Ensure your Oncology Documentation Leverages proper Coding for Moderate sedation


Moderate (Conscious) Sedation or MCS is the inducing of drugs to lower consciousness for any surgical procedure. However, the patient should be capable of responding to verbal direction (with or without nimble and tangible stimulation).

Starting 2017, with the changes in Medicare Physician Fee Schedule, moderate sedation will be billed and paid for using new CPT codes. Previously, sedation was billed as a part of the basic procedure. However, in oncology (especially in radiology), moderate sedation will now be reimbursed additionally (to the basic procedure). As this goes on to enhance accuracy in medical billing, it also creates new workflow requirements.

The new structure:

The changes here take into consideration the intra-service time (15 minute increments and must be aptly documented) and the patient age (under age 5, age 5 or above); and also takes into consideration if the primary physician is the same or not (the primary procedure being performed by the same or a different physician). The add-on codes refer to the addition of each 15 minute interval. It begins with the physician administering the sedation, and keeping a watch on the patient till the time the patient is stable.

Documentation requirements:

The report must comprise the patient’s age, intra-service time, and the physician’s details. Along with actual and elapsed time taken, pre and post sedation monitoring, and all pre and post services must be documented.

The changed codes:

The old codes have been eliminated (99143-99145 and 99148-99150). These codes however, are not to be used for reporting administration of medications for pain control, minimal sedation, deep sedation, or monitored anesthesia care (00100-01999).


As per accc-cancer.org, the following changes have been implemented:

99151: Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intra-service time, patient younger than 5 years of age

99152: patient age 5 years or older

99153: each additional 15 minutes intra-service time (List separately in addition to code for primary service)

99155: Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intra-service time, patient younger than 5 years of age

99156: patient age 5 years or older

99157: each additional 15 minutes intra-service time (List separately in addition to code for primary service)

CMS proposes values for new moderate sedation procedure codes and wants “a uniform methodology for valuation of the procedural codes that currently include moderate sedation as an inherent part of the procedure.” Codes that include moderate sedation for radiation oncology are 77371 (stereotactic radiosurgery, multi-source Cobalt unit) and hyperthermia services (codes 77600-77615).

Further, this table from hapusa.com can be used as a guide for  the new coding structure:

Total Intra-service time Sedation Code (99151, 99152, 99155, 99156) Additional Code (99153*, 99157)
Less than 10 minutes None None
10 – 22 minutes X None
23 – 37 minutes X Use once
38 – 52 minutes X Use twice

Note: Code 99153 is a ‘technical-only’ code and does not include the services in a hospital, but in a practitioner’s office setting only.

The new changes in 2017 in codes, rules and regulations will certainly bring about challenges and apprehensions in oncology billing and coding. But ensuring compliances and guidelines by oncology coders will make it relatively easier for accurate and timely reimbursements.

Posted in Medical Billing, Medical Coding, Practice Management, Revenue Cycle Management (RCM) | Tagged , , , , , | Leave a comment

Is EMR Software The Right Choice to Optimize Podiatry Billing and Collection?

Is EMR Software The Right Choice to Optimize Podiatry Billing and Collection?

On any given bustling practice day, it can be a troublesome decision for you to decide on using Podiatry EMR software. However, a major hindrance for some doctors is the price and for others it is time. So, the moot question that stands in front of Podiatrist is, ‘Is EMR software the right choice to optimize Podiatry Billing and Collection’?

With a holding up room reliably stuffed with patients waiting to be treated for ankle sprains, ulcers identified with diabetes, delicate tissue wounds in the feet and an assortment of different issues, there’s no opportunity to arrange, execute and implement your in house staff with the EMR prerequisites. In such a scenario what comes to a Podiatrist’s help is an able medical billing and coding partner, who has the know-hows and expertise in dealing with the software.

For those doctors who aren’t exactly prepared to adopt podiatry EHR systems and electronic medical records, frequently swing to automating individual portions of their office – primarily administrative and clerical in order to reduce some of the paperwork and general work load.

This can include things like:

Electronic Super-bill generated via Podiatry EMR Software  

A few facilities use Practice Management Software to some extent and might be utilizing billing software as well. In case you’re utilizing this in some form, you should seriously think about having changes made, so that your superbills print the subtle elements of the last visit of every patient. With an electronic superbill set up, you can complete majority of the functions at the touch of your fingertips.

Podiatry EMR Software – Analyzing the Templates

A few doctors are savvy enough with the software they use to make templates for chart notes, letters and other documentation in the facility. These layouts can lessen errors, let you focus on patient treatment, and decrease treatment times to streamline experiences. The drawback is that one has to still deal in printed layouts.

Podiatry EMR is intended to streamline this procedure. The frameworks come preloaded with a wide assortment of templates for treatment, and relying upon your set up (electronic EMR or on site EMR) the expenses are minimal keeping in mind the end goal to keep up secure copies of patient data. You’ll be sparing lots of time and cash by putting resources into Podiatry electronic medicinal records that are preloaded with every one of the templates you need to generate claim reimbursement copies and undertake an error free Podiatry billing and coding.

Podiatry EHR Software to manage and track prescriptions

Regardless of the possibility that your office uses simple practice management software, few offer point by point and in-depth review of prescriptions for tracking purposes. This is the very reason patients across US have issues, with medications, improper dosing and no-follow up on some treatment procedures.

Finally, if you want to improve and augment the patient experience and work flow by utilizing mobile technology or applications in your Podiatry practice, the best investment one can make is in a complete Electronic Medical Records system.  If not done, you may encounter un-ending problems in file sharing via a wireless network including file corruption, data breach and loss, security issues, information saved on the wrong drive and more

With Podiatry EMR software, all patient data, administrative functions, schedule, billing and coding, prescribing medications and treatment templates are centrally located, secure and easy to access no matter what technological platform you’re using in the facility. If the income cycle is still in derailing zone and errors and omissions appear on the claims, partnering with an able medical billing and coding company is a good way to ensure streamlined profits.

Posted in Accounts Receivables, Claims Denials, EMR / EHR / Health IT, Medical Billing, Medical Billing Company, Medical Billing Services, Medical Coding, Podiatry Billing, Practice Administration, Practice Management, Revenue Cycle Management (RCM) | Leave a comment

Should optometrists be allowed to perform surgeries?


Optometrists are the independent primary health care professionals for the eye; The current trends in optometry billing are driving down the reimbursement process.  Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. (Reference: American Optometric Association). Optometry practice was legalized in 1901 starting with Minnesota and introduced as a university course for the first time in 1910. Optometrists hold ODs  (Doctor of Optometry) with 4 years of professional education in optometry that concentrate on the  study of eyes enabling them to carry out eye examinations to diagnose any vision problems, prescribe contact lenses, eye glasses, treat eye diseases by prescribing eye medication(excluding Massachusetts for glaucoma) without surgical intervention. Any treatment beyond the scope of OD education requires further training and testing as per law.

Often there is confusion between an Optometrist and an Ophthalmologist. An ophthalmologist is regarded as a trained medical doctor who has earned an MD (Medical Doctor) or DO (Doctor of Osteopathy) degree and who is licensed to surgically invade the eye. Like the Optometrists, they have typically spent four years in undergraduate studies, four years in medical school, but unlike optometrists, they have to spend another three additional years studying surgery and diseases of the eye.

Over the years as technologies and treatments advance, optometrists are getting more involved in going beyond eye exam and prescribing lenses and eye glasses. As on date, three states in the United States Oklahoma, Louisiana and Kentucky permit optometrists to perform laser surgeries. ODs learn laser therapy and surgical procedure as part of continued education before they are legally allowed to perform laser surgeries in these states.

Based on a recent report by the American Optometry Association (AOA), optometrists (OD) perform 88 million comprehensive eye exams annually, comprising 85 percent of all eye exams, compared to only 16 million (15 percent) exams performed by ophthalmologists (MD)]. These statistics, although based on unverified methodology, yet still demonstrate that most Americans rely on optometrists for their eye care needs

As recently as March 2017, there has been what is known as the “Eyeball Wars” between Optometrists and ophthalmologists. The pros and cons have been debated a lot. So let’s review the contention between the optometrists and the ophthalmologists: Optometrists maintain the proposal is an access-to-care issue it would allow optometrists who receive special training to perform certain kinds of surgery in which “human tissue is injected, cut, burned, frozen, sutured, vaporized, coagulated, or photo disrupted by the use of surgical instrumentation; while ophthalmologists argue it would endanger patient safety.

Advocacy of allowing optometrist to perform surgeries come from the fact that patients would have improved access to eye care in rural areas where optometrists outnumber ophthalmologists. Optometrists as a practice perform laser surgeries for treating ocular abnormalities, minor procedures of removing foreign body removal, draining a stye or epilating lashes. All these fall under the surgical procedure category. These are urgent in nature, as patients cannot wait for long periods to get appointments from an ophthalmologist, and especially have faster access to an optometrist within a day or two. This also indirectly reduces Medicaid costs as fewer referrals and visits (to ophthalmologist).

One of the cons here is, ophthalmologists will not treat patients who are on Medicaid, while optometrists care for patients who are on Medicaid or who are indigent- The complexity of medical billing.

Both sides have also pointed to evidences to support their view: Oklahoma, which has allowed expanded work for optometrists the longest, there were only two reported complaints for more than 25,000 procedures. On the other hand, Ophthalmologists pointed to a research paper that found glaucoma patients who had a certain type of laser surgery returning for treatment on the same eye 35.9 percent of the time when an optometrist did the work, as opposed to 15.1 percent of the time when an ophthalmologist conducted it.

However, as per the news, the optometrists have had a strong political backing and waiting for the House Bill 36 to pass would probably be just a matter of time. Caution is of course required among optometrists, given that ophthalmologists have advanced training in the “surgery” tasks and the years they put in before practicing.

However, if certain conditions, under which optometrists can practice certain eye surgeries, are laid down and certain certifications and audits implemented, this would then be a win-win for both parties, given certain circumstances that would be disadvantageous to the patients.  Delivery of care and its efficiency for the patient is the crucial point here- and it is for the policy makers to take this to the receivers and enquire what is required and how. Although, integrated care practices that involve both the optometrists and the ophthalmologists are slowly emerging given the overlapping of eye care pre and post- the debate on who can do what may take a while till the short sighted details are worked for a more far sighted vision!

Posted in Healthcare Reforms, Medical Billing, Medical Coding, Optometry Billing, Revenue Cycle Management (RCM) | Tagged , , | Leave a comment

Leverage data analytics for medical billing to improve patient experience


Health systems and hospitals across the nation are faced with different revenue management challenges, some of which are caused by the rise in transition to the value based payment alternatives, consumerism and high deductible health coverage plans.

Off late, it has pushed patients to become more involved in healthcare decision making. Better transparency into costs and performance has given the patients great insights hence they have become very choosy when they are shopping for their medical health care.

With many not able to afford their out-of-pocket insurance costs to pay off their account balances, many hospitals across the nation are seeing their bad debt rise.

To address this challenge, hospitals and health systems must stay on top of their patients’ wants and needs. With the shift to value-based care, patient treatment goes beyond clinical care to include factors such as cleanliness of the facility, staff behavior and the billing experience. This transition makes it vital for provider organizations to ensure patients are satisfied from admission to discharge and also after they leave the hospital.

Enhance & Expand Patient Experience

With the rise of consumerism in healthcare, patients are now expecting more retail-like experience from hospitals and health systems, and organizations are failing to adapt this new environment and may see their finances suffer.

Although patient experience improvement touches every part of an organization, one important area of focus for hospitals and health systems should be medical billing.

Improvement in this area requires provider organizations to set expectations up front so patients don’t get upset. By opening up communication and providing patients with price estimates before they receive care, hospitals and health systems can improve the patient experience and also likely to increase the likelihood of collecting payment.

How Leveraging Data Analytics Can Help

The first important step to improving patient experience is gaining insights into patient behavior and preferences. To explore patient experience issues at a deeper level, many hospitals and health systems are using data analytics.

If you don’t have good analytics, you can’t predict behavior and you can’t improve patient experience. Data analytics solutions can help hospitals and health systems increase revenue and get a leg up on competitors in their market. In the past, hospital revenue cycle problems were managed as they arose. Today, organizations can use data analytics to take steps to minimize or even avoid these issues.

Hospitals and health care systems can use data analytics to determine a patient’s tendency to pay. This will let the organization to determine if the patient is likely to pay their bill without additional follow up, if they need a reminder such as a phone call or letter, or if they’re likely to never pay their bill. This information can be used to determine areas where they could improve the process, such as by providing more ways to pay, to help make the patient’s experience better and have a positive impact on the organization’s finances.

Bottom Line

Healthcare systems and hospitals are facing a myriad of revenue challenges as the industry is now undergoing a major shift – shifting to value-based care. The key to navigating this transition is to take steps to improve the patient experience.

Boosting patient satisfaction requires organizations to create an integrated experience where patients don’t have the opportunity to get unhappy.

Posted in Medical Billing, Medical Coding, Revenue Cycle Management (RCM) | Tagged , , , , , | Leave a comment

Otorhinolaryngology Surgery: Taking augmented reality into operation room


Over the last few years, technological advancements in medicine have created new ways for surgical interventions requiring minimizing invasiveness in the internal anatomy, along with new developments in visual examination to provide treatments. Further, a new and safer approach has been devised using ‘augmented reality’ which combines ‘computer generated images of preoperative imaging data with real-time views of the surgical field.’

The background:

The basis of computer assisted surgery (CAS) lies in the field of neurosurgery where actual mechanisms were used along with CT images on computers. Improvements along the way came with additions as MRI images, computer graphics, tracking devices, sensors etc. Today, CAS is applied in other fields such as ear, nose and throat surgery (ENT), cardiac and minimally invasive surgeries, eye surgery and many other disciplines. Further to advancements in CAS is the ‘Augmented Reality’ technique. It lies between reality (real world) and virtual reality (a computer simulated environment) which interacts with the human, finally, displaying the image on a 3D stereo display.

Augmented Reality:

In the preoperative phase, the surgeon usually has an idea of where the target abrasion is and plans his route of operation. But with augmented reality, it becomes easier to mark structures on radiographic images, which are further augmented on live video camera images, and view the targeted area thereby creating a ‘semi-immersive’ environment. It has been created by the technology company Scopis, based in Berlin. This technology can also be used for other surgical procedures such as spinal, craniofacial, cardiac, maxillofacial, orthopedic and neurological operations. This system records the planning stage and actual surgery.

Otorhinolaryngology surgery:

Surgeons are using this artificial intelligence technique to treat patients that require ear, nose and throat surgeries. This has first been tried in Canada where surgeons have used augmented reality with mixed reality to perform a surgery in the otorhinolaryngology field (sinus surgery). This technology makes use of scans and an endoscopic camera which then directs the route of the surgery i.e. real-time positioning in patients) and helps in avoiding important nerves such as optic nerves or the internal carotid artery. This state-of-the-art technology is known as Target Guided Surgery (TGS).

For this endoscopic sinus surgery (ESS) that uses ‘Computer Assisted ENT Surgery using Augmented Reality’ (CAESAR), especially for the frontal recess surgery, it allows for instrument tracking which facilitates viewing and cannulation of the frontal sinus outflow passageway without dissecting the actual frontal recess anatomy. This procedure uses the orthogonal computed tomography images (CT) images. Navigation during the surgery becomes very easy in the cadaveric model of ESS, also reducing the possibility of complications. In simple terms, it becomes extremely easy for the surgeon to view structures, virtually and superimposed (augmented), which otherwise might go unnoticed by the human eye. This includes operations of calibration, tracking and registration simpler, also allowing comparisons and alternatives for the operations.

The benefits:

Augmented reality technique assists in fixing and mending of other anatomic targets during the course of operation, further allowing for accurate localization of the anatomy. In addition, augmented reality technology is easily enabled or disabled (intraoperatively too) by fixing an endoscopic adapter. Planning and viewing in augmented reality makes it easy to sketch markings, 3D structural arrangement, target the path and osteotomy lines. While a surgeon is performing the surgery, an alarm zone can guide and warn him visually and aurally when he is advancing towards the designated mark or constitution.

Augmented Reality is one of the new approaches which surgeons have begun to use for operations by utilizing video frames, images and 3D graphics, in real time. The basis lies in planning and real-time positioning.

Posted in Healthcare Reforms, Medical Billing, Medical Coding, Revenue Cycle Management (RCM) | Tagged , , , , | Leave a comment

ASC Medical Billing: Key Points to Note


ASC stands for Ambulatory Surgery Centers or Outpatient Surgical Center that is a healthcare facility where patients need not be admitted. The patient is simply taken in, treatment is provided and after-care procedures are levied; after which he can leave. ASC is perfect for minor injuries or treatments and is cost-effective, safe, and easy and is widely practiced in many countries. ASC billing procedures are also covered by Medicare; thus ensuring an outsourced medical billing company looks after the costs of the same.

Although ASC and ASC medical billing services has become very common these days and the entire process is simplified in terms of rendering treatment and billing. Also, there are some key points that come in handy and should be followed while undertaking any ASC treatments.

Listed below are some of the points to bear in mind during ASC and outsourced ASC medical billing:

  • The ASC facility service reimbursement rate comprises of the following:

– The use of an ASC facility, operating and recovery rooms along with good preparation area, emergency equipment and observation room, plus the use of a waiting room or lounge by the patients and relatives

– Administrative services such as scheduling, record keeping, housekeeping and related items as well as coordination for discharge, utilities and rent

– Services connected to the procedure and other related amenities provided by nurses, orderlies, technical staff and others involved in the patient’s care

  • ASC cannot be levied to patients under the following conditions:
  • If they are not emergent or life threatening (for example, in case of a heart transplant or reattachment of a severed limb)
  • They cannot be performed safely in a physician’s office
  • They can be optional
  • They can be critical
  • Procedures that do not involve key blood vessels or result in major blood loss, and cannot involve extended invasion of a body cavity.
  • A great number of modifiers are used on ASC billing. These include the following:
  • Repeat procedure or service by same physician
  • Repeat procedure by another physician
  • Unplanned return to the operating/procedure room for a related procedure on the same day
  • Unrelated procedure or service by the same physician on the same day
  • Bilateral procedure
  • Numerous procedures (not for Medicare)
  • Reduced services
  • Staged or related procedure or service by same physician on same day
  • Distinct procedural service
  • Discontinued outpatient procedure prior to administration of anesthesia
  • Discontinued outpatient procedure after administration of anesthesia
  • Services covered under ASC:
  • Ambulance Services
  • Artificial Legs, Arm, and Eyes
  • Implantable Durable Medical Equipment
  • Non-Implantable Durable Medical Equipment
  • Leg, Arm, Back and Neck Braces
  • Physician’s Services
  • Prosthetic Devices
  • Independent Laboratory Services

Going ahead, it is also important to ensure that the outsourced medical billing services are taken care of in the right manner and at the right time. A good way to look at it is to ensure your billing processes are efficient and correct since ASC is much quicker than regular hospitalization and leaves you little time to make important decisions; making it necessary to get it right.

Posted in Accounts Receivables, Ambulatory Surgical Centers, Claims Denials, Medical Billing, Medical Coding, Practice Administration, Practice Management, Revenue Cycle Management (RCM) | Tagged , , , , , , , , | Leave a comment

How can woundcare nursing change your life?


The image of nursing has come a long way from the Florence Nightingale. Traditionally and generically, nurses have more than often been regarded as the healers of the medical world – healing patients with comforting words, tending their wounds and dressings. The nursing profession is now no longer just a “calling” but offers a more professional platform for the nursing professional. It offers them a multitude of avenues and specialization, and thus nursing is no longer thought of having just a good bedside manner and compassion.

The National Nurses Week is celebrated from May 6-12 annually to regard some of the great sacrifices and care provided to the patients across the state.

Nursing spans across from the basic cleaning of the wound to critical care, and across a range of settings from the small clinic and hospitals to the battlefields; and in today’s more technologically advanced world of wound care from gene therapy to gauze, it is but the nurse

who principally cares for the patients with wounds.

Wound healing encompasses dressings and infection control & the promotion of therapeutic nutrition, mobility, psychosocial support, hygiene, and comfort. This entire gamut of wound healing is under the practice of a nurse, albeit a certified wound care specialist who goes through a rigorous nursing curriculum and countless hours of specialized training, to address not just the clinical needs but also the patients’ physiological needs.

In 1968, the Wound Ostomy and Continence Nurses (WOCN) Society was formed and today after nearly 50 years is regarded as the oldest wound care society, and its WOCN Board certification is considered the gold standard for wound nursing, having certified over 6,100 nurses worldwide.  It began with a mission to promote educational, clinical and research opportunities to advance the practice and guide the delivery of expert health care to individuals with wound, ostomy, and continence issues. Today, the WOCN Board certification is offered at two levels: basic/baccalaureate level and advanced practice/master’s level. Tri-specialty or individual specialty in wound and/or related fields of continence and ostomy care are also offered.

Importance of Wound care

Wound care as a specialty is thus increasing in importance as more and more Americans suffer from complex conditions that can lead to chronic and hard-to-heal wounds.

Studies have shown that a rough population prevalence rate for chronic non-healing wounds in the United States is 2percent of the general population. Although, prevalence rate of chronic wounds is regarded as similar to that of heart failure, research has put forth a conservative estimate of the staggering cost of caring for these wounds which is said to exceed $50 billion per year, said to be 10 times more than the annual budget of the World Health Organization. According to the AAWC fact sheet (May 2014), 4.8 million Americans are stated to have a skin wound or ulcer that would need to be treated.

Three key patient groups that are growing and will need wound care services: diabetes patients, the elderly and the bariatric population. Wound care patients need wound care equipment and supplies throughout their care, which can last for a long time.

And, the three key categories a wound care provider can offer: dressings and bandages, therapeutic support surfaces, and negative pressure wound therapy (NPWT). These offer points of specialization, along with a wide range of items that support a very broad wound care business.

What does Wound care Nursing Involve?

Wound care nursing is an especially fulfilling practice because as a nurse you actually help the body heal. Wound care nurses require a lot of patience, respect for the patient, and ambition to stay up-to-date on current procedures and techniques. Besides, they work not just with the patient but with the family by educating and providing care instructions for patients and families. Chronic wounds need continual care and nurses who specialize in wound care need to be particularly vigilant in order to prevent any complications like infection.

Opportunities for Wound care Nurses

Given the categories of patient groups that need wound care nursing and the specialties within wound care itself, the opportunity is broad. With the right level of commitment, and passion wound care nurses can establish themselves as an expert resource in the healthcare marketplace. The median salary of a wound care nurse is $64,076 with a range of $41,701 – $83,160. An entry-level Wound Care Nurse with less than 5 years of experience can expect to earn an average total compensation of $57,000 based on 267 salaries provided by anonymous users. Average total compensation includes tips, bonus, and overtime pay. A Wound Care Nurse with mid-career experience which includes employees with 5 to 10 years of experience can expect to earn an average total compensation of $61,000 based on 162 salaries. An experienced Wound Care Nurse which includes employees with 10 to 20 years of experience can expect to earn an average total compensation of $63,000 based on 118 salaries. A Wound Care Nurse with late-career experience which includes employees with greater than 20 years of experience can expect to earn an average total compensation of $64,000 based on 60 salaries.

The Roles and Duties of a Wound Care Nurse

  • Evaluate and observe wounds
  • Debride, clean, and bandage wounds
  • Understand and determine treatment required
  • May involve specializing in certain wound types like foot ulcers etc
  • Work with patients and caregivers to monitor wounds
  • Prepares proper documentation for Medicare reimbursement and write orders to promote wound healing and the prevention of skin breakdown

Thus, the employment outlook for a wound care nurse is very good. Given the aging population and changing lifestyle, demand for wound care nurses in a variety of settings from acute care in hospitals to nursing home care, will always be on the up and up. It offers stability, is fairly independent specialty and offers flexibility in the area of nursing.

So if one has a bit of compassion and the need to heal others, then one doesn’t need to be a physician. Being a wound care nurse can bring a lot of fulfillment to your life just by easing your patient’s pain and providing relief. Yes you do need a strong heart and nerves of steel when cleaning wounds. But to provide relief and ease the pain at the end of the day, makes one sleep knowing that your patient will rest easy in the days to come!


Posted in Medical Billing, Medical Coding, Practice Management, Revenue Cycle Management (RCM), Wound Care Billing | Tagged , , , , , , , , | Leave a comment