Billing Archive

Michele James Smith asked:




This time, CPT 2011 brings major overhaul to cardiac catheterization coding. As a matter of fact, there are 19 deleted cardiac codes, 20 added cardiac cath codes and only eight cardiac cath codes that remain the same.

To start with, here we will focus on the rules that apply jointly to new left (LHC) and right heart cath (RHC) codes 93451-93453:

93451: RHC including measurement(s) of oxygen saturation and cardiac output, when performed 93452: LHC, including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed 93453: Combined RHC and LHC including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed.

Remember: Some of the deleted cardiac cath codes are 93501 (Right heart catheterization), 93510 (LHC…), and 93526 (Combined RHC and retrograde left heart catheterization), which you may have used in reporting similar services last year. The entire list of deleted codes includes 93501, 93508-93529, and 93539-93556.

Taking a look at the overarching section guidelines

As you would anticipate with so many code changes, CPT offers new ‘Cardiac Catheterization’ section guidelines to help you use the just-in codes the right way.

Families: Keep congenital case codes separate

CPT segregates the cardiac cath codes into two families:

a) For congenital heart disease
b) Those for all other conditions

Codes 93451-93453 fall under the “all other” family, however do not miss that CPT guidelines include them in the codes proper for cases involving ‘anomalous coronary arteries, patent foramen ovale, mitral valve prolapse, and bicuspid aortic valve’. What’s more, there is no separate code for congenital LHC.

What is included: Cath Introduction to Closure

According to CPT section guidelines, a cardiac cath is a diagnostic medical procedure including all of the following:

Introduction, positioning as well as any required repositioning of catheter(s) within the vascular system Recording intracardiac and/or intravascular pressure(s) Final evaluation and report of the procedure

If you verify the codes in the manual, you will also find the symbol indicating the codes include conscious sedation when performed by the same physician.

Codes 93451-93453 also include the ‘road mapping’ angiography the cardiologist uses to place the catheters. This means you shouldn’t code injections separately or the imaging supervision and report related to the road mapping. But then you may report contrast injections and the supervision and report for imaging that has a separate procedure code.

In the end, CPT guidelines declare that you shouldn’t separately report placing the closure device at the access site. Also, you should not report any contrast injection required for placing the closure device.

Add-on codes: Capture separate injection

CPT added various new add-on codes that you may report in addition to multiple cardiac cath codes, including 93451-93453.

First are various imaging/injection procedure codes:

RV/RA angiography: +93566 Aortography: +93567 – Pulmonary angiography: +93568

CPT’s ‘Injection Procedures’ guidelines show that the above codes don t include catheter introduction; but then they do include repositioning the catheter and using automatic power injections. Also, you have CPT’s approval to report any combination of +93566, +93567, and +93568 with your cardiac cath code. For instance, if the cardiologist carries out and documents both aortography and pulmonary angiography, you may use both +93567 and +93568. You are not limited to reporting just one code.

To add to it, if the cardiologist carries out angiography of noncoronary vessels “as a distinct service,” you should take a look at the Radiology and Vascular Injection Procedures sections to find the proper codes.

More add-on codes: Capture Hemodynamic Response Opportunity

If the cardiologist administers a pharmacologic agent or has the patient exercise to evaluate hemodynamic response, you may use the following apart from the cardiac cath codes:

Agent: +93463: Exercise: +93464

Use each code only once per cath procedure. CPT guidelines show that the above codes are proper when the cardiologist uses the pharmacologic agent or exercise with the specific reason of repeating hemodynamic measurements to assess hemodynamic response.

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Hayley A Smith asked:




In the fall out of the global recession, businesses are being forced into streamlining their financial processes. The best way to find out how much money you can save on your financial processes and the quantity of resources you can save is to complete the ‘Green Calculator’.

It takes into account the materials and energy used in the creation and distribution of a standard paper invoice, three pages long. It will not only calculate and display the approximate carbon footprint (CO2) that you could save, it also presents the quantity of trees, water and solid waste your organisation could save each year with green paperless invoicing.

Did you know that an average company sending out 12,000 invoices per month could annually save the following:

• 14.4 tonnes of carbon
• 57.6 trees
• 180,000 litres of water
• 1872kg of solid waste

There are e-invoicing solutions for both Accounts Payable and Accounts Receivable processes, with sophisticated, yet easy to use solutions with many unique features and benefits.

Paperless invoicing provides functionality throughout the entire supply chain, from purchase requisition all the way through to payment. Accounts Receivable e-invoicing consolidates invoice data from disparate billing solutions into one manageable location – an ideal service for automating complex billing processes that require additional workflow continuity.

Meanwhile Accounts Payable e-invoicing automates the process and delivers supplier invoice data directly into your financial systems. It is an ideal service for automating complex billing processes that require additional workflow functionality and bespoke work.

Not only is paperless invoicing an environmentally friendly process, it can realistically cut the cost of end-to-end processing and human resources, including print, delivery, approval, cash management and archiving.

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Hosea Lim asked:




Are you planning to put up a business these days? Well, if you do, then, maybe this will be helpful to you. There are ways on how you can start an online career but first, you need to think and plan for a lot of things first before you start. Aside from thinking about the designs and layouts for your online website, it is also important for you to learn more about how to set up your online invoicing so that you will not have a hard time receiving payments from your clients. There are lots of companies nowadays that are offering free invoicing to help you solve your business concerns. Ballpark is among those companies who are starting out their career in online invoicing system.

This is their new service that will make you share and edit your estimates and your invoices online. They have lots of applications that will enable you to make invoices that will be very useful for your business needs. This company continuously makes improvements to their website and to their applications as well to provide better services to their patrons. Aside from their free invoicing system, they have launched couple of things that will also be helpful to you. These are just some of the improvements they made and new features they have added to their lists of services you can get for free:
They have improved their email client notifications, their PDF system is new and this has been developed to give options for clients if they need to attach their files in a PDF mode. Ballpark also improved their speed to give a reliable connection to those who are downloading applications. If you have a multiple account with them, you don’t have to worry because they have worked it out so that you will not have a hard time accessing all your accounts. Free invoicing will never be easy without Ballpark and their team. The notifier for Mac is now available so if you are a Mac user, you don’t have to worry about email notifications because it will be very easy for you to access your account. Optimized Dashboard for iPhone users is now made available by Ballpark. Free invoicing software is also available for iPhone users so you can now access your finances and your account with Ballpark using the new version on your phone. Improved contact management is also here to help you manage your account easily. There is a big change when it comes to the client view and still, it is for the betterment of the business you have and it will surely make life easier in the long run. There is also a custom domain available now for personalize branding approach. Business invoicing will be easier with this feature.

When you want the best for your business, you need to look for options and with these options you can compare and then decide which one is just the best for your business needs. Choosing an invoice program is not that hard but of course, you need to look for helpful reviews as well.

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John M Van asked:




If you own or run a business and indulge in regular financial transaction for the sale of any goods and services you provide, it is necessary and beneficial to obtain an invoice form for the purpose of billing and record keeping. An invoice form is a document with details of all the sales made. An invoice is made with the aid of a sample invoice form which helps you to decide the final look of the invoice.

These forms are a prelude to main invoices and give you the liberty to edit and select the format you finally approve of. Invoices can be of many types and differ in shapes and sizes to colors and fonts. However, all invoices have one similar feature. They all contain blank margins and fields against which the information is recorded. These fields are related to the details of the business conducted. You need to fill up the information to complete the invoice and submit it to the client for clearance. An aesthetically designed invoice form can enhance the overall look to impress clients in a professional way.

All invoices, irrespective of appearance, need some basic content. Your name, commercial address and contact information is a must on the invoice. You should mention the registration number of your business as well as the date on which the invoice is being made. The serial number should also be included. This has to be followed with the reference details of the customer and address for billing. The price and quantity for the commodity sold and any taxes applicable must be mentioned too. You can have a margin for any extra instructions and comments in the invoice form.

An invoice form is one of the most necessary documents one can get for regular transaction deals. This is why it is required to go through a sample invoice form to get the best possible one in the format most suitable for your needs.

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Scott Miscall asked:




Small business online invoicing is a fast growing trend for small to medium sized businesses and institutions. Initiating a well conceived web based invoicing solution will result in almost instant and meaningful results when it comes to getting the cash flowing into your bank account.

Electronic invoicing will save you lots of previously wasted time by reducing redundant, out-dated manual billing activities. The small business online invoicing system will send out all those bills automatically with no need to type out each one individually. An online invoicing solution will even cut other costs by eliminating the need for sending out old fashioned invoices through the mail as well as time consuming follow up phone calls.

Small business invoicing has now moved into the twenty first century and small companys can now improve on their cash flow by getting paid faster, which not only helps the bottom line but also saves on the stress of chasing outstanding cash. Online invoicing will make your invoicing system appear far more professional and will also improve customer loyalty by making it much easier for them to make payments on goods or services they have ordered.

Web based invoicing software is surprisingly cost effective, with no initial big outlay and only a low monthly payment, that should very easily cover its costs by bringing in payments faster as well as saving many sleepless nights. Web based invoicing makes it easy for clients to pay, they can even use Amazon payments, PayPal or regular credit card payments to settle their invoice the moment it arrives. This is an obvious benefit as it means that they will not put off payment until the next time they visit the post office to pick up some stamps; these are the great advantages of online invoicing.

Online invoicing software could be a way to ease the cash flow troubles of your company, it may be a solution that not only saves you large amounts of time but also gets cash dropping into your bank account. Web based invoicing solution implementation may well pay for its self immediately that very same day, if you can get in just one outstanding invoice, even a small one.

Online invoicing software will bring to an end the idea of typing and mailing out invoices and reminders. That way of collecting outstanding funds is about to disappear and online invoicing is about to replace it forever. With a system that cuts out the middleman and sends the invoice directly to the person who pays it, Thus avoiding unnecessary delays while the invoice travels through the mail and then slowly makes its way back to you in the form of a check that may take days or even weeks to clear. Small business online invoicing will give you the returns you deserve in a very short time and at a very low cost.

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John M Van asked:




There are a lot of advantages in having your own proforma invoice that is specific to your company. It is used to supply details on a specific order that may be needed by a buyer. It relays what the order consists of and what the costs will be. The buyers will then have an idea of what your company has to offer.

A proforma invoice is part of what will entice the buyers to purchase what they need from your company. This means that a lot of consideration should be taken when designing a proforma invoice template.

Before you start designing the template, you have to take note of a number of things. The proforma invoice is an official document. Although it is not a binding document, it can be used as an official document. It may be used by a buyer to convince his company to purchase from yours or it may be used by the buyer to procure funding from financial institutions. Therefore, you will need the make a template that mirrors a high level of professionalism of the company.

You will also have to consider what you will include in the proforma invoice. The details on the proforma have to be orderly and it is best to subdivide them into sections. Have a section with the company mini profile which has the logo and contacts. There should also be the section with the buyer’s information including the details. The section that has the information about the order is also important and should include the descriptions and the quantities.

Before designing the template, you need to have a look at examples of other invoices. This will give you an idea on how to lay out all the information as expertly as possible. You can get help from different sites on how to skillfully design templates.

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Angela S. Martin asked:




Every year during the month of October, you get to see new diagnosis codes, code deletions and code revisions. And this year too it’s no different. But compared to previous years, urology coders will see fewer changes this year. Here are some urology coding changes that you need to know to code right for your practice.

If we go by the proposed changes, we might see the addition of one new personal history code specific to genitourinary congenital corrections: V13.62. This is one of the most important changes for urology coders as your urologist may need to indicate this history for some patients.

For instance: Your urologist tends to chronic prostatitis in an adult patient who had a hypospadias penile repair as a child. If you add V13.62 to your claim as well as use 601.1, it’ll add to the reporting accuracy of your overall clinical scenario.

Occasionally, you may also use five new fecal impaction and incontinence codes in your urological practice. This time ICD 9 deletes 787.6 and comes up with five new codes.

Your urologist may use one of the new diagnoses for a thorough ICD-9 clinical description in a patient with severe urinary incontinence as well as fecal impaction or fecal incontinence.

ICD 9 2011 has expanded the BMI codes to show higher BMIs with five new codes.

Benefit: BMI has become an important health tool and the new codes will certainly provide more data.

There are seven key signs that count for the constitutional bullet in the E/M physical exam coding, and there are those who think that BMI should be an eight option. If that eight bullet gains traction and comes into play for medical coders, the new V codes could help significantly.

To review these changes for urology coding, sign up for an audio conference. When you sign up for one, you’ll stay on top of the changes in both diagnosis and procedure codes for the coming year, apart from staying tuned to all the changes taking place in the coding world. The best part of such conferences is that even if you missed out on a scheduled conference, you can always listen to the recordings in CDs and PDF transcripts. And to top it all, you also stand to acquire CEUs on attending the same.

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Erin Masercola asked:




No doubt about it. One of the biggest coding challenges in 2010 will be how to code consults – or what used to be consults. Hospital inpatient visits will be especially tricky.

But don’t worry. My Coding Career has consulted the experts to gather these 10 best practices for consult coding in 2010.

The background: Medicare has scrapped consultation codes, and in 2010 will no longer accept codes from CPT’s 99241-99255 section. So, when you’re billing Medicare, you’ll have to find other codes to describe what used to be consults. Meanwhile, some non-Medicare payers will continue to accept consultation codes.

Here are 10 steps you can take to get paid and stay compliant:

1. Expect some larger payers to ditch consult codes as well. Some larger private payers (such as Blue Cross Blue Shield, Aetna, and Humana) will follow Medicare’s lead and won’t accept consult codes in 2010, experts predict.

2. Check with your payers. Some payers will continue to accept consult codes. Payers will announce their consult code policies by mid-December.

Tip for executing #1 & #2: Keep a spreadsheet to track each of your payers’ 2010 consult code policies, and be sure to document their instructions.

Next, what about Medicaid?

3. If you bill Medicaid, check with your state for consult instructions. Just because Medicare isn’t accepting consult codes doesn’t mean things are the same for Medicaid across the board.

4. If two or more physicians see a patient during a hospital stay, make double-sure the ICD-9 codes and/or the physician notes justify the need for two or more physicians to see the patient.

5. Stop thinking of CPT 99221-99223 as ‘admit codes.’ When a physician consults a patient on his first day in the hospital, you should use an initial hospital code. More than one physician can use an initial hospital care code for the same patient, as long as you keep #4 in mind.

6. Meet modifier ‘AN.’ When billing Medicare, modifier ‘AN’ designates a doctor as the admitting physician. If no one uses the modifier, the claim will be subject to medical review, experts predict.

7. Look at time when choosing codes for hospital inpatient care you’re billing to Medicare. At the higher levels, consults’ transfer to hospital care codes will benefit your practice’s bottom line. For 99244 and 99245, you would gain approximately 30 percent in pay if you also report the prolonged services.

8. Expect reimbursement to be lower for lower-level hospital inpatient visits that would have been consults under Medicare’s old system.

9. Focus on total work when coding for split/shared inpatient visits for Medicare. You can ignore one requirement here thanks to Medicare’s invalidation of the consult codes. Even if the physician does not duplicate the key components that the nonphysician practitioner (NPP) performed, you can count all medically necessary history, examination, and medical decision making that the and physician each individual performs and documents on a calendar day.

10. Apply your new/established patient rules when coding visits that would have been consults under Medicare’s old rules. For example, say an internist sends a patient to a cardiologist for an opinion, and that patient saw that cardiologist two years before. The cardiology practice should choose from the ‘established’ patient codes to bill the visit.

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Kyle Inglarda asked:




If you love snorkeling and fishing there is a good chance that you will enjoy spearfishing. A lot of people who get into the sport get hooked (pun unintended!) very quickly. The thing is though, rather than going out and buying the best gear that is out there for spearfishing and then finding out that maybe you don’t really like the sport, you need to get some starting gear. A lot of people already have snorkeling gear, and if you enjoy that as a sport there is a good chance the gear that you have will do until you start getting very serious with your spearfishing.

One of the biggest expenses with Spearfishing is buying a gun. You can buy Cheap Spearguns for under $50, but they often don’t work that well. Still, they are better than nothing and are often a good start. I learned spearfishing and got into the sport by using a Pole Spear, which is much cheaper and much less likely to go wrong. Sure, you might not be able to land huge fish with them, but they are enough to give you a taste of what spearfishing is like. I know the first decent gun I purchased blew me away. I could barely load it, and the spear shot very quickly.

The great thing about spearfishing is that it costs very little to go out each time, meaning you can justify spending a bit more on a good gun and a good wetsuit. These two things are the most important, and then your fins can be upgraded. You also need a good knife, a float or spearfishing reel, depending on what sort of fish you are trying to shoot. Spearfishing has had such a bad rap in the past few decades, when in reality it is one of the most ecological types of fishing, it doesn’t cost much to do and it isn’t overly risky either. I can’t recommend spearfishing more; its an awesome sport.

Kansieo.com

J. Paul Spencer asked:




Sometimes, honesty is the best policy. With regard to writing this article, I was woefully unprepared. Any number of reasons for this are available, from the sudden lack of relevant government transmittals and general industry silence ahead of the holidays, to the fact that I still have gifts to buy and have maybe 10 hours of useful daylight left in order to do it.

So, with 9 days before the new year, I present a slapdash overview of relevant changes to the HCPCS code set for 2010. I’m going to attempt as best I can to restrict my updates to code that I myself have seen our client base utilize on a regular basis, or new codes that represent a service that is widely provided in the world at large. This will keep this posting from slipping precipitously into the Gorge of Too Much Information:

A6200-A6202 – These codes are currently used for composite dressing pads without adhesive borders. These codes are disappearing on January 1, 2010. There are no codes to replace these codes, based on the fact that these codes have been covered based on individual carrier discretion for some time (read: not often or at all).

G0151-G0155 – This represents a new set of codes for 2010 for different types of therapy services provided to patients in either the home health or hospice settings. These services are billed in 15-minutes increments.

G0420 – This is a new code for individual chronic kidney disease education. This code is billed on an hourly basis. Once the actual dollars and cents fee schedule is released for 2010 by Medicare, this code can be accurately assessed for usefulness.

J7322 – The code for Synvisc is changing for 2010. J7322 is being replaced by J 7325. The reason for this has to do with there now being more than one type of Synvisc now available. Code J7325 now covers more than one Synvisc derivative.

Elastic Orthoses – Several HCPCS L codes are being deleted from the HCPCS code set. Since April 1st, 2009, the codes to be deleted have been found by CMS to not meet the definition of a brace and coverage has been denied. The deletion of these codes is a natural progression from that determination.

The majority of the balance of changes to the 2010 HCPCS code set are an expansion of the existing Physician Quality Reporting Initiative (PQRI) codes. If you are currently utilizing PQRI, a quick review of these codes may be worth a look.

Thus concludes this somewhat informative and not the least bit inspired article. As you conclude your holiday seasons, do your best to show a little kindness. You’d be surprised how far it goes, and how much it will be appreciated. As Randy Newman says, “It’s a jungle out there”.

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