Correct Medical Billing and Coding in the Healthcare Industry

Topics: ICD-10 Procedure Coding System, Insurance, Patient Pages: 11 (3430 words) Published: December 16, 2012
Correct Medical Billing and Coding in the Healthcare Industry
Medical billing and coding is one of today's topics. When services are billed for patients, they must be coded based on the documentation the physician has dictated in the patients chart to receive payment from the insurance company. As the physicians office and/or hospitals practice correct medical billing and coding, this will prevent audits being brought forth in their practice and/or hospital.

Kenny, Christopher,Correct Coding for Dialysis Billing Providers must ensure proper coding to avoid returned claim, 2012.

This article is geared for those in the medical field who do coding and billing in hospitals for dialysis. The author is educating the coders and billers how to correctly code for dialysis billing. He mentions that The Centers for Medicare and Medicaid, issued a transmittal that has revised the Medicare claims processing manual as it pertains to hospitals billing for dialysis procedures that are non covered under the ESRD benefit for emergency dialysis. In addition, the author discusses how the hospitals should utilize Healthcare Common Procedure Coding System billing code G0275 and code 90935 for hemodialysis. Only to bill G0275, if the hospital is a ESRD facility, emergency services, and when dialysis is performed with related procedures, such as a vascular access procedures or when performed following treatment for an unrelated medical emergency.

The author also continues to elaborate on procedure code 90935, in that, this code should be used for hospital inpatient, whether they have ESRD or not and has Part B coverage only. As the billers and coders take note of the correct coding, for dialysis and hemodialysis, they will receive a reimbursement for both procedure codes of $436.56, each time they are billed.

This method of correct coding /billing for those who bill strictly for dialysis and hemodialysis,will generate their organization a wealth of revenue.

NATIONAL INTELLIGENCE REPORT®.Celebrating Our 33rd Year of Publication CMS Recommends Fee Crosswalk for New Lab Codes, Gap-Fill Payment for New Molecular Pathology Codes. Vol. 12, Iss. 16, September 6, 2012

This article discusses the importance of the fee crosswalk for new lab codes and gap-fill payment for new molecular pathology codes. The discussion around the lab codes, it draws on The Centers for Medicare and Medicaid services, in that they have posted its preliminary payment determinations for the 16 new CPT laboratory test that are to be added to the Medicare Part B fee schedule, effective, January 1, 2013.

The author is educating the coders and billers as of the date when the change took effect and how this change will impact CMS and their contractors.

The change took place, August, 2012, CMS presented the 2013 pricing determinations for 101 new CPT molecular pathology codes and 10 multianalyte assays with algorithmic analyses CPT codes. Included in the new lab codes are one chemistry code, two immunology, eight tissue typing and five microbiology. As these new codes are cross walked the codes will be paid at a similar code rate. The new molecular pathology codes, CMS, has proposed that the gap-fill method in 2012 in pricing the MDx codes, will be payable under the Part B clinical Lab Fee Schedule. The new molecular codes will replace the staking codes that Medicare currently uses for molecular tests. The codes include 92 tier 1 analyte specific codes high volume 81200-81383 and tier 2 resource level codes for low volume procedures of 81400-81408.

The author shares this information regarding the coding crosswalk change for the codes mentioned, this change allows CMS and the contractors to have opportunity to have control over how the tests are performed, which will benefit how their cash flow is controlled.

Miller, Douglas E., Fox-Smith, Kristin. (2012). Pharmacy revenue cycle audits can bring unexpected...
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