We all want to do a perfect job, report accurate claims, and
get the complete reimbursement for the services that are performed in
our services. And denial, of course, is something that we would never
want to see. But if you have been receiving denials on your Part B codes
lately, there could be a number of reasons. One important thing that
could be doing wrong is inaccurately linking the diagnoses listed on the
encounter form with the procedure codes. The codes you use to report
the services your physician rendered decide the payment your practice
will get, and sometimes you could be over- or under-coding, thus
inviting denials or, in worst cases, audit attacks.
Have a look at these top five sources of claims denials that you should avoid:
1. Inaccurate reporting of diagnosis codes
Coders often incorrectly link ICD-9 codes with corresponding medical procedures. Several coders have complained of rejections when they report the CPT® code 15823.
Medicare will often reject this service as cosmetic surgery unless you tie it to an appropriate diagnosis code that proves medical necessity, such as 374.30 (Ptosis of eyelid, unspecified) and 374.34 (Blepharochalasis).
2. Improper reporting of bilateral services
Errors related to unilateral versus bilateral can also cause problems in processing your claims. Reporting the procedure code 92235 (Fluorescein angiography [includes multiframe imaging] with interpretation and report) is especially problematic.
3. Misuse of alpha modifier
Coders are found to often misuse–or not use–the eye modifiers (-LT, Left side; and -RT, Right side). But these modifiers can be the key to making sure that you get the reimbursement you deserve, especially when your physician performs similar procedures on both the eyes of the patient.
If, during the postoperative period for cataract surgery on a patient’s left eye, the physician notices that the right eye also has a cataract, and so he provides the service for the other eye. In this case you would report the code 66830 for the first eye. You should report the surgery for the other eye (right) using one of the eye modifiers.
4. Overlooking Eyelid-Modifier Opportunities
Occasionally, the eyelid modifiers (-E1–-E4) are preferable to the eye modifiers -RT and -LT. Consider for example, your ophthalmologist performs 67904 (Repair of blepharoptosis; [tarso] levator resection or advancement, external approach) on the patient’s both upper eye lids. When the procedure is performed bilaterally, you should use the codes 67904–50 for Medicare. In this case, you should not use the eye modifiers or the eyelid modifiers.
5. Using Outdated Manuals
Use of an old, obsolete, or deleted procedure or diagnosis codes is a very common error. Practices are often found to be submitting codes that have been removed from the CPT® manual or they use some specific codes in error, particularly the age-specific codes.
Keep these common errors in mind to prevent them from happening the next time, and to ensure that you submit slick claims.
Have a look at these top five sources of claims denials that you should avoid:
1. Inaccurate reporting of diagnosis codes
Coders often incorrectly link ICD-9 codes with corresponding medical procedures. Several coders have complained of rejections when they report the CPT® code 15823.
Medicare will often reject this service as cosmetic surgery unless you tie it to an appropriate diagnosis code that proves medical necessity, such as 374.30 (Ptosis of eyelid, unspecified) and 374.34 (Blepharochalasis).
2. Improper reporting of bilateral services
Errors related to unilateral versus bilateral can also cause problems in processing your claims. Reporting the procedure code 92235 (Fluorescein angiography [includes multiframe imaging] with interpretation and report) is especially problematic.
3. Misuse of alpha modifier
Coders are found to often misuse–or not use–the eye modifiers (-LT, Left side; and -RT, Right side). But these modifiers can be the key to making sure that you get the reimbursement you deserve, especially when your physician performs similar procedures on both the eyes of the patient.
If, during the postoperative period for cataract surgery on a patient’s left eye, the physician notices that the right eye also has a cataract, and so he provides the service for the other eye. In this case you would report the code 66830 for the first eye. You should report the surgery for the other eye (right) using one of the eye modifiers.
4. Overlooking Eyelid-Modifier Opportunities
Occasionally, the eyelid modifiers (-E1–-E4) are preferable to the eye modifiers -RT and -LT. Consider for example, your ophthalmologist performs 67904 (Repair of blepharoptosis; [tarso] levator resection or advancement, external approach) on the patient’s both upper eye lids. When the procedure is performed bilaterally, you should use the codes 67904–50 for Medicare. In this case, you should not use the eye modifiers or the eyelid modifiers.
5. Using Outdated Manuals
Use of an old, obsolete, or deleted procedure or diagnosis codes is a very common error. Practices are often found to be submitting codes that have been removed from the CPT® manual or they use some specific codes in error, particularly the age-specific codes.
Keep these common errors in mind to prevent them from happening the next time, and to ensure that you submit slick claims.
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