OK, SO HOW IS THIS GOING TO HELP ME ON MONDAY? DISCLAIMER DISCLAIMER

Transcription

1 OK, SO HOW IS THIS GOING TO HELP ME ON MONDAY? Presented by Harry Goldsmith, DPM Tony Poggio, DPM DISCLAIMER Don t blame Samuel Merritt, Codingline, our sponsors, or the people of Oakland for the content of this talk, our attempts at humor, or your bad luck... DISCLAIMER Not everything we say is true for all payers in all cases 1

2 STATEMENT OF FACT: Just because you got paid doesn t mean you billed it right or that the payer won t eventually wake up CORRECT CODING ADDING TO YOUR BOTTOM LINE WARTS AND ALL New for 2007 err, this is a biggie CPT CPT warts 15 and beyond warts CPT 17000, CPT 17003, CPT

3 Next THE NASTIEST CUT OF ALL 0.2 cm each 2 cm 2 cm cm cm = 2.4 cm 3

4 Next DEFINING EXCISION CPT 1142x vs. CPT CPT CPT 11426: Excision of benign lesion (specified by size of lesion and margins) CPT CPT 17111: Destruction of benign lesion, any method (specified by number of lesions destroyed) 4

5 Next FORMS 5

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8 WOUND: DOCUMENTATION WOUND: DOCUMENTATION WOUND: DOCUMENTATION 8

9 PODIATRY INSTITUTE Next MOTION ANALYSIS 9

10 MOTION ANALYSIS Next BROUGHT TO YOU BY Provider Beware Split billing for diagnostic testing in your office provided by outside companies Nerve Conduction, EMG Non-Invasive Vascular Diagnostic Ultrasound Physical Therapy MRI etc 10

11 Next CHECKING EM TWICE Pre-Auths: Investigation/Experimental Subtalar arthroereris (aka arthroereisis) (CPT 28899) Smaller joint arthroscopy (MTPJ, subtalar) OATS procedure on the foot Radiofrequency/cryosurgery/coablation of musculoskeletal structures CHECKING EM TWICE Pre-Auths: Investigation/Experimental Platelet Gel Implant Certain custom foot orthotics? (L3000) ESWT (CPT 28890) 11

12 ESWT (CPT 28890) Medicare (NHIC) Currently covered Reimbursement rate different for office and outpatient hospital Not covered ASC Do you want it covered? ESWT (CPT 28890) Non-Medicare With many payers it is NOT covered Always pre-authorize the service (coverage) Who knows how much the insurer assuming ESWT is covered will pay? Next 12

13 THE WHOLE ENCHILADA OK, THEN, WHAT IS REGIONAL ANESTHESIA? THE WHOLE ENCHILADA 13

14 Next EMR, DICTATION, SCRIBE Electronic medical records Dictation/transcription Your Own Scribe ELECTRONIC MEDICAL RECORDS 14

15 ELECTRONIC MEDICAL RECORDS We will make wider use of electronic records and other health information technology, to help control costs and reduce dangerous medical errors. (Applause.) God bless America. (Applause.) President George Bush, State of the Union, 2006 POTENTIAL BENEFITS OF EMR Quality documentation tool Increases productivity Prompts you Information delivered everywhere you want it delivered Searchable POSSIBLE NEGATIVE EMR ISSUES Takes more time to produce note than time seeing the patient Not ready for prime time The end product does make sense Too expensive Learning curve high; commitment required Tendency to rely on templates, clones, macros -making all records read the same 15

16 HERE S WHAT YOU WANT An EMR that is wholly integrated within your practice software (billing, scheduling) An EMR that was developed medically general, specialty specific Multiple avenues for adding records An EMR that allows you to individualize examination and decision making An EMR that prompts you to consider proper choices DON T CONSIDER PURCHASING AN EMR Until you understand both the negatives and benefits of acquiring an EMR Until you and your staff are committed to undergo the learning process ( trials and tribulations ), and are willing to make maximum use of the EMR potentials LOOK FORWARD TO AN EMR Saving you time Assisting you in developing a thorough, clear, quality individualized medical record a meaningful medical record Preventing things from falling through the cracks Increasing both your practice effectiveness and efficiencies 16

17 Next THE CASH PRACTICE Cash is good THE CASH PRACTICE Practices that deal in high volume, low dollar services are considered cash n carry Practitioners have come to rely on insurers to pay their fees Practitioners have lost sight of the value of their services 17

18 BENEFITS OF CASH You don t have to bill insurers You don t have to wait for payments You don t have the same level of payer hoops to jump through The patient becomes a consumer You hardly ever get audited Cost vs. Value Next 18

19 WHAT IF YOU HAVE? A Medicare at risk patient with 2 painful thick mycotic nails 8 long normal nails 2 corns? How do you code it? WHAT IF YOU HAVE? 2 painful thick mycotic nails CPT (or CPT Q8-59) 8 long normal nails CPT Q8 2 corns CPT Q8 Next 19

20 GLOBAL CONCEPTS How many global days are assigned to CPT (hammertoe correction)? Next 20

21 GLOBAL FRACTURE CODING When I have a patient with a closed fracture, should I bill the global fracture care codes, or should I bill each visit, x- rays, casting application, etc.? Next MEDICARE CAST SUPPLY CODES Q Cast Supply Codes - Q4037 Short leg cast, adult, plaster - Q4038 Short leg cast, adult, fiberglass - Q4039 Short leg cast, pediatric plaster - Q4040 Short leg cast, pediatric fiberglass - Q4041 Long leg splint, adult, plaster - Q4042 Long leg splint, adult, fiberglass - Q4043 Long leg splint, pediatric, plaster - Q4044 Long leg splint, pediatric, fiberglass - and 44 other cast supply codes 21

22 CAST SUPPLY CODES A Cast Supply Codes - A4580 Cast supplies (e.g. plaster) - A4590 Special casting material (e.g. fiberglass) Bill based on the number of rolls of casting material actually used (indicate # in the unit section of the HCFA 1500 claim form) Next AN ORTHOTIC QUESTION I have a colleague who has a diabetic patient who unfortunately had to have the left leg amputated. My colleague has been treating the patient s remaining right foot when one day the patient reported that she still had pain where her left foot should be. My colleague, of course, diagnosed phantom limb pain. 22

23 HIS DILEMMA He told me he was considering fabricating a phantom orthotic for the absent left foot. 1. Does he really have to make the phantom orthotic? 2. How would he bill for this? 3. Would this be considered fraud? ORTHOTIC CODING What is the code for the custom foot orthotics whether functional or accommodative that podiatrists typically dispense? CUSTOM FOOT ORTHOTICS 23

24 ORTHOTIC CODING L3000-RT L3000-LT AOPA GUIDE L3010 L

25 L3030 L3000 ORTHOTICS Why custom vs. pre-fab (stock) orthotics? What if the managed care plan pays too low? How should I handle the payer that is asking for a lab invoice? Can I collect a deposit? Can I bill for casting the orthotics? 25

26 ORTHOTIC CASTING CPT Unlisted casting code It s a professional service (not a technical service) Bill it once (represents bilateral impression casting) Do NOT bill A4580 or A4590 for supplies Force mat or computer scanning to obtain a model of the foot for orthotics has no code or allowance ORTHOTICS Can I bill for the plaster splints used? Can I bill for follow-up? Next 26

27 SURGERY CODING SURGERY CODING FIXED PICK A MODIFIER, ANY MODIFIER TA thru T9 LT RT 27

28 THE -22 MODIFIER DELAY So, what happens if there is a circumstance you are sure requires a -22 modifier? ARTHROPLASTY Huh? Hammertoe Correction CPT Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) 28

29 HAMMERTOE CODING CPT HAMMERTOE GLOBAL COMPONENTS Exostectomy, partial Digital tenotomies IPJ capsulotomies Tendon transfer (digit) IPJ implant SOMETIMES YOU GET LUCKY Metatarsal-phalangeal joint capsulotomytenorrhaphy Simple releases included in CPT Complete MTPJ release separately reimbursable (CPT 28270) 29

30 I&D I m supposed to bill CPT when I do an I&D of a paronychia, right? ANY LAST WORDS? Questions? Thank you, and thank our exhibitor/sponsors 30