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Make quick and easy work of determining which procedures and services are bundled and when. Most coders, billers, and clinicians are familiar with the concept of the surgical package or global period; but they may be unclear about when the global period begins and ends, and which procedures and services may be reported (and paid […]
The post Your Quick Guide to the Global Surgical Package appeared first on AAPC Knowledge Center.
Hospital quality leaders who find themselves growing more skilled and successful in continuous survey readiness (CSR) activities now have two accreditation-specific certifications available to them. This article and accompanying chart will provide you with a way to compare and contrast these certifications across 30 parameters.
When assigning a ICD-10-CM diagnosis code(s) for a surgical complication, report the code for the complication first, followed by any additional diagnosis code(s) required to report the patient’s condition. Example 1: Complication from a surgical procedure for treatment of a neoplasm. The complication is the listed first, followed by a code for the neoplasm or […]
The post Surgical Complication Diagnostic Coding: Quick Tip appeared first on AAPC Knowledge Center.
Please see the attached OP Note:
Procedures:
1. Redo bilateral L4 laminotomies and foraminotomies, decompression bilateral L4 nerve roots.
2. Redo bilateral L5 laminotomies and foraminotomies, decompression bilateral L5 nerve roots.
3. Right L4 transpedicular approach with far lateral decompression right L4 nerve root
4. Right L5 transpedicular approach with far lateral decompression right L5 nerve root
5. L4-L5 TLIF procedure with a titanium titan interbody cage.
6. L4-L5 posterior lateral arthrodesis with local morselized autograft and DBM.
7. Left sided L4-L5 RTI pedicle screws
8. Modifier 22 for extra degree of difficulty given the severe amount of collapse and scarring from prior surgery, which all required extensive careful microdissection bilaterally and adding over an hour to the standard surgical procedure.
9. Microscope for microdissection of spinal canal.
10. SSEP, EMG monitoring and intraoperative screw stimulation performed by neuro monitoring associates, which remained stable throughout.
INTRAOPERATIVE FINDINGS: Severe stenosis and collapse at L4-5, which was decompressed widely and the disk space opened up and distracted up well with a Titan interbody TLIF cage. There was dense scarring at the L4-L5 level and microdissection and it should be reflected in the primary coding.
Any help and pointing me in right direction.
Thank You in advance!!!
Jessica
If you have to go to an hospital emergency room (ER) you will likely have to wait a period of time before you see a doctor. The ERs are always busy, even during the night.
It helps to know how the system works so you will be properly prepared. You want to see a nurse and a medical doctor as soon as possible.
You are usually greeted by a triage nurse who will assess the priority of your medical need. This person will provide a visual cursory exam and then ask several questions. It is in your best interest to have your medical history prepared. This will make sure it is complete and accurate.
So, before you endure a medical emergency write your medical history on an index card (or any good paper). Be sure to include all allergies and conditions you have. List all previous illnesses (but not minor colds, cuts and such) You may want to put this card in a special place so you can easily find it or tell someone where it is. Perhaps your wallet would be the best place to put this information.
Your nurse will be asking such questions as the time of onset of the condition and all medications you are taking at time. This is not the time to draw conclusions about your condition, assumin you are not a physician. Do not selectively omit any information, even if you think it is too minor to mention. If your situation involves breathing or bleeding, tell the nurse about that first because life threatening conditions are given first priority in the emergency room.
Since the hospital will naturally want to know how you are going to pay for the ER care, be sure to put your health insurance policy number on the back of the medical card. Include your date of birth, Social Security number, your employer’s address and phone number.
If you arrive at a hospital by ambulance, you are usually given high priority. They will, at least, wheel you into an ER room where you will wait for care. If you think your condition needs very fast care, be sure to call an ambulance. When you get to the hospital you are automatically considered a patient of the hospital. This is not so if YOU walk in through the main door without an official escort.
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Let’s accept that no one ever plans to be sick. Well…almost, except after the forecast of a sunny Friday afternoon following a gruelling week. So what options do you have when you wake up with a sore throat or a fever that refuses to go away? Local Primary Care Physicians are booked up weeks ahead in the season of cold and flu and nothing could be sworse than walking into an emergency room with a running nose sore throat and a cough. Sitting for hours in a waiting room to see a doctor when you are feeling sick is nothing short of a punishment. Only option is to choose between toughing it out by burying your head under covers with a steaming cup of chicken soup or visiting the nearest walk in clinic
Walk in clinic offers brilliant solution when your condition is not life threatening but still demands immediate medical attention, without long wait and inconvenience of a hospital. Walkin clinic of Manhattan provide similar services as offered by hospitals and emergency rooms with minimum waiting period and far less expense.. You can just schedule same day appointment and walk into a walkin clinic and see the doctor. No wonder most people now prefer walk in clinic for unexpected illnesses and minor injuries.
Walk in Clinic of NYC is a same day appointment medical facility that provides a gamut of services including treating acute conditions, follow up and preventative care services. Sinus infections, cold and flu, allergies sore throats, migraines, sprains, bronchitis, ear infections and minor burns and cuts are some of the ailments which are treated at Walk In Clinic of NYC. Health screenings, physical examinations and vaccinations available at walk in clinic that help in preventing sickness in the future.
Centrally located in midtown Manhattan, Walk In Clinic of NYC ensures prompt medical services at reasonable rates for those who has no insurance, otherwise most insurances accepted. With provision of same day appointments you don’t have to wait for long hours. You can also get prescription and medication refills in case you are unable to reach your doctor. When you schedule an appointment before visiting Walk In Clinic of NYC, it minimises the waiting time and guarantees a relaxing visit.
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To know more about various services offered by walk in clinic of NYC, logon to http://www.walkinclinicnyc.com/
2018 ICD-10-CM includes many new, revised, and deleted diagnosis codes, some of which pertain to mental disorders. To save you the time it takes to cross walk these codes to their Diagnostic and Statistical Manual of Mental Disorders (DSM-5) counterparts (or vice versa), the American Psychiatric Association (APA) has done it for you. For 2018, there […]
AAPC Knowledge Center
The American Cancer Society’s Great American Smoke Out is a nationwide day, the third Thursday in November, dedicated to helping smokers stop smoking. So far, it has worked! There are now more former smokers in the Nation than current smokers.
When trying to quit smoking, support can make all the difference! If your medical practice is already providing smoking cessation counseling and treatment, did you know you can bill and get reimbursed for your services?
Stats About SmokingIn 2010, 7 out of 10 smokers who desired to quit were successful! It is possible to quit smoking with proper help from your doctor. When smoking is stopped, for even one day, the human body reaps the benefits of overall better health and the decreased risk of cancer.
The American Cancer Society says that there are scientifically proven ways to stop smoking, and many medical practices may already be using them.
Effective treatments, according to the American Cancer Society include:
One treatment may not work alone. Many people need a combination to quit once and for all.
In 2014, smoking cessation became a covered benefit under the Affordable Care Act (Obamacare). This means that Medicare and commercial insurance carriers must provide smoking cessation counseling and interventions. These services include:
For a Medicare patient to qualify for smoking cessation counseling they must meet the following requirements:
Reimbursement may be possible if you bill the patient’s insurance company correctly. Medicare covers 2 cessation attempts per 12-month period. Each attempt includes a maximum of up to 4 intermediate (99406) or intensive (99407) counseling sessions, with a total Medicare benefit of 8 sessions per year.
The CPT codes are listed below for billing for smoking cessation:
99406 – Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
99407 – Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
A modifier 25 may be appropriate to append to the primary E/M visit code.
Note that as of September 30, 2016 HCPCS codes G0436 and G0437 for smoking cessation have been deleted.
Some commonly used ICD-10 diagnosis codes used, if appropriate given your patient’s situation, may include:
F17.200 Nicotine dependence, unspecified, uncomplicated
F17.201 Nicotine dependence, unspecified, in remission
F17.210 Nicotine dependence, cigarettes, uncomplicated
F17.211 Nicotine dependence, cigarettes, in remission
F17.220 Nicotine dependence, chewing tobacco, uncomplicated
F17.221 Nicotine dependence, chewing tobacco, in remission
F17.290 Nicotine dependence, other tobacco product, uncomplicated
F17.291 Nicotine dependence, other tobacco product, in remission
Z87.891 Personal history of nicotine dependence
Though the billing codes are relatively simple, there are rules to follow when billing Medicare based on the patient’s symptoms.
The Medicare Learning Network from CMS provides information that may be helpful.
Check with your local Medicare carrier or private insurance company for their rules and requirements before billing for smoking cessation.
The documentation in the medical record must support the billing of the cessation code. The documentation needs to record what was discussed during counseling and should show a significant and separately identifiable service.
Items to document may include to following elements:
An entry in the patient’s health record simply stating that the doctor spent 11 minutes counseling the patient on tobacco use will not cut it and will not meet the standard for medical necessity or to be able to bill the codes.
Are you losing money by not coding and billing for smoking cessation? If you are already counseling for smoking cessation in your practice, you are doing the work, so get paid for it.
Medicare reimbursement for 99407, smoking cessation for longer than 10 minutes of counseling is $ 27.93.
The 10 minute or longer consult may not apply to everyone. The 3 to 10 minute counseling code, 99406, reimburses $ 14.32. These are national reimbursement amounts, your local Medicare payments may vary.
99406 = $ 27.93
99407 = $ 14.32
For Medicare co-insurance and deductibles are waived.
A couple of resources your doctor can provide to their patients are: The American Lung Association hosts the Freedom From Smoking group that helps coach the smoker to quit. They offer free support and tools to get the person to stop smoking.
The CDC mentions calling 1-800-QUIT-NOW (1-800-784-8669). This can help if the patient is not computer savvy, but wants help. They will also give free support and advice, developing a plan that’s right for the patient.
Steps to helping our patients become smoke-free are reimbursed by many insurance companies. Beyond getting paid for the counseling, patients will give you credit for helping them start their journey to a smoke-free, healthier life.
Quitting isn’t easy, so make sure your patients know how much you support them every step of the way!
Is your practice billing for smoking cessation? Let me know in the comments.
— This post Quick Guide: Billing for Smoking Cessation Counseling 99406 and 99407 was written by Manny Oliverez and first appeared on Capture Billing. Capture Billing is a medical billing company helping medical practices get their insurance claims paid faster, easier and with less stress allowing doctors to focus on their patients.