Understanding Consultation Guidelines
Are you frustrated by bundling denials?  Do you or your staff have a hard time determining when modifier -59 is appropriate? 

Check out my article, "General Surgery Coding Concepts" below!

Erica's Articles:
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Web site designed & hosted by Erica Schwalm © 2005 at Homestead™
Not all payors use CCI edits to process claims!  Always ask your payors which claims editing software they are using.  Some use McKesson, which you can now access online.  Two places I know of are through the Tufts website and the Aetna website.  (You will need to sign up for a provider log-in if you don't already have one.)
The Encounter Form: Are you missing out on deserved reimbursement?

General Surgery Coding Concepts
Understanding the Global Surgical Package, Correct Coding, and the
Physician Fee Schedule Relative Value File


To Use Modifier -25 or Not To Use Modifier -25, that is The Question!                                        
                                        
E&M Coding Based on Time & Counseling Services
This page was last updated: June 17, 2008

Need help understanding the basics of E&M Coding?  Read this article! 

*The Three Key Components: History, Exam and Medical Decision-Making

Click here for printer friendly version (Word doc.)
Did you know CMS recently updated their consultation billing guidelines?
Click here for printer friendly version (Word doc.)
Modifier -59 Appeal Letter
Modifier -25 Appeal Letter
Modifier -22 Appeal Letter - Request for Additional Payment
E&M Auditing Tool - 1995 Guidelines
I made this a double-sided copy, laminated it, and glued a dry-erase pen to it so I could use it over and over again! 
Really good E/M Article & auditing tools at CRN (plus many other useful forms)! http://www.codingandreimbursement.net/forums/forumdisplay.php?f=78
Final Request Appeal Letter  - (Final request appeal letter, quotes MA prompt pay laws.)
Are you ever confused about coding for Pap smears or Annual GYN exams?  Does your office seem to get a lot of denials for these services?  Does your staff understand the differences between Medicare's high risk and low-risk criteria? Read this Article!
Coding GYN Exams and Pap Smears
After you read this, check out the E&M Coding exercises on the Games & Quizzes page!
More Forms:
Practice E&M Coding - Check out my Games & Quizzes Page!
Documentation templates (created for PM&R physician): 
Exam Form 1Exam Form 2Exam Form 3
Internal Chart Auditing Form
Submitted by Debra Murphy, MBS from Atlanta (modified by me).  Thanks Debra! :-)

Coding Colonoscopies

Updated Jan. 2008!
CMS clarifies - when screening colonoscopy turns therapeutic
Erica's Templates & Forms:
45380 denied with 45385 Appeal Letter
Don Self's Free Documents Page
This is THE BEST collection of free forms on the Internet!  Scroll through this extensive list and find everything you need:  All kinds of auditing forms, superbills, collection letters, etc.
Leslie's Free Forms
More Articles, etc:
"The Ins and Outs of Professional Courtesy" article from CodeRyte
PROFESSIONAL COURTESY:
OB/GYN:
"Review of Obstetric Coding Guidelines" (ICD-9) article from For The Record

"Coding for Pelvic Floor Disorders" (ICD-9) article from For The Record

INCIDENT TO & NPP BILLING GUIDELINES:
"Incident to" article from HealthCare Quality Consultants
BILLING - GETTING STARTED & WORKING FROM HOME:
"Medical Billing as a Home-based Business" article from Practice Managers Resource & Networking Community Website
Billing for Prolonged Physician Services
"Coding on the Basis of Time for Physician Services" article from AAFP/Family Practice Management
EVALUATION & MANAGEMENT SERVICES:
"Coding Better for Better Reimbursement" article from the American Academy of Family Physicians

Here's some more articles, resources, etc. that you may find helpful. 
Coding for Critical Care Primer from the Society of Critical Care Medicine
APPEALS, COLLECTIONS & A/R MANAGEMENT:
"Navigating the Patient Appeals Process" article from the American Academy of Family Physicians
"Best Practices in Claims Processing" article from the American Academy of Family Physicians
"Questions to Ask About Your Accounts Receivable" article from the American Academy of Family Physicians
"Patient Balances: Getting to the Root of the Problem" article from the American Academy of Family Physicians
"Beyond the Codes - Tracking Reimbursements Is Key" article from Physicians Practice

"Payment Plans for Patients - Better Collections for You" article from Physicians Practice

"Three Steps to Fewer Denials" article from Physicians Practice
"Coding: Consult or Confusion?" article from Physicians Practice

"Incident To Services" by the Connecticut State Medical Society
Incident to services, Medlearn Matters Number: SE0441
Reimbursement Info for PAs, from the American Academy of Physician Assistants
"Billing For Nurse Practitioner Services -- Update 2005: Guidelines for NPs, Physicians, Employers, and Insurers" article from Medscape (register, it's free)
"Analyzing your Accounts Receivable" article from Accuchecker
MODIFIERS:
"Modifier 59 Article: Proper Usage Regarding Distinct Procedural Service" article from CMS
Modifiers 58, 78, and 79 article from NHIC Medicare
Click here to join ericacodes
Click to join ericacodes
Billing/Coding the Obstetrical Package,
"In a Nutshell" posted by me on the Medical Reimbursement Professionals Exchange forum.  Check them out - lots of good info!
Patient History Form
From Physician Reimbursement Systems
Patient Information Update Form
From Medical Economics
OTHER PRACTICE MANAGEMENT RESOURCES:
"This piece of paper can boost your income" - Great article on designing charge tickets from Medical Economics
THE FRONT DESK:
“Modifiers – It’s All About the Money!” - A nice grid that shows how each modifier affects reimbursement from Accuchecker
Verification of Eligibility & Benefits Form from KarenZupko & Associates, Inc
Billing for a covered service with a preventive exam (Medicare) - article from Medical Practice Consulting

NST Template from audioeducator.com
How to traffic phone calls - a form to help you avoid disruption and loss of staff time during typically busy workdays, article & form from Medical Economics
How to cut A/R - "Think outside the billing-department box. It takes an entire practice to collect a dollar."  Another great article from Medical Economics


Tips for Front Desk Collections from Medical Economics
Family Practice Superbill from AAFP.
See related article published in the September 2006 issue of Family Practice Management
Additional resources, forms, articles & links can also be found on my yahoo group page.  Click here to join. 
"Choosing the Right Coding Credential"
By Stacie L. Buck, RHIA, CCS-P, LHRM, RCC
Coding Coronary Artery Bypass Grafts (CABG) - Article & Quiz
Billing for 3rd-Party Requested Exams (e.g. Pre-employment Physicals, Sports Physicals, etc.) - Great Article from Family Practice Management.  Click Here: http://www.aafp.org/fpm/20061000/39spor.html
Free E&M Resources & FREE AAPC CEUs !!!!