I'm hoping that maybe I can get a little assistance with a couple of questions I have...somehow, overnight, I seem to have gone from just a data entry person to working in the billing department. I work from home and had been entering patient information for Meaningful Use purposes into an EHR. The past few weeks, I've been trained on running billing reports and entering charges from patient superbills. Although, I have no idea how this happened (I literally just got emails and phone calls out of the blue from my boss and the billing department just informing me that they want to train me on new things), I'm happy to take on the new tasks. However, my boss is not a medical coder nor a medical billing specialist. The insurance specialist is helpful, but I have to communicate via email or by playing phone tag. Therefore, I have a couple of questions that maybe some of our Andrews experts can help with...I work for dermatologists and on the superbills there are E/M CPT codes circled and then other procedure codes for biopsies, lesion destructions, etc. I was instructed to use modifier -25 whenever there is an E/M visit and another procedure. Makes sense to me based on what I learned in Module II. However, I have come across a "warning" that the patient is still in the global period for a prior procedure on several occasions. I was not instructed on the use of modifer -24 on those E/M visits, but I'm wondering if I should? If the E/M visit is clearly for an unrelated situation than what was done in the previous surgical package, I'm thinking that -24 is necessary. Am I correct? The reason I'm asking here and not through my employer is because when I asked them about making sure that the diagnoses were entered in the correct order, I was told not to worry about it and just type them in any order - (of course, dermatology doesn't have a lot of "code first" situations, but still that was a red flag to me because it's drilled into us here at Andrews to follow the coding guidelines and my providers mix symptoms and Z codes and hand written notes that I have to look up in a variety of different orders...I'm not a professional coder. I'm not certified in anything, yet! So I'm kind of freaking out!). My other question has to do with ICD-9 codes. Some of my doctors mix the ICD-9 and ICD-10 codes. I can enter both per whatever the insurance requires, but I'm wondering if it's okay to mix them or should I go ahead and convert any ICD-9 codes to ICD-10 codes if there is a clear correlation? I also run the billing reports for several providers and I'm not noticing many situations where the insurance company is denying claims for coding issues. I'm just wondering if anyone has any insight on this? I've never worked in this field...I'm only about 3/4 of the way through Module III...and my name is on the reports so I am accountable if something isn't correct. Guidance or suggestions would be greatly appreciated!
I totally agree with you about the "red flag" and that you don't want to put wrong information anyway, but you are responsible in the end. The latest (February) AAPC Healthcare Business Monthly magazine addresses that very issue; in fact it's in big print on the cover. Maybe you could get your supervisor to read that information.
Donna G
Donna, I just looked up that article and read the pdf. Very interesting. I ended up asking a different person who actually goes into the office everyday about some of the modifers and she was very helpful. I also just refuse to enter any charges from a superbill that aren't crystal clear. I'm just sending them back to the doctor for clarification. Fortunately, it doesn't appear that this particular practice over codes. They just don't always clearly note which diagnosis goes with which procedure, etc. At this point, I want to be careful so that claims are not rejected because I typed in the wrong information or was careless.