Published articles by Cristina Bentin, President
of Coding Compliance Management, LLC.

10 Best Practices for Establishing Internal Coding Audits. Becker’s ASC Review, July 28, 2010. An existent compliance plan not only detects incorrect coding practices, it may also be considered by some federal agencies when determining whether reasonable efforts were taken to avoid and detect fraud and abuse. Let's look at the following 10 best practices for establishing internal coding audits at your ASC.

8 Key Points to Consider (and a Checklist to Use) When Selecting an External Coding Audit Company. Becker’s ASC Review, July 27, 2010. ASCs should incorporate an external audit into their compliance programs. Formal coding audit protocol should define the purpose of the audit, frequency of review and sample size. The difficult part is selecting a credible auditing company. The interview process can be tedious, but remember, your final selection will impact your facility's bottom line. Consider the following key points when conducting your search.

ICD-10 Implementation for ASCs: What You Must Do Now. Becker’s ASC Review, July 26, 2010. If you think you can wait until 2013 to evaluate your system processes and work protocols for the ICD-10 implementation, think again! The ICD-10 implementation doesn't mean you simply need to purchase a new coding manual. Just for starters, did you know electronic transaction version 4010 will change to version 5010 beginning with internal testing in 2010 and external testing as early as Jan. 1, 2011? If you've just experienced a "deer in the headlights" reaction, fear not. This column will bring you up to speed.

Physician Queries Done Right. Outpatient Surgery Magazine, May 2010. How to ask a physician to clarify inconsistent or vague documentation. While most surgeons document the surgical procedures they perform in your facility with the utmost precision, there may be times when your coder needs clarification or additional documentation before she can assign the proper codes. When there’s conflicting, incomplete or ambiguous information in the operative report, you must ask the physician to verify the procedure performed and to get any written clarification in the form of an addendum. The official name for this is a “physician query.” What it really means is, “Doc, we need you to clarify exactly what you did.”

3 Critical Knee Arthroscopy Coding Pitfalls Impacting an ASC's Bottom Line. Becker’s ASC Review, March 31, 2010. One of the biggest challenges in coding knee arthroscopies is determining whether to select CPT code 29877, Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) or 29879, Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture. Here are three points to keep in mind to accurately report an arthroscopy of the knee.

Best Practices to Ensure Coding Accuracy for Erratas, Category III Codes and CMS & AMA Updates. Becker’s ASC Review, March 03, 2010. Diligent ASC coders always make sure they have the most current information from manuals, coding software, Medicare edits and the like. But sometimes they forget to check for updates that coding authorities issue during the year, such as Erratas, new Category III codes and monthly updates from CMS and the AMA.

What’s New in CPT® for 2010? Focus, January/February 2010. Changes the American Medical Association (AMA) introduced in its Current Procedural Terminology (CPT®) codes for 2010 reemphasize the need for staff education and correct coding practices at your ASC, where less than perfect documentation and coding could significantly impact your bottom line. This article provides an overview of the changes ASC coders can expect to encounter in 2010.

When Is It OK to Bypass Medicare Edits? Outpatient Surgery Magazine, January 2010. Apply a modifier when it’s appropriate, not automatically. Automatically applying a modifier every time one’s allowed is a surefire way to leave money on the table. Just as it’s important that your coders know when a combination of codes warrants a bundling edit, it’s crucial that they know when it’s OK to bypass an edit.

Getting Reimbursed for Shoulder Scopes. Outpatient Surgery Magazine, March 2010. Even the most common procedures can challenge the most experienced coders. Reimbursements for orthopedic surgeries under the Medicare ASC payment system are on the rise. But if you don’t accurately report and code these cases, you won’t receive the maximum reimbursement. This is particularly true, I’ve found, of common shoulder cases. Let’s review a few of those procedures that, if coded improperly, could mean you’re leaving money on the table.

How to Report Post-op Pain Blocks. Outpatient Surgery Magazine, October, 2009. Deciphering different post-op pain directives is key to getting the proper reimbursement. When it comes to getting paid for post-op pain blocks, not all payors require the same documentation and proof of medical necessity. Some commercial carriers follow the Medicare edits and guidelines while others don’t follow Medicare reimbursement — potentially allowing for more aggressive coding and reporting. Here’s a review of different post-op pain directives.

Guide to Understanding RACs: 5 Steps for Your ASC to Become Better Prepared. Becker’s ASC Review, August 21, 2009. With Recovery Audit Contractors dedicated to making significant recoveries from healthcare providers, it is critical that all providers are compliant with Medicare coding and reimbursement requirements. Upfront compliance is essential to avoiding overpayments and/or underpayments as a result of incorrect coding and billing.

5 Best Practices for Improved Coding of Orthopedic and Spinal Procedures. Becker’s ASC Review, April 28, 2009. The reporting of orthopedic, spinal and pain management procedures continue to provide challenges for many ASCs regardless of whether the coder is a novice or a seasoned veteran. Below are five best practices to help ensure your facility captures reimbursement opportunities while adhering to coding guidelines.

General Surgery Coding Guidance for 2009 Additions and Revisions. Becker’s ASC Review, November 24, 2008. While ASC facilities can expect a reduction in reimbursement in the specialties of pain management and GI in 2009, general surgery sees several procedures new to CPT and also some to the Medicare-approved procedures list which may offer reimbursement opportunities. Here is an analysis of these coding changes in three areas of general surgery and best practices to ensure you code and continue to code correctly these procedures.

News of note ...

July 28, 2010. Becker’s ASC Review names CCM President Cristina Bentin as one of the “107 Great Women Leaders in the ASC Industry.

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