Check the Vital Signs of Your Medical Practice-Part 1

A Medical Practice is a unique business in many ways, but it is still a business and must be treated as such.  Checking the health of your practice is similar to checking the health of your patients.  In this three part series, we will look at these Vital Signs, pulse, blood pressure and temperature, to help you assess the financial well-being of your medical practice.

We will begin in Part 1 with the Pulse -    

How many new patients are you seeing each month?

By analyzing the trends month over month, you will be able to calculate your current growth rate and estimate the potential need for increased staffing and other infrastructure changes.  If close monitoring of your patient numbers shows a progressive decline or steep increase, it can give you the opportunity to research the reason why.  One reason could lie in the next item on our list, referrals.

Who is referring those patients to you?

With the almighty internet, physicians have been able to reach out much more easily and cost effectively to a wider range of patients.  While many people with basic medical needs may feel comfortable doctor-shopping online, there are many who have complicated issues.  These referrals generally come from colleagues and satisfied patients.  Know which providers in your area are referring patients to your office and always keep the lines of communication open in regards to those mutual patients.  A happy, well-taken-care-of patient is the best advertising.  Many times less than stellar office staff can scare away patients who “love” their doctor, and those unpleasant episodes can make their way back to the referring colleague.  Watch for trends that would show a reduction in referrals from a particular source and take the time to reach out personally.   

These two reports are just a small sampling of the extensive selection of practice management reporting options built into the Report Center module of Iridium Suite Medical Billing Software.

Be sure to watch for the upcoming publication of Part 2:  Blood Pressure.

                                                      

Inaccurate or non-specific diagnosis coding can adversely affect your reimbursement of medical claims.

 

Many categories of the ICD-9 contain codes that represent the non-specified site of a certain neoplasm. The are typically indicated with a “9” as the last digit of the code.

Even though all of these codes are viable, accepted diagnoses, many payers, especially Medicare, highly encourage the use of the more “site specific” codes. Failure to be specific can in some instances cause Medical Necessity denials as the non-specific codes may not be listed as acceptable in the payers' Medical Policies. Also, if audited, a discrepancy between the treating diagnosis in the medical chart and the diagnosis submitted on a claim, could cause payment reversals and money due back to the payer.

In all medical specialties, the patient medical record should dictate what services are billed and the diagnoses used.

One specialty example is Radiation Oncology. The prescriptions for Radiation Therapy Treatment Courses are very site specific, so this information is one of the most helpful tools in proper diagnosis coding when used in conjunction with patient data the medical staff has entered into the medical record.

In any specialty, but quite frequently in Radiation Oncology, a patient can have numerous diagnoses that require treatment. In these instances, it is especially important to indicate the proper diagnosis priority on your services. The priority one diagnosis should always be the current treating diagnosis for the service you are billing.

Another frequent situation in Radiation Oncology billing arises when treating a patient for metastatic disease. The metastatic treatment site will be listed as the priority one diagnosis with the primary original site diagnosis listed as the second.

Other specialties would follow a similar scenario if they were treating a complication diagnosis, billed as priority one, from an initial diagnosis, billed as priority two.

Billing and coding software with comprehensive ICD -9 and ICD-10 code files, as well as an ICD 10 conversion crosswalk, such as Iridium Suite can assist your office in accurately billing the most specific diagnoses for the patients in your practice.

2013 Orthopedic Surgery CPT Code Changes and Additions

These are the highlights of the seven CPT code changes and a listing of numerous CPT code additions affecting Orthopedic Surgery billing in 2013.  Make sure you review the full CPT manual for complete details of all coding changes to insure you receive your optimum claim reimbursements.

                                                         
Spine CPT

Guideline Change: CPT codes 22633 and 22634 may be appropriately related as primary or index codes for spine bone grafts (20930–20938), instrumentation (22840–22844, 22848, 22845–22847), and intervertebral device (22851) codes.  

 Bone marrow aspirate

Clarification: Use of bone graft codes (20930–20938) related to bone marrow aspiration. CPT code 38220 defines the work associated with the harvest of bone marrow for bone grafting only. (Billing Note: Category III code 0232T should be used when bone marrow aspiration is performed for platelet-rich stem cell.) 

Cervical Spinal Arthrodesis Guideline

Guidelines Added:  CPT codes 22554, 22585, 63075, and 63076; if the work associated with these procedures is performed during the same surgery by the same surgeon or by two separate surgeons/individuals during the same session, the correct codes are 22551 and 22552. (Billing Note: CPT codes 63075 and 22554 may not be unbundled and reported for the same patient, same session.)

Cast application

Guideline Change:  Refer to the section “Application and Strapping” for specific changes regarding the application of the first cast, its removal, coding by the individual who performs the initial service, and restorative management. (Billing Note: CPT code 29590 (Denis-Browne bar (splint) with manipulation and casting (eg, for metatarsus adductus, clubfoot) was deleted.)

Hip arthroscopy

Clarification: CPT code 29916 (Arthroscopic labral repair of a torn labrum) is considered inherent to CPT codes 29915, 29862, and 29863. (Billing Note:  CPT code 29916 should not be reported in addition to CPT codes 29915, 29862, or 29863 because the repair is already included in these codes, whether as a takedown and repair or a repair of an already torn labrum.) 

Chemodenervation

Guideline Change:   CPT code 64614 (Chemodenervation of muscle(s); extremity and/or trunk muscle(s) (eg, for dystonia, cerebral palsy, multiple sclerosis) may only be reported once per extremity. The parenthetical (s) was removed from extremity. (Billing Note:  CPT code 64614 states that modifier 50 should not be appended to this code. Check with your payers to determine specific rules to code submission.)

Intraoperative nerve monitoring

Clarification: Intraoperative nerve monitoring by the operating surgeon is included in the primary surgical service and is not separately reportable.

Update your medical billing system with the following new CPT codes for 2013:
Spine

22586—Arthrodesis, pre-sacral inter-body technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, L5-S1 interspace 

0309T—Arthrodesis, pre-sacral inter-body technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft, when performed, lumbar, L4-L5 interspace (Billing Note: List 0309T separately in addition to code for the primary procedure 22586) 

Shoulder Arthroplasty

23473 - Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component.

23474 - Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component.

Elbow Arthroplasty

24370 - Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar component.

24371 - Revision of total elbow arthroplasty, including allograft when performed; humeral and ulnar component.

Nerve Conduction
 
(Billing Note:  Guideline instructions related to the reporting of electromyograms (EMGs) and nerve conduction studies (NCS) are found in the beginning of their respective CPT sections.)

 CPT codes 95900–95904 were deleted and replaced by the following CPT codes: 

95907—Nerve conduction studies; 1–2 studies

95908—Nerve conduction studies; 3–4 studies

95909—Nerve conduction studies; 5–6 studies

95910—Nerve conduction studies; 7–8 studies

95911—Nerve conduction studies; 9–10 studies

95912—Nerve conduction studies; 11–12 studies

95913—Nerve conduction studies; 13 or more studies

Extracorporeal Shock Wave: Wound Healing

Two new Category III codes for extracorporeal shock wave for wound healing were introduced: 

0299T—Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; initial wound

0300T—Each additional wound (Billing Note:  List separately in addition to code for primary procedure.)

Infrastructure is Key in Medical Billing Systems Software

If you answer yes to these questions below, then infrastructure is a main consideration when choosing your Medical Billing Practice Management solution.

Are you looking for a new medical billing software, but do not want to buy a bunch of new hardware?
Do you need Mac medical billing software to add I-Pads to use in your clinic or   hospital rounds?
Do you want to get rid of that clunky server under the desk?
 Do you want use web billing software that you can access from anywhere, even home, day or night?
Is creating workflow that fits your billing needs important?
Do you value real financial accountability?
As you perform your medical billing software comparison,  look for these key items:

• Web medical billing with no special hardware
• Compatible with Windows, Mac, Linux and other operating systems
• Maintained remote servers
• A system truly designed around the biller's workflow
• Customization of reports and in-depth accounts receivable analysis

Iridium Suite from Medical Business Systems brings you    
all the benefits of a great infrastructure, superb                
practice management reporting and much more.