When Is A Claim Submitted By A Medical Coding Company Denied As A Duplicate Service?

When Is A Claim Submitted By A Medical Coding Company Denied As A Duplicate Service?

Every practice deals with claim denials and ‘duplicate service’ is a common reason for denial. When a claim submitted by a medical coding company is denied as a duplicate service, it indicates that more than one claim was submitted for the same service, for the same patient, for the same date of service.

Blue Cross Blue Shield defines a duplicate claim as: “Any claim submitted by a physician or provider for the same service provided to a particular individual on a specified date of service that was included in a previously submitted claim”. This does not include corrected claims.

In most cases, the claim would have been already processed and paid or it is identical to a previously submitted claim. Practices need to strictly adhere to claim submission rules to avoid duplicate claims, which are not only counterproductive and costly, but can lead to scrutiny and integrity actions by the Medicare administrative contractor (MAC).

Reasons for Duplicate Claim/Service Denials

  • The service was performed more than once on the same day: The same provider may provide the same service for the same patient multiple times on the same day. The first claim is likely be processed and paid, and the second claim will be denied as a duplicate claim or service.

    Modifier 76 Repeat procedure or service by same physician or other qualified health care professional, should be appended to the second claim to indicate that the procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. Modifier 76 is used for surgeries, x-rays and injections. If the claim is denied again, you can appeal and provide documentation.

  • The same service was performed by another provider on the same date: A patient may receive a service on the same day with two different providers, A and B. If provider A submitted a claim with the same CPT code as provider B and received a payment prior to provider B’s claim, then provider B’s claim will get denied. In this case, the insurance company should be informed that provider B also performed the service and send the claim back for reprocessing. If the claim is not reprocessed, it can be appealed with supporting documentation.
  • Same service was performed bilaterally by one provider: Suppose the same provider performed the same procedure on both legs of the patient and both claims were submitted without the correct modifier, one claim may be paid and the other denied as a duplicate claim. Appending modifier 50 or RT and LT modifiers would indicate the same procedure performed bilaterally.
  • The service was performed once but billed twice: If the claim for a service is submitted twice, it will be denied as duplicate. This can occur inadvertently, but is a costly mistake. The payer will reimburse only the original claim and deny the second one. The practice’s medical billing service provider should ascertain whether the original claim has been processed for payment.
  • Submitting a corrected claim without proper information: It is important to file a corrected claim according to the payer’s specific instructions below to ensure that payer can identify the original claim, understand the correction that is required and ensure that the resubmitted claim is not denied as a duplicate. When a claim is corrected and resubmitted, it should be clearly indicated as a corrected claim along with the original claim ID, and reason for attachments or corrections. Claims that are submitted without the necessary information will be returned or denied as duplicates.

How to Respond to Duplicate Service Denials

  • If the claim for a service performed more than once on the same day is denied, verify if you submitted the claim with the appropriate modifier and other requirements. If not, rebill it with the correct modifier. On the other hand, if you submitted the claim correctly and it was still denied, submit a letter of appeal with documentation for each specific service to prove it was performed more than once and therefore is not a duplicate service.
  • For a claim that was submitted twice, a Find a Code article recommends verifying the following:
    • If the payment was made on the first claim, whether it was sent to the correct address?
    • If the check was deposited but missed in the posting process?
    • If payment was sent to the patient for failure to check the ‘accept assignment’ box on the HCFA form?
    • If the first claim submitted was denied and the denial was handled correctly. Sometimes claims can be resubmitted by simply correcting a diagnosis code, modifier, or other problem.
  • Denial due to ‘same service performed by another provider on the same date’ can be appealed using the method required by the insurance. Appeal methods differ among payers.

Partnering with an experienced provider of physician billing services can minimize claim denials and rejections and other billing errors. In the event that a claim is denied, they will follow up on it, and appeal claims that have not been processed correctly. Experts would also be familiar with the appeals and claim resubmission methods for each insurance company.

April Is Parkinson’s Disease Awareness Month – Know More About PD

April Is Parkinson’s Disease Awareness Month – Know More About PD

The month of April marks “Parkinson’s Disease (PD) Awareness Month” – a good time to generate public attention about PD – a progressive neurodegenerative disorder. Sponsored by the Parkinson’s Foundation, the campaign makes life better for people with PD by improving care and advancing research towards a possible cure. A neurodegenerative disorder, PD involves progressive damage of the brain over many years. It leads to progressive deterioration of motor function due to loss of dopamine-producing brain cells. The exact cause of PD is unknown, but several factors like genes, the presence of Lewy bodies in brain cells and environmental triggers appear to play a crucial role. Initial symptoms of this condition may vary from one person to another. However, in most cases early symptoms may be mild and unnoticed. Although this neurological condition can’t be fully cured, medications can dramatically reduce or improve the severity of symptoms. However, in advanced cases, surgery may be recommended to regulate certain regions of the brain and improve the symptoms. Billing and coding for PD can be a challenging process. Relying on the services of a reputable physician coding company can help in precise documentation of this neurodegenerative disorder.

Prior to COVID, the Centers for Disease Control and Prevention (CDC) rated complications from PD as the 14th leading cause of death in the United States. As per reports from the Parkinson’s Foundation, PD affects about 10 million people globally and about 1 million people in the United States. In most cases, only 4 percent of all cases are diagnosed before age 50 and hence aging is the biggest risk factor for developing PD. In fact, PD is regarded as the second most common age-related nerve degenerating disease after Alzheimer’s.

The month-long campaign is a unique platform to promote a better understanding about this neurological disorder and how it can affect a person. It aims to highlight the symptoms and risk factors associated with this condition and diagnose it during the early stages or even prevent it if possible. Often, symptoms of PD begin on one side of the body and usually remain worse on that side, even after symptoms begin to affect both sides. Generally, this condition develops gradually, (beginning with a barely noticeable tremor in just one hand). On the other hand, it can also cause stiffness or slowing of movement. Other common signs and symptoms include – slowed movement (bradykinesia), rigid muscles, speech changes, impaired posture and balance, loss of automatic movements and writing changes.

There are no specific tests that exist to diagnose Parkinson’s disease. Initial diagnosis of the condition may begin with a detailed evaluation of medical history, review of signs and symptoms and a neurological and physical examination. Neurologists or other physicians may request a specific single-photon emission computerized tomography (SPECT) scan called a dopamine transporter scan (DaTscan). Imaging tests like – MRI, ultrasound of the brain, and PET scans may also be used to help rule out other disorders. In addition, physicians may also order lab tests, such as blood tests, to rule out other conditions that may be causing the symptoms. Treatment methods include medications and incorporating several positive lifestyle changes. Medications will help people manage problems with walking, movement and tremor. These medications also increase or substitute for dopamine, a specific signaling chemical (neurotransmitter) in the brain. Neurologists who diagnose and administer treatment procedures must correctly document the same using the right medical codes. Physician billing services provided by professional providers ensure that the correct medical codes are reported on the claims. ICD-10 codes for diagnosing PD include –

G20 – Parkinson’s Disease

G21 – Secondary Parkinsonism

  • G21.0 – Malignant neuroleptic syndrome
  • G21.1 – Other drug-induced secondary parkinsonism
  • G21.2 – Secondary parkinsonism due to other external agents
  • G21.3 – Postencephalitic parkinsonism
  • G21.4 – Vascular parkinsonism
  • G21.8 – Other secondary parkinsonism
  • G21.9 – Secondary parkinsonism, unspecified

As part of the campaign, hospitals, healthcare centers, and other types of medical facilities across the world will host education seminars, podcasts, fitness classes, discussions, and presentations and share information on social media to raise public awareness about PD. The theme for the 2021 campaign is – #KnowMorePD – which aims to challenge people to test their knowledge of Parkinson’s disease and spread the word. In keeping with the event’s theme, the foundation developed what it calls a #KnowMorePD Quiz – which supporters are asked to share on social media. If the quiz is taken during April, participants will be entered into a weekly drawing for a $25 Amazon gift card. Supporters are encouraged to submit narratives to the organization’s “My PD Story” effort to tell people what it’s like to live with Parkinson’s and how the foundation is helping. Supporters are encouraged to post to social media using the hashtag #KnowMorePD. “All throughout the month, photos, videos, facts, stories, and resources on social media will be posted to raise awareness about PD and the Parkinson’s Foundation efforts to spread awareness about PD. People can follow along and engage with @ParkinsonDotOrg on their social media platform of choice for the newest information to help you #KnowMorePD.

January Is Thyroid Awareness Month – Stay Informed about Thyroid Related Disorders

January Is Thyroid Awareness Month – Stay Informed about Thyroid Related Disorders

January – the month for new beginnings – is observed as “Thyroid Awareness Month” in the United States. Sponsored by the American Association of Clinical Endocrinologists, the campaign calls attention to the various health problems connected to the thyroid. It aims to generate awareness about the health and function of the thyroid gland – a small, butterfly-shaped gland located at the base of the neck. The thyroid gland releases hormones that help regulate metabolism, body temperature and other core physical functions. It controls the functions of many of the body’s most important organs, including the heart, brain, liver, kidneys and skin. Dysfunction occurs when the thyroid produces either too much or too little thyroid hormone. Thyroid disorders are of different types which include – hyperthyroidism, hypothyroidism, goiter, thyroid nodules and thyroid cancer. Undiagnosed thyroid disease may put patients at risk for other health conditions like cardiovascular diseases, osteoporosis, and infertility. Treatment for this condition involves a combination of medications and surgery (in severe cases). Early and accurate diagnosis of thyroid disorders is a difficult task as in most cases the symptoms develop slowly (often over several years). Billing and coding thyroid gland related disorders can be challenging. Endocrinologists or other specialists who treat these conditions need to report the diagnosis and other procedures using the correct medical codes. For correct clinical documentation of this disorder, physicians can utilize the medical billing services offered by reputable medical billing companies.

The 2021 campaign highlights the crucial role the thyroid plays in the ability of major organs to function. It aims to highlight the need for people to get tested if they experience unexplained symptoms. Up to 30 million Americans are estimated to have a thyroid condition. Most people with thyroid disease don’t even know they suffer from it. Women are five to eight times more likely to suffer from this condition than men.

The exact cause associated with this disorder is unknown. In most cases, different types of thyroid disorders occur when the thyroid gland produces too much hormone (hyperthyroidism), or not enough hormones (hypothyroidism). Depending on how much or how little hormone the gland produces, people may experience symptoms like – weight gain/loss, restlessness or tiredness, dry, coarse skin and hair, intolerance to cold, infrequent, scant menstrual periods, sleep disturbances, enlarged thyroid gland, and hoarse voice among others. Health experts consider this campaign as a unique platform to publicize information about thyroid diseases and educate and encourage people to visit their physicians for a simple blood test to determine if they require any specific treatment.

As the symptoms associated with different thyroid disorders vary and resemble other conditions, performing an accurate diagnosis often remains a challenging task. Initial diagnosis of this condition begins with a physical examination and review of previous medical history. Blood tests may be performed as part of the diagnosis to measure levels of thyroid stimulating hormone (TSH), Anti-TPO antibodies, T3 and T4 (thyroxine) and Thyroglobulins. In addition, several imaging tests like Thyroid scans, CT scans, Ultrasound, or PET scans may also be performed when thyroid nodules or enlargement are present. In severe cases, fine needle aspiration and biopsy are used to remove a sample of cells or tissue from the thyroid gland for detailed analysis. Treatment modalities for thyroid conditions help restore normal blood levels of thyroid hormone and these include – anti-thyroid medications, thyroid hormone pills, injecting thyroid-stimulating agent, radioactive iodine therapy (that disables the thyroid), and even thyroid surgery to remove part of, or the entire gland (in extreme cases).

Endocrinology medical billing and coding can be a complex task. Endocrinologists or other specialists who treat patients with different types of thyroid disorders need to use the correct medical codes for accurate documentation. By outsourcing physician billing services, healthcare practices can ensure accurate claims submission and correct reimbursement. ICD-10 codes for diagnosing thyroid disorders include-

  • E00 – Congenital iodine-deficiency syndrome
  • E01 – Iodine-deficiency related thyroid disorders and allied conditions
  • E02 – Subclinical iodine-deficiency hypothyroidism
  • E03 – Other hypothyroidism
  • E04 – Other nontoxic goiter
  • E05 – Thyrotoxicosis [hyperthyroidism]
  • E06 – Thyroiditis
  • E07 – Other disorders of thyroid

Healthcare centers, hospitals and other community health systems across the US will host a wide range of events as part of the 2021 monthly observance. These include – performing thyroid neck check on a regular basis, encouraging friends and family to get tested for thyroid, arranging discussions that emphasize the importance of early treatment and showing valuable support by making donations to many research or treatment institutions across the country. Affected patients can share their powerful stories via different social media platforms and help to strengthen understanding, cultivate empathy, and ultimately create change.

Documenting Bronchiolitis – A Common Pediatric Respiratory Infection

Documenting Bronchiolitis – A Common Pediatric Respiratory Infection

Regarded as a common lower respiratory tract infection in young children and infants, bronchiolitis causes inflammation and congestion in the small airways (bronchioles) of the lung. Affecting children and babies (below the age of 2 years), the condition is generally caused by a virus that affects the smallest air passages in the lungs (called the bronchioles). Bronchioles help control airflow in the lungs. Any specific damage or infection within the bronchioles can make them swell or become clogged thereby blocking the free of oxygen. Typically, the peak time for bronchiolitis is during the winter months. Most cases of bronchiolitis are mild and clear up within 2-3 weeks even without any specific treatment. On the other hand, some children experience severe symptoms and need hospital treatment. The treatment modalities for this condition depend on when the condition was diagnosed and how far the condition has progressed. Physicians while diagnosing the symptoms should correctly document the procedures performed in the patients’ medical records. Correct diagnosis of bronchiolitis symptoms is crucial to provide appropriate care and treatment. Outsourcing billing and coding tasks to a reliable medical billing and coding company can help physicians simplify their documentation process.

Most cases of bronchiolitis are caused by the respiratory syncytial virus (RSV). RSV is a common virus that affects children by the age of 2 years and is also common in babies less than 1 year of age. The contagious virus produces inflammation, mucus, and swelling in the airways. Other viruses like adenoviruses (that target mucous membranes), influenza viruses (that cause inflammation in the lungs, nose, and throat) also cause this specific condition. In fact, these viruses can easily spread and contract through droplets in the air when someone who is sick coughs, sneezes or talks. It can also be spread by touching shared objects (such as toys or towels) and then touching the eyes, nose or mouth. In addition, in some rare cases, bronchiolitis can also occur due to other causes like respiratory infections, adverse reactions to medications and exposure to fumes from chemicals (like ammonia, bleach, and chlorine).

Identifying the Symptoms and Risk Factors

The signs and symptoms associated with the condition are similar to those of a common cold such as a runny/stuffy nose and a cough. These symptoms can last for several days to weeks. However, as the condition progresses, patients experience other related symptoms like –

  • Rapid or shallow breathing
  • Wheezing
  • Turning blue or gray in the lips, fingertips or toes
  • Ribs that appear sunken during attempts to inhale (in children)
  • Nasal flaring (in babies)
  • Making grunting noises
  • Having trouble sucking and swallowing
  • Fatigue
  • Crackling or rattling sounds heard in the lungs
  • Being sluggish

As mentioned above, bronchiolitis typically affects children under the age of 2 years. On the other hand, infants (younger than 3 months of age) are at greatest risk of getting bronchiolitis as their lungs and immune systems do not get fully developed. Other factors that are linked with an increased risk of bronchiolitis in infants include – premature birth, underlying heart or lung condition, never having been breast-fed (breast-fed babies receive immune benefits from the mother), exposure to tobacco smoke and weakened immune system.

Bronchiolitis and Bronchitis – Primary Point of Difference

These conditions not only sound similar, but are similar in some ways. Both the conditions are caused by a virus and both affect the smaller airways – bronchioles. Bronchitis generally affects older children and adults, while bronchiolitis is more common in younger children.

Diagnosing and Treating Bronchiolitis

Diagnosis of this condition is usually based on the symptoms and an examination of the child’s breathing. Physicians will examine the child and listen to their lungs. A pulse oximeter – an electronic device – can be placed painlessly on the fingertips or toes of the child to find out how much oxygen is there in the child’s blood. Physicians may also ask about the signs of dehydration, especially if the child has been refusing to drink or eat or has been vomiting. In case of severe bronchiolitis, if the symptoms are worsening or if another problem is suspected, physician may order other tests, like- Chest X-ray, Blood tests (to check the white blood cell count) and Viral testing (collecting a sample of mucus to test for the virus) causing bronchiolitis.

As mentioned above, bronchiolitis typically lasts for two to three weeks. In most cases, children with bronchiolitis can be cared for at home with supportive care. However, it is important to be alert for changes in breathing such as difficulty to breathe or making grunting noises with each breath. As viruses cause bronchiolitis, antibiotics used to treat infections caused by bacteria – will not be effective. In some cases, bacterial infections (such as pneumonia or an ear infection) can occur along with bronchiolitis and the doctor may prescribe an antibiotic for that infection. A small percentage of children may need immunosuppressant medications, oxygen therapy or intravenous (IV) fluids, which will be prescribed by the physicians and given in the hospital. Breathing exercises and stress reduction can help ease breathing difficulties. The diagnostic tests and treatment procedures for bronchiolitis must be correctly documented using the right codes. Outsourced billing services from a reliable and experienced medical billing company can help physicians report the correct billing codes. ICD-10 codes include –

  • J21 Acute bronchiolitis
  • J21.0 Acute bronchiolitis due to respiratory syncytial virus
  • J21.1 Acute bronchiolitis due to human metapneumovirus
  • J21.8 Acute bronchiolitis due to other specified organisms
  • J21.9 Acute bronchiolitis, unspecified
  • J22 Unspecified acute lower respiratory infection

Bronchiolitis can be spread through close contact, saliva and mucus. Recovery from this condition requires extra rest and increased fluid intake. The virus that causes bronchiolitis is very common and easily spread, therefore preventing it completely is not possible. However, it is possible to reduce the likelihood of your child developing or spreading the infection by following certain steps like – maintaining a smoke-free environment, humidifying the air, frequently offering small amounts of fluid (such as water or juice to prevent dehydration), trying saline nose drops (to ease congestion), OTC pain relievers, avoiding contact with others who are sick and practicing good hand washing habits.

Medical billing and coding for bronchiolitis can be complex. By outsourcing physician billing services, healthcare practices can ensure correct and timely medical billing and claims submission.

Significant CPT Code Changes for Cardiology in 2020

The 2020 CPT code updates by the American Medical Association (AMA) include 394 code changes, including 248 codes, 7 deletions and 75 revisions. Cardiology has 26 new codes and 11 deleted codes. Cardiology medical billing is a challenging process that requires staying up to date with yearly code changes. Outsourcing the task to an expert can ensure accurate and compliant coding and billing to ensure that money is not left on the table.

  • Pacemaker Removal: Code 33275, leadless pacemaker removal, was revised to include imaging guidance

33275 Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (Eg. fluroscopy, venous ultrasound, ventriculography, femoral venography), when performed

  • Pericardiocenteisis: There are 4 new codes for pericardiocenteisis (33016, 33017, 33018, 33019) that take age into account as well as whether or not the patient has congenital cardiac anomaly. New code 33016 for pericardiocentesis includes imaging guidance when performed. Code 33010 has been deleted.

Deleted: Code 33010 – pericardiocenteisis; inital

New codes

33016 Pericardiocentesis, including imaging guidance when performed

New codes 33017, 33018, and 33019 are related to services in the pericardium. These codes imply that in order to report pericardial drainage with insertion of an indwelling catheter, the catheter needs to remain in place when the procedure is completed.

33017 pericardial drainage with insertion of indwelling catheter, percutaneous, including fluoroscopy and/or ultrasound guidance, when performed; 6 years and older without congenital cardiac anomaly

33018 including fluoroscopy and/or ultrasound guidance, when performed; birth through 5 yrs of age or any age with congenital cardiac anomaly

33019 pericardial drainage with insertion of indwelling catheter, percutaneous, including CT guidance

There are several new parenthetical notes on the use of these codes. The notes state that these codes cannot be reported in addition to many radiological codes that already include the service. For eg, code 75989 (radiological guidance – fluroscopy, ultrasound or computed tomography) for percutaneous drainage (e.g., abscess, specimen collection) cannot be reported with placement of catheter, radiological supervision and interpretation) in addition to 33017, 33018 or 33019.

  • Endovascular Repair of Iliac Artery: Endovascular repair has evolved as an alternative to surgical repair and may be a useful option for patients at high surgical risk. There are 2 new codes for iliac branched endograft (IBE) – 34717 and 34718. 34717 is an add-on code for repair at time of aorto-iliac endograft.

34717+ Endovascular repair of iliac artery at the time of aorto-iliac artery endograft placement by deployment of an iliac branched endograft including pre-procedure sizing and device selection

34718 Endovascular repair of iliac artery, not associated with placement of an aorto-iliac artery endograft at the same session, by deployment of an iliac branched endograft, including pre-procedure sizing and device selection

  • Ascending Aorta Graft: This procedure involves excision of the ascending aorta and underside of the aortic arch, and placement of a thoracic aortic stent graft into the descending aorta at the time of the arch repair (www.emoryhealthcare.com). There are 2 new codes for ascending aorta graft and one new code for transverse aortic arch graft

33858 Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed, for aortic dissection

33859 Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed, for aortic disease other than dissection (e.g., aneurysm)

33871 transverse aortic arch graft, with cardiopulmonary bypass, with profound hypothermia, total circulatory arrest and isolated cerebral perfusion with reimplantation of arch vessel(s) (eg, island pedicle or individual arch vessel reimplantation

  • Exploration of Artery

Changes have been made to the artery exploration set of codes. Code 35701 was revised and 2 new codes 35702 and 35703 were added, and three codes (35721, 35741 35761) were deleted.

Revised: 35701 Exploration not followed by surgical repair, artery; neck (leg, carotid, cubclavian)

New

35702 Upper extremity (eg, axillary, brachial, radial, ulnar)

35703 Lower extremity (eg, common femoral, deep femoral, superficial femora, popliteal, tibial, peroneal

The American College of Surgeons draws attention to the following points on the use of the new codes for exploration of artery:

  • Previously, the code descriptors for exploration of artery had included “with or without lysis of artery”. As lysis of artery is rarely done during exploration, this language has been removed from the code descriptors in 2020.
  • When artery exploration is performed on the same side of the neck as blood vessel repair, exploration of postop hamorrhage, thrombosis, or infection; or flap or graft procedures in the neck, code 35701 may not be reported separately.
  • When artery exploration is performed on the same extremity as blood vessel repair, code 35702 or 35703 may not be reported separately.
  • Codes 35701, 35702 and 35703 may be reported only once with a surgical procedure performed by the same surgeon if the other procedure is a nonvascular surgical procedure and the artery exploration is performed thru a separate incision.

Other new codes for cardiology include:

  • 78429 Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall motion(s) and/or ejection fraction(s), when performed, single study; with concurrently acquired computed tomography transmission scan
  • 78430 Perfusion study (including ventricular and motion(s) and/or ejection fraction (s), when performed), single study, at rest or stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan
  • 78432 Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall motion(s) and/or ejection fraction(s), when performed), dual radiotracer (eg myocardial viability)
  • 78433 Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall motion(s) and/or ejection fraction(s), when performed), dual radiotracer (eg myocardial viability) with concurrently acquired computed tomography transmission scan
  • 78434+ Absolute quantitation of myocardial blood flow (AQMBF), positron emission tomography (PET), rest and pharmacologic stress (list separately in addition to code for primary procedure)
  • 93356+ Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics (list separately in addition to codes for echocardiography imaging)

It can be a real challenge for busy cardiology practices to stay current with all the updates each year. Cardiology physician billing services can ease the task and help providers ensure accurate and compliant coding to prevent denials and optimize reimbursement.