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News and Important Information

New for 2023: Acupuncture CPT Codes for Medical Billing Expanded coverage for Medicare (2022-12-29) Needle insertion(s) without injection(s)
20560: 1 or 2 muscle(s)
20561: 3 or more muscles

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Information Sharing with the Feds is Risky Business

by  David M. Glaser, Esq.

Over the last few weeks, a few articles of mine addressed interacting with government agents. One topic that I did not discuss was determining whether you can, should, or must share information with the government.  Unfortunately, it’s not possible to definitively answer that question for every topic, even in...

CMS Unveils 2024 Medicare PFS, OPPS Proposed Rules

by  Mark Spivey

The OPPS proposal did not feature reference to several high-profile issues industry leaders have been awaiting reform on. Federal officials yesterday unveiled a pair of proposed rules, featuring potential adjustments to the Medicare Physician Fee Schedule (PFS) and Outpatient Prospective Payment System (OPPS) for the 2024 calendar year....

Understanding, Identifying, and Reporting Combination Codes

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Coders often see conditions that seem to always be reported together. Diabetic patients tend to develop other conditions as the diabetes continues to progress instead of improving. Combination codes are one of those types of codes that identify multiple conditions or diseases but have their own set of special coding guidelines.

Is the End Really Near?

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

What happens once the COVID-19 emergency declarations have ended?

Relative Value Units (RVUs) the Easy Way, Really?

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

The Medicare Physician fee schedule was implemented in 1992 using a relative Value scale methodology called RVUs to base payment rates on the resources used to perform the service. This is currently how the Medicare Physician Fee Schedule (MPFS) is set. But beware, there may be an industry-wide change to a Value-Based Payment. We will save that for another time; this article will focus on how the RVUs are calculated and Medicare Fee schedules.

REMINDER: CMS Discontinuing the use of CMNs and DIFs- Eff Jan 2023 Claims will be DENIED!

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Updated Article - REMINDER! This is important news for durable medical suppliers! Effective January 1, 2023, CMS is discontinuing the use of Certificates of Medical Necessity (CMNs) and DME information forms (DIFs). We knew this was coming as the MLN sent out an article on May 23, 2022, but it is time to make sure your staff knows about these changes.

2023 ICD-10-CM Code Changes

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

In 2022 there were 159 new codes; the 2023 ICD-10-CM code update includes 1,176 new, 28 revised, and 287 deleted codes, a substantial change from last year. The 2023 ICD-10-CM codes are to be used for discharges from October 1, 2022 through September 30, 2023, and for patient encounters from ...

Emergency Department - APC Reimbursement Method

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

CMS pays emergency department visits through a payment method using Ambulatory Payment Classifications (APCs). Most payers also use the APC reimbursement system; however, there may be some differences in payer policies (always review your specific payer policy). APCs are the primary type of payment made under the OPPS, comprising groupings ...

CMS says Less Paperwork for DME Suppliers after Jan 2023!

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

This is important news for durable medical suppliers! Effective January 1, 2023, CMS is discontinuing the use of Certificates of Medical Necessity (CMNs) and DME information forms (DIFs). We knew this was coming as the MLN sent out an article on May 23, 2022, but it is time to make sure your staff knows about these changes.

E/M Changes Coming Our Way in 2023!

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Changes are one thing we can count on being consistent; even though this is one we have been anticipating, it is time to prepare, and we will have some work to do. The AMA released the new 2023 E/M Guidelines early to help us prepare for the change effective January ...

$636 Million in Overpayments Made by Medicare to Providers for Neurostimulators

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

According to the OIG "MEDICARE OVERPAID MORE THAN $636 MILLION FOR NEUROSTIMULATOR IMPLANTATION SURGERIES." So often we think if we get paid, we must be doing it right, well this is not always the case. You may get paid and then have to return the funds if billed incorrectly or a step ...

Coding for a Performance of an X-ray Service vs. Counting the Work as a Part of MDM

by  Stephanie Allard, CPC CEMA RHIT

When x-rays are audited on the same date as an E/M encounter we have one of three decisions to make about the work that went into the radiological exam when the practice owns x-ray equipment and does their own interpretations internally. First, we must determine whether the x-ray was...

Medicare Auditors Caught Double-Dipping

by  Edward Roche, PhD JD

Overlapping extrapolations require providers to pay twice. Some Medicare auditors have been caught “double-dipping,” the practice of sampling and extrapolating against the same set of claims. This is like getting two traffic tickets for a single instance of running a red light. This seedy practice doubles the amount...

2022-03-10-MLNC - COVID-19 Monoclonal Antibodies: Revised Emergency Use Authorization for EVUSHELD

by  CMS - MLNConnects

News - COVID-19 Monoclonal Antibodies: Revised Emergency Use Authorization for EVUSHELD - Program for Evaluating Payment Patterns Electronic Reports for Short-term Acute Care Hospitals - Quality Payment Program: 2020 Performance Information on Care Compare - Skilled Nursing Facilities: Submit Technical Expert Panel Nominations by March 16 ...

Cybersecurity & Ransomware Warnings

by  Wyn Staheli, Director of Content - innoviHealth

Although HIPAA Security protocols have been in effect for some time, as technology advances, if we are not diligent, gaps can be left available for intruders. On top of that, on February 23, 2022, the American Hospital Association issued a cybersecurity advisory. They stated, “there is concern that Russia may retaliate against the U.S. and allied nations with disruptive cyberattacks.”

Changes in RPM for 2021! Now, Wait for it... New RTM Codes for 2022

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Remote physiologic monitoring and clinical data monitoring is a relatively new concept thriving and growing as an essential component for telehealth services. According to global consumer trends, a company called Dynata reported, "Among the 39% of people who consulted a healthcare professional, two-thirds used telemedicine, many of them for the first time ...

Understanding ASCs and APCs: Indicators and Place of Service

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

The decision regarding the most appropriate care setting for a given surgical procedure is determined by the physician based on the patient's individual clinical needs and preferences. Of course, there is a difference in reimbursement, and the billing depends on where the procedure took place, such as an office setting, inpatient ...

Is Your Organization Ready to Deal with Provider Relief Fund (PRF) Audit Contractors?

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Audits are currently underway to verify the monies distributed through the CARES Act were warranted and properly used by those organizations that received them. The federal government has contracted with financial institutions such as KPMG and PricewaterhouseCoopers, among others, to perform these audits referred to as Provider Relief Fund (PRF) audit contractors, funded with monies from the very same program. There were four phases of funding disbursements with phase 1 audits beginning in September. How ready are you to be audited?

ICD-10-CM Cracks Down on the Use of "Unspecified" in the 2021 Official Guidelines

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

We always knew there would come a day when payers would look down on an "unspecified" diagnosis code and possibly even deny it or delay payment until a review of the record could be performed. ICD-10-CM was adopted by the U.S. for data analytics, which cannot be accurate if unspecified codes are reported when the documentation verifies greater specificity. Join us for a look at the many guideline changes to ICD-10-CM, a review of the newest code changes and suggestions on documentation improvement to elevate coding protocols.

Injection Services

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Injection Service Codes Injection service codes, are reported under administration of vaccines/toxoids, using 96372, 90460, 90461, 90471, 90472, 0001A, 0002A, 0003A, 0011A, 0012A, 0021A, 0022A, 0031A, 0041A, and 0042A. Other injections services include: Non-antineoplastic hormonal therapy injections – 96372 Anti-neoplastic nonhormonal injection therapy 96401 Anti-neoplastic hormonal injection therapy- 96402 Allergen immunotherapy - 95115-95117 According to CMS, do ...

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Select the title to see a summary and a link to the full webinar information.  some webinars require a subscription to view.

Medicare Announces Coverage of Acupuncture Services for Chronic Low Back Pain 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Medicare Announces Coverage of Acupuncture Services for Chronic Low Back Pain

Rock Solid Care Plans 

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

Don't ever let anyone challenge your care plans ever again. If you can know what the regulators are looking for while still being free to deliver the care you deem to be best for your patient, then you win. And your patient wins. Join Dr. Gwilliam, certified professional medical auditor, and all around nice guy, as he guides you to the steps to create rock solid care plans that will stand up to third party scrutiny.

ICD-10-CM Changes Effective October 1, 2019 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Are you aware of the ICD-10-CM code changes set take effect as of October 1, 2020? Do any of them apply to your organization? Which of them will be assigned as an HCC? What are the documentation and coding guidelines applicable to them and which guidelines are changing or being ...

Telehealth Policies for Medicare and Commercial Payers 

Telehealth Policies for Medicare and Commercial Payers

E/M and the Organ Systems Part 2 of 2 

E/M and the Organ Systems Part 2 of 2

E-M and the Organ Systems (Part 1) 

E-M and the Organ Systems (Part 1)

HCC Coding Tool 

by  Find-A-Code™

How to use Find-A-Code's HCC Coding Tool

Success with Out-of-Network Billing in Today's Environment Part 2 

by  Find-A-Code™

In this webinar Maxine will be presenting information and tips for understanding and billing Employment Retirement Income Security Act (ERISA) insurance plans. She will explain the rules and regulations concerning ERISA plans, as well as procedures for handling/appealing "adverse denials" of claims. Coders and Insurance Billing Specialists should not miss this informative presentation.

Success with Out-of-Network Billing in Today's Environment Part 1 

by  Find-A-Code™

In this webinar Maxine will be presenting information and tips for understanding and billing Employment Retirement Income Security Act (ERISA) insurance plans. She will explain the rules and regulations concerning ERISA plans, as well as procedures for handling/appealing "adverse denials" of claims. Coders and Insurance Billing Specialists should not miss this informative presentation.

All About Knee Coding & Auditing 

by  Find-A-Code™

Total knee replacement now acceptable ASC procedure also, not auditing for a year. Knee replacement coding, knee joint injections, auditing using FAC, LCDs, drugs, modifiers.

Evaluation and Management Coding and Auditing 

by  Find-A-Code™

Are you responsible for selecting or reviewing Evaluation and Management service levels? Do you wonder how well you know the rules and how to apply them? Join Aimee in this webinar to review and then applly the rules of E/M coding. She will also do a live demonstration of the new Find-A-Code E/M Calculator Tool to assess the level of E/M service for two office visits, one new (99201-99205) and the other established (99212-99215).

Coding and Auditing TeleHealth Services 

by  Find-A-Code™

Do you report or audit Telemedicine services now or are you considering offering them? Come and learn more about the rules and guidelines surrounding Telehealth services including, documentation requirements, eligible CPT and HCPCS Level II codes, modifiers, and the newest updates to Medicare Telehealth policies.

Using Find-A-Codes Anatomy Images 

by  Find-A-Code™

Diagnosis coding is difficult when clinician documentation does not match up with the definitions found in the ICD-10-CM code set. Find-A-Code's anatomy images educate both coders and students - bridging the gap between coders and clinicians while simplifying code selection.

FAC Updates Plus Tools for HCC Coding Chart Review February 

by  Find-A-Code™

Join Taylor to see how you can access free CEUs in 3 clicks, included with top-tier Find-A-Code subscriptions! Also highlighting our New and Improved NCDs system, and how to use the WK Drug Database for HCC Coding/Chart Review

2018 Updates and New Tools 

by  Find-A-Code™

2018 Find-A-Code updates and new tools

Proper Coding and Billing for Drugs, Biologicals and Injections 

by  Find-A-Code™

Proper Coding and Billing for Drugs, Biologicals and Injections

The Importance of Gathering Organizing and Using Fee Schedules 

by  Find-A-Code™

The Importance of Gathering Organizing and Using Fee Schedules

Using Find-A-Code's New Evaluation and Management Calculator Tool 

by  Find-A-Code™

Using Find-A-Code's New Evaluation and Management Calculator Tool

HCC Risk Adjustment 

by  Find-A-Code™

HCC Risk Adjustment

Does a Self-Care Rx Effect Medical Reimbursement and How? 

by  Tom Grant DC, Med-Legal Consultant, Pragma Intel Director of Education

This is the easiest of therapies to initiate and it adds great medical value. Most DC's do not prescribe/proscribe self-care instructions. Self-care Rx's have defined timelines for implementation and updates. Done incorrectly, self-care Rx's damage medical value and decrease reimbursements.

How to Check NCCI Edits Using FindACode 

by  Find-A-Code™

How to Check NCCI Edits Using FindACode

ICD-10-CM Updates for the Auditor, a NAMAS webinar 

by  Find-A-Code™

ICD-10-CM Updates for the Auditor, a NAMAS webinar

ICD-10-CM Training - Session 01 

by  Find-A-Code™

ICD-10-CM Training - Session 01

ICD-10-CM Training - Session 02 

by  Find-A-Code™

ICD-10-CM Training - Session 02

ICD-10-CM Training - Session 03 

by  Find-A-Code™

ICD-10-CM Training - Session 03

ICD-10-CM Training - Session 04 

by  Find-A-Code™

ICD-10-CM Training - Session 04

ICD-10-CM Training - Session 05 

by  Find-A-Code™

ICD-10-CM Training - Session 05

ICD-10-CM Training - Session 06 

by  Find-A-Code™

ICD-10-CM Training - Session 06

ICD-10-CM Training - Session 07 

by  Find-A-Code™

ICD-10-CM Training - Session 07

ICD-10-CM Training - Session 08 

by  Find-A-Code™

ICD-10-CM Training - Session 08

ICD-10-CM Training - Session 09 

by  Find-A-Code™

ICD-10-CM Training - Session 09

ICD-10-CM Training - Session 10 

by  Find-A-Code™

ICD-10-CM Training - Session 10

ICD-10-CM Training - Session 11 

by  Find-A-Code™

ICD-10-CM Training - Session 11

ICD-10-CM Training - Session 12 

by  Find-A-Code™

ICD-10-CM Training - Session 12

ICD-10-CM Training - Session 13 

by  Find-A-Code™

ICD-10-CM Training - Session 13

ICD-10-CM Training - Session 14 

by  Find-A-Code™

ICD-10-CM Training - Session 14

ICD-10-CM Training - Session 15 

by  Find-A-Code™

ICD-10-CM Training - Session 15

ICD-10-CM Training - Session 16 

by  Find-A-Code™

ICD-10-CM Training - Session 16

ICD-10-CM Training - Session 17 

by  Find-A-Code™

ICD-10-CM Training - Session 17

ICD-10-CM Training - Session 18 

by  Find-A-Code™

ICD-10-CM Training - Session 18

ICD-10-CM Training - Session 19 

by  Find-A-Code™

ICD-10-CM Training - Session 19

ICD-10-CM Training - Session 20 

by  Find-A-Code™

ICD-10-CM Training - Session 20

ICD-10-CM Training - Session 21 

by  Find-A-Code™

ICD-10-CM Training - Session 21

ICD-10-CM Training - Session 22 

by  Find-A-Code™

ICD-10-CM Training - Session 22

ICD-10-CM Training - Session 23 

by  Find-A-Code™

ICD-10-CM Training - Session 23

ICD-10-CM Training - Session 24 

by  Find-A-Code™

ICD-10-CM Training - Session 24

ICD-10-CM Training - Session 25 

by  Find-A-Code™

ICD-10-CM Training - Session 25

ICD-10-CM Training - Session 26 

by  Find-A-Code™

ICD-10-CM Training - Session 26

ICD-10-CM Training - Session 27 

by  Find-A-Code™

ICD-10-CM Training - Session 27

ICD-10-CM Training - Session 28 

by  Find-A-Code™

ICD-10-CM Training - Session 28

ICD-10-CM Training - Session 29 

by  Find-A-Code™

ICD-10-CM Training - Session 29

ICD-10-CM Training - Session 30 

by  Find-A-Code™

ICD-10-CM Training - Session 30

ICD-10-CM Training - Session 31 

by  Find-A-Code™

ICD-10-CM Training - Session 31

ICD-10-CM Training - Session 32 

by  Find-A-Code™

ICD-10-CM Training - Session 32

ICD-10-CM Training - Session 33 

by  Find-A-Code™

ICD-10-CM Training - Session 33

ICD-10-CM Training - Session 34 

by  Find-A-Code™

ICD-10-CM Training - Session 34

ICD-10-CM Training - Session 35 

by  Find-A-Code™

ICD-10-CM Training - Session 35

ICD-10-CM Training - Session 36 

by  Find-A-Code™

ICD-10-CM Training - Session 36

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