Physicians Practice - March 2008 - (Page 41)

BILLING AND COLLECTIONS TIMING IS EVERYTHING If you spend more than half of an E&M visit counseling the patient or coordinating their care face-to-face, you can bill the visit based on time. “Say a patient is coming in after an MRI and you have concerns about a neoplasm. The visit is going to be going over the MRI and treatment options with risks and beneﬁts. Maybe there is no exam, but there is medical decision-making and probably some history,” Jones explains. This can all take a good chunk of time — the sort of visit where you should consider a time-based code. In many instances, this can be more lucrative than a bill based on the exam, history, and medical decision-making. Just make sure to document the time you spent and what the discussion was about. MODIFY MODIFIER USE “Over the past 90 days, we’ve had over 300 questions that relate to modiﬁer use,” adds Jill Wolf, vice president, content and service integrity for Accuro Business Intelligence, conﬁrming the complexity of the problem. this modiﬁer alerts the payer that it should not bundle. The secret here is (a) knowing what is usually bundled, and (b) knowing when it’s appropriate to unbundle. Ask your coder or biller to sit down and explain when you should indicate A TWO-DIGIT PROBLEM “Modifiers tend to stymie people.” Belinda Ratcliff “Modiﬁer use is one of the easiest ways for an ofﬁce to mitigate denials as well as improve their cash ﬂow, but modiﬁers tend to stymie people,” says Belinda Ratcliff, director of client services for Global Healthcare Alliance, which offers Web-based claims processing software and services to physicians. But you can get this. Grab some EOBs and review your use of these three core modiﬁers: 26 – Professional component: Attaching this modifier indicates that you performed only the professional part of a service (studying a report) but not the technical component (such as actually taking an X-ray). It means you should get paid for just a portion of the service. The big mistake here, says Ratcliff, is overuse of the modiﬁer. “It’s OK to bill for complete reimbursement if the equipment and overhead [the technical component] is yours.” 25 – Signiﬁcant, separately identiﬁable, evaluation and management service by the same physician on the same day of the procedure or other service: that there are unusual circumstances for procedures that are commonly bundled. “It all boils back down to being educated,” Ratcliff says. MANAGE THOSE EDITS IN SUMMARY Today’s practices need to get paid right the ﬁrst time — not spend time working denials or rejected claims. Correct coding can help. To get a grip on your coding, focus on these common trouble spots: • E&M codes: Create templates that help you remember what you need to document for each level of service. help you get paid correctly for your hard work. Review the deﬁnitions for problem modiﬁers such as 25, 26, and 59. Consider using technology to keep up with medical necessity and bundling edits from payers. • Use modiﬁers the right way to Practices have a tendency not to use this modiﬁer, or not to bill an E&M at all if they do a separate procedure or other service the same day, Ratcliff says. But this is simply choosing to perform the service for free, because “if you don’t use it, you will not be paid.” If there is a complete E&M and a completely separate service — say, for example, you notice a lesion in the course of an exam for bronchitis and you remove it — then add the 25 modiﬁer to the E&M and also bill the lesion removal. Payers may still balk at paying you, but at least you’ve coded correctly. 59 – Distinct procedural service: Sometimes, the biggest problem for a practice isn’t picking the right codes, but pairing them to avoid denials for medical necessity and watching for inappropriate bundling edits. Most medical necessity denials happen because diagnosis codes (ICD-9 codes) on the claim don’t match up with procedural codes (CPT codes). “The connection between ICD and CPT is very crucial from a medical necessity standpoint,” says Wolf. “This is where physicians often fall down.” Imagine if you saw a claim that indicated the patient was suffering from an ear infection, but the READ MORE ABOUT IT! Visit PhysiciansPractice.com for more advice on coding and claims collections: •Read more about technologies that can help you code right the first time by typing “coding software” in our Search Articles box. •Get answers to common coding questions by typing “coding” in our Search Q&A box. • Learn to manage edits properly. If you need to use a combination of codes that would usually be bundled, but should not be in this instance (say, because you focused on more than one part of the body), •Read additional feature articles on good coding practices by clicking on the “Coding” bar on the left-hand side of our home page. WWW.PHYSICIANSPRACTICE.COM MARCH 2008 | PHYSICIANS PRACTICE | 41 http://PhysiciansPractice.com http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - March 2008

Physicians Practice - March 2008 Contents The Bigger Picture: Try a Little Tenderness Second Opinion Letters Physicians Practice Pearls: The Value of First Impressions Noteworthy Cover Story: Your Complete Guide to Patient Service Billings & Collections: Rules to Code By The Administrators Desk: Selecting an EMR Technology: Learn to Love Your Nerd Ask The Experts Coding The Guide The Tech Doctor: All About Blogs The Great Practice Makeover: When Bad Things Happen to Good Practices Start It Up - NEW! The Law: Audits 101 In Practice: Do As I Say... Pretty Please? Healthonomics: Handling the Changes Wrought by Medicare D Classifieds Advertiser Index

Physicians Practice - March 2008

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