Author Archives: iMAX Medical Billing

Time-Based Code Reporting

When calculating time spent performing a time-based procedure or service, include only those items specifically detailed in the code descriptor. For example, when reporting critical care services (e.g., 99291-99292), you may include the time spent interpreting cardiac output measurements or chest X-rays, performing ventilator management or vascular access, and other services enumerated within CPT® as inclusive of critical care. You may not count toward critical care the time spent performing other, separately reportable services (e.g., endotracheal intubation for airway support, 31500). Carefully review CPT® guidelines and code descriptors to determine which activities you may count toward the time of a

Modifier 59 – To Use or Not to Use

I often call Modifier 59 the prednisone of modifiers. That is because it is very powerful and can do a lot for you, like prednisone is for the patient. But at the same time, it is a two-edged sword, the modifier 59 is exceptionally dangerous when used incorrectly and care is not applied, just like a doctor would find for their patient when using prednisone. Modifier 59 is the universal unbundling modifier. When used on a claim line, it unbundles two procedures that normally would be bundled and not paid together. Modifier 59 is telling the payer that this situation

Oil Your Practice Management Skills in 2018

It’s the new year and the perfect time to make sure your physician’s practice is productive and compliant, and most importantly that your patients are happy. The way you manage patients, the revenue cycle, technology, staff, and medical records can help your practice’s gears move at maximum efficiency to promote a workflow that makes the most out of your resources. Let’s explore ways you can improve office tasks. According to Physicians Practice’s “9 Priorities for Practice Management in 2018,” there are nine ways you can keep healthcare tasks moving to maintain a viable healthcare operation this year: • Protect confidentiality

10 Documentation and Coding Principles to Demonstrate Medical Necessity

When preparing medical documentation and coding medical conditions, keep these 10 principles in mind to demonstrate medical necessity for services reported: List the principal diagnosis, condition, problem, or other reason for the medical service or procedure. Be specific when describing the patient’s condition, illness, or disease. Distinguish between acute and chronic conditions, when appropriate. Identify the acute condition of an emergency situation (e.g., coma, hemorrhage, etc.). Identify chronic complaints, or secondary diagnoses, only when treatment is provided or when they affect the overall management of the patient’s care. Identify how injuries occur. Assign diagnosis codes to the highest documented level

CMS Guidance for Date of Service Professional Claims

From specimen collection to maternity packages, inspect coding and billing DOS rules. On Sept. 19, 2017, the Centers for Medicare & Medicaid Services (CMS) released MLN Matters® article SE17023 for physician and non-physician practitioners who submit claims on either the CMS-1500 form or electronically via the X12 837 Professional Claim to Medicare administrative contractors (MACs) for Part B service charges. The MLN Matters article does not offer new guidance, but reiterates how to represent the date of service (DOS) on Part B outpatient provider claims. It also reminds providers, “Expenses are considered to have been incurred on the date the

Officials: Medicaid expansion repeal could halt momentum in opioid fight

CHILLICOTHE – If Medicaid expansion isn’t continued, Chillicothe Mayor Luke Feeney and others are concerned it could derail local efforts to combat opiate addiction. Feeney, Michelle McAllister, coordinator of the Heroin Partnership Project, and Cheryl Beverly, founder of Cheryl’s House of Hope, expressed concerns during a brief press conference on Friday. “Ross County has been one of the hardest hit in the opiate epidemic and we are finally beginning to make headway, but without Medicaid expansion, our efforts will be pushed back tremendously,” McAllister said, referencing in part the decrease in overdose deaths in 2017. “If we don’t have Medicaid expansion,

Drug problem in Ashland shifting from opiates to meth

ASHLAND – These days, Ashland Police and METRICH drug task force detective Brian Evans get more calls about crystal meth than heroin. He estimates Ashland police officers find methamphetamine about three to five times as frequently as they find marijuana during traffic stops. In 2015, just one meth case came across Evans’ desk. In 2016, he saw 17 cases involving the drug. Last year, the number rose to 37. This year alone, the department has had 14 METRICH meth cases, with the drug showing up in more than half the total 22 METRICH cases as of April 11. Meanwhile, the

Medical community avoided discussions about opioid crisis

A paragraph in an Akron Beacon Journal story last fall raised tough questions about the medical industry. The story was about a local hospital successfully managing pain following surgery by prescribing medications other than addictive opioid painkillers. The paragraph said this of the nonopioid experiment: “The patients were easy to convince. It was tough to convince the other surgeons, anesthesiologists and nurses because it challenged their typical teachings.” Opioids are the drugs killing more than 4,000 Ohioans a year, and a study by the state showed that 80 percent of those who died of an overdose were at one time

Enquirer wins Pulitzer Prize for Seven Days of Heroin coverage

In the next seven days of the heroin epidemic, at least 180 people in Greater Cincinnati will overdose and 18 will die. Babies will be born to addicted mothers. Parents will go to jail. Children will end up in foster care. This is normal now.;-how-heroin-crisis-normal-now/105408394/     The Cincinnati Enquirer staff has won a Pulitzer Prize in the local reporting category. The story “Seven Days of Heroin” was recognized by the Pulitzer board “for a riveting and insightful narrative and video documenting seven days of greater Cincinnati’s heroin epidemic, revealing how the deadly addiction has ravaged families and communities.” The Enquirer

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