All of these billing tools are free. However, Medicare and other carriers change their LCDs and other policies constantly!!! We will email you when we update these forms. Please sign up for our Email List so we can send you a reminder email when the form is updated. This way, we can ensure that you stay current. We also get requests from providers to add DX and CPT groups to these forms. For instance, we are in the process of adding infrared and diathermy, as well as reasonable and customary limits for modalities; and a modifier usage table.
Billing Tools
For Otolaryngologists
2007 DX Coding Changes for Otolaryngology. This is not an all-inclusive list of changes. Rather, I have included the codes that our physicians frequently utilize. Of particular note is the deletion of 478.1. This code now requires a 5th digit.
For PTs
Medicare LCD for PT in Reverse. No more dragging around a 35-page document and endless thumbing to figure out if Medicare will pay for the procedure you want to perform, given the patient's DX. We created this for the PT After Hours series in WV and for the Ohio Physical Therapy Association. Our billing clients also use it extensively to avoid Medicare denials for "medical necessity" and as a tool to determine when to have an ABN signed by a patient. Note: this is specific to Palmetto GBA for Ohio and West Virginia, although can be used as a general guideline for other insurances. We are considering adding other Medicare carriers' LCDs. Join our Email List so we can send you a notice when we get your state finished!
NEW! Billing Specialist Interview Questions. If you're hiring an in-house biller, make sure you're getting one with the experience, qualifications and drive that you need. You're putting your entire livelihood and the stability of your practice in this person's hands, so make sure you're getting a good one! Also see our Working with a Medical Billing Company handout if you're considering putting this function in the hands of a professional.
For Chiros
Chiropractic DX Coding for Medicare. People swarm our booth when we attend chiropractic association conferences to get their hands on one of these. We usually run out of our laminated version! All of our clients keep them in their exam rooms. If used properly, you will not have any difficulties with Medicare denying for "medical necessity" because you will choose the correct primary diagnosis code AND the secondary diagnosis code that will result in the most visits being allowed. This is specific to Palmetto GBA for Ohio and West Virginia. Do not use this for Trailblazer.
NEW! Spinal/Extremity Adjustment Billing Handout. For "newbies" to your staff, this handout is an easy reference to make sure you've put enough DXs on your claims to justify the level of adjustment you are billing. Note that Extremity Adjustments are "one or more regions" so you cannot bill multiple units.
Links and Resources
FlashCode. Free Internet based resource to check the validity of diagnosis codes. Click on the bullseye on the main page. Click the bullseye again on the next page. Then enter your code in the box at the top center. It will tell you if you have a "good" code or if you need a 5th digit.
Ecare upin. Lookup upin numbers and specialty codes for referring physicians.
National UPIN registry. Lookup upin, specialty designations and unique physician ID numbers for referring physicians.
Funny. Just a way of sharing our warped office humor.