Companies Need To Know What To Do To Avoid Commercial Litigation

Posted by Jane Markovich on September 30th, 2016
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Cover ups in the corporate world do happen quite often, but we’re not talking conspiracy theories here. We’re talking about employees not reporting certain incidents, and we’re talking about all kinds of people sweeping things under the rug when it comes to business dealings. It happens on the customer side of things, and it happens within companies as well. These situations can fester, and they are just one reason why commercial litigation happens all too often. It can definitely be avoided a lot of the time if problems are addressed early enough. Businesses also need to pay close attention to problems that seem to arise all too frequently. There are always going to be issues, but if a certain type of problem is often reoccurring, it needs to be focused on so that changes can be made. As well, it’s also about prevention, meaning that risks should be assessed for businesses on an individual basis. As you can imagine, it’s more than just about addressing issues, as it’s also about proper communication in general. When communication breaks down in different ways, all kinds of problems can arise. Surely, they won’t all lead to commercial litigation, but they are problems nonetheless. It can also be helpful to have a legal department keeping tabs on everything in relation to your company. If you don’t have a legal department, you can always speak with a lawyer who handles these matters. A good commercial litigation lawyer can help you mitigate risk and prevent you from needing him or her for handling court cases and civil suits related to your business. What else can you do? Document everything including all negotiations, and make sure you ask questions when necessary. You never want to be left in the dark about matters related to your business. Vetting employees properly is also important, meaning background checks. Does your business do everything it can to avoid litigation?

Am I Going On Vacation Next Year (Monday September 26 2016)?

Posted by Jane Markovich on September 28th, 2016
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Today is my forty fifth birthday and I am spending the day just chilling in my apartment. Actually I am currently on a weeklong vacation from my place of employment. Next year, I might want to go on vacation somewhere like Hawaii or maybe to Australia (where the majority of expenses will be for airfare to fly over there and back). I have never been to Hawaii and my last & only trip to Australia was back in December of 2003 with my girlfriend at the time and I have been itching to go back every since.

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mammaplasty coding

Posted by Jane Markovich on September 19th, 2016
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Skin tags, or dermatofibromas, are fleshy, pedunculated growths that can occur anywhere, but most often arise on the neck, axillae, or groin area. They are usually removed with electrodessication or with a scalpel or scissors. Frequently, local anesthesia is used for this procedure. Because skin tags generally occur in clusters, and are simple to remove, they are coded separately from the destruction of other types of skin lesions. The CPT® 11200Removal of skin tags, multiple tags, any area; up to and including 15 lesions code for skin tag removal includes the first 15 lesions removed. The CPT® +11201 … each additional 10 lesions (List separately in addition to code for primary procedure) code is used for each additional 10 lesions. For example, if 25 lesions are removed, code both 11200 and 11201.


Many skin lesions are recognized easily as requiring removal without needing a biopsy. Typically, this would include actinic keratoses (crusty areas of sun damaged skin), irritated seborrheic keratoses (a brownish, raised, benign skin growth), and warts. These lesions are often simply destroyed. Commonly, this is performed with cryotherapy (often using liquid nitrogen) or electrocautery (aka electrodessication). Often, keratoses and warts are multiple, and the precise count of treated lesions is necessary when selecting the correct codes.

Usually, moles and other skin lesions require complete removal, or excision. The proper code selection depends upon whether the lesion is benign or malignant, so coding often waits until the pathology report is available. Physicians usually document the lesion size, which may vary. Be sure your physician gives you the total size of the excision, including the margins of tissue removed plus the lesion width. This total size is used to determine the correct excision code. There are illustrations in the CPT® Surgery Section that explain this point.

In family practice, most lesion excisions involve simple repair, which is included in the excision code. However, if the repair is more complex, such as requiring a layered closure or moving adjacent tissue to cover the wound, a separate wound repair code may be applicable.

Communicate for Correct Coding

When applying coding rules to skin condition treatments, it’s important that the medical record give precise information about the condition treated. If the record is unclear, the door is opened for the coding staff to discuss the care and treatment with the provider. This discussion is a valuable opportunity for the coder to explain the documentation essentials for proper coding and payment. Working together in this way, health care providers and coding professionals achieve their common goals of reducing audit liabilities and enhancing practice revenue.

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Heterograft coding

Posted by Jane Markovich on September 18th, 2016
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Brachial plexus 64415Axillary 64417Sciatic 64445Femoral 64447Other peripheral nerve or branch 64450Examples of nerve block procedures with anesthetic delivered by continuous infusion by catheter include:Brachial plexus 64416Sciatic 64446Femoral 64448Lumbar plexus 64449Coding Tips:Modifier 51 is appended to reflect an additional procedure performed at the same session by the same provider.Modifier 59 is appended to indicate a procedure or service was distinct or independent from other services performed on the same day. It also identifies procedures/services that are not normally reported together, but are appropriate under the circumstances.The insertion and administration of an epidural or major nerve catheter (CPT codes 62318, 62319, 64416, 64446, 64448, and 64449) by an anesthesiologist for anesthesia purposes during a surgical procedure is included in the anesthesia management service code and is not separately reimbursable. The appropriate anesthesia code must be submitted with an anesthesia modifier(s) and time for the procedure.An injection or catheter insertion before, during, or following the surgical procedure for postoperative pain management is a separately reimbursable service. Modifier 59 must be appended to the appropriate procedure code to indicate a distinct procedural service was performed.Example: A patient has an epidural block with sedation and monitoring for arthroscopic knee surgery. The anesthesia practitioner reports CPT code 01382 (Anesthesia for diagnostic arthroscopic procedures of knee joint). The epidural catheter is left in place for postoperative pain management. The anesthesia practitioner should not also report CPT codes 62311 or 62319(epidural/subarachnoid injection of diagnostic or therapeutic substance), or 01996 (daily management of epidural) on the date of surgery. CPT code 01996 may be reported with one unit of service per day on subsequent days until the catheter is removed.On the other hand, if the anesthesia practitioner performed general anesthesia reported as CPT code 01382 and at the request of the operating physician inserted an epidural catheter for treatment of anticipated postoperative pain, the anesthesia practitioner may report CPT code 62319-59 indicating that this is a separate service from the anesthesia service. In this instance, the service is separately reportable whether the catheter is placed before, during, or after the surgery. Anesthesia Claim ModifiersPhysicians report the appropriate anesthesia modifier to denote whether the service was personally performed, medically directed, or medically supervised. One of the following modifiers must be reported with anesthesia services in the first modifier field to indicate who performed the anesthesia service:AA - Anesthesia services performed personally by the anesthesiologistAD - Medical supervision by a physician: more than four concurrent anesthesia proceduresQK - Medical direction of two, three or four concurrent anesthesia procedures involving qualified individualsQX - CRNA service: with medical direction by a physicianQY - Medical direction of one Certified Registered Nurse Anesthetist by an anesthesiologistQZ - CRNA service: Without medical direction by a physicianThe following modifiers can be reported in the 2nd position under appropriate circumstances in addition to one of the previous anesthesia modifiers:QS - Monitored anesthesia care service23 - Unusual anesthesia. Note: When using modifier 23, appropriate documentation must be submitted with the claim.Medical coding training online

Repeat Laboratory Test coding

Posted by Jane Markovich on September 12th, 2016
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Minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. At times, while a primary operating physician may plan to perform a surgical procedure alone, however, during an operation circumstances may arise that require the services of an assistant surgeon for a relatively short time. In this instance, the second surgeon provides minimal assistance, for which he/she reports the surgical procedure code with the 81 modifier appended.

Although the intent of the assistant surgeon modifiers is to report physician services, many users report the modifiers for a variety of nonphysician surgical assistant services. The most common misinterpretation of the assistant surgeon modifier is to report PA or NP assistant surgical services.

For example, Medicare allows claims for nurse practitioners and other non-physicians assisting in surgery. Providers simply must append modifier AS (physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery) to the surgical code. Furthermore, “modifier 80, 81 or 82 [assistant surgeon (when qualified resident surgeon not available)] must also be billed when modifier AS is billed” or the claim will be returned to the provider.

Although, from a CPT perspective this is not the intended use of the assistant surgeon modifiers, Medicare is not alone in establishing its own guidelines for reporting assistant surgeon services.

Since each third-party payer may establish reporting guidelines that vary from CPT guidelines, a clear understanding of each is essential.

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Anesthesia reimbursement coding

Posted by Jane Markovich on September 9th, 2016
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Moderate sedation (conscious sedation) is defined as a drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accomplished by light tactile stimulation. No interventions are required to maintain a patient airway, spontaneous ventilation is adequate and cardiovascular function is usually maintained.

Regional anesthesia is anesthesia affecting only a large part of the body, such as a limb or the lower half of the body. Regional anesthetic techniques can be divided into central and peripheral techniques. The central techniques include so called neuraxial blockade (epidural anesthesia, spinal anesthesia). The peripheral techniques can be further divided into plexus blocks such as brachial plexus blocks, and single nerve blocks. Regional anesthesia may be performed as a single shot or with a continuous catheter through which medication is given over a prolonged period, e.g., continuous peripheral nerve block.Regional nerve blockade, or more commonly nerve block, is a general term used to refer to the injection of local anesthetic onto or near nerves for temporary control of pain. It can also be used as a diagnostic tool to identify specific nerves as pain generators. Permanent nerve block can be produced by destruction of nerve tissue.Medical coding training online

Preventive Services coding

Posted by Jane Markovich on August 29th, 2016
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Appending modifier TC Technical component indicates that only the technical component of a service/procedure has been provided. Generally, the technical component of a service/procedure is billed by the entity that provides the testing equipment.


Physicians providing services for Medicare patients in a hospital or facility setting cannot claim the technical portion of a procedure. Under the diagnosis-related group (DRG), the hospital/facility receives payment for the technical component of Medicare inpatient services. Similarly, Medicare rules require that payment for non-physician services provided to hospital patients (such as the services of a technician administering a diagnostic test) are made to the hospital.


Just as there are codes that describe professional-only services for Medicare, so are there codes describing technical component-only services (e.g., 93005 Electrocardiogram; tracing only, without interpretation and report).


A “global” service includes both the professional and technical components of a single service. When reporting a global service, no modifiers are necessary to receive payment for both components of the service.

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tonsillectomy and adenoidectomy coding

Posted by Jane Markovich on August 28th, 2016
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The technical component of a diagnostic service/procedure accounts for equipment, supplies, and clinical staff (such as technicians). Payment for the technical component also includes the practice expense and the malpractice expense. Fees for the technical component generally are reimbursed to the facility or practice that provides or pays for the equipment, supplies, and/or clinical staff.

Procedures/services that may include both a professional and technical component are found commonly within the “Radiology,” “Pathology and Laboratory,” and “Medicine” sections of the CPT® codebook.


Separate payment may be made for the technical and professional components of a procedure if, for example, a clinic provides the technical component of a service/procedure, while an individual physician performs the professional component. In such situations, each provider must submit a claim and bill only for the service performed.


To identify professional services only for a service/procedure that includes both professional and technical components, append modifier 26 Professional component to the appropriate CPT® code, as instructed in CPT® Appendix A (“Modifiers”). Note that modifier 26 is appropriate when the physician supervises and/or interprets a diagnostic test, even if he or she does not perform the test personally. Do not append modifier 26 if there is a dedicated code to describe only the professional/physician component of a given service (e.g., 93010Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only).

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Howard Hewitt – Latest Unsung (Wednesday, August 24, 2016)

Posted by Jane Markovich on August 27th, 2016
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The latest unsung episode aired earlier tonight and it featured legendary rhythm and blues performer Howard Hewitt. I forgot how incredible his voice is especially on the earlier Shalamar songs from the mid to late 70s and early 80s. He is one the list of increible Rhythm and Blues singers like Teddy Pendergrass, Johnny Gill, The Leverts – father and son – Eddlie and Gerald, Marvin Gaye, Luther Vandross, etc, etc, etrc. As I type this, I am reminded that I need to put together a playlist featuring all of these gentleman that I can listen to when I get the feeling to.

Ultrasound coding

Posted by Jane Markovich on August 25th, 2016
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Mutually exclusive edits identify code pairs that Medicare has determined, for clinical reasons, are unlikely to be performed on the same patient on the same day. For example, a mutually exclusive edit might identify two different types of testing that yield equivalent results. When two mutually exclusive services are submitted on a claim, only the service of lesser value will be reimbursed.

Table 1 provides a short sample of Column 2 edits for CPT code 12001 (Simple wound repair, up to 2.5 cm). CPT code 64450 (peripheral nerve/branch block) in Column 2 is considered an integral part of the Column 1 service, but a modifier is appropriate to override the CCI edit for 64450 in combination with 12001 if the block is for a separate session, separate injury or separate anatomical area.

HCPCS Level II code G0168 (Dermabond repair) is also considered an integral part of the simple laceration repair 12001 and a modifier is allowed to bypass the NCCI/CCI edit. Although you would not typically report both 12001 and G0168 for the same beneficiary on the same date of service, it is clinically conceivable that you would repair 2 distinct wounds on a single patient, one utilizing Dermabond and a second a simple repair utilizing sutures.

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