Category Archives: Medical Billing Coding

Be prepared for radiology coding changes in 2017

Get ahead the changes of radiology-specific in 2017. Mammography codes are overhauled and summarized.

Changes in Mammography Codes 2017

New Codes Description Deleted Code
77065 Diagnostic mammography, including CAD when Performed; unilateral 77055 / 77051
77066 Diagnostic mammography, including CAD when performed; bilateral 77056 / 77051
77067 Screening mammography, bilateral (2-view study of each breast), including CAD when performed 77057 / 77052


Bristol healthcare service streamlined ICD-10 well before 10/01/2016

October 1, 2016 is marked as end of a one year that allowed by the center for Medicare and Medicaid services (CMS) and the American medical association.  The grace period was a joint initiative created between CMS and AMA to help ease the transition from ICD-9 to ICD-10 for physician practices.

Our team of certified coders efficiently managed to transit from ICD-9 to ICD-10 well before the stipulated dated.  Initially we struggled with cardiology coding in E and G codes but very soon managed to submit corrected claims.

To keep you posted

The end of this transitional period could be a tough one if your coding professionals neglect to prepare for it.

The transition to the ICD -10 and Related Health Problems appears to have gone well so far, despite widespread anxiety that it would wreak mess across healthcare as providers struggled to comply with the new coding structure, heightened specificity and documentation requirements.  Nevertheless, physicians still face significant obstacles in two main areas as the ICD-10 transition continues.  According to a recent survey, it is not yet clear how much of the ICD-10 implementation’s success so far stems from the first-year concessions for providers negotiated by the AMA in collaboration with the CMS.  This elasticity allow coders to be reimbursed for wrongly coded claims as long as the erroneous code submitted is in the same wide family as the correct one.  Coders make sure your providers will no longer be reimbursed for these wrongly coded claims when the grace period ends on September 30, 2016.

Feel free to contact us to find- How we managed to implement ICD-10 well before the grace period.

Bring together your team for a successful contract negotiation.

Our Credentialing specialist team lead by Mr. Albert Marvin successfully implemented and negotiated contract for a Neurology physician this April, 2016.

Very recently we introduced ancillary healthcare services to encourage our clients utilizing Credentialing and Contracting services at no extra cost.  We know “Nothing fits the same for all”. Also, we recommend our physicians to demand their annual report card that lets physicians know how they stand with their peers.

All Healthcare Payers GOAL is to place physician’s front and center in the mission to improve the health of their members, and LOWER OVERALL HEALTHCARE COSTS.

Physicians/Practice Managers are you sure you are getting the best rate available for your healthcare services?

Your practice future depends on effectively negotiating with your private payer plans.

Become PQRS Expert.  Negotiate your low hanging fruit; create your top 10 Dx code along with cost associated CPT, Monitor your payer mix from year to year, because payer contributions to your business can change over time.

Know when each of your contracts expires and how much notice you must give to make changes.  Experts recommend the following contractual elements as areas to which practices should pay attention:

  • Retro/Authorization procedure for treatment.
  • Period allowed appealing a denied claim.
  • Requirements relating to use of oral or injectable drugs.
  • Time specified for clean claim payment, and interest paid for late payment.
  • Procedure for adding new service lines.
  • Period required for providing notice of modification proposals.
  • Cancellation clause, including the advance notice required.

Feel free to e-connect or call Bristol Healthcare Services to find HOW and WHEN to negotiate or renegotiate your current contracts to include the best reimbursement rate for your practice.

New Guidance – Medicare Physician Fee Schedule

Some changes you’ll find in the April 2016 update actually went into effect the first of the year.

They are:

HCPCS Level II code G0464 Colorectal cancer screening; stool-based DNA and fecal occult hemoglobin (e.g., kras, ndrg4 and bmp3) is now assigned a procedure status of I Not valid for Medicare purposes. Medicare uses another code for reporting of, and payment for, these services. (Code not subject to a 90 day grace period)

CPT 10030 is now assigned global period days of 000 Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable.

CPT 77014 is now assigned a PC/TC indicator of 1 Diagnostic tests/radiology services. These codes generally have both a professional and technical component. Modifiers 26 and TC can be used with these codes.

CPT 80055 is now assigned a procedure status of X Statutory exclusion. These codes represent an item or service that is not in the statutory definition of “physician services” for fee schedule payment purposes. No RVUs or payment amounts are shown for these codes and no payment may be made under the physician fee schedule. (Examples are ambulances services and clinical diagnostic laboratory services.)

Medicare administrative contractors will not search their files to either retract payment for claims already paid or retroactively pay claims. It is the responsibility of the healthcare provider to correct claims for these codes.

Effective for services performed on or after April 1, 2016:

G9678 is assigned a procedure status of X

G9481 (Remote E/M new patient 10 mins) has a PE RVU = 0, all other MPFS indicators/values = 99201

G9482 (Remote E/M new patient 20 mins) has a PE RVU = 0, all other MPFS indicators/values = 99202

G9483 (Remote E/M new patient 30 mins) has a PE RVU = 0, all other MPFS indicators/values = 99203

G9484 (Remote E/M new patient 45 mins) has a PE RVU = 0, all other MPFS indicators/values = 99204

G9485 (Remote E/M new patient 60 mins) has a PE RVU = 0, all other MPFS indicators/values = 99205

G9486 (Remote E/M est. patient 10 mins) has a PE RVU = 0, all other MPFS indicators/values = 99212

G9487 (Remote E/M est. patient 15 mins) has a PE RVU = 0, all other MPFS indicators/values = 99213

G9488 (Remote E/M est. patient 25 mins) has a PE RVU = 0, all other MPFS indicators/values = 99214

G9489 (Remote E/M est. patient 40 mins) has a PE RVU = 0, all other MPFS indicators/values = 99215

G9490 (Joint replace mod home visit) with all MPFS indicators & RVUs = those of G9187.

Codes G9481-G9490 are new and are assigned Type of Service 1 Medical care.

Source: MLN Matters MM9531

Recent ICD – 10 Changes in Nephrology, Cardiology and Pediatrics Medical Billing

A Big Change – ICD-10 in Nephrology, Cardiology and Pediatrics Medical Billing

Nephrology, along with cardiology and, pediatrics will be tougher smash than other specialties during the ICD-10 transition. The National Kidney Foundation states that 26 million adults have chronic kidney disease (CKD).   Nephrology will see significant changes to coding; Errors in application of new coding can impact the billing of your patients.  Take steps to learn the coding and prepare for a smoother transition.

New Coding for Your Nephrology Practice

New multiple ICD-10 codes make it all more necessary for the staff’s to educate early in order to avoid billing complications.

Some of the highlights include:

  1. Various codes required for coding diabetic CKD. ICD-9 has a single code for diabetes but the ICD-10 has 5 codes.  One references the stage of CKD and the other is indicative of the form of diabetes with CKD.  ICD – 250.40, Diabetes type 2 or unspecified with renal manifestation not stated as uncontrolled will be coded as E11.22, Diabetes type 2 with diabetic chronic kidney diseases and N18.1-N18.6, CKD stage, or E11.29, Diabetes with other diabetic kidney complication (renal tubular degeneration).
  2. Hypertensive CKD takes two codes in ICD-10. The first code is to indicate that the patient exhibits hypertension and CKD, the second code is for the level of CKD.
  3. Hypertension coding decreases. I10, essential (primary hypertension), the new coding under ICD-10, denotes for 401.0, malignant essential hypertension, 401.1, benign essential hypertension, and 401.2, unspecified essential hypertension. The same type of pattern occurs with 403.00, 403.10, and 403.90 which fall under I12.9.  Also 403.01, 403.11 and 403.91 become I12.0.
  4. CKD codes have a single code in reference to their stage. For example, chronic kidney stage III, originally coded as 585.3, becomes N18.3 in ICD-10.  Codes begin with a letter, except for U, followed by three to up to seven digits. There are exceptions to this application in ICD-10 coding as in the coding for chronic gout, M1a.
  5. ESRD coding is a direct one-to-one conversion, as well as acute renal failure coding. Other common condition coding changes include over fluid overload, edema, and hyperlipidemia other and unspecified.

Justin Derkack, ICD-10 Coding project manager at Bristol Healthcare Services, recommends that practices give themselves generous time to make the transition to ICD-10.   “It takes time to start rolling out the effort. If you wait too long, the ramp up time will be tremendously difficult.  You need to get lots of people on the same page and that doesn’t happen overnight.”

Postponing ICD-10 Transition Could Cost Your Practice Lot of Money!

All of the changes that influence Nephrology coding in ICD-10 make it commanding that providers take the time to guarantee that all required staff are competently trained and that the internal systems in place can submit the new coding and manage their medical billing efficiently.

How to Become a Certified Medical Coder?

Medical coding is vital to the healthcare facilities all over the world and has become one of the leading job markets in the country today. It is considered as a future profession for todays’ younger generation as it offers rewarding job. According to statistics, the job sector in medical coding is expected to grow sooner than expected throughout 2015. This is mainly due to the constant demands and requirements of the medical industry as a whole. Initially, there was an increase in the population growth leading to high level of scrutiny for healthcare procedures met by the insurance companies. Owing to this, the future healthcare industry will require more and more certified medical coders to meet the demands of the insurance firms.

Medical Coding is certainly a profession that is quite promising, especially for individuals who are considering a good start-up to boost their career.   Though a proper educational degree is not a must, a complete know-how of the basics of medical coding and billing along with an accredited certificate from AHIMA (American Health Information Management Association) or the AAPC (American Academy of Professional Coders) is necessary. With this certificate in hand, you can certainly earn a decent income depending on your experience and the nature of task allotted to you. In order to secure managerial positions, you need to have a thorough knowledge about the CPT surgical & non-surgical coding, medical terminology, pathology, pharmacology, anatomy, healthcare ethics & laws, physiology and much more. The primary role played by the certified medical coders is to assign standardized alphanumeric codes for multiple services offered by the physicians. Based on these codes, the insurance companies are promptly billed in order to obtain timely payment for the medical practitioners.

Medical coders are not only high in demand in hospitals, clinics, nursing homes and healthcare centers, they are also required in medical coding & billing companies, insurance agencies, law firms, healthcare agencies, consulting firms and much more. Medical coding is a profitable option for those who are interested in pursuing this area of healthcare management as it is sure to open up new prospects in employment in the near future. There are even online certification programs in Medical Coding offered by various institutions to equip all aspirants with the requisite knowledge on medical coding.

Certified Medical Coders work under various time settings which depend on the kind of institution they are working in. Most of them work in shift basis as the healthcare sector is open for 24 hours a day. At times, the Certified Coders need to cope up by working for approx. 40 hours per week or they are given an option to work from their home settings. This is a great option for the Certified Medical Coders, especially women who want to work in that kind of relaxed environment with their own preferred work settings.

Medical coding is a pertinent part of the healthcare industry and hence there will definitely not be any drastic effects of recession in pursuing this career.