treatment for post-operative complications that requires a return visit to the operating room. In such case Modifier 78 (Return to the operating room for related procedure during postoperative period) should be added for the procedure performed during the return visit.</li>
</ol>Please have a look into Medicare Claim Processing for the payment of Evaluation and Management services provided during Global period of surgery.

Global Period Calculator: CPT Codes, Services and Package Information

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