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I heard that some insurances will start denying ICD-10-CM codes starting in April and May is this true?

The chief complaint and HPI must be attributed to one of these: 2 or more self-limited or minor problems; 1 stable chronic illness, 1 acute uncomplicated illness or injury; 1 stable acute illness; 1 acute uncomplicated illness or injury requiring hospital inpatient or observation. Once you attributed the visit to one of these, you provide a focused exam on the problem(s) and then most likely will not satisfy data element, so provide a specific diagnosis drawn from the exam and reasons why they were there, then jump to what makes this MDM low risk. A perfect example is requesting the patient to take an OTC medication. You need to be specific and example might be: OTC Medication Management: Tylenol 325mg, take 1-2 tablets every 4-6 hours while symptoms last.

I want to be paid for an E&M 99213, what are the key components in my medical record that allows me to pass an audit?

I received a request from Optum representing UHC to send in my medical records for a minor procedure. Should I be concerned about a “Pre-Payment” review? Is there any advice on what to do?

I asked one of our leaders this question and I agree with Dr. Ed Pryzchchek: in order to be considered a new patient, they cannot have been seen by “…the exact same specialty and subspecialty, who belongs to the same group practice, within the last 3 years.” He made a very good point that “however, as I thought about this, I could think of 1 possible exception. That would be if the ortho group already has 1 podiatrist who actually saw this patient within the last 3 years, and now they are adding a 2nd podiatrist who is now seeing this patient. If an ortho group has now a 2nd podiatrist in the group, the one asking the question, it would not be new in this scenario.”

Hello djfreedman. The coding for new or existing patient is based upon the individual providers NPI number. If the patient was never seen by you, even though they were seen in the orthopedic practice and any old claims had the practice NPI, you can still bill this patient as a new patient, if they are new to you, utilizing your personal NPI number.

QUESTION: I have closed my office, and I joined an orthopedic group. If I am seeing a patient that is new to me, but has been seen within 3 years by other doctors in the practice, am I allowed to bill it as a new patient encounter? Thank you.

Blue Choice Carefirst denied a PTP edit CPT 11721-59 when billed with CPT 11056 with a denial reason code of “ccy”, I have never heard of this edit do you know what it is? I looked on their website and can’ find this anywhere! So, the we did some digging into this It turns out the EOB stated “ccy” and on the EOB=Provider must submit a valid modifier procedure code combination, really?

It turns out that CMS decided the LCA terminology was not appropriate. In addition to the LCD, CMS has the contractors now using either or both “LCD Reference Article” and “Billing and Coding Article” to outline payment and coding.

Did Medicare do away with the LCA’s?

ANSWER: When you look up ICD-10-CM code- I73.89, this is what you see: * I73.8 Other specified peripheral vascular diseases * Excludes1: diabetic (peripheral) angiopathy (E08-E13 with .51-.52) This means you must use E11.51 or E11.52 not I73.89 with E11.40

I just got back an EOB and the insurance denied my E&M when I used I73.89 with E11.40, why?