Magazine article Medical Economics

Coding Cues: Answers to Your Questions about . .

Magazine article Medical Economics

Coding Cues: Answers to Your Questions about . .

Article excerpt

Perks for valued patients

We are a rural subspecialty practice, and many of our patients travel very long distances to see us. Given the price of gas these days, we would like to reward these patients by providing gas cards in varying denominations relative to the distances they travel. Will we run afoul of any government regulations in doing so?

The OIG Compliance Program for Individual and Small Group Physician Practices identifies "Improper Inducements, Kickbacks and Self-Referrals" as specific risk areas to be addressed in any practices compliance plan. An example of inappropriate inducements is that of a provider who routinely waives copay and deductible amounts as an incentive for patients to be seen by that practice. Whether or not a gas card for your patients would fall within that prohibition is something you may wish to learn from the OIG in an opinion letter. Contact your local carrier about the process for doing so.

Billing same-day procedures

We are having difficulty getting paid for visits that occur on the same day that procedures are done in our office, even though we are using modifier 25. In many instances, the procedure is the result of the visit that day, so billing both the E/M and procedure is appropriate. Any suggestions?

One reason you may be experiencing rejections is that the visit occurs in the global period of another procedure. Even if you indicate a different diagnosis, insurer edits may not pick it up. If that is the case, modifier 24 ("Unrelated E/M Service by the Same Physician During a Postoperative Period") would be more appropriate.

In addition, if the decision for a major surgery (90-day global period) is truly made during a visit, modifier 57 should be used when billing the service.

ABN and Medicare exclusions

We routinely provide services to our Medicare patients that are listed as "non-covered." We were told we must now supply the patient with an ABN, even if the service has never been covered by Medicare. …

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