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  • Q/A: May we bill an E/M code for a wound care first visit

    Q.  Several of our facilities that include hospital-based outpatient wound care clinics have requested guidance in the following scenario.

    A patient arrives at the clinic with a physician order for wound debridement. This is the patient’s first visit, and the patient meets the CPT new patient definition. The nurse performs the debridement and documents a history and physical.

    Because this is a first visit, may we bill for an E/M level and the debridement? Should we bill only for the debridement in subsequent visits

  • Tip: Determine the number of specimens to code surgical pathology correctly

    If you perform a level IV surgical pathology (88305) on more than one specimen from the same patient, the unit of service for this code is the number of specimens requiring individual exam and pathologic diagnosis. Use modifier -59 to indicate tests provided for different specimens.

  • OPPS final rule: CMS finalizes changes for drug payment formula, physician supervision

    The 2010 OPPS final rule released on October 30 contains few surprises, but does finalize two changes that received considerable attention when CMS proposed them.

  • Note: CMS issues 2010 final rule for ambulatory surgery centers and most hospital outpatient departments

    CMS has released a display copy of the outpatient prospective payment system (OPPS) final rule for 2010, which also includes the 2010 changes to the rules for ambulatory surgery centers (ASCs).  This final rule will be published in the Federal Register on November 20.  In terms of reimbursement, OPPS hospitals that meet quality indicator reporting requirements for 2010 are entitled to the “full update,” which will result in a 2.1% increase in their payments for 2010.  Those OPPS hospitals that do not meet their quality indicator reporting requirements will be subject to a reduced update of 0.1% in 2010.  ASCs, on the other hand, will receive a 1.2% inflation update beginning January 1, 2010.

  • HIPAA Q&A: Red Flags Rule

    Learn the answer to this tough compliance question.

  • BA contract addendum

    Does anyone have a sample of an addendum that can be added to our BA agreement that puts us into compliance with the HITECH-HIPAA or do we need to re-write and retain all new BAs to include the requirements for HIPAA?