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May 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.  CPB will be able to handle ICD-10 coding for our clients just as we have ICD-9.

For those looking for inexpensive coding assistance, offers 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. 

Offices Running On Time

Does your office often run late?  It is one of the most common complaints from patients causing some patients to find another provider.  One of the challenges of running a medical office is seeing patients on time.  It is also fairly easy to solve.  Here are a few tips:

The physician is the leader of the office.  If being on time is a priority for him/her, then it must be transferred to the staff.  It is a BIG step.  That means starting office hours on time, or even early if a patient has arrived early.  Great way to start the day or afternoon session!

  • Ask patients to arrive 15 minutes early to sign in, recheck insurance and any other changes since the previous visit, collect co-pays, etc. so that they are ready to go on time.


  • If you allow walk-ins, keep in mind that your appointment patients should have first priority.  They likely have plans also and sitting in an office waiting for someone who did not make an appointment will not be appreciated.  If someone is being seen unexpectedly for an urgent medical problem, explaining to the other patients shows you care about their time also.


  • Getting patients to tell you all of their concerns for that visit can be challenging.  Sometimes the patient saves the most complex issue for the end of the visit!  To get a list of all medical issues you could provide the patient with a form (paper or electronic) to complete after arrival.  The medical assistant can then use that list as a starting point for discussion.
  • If the office is always running late, take a look at how many patients are booked over a two week time period.  Compare it to the time clock when staff clocked out.  What is the average amount of time per patient?  Maybe changing your time slots that more closely reflects your time pattern will make it better for the patient and office. 

Remember, Happy patients tend to refer their friends!

Transitional Care Management

As of Feb. 25, 2015 TriCare will now cover these codes (99495 & 99496) also. 

Chronic Care Management – Horizon Medicare Blue – no coverage

Horizon Medicare Blue (Medicare Advantage plan) is NOT covering the Chronic Care Management (CCM) code – 99490. 

We have notified CMS and they are investigating.


Denial for Billing Both an Office Visit & Procedure on the Same Day

Colleagues are beginning to report more insurances denying the E/M service when performed with a procedure DESPITE the use of modifier "-25". But there's no basis for this denial based on the claims submission alone. Two different (unrelated) diagnosis codes are NOT required, tho often makes a difference. And on the face of the claim, everything looks like it was billed appropriately.

When this happens, payers are testing providers to see if you feel strongly enough that the E/M was significant and separately identifiable.  If so, we strongly encourage you to support an appeal.  We will need a copy the medical records to prepare an appeal letter.  If insurers deny enough of these and you do NOT fight back, you are essentially agreeing that your billing is not correct.  Very important to fight for what you believe is rightfully yours.

Many insurers will “pend” your claim and request medical records if they have reason to be concerned that the service wasn't billed correctly – but not all will.

It is important to appeal all denials where the clinical documentation clearly identifies that is was both significant AND separately identifiable from the typical pre-procedure work that is done when the procedure was planned.

This obviously requires, that the provider's documentation of the problem be clear, cogent and specifically customized to be unique to the clinical presentation of the patient. In other words, if you're using an EMR template, be certain that your E/M documentation is not too "generic" to support your argument that the service was significant and separately identifiable.

What is likely to happen over time is that when you've repeatedly demonstrated that the criteria for the use of modifier -25 HAS been met, they'll put you on the "secret list" of providers they no longer automatically deny when the two services are billed together (with modifier "-25" on the E/M).

2015 Client Newsletter Archive