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Medical Coding and Billing Articles

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VA: How UCR Charges are Determined


How does the VA determine charges billed to third party payers for Veterans with private health insurance? According to the VA. "38 C.F.R 17.101 stipulates the basic methodology by which VA bills third party insurance carriers. In order to generate a charge for medical services, VA establishes reasonable charges for five ...

tags  Payer: VA - Veterans Administration    Topic: Fees   

VA- Reasonable Charges Rules, Notices, & Federal Register


tags  Payer: All Payers    Payer: VA - Veterans Administration    Specl: All Specialties    Topic: Fees    Topic: Reimbursement    Topic: UB04 Form and Coding   

ICD-10 Appendix E


Z00.00 Z01.20 Z02.3 Z03.810 Z34.00 Z38.4 Z51.11 Z52.4 Z00.01 Z01.21 Z02.4 Z03.818 Z34.01 Z38.5 Z51.12 Z52.5 Z00.110 Z01.30 Z02.5 Z03.89 Z34.02 Z38.61 Z52.000 Z52.6 Z00.111 Z01.31 Z02.6 Z04.1 Z34.03 Z38.62 Z52.001 Z52.810 Z00.121 Z01.411 Z02.71 Z04.2 Z34.80 Z38.63 Z52.008 Z52.811 Z00.129 Z01.419 Z02.79 Z04.3 Z34.81 Z38.64 Z52.010 Z52.812 Z00.2 Z01.42 Z02.81 Z04.41 Z34.82 Z38.65 Z52.011 Z52.813 Z00.3 Z01.810 Z02.82 Z04.42 Z34.83 Z38.66 Z52.018 Z52.819 Z00.5 Z01.811 Z02.83 Z04.6 Z34.90 Z38.68 Z52.090 Z52.89 Z00.70 Z01.812 Z02.89 Z04.71 Z34.91 Z38.69 Z52.091 Z76.1 Z00.71 Z01.818 Z02.9 Z04.72 Z34.92 Z38.7 Z52.098 Z76.2 Z00.8 Z01.82 Z03.6 Z04.8 Z34.93 Z38.8 Z52.10 Z99.12 Z01.00 Z01.83 Z03.71 Z04.9 Z38.00 Z39.0 Z52.11 Z01.01 Z01.84 Z03.72 Z31.81 Z38.01 Z39.1 Z52.19 Z01.10 Z01.89 Z03.73 Z31.82 Z38.1 Z39.2 Z52.20 Z01.110 Z02.0 Z03.74 Z31.83 Z38.2 Z42.1 Z52.21 Z01.118 Z02.1 Z03.75 Z31.84 Z38.30 Z42.8 Z52.29 Z01.12 Z02.2 Z03.79 Z33.2 Z38.31 Z51.0 Z52.3 ...

tags  Topic: ICD10CM Coding   

Now That is Fraud! Genetic Testing "Public alert"


Genetic testing is becoming very popular. In fact, so popular you might see it in places you would not expect such as a community event, fairs or any event happening in your community. Some labs may even offer FREE screening for genetic testing. Watch for FREE screening announcements or advertisements ...

tags  Payer: CMS|Medicare    Specl: Laboratory|Pathology    Topic: Fraud    Topic: OIG   

CMS says Codes are on the Move!


Have you noticed your LCDs are missing something? CMS is moving codes out of LCDs and into Billing and Coding Articles. MACs began moving ICD-10-CM, CPT/HCPCS, Bill Type, and Revenue codes in January 2019, and will continue through January 2020. Therefore, if there is an LCD with its codes removed, you will find ...

tags  Payer: CMS|Medicare    Specl: All Specialties    Topic: LCDs and NCDs   

Why is HIPAA So Important?


Why is HIPAA So Important? Some may think that what they do to protect patient information may be a bit extreme. Others in specialty medical fields and research understand its importance a little more. Most of that importance lies in the information being protected. Every patient has a unique set of ...

tags  Payer: CMS|Medicare    Specl: All Specialties    Topic: HIPAA    Topic: Practice Management   

Eliminating Consultation Codes?


There are a few payers that have joined with CMS in discontinuing payment for consultation codes. Most recently, Cigna stated that, as of October 19, 2019, they will implement a new policy to deny the following consultation codes: 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254 and 99255. United Healthcare announced they ...

tags  Topic: CPT Coding    Topic: E+M Documentation and Coding   

Hypertension & ICD-10


Hypertensive Diseases and ICD-10. Helps and examples for these codes.

tags  Specl: All Specialties    Specl: Cardiology|Vascular    Topic: Coding    Topic: Diagnosis Coding    Topic: ICD10CM Coding   

Regence: Dental Procedures Under The BlueCard Program?


This information can be found on Regence/Blue Cross Dental procedures explaining additional benefits for dental procedures. Regence currently does not offer dental benefits, however, there are times a patient can receive treatment with a Blue Cross provider and qualify under their medical benefits. In addition, Regence informs the providers to file these claims ...

tags  Loc: All Locations    Payer: BC|BS    Specl: Dental    Topic: Billing   

2020 Official ICD-10-CM Coding Guideline Changes Are Here!


It’s that time of year for offices to get ready for the ICD-10-CM code revisions. As part of that process, it’s also good to know what is going on with the ICD-10-CM Official Guidelines for Coding and Reporting. In the examples listed below, strikeout text is deleted and highlighted text ...

tags  Specl: All Specialties    Topic: Compliance    Topic: ICD10CM Coding   

Federal Workers Compensation Information


When federal employees sustain work-related injuries, it does not go through state workers compensation insurance. You must be an enrolled provider to provide services or supplies. The following are some recommended links for additional information about this program. Division of Federal Employees' Compensation (DFEC) website Division of Federal Employees' Compensation (DFEC) provider ...

tags  Specl: Acupuncture|Alternative    Specl: All Specialties    Specl: Anesthesia|Pain Management    Specl: Behavioral Health|Psychiatry|Psychology    Specl: Chiropractic    Specl: Neurology|Neurosurgery    Specl: Ophthalmology    Specl: Physical Medicine|Physical Therapy    Specl: Podiatry   

Do ICD-10 Updates Have Your Heart Beating Irregularly? Check Out the New Atrial Fibrillation Codes


Atrial fibrillation (AF) is the most common type of abnormal heart rhythm (arrhythmia). It is caused by a disorder in the heart’s electrical system. AF is the result of abnormal contractions of the atria (upper two chambers of the heart) causing them to quiver and beat out of sync with ...

tags  Loc: All Locations    Payer: All Payers    Specl: Billing    Specl: Cardiology|Vascular    Specl: Emergency Medicine    Specl: Endocrinology    Specl: General Surgery    Specl: Internal Medicine    Specl: Interventional Radiology    Specl: Laboratory|Pathology    Specl: Oncology|Hematology    Specl: Orthopedics    Specl: Pediatrics    Specl: Primary Care|Family Care    Specl: Pulmonology    Specl: Radiology    Specl: Skilled Nursing    Topic: Coding    Topic: ICD10CM Coding   

The New ICD-10-CM Code Updates Are Here — Are You Ready?


Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99) A small revision in the description changed[STEC] to (STEC) for B96.21, B96.22, B96.23. Remember, in the instructional guidelines, ( ) parentheses enclose supplementary words not included in the description (or not) and [ ] brackets enclose synonyms, alternative wording, or explanatory phrases. Chapter 2: ...

tags  Loc: All Locations    Payer: All Payers    Specl: All Specialties    Topic: Coding    Topic: Denial Management    Topic: Diagnosis Coding    Topic: Documentation    Topic: Guidelines and Manuals    Topic: Guidelines ICD-10-CM    Topic: ICD10CM Coding    Topic: ICD9v3 Coding   

New Codes for Dry Needling


Find out what you need to know about the new codes for dry needling, also known as trigger point acupuncture.

tags  Specl: Acupuncture|Alternative    Specl: Anesthesia|Pain Management    Specl: Chiropractic    Specl: Physical Medicine|Physical Therapy    Topic: CPT Coding    Topic: Procedure Coding   

CMS and HHS Tighten Enrollment Rules and Increase Penalties


This ruling impacts what providers and suppliers are required to disclose to be considered eligible to participate in Medicare, Medicaid, and Children's Health Insurance Program (CHIP). The original proposed rule came out in 2016 and this final rule will go into effect on November 4, 2019.  There have been known problems ...

tags  Specl: All Specialties    Specl: Chiropractic    Topic: Medicare   

Vaccine Administration - When The Right Vaccine Code is Not Enough


Understanding how to apply immunization administration codes properly will support correct reimbursement for vaccinations. Reporting the right vaccine code alone is not enough to guarantee proper billing. The majority of the time, providers can charge for the vaccine/product as well as the administration of the vaccine; always consult your payer ...

tags  Specl: Pediatrics    Specl: Primary Care|Family Care    Topic: CPT Coding    Topic: Diagnosis Coding    Topic: HCPCS Coding    Topic: ICD10CM Coding    Topic: Modifier Coding    Topic: Preventive Medicine    Topic: Procedure Coding   

Q/A: How Do I Bill a House Call?


Question If a provider makes a house call to/for a patient, is there a way that it is represented on the claim form?  A modifier, or something else? Answer Modifiers are not used to identify that a service was performed in the patient's home. However, other modifier rules must be followed (e.g., modifier GP ...

tags  Topic: Claims Processing    Topic: CPT Coding    Topic: E+M Documentation and Coding    Topic: Modifier Coding    Topic: Procedure Coding   

Wellness In the Dental Practice


This course is the beginning of change. Understanding that patients have additional benefits under their dental plans will provide you with the changes taking place in the world of billing. Objectives PROFESSIONAL GROWTH Professionally your team members will be pushed and stretched as you develop your new system. They will require advanced training ...

tags  Specl: Dental    Specl: Oral and Maxillofacial Surgery   

Spotlight: UCR Fees are Available on DRGs- Check it Out!


Check out the information page on any DRG! Look up DRGs by going to the list of DRG codes found under the Codes tab at the top of the page, or simply type in the desired DRG by using the search bar on the homepage. When using the search bar, be sure you have the ...

tags  Topic: Fees   

Help is on the way!


Dental carriers are starting to deny coverage for treatment considered a medical necessity! Dental offices are just charging the patient for those services or patients are refusing the treatment. Have you considered why that service should be full fee for the patient when they have coverage under their medical insurance? ...

tags  Specl: Dental    Specl: Oral and Maxillofacial Surgery   

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