Click here for more sample CPC practice exam questions with Full Rationale Answers

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Click here for more sample CPC practice exam questions and answers with full rationale

Practice Exam

CPC Practice Exam and Study Guide Package

Practice Exam

What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

CPC Exam Review Video

Laureen shows you her proprietary “Bubbling and Highlighting Technique”

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Practice Exam

2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Cardiovascular Associates, P.C. Consents to Pay the United States Over $399,000 to Settle False Claims Act Allegations Relating to Improper Billing Practices

Cardiovascular Associates, P.C. has consented to pay $ 399,230.35 to settle asserts that they submitted false cases to the United States for administrations not rendered. Cardiovascular Associates P.C. is a therapeutic practice with workplaces situated in Rockville, Olney, Laurel and Germantown, Maryland.

Read The Full Story Here!

The post Cardiovascular Associates, P.C. Consents to Pay the United States Over $ 399,000 to Settle False Claims Act Allegations Relating to Improper Billing Practices appeared first on The Coding Network.

The Coding Network

Auditor states drug ordered as IV over 2 minutes must have a doc stop time?

Hello everyone,

We are currently experiencing a situation in which an auditor is stating that all IV drugs ordered by the physician with an expected duration of 1-2 minutes must have a documented stop time in order to charge the 96374, 96375 or 96376.

I have never encountered a situation like this in over 5 years. Perhaps I’ve missed verbiage in the CPT coding book that states it must be present?

Any help would be appreciated.

Medical Billing and Coding Forum

Surgeon states polyp pathologist states normal

Hi,

I’ve a case where the encounter is for screening colonoscopy (ICD-10-CM: Z12.11). The surgeon found a polyp (ICD-10-CM: K63.5) in the transverse colon and excised it using snare (CPT 45385). Pathology report comes a few days later and states the excised tissue as "normal colonic mucosa".

Did the surgeon excised normal tissue only and if that is the case what would be the codes? Should we code for biopsy only and not snare since there was no lesion that was excised and was rather normal tissue?

I’ve narrowed it down to:

1. ICD-10-CM: Z12.11, K63.5; CPT: 45385; OR
2. ICD-10-CM: Z12.11; CPT: 45380

Any insights?

Thanks!

Amber

Medical Billing and Coding Forum

United States Reaches $125,000 Civil Settlement

The US Attorney’s Office for the Eastern District of Missouri announced today that the US, Foot Healers, and its subsidiaries (Foot Healers) reached a civil settlement that will resolve the US’s claims against Foot Healers under the False Claims Act for knowingly submitting false claims to Medicare for podiatry services.

Click here for the full story!

The post United States Reaches $ 125,000 Civil Settlement appeared first on The Coding Network.

The Coding Network

Coding Clinic States use Z12.11 on High Risk Screening Colonoscopy???

I reviewed documentation from a recent AskMueller seminar of GI coding and billing and it states to assign Z12.11 screening for malignant neoplasm as the primary diagnosis code for high risk screening colonoscopy, stating a surveillance colonoscopy is a screening colonoscopy. I had never heard this before so I started to do some research and found a different set of documents from another AskMueller seminar by a different trainer that states to only use Z12.11 on a high risk surveillance colonoscopy **IF** instructed by the payer policy. I’ve encountered several AHA/AHIMA posts that state the Coding Clinic recently recommended to use Z12.11 as the primary diagnosis code, but payers haven’t changed their policies. This contradicts Medicare guidelines and the vast majority of commercial payer guidelines. Most state that once a history of polyps or cancer, all future screening colonoscopies are high risk (until you have no polyps detected and you are returned to the 10 year interval for screening) and to report the appropriate "history of" code as primary dx and use modifier 33 or PT if further polyps detected.

The AGA in their GI CPT updates review states that audits have begun and take backs are happening on charges billed as routine screening colonoscopy when signs, symptoms or disease are in the medical record (personal hx of colon cancer and/or polyps is a condition). Also, I’m also thinking of the logistics of reporting screening turned diagnostic with this change (if it truly is valid). Currently a commercial high risk colon for personal hx polyps that removes a tubular adenoma by snare is reported 45385, 33 Z86.010, D12.* … it would now be reported as 45385, 33 Z12.11, Z86.010, D12.* ?? I’ve talked with many claims processors and a lot of clinical edits don’t go beyond the primary dx. It would be perceived as a routine preventive colon, not high risk.

I’m just afraid that everyone will start throwing the Z12.11 on ALL colonoscopies and payers will pay, waiving patient out of pocket, then audits will ensue and take backs will be recouped and billing departments will need to chase patients for the out of pocket expenses (and these take backs can occur years after the original billing). A personal hx of polyps, cancer, colitis, etc. allows patients to have more frequent screenings which classifies them as not routine.

Any links to literature that you’re aware of that is gold standard to support this change would be greatly appreciated. I did send a mesage to AskMueller to see if they could clarify their statement. I think payers should cover both routine and high risk colonoscopy 100% it’s ridiculous the different interpretations from payer to payer and policy to policy within the same payer. Some BCBSMi policies cover any kind of colonoscopy once a year with no patient out of pocket and then some others are grandfathered and screenings of any kind are not a benefit.

Thanks in advance for any feedback!!

Medical Billing and Coding Forum

Path states BENIGN LYMPHOID PSEUDOPOLYP – Can’t find a code.

I’ve researched and researched and just get mixed information.

We have to code path results, if positive. How would this be coded – benign lymphoid pseudopolyp of the colon. Also, maybe because it’s so many years later – I can’t find a pseudopolyposis code in ICD-10 2018 (there is an old thread in these forums that says use pseudopolyposis)…there’s a K51.40 inflammatory polyps of the colon, but based on my diagnosis – it doesn’t sound inflammatory so I’m leery of using that. Is it a benign neoplasm of colon?

Thanks.

Kimberlee

Medical Billing and Coding Forum

20 States Challenge ACA’s Constitutionality

Led by Texas’ attorneys generals, 19 other states have filed suit in the US court, North District of Texas, arguing the Patient Protection and Affordable Care Act, which is both known as the ACA and Obamacare, is no longer constitutional based on a previous case and the recent tax cut law. ACA “Unlawful” The states argue that […]
AAPC Knowledge Center

United States of Care: Healthcare over Politics

A diverse group of leaders, including former Acting Administrator of the Centers for Medicare & Medicaid Services (CMS) Andy Slavitt, have come together to form a new movement that will champion the cause of affordable healthcare without mucking up the works with politics. They call it United States of Care. Serving as Board Chair of United […]
AAPC Knowledge Center

CMS Extends Enrollment Moratoria in Fraud-ridden States

Continuing the effort to prevent and combat healthcare fraud, waste, and abuse where it occurs most, the Centers for Medicare & Medicaid Services (CMS) has extended the statewide temporary moratoria on the enrollment of new Medicare Part B, Medicaid, and Children’s Health Insurance Program (CHIP) non-emergency ground ambulance providers and suppliers and home health agencies, sub-units, and […]
AAPC Knowledge Center

Thai Medical Tourism and Arab States

Medical tourism within Thailand has increased dramatically over recent years. If we look back over the previous five years alone we can see an almost four fold increase in medical tourists arriving in Thailand. In 2005 there were around 500,000 medical visitors seeking treatment in Thailand, by 2009, this number had increased to approximately 1,400,000. This is a large increase by any standard and there are good reasons for it. Firstly, Thailand is able to offer highly competitive prices for treatment in comparison to most developed nations. Secondly, the quality of hospitals and trained personnel is of a standard similar to those seen throughout the very best hospitals worldwide. Thirdly, and possibly most importantly, Thailand is well placed in being able to offer a wide range of tourist attractions and resort choices. It is possibly this last factor that has helped to drive the industry forward as potential medical tourists seek to combine their scheduled treatments with an exotic holiday.

Helping to further develop the medical tourist industry within Thailand have been the incredible investments and developments made by the private hospital sector. Looking to benefit from the growing trend of visitors, private hospitals have invested heavily in buildings, state of the art equipment and staff. Leading the way in attracting visiting patients have been hospitals like Bumrungrad International Hospital and the Bangkok Hospital Group. These hospitals attract as many as half of their patients from outside of Thailand. If we look at the country distribution of medical visitors, important markets include; Europe, Japan, America, Bangladesh and Myanmar. This combined market accounts for approximately 25% of the total. Arab states, incredibly total almost 60% of the total market. So why are Arabs, in ever increasing numbers seeking medical treatment from outside of their home country?

Unlike many other countries, surprisingly cost is not necessarily one of the primary reasons. If we take the example of the U.A.E., who staggeringly account for over 40% of Thailand’s medical tourism industry, many of the country’s inhabitants can be considered as wealthy by any measure. Clearly, this group of people is unlikely to visit Thailand, for medical treatments, on cost considerations alone. Reasons cited for seeking treatment outside of the UAE include a loss of faith in local services, with many complaining that the overall quality of local service is not up to standard. Also, visitors see a visit to Thailand, for medical treatment, as an ideal opportunity for a vacation in a liberal environment with extensive leisure options available. 

Arabs have a history of seeking medical treatment from outside of their own country, but what has changed is that since the mainland terrorist attacks on the USA in 2001, they are now more reluctant to seek medical treatment from western countries. This is principally since they sadly and all too frequently feel, particularly in America, a sense of hostility towards them. When arranging, in some cases life saving surgery, it is obvious that a more relaxed and welcoming environment is far more likely to induce both a quicker recovery and a more positive experience. In this regard Thailand has very much been the one to gain.

In response to this influx of Arabs patients, hospitals in Thailand have been quick to respond and have made extensive efforts to further grow this lucrative market sector. Hospitals like The Bumrungrad International Hospital have already furnished their facilities to the very highest of standards. Additionally, with Arab speaking staff, a choice of Halal food, numerous prayer rooms and even strategically placed compasses pointing to MECCA, everything has been done, and continues to be done, to ensure a very comfortable stay for the Arab visitor.

With the huge revenues involved from medical visitors to Thailand from Arab countries, the Tourism Authority of Thailand (TAT) have targeted this specific group, and are currently engaged in a wide range of promotional activities, in an attempt to further expand the market. The TAT has very ambitious plans to grow this sector, but the U.A.E. is not going to give up without a fight. Currently under construction, and due to be completed this year, is the huge and costly development of Dubai Healthcare City (DHCC). If this new initiative is enough to slow down and ultimately reverse the flow of patients from the U.A.E. remains to be seen.

This article was written and submitted by Mark Alexander, CEO and chief SEO consultant for www.seo2marketing.com and www.seo2marketing.co.uk. Search engine optimization services Bangkok and Leeds in the UK.