Free Otolaryngology Coding Resource: Q&As on Flexible Laryngoscopic Procedures From AAO-HNS

The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) provides numerous valuable, free and members-only resources on billing and coding on its website.

One free ENT resource that was approved earlier this year is three Q&As on flexible laryngoscopic procedures.

The questions AAO-HNS addresses are as follows:

  • How do I code for percutaneous laryngeal injections using flexible endoscopic guidance?
  • What if the laryngeal injection is done through the flexible scope?
  • Is flexible laryngoscopy using a distal chip scope also coded with 31575-31578?

Access these Q&As on flexible laryngoscopic procedures.

ENT, immunology and allergy billing and coding is extremely complex and challenging. Failing to properly code and bill for services in these specialties can not only result in money left on the table but also heavy fines from CMS.

Contact PGM Billing, one of the nation's leading providers of physician billing services, to find out how we can work with your allergy, immunology or ENT practice to help ensure you receive proper compensation for services provided and keep you out of legal hot water.

Same-Day Billing Guidelines for Mental Health Services

Last September, CMS published a Medicare Learning Network brochure on mental health services.

Included in this brochure is an informative section discussing same-day billing guidelines. Note: The information in this section, and publication, applies only to the Medicare Fee-For-Service Program, also known as Original Medicare.

According to CMS, integration of the following services is an approach to healthcare that can better address the needs of all individuals, including those with mental health and substance use conditions:

  • Mental healthcare services (which under the Medicare program includes treatment for substance abuse);
  • Alcohol and/or substance (other than tobacco) abuse structured assessment, and intervention services (SBIRT services) billed under Healthcare Common Procedure Coding System (HCPCS) codes G0396 and G0397; and
  • Primary healthcare services.

This is regardless of whether a patient is receiving care in a traditional primary care setting or a specialty mental or substance use healthcare setting.

CMS notes that Medicare Part B pays for reasonable and necessary integrated healthcare services when they are furnished on the same day, to the same patient, by the same professional or a different professional. This is regardless of whether the professionals are in the same or different locations.

The following are recognized as being eligible under Part B to provide diagnostic and/or therapeutic treatment for mental, psychoneurotic, and personality disorders as well as Medicare SBIRT services, to the extent permitted under state law:

  • Physicians (medical doctors and doctors of osteopathy), particularly psychiatrists;
  • Clinical psychologists;
  • Clinical social workers;
  • Clinical nurse specialists;
  • Nurse practitioners;
  • Physician assistants;
  • Certified nurse-midwives; and
  • Independently Practicing Psychologists.

In general, Medicare-covered services are those services that are considered medically reasonable and necessary to the overall diagnosis or treatment of the patient’s condition or to improve the functioning of a malformed body member. Services or supplies are considered medically necessary if they meet the standards of good medical practice and are:

  • Proper and needed for the diagnosis or treatment of the patient’s medical condition;
  • Furnished for the diagnosis, direct care, and treatment of the patient’s medical condition; and
  • Not mainly for the convenience of the patient, provider, or supplier.

Services must also meet specific medical necessity criteria defined by National Coverage Determinations and Local Coverage Determinations. For more information about the Medicare coverage determination process, visit the CMS website. For every service billed, CMS advises that you must indicate the specific sign, symptom or patient complaint necessitating the service. Although furnishing a service or test may be considered good medical practice, Medicare generally prohibits payment for services without patient symptoms or complaints or specific documentation.

Medicare also pays for multiple mental health services furnished to the same patient on the same day. However, the Medicare program prohibits inappropriate and/or duplicate payment for services furnished on the same day. In general, CMS advises you to consult with your local Medicare Administrative Contractor (MAC) to determine if local or national policies may prevent you from billing for certain services on the same day. To find MAC contact information, refer to the CMS website.

Mental health billing guidelines are complex. Services are often rendered in multiple facilities and locations, and coverage for diagnosis and treatment varies widely. It takes a significant amount of time to learn the guidelines — guidelines that are frequently updated and revised.

PGM Billing is a leading provider of mental health billing services. PGM has a core team of medical billing specialists that work closely with practices to identify problem areas and provide education on appropriate billing practices and procedures.

To learn more about our PGM's mental health medical billing services, request a free demo today.

Free Emergency Medicine Billing Resource: 'ICD-10 For the Busy Emergency Physician' Manual

The American College of Emergency Physicians provides a free, informative manual on ICD-10 you can access regardless of whether you are a member of ACEP.

Titled "ICD-10-CM For The Busy Emergency Physician" (pdf), ACEP says it was created by ED physicians for ED physicians to help provide an easy to read, clinically based reference. 

Sections in the manual include the following:

  • What is ICD-10-CM?
  • Comparison of ICD-9-CM to ICD-10-CM
  • Key ICD-10-CM Concepts Severity of Illness
  • Key ICD-10-CM Concepts First Listed (Principal) Diagnosis
  • Key ICD-10-CM Concepts: Signs and Symptoms/ Unspecified
  • Key ICD-10-CM Concepts: Episodes of Care for Injuries and Poisonings, Initial Encounter
  • Key ICD-10-CM Concepts: Enhanced Anatomic Specificity
  • Key ICD-10-CM Concepts: Sprains and Strains
  • Key ICD-10-CM Concepts: External Cause of Injury

Access the emergency medicine ICD-10 manual (pdf).

The transition to ICD-10 will create significant coding and billing challenges for emergency medicine. Providers are likely to face disruptions in their payments and will find submitting accurate, complete claims challenging due to the significantly more complex, detailed nature of the ICD-10 code set compared to ICD-9.

To reduce the negative impact of the transition while cutting the costs associated with employing medical billers, outsource your billing to an emergency medicine billing company such as PGM Billing. PGM is one of the nation's leading medical billing agencies, with more than 30 years experience of coding and billing experience. The PGM team of certified medical billing and coding experts will manage all aspects of your billing, ensuring you receive proper compensation for services provided.

What Does a Medical Laboratory Technician Do?

With the improvement in the medical health care facilities, there has been a phenomenal increase in the average life span of a person. There has been a steep increase in the diagnostic facilities and this has also spawned an increase in the need of Medical Lab Technician. The scope for a Medical Lab Technician is bound to increase in the coming months and the career prospects are excellent for anyone who is opting for a career as a Medical Laboratory Technician. However before jumping into a career in this paramedical field, it is important that you have a firsthand knowledge of how it is accomplished.

What does a medical laboratory technician do?

This question may evoke a rather ambiguous answer since it depends upon the placement of employment. The basic and general answer to this question is that a medical laboratory technician who performs laboratory tests and procedures.

The medical laboratory technician has to clear a certificate program or associated degree where they learn the different aspects of the job. There are some who take the exam directly and become certified which states that they have obtained the necessary skills to potential employers. However such incumbents have to have a certain number of years associated with the paramedical field and must be able to furnish the appropriate proof in this effect.

One of the most important parts of the Medical Laboratory Technician certificate or diploma is to teach the incumbents how to keep themselves and their associates safe from accidental contamination from the infectious fluids which they would be collecting for analysis.

Clinical laboratory technologists play a very crucial part in the detection and diagnosis of any disease. With increasing burden on the Doctors, a need was felt for the outsourcing of some of the load on the doctors by having a separate component in the healthcare sector that can look into the Laboratory testing aspects. These important lacunas are filled by the Clinical Lab Technologists who take upon themselves the task of conducting different tests in the clinical laboratory. Clinical lab technologists are entrusted with many important tasks such as

  • Analyzing body fluids, and cells
  • Identify different bacteria, parasites, and other microorganisms
  • Analyze the chemical content of body fluids such as CSF, Semen and urine
  • Testing the blood groups and "Rh" factor before transfusion
  • Testing the drug levels in the blood and the efficacy of the drugs
  • Preparing specimens for examination like tissue mounting for testing the nature and the malignancy if any
  • Identifying abnormal cells in blood and body fluids
  • Proficiency of operating microscopes and sophisticated laboratory equipment's

A medical technician prepares specimens of different body fluids for analysis and also performs a number of automated tests as well as manual tests. However they are not qualified to make any inference or assess the results which remain the sole jurisdiction of the doctors. However they stringently follow the instructions given for the tests.

The tests can include a wide range of tests such as:

  • Test for abnormalities in the blood and the body fluids
  • Efficacy of drugs
  • Blood type
  • The strain of Bacteria
  • Parasites
  • Microorganisms
  • Sensitivity of organisms against different antibiotics

Most of these procedures are done by Medical Laboratory Technicians. Medical Laboratory Technician works with different equipments to analyze samples that have been given to them and this includes microscopes, cell counters, and a lot of automated and computer equipment that can do a lot of different tests at the same time. As more and more tests are becoming automated the importance of Medical Laboratory Technicians are increasing.

Top Billed Chiropractic Codes: ICD-9 to ICD-10 Conversion

Priority Health, a Michigan-based health plan, provides a valuable, free resource for chiropractors.

The one-page resource identifies top billed chiropractic ICD-9 codes, along with their general description, and then provides the corresponding ICD-10 diagnosis code(s).

Oct. 1, 2015 was recently confirmed as the new ICD-10 transition compliance date for healthcare providers.

The Priority Health resource provides the ICD-9 to ICD-10 conversion (pdf) for diagnoses that include:

  • Cervicalgia
  • Lumbago
  • Nonallopathic lesions of the head, cervical, thoracic, lumbar, sacral and pelvic region
  • Neck and lumbar sprains
  • Displacement of lumbar intervertebral disc without myelopathy
  • Closed dislocation of vertebra

CMS estimates that a majority of chiropractic claims fail to meet one or more documentation requirements. PGM Billing has more than 30 years of experience in chiropractic billing. Contact PGM to learn how its team of certified medical coders and billing experts can manage all aspects of your chiropractic billing to help ensure you're not leaving money on the table or raising red flags.



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