New and Established CPT code list

A new patient is one who has not received any professional services from a physician or from another physician of the same specialty who belongs to the same group practice, within the past three years. Providers must use procedure codes 99201, 99202, 99203, 99204, and 99205 when billing for new patient services provided in the office or an outpatient or other ambulatory facility. New patient visits are limited to one every three years, per client, per provider.

An established patient is one who has received professional services from a physician or from another physician of the same specialty within the same group practice, within the last three years. Providers must use procedure codes 99211, 99212, 99213, 99214, and 99215 when billing for established patient services provided in the office or an outpatient or other ambulatory facility:

When an office visit is billed with the same date of service as a THSteps medical checkup or exception to periodicity visit, the office visit must be billed as an established patient visit. If a new patient visit is billed with the same date of service as a THSteps medical checkup or exception to periodicity visit, then the new patient visit will be denied.

Modifier 25 may be used to identify a significant, separately identifiable E/M service performed by the same physician on the same day as another procedure or service. Documentation that supports the provision of a significant, separately identifiable E/M service must be maintained in the client's medical record. The documentation must clearly indicate what the significant problem/abnormality was, including the important, distinct correlation with signs and symptoms to demonstrate a distinctly different problem that required additional work and must support that the requirements for the level of service billed were met or exceeded.

The date and time of both services performed must be outlined in the medical record and the time of the second service must be different than the time of the first service, although a different diagnosis is not required.

An established patient visit that is billed with the same date of service as a new patient visit by the same provider will be denied as part of another procedure except when the established patient visit is billed with a new THSteps medical checkup.

Office visits (procedure codes 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, and 99215) provided on the same date of service as a planned procedure (minor or extensive) are included in the cost of the procedure and are not separately reimbursed.

Office visit procedure code 99211, 99212, 99213, 99214, or 99215 must be billed by the same provider with the same date of service as a group clinical visit.

Procedures that are included in the E/M service (e.g., binocular microscopy, noninvasive ear or pulse oximetry for oxygen saturation, etc.) are denied as part of another procedure when billed by the same provider with the same date of service as one of the following office or outpatient consultation visit procedure codes:

Procedure Codes

99201

99202

99203

99204

99205

99211

99212

99213

99214

99215

99241

99242

99243

99244

99245

Emergency department-based physicians or emergency department-based groups may not bill charges for inconvenience or after hours services (procedure code 99050, 99056, or 99060)

Medicine CPT code List

Immunization Injections 90700 - 90749
Therapeutic/ Diagnostic Infusions ( excludes chemo) 90780 - 90781
Therapeutic or Diagnostic Injections 90782 - 90799
Psychiatry 90801 - 90899
Biofeedback 90901 - 90911
Dialysis 90918 - 90999
Gastroenterology 91000 - 91299
Ophthalmology 92002 - 92499
Special Otorhinolaryngologic Services 92502 - 92599
Cardiovascular 92950 - 93799
Non-Invasive Vascular Diagnostic Studies 93875 - 93990
Pulmonary 94010 - 94799
Allergy and Clinical Immunology 95004 - 95199
Endocrinology 95250
Neurology and Neuromuscular Procedures 95805 - 96004
Central Nervous System Assessments/Tests 96100 - 96117
Health and Behavior Assessment/Intervention 96150 - 96155
Chemotherapy Administration 96400 - 96549
Photodynamic Therapy 96567 - 96571
Special Dermatological Procedures 96900 - 96999
Physical Medicine and Rehabilitation 97001 - 97799
Medical Nutrition Therapy 97802 - 97804
Osteopathic Manipulative Treatment 98925 - 98929
Chiropractic Manipulative Treatment 98940 - 98943
Special Services Procedures and Reports 99000 - 99091
Qualifying Circumstances for Anesthesia 99100 - 99140
Sedation With or Without Analgesia 99141 - 99142
Other Services and procedures 99170 - 99199
Home Health Procedures/Services 99500 - 99539
Home Infusion Procedures 99551 - 99569

Identifying Adjustments and Voids on the Remittance Voucher

Adjustments on the Remittance Voucher

Adjustment requests are printed on the remittance voucher as two different claim entries.

The incorrectly paid claim is listed exactly as it was when it was originally reported. The transaction control number (TCN) for this entry is not the same as the original claim, but is a system-assigned, unique “credit” TCN. The original incorrect payment is credited back to Medicaid’s account. A minus symbol ( - ) appears just to the right of the incorrectly paid amount. The adjusted request is printed directly following the original claim entry.

Incorrect claim information on the original now shows as corrected. The difference between these two entries is the “NET” amount on the remittance voucher.

An Adjustment Reason Code (ADJ-R) and the TCN of the claim being adjusted are listed following the two claim entries. Adjustment reason codes are defined in the summary section of the remittance voucher.

Voids on the RV 

Void requests are printed as one claim entry. The entire claim is displayed and the payment amount is returned to Medicaid. A minus symbol ( - ) appears next to the amount.

Adjustment or Void Reason Codes

An Adjustment Reason Code appears with each adjustment or void shown on the remittance voucher. These numeric codes are explained on the remittance voucher.
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The Benefits of Outsourcing - Process of Medical Billing outsource

Are you a doctor who has a successful medical practice? Have you often heard friends suggesting you to switch outsourced medical billing if you are planning to expand your business further? If the answer to those two questions is “Yes!” you do not have to look any further. We are here to demystify the benefits of outsourcing for you.

First let’s understand what exactly outsourced medical billing is. Outsourcing your medical billing to a company that provides a more efficient solution to organize and arrange your medical billing records. These experienced firms bring their latest and trusted methods to manage your accounts after doing an in-depth analysis of your business. They may have one basic process but they fine-tune in to meet the needs of each client. So before you decide if you want to adopt this model for your business, let’s have a look at some of the benefits of outsourcing.

When you opt for an outsourcing firm to handle your medical billing, you can go back to doing what you do best. You can continue to be the friendly doctor you always dreamt to become, instead of constantly worrying about the financial aspects of the business. Healthcare billing has become quite complex in the last few years. Also the rules of insurance companies and other regulatory agencies change so frequently that it has become almost impossible to keep a tab on all of that. But when you pick a partner to handle your outsourced medical billing, they will resolve all your tensions. After all you have left the task of worrying to the experts.

Also with a company that is dedicated to your medical billing, the rate of defaulters is reduced. After all the company is only going to get paid if it completes the task it was assigned to do. Also, you may not believe it at first when we tell you; but you can actually lower your expenditure this way. It is true that the company will charge a fee for their services, but this cost will still be lower than what you would have spent to train your nursing staff to collect medical bills. And then you also have to worry about buying financial software with its constant updates. But the cost of this software is included in the outsourcing package now.

If you are still not happy with the benefits of outsourcing your medical billing, the last reason will surely make you reconsider your position. If you are suspicious that your employees are stealing from the medical bills, this is the best way to put that suspicion to rest once and for all. You still remain the head of the business, but you have only hired a company to handle one aspect of your business.  

ICD coding system

ICD coding system

ICD coding system

ICD (International Classification of Disease) is a coding system for which the first edition was published in 1900, and it is being revised at approximately 10-year intervals. The most recent version is ICD-10, which was published in 1992. WHO is responsible for its maintenance.

In US, the coding is still based on ICD-9-CM, which contains more detailed codes.
ICD consists of a core classification of three-digit codes, which are the minimum requirement for reporting the reason for the encounter. An optional fourth digit provides an additional level of detail. At all levels, the numbers 0 to 7 are used for further detail, whereas the number 8 is reserved for all other cases and the number 9 is reserved for unspecified coding.

The basic ICD is meant to be used for coding diagnostic terms, but ICD-9 as well as ICD-10 also contains a set of expansions for other families of medical terms. For instance, ICD-9also contains a list of codes starting with the letter “V” for reasons for encounter or other factors that are related to someone’s health status. A list of codes starting with the letter “E” is used to code external causes of death. The nomenclature of the morphology of neoplasms is coded by the “M” list.
The disease codes of both ICD-9 and ICD-10 are grouped into chapters. For example, in ICD-9, infectious and parasitic diseases are coded with the three-digit codes 001 to 139, and in ICD-10 the codes are renumbered and extended as codes starting with the letters A or B; for tuberculosis the three-digit codes 010 to 018 are used in ICD-9, and the codes A16 to A19 are used in ICD-10. The four-digit levels and optional five-digit levels enable the encoder to provide more detail. Table below gives examples of some codes in the ICD-9 system.

Example of a Four-Digit Code Level in ICD-9 and the Five-Digit Code Level as Extended by the ICD-9-CM
________________________________________
Code Disease
________________________________________
001 - 139 Infectious and parasitic diseases
001 - 009 Infectious diseases of the digestive tract
003 Other Salmonella Infections- 003.0 Salmonella gastroenteritis
- 003.1 Salmonella Septicemia
- 003.2 Localized Salmonella Infections
- 003.20 Localized Salmonella Infection, Unspecified
- 003.21 Salmonella Meningitis- 003.22 Salmonella Pneumonia
- 003.23 Salmonella Arthritis- 003.24 Salmonella Osteomyelitis- 003.29 Other Localized Salmonella Infections
- 003.8 Other Specified Salmonella Infections
- 003.9 Salmonella Infections, Unspecified
________________________________________
The U.S. National Center for Health Statistics published a set of clinical modifications to ICD-9, known as ICD-9-CM. It is fully compatible with ICD-9, but it contains an extra level of detail where needed. In addition, ICD-9-CM contains a volume III on medical procedures.

CPT Coding System

CPT Coding System

Current Procedural Terminology (CPT), Fourth Edition, is a listing of descriptive terms and identifying codes for reporting medical services and procedures. The purpose of CPT is to provide a uniform language that accurately describes medical, surgical, and diagnostic services, and thereby serves as an effective means for reliable nationwide communication among physicians, patients, and
third parties

The American Medical Association (AMA) first developed and published CPT in 1966. The first edition helped encourage the use of standard terms and descriptors to document procedures in the medical record; helped communicate accurate information on procedures and services to agencies concerned with insurance claims; provided the basis for a computer-oriented system to evaluate operative procedures; and contributed basic information for actuarial and statistical purposes.

The first edition of the CPT code book contained primarily surgical procedures, with limited sections on medicine, radiology, and laboratory procedures.
The second edition was published in 1970, and presented an expanded work of terms and codes to designate diagnostic and therapeutic procedures in surgery, medicine, and the specialties. At that time, five-digit coding was introduced, replacing the former four-digit classification. Another significant change was a listing of procedures relating to internal medicine.

In the mid- to late 1970s, the third and fourth editions of the CPT code were introduced. The fourth edition, published in 1977, represented significant updates in medical technology, and a procedure of periodic updating was introduced to keep pace with the rapidly changing medical environment. In 1983, the CPT code was adopted as part of the HealthCare Common Procedure Coding System (HCPCS) (Formerly called as HealthCare Financing Administration's (HCFA) Common Procedure Coding System) . With this adoption, HCFA mandated the use of HCPCS to report services for Part B of the Medicare Program. In October 1986, CMS also required State Medicaid agencies to use HCPCS in the Medicaid Management Information System. In July 1987, as part of the Omnibus Budget Reconciliation Act, HCFA mandated the use of CPT for reporting outpatient hospital surgical procedures. Today, in addition to use in federal programs (Medicare and Medicaid), CPT is used extensively throughout the United States as the preferred work of coding and describing health care services

Medicare

Medicare

Medicare is the federal (national) health insurance program for Americans age 65 and older and for certain disabled Americans. If individual is eligible for Social Security or Railroad Retirement benefits and are age 65, he and his spouse automatically qualify for Medicare.

Medicare has two parts: hospital insurance, known as Part A, and supplementary medical insurance, known as Part B, which provides payments for doctors and related services and supplies ordered by the doctor. If individual is eligible for Medicare, Part A is free, but insured must pay a premium for Part B.

Medicare will pay for many of insured health care expenses, but not all of them. In particular, Medicare does not cover most nursing home care, long-term care services in the home, or prescription drugs. There are also special rules on when Medicare pays patient’s bills that apply if patient have employer group health insurance coverage through his own job or the employment of a spouse.

Medicare usually operates on a fee-for-service basis.
Some people who are covered by Medicare buy private insurance

, called "Medigap" policies, to pay the medical bills that Medicare doesn't cover. Some Medigap policies cover Medicare's deductibles; most pay the coinsurance amount. Some also pay for health services not covered by Medicare. There are 10 standard plans from which individual can choose (some States may have fewer than 10.) If an individual buy a Medigap policy, he should make sure that he does not purchase more than one.