Small Errors Could Cost Big Bucks When Billing for I&D

Q: While reviewing charts where incision and drainage (I&D) procedures were being performed, I came across instances where Current Procedural Terminology (CPT) code 10060, “Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single” was billed for treatment of an abscess on the finger. I believe this is an error, since this procedure involved an abscess of the finger pad and not just paronychia. Can you explain the different I&D procedures please?   A: If the procedure documentation in your …
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2019 International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Codes

October 1, 2018 will bring 279 new codes to ICD-10-CM. Combined with 51 deactivated codes (and 143 revised codes), that brings the total number of ICD-10-CM codes to 71,932. We identified a few examples that are especially important for urgent care coders to be aware of; a complete list of ICD-10-CM changes can be found on the CMS website at https://www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-CM.html. Chapter 2: Neoplasms (C00-D49) Melanoma and other malignant neoplasms of the skin The codes addressing carcinoma, melanoma, and neoplasm of the eyelid have been split into separate codes to …
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Clarifying the Coding for Splint and Cast Application by Nonphysicians

Q: I would like clarification on an article I read in The Journal of Urgent Care Medicine (JUCM) online archive. The article, Splint and Cast Application Performed by Someone Other than Physician, referenced that nonphysician staff could bill for splint and cast application. Will you please expand on the references and confirm that we can bill for splint and cast application if it is done by someone on staff other than the physician? A: Yes, you can still bill for the service if the application is performed by someone other …
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New Medicare Cards

Q: The Centers for Medicare and Medicaid Services (CMS) started issuing new Medicare cards to beneficiaries in April of this year. What do I need to know about these changes to limit disruption to my patients and medical practice? A: CMS is required to issue new Medicare cards as a part of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, which mandates that CMS remove Social Security Numbers (SSN) from all Medicare cards by April of 2019. The primary reason behind the change is to combat identity theft …
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Reduction in Reimbursements for Modifier -25

Q: Last fall, Anthem Blue Cross Blue Shield sent a notice to physicians in several states regarding their intent to reduce reimbursement rates on any evaluation and management (E/M) services billed with modifier -25, “significant, separately identifiable E/M,” by 50% effective January 1, 2018. What are the implications for urgent care? A: This announcement initially spurred action from the California Medical Association (CMA) to coordinate with the American Medical Association (AMA), as well as other state medical and dermatology societies, to squelch the effort. Based on that feedback, Anthem then …
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