These charts look at denial rates for both outpatient and inpatient E/M services in 2009 and 2010, for 10 specialties that have very high annual Medicare E/M utilization. Denial rates are higher for the high-level codes compared to the mid-level codes. Orthopedic surgery and urology have the highest denial rates regardless of code level, while hematology/oncology, pulmonary disease and dermatology are among the lowest.

Q. We have a Medicare patient diagnosed with 279.00 (hypogammaglobulinemia, unspecified) who is receiving 4 CC of gamma globulin every 30 days.  At this point we haven’t received any guidance from Medicare. Are we billing J1460 (gamma globulin 1 CC inj) correctly? Are there any modifiers used for this J-code that should be used? Will these claims get paid or denied?

This tool is a handy quick-reference chart that shows all five new Q-codes for flu vaccines, introduced in 2011. The chart, which in Microsoft Excel 97-2003 format, can be printed and posted in your office to help your billers, coders and clinicians distinguish between the Q-codes, listing their name, manufacturer, chareg and administration code, and dosage guidelines.

by Cheryl Clark

New CAQ program for physician assistants in five specialty areas

by Carrie Vaughan

The National Commission on Certification of Physician Assistants (NCCPA) launched a new certificate of added qualifications (CAQ) program for certified physician assistants (PA) practicing in cardiovascular and thoracic surgery, emergency medicine, nephrology, orthopedic surgery, and psychiatry.

At some point, usually in the midst of struggling with third-party payers over meager reimbursement and oppressive bureaucracy, most physicians fantasize about chucking it all and just dealing directly with patients on a cash basis. It's only a dream for most doctors, but one surgeon in Las Vegas has found a way to make it work.

by Joe Cantlupe

by John Commins

by Margaret Dick Tocknell