American College of Physicians: Internal Medicine — Doctors for Adults ®

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Billing and coding Q&As

Coding/documentation | Home care | Inpatient care | Medicare policies | Office visits | Screening and preventive care


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Coding/documentation

CMS considers codes for additional non-face-to-face services

New codes will allow billing for the complicated and far-reaching services that are provided as part of chronic complex care. More

Begin to apply ICD-10 in real-life practice

CMS has begun to apply ICD-10 coding standards more concretely, such as adding them to future versions of its coverage policies. More

ICD-10 advice, and clarifying transitional care management

The reset compliance date of Oct. 1, 2014, means that internists must move forward with transition and education plans for using the new ICD-10 codes. Start by examining documentation needed to assign the new codes. More

Variety of coding changes loom for 2013

A partial freeze on diagnosis coding updates has been extended one year, while new care management codes will be introduced in 2013. More

Take advantage of ICD-10 codes being delayed once more

Compliance with the switch to ICD-10 diagnosis coding has been delayed to Oct. 1, 2014. The delay will let doctors, software developers and vendors fully test the new coding set in the office setting. More

Will you be ready for ICD-10?

Even though ICD-10 has been delayed, it is important to continue planning for the eventual transition. More

Learn proper coding for modifiers 59 and 25

Learn how to properly use two similar evaluation and management codes to avoid later denials and challenges. More

CMS delays ICD-10, offers new overpayment options

The Centers for Medicare and Medicaid Services heard the primary care community's complaints and have delayed ICD-10 implementation until further notice. The agency did, however, launch several new tactics in order to collect overpayments. More

Learn about potential auditors to avoid becoming a target

Four programs overlook a practice's billing and coding efforts, and each has its areas of emphasis. There are seven simple steps to follow that will help a practice avoid incurring an audit. More

Incentive programs yield mixed results for expectant internists

Three programs that promised more reimbursement for primary care delivered mixed results. The Centers for Medicare and Medicaid Services laid out who actually received more for participating in these programs, and how much. More

Medicare updates affect audits, modifiers and version 5010

This month’s column covers three timely yet disparate topics: a new CPT modifier, readiness for version 5010 electronic claims transactions, and the looming expansion of the recovery audit contractors. More

Internists need to know coding for CPAP, observation services

There’s more to internal medicine than evaluation and management services. Two of the more common of the uncommon services to code for include CPAP for sleep disorders, and guidance on billing for observation and same-day discharges. More

New year brings big, small changes to practice administration

Federal regulations will change how internists practice this year. Learn about the primary care incentive program, the annual wellness visit and medical savings accounts. More

New billing codes for ‘subsequent observation care’ services

Internists can use new procedure codes to be paid for the increasingly common service of evaluating and managing a patient after admission to observation status in a hospital. More

CMS expands tobacco cessation counseling, focuses on audits

Developments at the Centers for Medicare and Medicaid Services will benefit those who want to quit smoking, but will also increase audit scrutiny over physician and facility claims. More

Annual ICD-9 diagnosis code revisions take effect in October

A review of the annual updates to the ICD-9 code set finds that there are more codes affecting internists than in years past. ACP digests these, as well as category headings and exclusion notes. More

Claims coding edits target improper payments, errors

Knowing the ins and outs of claims coding edits speeds reimbursement, but they are tricky even for experienced office staffers. Learn how to do them properly, and what resources exist to help. More

Quick tips for billing locum tenens doctors

Locum tenens doctors add flexibility and the ability to fulfill specific practice needs. Billing on their behalf requires modifiers and paying attention to a 60-day grace period when using National Provider Identifiers. More

Coding for anticoagulation as tricky as managing it

Diagnosis, lab tests and management make up the three key considerations when coding for anticoagulation management through Medicare. An expert sorts out the issues and scenarios for a variety of scenarios. More

Know the rules to avoid common errors, appeal unfair denials

Simple steps within the control of a practice’s billing staff can reduce denied claims from private insurance companies. Knowing what types of errors are the most frequent can help staff avoid making them in the first place. More

Making sense of CMS’ new policy on consultation billing

CMS stopped recognizing CPT consultation codes and issued instructions to physicians only a few days before the new policy took effect. ACP’s practice management staff digest what internists need to know to stay atop of billing for 2009, documentation, the “3-year rule” and cross-walks for services previously billed as consultations. More

Clinicians crucial to avoiding coding errors

Beware believing that coding isn’t an important part of an internist’s job. What gets overlooked could cost a significant amount if errors go unchecked, especially in the era of Recovery Audit Contractors. More

CMS dramatically changes CPT consultation billing for 2010

CMS no longer recognizes CPT consultation codes 99241-99255 for consultations. ACP’s practice management staff explain how to bill for outpatient and inpatient visit codes. More

Medicare, many insurers announce coding rules for H1N1

The federal government will pay for H1N1 vaccine, and most large insurers are planning to pay only for its administration. Find out which codes to use and with which insurers. More

Adapt to ICD-9 changes most relevant to internal medicine

An expert from ACP’s Regulatory and Insurer Affairs section clarifies the changes to ICD-9 coding that ACP expects will most affect internal medicine practices. Changes took effect OCt. 1, and obsolete ICD-9 codes could result in denied or rejected claims. More

Expert hints at how GI practices can keep coding current

Medicare’s Recovery Audit Contractors are, in fact, auditing physicians more than ever. The “incident to” provision and teaching physician guidelines cause the greatest confusion and require special attention to ensure they are used correctly. More

Future claims: Moving toward ICD-10 and new standards

ICD-10 and transactions standards are changing. ACP’s practice management staff advise how to stay up-to-date across the entire office as Medicare expands its 13,000 diagnosis codes to more than 68,000. More

PQRI improvements based on physician feedback, says CMS

Medicare's pay-for-reporting program, the Physician Quality Reporting Initiative provides more and different options for physicians to report on quality measures, and staying current on the rules and requirements can be a challenge. More

The Medicare e-prescribing incentive—a carrot and a stick

A how-to column on earning an additional $4,000 this year, and practical tips on choosing an electronic health record system. More

2009 brings some changes to Welcome to Medicare exam

Medicare's initial exam adds new benefits, including end-of-life planning and body mass index measurements. Find out how this will benefit your practice. More

Frequently used codes relocated throughout CPT for 2009
New CPT codes took effect Jan. 1, so our coding expert tells you where to look for commonly used codes. More

Billing for interactions with a patient's family, caregivers
More than 44 million Americans care for an adult family member or friend. Physicians often discuss patient care with these people and may bill appropriately. More

Practice Rx
Hospitals are working more closely with their admitting physicians to make them aware of the need for better documentation on pre-existing conditions. More

Practice Rx
Update ICD-9 coding materials now to meet October deadline
September ’08

It's not too late to start reporting quality data to Medicare and receive a bonus payment. Learn how to submit claims on 15 consecutive eligible Medicare patients to receive a bonus of 1.5% of allowed Medicare charges from July 1 to Dec. 31. More

Practice Rx
Medicare expands its private contractor audits nationwide
June ’08

Practice Rx
Medicare implements new advanced beneficiary notice form
May '08

Practice Rx
When and how to use new phone and Internet E/M coding
April ’08

Practice Rx
Medicare’s vaccination payments covered in a variety of ways
March ’08

Practice Rx
February '08

Practice Rx (January 2008)

Health Care Act creates way to bill for VZV vaccine
Also, get an early look at changes to medically unlikely edits and the Physicians Quality Reporting Initiative. (March 2007)

2007 rings in changes to anticoagulation management
The new year also brings new language to clarify reimbursement for consultations, screenings and vaccines. (January-February 2007)

Defining home visits
Plus, how location affects payments. (December 2006)

Billing tips to ease the aches and pains of flu season
Plus, how to tell which Medicare patients are covered for abdominal aortic aneurysm screening. (November 2006)

Make sure your diagnosis codes match ICD-9 changes
New codes in effect Oct. 1. (October 2006)

Clarifying rules on new vaccines, oxygen prescribing
How to bill for new vaccine approvals; prescribing oxygen to Medicare patients. (September 2006)

Investing in an audit can reveal costly coding errors
Here are some strategies for determining if you're choosing the right E/M codes and what to do if you find problems. (July-August 2006)

Billing changes you need to know for hospice patients
Moving from curative to palliative care signals an important change in billing practice. (May 2006)

The New Year brings more changes to CPT E/M codes
Internists will be most affected by changes to the evaluation and management services codes. (January-February 2006)

Will the new drug benefit affect physician workflow?
"Dual eligibles" and a new appeals process all promise to require more of your time. (December 2005)

Medicare implements new claims appeal procedures
Medicare is making changes to the fee-for-service claims appeal process. (October 2005)

Medicare ushers in new smoking cessation coverage
Tobacco use remains the No. 1 cause of preventable death in this country. (May 2005)

How should you bill and code for patients with diabetes?
Proper billing and coding will help ensure prompt payment and compliance with standards. (October 2004)

Diabetes care: the right way to bill and code lab tests
Medicare will probably pay for lab tests related to diabetic care if tests are supported by diagnosis code. (Web Only)

The new ICD-9 codes that every internist should know
A discussion on the changes that have been made to codes in the International Classification of Diseases. (Web Only)

How to aggregate physician time to bill E/M services
Tips for billing aggregate time for critical care, prolonged services with direct contact and attending physician services. (May 2004)

New changes to CPT codes that will affect internists
Important CPT changes include those for E/M, lab/panel and vaccine codes. (January-February 2004)

How to use coding 'edits' to prevent billing problems
Medicare has put information to help physicians avoid rejected claims online, and it's free. (November 2003)

A list of Medicare coding edits by procedure
You can download correct coding initiative edits by type of service or procedure. (Web Only)

The new ICD-9 codes that every internist should know
Most insurers will give you until Jan. 1 to start using new codes to report your services. (September 2003)

Trouble with health plans? Report problems online
A new complaint form will help organized medicine track problems with insurers. (July-August 2003)

CPT changes codes for patient transport, labs and call
Internists will be most affected by changes to codes for patient transport, blood collection and special services (February 2003)

Tips to help you avoid making common billing mistakes
Watch out for incomplete information, incorrectly entered information and filing deadlines (November 2002)

Changes to ICD-9-CM codes that will affect internists
New and changed ICD-9 Codes will affect how you bill (October 2002)

Providing uncovered services? Use these modifiers
Using modifiers will speed denials or remove suspicion that you routinely bill for unnecessary services (May 2002)

Evaluation and management code changes in CPT 2002
CPT has added several new codes covering patient transport, critical care, care plan oversight and preventive medicine (January 2002)

Archive

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Home care

Why and how to monitor hypertension at home

Home measurement of high blood pressure overcomes variability inherent in office measurements, delivers better assessment of systolic pressure (and hence, of possible cardiovascular events) and offers a better chance of discontinuing drug therapy. More

House calls becoming a viable practice model

Think of it as the patient-centered medical home’s ultimate evolution—care inside the patient’s own home. More doctors are making house calls, either to patients who don’t travel easily, or to improve the quality of care they could deliver in an office. More

Medicare clarifies its definition of 'homebound'
The revision allows beneficiaries who occasionally leave home for nonmedical purposes to still be classified as homebound (June 2001)

Medicare changes some rules on home health billing
Medicare now pays a separate fee to certify and recertify home health care plans. Here's how to bill for these services. (March 2001)

Billing for preventive exams, assisted living visits
Coding and billing tips for physicals and visits to patients in assisted living (September 2000)

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Medicare policies

ACP members can influence policy on Medicare’s fee schedule

Over the next six to 18 months, ACP will ask randomly chosen members to complete surveys to influence Medicare reimbursement. We outline what members can expect as part of the process. More

CMS delays ICD-10, offers new overpayment options

The Centers for Medicare and Medicaid Services heard the primary care community's complaints and have delayed ICD-10 implementation until further notice. The agency did, however, launch several new tactics in order to collect overpayments. More

Learn about potential auditors to avoid becoming a target

Four programs overlook a practice's billing and coding efforts, and each has its areas of emphasis. There are seven simple steps to follow that will help a practice avoid incurring an audit. More

Medicare updates affect audits, modifiers and version 5010

This month’s column covers three timely yet disparate topics: a new CPT modifier, readiness for version 5010 electronic claims transactions, and the looming expansion of the recovery audit contractors. More

Internists need to know coding for CPAP, observation services

There’s more to internal medicine than evaluation and management services. Two of the more common of the uncommon services to code for include CPAP for sleep disorders, and guidance on billing for observation and same-day discharges. More

Start preparing now for ICD-10’s looming requirements

The new code set is much larger and will impact not only office staff but vendors. It’s now time to start preparing for the transition, which is closer than you think. More

Complete version 5010 before starting ICD-10

Offices must convert to a new electronic standard format, called version 5010, before they can implement ICD-10 in their offices. End-to-end testing must be complete by the end of the year. More

New year brings big, small changes to practice administration

Federal regulations will change how internists practice this year. Learn about the primary care incentive program, the annual wellness visit and medical savings accounts. More

New billing codes for ‘subsequent observation care’ services

Internists can use new procedure codes to be paid for the increasingly common service of evaluating and managing a patient after admission to observation status in a hospital. More

CMS expands tobacco cessation counseling, focuses on audits

Developments at the Centers for Medicare and Medicaid Services will benefit those who want to quit smoking, but will also increase audit scrutiny over physician and facility claims. More

Help ACP determine Medicare’s physician service payments

ACP will invite randomly selected members to provide feedback that could influence Medicare reimbursement on services common to internal medicine. More

Quick tips for billing locum tenens doctors

Locum tenens doctors add flexibility and the ability to fulfill specific practice needs. Billing on their behalf requires modifiers and paying attention to a 60-day grace period when using National Provider Identifiers. More

Coding for anticoagulation as tricky as managing it

Diagnosis, lab tests and management make up the three key considerations when coding for anticoagulation management through Medicare. An expert sorts out the issues and scenarios for a variety of scenarios. More

CMS dramatically changes CPT consultation billing for 2010

CMS no longer recognizes CPT consultation codes 99241-99255 for consultations. ACP’s practice management staff explain how to bill for outpatient and inpatient visit codes. More

Future claims: Moving toward ICD-10 and new standards

ICD-10 and transactions standards are changing. ACP’s practice management staff advise how to stay up-to-date across the entire office as Medicare expands its 13,000 diagnosis codes to more than 68,000. More

CMS changes rules on inpatient exams, documentation. (April 2007)

Health Care Act creates way to bill for VZV vaccine
Also, get an early look at changes to medically unlikely edits and the Physicians Quality Reporting Initiative. (March 2007)

2007 rings in changes to anticoagulation management
The new year also brings new language to clarify reimbursement for consultations, screenings and vaccines. (January-February 2007)

Demystifying Medicare Part D's exceptions and appeals
If you're struggling with Medicare's new prescription plan, you're not alone—here are some FAQs that can help. (April 2006)

Letters
Readers comment on care coordination codes, patient communication, and end-of-life care. (March 2006)

Medicare revamps how it answers physician questions
Under the new Medicare drug benefit, contractors must improve their methods of communication. (July-August 2005)

Medicare ushers in new smoking cessation coverage
Tobacco use remains the No. 1 cause of preventable death in this country. (May 2005)

A look at Medicare's kinder, gentler auditing process
Last year's Medicare reform bill and a new CMS program give physicians some relief from onerous audits. (July-August 2004)

Complaints about your carrier? CMS wants to know
The CMS is trying to improve the services physicians get from Medicare carriers. (April 2004)

New Medicare reform boosts pay for rural physicians
Recently enacted Medicare reform legislation increases payments for physicians in rural and other underserved areas. (March 2004)

Recent CMS lab test standards simplify billing rules
Medicare has standardized policies for physician documentation requirements and frequency limitations for lab tests. (December 2003)

Medicare paying more for pneumococcal, flu vaccines. (October 2003)

How the new Medicare rates will affect your practice
Get answers to your questions about the new Medicare rates implemented on March 1 (April 2003)

Think Medicare won't cover it? Use this new form
New standardized ABNs help you inform beneficiaries that they are expected to cover the cost of services Medicare declines to pay for (March 2003)

Medicare issues new rules to bill for shared services
How to bill for E/M services provided jointly with a nonphysician provider (December 2002)

Medicare updates billing rules for teaching physicians
In a clear win for internists, attendings do not need to repeat documentation already provided by residents (January 2003)

CMS establishes national standards for lab tests
The new rule creates uniform, national Medicare coverage for common lab tests. (July-August 2002)

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Inpatient care

New billing codes for ‘subsequent observation care’ services

Internists can use new procedure codes to be paid for the increasingly common service of evaluating and managing a patient after admission to observation status in a hospital. More

Visiting an inpatient admitted by another physician
Normally when two physicians bill for seeing the same patient on the same date, they are treating different aspects of the patient's condition (February 2002)

Billing services provided by moonlighting residents
Residents generally need identification numbers to bill for services provided outside their training program (November 2001)

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Office visits

Internists need to know coding for CPAP, observation services

There’s more to internal medicine than evaluation and management services. Two of the more common of the uncommon services to code for include CPAP for sleep disorders, and guidance on billing for observation and same-day discharges. More

New year brings big, small changes to practice administration

Federal regulations will change how internists practice this year. Learn about the primary care incentive program, the annual wellness visit and medical savings accounts. More

How to bill Medicare for a pre-operative assessment
Many preoperative assessments can be billed as consultations (September 2001)

How to define 'new' patients and code flu shots
Select correct CPT codes for new patient visits and immunizations (December 2000)

Billing for a same-day service and minor procedure
How to code for an E/M service and minor procedure provided on the same day (October 2001)

Billing guidelines for anticoagulant monitoring
How to code and bill when monitoring patients on anticoagulants (July-August 2000)

How to bill for services performed when you're away
Medicare lets you bill for patient care performed by others—if you meet certain requirements (July/August 1999)

Archive

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Screening and preventive care

Internists need to know coding for CPAP, observation services

There’s more to internal medicine than evaluation and management services. Two of the more common of the uncommon services to code for include CPAP for sleep disorders, and guidance on billing for observation and same-day discharges. More

New year brings big, small changes to practice administration

Federal regulations will change how internists practice this year. Learn about the primary care incentive program, the annual wellness visit and medical savings accounts. More

Medicare paying more for pneumococcal, flu vaccines. (October 2003)

Medicare expands several of its screening policies
Medicare now pays for more frequent screening tests for colorectal, cervical and vaginal cancers (July-August 2001)

How to define 'new' patients and code flu shots
Select correct CPT codes for new patient visits and immunizations (December 2000)

How to bill Medicare for prevention-related care
Bill services that address problems discovered during physicals (May 2000)

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