Practice Management
Urgent message: The escalating pressure on the industry to decrease health care costs has resulted in an increase in audit activity from government and private payors for everything from billing and coding to HIPAA and kickbacks. Therefore, it’s more important than ever for urgent care centers to build a culture of compliance. DAMARIS L. MEDINA The health care industry is in the throes of a dynamic regulatory enforcement climate. Federal and state regulators and third-party …
Read MoreDAVID STERN, MD (Practice Velocity) Q. I understand that we will be able to bill for cerumen removal for both ears in 2014. Is that true? A.Yes. In 2014, you will be able to bill CPT code 69210, “Removal impacted cerumen requiring instrumentation, unilateral” with modifier -50, “Bilateral procedure.” Keep in mind, Medicare will typically not cover simple, non-impacted earwax removal. CMS requires that physicians meet the following criteria for reimbursement of the removal of …
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DAVID STERN, MD (Practice Velocity) Q. We perform a lot of IV infusions in our urgent care facility. Sometimes we also perform IV pushes and hydration at the same time as the infusion. We have been billing CPT codes 36000, 96365 -59, 96360 -59, and 96374 -59. Medicare pays for these codes when we append the -59 modifier but I am concerned that this may not be the correct way to bill after reviewing some …
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DAVID STERN, MD (Practice Velocity) Q. Can a Physician Assistant (PA) bill a claim under a supervising physician even when the supervising physician is not physically present during the patient visit? A.A PA can render services when the physician is not on site. Incident-to billing (a specific CMS method for billing midlevel services with the physician as rendering provider) would never apply in this case. Services rendered in this situation should be billed with the …
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DAVID STERN, MD (Practice Velocity) Q. How do you code for a Sexually Transmitted Diseases (STD) screening visit in a patient who has no symptoms? Can you use a preventive medicine code (99387-99397) and still receive reimbursement? A.You would code based on the service provided. If you performed a physical and collected the specimen to send to the lab, then you would bill the appropriate preventive medicine Evaluation and Management (E/M) code. If the only …
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DAVID STERN, MD (Practice Velocity) Q. We offer Physical Therapy services to patients in our urgent care center and some patients have Medicare insurance. I understand there are new codes that we must use for Medicare. What are they and how do we use them? A.The Centers for Medicare and Medicaid Services (CMS) was mandated by the Middle Class Tax Relief Act of 2012 to collect information regarding beneficiaries’ function and condition, therapy services furnished, …
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