Late or no-show patients? Take a look at these options

Take a look at this ophthalmology coding scenario:

There are some patients who regularly miss appointments or show up late. We would like to focus on the importance of keeping appointments without alienating the patients. As such, can you bill for no-show visits and/or charge a fee for being late?

Well, whether you can bill for no-show visits or charge a late fee will depend on your payer contracts and the laws in your state. Some contracts bar no-show charges or fees not related to patient services. Take a look at your contract and state laws and if both allow such charges, go ahead and bill the patient for this difficulty.

There are many practices that charge a fee for missed appointments; however there are other choices to consider. Take a look at these suggestions from other practices: if you charge for missed appointments or a certain number of late arrivals, post that information so that patients know about the policy. Cover notices on the registration form, in the registration area and in the waiting room. Some practice writes off the first occurrence and take it as part of patient education.

You should have a financial policy that mentions the fee in writing. You should also have the patient sign a copy of the policy, which he keeps, in addition to one you will keep. This way, he can't claim he was never told or didn't see the notification.

You should tell late arrivals that your staff will fit them in as best you can; however that patients who are on time for appointments will get preference. Give the patient the choice of rescheduling later.

If the patient happens to miss an appointment, you need to send a follow-up letter. Set guidelines for the practice and send a stronger letter every time until you reach the predetermined point of dismissing the patient (normally three missed or late arrival appointments).

Remember: You should be sure to note the missed or late arrival appointment in the patient chart especially when the patient is coming in for diagnostic tests like visual fields or optical coherence tomography (OCT). This may be helpful in safeguarding the practice from abandoned patient lawsuits. Going through how your practice handles this issue is a good opportunity to assess scheduling and other issues from an internal perspective. If you are in a larger multispecialty clinic or in an area where traffic and parking are a recurring problem, realize that these issues might be impacting your patient's ability to be on time. What's more, take a look at how you schedule sick visits; many will be ‘no shows' of you book them a day or two ahead because the patient encourage your physicians to be on time. Some patients think that if the doctor is getting late, it will not matter or will not be noticed if they are late for the scheduled time.

Cpt 2011 Brings Two New Codes For Home Study Among Other Key Changes

If you perform sleep studies, you need to upgrade your coding style this year.

This time, CPT brought some big changes as far as pulmonology coding is concerned. Here are some codes you will have know this year. As such, if you have been using inactive or unrevised codes, you are risking denials for sure.

Two new codes for Sleep Study

The good news is home sleep studies type II had made a straight transition from Code G0398 to 95806 in last year's CPT. Now the codes for home sleep studies type III and IV now have their own category I codes for this year: 95800 and 95801.

These sleep study codes have been established for reporting unattended sleep study testing services. These codes appear with a number (#) symbol to indicate that they are out of numerical sequence.

Other new pulmonology codes on focus

For trachea and bronchi, a new code has been created to report bronchoscopy with balloon occlusion, with assessment of air leak, with the administration of occlusive substance, if performed. Other codes that have been included this year are: 90470, 0250T -, 0251T and 0252T.

CPT codes 0250T, 0251T, 0252T have not been assigned any physician work relative value units. This means that payment is only received by the facility for these services.

There are revisions to Photodynamic Therapy Guidelines and Others

CPT has also revised photodynamic therapy coding. So from January 1 this year, you need to pay attention to the documented time in case a modifier is necessary. CPT also adds various parenthetical guidelines after codes 96570 and 96571. If the pulmonologist carries out 96570 for less than 23 minutes, you should report modifier 52. For each increment after the first 30, you have to get to the eighth minute for each interval. Other CPT 2011 revised codes include 90662, 90663 , and 90670.

Evaluation and management changes offer a sneak peak.

This year, CPT has made significant revisions to the hospital observation services section, including the addition of three new resequenced codes in the subsequent hospital observation subsection. More revisions have also been made in the hospital inpatient services, pediatric critical care patient transport, and inpatient neonatal and pediatric critical care subsections.

Here are three new evaluation and management codes that can impact your pulmonology practice's coding success: 99224, 99225 and 99226.

Backache example to help your ICD-9 coding

With not much time to go for October 1, 2013, there is no denying that now everyone is training eyes on ICD-10. However, in doing so, you should not ignore your ICD-9 coding options. Here's a scenario to help your understanding of ICD-9 codes:

Patient A comes to your office for treatment of severe, chronic pain in the right side of his back. The pain had started about 10 months ago. In the right lumbar multifidus muscle for pain relief, your interventional radiologist uses ultrasound guidance to administer two trigger point injections (TPIs). But then his chart notes only say that the patient had 'pack pain'.

You get the chart and also get to see your radiologist performed trigger point injections on other patients in the past, using 20552 and 76942. The most recent injections carried out on the other patients' backs were for myofascial pain.

Minus more specific diagnosis, you should assume that Patient A also has myofascial pain, and report one unit of 20552 with a diagnosis of 729.1?

Well, the answer here is no. Making assumptions does not support compliant coding. From a clinical standpoint, pain can be caused by various reasons. Even if the diagnosis seems obvious, coders are not clinicians and should never make presumptions.

If your radiologist did not specifically document myofascial pain or myalgia and you use one of those codes, you could land in trouble in case of a payer audit. Such mistakes are just the kind of thing that auditors watch out for. In its place, you may be required to report an unspecified code, such as 724.5.

Remember payers may not always accept 'unspecified' codes in assistance of a service; however some payers will reimburse for 724.5 for trigger point injections. As such, be sure to study your payer coverage policies well prior to determining if the diagnosis fits the payer's rules. As a coder, you should be aware of payer policies and LCDs to be able to convey that information to the physician.

Bear in mind that spot on medical coding requires that you select code based on the documentation you must never report a diagnosis code just because you are aware the payer will pay the service if you report that diagnosis.