University Medical Center

Practice Management Pearls

Volume 1, Issue 3 January 2013

Tip of the Day: NextGen Dx Tab

Please update patients diagnoses at least once every 3-6 months or so to accurately reflect the status of their diagnoses The easiest way to do this is under the NextGen Dx tab. Here you can change the status of chronic diseases and resolve old acute illnesses still on their active dx list. With the impending implementation of ICD-10, we need to be as specific as possible in our diagnoses moving forward (ie 789.03 for LLQ abd pain instead of 789.00 for abd pain, unspecified

Ancillary Services...Do They Matter?

After a long holiday hiatus, PMP is back! This being the cough, cold, and flu season, it is also the season of nebulizer treatments, vaccinations, and medication injections. First of all, it is important that with each patient you see, that everything that you did for that patient is appropriately documented and linked to the corresponding ICD-9 (soon ICD -10) diagnosis code. If you are seeing a patient for cough, and you want to order a chest x-ray, it is important that the CXR is ordered under the cough diagnosis and not the patients diabetes diagnosis. Otherwise, you run the risk of claim denial from insurance. Similarly, if you order an EKG, it is important to link it back to the cardiac or other complaint for which you ordered it.

Ancillary Services: 1 code or 2?

Certain ancillary services, like x-rays, EKGs, spirometry, and pap smear collections have single CPT codes to send to the superbill. However, quite a few ancillary services require more than one code. The most common incidences in primary care are below. Vaccinations: vaccine itself and the administration of it Nebulizer treatments: medication itself (J code) and the administration of it Injections: medication itself (J code) and the administration of it IUD/Nexplanon insertion: device itself and the placement of it Lets talk vaccines first, as this is the most complicated. The vaccine has to be ordered/billed in 2 parts: the vaccine itself and the administration of it. The vaccine code itself is the easy part, as this is what is automatically sent to the superbill within NextGen when a vaccine is ordered. The administration codes are the tricky part. Administration codes differ by insurance (Medicare uses G codes; adult codes are 9047x codes; pediatric codes are 9046x codes). The admin codes also differ by the number of components within the vaccine. For example, a child comes in to receive a DTaP-HIB-IPV vaccine. This vaccine has 5 components: D, T, aP, HIB, and IPV. 90698 is billed for the vaccine itself. 90460 is billed for the 1st component, and 90461 x 4 is billed for the next 4 components. For our VFC peds patients, these convert to zero-charge codes in the billing office under Medicaid guidelines. However, for private insurance pediatric patients, these charges can really add up. The average amount of missed charges for a pediatric private insurance patient coming in for a WCC, based on undocumented/unbilled vaccine admin codes, is about $200 alone.

Inside this issue:

AS: Do They Matter? Tip of the Day 1 Code or 2? Getting Paid 1 1 12

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Practice Management Pearls

Ancillary Services: 1 code or 2? (continued)

Kathy Pritchett from the UMC billing office has been leading the way with helping us ensure appropriate vaccination documentation and billing, and Jennifer Croft helped develop a workflow in the FM clinics. Next up nebulizer treatments. The nebulizer medication is billed by unit as a J code. The administration of the treatment is billed separately. Fortunately, these can both be ordered from the My Plan tab in NextGen. The medication (usually albuterol) is found under Office Medications - Albuterol noncomp unit J7613. The nebulizer admin code is under Office Procedures Airway inhalation treatment < 60min 94640. You cannot bill one without the other. If you give 2 treatments, you should code for the J code x 2 but only 1 admin code as you use the same DME for both. Thirdlymedication injections. Similarly to nebulizer treatments, medication is billed by unit as a J code, and the admin of the injection is billed separately. There is only 1 medication admin code. It is the same, whether you are giving Rocephin, B12, or a Depo shot. The injection admin code is found under Office Procedures - THER/PROPH/ DIAG INJ, SC/IM 96372. The medication is found under Office Medications. It is important to recognize the number of units specified, as it differs from medication to medication. For example, Ceftriaxone/Rocephin comes in 250mg units, but Ketorolac/Toradol comes in 15mg units. Therefore, if you give a patient 1 gram of Rocephin IM, you should code for the injection 96372 and 4 units of Rocephin. LastlyIUD/Nexplanon insertion. In this case, the device is treated just as medications are above. You must code for the procedure and the device/medication. The difference is that this is done from the NextGen procedure templates on the SOAP note tab. You can check to make sure both codes went through by checking the superbill before signing off Procedures button that looks like a white bag with a red cross on it.

Putting it all together...

Coding 69210: Ear Wax Removal Documentation requirements for reimbursement: History of symptoms and/or hearing loss Procedure must be performed by the physician using instrumentation Documentation of exam after procedure

Getting Paid
Feedback
We want to hear from you! Please forward any and all feedback to Dr. Scarbrough and Allyson Welch. Thanks!

So, back to the beginning. This being cough and cold season and all. Lets take, for example, the average patient who comes in with a moderate COPD exacerbation who has an early consolidation on CXR. In the office you give an albuterol breathing treatment and shots of 1 gram of Rocephin and 125mg Solumedrol, but forget or send any of it to the superbill in NextGen. This adds up to over $200 in missed codes/charges. After skin procedures and joint injections, the following are the top paid ancillary services in primary care:

Anoscopy Cerumen removal Airway treatment (nebulizer) Spirometry Pap smear Contraception: Implanon/ Nexplanon, IUDs, etc . EKG Holter Monitors Top unpaid ancillary service (whether government or private insurance)? Pulse oximetry. Why? Who knows.