Coding Notes - Billing & Coding Pocket Guide

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Copyright 2007 by F. A. Davis.

Copyright 2007 by F. A. Davis.

Providers Coding

NotesBilling and Coding Pocket GuidePurchase additional copies of this book at your health science bookstore or directly from F A. Davis by shopping . online at or by calling 800-323-3555 (US) or 800-665-1148 (CAN) A Daviss Notes BookF. A. Davis Company Philadelphia

Alice Anne Andress, CCS-P, CCP

Copyright 2007 by F. A. Davis.

F A. Davis Company . 1915 Arch Street Philadelphia, PA 19103 Copyright 2007 by F A. Davis Company . Copyright 2007 by F A. Davis Company. All rights reserved. This prod. uct is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in China by Imago Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Acquisitions Editor: Andy McPhee Manager of Content Development: Deborah J. Thorp Developmental Editor: Elizabeth LoGiudice Art and Design Manager: Carolyn OBrien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F A. Davis . Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036-1745-3/07 0 $.10.

Copyright 2007 by F. A. Davis.

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Copyright 2007 by F. A. Davis.

Look for our other Daviss Notes titlesRNotes: Nurses Clinical Pocket Guide, 2nd edition ISBN-10: 0-8036-1335-0 / ISBN-13: 978-0-8036-1335-5 Coding Notes: Medical Insurance Pocket Guide ISBN-10: 0-8036-1536-1 / ISBN-13: 978-0-8036-1536-6 Derm Notes: Dermatology Clinical Pocket Guide ISBN-10: 0-8036-1495-0 / ISBN-13: 978-0-8036-1495-6 ECG Notes: Interpretation and Management Guide ISBN-10: 0-8036-1347-4 / ISBN-13: 978-0-8036-1347-8 IV Therapy Notes: Nurses Clinical Pocket Guide ISBN-10: 0-8036-1288-5 / ISBN-13: 978-0-8036-1288-4 LabNotes: Guide to Lab and Diagnostic Tests ISBN-10: 0-8036-1265-6 / ISBN-13: 978-0-8036-1265-5 LPN Notes: Nurses Clinical Pocket Guide ISBN-10: 0-8036-1132-3 / ISBN-13: 978-0-8036-1132-0 MedSurg Notes: Nurses Clinical Pocket Guide ISBN-10: 0-8036-1115-3 / ISBN-13: 978-0-8036-1115-3 NutriNotes: Nutrition & Diet Therapy Pocket Guide ISBN-10: 0-8036-1114-5 / ISBN-13: 978-0-8036-1114-6 MA Notes: Medical Assistants Pocket Guide ISBN-10: 0-8036-1281-8 / ISBN-13: 978-0-8036-1281-5 OB Peds Womens Health Notes: Nurses Clinical Pocket Guide ISBN-10: 0-8036-1466-7 / ISBN-13: 978-0-8036-1466-6 Ortho Notes: Clinical Examination Pocket Guide ISBN-10: 0-8036-1350-4 / ISBN-13: 978-0-8036-1350-8 PsychNotes: Clinical Pocket Guide ISBN-10: 0-8036-1286-9 / ISBN-13: 978-0-8036-1286-0 Screening Notes: Rehabilitation Specialists Pocket Guide ISBN-10: 0-8036-1573-6 /ISBN-13: 978-0-8036-1573-1 Rehab Notes: Evaluation and Intervention Pocket Guide ISBN-10: 0-8036-1398-9 /ISBN-13: 978-0-8036-1398-0 IV Med Notes: IV Administration Pocket Guide ISBN-10: 0-8036-1446-2 / ISBN-13: 978-0-8036-1466-8 MedNotes: Nurses Pharmacology Pocket Guide, 2nd Edition ISBN-10: 0-8036-1531-0 / ISBN-13: 978-0-8036-1531-1 For a complete list of Daviss Notes and other titles for health care providers, visit

Copyright 2007 by F. A. Davis.

1General Billing and Insurance GuidelinesPatient Registration FormThe patient registration form is one of the most important forms in a medical practice. It contains all necessary information required for billing for services and procedures. This form should be updated yearly. Patient information should be reviewed and verified at each patient encounter to ensure that the practice has the most current and accurate information on file. Each item on the form should be verified by asking the patient, Do you still live at . . . instead of using a general statement such as Has anything changed since your last visit? A copy of the patients health insurance card, both front and back, should be copied during each visit. This form should contain the following information:

DataDate Patients name Patients address Patients phone number

ReasonRequired for billing purposes Required for billing purposes Required for billing purposes Required for billing purposes and to contact patient regarding appointments and testing results Required for billing purposes Required for billing purposes Required for patient identification purposes only Required for billing purposes

Patients date of birth Patients age Patients social security number Guarantors name, address, and phone number if patient is not guarantor Employers name, address, and phone number

Required for billing or if patient needs to be contacted during working hours(Continued text on following page)



Copyright 2007 by F. A. Davis.

DataSpouses name Spouses employers name, address, and phone number Insurance company name, address, and phone number Insurance identification and group numbers Person to be notified in case of emergency Referred by Patients signature Some forms will contain the following: List of current medications Past illnesses/surgeries Allergies

ReasonMay be required for billing purposes May be required for billing purposes or if spouse needs to be contacted during working hours Required for billing purposes

Required for billing purposes Required in case of emergency Required for billing purposes and quality of care purposes Required for billing purposes

For clinical reasons

Review this form for completeness as this information is critical to the billing process. Any missing information should be completed by asking the patient questions. There are some key areas to look for that may be tell-tale for nonpaying patients. These areas are: Incomplete information on the form Questionable employment information No phone number Post office box listed in lieu of a street address Motel address No insurance information No referral information


Copyright 2007 by F. A. Davis.

3A potential nonpaying patient may sometimes be identified by items on the previous list. If any of the listed elements exist, extra care should be taken to obtain accurate and complete information.

Patient Encounter FormOne of the most important factors in medical billing is an accurate billing form. This form has many names, patient encounter form, superbill, fee slip, charge slip, billing form, etc. This form is used to communicate the patient visit charges to the billing personnel. All information on this form must be accurate and complete and contain the following information: Patients name Patients address Patients home phone number Patients account number/medical record number Guarantors name Patient/guarantors insurance company and identification number Date of service Date of birth Provider name Diagnosis section CPT code section Space for next appointment Space for provider to complete with any studies that may need to be ordered This form must be reviewed and updated twice a year when the codes are updated. Deleted codes, new codes, and revised codes should be updated when necessary. The patients should be questioned at each visit to identify any changes that may have occurred since their last visit.



Copyright 2007 by F. A. Davis.

Life Cycle Of An Insurance FormNew Patient, OfficeA new patient is one who has not been seen by the physician or any physician in that specialty group within the last 3 years. These visits are reported using codes 9920199205. Detailed information regarding these codes can be found in Tab Two. The steps involved in an office visit for a new patient are:

Step 1The patient arrives at the office. The patient is either interviewed or completes a patient registration form to obtain information listed to the right. If the patient registration form is not completed in its entirety, the office staff should question the patient in order to obtain all the necessary information. Some offices will have the patient complete a history form in ad