Cape Medical Billing: Providing Expert Medical Billing Solutions

Like Cape Medical Billing on Facebook

Call Today 888-MED-BILR

April 2015 Client Newsletter





Well, it appears ICD-10 will go into effect on October 1, 2015.  We will be contacting you to discuss how your practice will make this transition so it is smooth on October 1 and after.  There are options, both paper and electronic. Cape Medical Billing will be able to handle ICD-10 coding for our clients just as we have ICD-9. 


While CMB has tested and verified we are fully prepared for ICD-10, including our software, everyone in the industry is strongly recommending providers plan ahead for cash flow issues in case the insurers do not process claims properly.  Arranging working capital of six months seems to be the most common timeframe.  A line of credit with your bank is a common way to do this. 


For those looking for inexpensive coding assistance, http://www.icd10data.comoffers online access for a rather economical fee - FREE!  And it works on tablets and smartphones.  Since ICD-10 requires more information than ICD-9, you should take a look at some of your common Dx's to view the various additional information that is required - you will likely be surprised.  Many of the "Misc." ICD_9 codes do not have ICD-10 equivalents. 



Billing Home INR Interpretation - G0250


G0250 is not covered when billed on the same DOS as an office visit.  Medicare considers the interpretation during the office visit as part of the office visit.  So if that is your fourth time, you will need to wait until the next INR to bill G0250.  It will always need a separate date of service than any other charges. 






Reprinted with permission:


The issue is whether that initial or subsequent exam meets the criteria for being both significant and/or separately identifiable from the global work associated with the performance of the procedure (e.g., nail debridement, I&D, etc.). 

There is an urban myth that "initial visits" are always separately reportable (irrespective of whether the CCI edits specifically bundle a particular procedure with a CPT 99201-99205 codes). But the Correct Coding Initiative (CCI) manual instructions address this in Chapter III, page 4, of the NCCI manual instructions.  The same instructions are found in other chapters in regards to services other than integumentary procedures as well: 

"....If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. In general E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is new to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure...." 

The work up the problem the first time is separate from the work associated with the performance of the nail debridement. However the audit questions is whether or not it was necessary to do a SIGNIFICANT work up of this problem. 

The requirement isn't looking at the fact that as a good doctor, you need to acquaint yourself with the patient's medical history in order to practice good medicine. They are literally looking at what work was needed in order for you to diagnose the patient's presenting problem(s) and decide on a treatment plan for the problem. If your documentation DOES show a significant work up, then it is billable. 

And if the assessment needed to determine that debridement was the appropriate treatment was fairly straightforward (i.e., didn't require a significant work up of the problem), then you'll know that for similar cases in the future, you'll just bill for the procedure alone. 

Joan Gilhooly, CPC, CPCO 




Medicare is in the third phase of re-validation.  Be sure to alert your staff - if a letter is received notifying you to start that process - it should be immediately brought to your attention.  Failure to file the re-validation paperwork results in stoppage of all Medicare payments until the applications are filed.  


2015 Client Newsletter Archive